がん患者を支援する訪問看護師の困難感

This study aimed to identify difficulties of visiting nurses who provide assistance to home-based cancer patients requiring palliative care. In survey１, a questionnaire survey was conducted involving３０visiting nurses working for visiting nursing stations（valid response rate :９０％）, and the data were analyzed using descriptive statistics. In survey ２, a semi-structured interview based on an interview guide was conducted involving４visiting nurses working for visiting nursing stations, and the data were analyzed using a qualitative and inductive approach. The results of survey１showed that the visiting nurses were more likely to experience difficulties with the worsening of a patient’s health status and at the initiation of home-based care. They also experienced difficulties with understanding medical conditions of patients and their families, supporting decision-making, and cooperating with visiting physicians. Their level of understanding about the explanation given by physicians and the sense of value of patients and families were factors that affected such difficulties, and so, in order to resolve them, the importance of cooperating to secure medical and nursing personnel and creating a setting where they can share their knowledge of patients’ conditions and treatments was indicated. In survey ２, the following ６ categories were extracted as difficulties encountered by visiting nurses providing assistance to home-based cancer patients requiring palliative care :［dealing with the worsening of the disease］, ［predicting the end of life］, ［being unable to care for patients without cooperation］,［being involved with patients by understanding their life before illness］,［preparing a home care environment for a patient’s end-of-life］, and［limits of current work situations］. The findings suggest the need not only to provide palliative care knowledge for the prediction and understanding of illness, but also to establish a system that allows multiple medical providers to assess patients’ conditions, in order to deal with their difficulties

ERRγ agonist under mechanical stretching manifests hypertrophic cardiomyopathy phenotypes of engineered cardiac tissue through maturation

iPS細胞から成熟した人工心筋組織の作製方法の開発 肥大型心筋症の治療法開発への利用に期待. 京都大学プレスリリース. 2023-10-06.Stretching and stimulating engineered heart tissues to accurately portray hypertrophic cardiomyopathy. 京都大学プレスリリース. 2023-10-17.Engineered cardiac tissue (ECT) using human induced pluripotent stem cell-derived cardiomyocytes is a promising tool for modeling heart disease. However, tissue immaturity makes robust disease modeling difficult. Here, we established a method for modeling hypertrophic cardiomyopathy (HCM) malignant (MYH7 R719Q) and nonmalignant (MYBPC3 G115∗) pathogenic sarcomere gene mutations by accelerating ECT maturation using an ERRγ agonist, T112, and mechanical stretching. ECTs treated with T112 under 10% elongation stimulation exhibited more organized and mature characteristics. Whereas matured ECTs with the MYH7 R719Q mutation showed broad HCM phenotypes, including hypertrophy, hypercontraction, diastolic dysfunction, myofibril misalignment, fibrotic change, and glycolytic activation, matured MYBPC3 G115∗ ECTs displayed limited phenotypes, which were primarily observed only under our new maturation protocol (i.e., hypertrophy). Altogether, ERRγ activation combined with mechanical stimulation enhanced ECT maturation, leading to a more accurate manifestation of HCM phenotypes, including non-cardiomyocyte activation, consistent with clinical observations

Thrombolysis with Low-Dose Tissue Plasminogen Activator 3–4.5 h After Acute Ischemic Stroke in Five Hospital Groups in Japan

Clinical data from Japan on the safety and real-world outcomes of alteplase (tPA) thrombolysis in the extended therapeutic window are lacking. The aim of this study was to assess the safety and real-world outcomes of tPA administered within 3-4.5 h of stroke onset. The study comprised consecutive acute ischemic stroke patients (n = 177) admitted across five hospitals between September 2012 and August 2014. Patients received intravenous tPA within <3 or 3-4.5 h of stroke onset. Endovascular therapy was used for tPA-refractory patients. In the 3-4.5 h subgroup (31.6 % of patients), tPA was started 85 min later than the <3 h group (220 vs. 135 min, respectively). However, outcome measures were not significantly different between the <3 and 3-4.5 h subgroups for recanalization rate (67.8 vs. 57.1 %), symptomatic intracerebral hemorrhage (2.5 vs. 3.6 %), modified Rankin Scale score of 0-1 at 3 months (36.0 vs. 23.4 %), and mortality (6.9 vs. 8.3 %). We present data from 2005 to 2012 using a therapeutic window <3 h showing comparable results. tPA following endovascular therapy with recanalization might be superior to tPA only with recanalization (81.0 vs. 59.1 %). Compared with administration within 3 h of ischemic stroke onset, tPA administration within 3-4.5 h of ischemic stroke onset in real-world stroke emergency settings at multiple sites in Japan is as safe and has the same outcomes

腰部脊柱管狭窄症患者の脊椎アライメントと大腿四頭筋柔軟性の関係

Several studies have reported that the sagittal vertical axis（SVA）in patients with lumbar spinal stenosis（LSS）is associated with health-related quality of life（QOL）and low back pain. Therefore, it is required to obtain optimal standing spinal alignment. However, the functional factors that increase SVA in LSS patients have not been fully clarified. Therefore, the purpose of this study was to investigate correlations between quadriceps flexibility and spinal sagittal alignment in patients with lumbar spinal stenosis（LSS）. We studied 30 LSS patients（16 males, 14 females, age 65.6±12.1 years）. The quadriceps flexibility was evaluated by measuring the heel-to-buttock distance（HBD）, and the standing spine alignment was evaluated by measuring each parameter from the whole spinal column X-ray sagittal plane image. Each relationship was examined using Spearmanʼs rank correlation coefficient. HBD was positively correlated with SVA（r=0.45, p<0.05）and PT（r=0.39, p<0.05）, respectively. It was suggested that quadriceps flexibility was associated with SVA in LSS patients. In conclusion, improving quadriceps flexibility through preoperative physiotherapy intervention may result in good standing spinal alignment in LSS patients. Randomized controlled trials are needed to determine whether increased quadriceps flexibility in LSS patients improves SVA

ERRγ enhances cardiac maturation with T-tubule formation in human iPSC-derived cardiomyocytes

ヒトのiPS細胞から新生児レベルまで成熟した心筋細胞を作製する. 京都大学プレスリリース. 2021-06-21.Lowering the cost of heart cell therapies. 京都大学プレスリリース. 2021-06-21.One of the earliest maturation steps in cardiomyocytes (CMs) is the sarcomere protein isoform switch between TNNI1 and TNNI3 (fetal and neonatal/adult troponin I). Here, we generate human induced pluripotent stem cells (hiPSCs) carrying a TNNI1[EmGFP] and TNNI3[mCherry] double reporter to monitor and isolate mature sub-populations during cardiac differentiation. Extensive drug screening identifies two compounds, an estrogen-related receptor gamma (ERRγ) agonist and an S-phase kinase-associated protein 2 inhibitor, that enhances cardiac maturation and a significant change to TNNI3 expression. Expression, morphological, functional, and molecular analyses indicate that hiPSC-CMs treated with the ERRγ agonist show a larger cell size, longer sarcomere length, the presence of transverse tubules, and enhanced metabolic function and contractile and electrical properties. Here, we show that ERRγ-treated hiPSC-CMs have a mature cellular property consistent with neonatal CMs and are useful for disease modeling and regenerative medicine

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction