Advance Requests of In-patients and Their Families regarding Medical Intervention Practices at the End of Life

Much emphasis is being placed nowadays on Advance Care Planning（ACP）. Under this circumstance, we report on the “advance-request form” prepared by our hospital, along with some relevant considerations. ［Intended Persons and Method］A total of ５３９ newly admitted patients and their families were asked to sign and submit the “advance-request form,” indicating their preferences on the following three kinds of end-of-life interventional practices:（ １）cardiac massage,（２）endotracheal intubation and mechanical ventilation, and（３）use of vasopressors. ［Results］Completed questionnaires were returned by ２１５ male and ３２４ female patients（average age :８２．３ years）. Of the responders, ７２（１４％）indicated their desire for all the three of the aforementioned interventions（［１］,［２］, and［３］）,６５（１２％）indicated their desire for only（１）, ４５（８%）indicated their desire for only（１）and（３）, １４（３%）indicated their desire for only（３）, while the remaining３４１（６３%）requested that none of these to be implemented. Of all the patients, ８７（１６％）patients were able to make their own decisions. ［Conclusion］About ３０％ or more patients and their families indicated their desire for some kind of life-sustaining treatment at the end of life. We believe that ACP only prioritizes a patient’s right to self-determination and that the practice of ACP should not lead to withholding of life-sustaining treatment

コウネンキ ジョセイ ニ ミラレル セイシン シンケイ ショウジョウ

Declining estrogen level associated with ovarian failure has wide-ranging and unwelcome consequences and leads to diverse metabolic changes and symptoms. The short-term effects are vasomotor instability and psychological symptoms, and medium-term effects include urogenital atrophy. On the other hand, long-term consequences are an increased risk of coronary artery disease, osteoporosis and possibly Alzheimer's disease. The hormonal change occurring around menopause and their influence may be enough to trigger emotional reactions such as depression. Furthermore, life events, personality also affect psychological symptoms which include forgetfulness, fatigue, irritability, loss of concentration, depressed mood, anxiety and sleep-related problems. Middle age is considered to be a period of increased role change and occurrence of stressful life events, particularly those called exit events. Such events include children moving out, elderly parents developing illnesses and requiring assistance or dying, partners or close friends aging or developing disease, separation and divorce. Hormone replacement therapy (HRT) improves mood and increases a sense of well-being in postmenopausal women, however estrogen was not effective in women with more severe depressive symptoms. When HRT is not advisable, other treatments such as Kampo medicine, anti-anxiety drugs and counseling should be considered. It is important for postmenopausal women suffered from psychological symptoms to look for signs of increased vulnerability to hormonal fluctuation and individualize treatment

コロンブス ノ タマゴ テキ ハッソウ ニ モトズイタ タイイ ヘンカンヨウ マット ノ シサク

We report on a new mat experimentally developed by us for changing the position of the body (named i-mat), based on an idea of a floating body. [Method] At first,4, approximately 70cm long, belts were attached to both the right and left side of the pad for tying to the beds. For a lateral position with a 30-degree tilt to the right side, the belt attached on the left side is fixed to the right bed fence and the length of the belt is adjusted so that the patient’s position becomes lateral with a 30-degree tilt. The body pressure levels (mmHg) at sites of bone were measured after position changes by using a simple body pressure-measuring device (PREDIA®) in 10 patients with an independence degree of daily living rating of C2 (group i) in whom the i-mat was used, and compared with the levels measured after position changes in patients where a mat made of urethane (Nasentpat®) was used (group N). [Results] The pressure levels in the sacral region and occipital region could be significantly lowered in group i as compared with that in group N. We also measured and compared the pressures at the major trochanter, acrominon, and iliac regions, because the high-pressure loaded region shifted to these regions on the side facing the bed in the lateral position. No significant differences in the pressure levels at the major trochanter and acrominon were found between the i and N groups. The pressure level in the iliac region in the i group was significantly higher than that that in the N group. [Conclusion] Use of this experimentally produced i-mat can significantly lower the pressure load at the sacral and occipital regions when the patient is placed in the lateral position of either side with a 30-degree tilt, as compared to that of Nasentpat®. But it appears that caution should be exercised to prevent the occurrence of bedsores in the iliac region

Rice (Oryza sativa L.) roots have iodate reduction activity in response to iodine

Although iodine is not an essential nutrient for higher plants, their roots take up and transport the element. However, the exact mechanisms involved in iodine uptake and metabolism in higher plants have yet to be elucidated. In this study, we compared two cultivars differing in iodine tolerance (“Nipponbare” and “Gohyakumangoku”) to increasing levels of I− and IO3- in the root solutions of water-cultured rice (Oryza sativa L.). We found that IO3- added to the root solutions was converted to I− in the presence of roots. Iodate reduction occurred over the course of several hours. Furthermore, the iodate reduction activity of “Nipponbare” (iodine-sensitive) and “Gohyakumangoku” (iodine-tolerant) roots increased after adding IO3- or I−. The roots of barley and soybean also showed iodate reduction activity and the activity responded to iodine treatment either with IO3- and I−. This study suggests that plant roots biologically reduce iodate to iodide and indicates that the iodate reduction activity of roots responds to external iodine conditions