Adrenocorticotropic hormone at pathophysiological concentration modulates the proliferation and differentiation of bone cells

SummaryBackground/purposeAdrenocorticotropic hormone (ACTH) plays a vital role in maintaining the function of the hypothalamic–pituitary–adrenal axis. Recent studies have demonstrated that ACTH directly affects the proliferation and differentiation of bone cells. However, the ACTH concentrations used in these studies appear to be markedly higher than the physiological concentrations. Here, we investigated whether ACTH at pathophysiological concentration affects the proliferation and differentiation of osteoblasts and osteoclasts.Materials and methodsWe evaluated the effect of ACTH at pathophysiological concentration on osteoclasts using tartrate-resistant acid phosphatase staining and on osteoblasts using alkaline phosphatase activity assay. Additionally, we conducted reverse transcriptase-polymerase chain reaction analysis.ResultsWe found that at pathophysiological concentration, ACTH does not affect osteoblast proliferation and inhibits osteoblast differentiation. Moreover, we showed that at pathophysiological concentration, ACTH does not affect the proliferation of bone marrow macrophages, but promotes differentiation of osteoclasts and induces expression of genes involved in bone resorption.ConclusionTaken together, our findings suggest that ACTH modulates the proliferation and differentiation of bone cells in vitro at pathophysiological concentration

The development and applications of ultrafast electron nanocrystallography

We review the development of ultrafast electron nanocrystallography as a method for investigating structural dynamics for nanoscale materials and interfaces. Its sensitivity and resolution are demonstrated in the studies of surface melting of gold nanocrystals, nonequilibrium transformation of graphite into reversible diamond-like intermediates, and molecular scale charge dynamics, showing a versatility for not only determining the structures, but also the charge and energy redistribution at interfaces. A quantitative scheme for three-dimensional retrieval of atomic structures is demonstrated with few-particle (< 1000) sensitivity, establishing this nanocrystallographic method as a tool for directly visualizing dynamics within isolated nanomaterials with atomic scale spatio-temporal resolution.Comment: 33 pages, 17 figures (Review article, 2008 conference of ultrafast electron microscopy conference and ultrafast sciences

Pre-operative anxiety and nursing care - Through two students'case studies on surgical patients -

手術前の看護は,患者が安全･安楽に手術を受けることができ,術後の回復過程がスムーズにいくように援助することである.その看護の一つとして術前不安の緩和に向けての援助がある。その人の不安レベルに応じた適切な看護援助を行うためには,患者の不安を正しくアセスメントすることが重要になる｡看護学生にとって,患者の不安への理解は,臨床実習の場で,患者を観察したり,患者と向き合って話を交わしたり,ケアを行ったりする体験を通して培われていくものであると思われる｡本論文では,2名の学生が行った術前不安に関する事例研究から,客観的に分析する方法を用いて患者を観察したり, 患者の話を聞いたり,看護行為を行うことによって,術前不安と看護援助の理解が深められることを論述した｡Pre-operative nursing is to care and educate a patient so that he/she can undergo an operation at ease and in safety and recover quickly after surgery. One of the pre-operative nursing is to relieve anxiety. It's very important for pre-operative nursing to assess pre-operative anxiety and do the nursing action according to patient's anxiety level. Nursing student seems to have much understanding of pre-operative anxiety through observing a patient's behavior, talking with a patient, and caring a patient in clinical practice. Two students'case studies on surgical patients are presented in this paper. This paper shows how they promote deeper understanding of pre-operative anxiety and the nursing care is promoted by observing the patient and listening objectively to what the patient says and giving appropriate feedback

Management of Lacerated and Swollen Tongue after Convulsive Seizure with a Mouth Protector: Interprofessional Collaboration Including Dentists in Intensive Care

We encountered a 74-year-old male patient with tongue laceration after convulsive seizures under intensive care. The tongue showed severe swelling, and the right ventral surface had been lacerated by his isolated and pointed right lower canine. Our university hospital has established a perioperative management center, and is promoting interprofessional collaboration, including dentists, in perioperative management. Dentists collaborating in the perioperative management center took dental impressions, with the support of anesthesiologists who opened the patientʼs jaw under propofol sedation, to produce a mouth protector. By raising the patientʼs bite, the completed mouth protector prevented the isolated tooth from contacting the tongue and protected the lacerated wound. Use of the mouth protector prevented the lacerated tongue from coming into contact with the pointed tooth, and the tongue healed gradually. These findings underscore that interprofessional collaboration including dentists can improve the quality of medical care

Shoulder pain in patients following lung resection

Aim and objective: The purpose of this study was to examine the frequency, influencing factors, and clinical course of shoulder pain in patients following lung resection. Background: Thoracoscopes have been introduced in the surgical treatment of lung cancer, and allow for less invasive surgery with a minimal incision. However, decubitus position-related shoulder pain on the operated side has not yet been investigated. Design: A longitudinal descriptive study. Methods: Patients who underwent lung resection in the decubitus position. Patients were interviewed 2 days before surgery and once daily for 5 days after surgery. Interview items included background data, the concomitant use of epidural anesthesia, operative duration, presence of preoperative shoulder stiffness (excluding shoulder pain), type of surgery, and site of operation. The intensity of pain was approximately 5 on an 11-point numerical rating scale. Descriptive statistics on patient backgrounds were obtained using SPSS Statistics 22 for Windows. Results: Of the 74 patients who underwent lung resection in a decubitus position, 30(40.5%) developed shoulder pain on the operated side. The highest rating occurred 1 day after surgery and decreased over time. The following two factors were found to influence shoulder pain on the operated side: operative duration(Z=-2·63;p=0·01), and presence of preoperative shoulder stiffness(excluding shoulder pain)(χ2＝4·16;p=0·04). Conclusions: This study demonstrated that approximately 40% of patients who underwent lung resection in the decubitus position developed shoulder pain. Relevance to clinical practice: The presence of postoperative shoulder pain was related to both the duration of the operation and to the presence of preoperative shoulder stiffness. Although the shoulder pain resolves within 4 days, it causes the patient additional discomfort and distress. Therefore, further research is needed on positioning for thoracotomy in order to investigate ways to reduce or eliminate this complication of lung surgery

