A Trial of the Dartmouth COOP Charts in Kurashiki Station Clinic

Measurement of functional status of the patient is useful in ambulatory clinic in primary care.1,2) A field test of the Dartmouth COOP charts (questionnaires) was performed on 144 patients aged 18 and over with chronic diseases who were visiting for either the second or subsequent time. As these charts produce a comprehensive picture of functional status, they are useful to the patient as well as the physician

A review of literature concerning safety in midwife-managed delivery units systems in Japan

院内助産システムの安全性を探ることを目的とし、医学中央雑誌を用いて、「院内助産システム」また、「院内助産」、「助産師外来」「バースセンター」のキーワードで国内文献を検索した。ヒットした 8３1 件のうち、２01２ 年から 5 年間に絞り ２61 件、さらに原著論文に限定して85 件が抽出された。そのうち、運用基準、医師への移行(医療介入 )率の記載、分娩アウトカム指標の記述がある文献 11 件を分析対象とした。　助産師外来の記載があった文献は 5 件、院内助産は 10 件、助産師外来と院内助産の記載があった文献は 4 件であった。　助産師外来から非助産師外来への移行率は 4.0 〜 8.8% であり、非助産師外来のローリスクからハイリスク移行率 9.0% に比較して低率であった。また、院内助産における医師の医療介入率は9.6〜44.4％で、非院内助産における医療介入率41〜46.6%より低率であった。分娩アウトカムは児の体重と臍帯血 pH、会陰裂傷においては非院内助産と有意差がなかった。　院内助産システムの運用基準は、産婦人科診療ガイドラインを基本に、各施設で独自に選定対象基準を記載しており、助産師外来は、妊娠初期から中期まで医師が担当する協働の実態があった。助産師外来と院内助産の安全性が示唆される一方で、分娩の施設間で運用基準が異なるため、系統的なメタ分析を妨げているという課題が見えた。以上から院内助産システムの運用に関するガイドラインの検討と院内システムの標準化を進展することが早急の課題と考える。This study was performed to verify the safety of midwife-managed delivery units in Japan based on a review of the domestic literature.　We conducted a literature review using the Ichushi-Web (Japan Medical Abstracts Society) and searched the domestic literature with the keywords “midwife-managed delivery units system,” “midwife-managed delivery units,” “midwife-led examinations,” and “birth center.” A total of 8３1 articles were identified, of which ２61 papers were published between ２01２ and ２016, from which 85 were extracted as original articles. Eleven transcripts were analyzed by extracting the transfer rate from midwife-led examinations to obstetrician-led examinations, obstetric intervention of midwife-managed delivery units, neonatal and physiological outcomes, and safety.　There were five studies with descriptions of midwife-led examinations, ten studies with descriptions of midwife-managed delivery units, and four describing both systems. The rate of transfer to obstetrician-led examinations was 4.0% – 8.8%, which was low compared to the high-risk transition rate of 9.0% for obstetric outpatients. The obstetric intervention rate in midwife-managed delivery units was 9.6% – 44.4%, which was lower than the obstetric intervention rate of 41% – 46.6% in deliveries managed by physicians. The neonatal and physiological outcomes were not significantly different according to the weight of the child, umbilical cord arterial blood pH, or perineal lacerations in the physician control group.　The operation criteria of midwife-led examinations and midwife-managed delivery units are based on the Obstetrics and Gynecology Clinical Practice Guidelines, and many facilities have established their own criteria. 　In outpatient midwifery clinics, the doctor was in charge from early pregnancy to mid-term.　This study suggested that midwife-led examinations and midwife-managed delivery units have good levels of safety. On the other hand, there were differences in operation standards among the facilities, which prevented more reliable meta-analysis of midwife-managed delivery units.　To further disseminate midwife-managed delivery units, it is necessary to evaluate not only the outcome items but also operational criteria, and establish standards according to the environment, facilities, and personnel of each facility

Collagen adhesion gene is associated with blood stream infections caused by methicillin-resistant Staphylococcus aureus

