Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Provision of social support and rehabilitation for patients with physical, mental, and functional problems after cancer treatment is important for long-term health-related quality of life (HRQOL). Effective use of human and financial healthcare resources requires identification of patients requiring rehabilitation. The objectives of the current study were to clarify the patterns of physical and psychosocial recovery over time, to evaluate the associations among baseline variables, treatment-related factors and HRQOL at 6 months, 1, and 2 years after breast cancer surgery, and to identify the significant factors predicting HRQOL at each point. A multicenter longitudinal study was performed to evaluate physical conditions, anxiety, depression, and HRQOL at 1 month (baseline), 6 months, 1, and 2 years after surgery in 196 patients (mean age: 53.3 years old) with early breast cancer and no postoperative recurrence. Physical conditions were evaluated using a patient-reported symptom checklist. HRQOL was rated using the functional assessment of cancer treatment scalegeneral (FACT-G) and the breast cancer subscale (FACTB). Anxiety and depression were rated using the hospital anxiety and depression scale (HADS). More than 50% of patients had local problems of "tightness", "arm weakness." and "arm lymphedema", and systemic problems of "reduced energy, fatigue, and general weakness" postoperatively. The HRQOL score significantly improved 1 year after surgery, and scores for physical, emotional and functional well-being also increased with time, whereas the score for social well-being was the highest at baseline and decreased with time. Depression and anxiety significantly improved with time. Concomitant disease, marital status, and the presence of a partner, anxiety and depression at baseline, pathological lymph node involvement, and adjuvant intravenous chemotherapy were significant factors predicting FACT-G scores at 6 months, 1, and 2 years after surgery. Depression at baseline was a strong predictor of HRQOL up to 2 years after surgery. These results suggest that physical rehabilitation is required for tightness and lymphedema to improve long-term postoperative physical function. A further study of psychosocial interventions is required to improve depression and social well-being after breast cancer surgery

Effect of TU-100 in NASH

Background : Non-alcoholic steatohepatitis (NASH) is associated with a higher risk of hepatocellular carcinoma (HCC), and the importance of the gut–liver axis has been recognized in NASH-associated HCC. We investigated the effect of TU-100 on the intestinal microbiome and hepatocarcinogenesis in a NASH model. Methods : Seven-week-old Tsumura Suzuki obese diabetes mice, a model that shows the spontaneous onset of NASH and HCC, were used. They were divided into a TU-100 treated group and a control group. Mice were sacrificed at 24 and 48 weeks to evaluate hepatic steatosis, fibrosis, carcinogenesis, cytokine expression, and microbiome abundance. Results : At 24 weeks, the TU-100 group showed significantly lower expression of IL6, IL1B, and ACTA2 mRNA in the liver (P < 0.05). At 48 weeks, the TU-100 group showed significantly lower levels of serum alanine aminotransferase. The TU-100 group also showed a lower rate of NASH than the control group (28% vs 72% ; P = 0.1). Tumor diameter was significantly smaller in the TU-100 group compared with that in the control group (P < 0.05). Regarding the intestinal microbiome, the genera Blautia and Ruminococcus were increased in the TU-100 group (P < 0.05), whereas Dorea and Erysipelotrichaceae were decreased in the TU-100 group (P < 0.05). Conclusions : TU-100 regulates the intestinal microbiome and may suppress subsequent hepatocarcinogenesis in the NASH model

Delayed emesis: moderately emetogenic chemotherapy (single-day chemotherapy regimens only)

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A県内の高齢者向け住まいのサービス提供体制と医療的ケア及び看取りの受け入れ意向との関連

目的：A県の高齢者向け住まいのサービス提供体制と医療的ケア及び看取りの受け入れ意向との関連を明らかにする． 方法：A県の高齢者向け住まい（463か所）に勤務する管理者等を対象とし，入居者の状況，サービス提供体制等の自記式質問紙調査を実施した．サービス提供体制と医療的ケア及び看取りの受け入れ意向の有無との関連について，χ2検定又はFisherの直接確率検定を行った． 結果：有効回答は130施設（有効回答率28.1％）であった．医療的ケアの受け入れ意向では，「施設に看護師が常駐」「夜間ケアを提供する職員の配置」等の11項目，看取りの受け入れ意向では，「施設に常勤の介護職員」「施設に常勤の看護師」「協力医療機関の24時間緊急往診要請への対応」「看取りのマニュアルの整備」等の14項目に関連があった． 結論：高齢者向け住まいにおける医療的ケア及び看取りの受け入れには，看護職員・介護職員の配置及び医療機関等との連携の必要性が示唆された．Objectives: To clarify the relationship between the service provision system of housing for the elderly in A prefecture and the intention to accept medical care and end-of-life care. Method: A self-administered questionnaire survey was conducted on residents’ status and components of the service provision system for managers working in residences for senior citizens in A Prefecture (463 facilities). The χ2 test or Fisher’s exact test was performed on the relationship between the service provision system and the intention to accept medical care and end-of-life care. Results: 130 valid responses were returned (effective response rate 28.1%). For the intention to accept medical care, 11 items were extracted, including “nurse resident in facility” and “allocation of staff providing night care”. For the intention to accept end-of-life care, 14 items were extracted, including“ full-time caregiver at facility”,“ full-time nurse at facility”,“ responding to 24-hour emergency visit requests with cooperating medical institutions” and“ maintenance manual”. Conclusion: It was suggested that the placement of nursing staff and cooperation with medical institutions are necessary for the acceptance of medical care and end-of-life care for the elderly.報

