脳血管疾患患者の回復期リハビリテーション病棟入院時の評価結果を用いた在宅復帰予測モデル

研究報告Original Articles　【目的】本研究は回復期リハビリテーション病棟入棟患者の在宅復帰に必要な条件を入棟時の評価結果から明らかにし在宅復帰予測モデルを提示することである．【対象】2009 年6 月から2012 年6月までに日高病院回復期病棟へ脳卒中連携パス対象患者として入院した患者69 名．【方法】リハカルテや病棟カルテより，回復期リハビリテーション病棟患者の入棟時の身体機能（FIM など）や基本情報（年齢，性別など），環境（同居者人数）などの10 の変数を収集し，帰結先（在宅復帰と非在宅復帰）の2 群に分け各項目について単変量解析を実施し，さらに決定木分析を実施した．【結果】単変量解析ではFIM の16 項目とHDS-R, 配偶者の有無，および同居者人数で2 群間に有意差がみられた．決定木分析では最初にFIM 社会交流，次いで，配偶者の有無，FIM トイレが選択された．【結語】在宅復帰を実現するためには，入院の共同生活がうまくできるよう支援し，自己管理能力を促進すること，そして転倒予防を重視したリハビリ治療が重要である．　Purpose: This paper presents a decision-making supportive model for the discharge of patients from rehabilitation wards. Moreover, it clarifies factors that determine whether patients in such wards are ready to be discharged. Subjects: We classified subjects into two groups: a discharged group and a non-discharged group. Methods: We examined the subjects’ rehabilitation and ward records. The collected data were subjected to univariate and decision tree analyses. Results:Univariate analysis showed that 10 non-disease factors exhibited significantly higher values in the discharge group. Decision tree analysis indicated that the score for social interaction in the Functional Independence Measure (FIM) should be the first factor considered when deciding whether a patient should be discharged. Subsequently, the presence of a spouse and toilet operations should be considered. Conclusion: Clinicians should check patients’ FIM scores before discharging them from rehabilitation wards. Additionally, we recommend that rehabilitation should begin with social interaction

Aaptamine-related alkaloid from the marine sponge Aaptos aaptos

A new aaptamine-related alkaloid, 1,3-dioxolo [4,5-d] benzo [de]-1,6-naphthyridine (methylenedioxyaaptamine, 1), was isolated from the organic extracts of the Bornean marine sponge Aaptos aaptos, together with a known aaptamine derivative, 8,9,9-trimethoxy-9H-benzo [de]-1,6-naphthyridine (2). The structure of compound 1 was elucidated by interpretation of its spectroscopic data. Two compounds were tested for their cytotoxic potentials against adult T-cell leukemia (ATL) cells, and compound 1 showed moderate cytotoxic potential

Difference in the Cesium Body Contents of Affected Area Residents Depending on the Evacuation Timepoint Following the 2011 Fukushima Nuclear Disaster

Estimating the internal thyroid dose received by residents involved in the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident has been a challenging task because of the shortage of direct human measurements related to the largest contributing radioisotope to the dose, I. In a previous dose estimation, we used the results of whole-body counter (WBC) measurements targeting Cs and Cs, based on the assumption that these radioisotopes were incorporated at the same time as I in the early phase of the accident. The main purpose of this study was to clarify whether the trace of the early intake remained in the WBC measurements that were started several months after the accident. In the present work, WBC data of 1,639 persons from Namie town, one of the heavily contaminated municipalities, were analyzed together with their evacuation behavior data. The results demonstrated that the cesium detection rate in the WBC results was several times higher in the late evacuees [who evacuated outside the 20-km radius of the FDNPP at 3:00 p.m. (Japanese Local Time) on 12 March or later] compared to the prompt evacuees (who evacuated before 3:00 p.m. on 12 March). Among the adults, the cesium detection rates (and the 90th percentile values of the Cs intake) of the prompt and late evacuees were about 20% (5.4 × 10 Bq) and 60% (1.6 × 10 Bq), respectively. Approximately 20% of the individuals analyzed were categorized as late evacuees. These differences in cesium would be caused by exposure to the radioactive plume in the afternoon on 12 March, which was likely to influence the late evacuees. On the other hand, the intake on 15 March, when the largest release event occurred, was expected to be relatively small for Namie town's residents. In conclusion, the trace of the early intake remained in the WBC measurements, although this would not necessarily be true for all subjects. The results obtained from this study would provide useful information for the reconstruction of the early internal thyroid doses from radioiodine in the future

