Physicians' attitudes about artificial feeding in older patients with severe cognitive impairment in Japan: a qualitative study

<p>Abstract</p> <p>Background</p> <p>The question of whether to withhold artificial nutrition and hydration (ANH) from severely cognitively impaired older adults has remained nearly unexplored in Japan, where provision of ANH is considered standard care. The objective of this study was to identify and analyze factors related to the decision to provide ANH through percutaneous endoscopic gastrostomy (PEG) in older Japanese adults with severe cognitive impairment.</p> <p>Methods</p> <p>Retrospective, in-depth interviews with thirty physicians experienced in the care of older, bed-ridden, non-communicative patients with severe cognitive impairment. Interview content included questions about factors influencing the decision to provide or withhold ANH, concerns and dilemmas concerning ANH and the choice of PEG feeding as an ANH method. The process of data collection and analysis followed the Grounded Theory approach.</p> <p>Results</p> <p>Data analysis identified five factors that influence Japanese physicians' decision to provide ANH through PEG tubes: (1) the national health insurance system that allows elderly patients to become long-term hospital in-patients; (2) legal barriers with regard to limiting treatment, including the risk of prosecution; (3) emotional barriers, especially abhorrence of death by 'starvation'; (4) cultural values that promote family-oriented end-of-life decision making; and (5) reimbursement-related factors involved in the choice of PEG. However, a small number of physicians did offer patients' families the option of withholding ANH. These physicians shared certain characteristics, such as a different perception of ANH and repeated communication with families concerning end-of-life care. These qualities were found to reduce some of the effects of the factors that favor provision of ANH.</p> <p>Conclusion</p> <p>The framework of Japan's medical-legal system unintentionally provides many physicians an incentive to routinely offer ANH for this patient group through PEG tubes. It seems apparent that end-of-life education should be provided to medical providers in Japan to change the automatic assumption that ANH must be provided.</p

A dataset of molluscan fauna sampled in river estuaries of medium and small size river in Kyushu island, Japan

Many studies have evaluated the ecological integrity of large-scale estuaries of continental rivers using biotic indicators such as fish, phytoplankton and benthic communities. However, few studies have focused on the river estuaries of small and medium rivers. Molluscan fauna data in large estuaries or in the estuaries of large rivers have been collected by the The National Census on River Environments (conducted by the Ministry of Land, Infrastructure, Transport and Tourism) or National Survey on the Natural Environment (conducted by the Ministry of Environment). On the other hand, molluscan fauna of small and medium rivers are managed by local governments and have rarely been investigated. This paper provides basic information on the molluscan fauna of 70 rivers in Kyushu, Japan, collected with the aim of conserving estuaries of small and medium rivers. In total, 37 families, 82 species and 21,827 individuals were collected. The data are all accessible from the document "A dataset of shellfish fauna sampled in estuaries of medium and small rivers in Kyushu, Japan (http://ipt.pensoft.net/resource.do?r=shellfishes_in_kyushu)". According to the Red Data Book published by the Japanese Ministry of Environment in 2018, 3 species were determined as Critically endangered and Endangered, 6 species were determined as Vulnerable and 13 species were determined as Near Threatened. The proportions of individuals classified as Critically endangered and Endangered from the total number of individuals were extremely low, but the proportions of Near Threatened individuals were high. Our results indicate that the risk of molluscan extinction in small- and medium-sized river estuaries in Kyushu is high and that immediate conservation is necessary

FRONTAL PLANE TAKE-OFF STEP MECHANICS OF LONG JUMPERS WITH AND WITHOUT A BELOW THE KNEE AMPUTATION

Frontal plane mechanics during the long jump take-off step are unknown for athletes with and without a transtibial amputation. This is an issue due to the importance of the knowledge for training and rehabilitation protocols or prosthetic design. In this study the take-off step of three long jumpers with and seven without a below the knee amputation (BKA) were analysed with regard to frontal plane mechanics. Three-dimensional motion capture (Vicon) and a force plate (Kistler) were used to capture kinematic and kinetic data. Inverse dynamic calculations (Dynamicus, Alaska) revealed differences in frontal plane center of mass kinematics and joint kinetics between groups. Specifically, athletes with BKA had lower medio-lateral ground reaction forces, lower frontal plane joint loads and an altered foot position pattern compared to non-amputee athletes