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) causes hospital- and community-acquired infections. It is not clear whether genetic characteristics of the bacteria contribute to disease pathogenesis in MRSA infection. We hypothesized that whole genome analysis of MRSA strains could reveal the key gene loci and/or the gene mutations that affect clinical manifestations of MRSA infection. Methods: Whole genome sequences (WGS) of MRSA of 154 strains were analyzed with respect to clinical manifestations and data. Further, we evaluated the association between clinical manifestations in MRSA infection and genomic information. Results: WGS revealed gene mutations that correlated with clinical manifestations of MRSA infection. Moreover, 12 mutations were selected as important mutations by Random Forest analysis. Cluster analysis revealed strains associated with a high frequency of bloodstream infection (BSI). Twenty seven out of 34 strains in this cluster caused BSI. These strains were all positive for collagen adhesion gene (cna) and have mutations in the locus, those were selected by Random Forest analysis. Univariate and multivariate analysis revealed that these gene mutations were the predictor for the incidence of BSI. Interestingly, mutant CNA protein showed lower attachment ability to collagen, suggesting that the mutant protein might contribute to the dissemination of bacteria. Conclusions: These findings suggest that the bacterial genotype affects the clinical characteristics of MRSA infection. (c) 2019 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases

A Novel Screening System for Claudin Binder Using Baculoviral Display

Recent progress in cell biology has provided new insight into the claudin (CL) family of integral membrane proteins, which contains more than 20 members, as a target for pharmaceutical therapy. Few ligands for CL have been identified because it is difficult to prepare CL in an intact form. In the present study, we developed a method to screen for CL binders by using the budded baculovirus (BV) display system. CL4-displaying BV interacted with a CL4 binder, the C-terminal fragment of Clostridium perfringens enterotoxin (C-CPE), but it did not interact with C-CPE that was mutated in its CL4-binding region. C-CPE did not interact with BV and CL1-displaying BV. We used CL4-displaying BV to select CL4-binding phage in a mixture of a scFv-phage and C-CPE-phage. The percentage of C-CPE-phage in the phage mixture increased from 16.7% before selection to 92% after selection, indicating that CL-displaying BV may be useful for the selection of CL binders. We prepared a C-CPE phage library by mutating the functional amino acids. We screened the library for CL4 binders by affinity to CL4-displaying BV, and we found that the novel CL4 binders modulated the tight-junction barrier. These findings indicate that the CL-displaying BV system may be a promising method to produce a novel CL binder and modulator

Genome-wide structural variant analysis identifies risk loci for non-Alzheimer’s dementias

We characterized the role of structural variants, a largely unexplored type of genetic variation, in two non-Alzheimer’s dementias, namely Lewy body dementia (LBD) and frontotemporal dementia (FTD)/amyotrophic lateral sclerosis (ALS). To do this, we applied an advanced structural variant calling pipeline (GATK-SV) to short-read whole-genome sequence data from 5,213 European-ancestry cases and 4,132 controls. We discovered, replicated, and validated a deletion in TPCN1 as a novel risk locus for LBD and detected the known structural variants at the C9orf72 and MAPT loci as associated with FTD/ALS. We also identified rare pathogenic structural variants in both LBD and FTD/ALS. Finally, we assembled a catalog of structural variants that can be mined for new insights into the pathogenesis of these understudied forms of dementia

EFFECTS OF AROMATHERAPY FOR SELF-CARE DURING PREGNANCY

Stress reduction care is important for pregnant women to decrease obstetric complications and children's health problems after birth. We investigated the long-term effects during pregnancy of daily self-care with aromatherapy using essential oils containing linalyl acetate and linalool. We randomly assigned 16 healthy pregnant women into an aromatherapy group and a control group. Nine participants were assigned to the aromatherapy group and seven participants to the control group. Intervention was started at 28 weeks of pregnancy and the results were assessed at 32 and 36 weeks of pregnancy as well as during childbirth. We conducted a comprehensive assessment using State-Trait Anxiety Inventory (STAI) and Visual Analogue Scale (VAS) as subjective questionnaire surveys and autonomic nervoqs activity from heart-rate variability as objective physiological indicators as well as the results of childbirth. The STAI traits showed significant aromatherapy effects (p＜0.05) for reducing anxiety. Moreover, a dose- response relationship was observed which demonstrated a significant difference (p＜0.016) within the aromatherapy group for the relaxing effects by VAS. This study revealed that it is effective to reconrmend self-care using aromatherapy with essential oils containing linalyl acetate and linalool for the purpose of reducing anxiety and providing relaxation over the long term during pregnancy. However, it is necessary to conduct further studies with an increased number of participants to investigate the effects on the autonomic nervous system and the effects on childbirth