Nonclosure technique with saline-coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy

金沢大学医学部附属病院肝胆膵・移植外科　Background/Purpose: Management of the pancreatic remnant after distal pancreatectomy is still debated, the most serious complication is development of a pancreatic fistula. We developed a nonclosure technique with saline-coupled bipolar electrocautery for preventing fistula formation after distal pancreatectomy as an alternative to traditional stump closure methods. Methods: The distinguishing feature of this technique is nonclosure of the stump, relying instead upon dependable ligation of the main pancreatic duct and sealing of the cut surface by shrinkage accomplished by low-temperature coagulation using saline-coupled bipolar electrocautery. A recent addition has been intraoperative stenting of the remnant pancreatic duct. Results: To date we have used the nonclosure technique in 40 cases, among which 5 (12.5%) developed fistulas: 4 in the nonstenting subgroup (14.8%) and 1 in the stenting subgroup (7.7%). According to a recent classification, 4 fistulas were considered grade A; 1, grade B; and 0, grade C. The grade B patient did not undergo stenting. Conclusion: Our preliminary experience should prompt more widespread evaluation of the nonclosure technique. © Springer Japan 2008

Early Intake of Radiocesium by Residents Living Near the Tepco Fukushima Dai-ichi Nuclear Power Plant After the Accident. Part 2: Relationship Between Internal Dose and Evacuation Behavior in Individuals

The Tokyo Electric Power Company's Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident exposed members of the public to radiation. This study analyses the relation between personal behavior data obtained from 112 out of 174 subjects who underwent whole-body measurements by the National Institute of Radiological Sciences (NIRS) during the period from 27 June to 28 July 2011 and their committed effective doses (CEDs) from Cs and Cs. The whereabouts of the 112 persons living in municipalities near the FDNPP (mainly, Namie town) on several days in March 2011 are graphed on maps. It was confirmed that most subjects started evacuation promptly and had left the 20-km-radius of the FDNPP by the end of 12 March. The individual CEDs were poorly correlated with the person's distances from the FDNPP at any day in March. Meanwhile, the percentage of persons remaining within the 20-km radius of the FDNPP was 100% at 16:00 on 12 March and 42.9% at 0:00 on 15 March for those with CEDs > 0.1 mSv, whereas the corresponding values were much lower for those with CEDs ≤ 0.1 mSv. This suggests that the time of evacuation would be one of the crucial factors for the early intake; however, more personal behavior data are needed to be analyzed to clarify the relevance to the individual internal dose

Comparison and characterization of α-amylase inducers in Aspergillus nidulans based on nuclear localization of AmyR

AmyR, a fungal transcriptional activator responsible for induction of amylolytic genes in Aspergillus nidulans, localizes to the nucleus in response to the physiological inducer isomaltose. Maltose, kojibiose, and d-glucose were also found to trigger the nuclear localization of GFP-AmyR. Isomaltose- and kojibiose-triggered nuclear localization was not inhibited by the glucosidase inhibitor, castanospermine, while maltose-triggered localization was inhibited. Thus, maltose itself does not appear to be an direct inducer, but its degraded or transglycosylated product does. Non-metabolizable d-glucose analogues were also able to trigger the nuclear localization, implying that these sugars, except maltose, directly function as the inducers of AmyR nuclear entry. The inducing activity of d-glucose was 4 orders-of-magnitude weaker compared with isomaltose. Although d-glucose has the ability to induce α-amylase production, this activity would generally be masked by CreA-dependent carbon catabolite repression. Significant induction of α-amylase by d-glucose was observed in creA-defective A. nidulans

