ヨボウ ト リハビリテーション : ギョウセイ ノ タチバ カラ

Stroke is the third leading cause of death and a leading cause of adult disability in theJapan and the Tokushima Prefecture. Preventing stroke is the most important strategy forreducing the mortality from this disease, the suffering number of disability and also thedisability-related cost.Major modifiable causal risk factors for stroke include hypertension, diabetes, cigarettesmoking, alcohol consumption, atrial fibrillation and obesity.Current policies and practices for stroke prevention include both high-risk andpopulation-wide components. The high-risk approach requires detection and managementof these risk factors, once established in the affected individuals. The population-wide approachuses interventions intended to shift the distribution of risk favorably in those populationsin which a given risk factor has become prevent. The approach of the Health andMedical Service Law for Elderly (Rou-jin Hoken Hou) is the former. The approach of thenew policy of health promotion (Kenkou Nippon 21) is the latter. “Kenkou Nippon 21” is theprevention agenda for the nation. It is designed to achieve the goal, increase quality andyears of healthy life.Rehabilitation is the essential medical service for after stroke patient. The goal of a rehabilitationprogram for the patient is to provide for optimal physical, psychologic, physiologic,and social adaptation. It is important in this regard that the physical restoration activitynot be terminated abruptly at discharge, but that maintenance program be developedwhich can be continued by the patient on his return home. Namely, it is important toestablish the care system for stroke patient in the community following hospital discharge.The ten-year strategy to make up the framework of Tokushima prefecture in 21 century“Shin Chouki Keikaku” was established in 1997. It was designed to improve the health,welfare and medical service systems include the rehabilitation system in community

Directed Differentiation of Patient-Specific Induced Pluripotent Stem Cells Identifies the Transcriptional Repression and Epigenetic Modification of NKX2-5, HAND1, and NOTCH1 in Hypoplastic Left Heart Syndrome

The genetic basis of hypoplastic left heart syndrome (HLHS) remains unknown, and the lack of animal models to reconstitute the cardiac maldevelopment has hampered the study of this disease. This study investigated the altered control of transcriptional and epigenetic programs that may affect the development of HLHS by using disease-specific induced pluripotent stem (iPS) cells. Cardiac progenitor cells (CPCs) were isolated from patients with congenital heart diseases to generate patient-specific iPS cells. Comparative gene expression analysis of HLHS- and biventricle (BV) heart-derived iPS cells was performed to dissect the complex genetic circuits that may promote the disease phenotype. Both HLHS- and BV heart-derived CPCs were reprogrammed to generate disease-specific iPS cells, which showed characteristic human embryonic stem cell signatures, expressed pluripotency markers, and could give rise to cardiomyocytes. However, HLHS-iPS cells exhibited lower cardiomyogenic differentiation potential than BV-iPS cells. Quantitative gene expression analysis demonstrated that HLHS-derived iPS cells showed transcriptional repression of NKX2-5, reduced levels of TBX2 and NOTCH/HEY signaling, and inhibited HAND1/2 transcripts compared with control cells. Although both HLHS-derived CPCs and iPS cells showed reduced SRE and TNNT2 transcriptional activation compared with BV-derived cells, co-transfection of NKX2-5, HAND1, and NOTCH1 into HLHS-derived cells resulted in synergistic restoration of these promoters activation. Notably, gain- and loss-of-function studies revealed that NKX2-5 had a predominant impact on NPPA transcriptional activation. Moreover, differentiated HLHS-derived iPS cells showed reduced H3K4 dimethylation as well as histone H3 acetylation but increased H3K27 trimethylation to inhibit transcriptional activation on the NKX2-5 promoter. These findings suggest that patient-specific iPS cells may provide molecular insights into complex transcriptional and epigenetic mechanisms, at least in part, through combinatorial expression of NKX2-5, HAND1, and NOTCH1 that coordinately contribute to cardiac malformations in HLHS

A Hepatocellular Adenoma in a Diet-induced Obese Mouse

A hepatic nodule was noted in a C57BL/6J mouse with diet-induced obesity at 53 weeks of age. Macroscopically, a protruding yellowish white nodule was observed on the visceral surface of the left lateral lobe. Light microscopy demonstrated clear demarcation from the compressed adjacent parenchyma, with loss of the distinct lobular pattern. The proliferating cells of the lesion varied in shape and showed cellular atypia and prominent nucleoli along with vacuoles of various sizes. Some of the cells contained various-sized eosinophilic inclusion bodies in their cytoplasm, and electron microscopy revealed the presence of lipid droplets in the rough endoplasmic reticulum. Eosinophilic inclusions were observed as electron dense granular material in the rough endoplasmic reticulum, with one or a few low density central cores. A diagnosis of hepatocellular adenoma was made based on these findings

The Anti-Ischemic Mechanism of Action of Ranolazine in Stable Ischemic Heart Disease

