Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

Osteonecrosis and osteoporosis are frequent adverse effects of glucocorticoid therapy of systemic lupus erythematosus (SLE). Idiopathic osteonecrosis (ION) of the femoral head occurs in 3–40% of patients receiving glucocorticoid, and can also develop in other bones. Higher doses of glucocorticoid and steroid pulse therapy are considered to be risk factors for ION of the femoral head. To analyze these risk factors, it seems important to detect early changes in the femoral head by magnetic resonance imaging and to monitor early clinical events attributable to steroid therapy. Prophylaxis with statins and warfarin remains debatable. The use of glucocorticoid is increase the risk of bone fractures. Bisphosphonate (BP) is used for its prevention and treatment of osteoporosis. Atypical femoral fracture (AFF) has been recently recognized as a complication associated with BP use. AFF is considered to be a form of stress fracture; localized periosteal thickening of the lateral cortex is often present at the fracture site. The thickening has been recently recognized as a complication associated with the use of antiresorptive agents such as BP and denosumab. As long-term BP/glucocorticoid use is a risk factor for beaking in patients with SLE , temporary withdrawal of BP administration should be considered

Factors related to administrative abilities of nurse administrators – focusing on confidence in nursing

Purpose: This study aims to identify factors related to the administrative abilities of nurses in education programs for nurse administrators. Methods: We distributed a selfrating questionnaire survey to 1291 nurse administrators in positions equivalent to head nurse in 69 participating hospitals among the 172 hospitals with 300 beds or more in the Kanto and Tokai regions of Japan. The surveyed items are ability in nurse administration, demographic characteristics, and workplace environment. Results: We received 984 (76.2%) responses. Excluding responses that included two or more choices to a question and where there was no response to questions of gender and administrative abilities, this left 880 (68.2%) responses which were considered valid and these were included in the further analysis. We performed a multiple regression analysis with the focus on confidence in nursing. Here, the nurse administrators who showed better administrative abilities reported that ‘I am decisive’, ‘My judgment in nursing is appropriate’, ‘I read books about new nursing and medical care developments’, ‘I can demonstrate my ability in this job’, ‘I fulfill my responsibilities to achieve goals in accordance with my beliefs’, ‘The present ward (department) has an active atmosphere that makes work enjoyable’, and ‘I work with an awareness of work-life balance (WLB)’. Nurse administrators who showed poorer administrative abilities reported that ‘I became less kind to people since I became a nurse’. Conclusion: The findings suggest that nurse administrators who are confident in themselves and their decision making abilities, who fulfill their responsibilities in accordance with their beliefs, who think their workplace culture is good, and who work with an awareness of WLB may have better administrative abilities. In addition, nurse administrators with low cynicism (developing negative attitudes) scores, a subscale of the burnout score, appear to have better administrative abilities. Education programs for nurse administrators need to Vol.4 No.1, May-2019include support that enables nurse administrators to work reliably with an awareness of WLB, in the efforts to improve the workplace environment, and ensure that they are prevented from developing cynical attitude

Genetic variation in the Catechol-O-Methyltransferase (COMT) gene and morphine requirements in cancer patients with pain

<p>Abstract</p> <p>Background</p> <p>Genetic variation contributes to differences in pain sensitivity and response to different analgesics. Catecholamines are involved in the modulation of pain and are partly metabolized by the catechol-O-methyltransferase (COMT) enzyme. Genetic variability in the <it>COMT </it>gene may therefore contribute to differences in pain sensitivity and response to analgesics. It is shown that a polymorphism in the <it>COMT </it>gene, Rs4680 (Val158Met), influence pain sensitivity in human experimental pain and the efficacy for morphine in cancer pain treatment. In this study we wanted to investigate if variability in other regions in the <it>COMT </it>gene also contributes to interindividual variability in morphine efficacy.</p> <p>Results</p> <p>We genotyped 11 single nucleotide polymorphisms (SNPs) throughout the <it>COMT </it>gene, and constructed haplotypes from these 11 SNPs, which were in Hardy-Weinberg equilibrium. We compared both genotypes and haplotypes against pharmacological, demographical and patient symptoms measurements in a Caucasian cancer patient cohort (n = 197) receiving oral morphine treatment for cancer pain. There were two frequent haplotypes (34.5% and 17.8%) in our cohort. Multivariate analyses showed that patients carrying the most frequent haplotype (34.5%) needed lower morphine doses than patients not carrying the haplotype, with a reduction factor of 0.71 (p = 0.005). On the allele level, carriers of alleles for six of the SNPs show weak associations in respect to morphine dose and the alleles associated with the lowest morphine doses constitute part of the most frequent haplotype.</p> <p>Conclusion</p> <p>This study suggests that genetic variability in the <it>COMT </it>gene influence the efficacy of morphine in cancer patients with pain, and that increased understanding of this variability is reached by expanding from analyses of single SNPs to haplotype construction and analyses.</p

