精神障害者の就労と地域生活が回復に及ぼす要因 : 有限会社を運営する当事者に焦点をあてて

The current trend in the mental health care system in Japan is to enable patients to live in the community. This research interview study included 11 employees at Company A who were diagnosed with a mental illness and examined the factors affecting their ability to return to work and community activities. Data in 4 categories were analyzed: challenges of community life (ability to cope with difficulties), independence in daily activities, new discovery of self (loss of a special existence), and living with prejudice and obstacles. Learning to overcome the challenges faced in society (ordinary difficulties) and encountering a variety of people helped to foster independent living skills. Patients also regained confidence in themselves and others and spoke of a promising future. A system focusing on a "return to independence" is essential to help mentally ill persons reintegrate into the community. Therefore, this issue must be addressed in the future

精神障害者の就労を支援する援助者の視点と役割に関する一考察 : 当事者が自主運営する有限会社「萌」の援助者の語りを通して

Studies have found links between work and the recovery of people with mental disabilities, and support is expected in terms of proposals and practices for various forms of work. `Moe\u27, a limited company independently managed by people with mental disabilities, operates in a commercial district by carrying out work that is rooted in the community. To clarify the perspectives and roles of supporters regarding Moe\u27s proposals and practices, interviews were conducted with the staff of Moe and they were analysed using a revised grounded theory approach. The following results were obtained: (1) a mutual understanding of value consciousness, (2) reflection on the existing support system, (3) efforts to encourage the understanding of those involved, (4) construction of new roles, (5) calm judgement and a positive attitude, (6) escort for independent activities, (7) attainment of joy and a sense of fulfilment. These findings clarified that supporters at Moe had examined their own way of providing aid to the people with mental disabilities by interacting with them and the environment, and were able to eschew the welfare standpoint of those concerned, rethink ways of intervening on behalf of such individuals, and assume a steering role in proposals, practices and activities related to independent forms of work for those concerned

地域におけるアルコール依存症の治療や支援の実態及び課題 アルコール依存症に関わる専門職の語りからその対策を考える

We attempted to clarify the current treatment and support for alcoholism and related issues incommunities to examine how to create a society in which alcoholics can live comfortably. We found thatalcoholics struggled with strong denial, mistaken responses from their families, delayed counseling andmedical consultations, difficulty continuing to participate in self-help groups, various prejudices, a lack ofspecialist hospitals and staff, and difficulty sharing information. Measures to address these issues includedimproving the legal system, acknowledging the need for a budget, activities to raise awareness amongcommunity residents, building mechanisms to connect people, providing school education, establishingintermediate facilities, and improving team work in communities. In addition, we found that engaging intreatment and support for alcoholism allowed the supporters to experience personal growth. Thesefindings suggest that continued efforts by entire communities to address alcoholism allow people to findhope such that people will continue to nurture their strengths and entire communities will continue togrow

Circadian production of melatonin in cartilage modifies rhythmic gene expression

Endochondral ossification, including bone growth and other metabolic events, is regulated by circadian rhythms. Herein, we provide evidence that melatonin has a direct effect on the circadian rhythm of chondrocytes. We detected mRNA expression of the genes which encode the melatonin-synthesizing enzymes AANAT (arylalkylamine N-acetyltransferase) and HIOMT (hydroxyindole O-methyltransferase), as well as the melatonin receptors MT1 and MT2 in mouse primary chondrocytes and cartilage. Production of melatonin was confirmed by mass spectrometric analysis of primary rat and chick chondrocytes. Addition of melatonin to primary mouse chondrocytes caused enhanced cell growth and increased expression of Col2a1, Aggrecan, and Sox9, but inhibited Col10a1 expression in primary BALB/c mouse chondrocytes. Addition of luzindole, an MT1 and MT2 antagonist, abolished these effects. These data indicate that chondrocytes produce melatonin, which regulates cartilage growth and maturation via the MT1 and MT2 receptors. Kinetic analysis showed that melatonin caused rapid upregulation of Aanat, Mt1, Mt2, and Pthrp expression, followed by Sox9 and Ihh. Furthermore, expression of the clock gene Bmal1 was induced, while that of Per1 was downregulated. Chronobiological analysis of synchronized C3H mouse chondrocytes revealed that melatonin induced the cyclic expression of Aanat and modified the cyclic rhythm of Bmal1, Mt1, and Mt2. In contrast, Mt1 and Mt2 showed different rhythms from Bmal1 and Aanat, indicating the existence of different regulatory genes. Our results indicate that exogenous and endogenous melatonin work in synergy in chondrocytes to adjust rhythmic expression to the central suprachiasmatic nucleus clock

アルコール専門病院における治療プログラムの実際 : 依存症者の回復力向上を目指す支援に焦点をあてて

In this study we investigated treatment programs at hospitals specializing alcoholism therapy and verified the relationships between these programs and improvements in alcoholics\u27 resilience. First, using previous studies on alcoholism and resilience, we investigated the considerations of recovery from alcoholism on the basis of the concept of resilience. The actual conditions of hospitals specializing in alcoholism therapy were then investigated to determine the effects of these programs on alcoholics\u27 resilience. These results revealed that the main treatment programs of these hospitals had the following objectives: (1) knowledge of one\u27s true self; (2) increased understanding of alcoholism and the development of coping skills; (3) establishment of interpersonal relationships; and (4) contemplationabout way of life in the future (continuing recovery). These four objectives overlapped with the components of resilience, which indicated the ability of alcoholics to overcome their illness and return to a healthy status. These findings indicate that the treatment programs at hospitals specializing in alcoholism therapy provide support that promotes these patients\u27 resilience

