Factors related to the occurrence of phlebitis in acute phase stroke patients receiving intravenous nicardipine

This study investigated the incidence of phlebitis associated with continuous nicardipine infusion in patients with acute-phase stroke. To identify patient factors related to the occurrence of phlebitis, and considering blood pressure values during nicardipine administration, we retrospectively investigated the nursing and medical records of 301 patients who were hospitalized for stroke. Of these, 92 patients met the inclusion criteria and had data showing whether phlebitis had occurred. We confirmed that phlebitis occurred in 38 patients (41.3%). Factors found to be significantly related to phlebitis onset were Glasgow Coma Scale (GCS)-verbal (V; p = .020) and -motor (M; p = .007), level of consciousness (total GCS score [(p = .009)]), nicardipine administration time (p = .001), nicardipine dose (p = .000), mean nicardipine rate of administration (p = .000), nicardipine dilution rate (p = .000), mean arterial blood pressure at first insertion (p = .030), and difference in the diastolic blood pressure at first insertion (p = .032). Multiple logistic regression analysis indicated that nicardipine administration time (odds ratio: 1.042, 95% confidence interval: 1.023–1.062, p = .000) was a related factor. Results also suggested that a decreased level of consciousness after the stroke onset (V3 or below and M5 or below) is related to phlebitis occurrence. Patients with stroke having a lower level of consciousness (total GCS score of 12 or below), who are being administered continuous nicardipine infusion, may require more frequent and careful infusion management and needle insertion site observation. Because phlebitis onset occurs after 24 h of continuous infusion, peripheral insertion site catheter replacement should be performed within 24 h

Factors related to the uncertainty stroke patients experience during treatment

[Purpose] The purpose of this study was to clarify the factors associated with the uncertainty patients with mild stroke experience regarding their illness. [Method] The participants in the study included stroke patients who had suffered a stroke but were able to communicate without cognitive impairment in an outpatient clinic or who were being hospitalized in a stroke care unit (SCU) or ward. Uncertainty regarding their illness was investigated using the Universal Uncertainty in Illness Scale (UUIS) (26 item, 6 subscale measurement scale, with scores ranging from 26–130) and Health-Related Quality of Life (QOL) SF-8 (8 item, 5–6 level Likert system) questionnaire. Data extracted from medical records included patient age, sex, type of stroke, time since onset, overlapping diseases, presence or absence of recurrent stroke, the National Institutes of Health Stroke Scale (NIHSS), ADL assessments using the Barthel Index (BI), and the presence or absence of family members living in the same house. For the analysis, Spearman rank correlation coefficients were calculated for the correlation between UISS and SF-8 in stroke patients after analyzing basic statistics. Comparisons of UUIS scores based on age, stroke type, BMI, time since onset, stroke severity (NIHSS), and ADL (BI) between the three groups were performed using the Kruskal-Wallis test, and comparisons between the two groups based on sex, the presence or absence of overlapping diseases, the presence or absence of stroke recurrence, the presence or absence of stroke sequelae, and the presence or absence of cohabitating families were performed using the Mann-Whitney test. Subsequently, multiple regressions with UUIS as an independent variable were performed on factors that showed significant differences in order to explore the factors related to UUIS. Approval was obtained from the Institutional Review Board of Tokushima University Hospital (Approval number 3134-1). [Results] Responses were obtained from 146 stroke patients. The mean age was 65.9 years (SD 13.9), 82 were men (56.2%), 64 were women (43.8%), 38 were acute phase patients (26.0%), 39 were recovery phase patients (26.7%) and 69 were maintenance phase patients (47.3%). The mean UUIS score in stroke patients was 72.0 (SD 23.1) and was high, at 82.0 (SD 23.3), in acute phase patients, in particular. In addition, significant differences in UUIS were seen based on age (p = .031), stroke type (p = .031), time since onset (p = .006), the presence or absence of stroke sequelae (p = .013), stroke severity (NIHSS) (p = .000), and ADL (BI) (p = .001). In multiple regression analyses, stroke severity, time since onset, and age were associated with stroke patient uncertainty (R2 = .221). [Conclusions] Stroke patients were characterized by uncertainty based on age, stroke type, time since onset, stroke severity (NIHSS), and ADL (BI). In particular, the uncertainty of acute phase stroke patients was higher compared to other chronic diseases due to time since onset, stroke severity (NIHSS), and ADL (BI). The three factors of stroke severity, time since onset, and age were associated with stroke uncertainty. In patients with high stroke severity (NIHSS 2 or higher), there was an indication that careful explanation and supplementation of information regarding the disease was required and that complicated information, such as disorders caused by the stroke and treatments, should be carefully explained to those 75 years and older (older people) as well as patients who experienced disease onset within less than 1 month