地域包括ケアシステムにおける訪問看護ステーションの経営状況と事業所特性及び地域特性，経営管理との関連―全国と群馬県の比較―

目的：全国及び群馬県の訪問看護ステーション（以下，ST）の経営状況と事業所特性及び地域特性，経営管理との関連を明らかにし，比較検討する． 方法：全国2,000人及び群馬県163人のST管理者を対象とし，自記式質問紙調査を実施した．有効回答は全国473人，群馬県55人で，経営状況と各項目との関連はχ2検定及びKruskal-Wallis検定を，さらに経営状況を目的変数とするロジスティック回帰分析を行った． 結果：全国では，看護師常勤・看護師非常勤・事務職員非常勤の従業者数，1人1日平均訪問回数，北海道・東北地域，収支のモニタリングが黒字に関連していた．群馬県では関連がみられず，全国に比して赤字のST割合が多く，経営管理の得点が低かった． 結論：経営状況の改善には，ST規模の拡大やST管理者の収支のモニタリングに焦点を当てた行動の有効性が示唆された．群馬県では，経営管理に関する分析の強化が必要である．Objectives: The financial status of home-visit nursing stations (STs) was analyzed in relation to business office characteristics, local community characteristics and business management, and the results between Gunma Prefecture and all prefectures in Japan were compared. Methods: A self-administered questionnaire survey was completed by 163 ST managers in Gunma Prefecture and 2000 ST managers from all over Japan. Valid responses were collected from 55 managers from Gunma Prefecture and 473 managers from all over Japan. The association between management status with each variable was analyzed by the chisquare test and Kruskal-Wallis test. In addition, logistic regression analysis was carried out with the status of management as the dependent variable. Results: For STs all prefectures in Japan, profitable business (black-ink balance) was associated with the number of employees (full-time nurses, part-time nurses and part-time clerical staff), the mean number of care receiver homes visited daily by each nurse, the district (Hokkaido/Tohoku) and revenue/expenditure balance monitoring. In Gunma Prefecture, the percentage of red-ink operation STs was higher and the score for business management was lower than in all prefectures in Japan. Conclusions: These results suggest that management actions focusing on expansion of the scale of STs and on revenue/ expenditure balance monitoring by ST managers are effective in improving the status of management. In Gunma Prefecture, reinforcement of how to analyze business management is needed.原

Diacylglycerol Kinase β Knockout Mice Exhibit Lithium-Sensitive Behavioral Abnormalities

BACKGROUND: Diacylglycerol kinase (DGK) is an enzyme that phosphorylates diacylglycerol (DG) to produce phosphatidic acid (PA). DGKβ is widely distributed in the central nervous system, such as the olfactory bulb, cerebral cortex, striatum, and hippocampus. Recent studies reported that the splice variant at the COOH-terminal of DGKβ was related to bipolar disorder, but its detailed mechanism is still unknown. METHODOLOGY/PRINCIPAL FINDINGS: In the present study, we performed behavioral tests using DGKβ knockout (KO) mice to investigate the effects of DGKβ deficits on psychomotor behavior. DGKβ KO mice exhibited some behavioral abnormalities, such as hyperactivity, reduced anxiety, and reduced depression. Additionally, hyperactivity and reduced anxiety were attenuated by the administration of the mood stabilizer, lithium, but not haloperidol, diazepam, or imipramine. Moreover, DGKβ KO mice showed impairment in Akt-glycogen synthesis kinase (GSK) 3β signaling and cortical spine formation. CONCLUSIONS/SIGNIFICANCE: These findings suggest that DGKβ KO mice exhibit lithium-sensitive behavioral abnormalities that are, at least in part, due to the impairment of Akt-GSK3β signaling and cortical spine formation