Patient affect and caregiver burden in dementia

BACKGROUND: Numerous studies focusing on the burden of caregivers of dementia patients have been published. However, there have been few studies focusing on positive affect as an important factor affecting the caregiver burden, and only a few studies comparing the caregiver burden between different dementia diseases have been reported. METHODS: Three hundred and thirty-seven consecutive caregivers of people with dementia participated in this study. The caregiver burden was evaluated by the short version of the Japanese version of the Zarit Burden Interview. RESULTS: Positive affect scores had a significant relationship with the scores of the short version of the Zarit Burden Interview. Caregivers for patients with dementia with Lewy bodies or frontotemporal dementia suffered from a greater burden than those for patients with Alzheimer's disease dementia. CONCLUSIONS: The caregiver burden differed between people caring for patients with different dementia diseases. Positive affect of dementia patients has a significant relationship with caregiver burden, independently from neuropsychiatric symptoms of patients

A Case of Autoimmune Hepatitis Associated with Idiopathic Thrombocytopenic Purpura and Chronic Thyroiditis

Autoimmune hepatitis (AIH) is frequently associated with extrahepatic autoimmune disorders such as rheumatoid arthritis, Sjogren\u27s syndrome, and chronic thyroiditis, but the association with idiopathic (immune) thrombocytopenic purpura (ITP) is rare. We report a 46-year-old Japanese woman who presented with severe thrombocytopenia, elevated levels of aminotransferases, immunoglobulin (Ig) G, and platelet-associated IgG (PAIgG), positive anti-nuclear antibody, and hypothyroidism. After a diagnosis of coexisting AIH, ITP, and chronic thyroiditis, the patient was treated with 30 mg/day of prednisolone orally. The patient responded to such treatment: showing an increase in the number of platelets and decrease of serum levels of aminotransferases, IgG, and PAIgG to within normal ranges. Discrimination of ITP from liver cirrhosis as a cause of severe thrombocytopenia seen in chronic liver disease is important because complications and therapy are quite different. Prednisolone as a treatment for All should be also effective for ITP, and therefore, ITP should be considered when liver dysfunction is accompanied by severe thrombocytopenia, particularly in the autoimmune types of liver diseases

The effect of G-CSF in a myocardial ischemia reperfusion model rat

Purpose : It has been reported that G-CSF administration improves cardiac function by reducing the area of the infarct in a myocardial infarction model rat. In the present study, myocardial infarction model rats, produced by ligation of the left anterior coronary artery, were prepared. The G-CSF effect for treating cardiac muscle cell disorders by ischemia reperfusion was studied. Methods : Myocardial infarction model rats were produced by ligation of the left anterior descending coronary artery in 12-week-old Wistar rats. G-CSF was administered subcutaneously daily at a dose of 100 μg/kg/day for 5 days to rats with a complete ligation (MI-G group, n=6) and rats in which the ligated coronary artery was reperfused 30 minutes after the ligation (R-G group, n=6). Physiological saline was subcutaneously administered to rats with a complete ligation and reperfusion (MI-C and R-C groups, respectively, n=6 each), as controls. After 4 weeks, the infarct area ratio (%), cardiac function on echocardiography (left ventricular ejection fraction), and a myocardial histopathological diagnosis were carried out and the results compared among the groups. Results : No significant differences were found in the proportion of the residual heart muscle in the infarct lesion, myocardial wall thickness, or left ventricular ejection fraction between the MI-G and MI-C groups. In contrast, the infarct area, myocardial wall thickness, and left ventricular ejection fraction were significantly improved in the R-G group compared to the R-C group (p<0.05). Conclusions : Any inhibitory effect of G-CSF on the infarct lesion was found in the myocardial infarction reperfusion model rat, but only a small effect was found in rats with a complete ligation-induced myocardial infarction. The findings in the present study, therefore, suggest that G-CSF is effective for treating cardiac muscle cell disorders by ischemia reperfusion

ノウソッチュウ カンジャ ノ コウクウナイ ショケン ト シカ カイニュウ ノ ユウヨウセイ ニツイテ

We analyzed the need for dental intervention in patients with acute cerebral vascular disorders. In this study, we enrolled 43 individuals in SCU (male: 28, female: 15) in need of oral health management. The mean age of the patients was 68.0 ± 14.9. They had been diagnosed as cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack. Thirteen subjects were affected with pneumonia and could not handle self-care management. Furthermore, 10 subjects had poor oral hygiene. There were clearly more pneumonia patients in the intubation group compared to the non-intubation group. In addition, 18 cases (41.9%) needed dental treatment, and 5 cases received dental treatment. Patients with acute stroke had poor oral hygiene with disturbance of consciousness and paralysis, suggesting a possible cause of pneumonia in these patients. Half of patients required dental intervention, indicating that oral management may be necessary for stroke patients to prevent the occurrence of pneumonia