回復期リハビリテーション病棟における在宅復帰を規定する要因の分析：群馬脳卒中連携パスデータの分析から

研究報告Original Articles　【目的】本研究は回復期リハビリテーション病棟入院患者の在宅復帰に必要な条件を明らかにしアプローチモデルを提案することである．【対象】2009 年6 月から2012 年6 月までにH 病院回復期病棟へ脳卒中連携パス対象患者として入院した患者149 名．【方法】リハカルテや病棟カルテより，患者の身体機能（FIM など）や基本情報（年齢，性別など），環境（同居者人数）などの13 の変数を収集し，帰結先（在宅復帰と非在宅復帰）を2 群に分け各変数について単変量解析を実施し，さらに決定木分析を実施した．【結果】単変量解析では疾患（脳梗塞，脳出血，くも膜下出血）以外の変数で2 群間に有意差がみられた．決定木分析では最初に退院時FIM 運動項目得点が，次いで，回復期病棟入棟期間，発症年齢が抽出された．【結語】在宅復帰を実現するためには，FIM の得点を確認し，回復期病棟入棟早期から退院に向けた準備が必要である．さらに高齢者には，急性期からのリハビリ介入あるいは発症早期に回復期リハビリテーション病棟に転入させる働きかけが必要である．　Purpose: In this study, we present a model for aiding decision-making regarding the discharging of patients from rehabilitation wards and clarify the factors that determine whether patients on such wards are ready to be discharged.　Subjects: We classified the subjects into two groups, the discharged group and non-discharged group.　Methods: We examined the subjects’ rehabilitation and ward records. Then, we subjected the collected data to univariate analysis and decision tree analysis.　Results: Univariate analysis showed that twelve non-disease factors exhibited significantly higher values in the discharge group. Decision tree analysis indicated that the score for physical motion in the Functional Independence Measure (FIM) should be the first factor considered when deciding whether a patient should be discharged. Then, the period of hospitalization and the age at onset should be taken into account.　Conclusion: Clinicians should check patients’ FIM scores before discharging them from rehabilitation wards. In addition, we recommend that rehabilitation should begin in the acute period in elderly patients. Therefore, it is important that elderly patients are admitted to the rehabilitation ward as soon as possible

回復期リハビリテーション病棟を退棟した脳卒中患者の分析 : 失語症の有無が治療効果と転帰先へ及ぼす影響

研究論文Original Articles　本研究の目的は，失語症の有無が訓練効果と在宅復帰に与える影響を明らかにすることである．回復期リハ病棟を退棟した脳卒中患者を対象にした．対象患者を失語症群と非失語症群に分け，患者の個人的因子や社会的因子，FIM をはじめとした諸検査の検査結果，入院期間，および転帰先などを比較した．その結果，失語症群は非失語症群に比して，入院時と退院時両方のFIM 成績が有意に低いこと，しかしながら失語症が在宅復帰へ及ぼす影響は確認できなかった．言語聴覚士は，理学療法士，作業療法士と連携して患者の日常生活機能の改善をコミュニケーションの側面から促進させる介入を積極的に実施する必要があると考えられた．　The purpose of this study is to investigate the effect of the presence or absence of aphasia on the treatment effect, discharge home, and the period of admission to the convalescent rehabilitation ward. We targeted stroke patients who left the convalescent rehabilitation ward. The patients were divided into aphasic group and non-aphasic group, and patientʼs personal factors, social factors, examination results of various examination including FIM, hospitalization period, and discharge home were compared. As a result, it was shown that the aphasia group has significantly lower FIM score at hospitalization and discharging compared to non - aphasia group, but the presence of aphasia did not affect discharge home. Speech therapists seemed to need to actively intervene in order to promote improvements of daily living functions of patients from the aspect of communication in collaboration with physiotherapists and occupational therapists