Recombinant human thrombomodulin inhibits neutrophil extracellular trap formation in vitro

The aim of this study was to investigate the effects of recombinant human-soluble thrombomodulin (rTM) on lipopolysaccharide (LPS)-induced, platelet-dependent neutrophil extracellular trap (NET) formation (NETosis). Human peripheral blood neutrophils and platelets were co-incubated with or without LPS (0.2 μg/ml) in the presence and absence of rTM (2 μg/ml). NETosis was confirmed by immunostaining and confocal microscopy. In the absence of platelets, LPS did not induce NETosis in the neutrophils. NETosis, however, was induced by LPS when neutrophils were co-cultured with platelets (64 % of neutrophils). Notably, rTM was able to fully inhibit NETosis in neutrophils cultured with platelets and in the presence of LPS. rTM did not induce NETosis in this co-culture system (p < 0.01 versus LPS in the absence of rTM). These results show that rTM can suppress LPS-induced platelet-dependent NETosis in vitro

A case of double inferior vena cava with a literature review and proposal for new classification

Summary We encountered a case of double inferior vena cava (DIVC) in a 76 year old male cadaver during anatomy practice at Matsumoto Dental University in 2015. The left and right internal iliac veins drained into the interiliac vein ran horizontal in front of the cape angle and joined the left and right external iliac veins. Then the inferior vena cava on each side originated.The width of the origin of the inferior vena cava were 13.7 mm and 11.6 mm on the right and left side, respectively. Based on the previous DIVCʼs classifications, we attempted to classify the DIVC and iliac venous system by combining the direction of the internal iliac veins (lateral (l), vertical (s), and medial (m)), the inclination of the interiliac veins (lower left to upper right (L to R), horizontal (H), and lower right to upper left (R to L)),and the width of the right and left IVC (RIVC>LIVC, RIVC=LIVC, and RIVCLIVC, H, l-l. In this case, hemi-azygos vein was not found, and the height of the left kidney was lower than the right one. We therefore investigated the co-existence of the venous system and the height of the kidney to the 53 cases and referred to the embryological relationship between them. The present classification provides basic knowledge for the clinical anatomy and surgery of the pelvic region

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room

Abstract Background The prognosis of conservative treatment for fragility fracture of the pelvis (FFP) in the older patients remains poor. Percutaneous pelvic screw placement (PPSP), which aids in the treatment of FFP, can be challenging to perform using fluoroscopy alone because of the proximity of blood vessels and neuroforamina. Hence, this study aimed to investigate the accuracy and clinical outcomes of PPSP using real-time 3D fluoroscopic navigation for FFP in the hybrid operating room. Methods This study included 41 patients with FFP who underwent PPSP in a hybrid operating room between April 2016 and December 2020. Intraoperative C-arm cone-beam CT was performed under general anesthesia. Guidewire trajectory was planned using a needle guidance system. The guidewire was inserted along the overlaid trajectory using 3D fluoroscopic navigation, and a 6.5 mm cannulated cancellous screw (CCS) was placed. The clinical outcomes and accuracy of the screw placement were then investigated. Results A total of 121 screws were placed. The mean operative time was 84 ± 38.7 minutes, and the mean blood loss was 7.6 ± 3.8 g. The mean time to wheelchair transfer was 2 days postoperatively. Pain was relieved in 35 patients. Gait ability from preoperative and latest follow-up after surgery was maintained in 30 (73%) patients. All 41 patients achieved bone union. Of the 121 screws, 119 were grade 0 with no misplacement; only 2 patients had grade 1 perforations. Conclusion PPSP using real-time 3D fluoroscopic navigation in a hybrid operating room was accurate and useful for early mobilization and pain relief among older patients with FFP with an already-installed needle biopsy application

Left toe grip strength and lumbar spine/ankle joint disease are associated with falls among frail older women

Background: Although toe grip strength has been closely associated with physical performance, the association between toe grip strength and history of falls in older adults remains unclear. The purpose of our study was to investigate the associations between physical function testing, including toe grip strength and falls in the previous 12 months, in community-dwelling frail older women. Methods: Forty-eight participants aged ≥65 years who were screened by a frailty checklist were included. We compared the faller group (n=18) and non-faller group (n=30) in terms of physical function including toe grip strength, hand grip strength, five-repetition sit-to-stand test, one-leg standing duration with vision, 5-meter walk test, and timed up-and-go test, as well as history of orthopedic disease. Results: Participants in the faller group had significantly weaker left toe grip strength than those in the non-faller group (p=0.009), whereas the other physical measurements were not found to be significantly different. Regarding orthopedic disease, the faller group had a significantly higher prevalence of lumbar spine and ankle joint disease compared with the nonfaller group (p=0.025 and p=0.001, respectively). Conclusions: Left toe grip strength and lumbar spine/ankle joint disease may be the most important physical function factors for predicting falls in frail older women