Present status of home health nursing in a Japanese hospital-based home health care agency

病院を基盤とした在宅看護提供機関における在宅看護の現状を調査し,在宅看護の現在の問題点を明らかにするとともに,在宅看護に携わる看護婦の役割について検討した｡本調査の結果,一人暮らしの患者は,家族に介護者のいる患者に比べ明らかにADLが高い場合も訪問看護を受けていることが分かった｡また,高齢者夫婦二人暮らしの患者と2世代以上家族の患者のADLに差はなく,このことは,高齢の介護者に相当の負担がかかっていると言える｡訪問看護内容としては, 日常生活自立度の低い患者への日常生活援助の実施率は高く,精神的支援や指導的看護技術の実施率は低かった｡在宅看護に携わる看護婦は, 日常生活援助に追われがちであるが,一次予防に焦点を当てたケア,患者や介護者の精神的支援,指導,ケアマネジメントを行うことは緊急の課題である｡We investigated the present status of home health nursing in a Japanese hospital-based home health care agency, to clarify present problems in home health nursing and to assess the roles of home health nurses. Based on our results, ADL of care recipients who lived alone were clearly independent compared with care recipients who lived with family care-givers. The level of ADL of both care recipients who lived with their spouses and those who lived with more than 2 family members were not different. It indicates that aged family care-givers assume great responsibility. In cases of bedridden recipients,daily life care was performed at a high rate, but mental care or teaching care was performed at a low rate. Home health nurses should focus on primary preventive care, mental care for recipients and care-givers, and teaching care or management of a care plan

Relationship between ceruloplasmin and oxidative biomarkers including ferritin among healthy Japanese

Serum ceruloplasmin (CP), a marker relevant to copper metabolism, is one of famous inflammation markers with a reduction in Wilson's disease, whereas serum ferritin is a marker relevant to iron metabolism. Recently, ferritin is pointed out to be related with oxidative stress. However, there is still no population research which showed the relation of CP and ferritin. Therefore, we investigated the relationship between CP and ferritin including oxidative stress biomarkers among healthy Japanese (n = 389). We measured serum CP, ferritin, Fe, high-sensitivity C-reactive protein (hs-CRP), and urinary oxidative stress biomarkers [H2O2, 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-isoprostane] and so on. Subjects showed that age; 41.7 ± 10.0 (year), CP; 31.9 ± 6.8 (mg/dl), ferritin; 123.5 ± 121.0 (ng/ml), hs-CRP; 0.89 ± 2.53 (mg/l), 8-OHdG; 10.2 ± 4.4 [ng/mg creatinine (Cre)] and H2O2; 6.5 ± 10.9 (µM/g Cre), (All data mentioned above were expressed as mean ± SD). CP was significantly and positively correlated with hs-CRP and inversely correlated with ferritin, Fe and 8-OHdG. By a multiple logistic regression analysis, odds ratio of CP according to quartiles of hs-CRP was 4.86, and according to quartiles of 8-OHdG was 0.39 after adjusting for age and other confounding factors. In conclusion, our findings suggest that CP was an antioxidative biomarker which controls oxidative stress, whereas ferritin was a marker which may participate in the generation of oxidative stress

The research on the problems of health care and living of the aged (Pursuing the cases of home treatment given to the elderly patients for one year after their discharge)

退院後の生活に目を向けた適切な退院指導がなされることは、高齢患者が安心して在宅療養を送る上で、重要な意味を持つ。そこで病院から在宅療養に移行した70歳以上の高齢者の抱える問題を4回に渡って1年間調査し、これまでに退院時、3ヵ月後、6ヵ月後の調査結果を報告した。本稿では1年を通じて回答のあった53名について健康と生活上の問題の変化を分析し、考察した。在宅療養に移行した高齢者の健康状態と生活上の問題は、ほぼ一致して退院後6ヵ月から1年後までに変化を認め、特に日常生活上の問題は著しく増加した。その原因として病状の悪化との関連が考えられた。また、高齢者の問題についての意識は、研究者の専門的な問題意識に比べて低かった。従って入院中に退院後の生活を予測することには限界があり、今後は退院指導の充実と伴に在宅サービスとの連携が重要であることを認めた。We planned to make emerge the problems felt by the elderly patients of 70 years and over given home treatment. As a means of our research, four times a year we sent a questinnaire to the aged who had been discharged. After collecting the answers of the questionnaires, we decided to focus on the 53 elderly patients who answered all four questionnaires, and then tried to make their problems emerge. The contents of the questionnaires were about their health care in a year and how their daily life changed. We can see that the condition of the elderly patients under home treatment and their living problems have changed almost without exceptions six months to a year after their discharge. Especially the number of the problems in their daily life increased remarkably. These results might be considered to be caused by the aggravation of their diseases. In addition, the elderly patients are not as conscious of their own problems as a specialist with a critical mind. Therefore, there is a limit to estimating the change in lifestyle of a discharged patient while they remain hospitalized. We consider it essential to get full discharge-care closely connected with home service for elderly patients