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

Clinical utility of F-18-FDG PET/CT in the follow-up of a large cohort of patients with high-risk differentiated thyroid carcinoma

Objective: To evaluate the clinical utility of F-18-FDG PET/CT in patients with high-risk DTC. Subjects and methods: Single-center retrospective study with 74 patients with high-risk differentiated thyroid cancer (DTC), classified in 4 groups. Group 1: patients with positive sTg or TgAb, subdivided in Group 1A: negative RxWBS and no foci of metastases identified at conventional image (n = 9)Group 1B: RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level (n = 13)Group 2: patients with histological findings of aggressive DTC variants (n = 21) and Group 3: patients with positive RxWBS (n = 31). Results: F-18-FDG PET/CT identified undifferentiated lesions and helped restage the disease in groups 1B and 2. The scan helped guide clinical judgment in 9/13 (69%) patients of group 1B, 10/21 (48%) patients of group 2 and 2/31 (6%) patients of group 3. There was no clinical benefit associated with group 1A. F-18-FDG PET/CT was associated with progressive disease. Conclusion: F-18-FDG PET/CT is a useful tool in the follow-up of patients with high-risk DTC, mainly in the group of RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level and in those with aggressive DTC variants. Additionally, this study showed that F-18-FDG PET/CT was associated with progression and helped display undifferentiated lesions guiding clinical assessments regarding surgeries or expectant treatments.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Ministério da Saúde (MS)Univ Fed São Paulo EPM Unifesp, Escola Paulista Med, Ctr Doencas Tireoide, São Paulo, SP, BrazilUniv Fed São Paulo EPM Unifesp, Escola Paulista Med, Lab Endocrinol Mol & Translac, Dept Med,Div Endocrinol, São Paulo, SP, BrazilHIAE, Dept Imagem, São Paulo, SP, BrazilUniv Fed São Paulo EPM Unifesp, Escola Paulista Med, Ctr Doencas Tireoide, São Paulo, SP, BrazilUniv Fed São Paulo EPM Unifesp, Escola Paulista Med, Lab Endocrinol Mol & Translac, Dept Med,Div Endocrinol, São Paulo, SP, BrazilFAPESP: 2006/60402-1MS: 25000.168513/2008-11Web of Scienc

A村の特定健康診査受診者の非肥満者を対象とした健診結果の実態及び血糖と生活習慣の関連

目的：A村の特定健康診査受診者の非肥満者を対象とした健診結果の実態及び血糖と生活習慣の関連を明らかにする． 方法：A村の平成29年度特定健康診査受診者のうち，血圧や血糖等の服薬をしていない非肥満者533人を研究対象者とした．非肥満者533人を高血糖の有無による2群に分け，生活習慣との関連を分析した． 結果：健診結果では，非肥満者は，LDLコレステロールの平均値が特定健診受診者全体よりも高かった． 生活習慣では，非肥満者において高血糖群の方が定期的な運動をしている割合及び遅い時間の夕食をとっていない割合が有意に高く，生活習慣が良好な割合が高かった． 結論：非肥満者のうち高血糖の住民は，生活習慣には留意していると考えられた．今後は，詳細な生活習慣を確認し，その結果とともに健診結果に基づく指導が重要である．Objectives: The purpose of this study was to clarify the actual conditions of specific health checkups for non-obese individuals in A Village and the relationship between blood glucose and lifestyle habits. Method: The research participants were the 533 non-obese people who were not taking medication among of the all people who received a specific health checkup in A Village in 2017. We divided the 533 participants into two groups based on the presence or absence of hyperglycemia, and the relationship between blood glucose and lifestyle habits was analyzed. Results: Average LDL cholesterol was higher in the participants than in the recipients of specific health checkups overall. In terms of lifestyle habits, the proportion of participants in the hyperglycemic group who exercised regularly and those who did not eat dinner late at night was significantly higher than the non-hyperglycemic group, and the proportion of favorable lifestyle habits was higher. Conclusion: Non-obese people with hyperglycemia were considered to be aware of healthy lifestyle habits. It will be important for medical professional to ask more detailed questions about lifestyle during health checkups and to provide health guidance based on the results of blood test data.原

Antimicrobial peptide for bacterial infection imaging: first case reported in Brazil