トクシマ ダイガク ビョウイン ニオケル シュウジュツキ コウクウ キノウ カンリ ノ ゲンジョウ ト カダイ

It has been shown that oral hygiene affects the onset of perioperative complications. The usefulness of perioperative oral function management aiming at the outbreak decrease in treatment complications and an early discharge was recognized. As a result, perioperative oral function management fee was founded at revision of medical service fees in Fiscal year 2012. 　In this clinical study, we evaluated the implementation of perioperative oral function management in Tokushima University Hospital. We examined 781 patients, including 563 patients for surgery and 218 patients for chemotherapy and radiotherapy. The mean age of patients was 58.8 ± 12.4 years old. 　The implementation rate of perioperative oral function management was 9.7% in the patients of surgery, and 17.4% in those of chemotherapy and radiotherapy. The highly required medical department was neurosurgery in the patients of surgery, and hematology in those of chemotherapy and radiotherapy. The mean number of tooth present was 21.3 ± 7.1 in the patients of surgery, and 19.8 ± 7.2 in those chemotherapy and radiotherapy. The rate of dental treatment was required in 40.5% of total patients who received surgery, and in 51.4% of patients who received chemotherapy and radiotherapy. The rate of patients who received denture treatment attained to 11.9% of the whole patients receiving surgery, and 13.3% of patients receiving chemotherapy and radiotherapy. 　It was revealed that there were many patients required potential demands in perioperative oral function management, and that there were many patients who need dental or denture treatment. We would like to develop perioperative oral function management by the interprofessional collaboration in health and social care

Intracellular Bacterial Infection and Invariant NKT Cells

The invariant (i) natural killer (NK)T cells represent a unique subset of T lymphocytes which express the Vα14 chain of the T cell receptor (TCR), that recognizes glycolipid antigens presented by the nonpolymorphic major histocompatibility complex (MHC) class I-like antigen presentation molecule CD1d, and they participate in protection against some microbial pathogens. Although iNKT cells have originally been regarded as T cells co-expressing NKR-P1B/C (NK1.1: CD 161), they do not seem to consistently express this marker, since NK1.1 surface expression on iNKT cells undergoes dramatic changes following facultative intracellular bacterial infection, which is correlated with functional changes of this cell population. Accumulating evidence suggests that NK1.1 allows recognition of "missing-self", thus controling activation/inhibition of NK1.1-expressing cells. Therefore, it is tempting to suggest that iNKT cells participate in the regulation of host immune responses during facultative intracellular bacterial infection by controlling NK1.1 surface expression. These findings shed light not only on the unique role of iNKT cells in microbial infection, but also provide evidence for new aspects of the NK1.1 as a regulatory molecule on these cells

ソクヨク ニ オケル ジンコウ ボウショウセン ガ ジリツシンケイカツドウ ニ アタエル エイキョウ

本研究は人工芒硝泉による足浴が自律神経活動に及ぼす影響について検討することを目的とした。健康な若年男女計6名(男性3名 : 20.7±0.6歳,女性3名 : 21.3±0.6歳)を対象に,人工芒硝泉浴,淡水浴,湯なし条件(対照座位)の足浴条件を1日1条件,ランダムな順序で施行した。対象者には20分間座位安静をとってもらい,引き続き足浴前値の測定を行った。足浴は座位にて41℃(33L)の温湯に両足膝下約10cmまで15分間浸漬して行った。足浴終了後は対象者自身が水分を拭き取り,両足を毛布で覆い,60分間座位安静を保った。その間,心拍数,心拍変動周波数に基づく自律神経活動,鼓膜温を測定するとともに,体感温度,眠気,疲労感などの主観的評価をVisual Analogue Scale(VAS)を用いて記録した。その結果,人工芒硝泉浴及び淡水浴により体感温度は有意に上昇したが,鼓膜温及び心拍数に有意な変動は見られなかった。また淡水浴後は交感神経活動の有意な亢進が認められたが,人工芒硝泉浴後はそれが見られなかった。本結果から人工芒硝泉による足浴は足浴後の交感神経活動の亢進を抑え,疲労感の低減に寄与する可能性が示唆された。This study was conducted to estimate the effect of a footbath with sodium sulfate (Na2SO4) on autonomic nervous system (ANS) activity. Each of three young healthy males (age, 20.7±0.6 years) and females (age, 21.3±0.6 years) participated in 3 conditions in random order, footbaths with or without Na2SO4, and a sitting position without water as a control. Each subject sat on a chair and kept quiet for 20min with heart rate (HR) stabilized, and subsequently basal measurements were conducted. In a sitting position, they dipped their calves 10cm under their knee joints into hot water (41℃, 33L) for 15min. Immediately after the bathing, they removed moisture, covered their knees with a blanket and sat for 60min thereafter. Counts of HR, ANS activity based on frequency of HR variability, and a core temperature using an eardrum thermometer were measured. The degree of thermal comfort such as relatively hot or relatively cool, sleepiness and fatigue were also estimated using visual analogue scales (VAS). As a result, both footbaths with and without Na2SO4 significantly increased the subjective thermal comfort, while the core temperature and HR counts were unaffected. Sympathetic nervous system (SNS) activity was significantly increased by the footbath without Na2SO4, but not with Na2SO4. These observations suggested that in the footbath, Na2SO4 might have an inhibitory effect on increased SNS activity, and induce some depressive effects on feeling of fatigue