CT によるray-summation 画像の画質と臨床的有用性: Digital radiography との比較

Ray-summation (raysum) images reconstructed from computed tomography (CT) volume data resemble digital radiography (DR) images. Therefore, they have a potential to be used instead of DR images.The aim of this study was to compare the physical image quality evaluated by signal-difference-to-noise ratio (SDNR) and clinical usefulness between raysum and DR images. We employed an oval water phantom simulating adult abdomen for image quality measurement. Raysum images were reconstructed from CT volume data using an assumed x-ray quality of 70 keV. DR images were obtained using an indirect-type flat panel detector system. The normalized noise-power spectrum (NNPS) for various same dose indices (DR: entrance surface dose, CT: CT dose index volume) were measured from raysum and DR images. SDNRs were calculated from the results of NNPSs, modulation transfer function (MTF), and cartilage material contrast. Five experienced observers visually compared each pair of a clinical raysum image and a DR image for nine clinical cases (head, finger, pelvis, and foot). MTF of raysum was significantly lower than that of DR. SDNRs of DR were superior to those of raysum for each dose index, by an average factor of 1.24. For head and pelvis images, raysum images were comparable or a little superior compared with the DR images, because the radiation doses of raysum was much higher than those of DR. For finger and foot cases, the raysum images were inferior to DR images due to its lower resolution. Our results indicated a limited clinical usefulness of raysum compared with DR.出版者照会後に全文公

Feasibility of a new hollow fiber silicone membrane oxygenator for long-term ECMO application

Currently in United States, there are no clinically-applicable hollow fiber extracorporeal membrane oxygenation (ECMO) oxygenators available. Therefore, our laboratory is in the process of developing a silicone hollow fiber membrane oxygenator for long-term ECMO usage. This oxygenator incorporates an ultrathin silicone hollow fiber. At this time, a specially-modified blood flow distributor (one chamber distributor) is centered in the module to prevent blood stagnation. An ex vivo long-term durability test for ECMO was performed using a healthy miniature calf for 2 weeks. Venous blood was drained from the left jugular vein of a calf, passed through the oxygenator and infused into the left carotid artery using a Gyro C1E3 centrifugal blood pump. A successful 2-week ex vivo experiment was performed. The O2 and CO2 gas transfer rates were maintained at the same value of 40 ml/min at a blood flow rate of 1 L/min flow and V/Q=3 (V=gas flow rate Q=blood flow rate). The plasma free hemoglobin was maintained around 5 mg/dl. After the experiment, no blood clot formation was observed in the module and no abnormal necropsy findings were found. These data suggest that the performance of this newly-improved oxygenator was stable, reliable, and acceptable for long-term ECMO

Significance of receiving mental health training and consultation for visiting nurses providing support to pregnant and postpartum women at high risk of psychosocial problems

本研究の目的は，心理社会的ハイリスク妊産婦を対象とした訪問支援事業に携わる訪問指導員が，メンタルヘルス研修およびメンタルヘルスコンサルテーションを受ける意味を明らかにすることである．7 名の訪問指導員に行った半構成的インタビューの内容を質的記述的に分析した．その結果，訪問指導員が抱えていた【ハイリスク妊産婦へのメンタルヘルス支援に関するゆらぎや不確かさ】が，メンタルヘルス研修およびメンタルヘルスコンサルテーションを受けることによって，【メンタルヘルス支援技術の獲得】【ハイリスク妊産婦の理解と関わりの促進】【支援方法の客観的評価】【心理的負担感の軽減】【チームへの波及効果】へ転換されたと考えられた．また，地域母子保健において，実践者である訪問指導員への教育的支援および継続的なコンサルテーションシステムの構築と精神科看護師の配置の必要性が示唆された．departmental bulletin pape

