上部消化管出血における血液凝固第XIII因子活性の低下

We report on blood coagulation factor XⅢ（F１３）activity in upper gastrointestinal bleeding （UGIB）due to peptic ulcer（PU）. 【Methods】From January ２０１１ to December ２０１６, 42 patients who had UGIB with PU, performed endoscopic hemostasis（EH）, and measured F１３ activity （normal range：７０‐１４０％）, were retrospectively studied. The clinical signs, peripheral blood, biochemistry, coagulation, F１３ activity, and endoscopic findings were examined by logistic regression analysis（LRA）in３２patients with successful hemostasis and１０patients with rebleeding. 【Results】There were２５elderly patients aged７０ and over. The average F１３ activity was ６５．７±２２．５％, ６８．３±２２．１％ in the case of successful hemostasis, below the lower limit of normal, and further decreased to ５７．５±１８．１％ in the case of rebleeding. LRA showed association with rebleeding in Forrest classification and F１３activity. 【Conclusion】F１３activity decreased in many cases of UGIB due to PU, and associated with rebleeding after EH

呼気筋トレーニングが在宅要介護認定者の呼吸指標および嚥下機能に与える効果

Expiratory muscle training（EMT） for improving cough function and prevention of aspiration pneumonia in healthy elderly individuals as well as patients with neurological disorders has received recent attention. Although 2 studies elucidated its effects on swallowing function in a small population of patients with Parkinson’s disease, its overall efficacy remains uncertain. The purpose of this study was to examine the effects of EMT on respiratory indices and swallowing function in elderly individuals receiving home care. The subjects were 22 community-dwelling elderly individuals receiving home care. An EMT training device（Threthold IMT） was applied with reversed use and the training period was 4 weeks. The loading pressure was 30% of baseline MEP and the training sessions were performed for 15 minutes twice a day. Each training session was monitored by a family member and recorded. Respiratory function［forced-vital capacity（FVC） and %FVC］ and respiratory muscle strength ［maximal expiratory pressure （MEP） and maximal inspiratory pressure （MIP）］ were measured at baseline and after 1, 2, 3 and 4 weeks of EMT, while swallowing function ［repetitive saliva swallowing test （RSST）］ was measured at baseline and after 4 weeks. Two-way ANOVA was performed with the factors of ADL score and measurement week. Statistical analysis showed that both factors had effects, though there was no correlation between them. MEP was significantly improved at 3 and 4 weeks after EMT as compared to the baseline, whereas other respiratory indices and RSST were unchanged after EMT. Our findings indicate that EMT can strengthen expiratory muscles and suggest the need for higher expiratory loading pressure. Further research should define the target population more clearly and establish an effective EMT protocol to improve swallowing function