OBJECTIVES: The purpose of this explanatory analysis was to investigate the relationship between ST-segment depression and the rate-pressure product (RPP) during exercise to determine whether ranolazine's mechanism of action was related to a reduction in myocardial oxygen demand or preservation of myocardial oxygen supply. BACKGROUND: In patients with stable ischemic heart disease, ranolazine increases exercise duration and reduces maximal ST-segment depression while exerting minimal effects on heart rate and blood pressure, although its mechanism of action during exercise has not been investigated. METHODS: Patients with stable ischemic heart disease (n = 191) were randomly allocated to a 4-period, double-blind, balanced Latin square crossover study to receive placebo, and ranolazine 500, 1,000, and 1,500 mg twice daily (bid) for 1 week each. Exercise treadmill tests were performed at baseline and at the end of each treatment period. The RPP and ST-segment depression were assessed before starting exercise, at each stage of exercise, and at maximal exercise. RESULTS: Compared with placebo, ranolazine produced a dose-dependent reduction in ST-segment depression that became more marked as exercise-induced ischemia became more pronounced, associated with clinically minor decreases in heart rate and blood pressure. At 12-min exercise, the amount of ST-segment depression compared with placebo and controlled for RPP was reduced by 22.3% on ranolazine 500 mg bid (p = 0.137), by 35.4% on 1,000 mg bid (p = 0.005), and by 45.8% on 1,500 mg bid (p < 0.001). CONCLUSIONS: The progressive magnitude of ischemia reduction on ranolazine was proportionally more substantial than the minor reductions in heart rate or RPP, suggesting that ranolazine's beneficial mechanism of action is most likely primarily due to an improvement in regional coronary blood flow in areas of myocardial ischemia

Novel Model of Pulmonary Artery Banding Leading to Right Heart Failure in Rats

Background. Congenital heart diseases often involve chronic pressure overload of the right ventricle (RV) which is a major cause of RV dysfunction. Pulmonary artery (PA) banding has been used to produce animal models of RV dysfunction. We have devised a new and easier method of constricting the PA and compared it directly with the partial ligation method. Methods. Eight-week-old male Sprague-Dawley rats (240–260 g) were divided into three groups: sham operation, partial pulmonary artery ligation (PAL) procedure, and pulmonary artery half-closed clip (PAC) procedure. RV function and remodeling were determined by echocardiography and histomorphometry. Results. Surgical mortality was significantly lower in the PAC group while echocardiography revealed significantly more signs of RV dysfunction. At the 8th week after surgery RV fibrosis rate was significantly higher in the PAC group. Conclusions. This procedure of pulmonary artery banding in rats is easier and more efficient than partial ligation

高齢者看護学教育における認知症模擬患者を導入した演習での学び

　本研究の目的は、認知症高齢者の模擬患者を導入した高齢者看護学演習での学生の学びを明らかにし、今後の演習プログラム精錬への示唆を得ることである。看護系短期大学に在籍する2年次生から演習終了後、「演習で学んだこと」に対する回答を得た。調査協力が得られた78名の回答を質的に分析した結果、《高齢者と接する私たちの態度》《コミュニケーションの工夫》《道具の活用・環境づくり》《回避的な対話》の4カテゴリーが抽出された。認知症高齢者と接する際の学生自身の態度や、コミュニケーションを行ううえでの具体的な技術にまで考えがおよび自分の学びとしていた。しかし一方で、認知症模擬患者の帰宅願望や不安を回避するような消極的な対応方法を学びとしてしまう可能性がみられたことから、認知症高齢者がもっている本質的な不安にたちかえるといった演習の振り返りを充実させる必要性があることが示唆された。The purpose of this paper is to sheld light on what students have learned in the nursing seminar for the elderly that uses simulated elderly dementia patients, and to gain pointers on how to refine or improve future seminar programs. After the seminar, the second year students in nursing college were asked to answer the question, "What did you learn in the seminar?" On the basis of the qualitative analysis of the responses from 78 people, I derived the following four categories: 1) "Attitudes of those who are in contact with the elderly," 2)"Communication schemes," 3)"Tool utilization and environment creation," and 4)"Evasive interaction." The categories cover the attitudes of students at the time of contact with elderly dementia patients, as well as their thinking and learning about specific techniques in communication. However, at the same time, it is possible that some students learned about dementia simulated patients, desire to return to their homes and about passive methods for avoiding anxiety. This suggests that a complete review of the seminar is necessary in order to obtain feedback from elderly dementia patients about their inner anxiety

模擬患者を活用した高齢者看護学演習に関する文献検討

　高齢者看護学における模擬患者または訓練を受けていない演者(準模擬患者とする)を活用した演習の効果について10件の文献を検討した。結果、両演者の演習の共通点は、リアリティのある演習ができる、高齢者の現実の姿に適合するコミュニケーション技術を獲得するための教育方法になることがわかった。さらに、模擬患者の演習では、症状の表現が難しい認知症事例や、障害をもち生活の不安を抱えた患者を社会背景も含めて演じる事例、継続した患者の過程を再現できる一連の看護過程演習の実施が可能である。加えて、認知症高齢者の世界に寄り添おうとする姿勢を育み、対象を理解する力と個別の援助の工夫と実施ができる効果が得られる。一方準模擬患者の演習は、演者の実年齢が高齢期であれば、自身の体験談を語ることで、身体的機能低下や「死の受容」の発達課題など高齢者の特徴とその人の生き方による個人差があることの理解が深まる。および大勢の演者を準備することが可能であり、その場合は全学生のロールプレイが実施できる