Fibroblasts as Local Immune Modulators in Ocular Allergic Disease

ABSTRACTVernal keratoconjunctivitis (VKC), a severe form of ocular allergic disease, is characterized by the formation of giant papillae at the upper tarsal conjunctiva and corneal lesions that threaten vision. Recent evidence indicates that resident fibroblasts function as immune modulators in the pathogenesis of the chronic allergic inflammation associated with VKC. The T helper 2 (Th2) cell-derived cytokines interleukin (IL)-4 and IL-13 stimulate the migration and proliferation of conjunctival fibroblasts as well as protecting these cells from apoptotic cell death, effects that likely underlie the hyperplasia of fibroblasts that contributes to the formation of giant papillae. Conjunctival fibroblasts also synthesize extracellular matrix proteins and tissue inhibitors of metalloproteinases as well as down-regulate the expression of matrix metalloproteinases in response to these cytokines, effects that likely contribute to the excessive deposition of extracellular matrix that is characteristic of giant papillae. Stimulation of fibroblasts in the corneal stroma with the combination of a proinflammatory cytokine and either IL-4 or IL-13 results in up-regulation of the expression of the chemokine eotaxin and thymus- and activation-regulated chemokine as well as of vascular cell adhesion molecule-1, which together mediate the infiltration and activation of eosinophils and Th2 cells. Fibroblasts therefore appear to play a central role in the induction and amplification of ocular allergic inflammation and the consequent development of giant papillae and corneal disorders in individuals with VKC. Fibroblasts and fibroblast-derived factors thus represent new and potentially important therapeutic targets for treatment of the giant papillae and corneal disorders associated with VKC

Low-Intensity Resistance Training with Moderate Blood Flow Restriction Appears Safe and Increases Skeletal Muscle Strength and Size in Cardiovascular Surgery Patients:A Pilot Study

We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 +/- 12.6 years, n = 21, M = 18) were randomly assigned to the control (n = 10) and the KAATSU RT group (n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5-7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.</p

Blood Flow Restriction Increases the Neural Activation of the Knee Extensors During Very Low-Intensity Leg Extension Exercise in Cardiovascular Patients:A Pilot Study

Blood flow restriction (BFR) has the potential to augment muscle activation, which underlies strengthening and hypertrophic effects of exercise on skeletal muscle. We quantified the effects of BFR on muscle activation in the rectus femoris (RF), the vastus lateralis (VL), and the vastus medialis (VM) in concentric and eccentric contraction phases of low-intensity (10% and 20% of one repetition maximum) leg extension in seven cardiovascular patients who performed leg extension in four conditions: at 10% and 20% intensities with and without BFR. Each condition consisted of three sets of 30 trials with 30 s of rest between sets and 5 min of rest between conditions. Electromyographic activity (EMG) from RF, VL, and VM for 30 repetitions was divided into blocks of 10 trials and averaged for each block in each muscle. At 10% intensity, BFR increased EMG of all muscles across the three blocks in both concentric and eccentric contraction phases. At 20% intensity, EMG activity in response to BFR tended to not to increase further than what it was at 10% intensity. We concluded that very low 10% intensity exercise with BFR may maximize the benefits of BFR on muscle activation and minimize exercise burden on cardiovascular patients

介護福祉教育と介護研修における「家政教育・研修ニーズ」に関する研究 : 6種類の施設・事業所の介護福祉士を対象とした調査結果の比較分析から

本研究では，介護福祉士が現在の仕事に「役立つ」と感じる有用な家政内容を「家政教育・研修ニーズ」とし，それを把握することで介護福祉教育（介護福祉士養成校での教育）と介護研修（介護現場での研修）の連携のあり方を明らかにすることを目的とした．質問票調査回答者のうち介護老人福祉施設109人，介護老人保健施設117人，認知症グループホーム69人，訪問介護137人，通所介護94人，通所リハ137人を分析対象とし，家政内容67項目の役立ち度を4段階で評価した．その結果，①事故・災害防止策や室内環境整備，加齢・障害・疾病に応じた栄養・調理の内容は共通して高い，②施設・事業所の特性によって異なる内容は調理知識・技術系，住居管理系，被服管理・技術系に分けられる，③養成校卒業者も介護福祉教育や介護研修で家政を学ぶ必要性を高く認識する傾向が判明した．以上を踏まえ，介護福祉士に必要な家政内容を養成校と介護現場の双方が周知し，介護福祉教育と介護研修が連動する中で継続的・段階的に学べる体制の必要性が示唆された．The study aims to clarify how a cooperation should be established between education at training school for certified care-workers and training for care-workers while certified care-workers experiences and comprehends the contents of effectibe household management in the job as “Home economics education/training needs”. Among the respondents for the questionnaire surbey, the study evaluated 67 household items with 4 useful levels by targeting 109 respondents at nursing care homes for elderly, 117 respondents at longterm care health facilities. 69 respondents at group home for elderly with dementia, 137 respondents for home-visit nursing care, 94 respondents for elderly day-service, and 137 respondents for elderly day-care as analytic subjects. As the result, the study found that ① Common to be a high level in accident/disaster prevention, indoor environment maintenance, and nutrition/cooking in accordance with aging/disability/sickness, ②Possible categorization for different contents by the characteristic of facility/business establishment such as cooking knowledge/technical related items, housing management related items, and clothing management/technical related items, and ③Even graduates from training school are more likely to highly recognize the need for learning household management throuth education at training school for certified care-workers and training for care-workers. With the consideration of the above, it is suggested that a continuous/phased learning system will be necessary while both training school and nursing care workplace understand necessary household contents, and education at training school for certified careworkers and training for care-workers work closely together