Communication with Families in the Last Days of a Patient’s Life and Optimal Delivery of a Death Pronouncement

Communicating with family members is critically important when a severely ill patient is experiencing their last few days of life. However, healthcare professionals (HCPs) have limited opportunities to learn effective and respectful ways to perform this communication. In recent decades, significant effort has been put forth to identify the phenomena that indicate the last hours and days of life and the optimal methods to deliver a death pronouncement, which will potentially help HCPs communicate compassionately with family members throughout the dying process. In this chapter, we will review the literature regarding the phenomena that indicate the last hours and days of life and the death pronouncement. Furthermore, we will discuss clinical implications derived from those articles and future research perspectives

Dose T2-weighted short TI inversion recovery images on cardiac magnetic resonance reflect disease activity in cardiac involvement of sarcoidosis patients?

The 76th Annual Scientific Meeting of the Japanese Circulation Society 2012年03月18日 Fukuok

Can late gadolinium enhancement on cardiovascular magnetic resonance describe cardiac involvement in patients with systemic sarcoidosis and/or suspect of cardiac involvement of sarcoidosis with cardiac symptoms?

2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 201

Comprehensive behavioral phenotyping of calpastatin-knockout mice

<p>Abstract</p> <p>Background</p> <p>Calpastatin is an endogenous inhibitor of calpain, intracellular calcium-activated protease. It has been suggested to be involved in molecular mechanisms of long-term plasticity and excitotoxic pathways. However, functions of calpastatin in vivo are still largely unknown. To examine the physiological roles of calpastatin, we subjected calpastatin-knockout mice to a comprehensive behavioral test battery.</p> <p>Results</p> <p>Calpastatin-knockout mice showed decreased locomotor activity under stressful environments, and decreased acoustic startle response, but we observed no significant change in hippocampus-dependent memory function.</p> <p>Conclusion</p> <p>These results suggest that calpastatin is likely to be more closely associated with affective rather than cognitive aspects of brain function.</p

Value of late gadolinium enhancement by magnetic resonance in patients with cardiac sarcoidosis: characteristic findings and clinical utility

73rd Annual Scientific Meeting of the Japanese Circulation Society 2009年03月 Osak

Value of late gadolinium enhancement by magnetic resonance in patients with cardiac sarcoidosis: characteristic findings and clinical utility

73rd Annual Scientific Meeting of the Japanese Circulation Society 2009年03月 Osak

浜松市内における教員の作業療法の認知度と必要性に関する調査

実践報告Practical reports　本研究の目的は，浜松市内の教育現場における作業療法の認知度，教員が児童・生徒において困っていること，作業療法の必要性などを調査することである．調査方法は，浜松市内の公立小・中学校，特別支援学校に勤務している教員242 名に対し，アンケート調査を実施した．結果は，小・中学校，特別支援学校において半数以上の教員が作業療法を知っていた．また半数以上教員が気になる児童・生徒がいると回答し，行動面，学習面，対人関係，自立活動面において，困り感を感じていた．しかし，作業療法の必要性については，小・中学校では，「どちらともいえない」や未回答の回答が半数以上を占めていた．OT が学校に介入するためには，外部専門家としての知識や実践を学び，県士会等の組織的に学校教育現場に関わることが必要である．　This study examines the need for Occupational Therapy (OT) awareness and skills, and the real-life needs of Hamamatsu-based educators who face OT challenges with their students. 242 public elementary, junior high school, and special education teachers completed a questionnaire. More than half of the surveyed teachers had a basic understanding of Occupational Therapy. Additionally, more than half the surveyed teachers said they had students with OT needs. Many teachers face difficulties with student behavior, learning challenges, communications, and student independence. In contrast, nearly half of the surveyed teachers also answered that they did not perceive there to be any pressing need for OT services or OT professional help for their students. The study finds that it is necessary for OT professionals and the OT Association to be more proactive in understanding the needs for local school and students. To accomplish this, it is necessary for the local OT Association to be systematically involved in local schools

Rapid Nucleotide Exchange Renders Asp-11 Mutant Actins Resistant to Depolymerizing Activity of Cofilin, Leading to Dominant Toxicity in Vivo

Conserved Asp-11 of actin is a part of the nucleotide binding pocket, and its mutation to Gln is dominant lethal in yeast, whereas the mutation to Asn in human alpha-actin dominantly causes congenital myopathy. To elucidate the molecular mechanism of those dominant negative effects, we prepared Dictyostelium versions of D11N and D11Q mutant actins and characterized them in vitro. D11N and D11Q actins underwent salt-dependent reversible polymerization, although the resultant polymerization products contained small anomalous structures in addition to filaments of normal appearance. Both monomeric and polymeric D11Q actin released bound nucleotides more rapidly than the wild type, and intriguingly, both monomeric and polymeric D11Q actins hardly bound cofilin. The deficiency in cofilin binding can be explained by rapid exchange of bound nucleotide with ATP in solution, because cofilin does not bind ATP-bound actin. Copolymers of D11Q and wild type actins bound cofilin, but cofilin-induced depolymerization of the copolymers was slower than that of wild type filaments, which may presumably be the primary reason why this mutant actin is dominantly toxic in vivo. Purified D11N actin was unstable, which made its quantitative biochemical characterization difficult. However, monomeric D11N actin released nucleotides even faster than D11Q, and we speculate that D11N actin also exerts its toxic effects in vivo through a defective interaction with cofilin. We have recently found that two other dominant negative actin mutants are also defective in cofilin binding, and we propose that the defective cofilin binder is a major class of dominant negative actin mutants

MEDICAL TREATMENT OF UNRUPTURED CEREBRAL ANEURYSMS

Background: Currently there are no pharmacological therapies for patients with unruptured cerebral aneurysms. Elsewhere we showed that the mineralocorticoid receptor antagonist eplerenone prevented the formation of cerebral aneurysms in our ovariectomized hypertensive aneurysm rat model. The current pilot study evaluated whether it can be used to prevent the growth and rupture of cerebral aneurysms in hypertensive patients. Methods: Between August 2011 and May 2014, we enrolled 82 patients with 90 aneurysms in an open-label uncontrolled clinical trial. All provided prior informed consent for inclusion in this study, and all were treated with eplerenone (25-100 mg/d). The primary end points of our study were the rupture and enlargement of the cerebral aneurysms. Results: Of the 82 patients, 80 (88 unruptured aneurysms) were followed for a mean of 21.3 months (153.4 aneurysm-years); 12 patients (15.0%) permanently discontinued taking the drug. One month after the start of eplerenone administration and throughout the follow-up period, eplerenone kept the blood pressure within the normal range. Most notably, no aneurysms smaller than 9 mm ruptured or enlarged. However, of 2 large thrombosed aneurysms, 1 enlarged and the other ruptured. The overall annual rupture rate was .65%; it was 13.16% for aneurysms larger than 10 mm; the overall annual rate for reaching the primary end points was 1.30%. Conclusion: Our observations suggest that eplerenone may help to prevent the growth and rupture of unruptured cerebral aneurysms smaller than 9 mm. To assess its potential long-term clinical benefits, large clinical trials are needed