「東アジア共同体」を設計する―現代アジア学へのチャレンジ―

Copyright (c) Center of Excellence-Contemporary Asian Studie

Definition and recommended cultural considerations for advance care planning in Japan: A systematic review

Although Delphi studies in Western countries have provided a consensus for practices pertaining to advance care planning (ACP), their findings may not be applicable to Asian countries with distinct, family-oriented cultures. This systematic review aimed to synthesize the definitions of and evidence for ACP and analyze recommended practices in Japan. We conducted a systematic review using narrative synthesis in December 2018. Key words were searched from Ichushi-Web by NPO Japan Medical Abstracts Society, Citation Information by the National Institute of Informatics, and Japanese Institutional Repositories Online databases. In addition, in August 2019, we conducted hand searching using Google Scholar and Google. We included original Japanese articles that addressed factors regarding ACP (e.g. definitions, elements, roles and tasks, and timing of ACP). Data were synthesized using thematic analysis. The study protocol was registered prospectively (PROSPERO: CRD42020152391). Of the 3512 studies screened, 27 were included: 22 quantitative and 5 qualitative. Five-position statements/guidelines were added by hand searching. Definitions and several distinct practice patterns of ACP and the importance of families' roles were identified. Unique recommendations addressed the importance of properly eliciting patients' preferences that are the best for both patients and families, engaging the public to raise awareness of ACP, and developing policies and guidelines for ACP. We identified the definition of and unique recommendations for ACP based on Japanese cultural values and norms. Further research is needed to evaluate the recommendations provided in this systematic review

Research on satisfaction of elderlies with dementia in health care facilities.

2つの老人保健施設に入所している痴呆老人について,観察者による彼らの満足度とその時に観察された行動の関係を明らかにすることを目的とする｡調査対象者は,2つの老人保健施設に入所中で,本人または家族より調査への了系の得られた,歩行可能な痴呆老人各14名,合計28名である｡観察者は対象者の行動を48時間観察し,どこで誰と何を行っているかとその時の満足度を調査票に記録した｡満足度は対象者の表情や態度から観察者が判断し,大変満足を⑤とし,どちらとも言えないを③,大変不満足を①とした5段階評定で示した｡その結果以下の3点が明らかとなった｡ 1)両施設で満足度の高い時間帯は,レクリエーションが含まれる"午前中の時間"であった｡ 2)満足度が高いのは,居場所では,"レクリエーションルーム･屋外"であった｡ 3)同行者は,"家族","観察者",行動は,"話をする",手伝いをするなど"自発的な行為"が多くみられた｡以上により,2つの施設で満足度ごとの時間帯,居場所,同行者と行動が似通っていたことから,客観的に痴呆老人の満足度を把握することは可能であると考える｡The purpose of this study was to clarify if there is a relationship between the satisfaction of elderlies with dementia in health care facilities by subjective views of the investigator and their actions. The subjects of this investigation were 28 fully functional elderly clients with dementia who were living in 2 health care facilities. They or their family consented to take part in our research. 14 clients were chosen from each facilities. The investigators observed the clients for 48 hours and recorded where they were, with whom they were, what they did, as well as the client's level of satisfaction. The satisfaction levels were judged from the clients' appearances or attitudes by the investigations. There were five satisfaction including from 1 : unsatisfied to 5 : great satisfaction. The following three points were observed both in two facilities in common ; (1) the high satisfaction time period was "morning" when recreation was included. (2) the client received a high level of satisfaction when they were in the "recreation-room" or "outdoors", (3) the client received a high level of satisfaction whom they stayed with "their family" or "observers", when talking to someone or helping someone positively. Analysis of these results demonstrated there was similar pattern between the time of day and place and their companion or their actions among the subjects in two facilities. It can be assumed that it is able to observe elderlies with dementia satisfaction degree objectively

Reptilian Heart Development And The Molecular Basis Of Cardiac Chamber Evolution

The emergence of terrestrial life witnessed the need for more sophisticated circulatory systems. This has evolved in birds, mammals and crocodilians into complete septation of the heart into left and right sides, allowing separate pulmonary and systemic circulatory systems, a key requirement for the evolution of endothermy(1-3). However, the evolution of the amniote heart is poorly understood. Reptilian hearts have been the subject of debate in the context of the evolution of cardiac septation: do they possess a single ventricular chamber or two incompletely septated ventricles(4-7)? Here we examine heart development in the red-eared slider turtle, Trachemys scripta elegans (a chelonian), and the green anole, Anolis carolinensis (a squamate), focusing on gene expression in the developing ventricles. Both reptiles initially form a ventricular chamber that homogenously expresses the T-box transcription factor gene Tbx5. In contrast, in birds and mammals, Tbx5 is restricted to left ventricle precursors(8,9). In later stages, Tbx5 expression in the turtle (but not anole) heart is gradually restricted to a distinct left ventricle, forming a left-right gradient. This suggests that Tbx5 expression was refined during evolution to pattern the ventricles. In support of this hypothesis, we show that loss of Tbx5 in the mouse ventricle results in a single chamber lacking distinct identity, indicating a requirement for Tbx5 in septation. Importantly, misexpression of Tbx5 throughout the developing myocardium to mimic the reptilian expression pattern also results in a single mispatterned ventricular chamber lacking septation. Thus ventricular septation is established by a steep and correctly positioned Tbx5 gradient. Our findings provide a molecular mechanism for the evolution of the amniote ventricle, and support the concept that altered expression of developmental regulators is a key mechanism of vertebrate evolution