Coping Behaviors and Collaboration among Staff of Multiple Occupation Classifications during Norovirus

In December 2012 a norovirus infection outbreak occurred in the Orthopedic Surgery Ward of Hospital A in Japan. This study aims to establish details of coping behaviors used by nurses, physicians, physiotherapists, and pharmacists of the facility, and examine the issues involved in infection control by team collaboration as well as the ways employed to deal with the infections. Participants in this study were thirty-seven medical professionals who were working in the Orthopedic Surgery Ward of Hospital A at the time the infection outbreak occurred, and who were still working there when the interviews were conducted. Interviews were conducted from January to April 2015, and the data from the interviews were analyzed using the “Trend Search 2008” text mining software. As a result of the analysis it was found that the nurses primarily communicated information by passing messages to the nurses who took over the duty at shift changes, but did not pass on the information to staff in other occupations or to the ward as a whole. The nurses clearly remembered that the ward was closed and it was a difficult experience, but did not remember details of the patients they were in charge of. The physicians clearly remembered individual patients they were in charge of, but they were not aware of the situation and state throughout the ward. The findings suggest that this difference is due to the differences in the occupational nature and sense of values of the staff involved. It is also found that physiotherapists did not feel a sense of crisis about the norovirus outbreak because they felt the patients in the ward appeared to be in better condition than patients in other wards, and that pharmacists lacked communication with staff in other occupations because they usually have heavy workloads. In concept mappings of physicians, physiotherapists, and pharmacists, the keyword places in the center of the maps, and is linked to and . Because the nurse plays a central role to report information among the four occupations, nurses should be aware of and assigned to play the role to coordinate team collaboration

Clinical Characteristics of Severe Refractory Asthma Associated with the Effectiveness of Bronchial Thermoplasty

We investigated the clinical characteristics of refractory asthma associated with the effectiveness of bronchial thermoplasty (BT). We retrospectively evaluated data from 10 patients who underwent BT between June 2016 and December 2017 at Okayama Medical Center. The following were measured before and 6 months post-BT: forced expiratory volume in 1.0 s (FEV1), fractional exhaled nitric oxide (FeNO), immunoglobulin E (IgE) level, blood eosinophil counts (Eosi), Asthma Quality of Life Questionnaire (AQLQ) score, and preventive medication use. At baseline, the mean post-bronchodilator FEV1 was 80.9% of the predicted value (range 45.6-115.7%). All patients were being treated with moderate- or high-dose inhaled corticosteroids and long-acting β2 agonists. The AQLQ improved from 4.26±1.67 at baseline to 5.59±0.94 at 6 months post-BT (p 0.5 points post-BT. For both allergic and eosinophilic asthmatics following mepolizumab, BT was not useful. BT was effective for non-allergic and non-eosinophilic or allergic asthmatics, but insufficient for both allergic and eosinophilic following mepolizumab

Long-term observation of fibrillation cycle length in patients under angiotensin II receptor blocker therapy for chronic atrial fibrillation

AbstractIntroductionThe long-term effect of angiotensin II receptor blockers (ARBs) on atrial fibrillation (AF) is unclear. In this study, we evaluated the change in the fibrillation cycle length (FCL) in patients under long-term ARB therapy for chronic AF.Methods and resultsThe study population consisted of 25 chronic AF patients who were prescribed the same medication for more than 6 years and in whom specific ECG recording for FCL evaluation could be performed before and after the 6-year observation period. The patients were divided into 2 groups: those with and without ARB (ARB group and non-ARB group and n=15 and 10, respectively). FCL was calculated by the spectral analysis of the fibrillation waves in the surface ECG. There was no significant difference in the clinical characteristics between the 2 groups. In the ARB group, the mean FCL was prolonged from 154±20ms to 187±37ms (p=0.005), whereas it remained unchanged in the non-ARB group (150±12ms vs. 149±10ms). In the comparison between patients with and those without FCL prolongation (>30ms; n=6 and 19, respectively), a significant difference was observed only in those prescribed ARBs.ConclusionIn cases of chronic AF, FCL might be prolonged under long-term ARB treatment

