Serum High-Sensitivity Cardiac Troponin T Is a Significant Biomarker of Left-Ventricular Diastolic Dysfunction in Subjects with Non-Diabetic Chronic Kidney Disease

Background: Chronic kidney disease (CKD) is associated with left-ventricular (LV) diastolic dysfunction (LVDD) which progresses to diastolic heart failure. However, biomarkers predicting LVDD in patients with CKD are largely unknown. Methods: In 93 patients with non-diabetic CKD, the relationships among echocardiography, high-sensitivity cardiac troponin T (hs-cTnT), B-type natriuretic peptide (BNP), and renal function were evaluated. LV mass index, peak early diastolic mitral filling velocity (E), peak early diastolic mitral annular velocity (E′), and E/E′ were recorded. Results: The E′ values were significantly decreased and E/E′, BNP, and hs-cTnT increased with increasing CKD stage. The CKD patients with LVDD with E′ Conclusions: These data suggest that hs-cTnT may be a useful biomarker of LVDD in non- diabetic CKD patients

A Decreased Level of Serum Soluble Klotho Is an Independent Biomarker Associated with Arterial Stiffness in Patients with Chronic Kidney Disease

Background: Klotho was originally identified in a mutant mouse strain unable to express the gene that consequently showed shortened life spans. In humans, low serum Klotho levels are related to the prevalence of cardiovascular diseases in community-dwelling adults. However, it is unclear whether the serum Klotho levels are associated with signs of vascular dysfunction such as arterial stiffness, a major determinant of prognosis, in human subjects with chronic kidney disease (CKD). Methods: We determined the levels of serum soluble Klotho in 114 patients with CKD using ELISA and investigated the relationship between the level of Klotho and markers of CKD-mineral and bone disorder (CKD-MBD) and various types of vascular dysfunction, including flow-mediated dilatation, a marker of endothelial dysfunction, ankle-brachial pulse wave velocity (baPWV), a marker of arterial stiffness, intima-media thickness (IMT), a marker of atherosclerosis, and the aortic calcification index (ACI), a marker of vascular calcification. Results: The serum Klotho level significantly correlated with the 1,25-dihydroxyvitamin D level and inversely correlated with the parathyroid hormone level and the fractional excretion of phosphate. There were significant decreases in serum Klotho in patients with arterial stiffness defined as baPWV >= 1400 cm/sec, atherosclerosis defined as maximum IMT >= 1.1 mm and vascular calcification scores of ACI>0%. The serum Klotho level was a significant determinant of arterial stiffness, but not endothelial dysfunction, atherosclerosis or vascular calcification, in the multivariate analysis in either metabolic model, the CKD model or the CKD-MBD model. The adjusted odds ratio of serum Klotho for the baPWV was 0.60 (p = 0.0075). Conclusions: Decreases in the serum soluble Klotho levels are independently associated with signs of vascular dysfunction such as arterial stiffness in patients with CKD. Further research exploring whether therapeutic approaches to maintain or elevate the Klotho level could improve arterial stiffness in CKD patients is warranted

Sensitization to alloxan-induced diabetes and pancreatic cell apoptosis in acatalasemic mice

AbstractHuman acatalasemia may be a risk factor for the development of diabetes mellitus. However, the mechanism by which diabetes is induced is still poorly understood. The impact of catalase deficiency on the onset of diabetes has been studied in homozygous acatalasemic mutant mice or control wild-type mice by intraperitoneal injection of diabetogenic alloxan. The incidence of diabetes was higher in acatalasemic mice treated with a high dose (180 mg/kg body weight) of alloxan. A higher dose of alloxan accelerated severe atrophy of pancreatic islets and induced pancreatic β cell apoptosis in acatalasemic mice in comparison to wild-type mice. Catalase activity remained low in the acatalasemic pancreas without the significant compensatory up-regulation of glutathione peroxidase or superoxide dismutase. Furthermore, daily intraperitoneal injection of angiotensin II type 1 (AT1) receptor antagonist telmisartan (0.1 mg/kg body weight) prevented the development of alloxan-induced hyperglycemia in acatalasemic mice. This study suggests that catalase plays a crucial role in the defense against oxidative-stress-mediated pancreatic β cell death in an alloxan-induced diabetes mouse model. Treatment with telmisartan may prevent the onset of alloxan-induced diabetes even under acatalasemic conditions

看護学生のコミュニケーション演習において認知症高齢者を演じた模擬患者の経験

本研究の目的は、認知症高齢者とのコミュニケーションを課題とした演習で、高齢者役をつとめた模擬患者の演習に向けた準備から実施までの一連の過程における経験の内容を明らかにすることである。研究方法は、演習に参加した模擬患者8名に「看護学生との演習や看護学生へのフィードバックを通して感じたこと、考えたことについて」インタビューからデータを得て質的に分析した。結果、〈認知症を演じる不安を乗り越え、経験と学びを生かして演じる〉、〈将来の自分を思い描く〉、〈看護学生との思いの違いを感じる〉、〈看護学生の不安やあせり、失敗を受容する〉、〈看護学生の気づきを拡げる手助けをする〉の5個のカテゴリーで構成されていた。演習に参加した模擬患者の一連の経験は、模擬患者自身の成長や老いと向き合う機会となっているという自分自身に向けた経験と、若い人々の成長に貢献したいという助言者としての役割を果たすという経験であった。Patients\u27 experiences were simulated and investigated from preparation to execution during a practical on “communication with elderly people with dementia.” Interviews were conducted with simulated patients (N=8) that were role played by participants in communication training. Interviews were conducted on simulated feelings of patients and thoughts about role playing with nursing students, as well as on providing feedback. The data were analyzed qualitatively. Results indicated the following categories: (1) overcoming anxiety about playing the role of elderly people with dementia and performing based on experience and learning, (2) imagining the future of oneself, (3) differences in thinking between nursing students and simulated patients, (4) accepting nursing students\u27 anxieties, impatience, and failures, and (5) helping nursing students expand their awareness. It was suggested that the experience of being simulated patients\u27 provided the students with opportunities to develop themselves and helped them face the process of their own aging. Furthermore, this experience was educational because it contributed to the development of the students