ABSTRACT Molecular imaging markers can be used to differentiate between infection and aseptic inflammation, determine the severity of infection, and monitor treatment responses. One of these markers is ubiquicidin(29-41) (UBI), a cationic peptide fragment that binds to the bacterial membrane wall and is labeled with gallium-68 (68Ga), a positron emitter radioisotope. The use of UBI in positron emission tomography (PET)/computed tomography (CT) for improved detection of lesions has been receiving considerable attention recently. Herein, we report the first case of 68Ga-UBI PET/CT performed in Brazil. The patient was a 39-year-old woman referred for a scan to confirm a clinical suspicion of chronic osteomyelitis of her fractured left tibia. PET images revealed radiotracer uptake near the posterior contour of the tibial fracture focus and the fixation plate, in the soft tissue around the distal half of the tibia, and in the non-consolidated fracture of the left distal fibula. Surgery for local cleaning was performed, and culture of a specimen collected from the surgical site confirmed the presence of Staphylococcus aureus. In the present case, 68Ga-UBI PET/CT, a non-invasive imaging modality, identified the infection foci in vivo, indicating its potential for clinical use

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

Friction Characteristics of Steel Pistons for Diesel Engines

The use of iron pistons is increasing due to the higher power requirements of diesel truck engines. Expansion of the iron piston is a common concern. The purpose of this study is to clarify the lubrication conditions of cast iron and steel pistons. Friction of steel and cast iron pistons were measured using the floating liner method. The friction of conventional aluminum pistons was also measured for comparison in this study. The measurement of the secondary motion of each piston was carried out to analyse piston friction, and the following findings were obtained. The cast iron piston showed boundary lubrication at compression top dead center (TDC). This is presumably caused by the larger tilting angle of the piston induced by the larger piston clearance. Steel pistons showed hydrodynamic lubrication conditions at TDC and BDC through each cycle, due to a good oil supply

Prostate cancer recurrence in vas deferens – fusion image guide as an important tool in dignosis

ABSTRACT The biochemical recurrence after local treatment for prostate cancer is an often challenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites. An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA-68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence. The fusion image technique combines the real–time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously. High resolution acquired in PET / MR associated with image fusion allows orientation procedures, even in areas of difficult access, with greater accuracy than conventional techniques

Socioeconomic status and type 2 diabetes complications among young adult patients in Japan

<div><p>Objective</p><p>To assess the relationship between socioeconomic status (SES) and complications of type 2 diabetes among young adults in Japan.</p><p>Design</p><p>A cross-sectional study.</p><p>Setting</p><p>Outpatient wards of 96 member hospitals and clinics of the Japan Federation of Democratic Medical Institutions.</p><p>Participants</p><p>A total of 782 outpatients with type 2 diabetes (525 males, 257 females), aged 20–40 years as of March 31, 2012. After excluding 110 participants whose retinopathy diagnosis was in question, 672 participants were analyzed.</p><p>Measurements</p><p>We examined the relations between SES (educational level, income, type of public healthcare insurance, and employment status) and diabetes complications (retinopathy and nephropathy) using a multivariate logistic regression analysis.</p><p>Results</p><p>The prevalence of type 2 diabetic retinopathy was 23.2%, while that of nephropathy was 8.9%. The odds of having retinopathy were higher among junior high school graduates (OR 1.91, 95% CI 1.09–3.34), patients receiving public assistance (OR 2.19, 95% CI 1.20–3.95), and patients with irregular (OR 1.72, 95% CI 1.03–2.86) or no employment (OR 2.23, 95% CI 1.36–3.68), compared to those with a higher SES, even after covariate adjustment (e.g., age, gender, body mass index). Similarly, the odds of having nephropathy were higher among patients with middle (OR 3.61, 95% CI 1.69–8.27) or low income levels (OR 2.53, 95% CI 1.11–6.07), even after covariate adjustment.</p><p>Conclusions</p><p>Low SES was associated with a greater likelihood of type 2 diabetes complications in young adults. These findings suggest the necessity of health policies that mitigate socioeconomic disparity and thereby reduce the prevalence of diabetic complications.</p></div

Response to Abemaciclib and Immunotherapy Rechallenge with Nivolumab and Ipilimumab in a Heavily Pretreated TMB-H Metastatic Squamous Cell Lung Cancer with CDKN2A Mutation, PIK3CA Amplification and TPS 80%: A Case Report

Inactivation of the cyclin-dependent kinase inhibitor 2A (CDKN2A) gene is considerably more frequent in squamous cell lung cancer (SqCLC) than in other subtypes of lung cancer and may be a promising target for this histology. Here, we present the course of diagnosis and treatment of a patient with advanced SqCLC, harboring not only CDKN2A mutation but also PIK3CA amplification, Tumor Mutational Burden-High (>10 mutations/megabase), and a Tumor Proportion Score of 80%. After disease progression on multiple lines of chemotherapy and immunotherapy, he responded favorably to treatment with the CDK4/6i Abemaciclib and later achieved a durable partial response to immunotherapy rechallenge with a combination of anti-PD-1 and anti-CTLA-4, nivolumab, and ipilimumab

General characteristics according to SES (%).

<p>General characteristics according to SES (%).</p