脳血管障害に用いる降圧剤の持続使用による静脈炎発生

静脈炎の発症に関する薬剤別の検討，脳血管障害時に降圧剤として用いているニカルジピンによる静脈炎の検討，脳血管障害に関連する患者要因と静脈炎の発症に関連する検討の3点から文献検討を行った． 脳血管障害患者の急性期における降圧を目的とする治療は，生命にかかわる重要な治療であるが，その時に発生する静脈炎発生時の患者の苦痛の緩和も見逃せない患者へのケアの一つである．重症状況で意識レベルも不安定な時期であるからこそ，丁寧な観察と静脈炎発生予防を心がけ，よりよい看護につなげなければならない．We examined literature in terms of three aspects: onset of phlebitis induced by each drug, phlebitis by nicardipine used as an antihypertensive agent at cerebrovascular disorder, and patients factors associated with cerebrovascular disorder and the onset of phlebitis. Although the treatment for the purpose of the depression in the acute phase of patients with cerebrovascular disorder is vitally important, the alleviation of the distress of patients at the treatment of phlebitis occurrence is also one of the important cares. Careful observation and prevention of phlebitis are necessary for better nursing because it is the time when the patients are seriously ill and their consciousness is unstable

Arginine enriched EN after total gastrectomy

The effects of early enteral arginine-rich nutrition (EAN) were analyzed among patients undergoing curative-intent total gastrectomy for gastric cancer. There were 19 patients in this prospective study, all randomly assigned to either a parenteral nutrition (PN) group or an EAN group for the first seven days after surgery. The EAN group received 1.8-fold greater arginine (10.1 g / day) compared with the PN group, which was administered through an enteral tube inserted into the jejunal loop. Both groups were provided almost identical amounts of total amino acids (54 g / day), and the total energy was set at 65% of the total requirement (25 kcal / kg / day). No significant differences were observed between the two groups in postoperative complications, length of hospital stay, oral intake, nutritional status, or body weight. The serum arginine profile was similar in the two groups, as it decreased significantly on postoperative day (POD) 1, and gradually returned to preoperative levels by POD 7. The nitrogen balance remained negative until POD 7 in the PN group, but turned neutral at POD 7 in the EAN group. While we could not confirm body weight loss improvement, these results suggested that early arginine-rich enteral nutrition could improve the nitrogen balance after total gastrectomy

Proteomics Portrait of Archival Lesions of Chronic Pancreatitis

Chronic pancreatitis is a chronic inflammatory disorder of the pancreas. The etiology is multi-fold, but all lead to progressive scarring and loss of pancreatic function. Early diagnosis is difficult; and the understanding of the molecular events that underlie this progressive disease is limited. In this study, we investigated differential proteins associated with mild and severe chronic pancreatitis in comparison with normal pancreas and pancreatic cancer. Paraffin-embedded formalin-fixed tissues from five well-characterized specimens each of normal pancreas (NL), mild chronic pancreatitis (MCP), severe chronic pancreatitis (SCP) and pancreatic ductal adenocarcinoma (PDAC) were subjected to proteomic analysis using a “label-free” comparative approach. Our results show that the numbers of differential proteins increase substantially with the disease severity, from mild to severe chronic pancreatitis, while the number of dysregulated proteins is highest in pancreatic adenocarcinoma. Important functional groups and biological processes associated with chronic pancreatitis and cancer include acinar cell secretory proteins, pancreatic fibrosis/stellate cell activation, glycoproteins, and inflammatory proteins. Three differential proteins were selected for verification by immunohistochemistry, including collagen 14A1, lumican and versican. Further canonical pathway analysis revealed that acute phase response signal, prothrombin activation pathway, and pancreatic fibrosis/pancreatic stellate cell activation pathway were the most significant pathways involved in chronic pancreatitis, while pathways relating to metabolism were the most significant pathways in pancreatic adenocarcinoma. Our study reveals a group of differentially expressed proteins and the related pathways that may shed light on the pathogenesis of chronic pancreatitis and the common molecular events associated with chronic pancreatitis and pancreatic adenocarcinoma

看護学部学生の国際的活動に関するニーズ調査

　本調査は，本学看護学部学生の国際的活動に関する意識や期待，活動の実態を明らかにし，看護学部における国際的活動の方向性を検討すること，それらの結果をもとに国際的な学びができる学習環境を整えることを目的として実施した．学部1回生83名を対象に無記名の自記式質問紙調査を行った．回収率は42％であった．69％の学生が国際的活動に関心があると回答した．関心がない理由として，「外国に興味がない」，「語学が苦手」，「多忙である」ことがあげられた．本学の全学部生を対象にした海外研修プログラムについて4割が参加を希望した．しかし，説明会については8割が知らず，情報提供の検討が必要であることが明らかになった．参加を希望しない理由には忙しいことが最も多くあげられ，看護学部のカリキュラムを考慮した研修企画のニーズもあることが明らかになった．しかし，経済的負担をあげる者もいた．学内において日常的に異なる文化や外国について知り，体験できる機会を設ける等の国際的活動も意義があることが示唆された

