松葉杖歩行における身体局所的疲労と潜在的適応学習

松葉杖歩行による下肢の疲労部位と程度、歩行パターンについて検討した。対象は松葉杖歩行未経験の大学2年生24名とし、200mを非利き足を完全免荷で松葉杖歩行させ、歩数と時間を計測・解析した。また荷重足とした利き足の大腿・下腿部の前後面、足背・足底部の歩行後の疲労感をNumerical Rating Scale（NRS）を用いて計測し、全ての部位のスコアを加算したものを総疲労スコアとした。その結果、下腿部と足底部に高い疲労感を認めた。また、総疲労スコアと歩数、総疲労スコアと総時間に弱い正の相関、歩行速度と総歩数、歩行距離と5m毎の歩数に中等度の負の相関を認めた。以上から、片側下肢の完全免荷松葉杖歩行の初回歩行では、荷重足の底背屈筋、足趾屈伸筋に疲労が出現しやすい可能性、歩幅が大きいと疲労しにくい可能性、また外的教示なしでも歩幅を大きくする適応的学習が生じる可能性が示唆された。We investigated the position and degree of fatigue in the supporting leg and a pattern of gait alterations at the first time of walking with crutches. Twenty-four college students participated in this study. The subjects walked with crutches with load to dominant leg for 200 m. The number of steps and time were measured. After walking, the degree of fatigue in the upper and lower leg and foot was measured by Numerical Rating Scale. All the scores were summed and the total fatigue score（TFS） was calculated. Fatigue was observed in the lower leg and sole. There was a low positive correlation between TFS and total steps and between TFS and total time. There was a moderate negative correlation between walking speed and steps and between steps per 5 m and walking distance. These results indicate that fatigue in the lower leg and sole is caused by gait alterations during first time of walking with crutches. Moreover, as a stride becomes large, it is harder for the leg and foot to fatigue. Finally, implicit adaptation, a gradually increasing stride without instruction, is caused during the first time of walking with crutches

Smartphone problem-solving and behavioural activation therapy to reduce fear of recurrence among patients with breast cancer (SMartphone Intervention to LEssen fear of cancer recurrence: SMILE project): protocol for a randomised controlled trial

Introduction: One of the most common distressing conditions experienced by breast cancer survivors is fear of cancer recurrence (FCR). There is, however, no standard intervention for ameliorating FCR. Our clinical experience and previous studies have suggested the potential benefits of problem-solving therapy (PST) and behavioural activation (BA). Given the huge number of cancer survivors and limited number of therapists to competently conduct PST and BA, we have developed PST and BA smartphone applications. This study aimed to evaluate the efficacy of the smartphone-based PST (Kaiketsu-App) and BA (Genki-App) apps in reducing FCR in patients with breast cancer. Methods and analysis: The SMartphone Intervention to LEssen fear of cancer recurrence project is an open-label, individually randomised, parallel-group trial. Allocation will be managed by a central server using a computer-generated random allocation sequence provided by an independent data centre. Participants will be randomised to smartphone-based intervention plus treatment as usual (TAU) or waitlist control with TAU alone. The primary endpoint of the study is the Japanese version of the Concerns About Recurrence Scale, which will be administered as an electronic patient-reported outcome on the patients’ smartphone after 8 weeks. Ethics and dissemination: The present study is subject to the ethical guidelines for clinical studies published by Japan’s Ministry of Education, Science and Technology and Ministry of Health, Labour and Welfare and the modified Act on the Protection of Personal Information as well as the ethical principles established for research on humans stipulated in the Declaration of Helsinki and further amendments thereto. The protocol was approved by the Institutional Review Board of Nagoya City University on 15 January 2018 (ID: 60-00-1171). Trial status: The randomised trial, which commenced on 2 April 2018, currently enrols participants. The estimated end date for this study is in March 2020. Trial registration number: UMIN000031140; Pre-results

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo