Does infrared visualization improve selection of venipuncture sites for indwelling needle at the forearm in second-year nursing students?

AbstractObjectivesTo evaluate the effectiveness of a vein visualization display system using near-infrared light (“Vein Display”) for the safe and proper selection of venipuncture sites for indwelling needle placement in the forearm.MethodsTen second year nursing students were recruited to apply an indwelling needle line with and without Vein Display. Another ten participants were recruited from various faculty to serve as patients. The quality of the venipuncture procedure at various selected sites was evaluated according to a scale developed by the authors. Time, scores and patterns of puncture-site selection were compared with respect to three different methods: [1] attempt 1 (tourniquet only), [2] attempt 2 (Vein Display only) and [3] attempt 3 (both). To validate the effectiveness of Vein Display, 52 trials were conducted in total.ResultsWe found that venipuncture site selection time was significantly improved with the Vein Display, particularly in the case of difficult to administer venipuncture sites. Overall, we found no significant difference with respect to venipuncture quality, as determined by our scale.ConclusionThese results suggest that equipment such as the Vein Display can contribute immensely to the improvement of practical skills, such as venipuncture, especially in the context of elderly patients

Histological heterogeneity of glomerular segmental lesions in focal segmental glomerulosclerosis

Focal segmental glomerulosclerosis (FSGS) involves considerable histological heterogeneity in terms of location and quality of the glomerular segmental lesions. The present study investigated the heterogeneity of segmental lesions in each variant of FSGS, determined by the Columbia classification, and its clinical relevance. All glomerular segmental lesions of 80 cases of primary FSGS were evaluated histologically based on location [tip (TIP), perihilar (PH), or not otherwise specified (NOS)], and quality (cellular or fibrous). Among the 1,299 glomeruli of the 80 biopsy specimens, 210 glomeruli (16.2%) had segmental lesions, comprising 57 (27%) cellular TIP, 4 (2%) fibrous TIP, 42 (20%) cellular NOS, 86 (41%) fibrous NOS, and 21 (10%) fibrous PH lesions. Each case was also classified into one of the five histological variants of the Columbia classification: collapsing (COL), TIP, cellular (CEL), PH, or NOS. Overlap of segmental lesions in different location categories was seen in the COL, TIP, and PH variants, and heterogeneity of quality was apparent in the COL and CEL variants. Histological findings of the CEL variant (endocapillary hypercellularity) were observed in nine of the 13 COL variants. Both location and quality correlated with disease duration, degree of proteinuria, and histological severity of global glomerular sclerosis and tubulo-interstitial lesions. These results demonstrated the histological heterogeneity of glomerular segmental lesions in all variants of the Columbia classification, except NOS. However, the fidelity of location and dominance of histological features were generally conserved in the TIP and PH variants. The COL and CEL variants warrant further investigation because of their overlapping histological findings and apparent histological heterogeneity in the glomerular segmental lesions

Ten Years of Provenance Trials and Application of Multivariate Random Forests Predicted the Most Preferable Seed Source for Silviculture of Abies sachalinensis in Hokkaido, Japan

Research highlights: Using 10-year tree height data obtained after planting from the range-wide provenance trials of Abies sachalinensis, we constructed multivariate random forests (MRF), a machine learning algorithm, with climatic variables. The constructed MRF enabled prediction of the optimum seed source to achieve good performance in terms of height growth at every planting site on a fine scale. Background and objectives: Because forest tree species are adapted to the local environment, local seeds are empirically considered as the best sources for planting. However, in some cases, local seed sources show lower performance in height growth than that showed by non-local seed sources. Tree improvement programs aim to identify seed sources for obtaining high-quality timber products by performing provenance trials. Materials and methods: Range-wide provenance trials for one of the most important silvicultural species, Abies sachalinensis, were established in 1980 at nine transplanting experimental sites. We constructed an MRF to estimate the responses of tree height at 10 years after planting at eight climatic variables at 1 km × 1 km resolution. The model was applied for prediction of tree height throughout Hokkaido Island. Results: Our model showed that four environmental variables were major factors affecting height growth—winter solar radiation, warmth index, maximum snow depth, and spring solar radiation. A tree height prediction map revealed that local seeds showed the best performance except in the southernmost region and several parts of northern regions. Moreover, the map of optimum seed provenance suggested that deployment of distant seed sources can outperform local sources in the southernmost and northern regions. Conclusions: We predicted that local seeds showed optimum growth, whereas non-local seeds had the potential to outperform local seeds in some regions. Several deployment options were proposed to improve tree growth

Maximum Glomerular Diameter and Oxford MEST-C Score in IgA Nephropathy: The Significance of Time-Series Changes in Pseudo-R2 Values in Relation to Renal Outcomes

The progression of immunoglobulin A nephropathy (IgAN) is currently assessed using the Oxford MEST-C score, which uses five indicators (mesangial and endocapillary hypercellularity, segmental sclerosis, interstitial fibrosis/tubular atrophy, and the presence of crescents) but has not yet included any risk factors related to glomerular size. Therefore, we tested whether adding another indicator, maximal glomerular diameter (Max GD), would improve the prognostic ability of this scoring system. The data of 101 adult patients diagnosed with IgAN between March 2002 and September 2004 were reviewed. We used McFadden’s pseudo-R2 and the corrected Akaike information criterion to assess model fit and the concordance (C)-statistic to assess discriminatory ability. A 10 μm increase in Max GD was significantly associated with a composite outcome (≥50% decline in the estimated glomerular filtration rate or end-stage renal disease). The receiver operating characteristic analysis determined the cut-off for high vs. low Max GD at 245.9 μm, and adding high Max GD to the MEST-C score significantly improved the model’s discrimination of renal outcomes at 5 and ≥10 years. Thus, including the Max GD in the Oxford classification of IgAN might increase its robustness and provide a more comprehensive prognostic system for clinical settings

社会的潜在支援力の強化による環境病患者サポート体制の確立

application/pdf化学物質過敏症（MCS）患者の社会参加状況を把握する横断的研究（n=325)の結果は、就業率、患者会所属率が低く、ICF概念モデルを支持していた。 MCS患者の看護を阻害している心理社会因子の探索を目的とした研究結果では、患者側は訪問看護を希望していたが、看護師から揮発する微量化学物質を避けるために利用を躊躇していた。一方、看護師側は、現行医療システム上の問題によって看護提供を躊躇していた。 看護師が周波数調整機器を持参する訪問看護においては、MCSの症状改善効果の結果を得た。しかし、脱化学物質状態で訪問できる看護師の養成が必須であったため、看護師がそれらの講習を受けられる研究センターを建設した。In a cross-sectional study (n=325) to understand the social participation status of patients with multiple chemical sensitivity (MCS), the employment rate and patient association affiliation rate were low, supporting the ICF conceptual model. In a study aimed at searching for factors that interfered with the care of MCS patients, MCS patients wanted to receive home-visit care by nurses. However, MCS patients were hesitant to use home-visit nursing because they wanted to avoid trace chemicals that nurses volatilize. Nurses were hesitant to provide nursing care to MCS patients due to problems with the current health system. When the nurse used the frequency adjustment equipment with the MCS patient, the patient realized that her symptoms had improved. However, to implement this method, nurses with dechemical status must be trained. Therefore, we have built a research center that can receive training to support MCS patients.2018年度～2021年度科学研究費補助金(基盤研究(B))研究成果報告書18H0302

静脈穿刺ナビゲーションシステム開発に向けた、前腕部静脈穿刺ハイリスクエリアの検討

application/pdf静脈注射における神経損傷回避のため「静脈穿刺ナビゲーションシステムの構築」を目指したが、本研究がターゲットとする前腕部皮神経の描出に適したMRIシーケンスの確立が進んでおらず、当初予定していた3次元神経イメージ走行および静脈穿刺ハイリスクエリアを表示するアルゴリズム構築の実現化には至らなかった。 しかし、MRI撮影時に用いるチューブマーカーや、撮影時の同一体位保持に関する課題の検討を進め、前腕部皮神経描出のための基盤を整えることができた。We aimed for construction of venipuncture navigation system to avoid nerve damage in intravenous injection. However,establishment of MRI sequence suitable for depiction of forearm cutaneous nerve has not progressed. Therefore we didn't lead to the realization of the algorithm construction to display 3D neural image and venipuncture high risk area. However, we were able to prepare a basis for depiction of the forearm cutaneous nerve by advancing examinations of tube markers used at the time of MRI imaging and problems related to retention of the same body position at the time of imaging.2015年度～2018年度科学研究費補助金(挑戦的萌芽研究)研究成果報告書15K1579

Long-term safety and efficacy of alogliptin, a DPP-4 inhibitor, in patients with type 2 diabetes: a 3-year prospective, controlled, observational study (J-BRAND Registry)

Introduction Given an increasing use of dipeptidyl peptidase-4 (DPP-4) inhibitors to treat patients with type 2 diabetes mellitus in the real-world setting, we conducted a prospective observational study (Japan-based Clinical Research Network for Diabetes Registry: J-BRAND Registry) to elucidate the safety and efficacy profile of long-term usage of alogliptin.Research design and methods We registered 5969 patients from April 2012 through September 2014, who started receiving alogliptin (group A) or other classes of oral hypoglycemic agents (OHAs; group B), and were followed for 3 years at 239 sites nationwide. Safety was the primary outcome. Symptomatic hypoglycemia, pancreatitis, skin disorders of non-extrinsic origin, severe infections, and cancer were collected as major adverse events (AEs). Efficacy assessment was the secondary outcome and included changes in hemoglobin A1c (HbA1c), fasting blood glucose, fasting insulin and urinary albumin.Results Of the registered, 5150 (group A: 3395 and group B: 1755) and 5096 (3358 and 1738) were included for safety and efficacy analysis, respectively. Group A patients mostly (>90%) continued to use alogliptin. In group B, biguanides were the primary agents, while DPP-4 inhibitors were added in up to ~36% of patients. The overall incidence of AEs was similar between the two groups (42.7% vs 42.2%). Kaplan-Meier analysis revealed the incidence of cancer was significantly higher in group A than in group B (7.4% vs 4.8%, p=0.040), while no significant incidence difference was observed in the individual cancer. Multivariate Cox regression analysis revealed that the imbalanced patient distribution (more elderly patients in group A than in group B), but not alogliptin usage per se, contributed to cancer development. The incidence of other major AE categories was with no between-group difference. Between-group difference was not detected, either, in the incidence of microvascular and macrovascular complications. HbA1c and fasting glucose decreased significantly at the 0.5-year visit and nearly plateaued thereafter in both groups.Conclusions Alogliptin as a representative of DPP-4 inhibitors was safe and durably efficacious when used alone or with other OHAs for patients with type 2 diabetes in the real world setting