Nurses' Practical Wisdom for the Support of Dementia Patients Among Hospital Outpatients

Purpose: To establish and understand nurses' practical wisdom and interventions of support for dementia and possible dementia patients at hospital outpatient wards. Methods: A qualitative design was used to collect data through semi-structured focus group interviews. The participants were 13 female nurses working at hospital outpatient wards.Data were analyzed using the KJ Method. Results: Seven themes symbolizing the properties of the final label were extracted as follows:‘Observation of patients with focused awareness, and are continuously engaged with their patients',‘Approach to the problems of the patients, and sensitively work to understand the worries of patients based on past cases of problems',‘Looking out for simple ways patients can look after themselves, implicitly and thoroughly, making the best use of the ways that patients are familiar with and which they are able to understand',‘Preparations for scheduled consultations by developing a network to assist with problem prevention and recording episodes about problems involving the patients',‘Requests for cooperation to continue treatment by choosing intermediaries/resources appropriately as based on the importance of the medical treatment',‘Responses that do not conflict with the feelings of the family by considering the possible reluctance of accepting that a family member has dementia', and‘Attitude not to blame matters on dementia by reflecting on how the environment and care ought to be'.’ Conclusion:Nurses' practical wisdom is a type of support provided for patients in a natural manner without being noticed as special or particular by the patients

Low Dose Cytosine Arabinoside Regimen for Overt Leukemia, Hypoplastic Leukemia and Myelodysplastic Syndromes : Hypoplastic Leukemia Responds Best.

In a series of 38 patients consisting of 13 with overt acute leukemia, 14 with hypoplastic leukemia, and 11 with myelodysplastic asyndromes (MDS), responsiveness to low dose cytosine arabinoside (LDAC) regimen was investigated to clarify the disease type most benefitted. LDAC was continuously administered intravenously at dose 0.2mg/kg/day and continued as long as possible to meet the pre-assigned target point of 5% marrow blasts which was confirmed by weekly marrow aspiration. Overall response rate was 47%; complete remission (CR) being 31% and partial remission (PR) 16%. CR rate was significantly different between the disease types ; 69% in hypoplastic leukemia, 23% in overt leukemia and 0% in MDS (p=0.01). In hypoplastic leukemia the survival time was significantly longer in the LDAC-treated cases compared with 15 historical control cases treated with supportive care only ; median survial being 750 days in the former and 250 days in the latter (p=0.01). In overt leukemia only three M2 AML cases obtained CR ; two of them were treated during hypoplastic phase induced by intensive chemotherapy. All CR cases eventually achieved the target point after 20 to 42 days (median 26) of LDAC administration. Substantial toxicity of LDAC was evident, but most cases tolerated well. The present investigation suggests that hypoplastic leukemia is the disease type most sensitive to LDAC regimen. Stratification of the elderly leukemia patients should be considered for this regimen

Infrequent RAS mutation is not associated with specific histological phenotype in gliomas

BACKGROUND: Mutations in driver genes such as IDH and BRAF have been identified in gliomas. Meanwhile, dysregulations in the p53, RB1, and MAPK and/or PI3K pathways are involved in the molecular pathogenesis of glioblastoma. RAS family genes activate MAPK through activation of RAF and PI3K to promote cell proliferation. RAS mutations are a well-known driver of mutation in many types of cancers, but knowledge of their significance for glioma is insufficient. The purpose of this study was to reveal the frequency and the clinical phenotype of RAS mutant in gliomas. METHODS: This study analysed RAS mutations and their clinical significance in 242 gliomas that were stored as unfixed or cryopreserved specimens removed at Kyoto University and Osaka National Hospital between May 2006 and October 2017. The hot spots mutation of IDH1/2, H3F3A, HIST1H3B, and TERT promoter and exon 2 and exon 3 of KRAS, HRAS, and NRAS were analysed with Sanger sequencing method, and 1p/19q codeletion was analysed with multiplex ligation-dependent probe amplification. DNA methylation array was performed in some RAS mutant tumours to improve accuracy of diagnosis. RESULTS: RAS mutations were identified in four gliomas with three KRAS mutations and one NRAS mutation in one anaplastic oligodendroglioma, two anaplastic astrocytomas (IDH wild-type in each), and one ganglioglioma. RAS-mutant gliomas were identified with various types of glioma histology. CONCLUSION: RAS mutation appears infrequent, and it is not associated with any specific histological phenotype of glioma

Generation of Induced Pluripotent Stem Cells and Neural Stem/Progenitor Cells from Newborns with Spina Bifida Aperta

Study DesignWe established induced pluripotent stem cells (iPSCs) and neural stem/progenitor cells (NSPCs) from three newborns with spina bifida aperta (SBa) using clinically practical methods.PurposeWe aimed to develop stem cell lines derived from newborns with SBa for future therapeutic use.Overview of LiteratureSBa is a common congenital spinal cord abnormality that causes defects in neurological and urological functions. Stem cell transplantation therapies are predicted to provide beneficial effects for patients with SBa. However, the availability of appropriate cell sources is inadequate for clinical use because of their limited accessibility and expandability, as well as ethical issues.MethodsFibroblast cultures were established from small fragments of skin obtained from newborns with SBa during SBa repair surgery. The cultured cells were transfected with episomal plasmid vectors encoding reprogramming factors necessary for generating iPSCs. These cells were then differentiated into NSPCs by chemical compound treatment, and NSPCs were expanded using neurosphere technology.ResultsWe successfully generated iPSC lines from the neonatal dermal fibroblasts of three newborns with SBa. We confirmed that these lines exhibited the characteristics of human pluripotent stem cells. We successfully generated NSPCs from all SBa newborn-derived iPSCs with a combination of neural induction and neurosphere technology.ConclusionsWe successfully generated iPSCs and iPSC-NSPCs from surgical samples obtained from newborns with SBa with the goal of future clinical use in patients with SBa

Early effect of oral administration of omeprazole with mosapride as compared with those of omeprazole alone on the intragastric pH

<p>Abstract</p> <p>Background</p> <p>The ideal medication for acid-related diseases should have a rapid onset of action to promote hemostasis and cause efficient resolution of symptoms. The aim of our study was to comparatively investigate the inhibitory effect on gastric acid secretion of a single oral administration of omeprazole plus mosapride with that of omeprazole alone.</p> <p>Methods</p> <p>Ten Helicobacter pylori-negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 6 hours after a single oral administration of omeprazole 20 mg or that of omeprazole 20 mg plus mosapride 5 mg (the omeprazole being administered one hour after the mosapride). Each administration was separated by a 7-days washout period.</p> <p>Results</p> <p>The average pH during the 6-hour period after administration of omeprazole 20 mg plus mosapride 5 mg was higher than that after administration of omeprazole 20 mg alone (median: 3.22 versus 4.21, respectively; <it>p </it>= 0.0247).</p> <p>Conclusions</p> <p>In H. pylori -negative healthy male subjects, an oral dose of omeprazole 20 mg plus mosapride 5 mg increased the intragastric pH more rapidly than omeprazole 20 mg alone.</p