High hydrostatic pressure induces slow contraction in mouse cardiomyocytes

Cardiomyocytes are contractile cells that regulate heart contraction. Ca2+ flux via Ca2+ channels activates actomyosin interactions, leading to cardiomyocyte contraction, which is modulated by physical factors (e.g., stretch, shear stress, and hydrostatic pressure). We evaluated the mechanism triggering slow contractions using a high-pressure microscope to characterize changes in cell morphology and intracellular Ca2+ concentration ([Ca2+]i) in mouse cardiomyocytes exposed to high hydrostatic pressures. We found that cardiomyocytes contracted slowly without an acute transient increase in [Ca2+]i, while a myosin ATPase inhibitor interrupted pressure-induced slow contractions. Furthermore, transmission electron microscopy showed that, although the sarcomere length was shortened upon the application of 20 MPa, this pressure did not collapse cellular structures such as the sarcolemma and sarcomeres. Our results suggest that pressure-induced slow contractions in cardiomyocytes are driven by the activation of actomyosin interactions without an acute transient increase in [Ca2+]i

LONG JUMP MECHANICS – OLYMPIC VERSUS PARALYMPIC CHAMPION

In the last 20 years the long jump world record of athletes with an amputation of the lower extremities has improved by over two meters. However, there is no recent research on amputee long jumping and no information about amputee long jump kinetics. In this study the take-off step of an Olympic and a Paralympic champion were analyzed with regard to jumping mechanics. A 3D motion capturing system (Vicon) and a force plate (Kistler) were used to capture kinematic and kinetic data. Inverse dynamic calculations (Dynamicus, Alaska) revealed remarkable differences with respect to mechanical loading and motor solutions between the transtibial amputee and non-amputee long jumper. Mechanical constraints and material properties of the prosthesis might influence the kinematic chain of the amputee athlete and impose the need for an alternative motor solution

原発性シェーグレン症候群モデルマウスにおいて唾液腺Natural killer細胞の恒常性の破綻がIFN-γを介して自己免疫病変を増強する

Objective: Innate lymphoid cells (ILCs), including natural killer (NK) cells, ILC1, ILC2, lymphoid tissue-inducer (LTi) cells, and ILC3 cell, play a key role in various immune responses. Primary Sjögren’s syndrome (pSS) is an autoimmune disease characterized by chronic inflammation of exocrine glands, such as the lacrimal and salivary glands (SGs). The role of NK cells among ILCs in the pathogenesis of pSS is still unclear. In this study, the characteristics and subsets of NK cells in the salivary gland (SG) tissue were analyzed using a murine model of pSS. Methods: Multiple phenotypes and cytotoxic signature of the SG NK cells in control and pSS model mice were evaluated by flow cytometric analysis. Intracellular expression of interferon-γ (IFN-γ) among T cells and NK cells from the SG tissues was compared by in vitro experiments. In addition, pathological analysis was performed using anti-asialo-GM1 (ASGM1) antibody (Ab)-injected pSS model mice. Results: The number of conventional NK (cNK) cells in the SG of pSS model mice significantly increased compared with that in control mice at 6 weeks of age. The production level of IFN-γ was significantly higher in SG NK cells than in SG T cells. The depletion of NK cells by ASGM1 Ab altered the ratio of tissue resident NK (rNK) cells to cNK cells, which inhibited the injury to SG cells with the recovery of saliva secretion in pSS model mice. Conclusion: The results indicate that SG cNK cells may enhance the autoreactive response in the target organ by upregulating of IFN-γ, whereas SG rNK cells protect target cells against T cell cytotoxicity. Therefore, the activation process and multiple functions of NK cells in the target organ could be helpful to develop potential markers for determining autoimmune disease activity and target molecules for incurable immune disorders

AMiBA: scaling relations between the integrated Compton-y and X-ray derived temperature, mass, and luminosity

We investigate the scaling relations between the X-ray and the thermal Sunyaev-Zel'dovich Effect (SZE) properties of clusters of galaxies, using data taken during 2007 by the Y.T. Lee Array for Microwave Background Anisotropy (AMiBA) at 94 GHz for the six clusters A1689, A1995, A2142, A2163, A2261, and A2390. The scaling relations relate the integrated Compton-y parameter Y_{2500} to the X-ray derived gas temperature T_{e}, total mass M_{2500}, and bolometric luminosity L_X within r_{2500}. Our results for the power-law index and normalization are both consistent with the self-similar model and other studies in the literature except for the Y_{2500}-L_X relation, for which a physical explanation is given though further investigation may be still needed. Our results not only provide confidence for the AMiBA project but also support our understanding of galaxy clusters.Comment: Accepted by ApJ; 8 pages, 3 figures, 5 table