模擬患者を活用した高齢者看護学演習に関する文献検討

　高齢者看護学における模擬患者または訓練を受けていない演者(準模擬患者とする)を活用した演習の効果について10件の文献を検討した。結果、両演者の演習の共通点は、リアリティのある演習ができる、高齢者の現実の姿に適合するコミュニケーション技術を獲得するための教育方法になることがわかった。さらに、模擬患者の演習では、症状の表現が難しい認知症事例や、障害をもち生活の不安を抱えた患者を社会背景も含めて演じる事例、継続した患者の過程を再現できる一連の看護過程演習の実施が可能である。加えて、認知症高齢者の世界に寄り添おうとする姿勢を育み、対象を理解する力と個別の援助の工夫と実施ができる効果が得られる。一方準模擬患者の演習は、演者の実年齢が高齢期であれば、自身の体験談を語ることで、身体的機能低下や「死の受容」の発達課題など高齢者の特徴とその人の生き方による個人差があることの理解が深まる。および大勢の演者を準備することが可能であり、その場合は全学生のロールプレイが実施できる

高齢者看護学教育における認知症模擬患者を導入した演習での学び

　本研究の目的は、認知症高齢者の模擬患者を導入した高齢者看護学演習での学生の学びを明らかにし、今後の演習プログラム精錬への示唆を得ることである。看護系短期大学に在籍する2年次生から演習終了後、「演習で学んだこと」に対する回答を得た。調査協力が得られた78名の回答を質的に分析した結果、《高齢者と接する私たちの態度》《コミュニケーションの工夫》《道具の活用・環境づくり》《回避的な対話》の4カテゴリーが抽出された。認知症高齢者と接する際の学生自身の態度や、コミュニケーションを行ううえでの具体的な技術にまで考えがおよび自分の学びとしていた。しかし一方で、認知症模擬患者の帰宅願望や不安を回避するような消極的な対応方法を学びとしてしまう可能性がみられたことから、認知症高齢者がもっている本質的な不安にたちかえるといった演習の振り返りを充実させる必要性があることが示唆された。The purpose of this paper is to sheld light on what students have learned in the nursing seminar for the elderly that uses simulated elderly dementia patients, and to gain pointers on how to refine or improve future seminar programs. After the seminar, the second year students in nursing college were asked to answer the question, "What did you learn in the seminar?" On the basis of the qualitative analysis of the responses from 78 people, I derived the following four categories: 1) "Attitudes of those who are in contact with the elderly," 2)"Communication schemes," 3)"Tool utilization and environment creation," and 4)"Evasive interaction." The categories cover the attitudes of students at the time of contact with elderly dementia patients, as well as their thinking and learning about specific techniques in communication. However, at the same time, it is possible that some students learned about dementia simulated patients, desire to return to their homes and about passive methods for avoiding anxiety. This suggests that a complete review of the seminar is necessary in order to obtain feedback from elderly dementia patients about their inner anxiety

Impact of newly developed, next-generation artificial endocrine pancreas

Background : Recent studies have shown that strict perioperative blood glucose management may reduce mortality and morbidity in critically ill adult patients. The purpose of this study was to assess the accuracy and efficacy of the intraoperative application of a newly developed, next-generation artificial endocrine pancreas (STG-55, Nikkiso Co., Ltd., Tokyo, Japan). Methods : Twenty patients scheduled to undergo surgery were enrolled in this study. The STG-55 is designed to be more user-friendly than its conventional counterpart (STG-22) while maintaining the latter’s fundamental functions, such as a closed-loop system using algorithms for insulin and glucose infusion. After anesthetic induction, a 20G intravenous catheter was inserted into a peripheral forearm vein and connected to a continuous blood glucose monitor. The resultant 105 scores for paired blood glucose values were compared by Bland-Altman analysis. Results : Stable blood glucose values were maintained automatically, and there were no complications related to use of the STG-55. A close correlation (r=0.96) was observed between continuous glucose measurements using the STG-55 and conventional intermittent glucose measurements. The difficulty of manipulation using this system was decreased by improved preparation procedures. Conclusion : The glycemic control system using the STG-55 could provide an alternative way to achieve effective and safe perioperative glycemic control

A Decreased Level of Serum Soluble Klotho Is an Independent Biomarker Associated with Arterial Stiffness in Patients with Chronic Kidney Disease

Abstract Background: Klotho was originally identified in a mutant mouse strain unable to express the gene that consequently showed shortened life spans. In humans, low serum Klotho levels are related to the prevalence of cardiovascular diseases in community-dwelling adults. However, it is unclear whether the serum Klotho levels are associated with signs of vascular dysfunction such as arterial stiffness, a major determinant of prognosis, in human subjects with chronic kidney disease (CKD)