Influencia del aditivo eucon 1037 en la resistencia a la compresión de un concreto de f´c= 350 kg/cm2 - Cajamarca

El uso de los aditivos en nuestros días se ha convertido en una práctica muy utilizada para la obtención de concreto con mejores características y que estas se adecuen a las exigencias de la obra o estructura donde este material será utilizado. Uno de los tipos de aditivos más utilizados son los aditivos plastificantes, los cuales presentan una característica fundamental que es la reducción de agua utilizada en la mezcla de concreto, logrando obtener concretos con mayor trabajabilidad con bajas cantidades de agua, permitiendo que la resistencia a la compresión del concreto aumente. El aditivo EUCON 1037 es un aditivo reductor de agua de alto rango que puede ser adicionado al concreto en obra o en una planta de concreto, ese aditivo permite obtener concretos de alta resistencia por trabajar a baja relación agua/cemento, así mismo facilita la colocación permitiendo reducir la mano de obra y permite producir concretos fluidos con resistencias superiores a lo normal. En la presente tesis de investigación se tiene como objetivo principal el determinar la influencia que presenta el adicionar aditivo EUCON 1037 en un concreto de f’c = 350 Kg/cm2 con dosificaciones de 1.2%, 1.4% 1.7% de aditivo por peso de cemento; dosificaciones que se toman a partir de lo que indica la hoja técnica del aditivo cuyo uso es de (0.7% - 1.9% / Kg de cemento). Para ello se realizó la elaboración de especímenes de concreto a partir de una adecuada elaboración de diseños de mezcla, los mismos que fueron sometidos a ensayos a compresión uniaxial, siguiendo los procedimientos de las normas ASTM y NTP correspondientes. Estos diseños de mezcla se elaboraron con agregados de la cantera Acosta (Rio Chonta), que cumple con lo estipulado en las normas correspondientes y que cuyas características físicas serán determinadas en laboratorio, permitiendo la elaboración de los diseños de mezcla. Al finalizar con el trabajo de investigación se llegó a la conclusión que el aditivo EUCON 1037 aumenta considerablemente la resistencia a la compresión de concreto de f’c = 350 Kg/cm2, tal es así que para una dosificación de 1.7% de aditivo por peso de cemento, el aumento con respecto de la mezcla que no presenta ninguna adición es de 28.21% a edad de 7 días y 14.92% a edad de 28 días.Tesi

Success of Crizotinib Combined with Whole-Brain Radiotherapy for Brain Metastases in a Patient with Anaplastic Lymphoma Kinase Rearrangement-Positive Non-Small-Cell Lung Cancer

Although crizotinib shows marked antitumor activity in anaplastic lymphoma kinase (ALK) rearrangement-positive non-small-cell lung cancer (NSCLC) patients, all treated patients ultimately develop resistance to this drug. Isolated central nervous system failure without progression at extracranial sites is a common progression pattern in ALK rearrangement-positive NSCLC patients treated with crizotinib. Here, we report the success of crizotinib combined with whole-brain radiotherapy in an ALK rearrangement-positive NSCLC patient who developed leptomeningeal carcinomatosis and progression of multiple brain metastases. Additionally, we focused on the mechanism involved by examining the plasma and cerebrospinal fluid concentrations of crizotinib in the present case

Genetic Tracing of Jatropha

Jatropha curcas L. (Jatropha), a shrub species of the family Euphorbiaceae, has been recognized as a promising biofuel plant for reducing greenhouse gas emissions. However, recent attempts at commercial cultivation in Africa and Asia have failed because of low productivity. It is important to elucidate genetic diversity and relationship in worldwide Jatropha genetic resources for breeding of better commercial cultivars. Here, genetic diversity was analyzed by using 246 accessions from Mesoamerica, Africa and Asia, based on 59 simple sequence repeat markers and eight retrotransposon-based insertion polymorphism markers. We found that central Chiapas of Mexico possesses the most diverse genetic resources, and the Chiapas Central Depression could be the center of origin. We identified three genetic groups in Mesoamerica, whose distribution revealed a distinct geographic cline. One of them consists mainly of accessions from central Chiapas. This suggests that it represents the original genetic group. We found two Veracruz accessions in another group, whose ancestors might be shipped from Port of Veracruz to the Old World, to be the source of all African and Asian Jatropha. Our results suggest the human selection that caused low productivity in Africa and Asia, and also breeding strategies to improve African and Asian Jatropha. Cultivars improved in the productivity will contribute to expand mass commercial cultivation of Jatropha in Africa and Asia to increase biofuel production, and finally will support in the battle against the climate change