A県における未受診妊婦支援の施策に関する基礎調査(2) : 背景要因について

【目的】A県において妊婦健康診査を未受診のまま分娩に至る妊婦の実態を把握し、その課題と対策を明らかにするために「出産後に妊娠届けを出した妊婦の現状及び未受診妊婦対策に関する調査」および「飛び込み分娩の状況及び未受診妊婦対策に関する調査」で収集したデータを繰り返しの有無、年代、地域等で詳細に検討し関連する要因を明確にしていく。【方法】A県内40市町村ならびに分娩を扱っている37の出産施設に対して調査を依頼した。調査期間は平成20年12月～平成21年1 月。医療機関は郵送、市町村は保健師の家庭訪問記録等。回収率は医療機関が3.8％、市町村が100％。【結果】飛び込み出産の理由は、経済的理由（分娩費用の全額支払いが5割）、相手との関係破綻、妊娠受容できず、受診時間確保できず、が主なものであり、繰り返す者は加えて保健管理の必要性を理解していない、であった。さらに初めて群では早産に異常分娩が多く、正期産には2500g以上の出生時が多かった。全体の12%を占める10歳代に関しては未受診が多く、同居者は家族であり、養育者も母や祖母であった。支援・相談者なし・不明が約8割となっており、孤立している様が伺え、妊娠への適切な対処が難しいことが分かる。【まとめ】必要な支援としては経済的サポート、医療的サポートさらには関連機関での情報の共有が求められるだろう。さらに10歳代への支援としては性教育のみならず、パートナーとの関係や家族を持つことの社会的な意味に関しての教育が求められる

Amphiphilic peptide-tagged N-cadherin forms radial glial-like fibers that enhance neuronal migration in injured brain and promote sensorimotor recovery

The mammalian brain has very limited ability to regenerate lost neurons and recover function after injury. Promoting the migration of young neurons (neuroblasts) derived from endogenous neural stem cells using biomaterials is a new and promising approach to aid recovery of the brain after injury. However, the delivery of sufficient neuroblasts to distant injured sites is a major challenge because of the limited number of scaffold cells that are available to guide neuroblast migration. To address this issue, we have developed an amphiphilic peptide [(RADA)3-(RADG)] (mRADA)-tagged N-cadherin extracellular domain (Ncad-mRADA), which can remain in mRADA hydrogels and be injected into deep brain tissue to facilitate neuroblast migration. Migrating neuroblasts directly contacted the fiber-like Ncad-mRADA hydrogel and efficiently migrated toward an injured site in the striatum, a deep brain area. Furthermore, application of Ncad-mRADA to neonatal cortical brain injury efficiently promoted neuronal regeneration and functional recovery. These results demonstrate that self- assembling Ncad-mRADA peptides mimic both the function and structure of endogenous scaffold cells and provide a novel strategy for regenerative therapy

Closure by iptakalim, a cardiovascular KATP channel opener, of rat pancreatic β-cell KATP channels and its molecular basis

Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes patients usually have accompanying cardiovascular disorders. Sulfonylureas have been the leading oral antihyperglycemic agents for type 2 diabetes treatment, which currently still constitute the most popular anti-diabetic drugs. Nevertheless, concern has arisen over the side eff ects of sulfonylureas on the cardiovascular system. Here we report that iptakalim, a novel cardiovascular ATP-sensitive potassium（ KATP） channel opener, closed rat pancreatic β-cell KATP channels and increased insulin release. Using whole-cell patch-clamp recordings, iptakalim depolarized β-cells, induced action potential fi ring and reduced pancreatic KATP channel currents. Using single-channel recordings, iptakalim reduced KATP channel open-probability independently of intracellular ATP concentrations. We demonstrated that iptakalim elevated intracellular Ca2+ concentrations and increased insulin release as revealed by fl uorescence imaging（ fura-2） and biochemical measurements, respectively. In addition, iptakalim signifi cantly inhibited the open-probability of recombinant Kir6.2/SUR1 and Kir6.2FL4A（ a traffi cking mutant of the Kir6.2） channels expressed in transfected human embryonic kidney （HEK） 293 cells. Collectively, iptakalim, a cardiovascular KATP channel opener, closes rat pancreatic β-cell KATP channels, which may result from direct inhibition of the Kir6.2 subunit. Therefore, iptakalim bi-directionally regulates KATP channels in cardiovascular and pancreatic tissues, and this unique pharmacological property suggests iptakalim could be used as a new therapeutic strategy for the treatment of type 2 diabetes with the potential benefi t in alleviating cardiac and/or vascular disorders frequently associated with diabetes

Efficacy of polymethylmethacrylate membrane hemodiafilter Filtryzer® PMF™-21A in improving pruritus in hemodialysis patients: a prospective interventional study

Abstract Background Hemodialysis-associated pruritus (HAP) occurs in 60–80% of hemodialysis patients. This significant complication not only decreases quality of life through sleep disturbance and depression, but also leads to poor survival outcomes. The polymethylmethacrylate (PMMA) membrane was the first synthetic polymer membrane for the hollow-fiber artificial kidney created in 1977. PMMA membrane dialyzers have been reported to be effective for improving various complaints, including pruritus, and nutritional status. In Japan, a PMMA membrane hemodiafilter Filtryzer® PMF™-A (PMF-A) was launched in November 2021 and subsequently became available for online hemodiafiltration (OHDF). This study aimed to determine whether PMF-A effectively improves pruritus in hemodialysis patients. Methods Participants were 20 patients (median age 74.5 years) on predilution OHDF (pre-OHDF) or postdilution OHDF (post-OHDF) using an Asymmetric Triacetate Membrane® hemodiafilter (FIX-210E eco or FIX-210S eco), who were experiencing pruritus of “very mild” or higher severity based on the Shiratori severity score either during the daytime or nighttime. After switching to post-OHDF with PMF-21A (substitution flow rate: 10 L/session), the substitution flow rate was gradually increased according to results of pruritus evaluation every 2 weeks over 3 months. The primary endpoint was the severity of pruritus evaluated using visual analogue scale (VAS) and the Shiratori severity score. Secondary endpoints included white blood cell count (WBC), hemoglobin level (Hb), platelet count (Plt), serum albumin level (Alb), high-sensitivity C-reactive protein (hsCRP), IL-6, dry weight (DW), and solute removal performance. Results The median VAS score was significantly decreased 2 weeks after switching compared with baseline (44 mm) and remained significantly decreased at Week 12 (22 mm; p < 0.01). From baseline to Week 12, 16 patients (80%) showed improvement in VAS score. The percentage of patients with mild to moderate daytime pruritus according to the Shiratori severity score decreased significantly from 80.0% to 45.0% (p < 0.05), whereas no significant change was observed for nighttime pruritus (p = 0.267). Pre-dialysis serum β2-MG levels were significantly higher at Week 12 compared with baseline. No significant changes were observed in WBC, Hb, Plt, serum Alb, hsCRP, IL-6, or DW. Conclusions OHDF with PMF-21A may be more effective in improving HAP