Implications of circadian rhythm disruptions for nurse managers

Background/Aim: Treatment errors are implicated among the devastating effects of shift work, which impacts our circadian rhythms and takes a toll on nurses’ health and level of fatigue and safe practice. Therefore, an understanding of the role of biorhythms, especially circadian rhythms, is essential for nurse managers who must provide for“ coverage” while also being responsible for issues affecting patient safety and staff health and satisfaction. This paper will outline implications of circadian rhythm disruption for nurse managers. Methods: Review of the literature about circadian rhythms is followed by suggestions concerning shift work for nurses based on the writings of C. N. Hoskins. This concludes with a shared educational program for nurse managers. Summary, Implication: The shift schedule is important; it is one of the causes of unnecessary cost, decreased workers’ motivation, increased workers’ health problems, sleepiness and giving up their night shift work. When nurse managers make shift schedules, they should be concerned with circadian rhythms; this will enable a decrease in treatment errors while increasing the status of workers’ health

Association between masticatory ability and oral functions

Mastication is the process of breaking ingested food with the teeth and mixing it with saliva to form a mass that is easy to swallow. However, few studies have reported on oral functions, such as occlusal force, tongue pressure, and mastication. The purpose of this study was to evaluate the association between masticatory function and oral functions, such as occlusal force and tongue pressure. In this study, there were 113 patients (41 men and 72 women; mean age, 68.4 ± 11.3 years) who visited dentists at the Hiroshima University Hospital, Hiroshima, Japan between April 2015 and November 2018. Masticatory function of the patients was evaluated using a masticatory ability test system. In addition, occlusal force was measured using a pressure-sensitive film and the maximum tongue pressure was measured with a tongue pressure measuring device according to a conventional method. The relationship of masticatory ability with occlusal force and tongue pressure was examined using multivariate analysis while considering patients? age, gender, and the number of remaining teeth. Masticatory ability was significantly related to occlusal force, maximum tongue pressure, age, body mass index, the number of remaining teeth, and occlusal contact area (p< 0.05). Multiple regression analysis identified that masticatory ability was significantly associated (p< 0.05) with occlusal force and maximum tongue pressure. Masticatory ability was significantly associated with occlusal force and maximum tongue pressure, indicating that the large muscle mass in the oral cavity is indispensable for improving masticatory function

Laparoscopic fundoplication for neurologically impaired adolescents with severe scoliosis

AbstractLaparoscopic antireflux procedure for patients with severe scoliosis is often challenging, as the esophageal hiatus lies in an extremely deep position and is frequently rotated. Reports regarding the clinical results of laparoscopic fundoplication are scarce, especially in patients with severe scoliosis. In this study, laparoscopic Nissen fundoplication was applied to seven adolescent patients aged between 19 and 29 years with neurological impairment and gastroesophageal reflux disease (GERD). The scoliosis among them was considerably severe with a median Cobb angle of 131°. Follow-up was conducted with a median period of 7.8 years. There was no intraoperative complication or recurrence of GERD. Two patients required tracheostomy, and one died due to recurrent pneumonia after fundoplication. Our experience suggested the feasibility of laparoscopic Nissen fundoplication with an arrangement of port layout even in neurologically impaired adolescents with severe scoliosis. As recurrent aspiration pneumonia can persist after fundoplication in some patients, an anti-aspiration procedure may be considered to achieve a higher quality of life

Chondroitin Sulfate Iron Colloid-Enhanced MR Imaging in Patients with Small Hepatocellular Carcinomas: Correlations with Hemodynamic and Pathologic Examinations

To determine the usefulness of chondroitin sulfate iron colloid (CSIC)-enhanced magnetic resonance imaging (MRI) in evaluation of the histologic grade of hepatocellular carcinoma (HCC), we performed a comparative study with computed tomography during arterial portography (CTAP) and CT arteriography. Twenty-one surgically resected HCCs 3 cm or less in diameter were examined. There were five well- differentiated, six well- to moderately-differentiated and ten moderately- or poorly-differentiated HCCs. T2-weighted spin echo images (repetition time: 2,000 ms, echo time: 90 ms) were taken before and after intravenous injection of 23.6 ?mol Fe/kg of CSIC. The differences between precontrast and postcontrast contrast-to-noise ratios (enhancement index) was correlated with the findings of CTAP, CT arteriography and histological examination. The enhancement index increased with statistical significance as the intranodular arterial perfusion increased (P < 0.01), and as the intranodular portal perfusion decreased (P < 0.01). Though the enhancement index tended to increase as the grade of malignancy increased, no statistical significance was found. CSIC-enhanced MRI allowed a noninvasive evaluation of the intranodular reticuloendothelial function. We consider this procedure as a supplementary method for evaluation of the histologic grade of HCC prior to performing invasive procedures such as angiography and biopsy

DA-Raf1, a competent intrinsic dominant-negative antagonist of the Ras–ERK pathway, is required for myogenic differentiation

Ras activates Raf, leading to the extracellular-regulated kinase (ERK)–mitogen-activated protein kinase pathway, which is involved in a variety of cellular, physiological, and pathological responses. Thus, regulators of this Ras–Raf interaction play crucial roles in these responses. In this study, we report a novel regulator of the Ras–Raf interaction named DA-Raf1. DA-Raf1 is a splicing isoform of A-Raf with a wider tissue distribution than A-Raf. It contains the Ras-binding domain but lacks the kinase domain, which is responsible for activation of the ERK pathway. As inferred from its structure, DA-Raf1 bound to activated Ras as well as M-Ras and interfered with the ERK pathway. The Ras–ERK pathway is essential for the negative regulation of myogenic differentiation induced by growth factors. DA-Raf1 served as a positive regulator of myogenic differentiation by inducing cell cycle arrest, the expression of myogenin and other muscle-specific proteins, and myotube formation. These results imply that DA-Raf1 is the first identified competent, intrinsic, dominant-negative antagonist of the Ras–ERK pathway