Pre-operative anxiety and nursing care - Through two students'case studies on surgical patients -

手術前の看護は,患者が安全･安楽に手術を受けることができ,術後の回復過程がスムーズにいくように援助することである.その看護の一つとして術前不安の緩和に向けての援助がある。その人の不安レベルに応じた適切な看護援助を行うためには,患者の不安を正しくアセスメントすることが重要になる｡看護学生にとって,患者の不安への理解は,臨床実習の場で,患者を観察したり,患者と向き合って話を交わしたり,ケアを行ったりする体験を通して培われていくものであると思われる｡本論文では,2名の学生が行った術前不安に関する事例研究から,客観的に分析する方法を用いて患者を観察したり, 患者の話を聞いたり,看護行為を行うことによって,術前不安と看護援助の理解が深められることを論述した｡Pre-operative nursing is to care and educate a patient so that he/she can undergo an operation at ease and in safety and recover quickly after surgery. One of the pre-operative nursing is to relieve anxiety. It's very important for pre-operative nursing to assess pre-operative anxiety and do the nursing action according to patient's anxiety level. Nursing student seems to have much understanding of pre-operative anxiety through observing a patient's behavior, talking with a patient, and caring a patient in clinical practice. Two students'case studies on surgical patients are presented in this paper. This paper shows how they promote deeper understanding of pre-operative anxiety and the nursing care is promoted by observing the patient and listening objectively to what the patient says and giving appropriate feedback

Assessment of Demineralization Inhibition Effects of Dentin Desensitizers Using Swept-Source Optical Coherence Tomography

The purpose of this study was to evaluate the mechanism of action and the inhibiting effects of two types of desensitizers against dentin demineralization using pre-demineralized hypersensitivity tooth model in vitro. In this study, we confirmed that a hypersensitivity tooth model from our preliminary experiment could be prepared by immersing dentin discs in an acetic acid-based solution with pH 5.0 for three days. Dentin discs with three days of demineralization were prepared and applied by one of the desensitizers containing calcium fluoro-alumino-silicate glass (Nanoseal, NS) or fluoro-zinc-silicate glass (Caredyne Shield, CS), followed by an additional three days of demineralization. Dentin discs for three days of demineralization (de3) and six days of demineralization (de6) without the desensitizers were also prepared. The dentin discs after the experimental protocol were scanned using swept-source optical coherence tomography (SS-OCT) to image the cross-sectional (2D) view of the samples and evaluate the SS-OCT signal. The signal intensity profiles of SS-OCT from the region of interest of 300, 500, and 700 mu m in depth were obtained to calculate the integrated signal intensity and signal attenuation coefficient. The morphological differences and remaining chemical elements of the dentin discs were also analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy. SS-OCT images of CS and NS groups showed no obvious differences between the groups. However, SS-OCT signal profiles for both the CS and NS groups showed smaller attenuation coefficients and larger integrated signal intensities than those of the de6 group. Reactional deposits of the desensitizers even after the additional three days of demineralization were observed on the dentin surface in NS group, whereas remnants containing Zn were detected within the dentinal tubules in CS group. Consequently, both CS and NS groups showed inhibition effects against the additional three days of demineralization in this study. Our findings demonstrate that SS-OCT signal analysis can be used to monitor the dentin demineralization and inhibition effects of desensitizers against dentin demineralization in vitro

Targeted deletion of the C-terminus of the mouse adenomatous polyposis coli tumor suppressor results in neurologic phenotypes related to schizophrenia

Background: Loss of adenomatous polyposis coli (APC) gene function results in constitutive activation of the canonical Wnt pathway and represents the main initiating and rate-limiting event in colorectal tumorigenesis. APC is likely to participate in a wide spectrum of biological functions via its different functional domains and is abundantly expressed in the brain as well as in peripheral tissues. However, the neuronal function of APC is poorly understood. To investigate the functional role of Apc in the central nervous system, we analyzed the neurological phenotypes of Apc 1638T/1638T mice, which carry a targeted deletion of the 3′ terminal third of Apc that does not affect Wnt signaling. Results: A series of behavioral tests revealed a working memory deficit, increased locomotor activity, reduced anxiety-related behavior, and mildly decreased social interaction in Apc 1638T/1638T mice. Apc 1638T/1638T mice showed abnormal morphology of the dendritic spines and impaired long-term potentiation of synaptic transmission in the hippocampal CA1 region. Moreover, Apc 1638T/1638T mice showed abnormal dopamine and serotonin distribution in the brain. Some of these behavioral and neuronal phenotypes are related to symptoms and endophenotypes of schizophrenia. Conclusions: Our results demonstrate that the C-terminus of the Apc tumor suppressor plays a critical role in cognitive and neuropsychiatric functioning. This finding suggests a potential functional link between the C-terminus of APC and pathologies of the central nervous system

精神科病院入院患者における身体合併症発症のハイリスク群のスクリーニング

摂食・嚥下機能と排尿機能、肥満度の調査により、身体合併症発症のハイリスク状態の患者をスクリーニングし、実態を把握すると共に、予防的取り組みについて考察することを目的とした。A県内にある公立精神科病院に入院中もしくはデイケアに通所中の精神疾患患者93名のスクリーニングを実施した。反復唾液嚥下テストにおいて、嚥下障害が強く疑われた患者は89名中14名（15.7％）であった。尿排出困難が強く疑われた患者は82名中44名（53.7％）であり、向精神薬の影響が考えられた。肥満者は92名中44名（47.8％）、ウエスト周囲径が男性85cm以上・女性90cm以上だった割合は、85名中64名（75.3％）であり、上半身肥満体型が多いことが示唆された。また、糖尿病が強く疑われる割合は、57名中13名（22.8％）という結果であった

Fluorescence imaging of ATP in neutrophils from patients with sepsis using organelle-localizable fluorescent chemosensors

Background: The activation of polymorphonuclear neutrophils (PMNs) plays an important role in sepsis. Previously, we showed that ATP release and feedback via ATP receptors are essential for PMN activation; however, the dynamics remain poorly understood. Two new fluorescent chemosensors, PMAP-1 and MitoAP-1, were developed to detect ATP in the plasma membrane and mitochondria of living cells, respectively. In this study, we aimed to evaluate ATP localization using these chemosensors in PMNs of sepsis patients. Methods: Live PMNs isolated from 16 sepsis patients and healthy controls (HCs) were stained with these chemosensors and observed by confocal microscopy, and their mean fluorescence intensities (MFIs) were evaluated using flow cytometry. CD11b expression in PMNs was also evaluated. Results: The MFIs of PMAP-1 and MitoAP-1 and CD11b expression in PMNs from sepsis patients on days 0–1 were significantly higher than those of HCs. The MFI of PMAP-1 and CD11b expression on days 3–4 decreased significantly compared to those observed at days 0–1, whereas MitoAP-1 MFI was maintained at a high level. The PMAP-1 MFI was significantly positively correlated with CD11b expression, white blood cell counts, neutrophil counts, and C-reactive protein levels in patients. Conclusions: The higher MFIs of PMAP-1 and MitoAP-1 in sepsis patients suggest a pivotal role of ATP for PMN activation. The temporal difference in ATP levels suggests that ATP plays different roles in the mitochondria and on the cell surface. These data should contribute to the understanding of the dynamics of ATP in PMNs and help to develop a novel therapy for sepsis