Functional tooth number and mortality

Aim: Previous studies on the association between intraoral conditions and mortality in community-dwelling older individuals reported that fewer present teeth (PT) are significant risk factors for mortality. However, how the number of PT relative to the number of functional teeth (FT), including both present and rehabilitated teeth, influences mortality has not been investigated fully. This study examined the impact of the number of FT on mortality among community-dwelling Japanese older adults. Methods: This study was a retrospective, observational and population-based follow-up study, which examined 1188 older individuals who participated in an annual geriatric health examination from 2009 to 2015. The average follow-up period was 1697.0 ± 774.5 days. The primary outcome was all-cause mortality at follow-up. The numbers of PT and FT of each participant were counted during an oral examination. In addition, demographics, clinical variables, blood nutrient markers, physical functions and perceived masticatory function were measured. Results: Kaplan–Meier analysis, followed by a log-rank test, revealed that fewer PT (P < 0.001) and FT (P = 0.002) were significantly associated with a reduced survival rate. Cox's proportional hazard analysis indicated that the number of FT, but not the number of PT, was a significant independent mortality risk factor after adjusting for demographics, clinical variables, nutrient markers and physical functioning (P = 0.036, hazard ratio: 2.089). Conclusions: Current results suggest that the number of FT more strongly predicts all-cause mortality than the number of PT among community-dwelling older adults. Further studies are necessary to consider the confounding of socioeconomic status and disability status

Number of functional teeth more strongly predicts all‐cause mortality than number of present teeth in Japanese older adults

Aim Previous studies on the association between intraoral conditions and mortality in community‐dwelling older individuals reported that fewer present teeth (PT) are significant risk factors for mortality. However, how the number of PT relative to the number of functional teeth (FT), including both present and rehabilitated teeth, influences mortality has not been investigated fully. This study examined the impact of the number of FT on mortality among community‐dwelling Japanese older adults. Methods This study was a retrospective, observational and population‐based follow‐up study, which examined 1188 older individuals who participated in an annual geriatric health examination from 2009 to 2015. The average follow‐up period was 1697.0 ± 774.5 days. The primary outcome was all‐cause mortality at follow‐up. The numbers of PT and FT of each participant were counted during an oral examination. In addition, demographics, clinical variables, blood nutrient markers, physical functions and perceived masticatory function were measured. Results Kaplan–Meier analysis, followed by a log‐rank test, revealed that fewer PT (P  Conclusions Current results suggest that the number of FT more strongly predicts all‐cause mortality than the number of PT among community‐dwelling older adults. Further studies are necessary to consider the confounding of socioeconomic status and disability status

Impact of number of functional teeth on independence of Japanese older adults

Aim To examine the relationship between the number of present and functional teeth at baseline and future incidence of loss of independence. Methods Participants were community-dwelling older individuals who participated in a comprehensive geriatric health examination conducted in Kusatsu town, Japan, between 2009 and 2015. The primary endpoint was the incidence of loss of independence among participants, defined as the first certification of long-term care insurance in Japan. The numbers of present and functional teeth at baseline were determined via an oral examination. Demographics, clinical variables (e.g., history of chronic diseases and psychosocial factors), blood nutritional markers, physical functions, and perceived masticatory function were assessed. Results This study included 1121 individuals, and 205 individuals suffered from loss of independence during the follow-up period. Kaplan–Meier estimates of loss of independence for participants with smaller numbers of present and functional teeth were significantly greater than for those with larger numbers of teeth. Cox proportional hazard analyses indicated that a smaller number of present teeth was not a significant risk factor after adjusting for demographic characteristics. However, the number of functional teeth was a significant risk factor after the adjustment (hazard ratio: 1.975 [1.168–3.340]). Additionally, higher hazard ratios were observed in other adjusted models, but they were not statistically significant. Conclusions The number of functional teeth may be more closely related to the future incidence of loss of independence than the number of present teeth. This novel finding suggests that prosthodontic rehabilitation for tooth loss possibly prevents the future incidence of this life-event