外来に通院している2型糖尿病患者の病気への対処

本研究は、外来に通院している2型糖尿病患者が、どのように病気に対処しているのかを明らかにすることを目的とした。平成13年1月から4ヶ月間かけて、兵庫県内1施設の外来に通院している2型糖尿病患者9名を対象に、インタビュー法及び参加観察法を行った。その結果、外来通院中の2型糖尿病患者の病気への対処に関して、「状況に身をおく」「生活時間に組み込む」「自分の身体をみる」「自分をみてもらう」「サポートを受けとる」「自分を原動力にする」「身体の障害や加齢によりできない」の7つのカテゴリーが明らかになった。「状況に身をおく」とは、糖尿病の療養をするために、習慣的に身についたものをつかったり、人との関係の中から身につけたものをつかったりすることであった。「生活時間に組み込む」とは、病気に対処するために、時間の軸を中心にして生活時間を組み立てたり、普段の生活を軸として療養が生活時間に入り込むことであった。「自分の身体をみる」とは、患者が病気に対処していく中で、身体を実感したり、対処のために数値を目安にしたり、身体の反応をとらえることであった。「自分をみてもらう」とは、患者が、医師や自分の身近なまわりの人に関心を向けてもらうことであった。「サポートを受けとる」とは、患者が、身近な人からの気遣いを実際的なサポートとして受けとることであった。「自分を原動力にする」とは、糖尿病の療養について思考したり、病気に対処していく意志をもつことであった。「身体の障害や加齢によりできない」とは、身体の障害や加齢による身体機能の衰えによって、病気への対処が困難になることであった。これら糖尿病患者の病気への対処に関する7つのカテゴリーは、糖尿病の療養を身につけること、糖尿病を生きる体験の深まりに関係していた。The purpose of this study was to clarify strategies for coping with the illness of type 2 diabetic patients in the out-patient department of a hospital. The participants were 9 type 2 diabetic outpatients. The data was collected using interviews and participant observation. The study clarified seven categories of strategies for coping with the illness. The subjects coped with their situations by using habitual physical skills and social skills. The subjects coped by structuring their regimens by scheduling their time and carrying on with their usual life. They sensitized themselves to their bodily conditions and were observed by their family and the doctor. Their strategy was to recognize their bodily signals to use their data for self management, and to respond to their body. The subjects received practical support from their family and/or friends. Their strategies were modified by the factors of stamina, aging and disability. Stamina reflected itself in an ability to think about the regimens of a diabetic or to have the will to cope with the illness. Aging and disability made it difficult for subjects to cope with the illness. These seven categories of coping were related to the establishment of regimens and the deepening of experience-based skills related to diabetes

Mdm20 Stimulates PolyQ Aggregation via Inhibiting Autophagy Through Akt-Ser473 Phosphorylation

Mdm20 is an auxiliary subunit of the NatB complex, which includes Nat5, the catalytic subunit for protein N-terminal acetylation. The NatB complex catalyzes N-acetylation during de novo protein synthesis initiation; however, recent evidence from yeast suggests that NatB also affects post-translational modification of tropomyosin, which is involved in intracellular sorting of aggregated proteins. We hypothesized that an acetylation complex such as NatB may contribute to protein clearance and/or proteostasis in mammalian cells. Using a poly glutamine (polyQ) aggregation system, we examined whether the NatB complex or its components affect protein aggregation in rat primary cultured hippocampal neurons and HEK293 cells. The number of polyQ aggregates increased in Mdm20 over-expressing (OE) cells, but not in Nat5-OE cells. Conversely, in Mdm20 knockdown (KD) cells, but not in Nat5-KD cells, polyQ aggregation was significantly reduced. Although Mdm20 directly associates with Nat5, the overall cellular localization of the two proteins was slightly distinct, and Mdm20 apparently co-localized with the polyQ aggregates. Furthermore, in Mdm20-KD cells, a punctate appearance of LC3 was evident, suggesting the induction of autophagy. Consistent with this notion, phosphorylation of Akt, most notably at Ser473, was greatly reduced in Mdm20-KD cells. These results demonstrate that Mdm20, the so-called auxiliary subunit of the translation-coupled protein N-acetylation complex, contributes to protein clearance and/or aggregate formation by affecting the phosphorylation level of Akt indepenently from the function of Nat5