日本における外国人旅行者の被災状況に関する分析～インターネット上で公開されている2018年および2019年に発生した災害の資料より～

　インターネット資料から訪日外国人旅行者の被災体験を明らかにすることを目的に検討した．2018 年および2019 年に発生した地震と風水害に関する8 件の災害を対象とした．検索サイトGoogle にて「災害名」と「外国人旅行者」を検索用語とし，外国人旅行者の被災状況や被災体験に関する記述を分析対象とした．今回の分析から，被災した訪日外国人旅行者には，驚きや不安，怖いといった心理的反応が生じること，災害への対処行動が分からないこと，情報にアクセスできない状況が起こり，それには言語，情報提供や情報量，情報への理解，通信手段の充電や接続に関する課題が関係していたこと，居場所を失うこと，強い疲労が起こり心身の健康が脅かされる状況が明らかになった．外国人旅行者が，言語に加え災害への準備性の面でも情報リテラシーが低い災害時要支援者であることを私たちは十分認識し，平常時において外国人旅行者が理解できる情報提供を検討すること，隣に困っている外国人旅行者がいれば声をかけるなど災害時に現実的にできる外国人対応を心がけること，被災した外国人旅行者の健康面に関しても視点を向け医療体制の備え強化につなげることが必要である

Increased Systemic Glucose Tolerance with Increased Muscle Glucose Uptake in Transgenic Mice Overexpressing RXRγ in Skeletal Muscle

BACKGROUND: Retinoid X receptor (RXR) γ is a nuclear receptor-type transcription factor expressed mostly in skeletal muscle, and regulated by nutritional conditions. Previously, we established transgenic mice overexpressing RXRγ in skeletal muscle (RXRγ mice), which showed lower blood glucose than the control mice. Here we investigated their glucose metabolism. METHODOLOGY/PRINCIPAL FINDINGS: RXRγ mice were subjected to glucose and insulin tolerance tests, and glucose transporter expression levels, hyperinsulinemic-euglycemic clamp and glucose uptake were analyzed. Microarray and bioinformatics analyses were done. The glucose tolerance test revealed higher glucose disposal in RXRγ mice than in control mice, but insulin tolerance test revealed no difference in the insulin-induced hypoglycemic response. In the hyperinsulinemic-euglycemic clamp study, the basal glucose disposal rate was higher in RXRγ mice than in control mice, indicating an insulin-independent increase in glucose uptake. There was no difference in the rate of glucose infusion needed to maintain euglycemia (glucose infusion rate) between the RXRγ and control mice, which is consistent with the result of the insulin tolerance test. Skeletal muscle from RXRγ mice showed increased Glut1 expression, with increased glucose uptake, in an insulin-independent manner. Moreover, we performed in vivo luciferase reporter analysis using Glut1 promoter (Glut1-Luc). Combination of RXRγ and PPARδ resulted in an increase in Glut1-Luc activity in skeletal muscle in vivo. Microarray data showed that RXRγ overexpression increased a diverse set of genes, including glucose metabolism genes, whose promoter contained putative PPAR-binding motifs. CONCLUSIONS/SIGNIFICANCE: Systemic glucose metabolism was increased in transgenic mice overexpressing RXRγ. The enhanced glucose tolerance in RXRγ mice may be mediated at least in part by increased Glut1 in skeletal muscle. These results show the importance of skeletal muscle gene regulation in systemic glucose metabolism. Increasing RXRγ expression may be a novel therapeutic strategy against type 2 diabetes

Indirect energy transfer channel between fast ions via nuclear elastic scattering observed on the large helical device

An energy transfer phenomenon between energetic ions, which cannot be explained only considering the Coulomb scattering process, was observed on a large helical device (LHD). This phenomenon often occurs in fusion reactivity enhancement and fast-ion slowing-down process that can be observed as a delay in the decay time of the D(d,n)3He neutron generation rate. The transferred energy required to induce such a reactivity enhancement or delay in the fast-ion slowing-down time (neutron decay time) was examined based on the Boltzmann−Fokker−Planck analysis in which a discrete energy transfer process, called nuclear elastic scattering (NES), is included. It was shown that even though the cross section of the NES is smaller than that of the Coulomb scattering, enough knock-on population appears in the energetic region in ion distribution function to induce the observable NES effects; thus, enough energy is transferred from beam ions to fast component of bulk ion distribution function indirectly and the transferred energy per unit time via NES is comparable to the Coulomb scattering rate. This study analytically demonstrates that the observed phenomena on LHD can be explained smoothly by considering the alternative indirect energy transfer channel between energetic ions, which can be comparable with the one via Coulomb scattering