【目的】団塊の世代が80 歳を超える2030 年前後から我が国は急激に死亡数が増加する。したがって End-of-Life Care （EOLC）の在り方を考えることが、社会として喫緊の課題になっており、また現在議論されているAdvance Care ...Planning（ACP）を進めるためにも不可欠である。この議論のためには、モデルとなる事例があることが望ましい。そこで、本研究では国内4自治体の医療レセプト、介護レセプトを用いて、徐脈性不整脈（心停止）で急性期病院に入院した患者の特性について検討を行った。【資料及び分析方法】分析に用いたデータは国内4自治体の2011年4月から2018年3月までの間に一般病床（結核病棟を除く）及び療養病床に徐脈性不整脈に相当する病名で入院した65歳以上患者の医科レセプトおよび介護レセプトである。一般病床および療養病床に当該病名で入院した月の当月と前月に介護保険サービスの利用がある者を本研究では対象者と定義した。これらの対象者について入院前1年間、入院後1年間の医療介護サービスの利用状況及び傷病の状況を、個人単位で医療・介護レセプトを連結したデータベースで把握し分析を行った。【結果】観察期間中に入院前後それぞれ1年間を追跡できた症例は15,147件で、平均年齢は85.5歳（標準偏差7.3歳）、女性割合は56.8％であった。死亡者の割合は65.3％で、52.0％が入院当月に死亡していた。入院当月を見ると一般病棟に74.8%が入院している。一般病棟入院前の所在を1か月前でみると施設介護サービスを受けていた者は17％程度であった。また、訪問診療を受けていた者が17.4％と多かった。1か月前の傷病の有病率をみると心不全が45.6%と最も多くなっていた。肺炎は11.4%、誤嚥性肺炎は4.5%であった。【考察】ターミナル期にある高齢患者が心停止となり、病院に搬送され心肺蘇生を受けるも50％が死亡退院であり、また65％が1年以内に亡くなっている状況は尊厳ある死という観点から考えたとき、このような医療の在り方は必ずしも本人の望むものではないだろう。このような状況を回避するためにもACPの実践が必要であると考えられ、そのプロセスに入るトリガーとなるイベントについて明らかにしていくことが今後の課題である。
We propose that specific osteocyte-matrix interactions regulate the volume-sensitive calcium influx pathway, which we have shown is mediated by stretch-activated cation channels (SA-Cat) and is ...essential for the stretch-activated anabolic response in bone. The current study measured the hypotonic swelling-induced increase in cytosolic calcium concentration, Ca(2+)(i), in rat osteocytes, and found that cells adherent to different matrices behave differently. Osteopontin and vitronectin, matrix molecules that bind the alpha(V)beta(3) integrin, induced larger responses to the hypotonic swelling than other matrix molecules that bind other integrins. Addition of echistatin, which is a soluble alpha(V)beta(3) ligand, significantly enhanced the hypotonic Ca(2+)(i) increase in addition to inducing an immediate increase in Ca(2+)(i) by itself. These results strongly support the contention that alpha(V)beta(3) integrin signaling in osteocytes interacts with that in mechanotransduction, which is downstream of SA-Cat.
Although sleep disturbance is a major public health problem in the elderly, few studies have examined the association between sleep disturbance and other related factors in Japan. We examined ...correlates of sleep disturbance among Japanese elderly. Participants in this cross-sectional study (255 men and 263 women) were those enrolled in a population-based health examination for 65 year-old residents in N City, Japan in 1996 and 1997. Epidemiological data were collected by a self-administered questionnaire. Sleep disturbances were assessed by three common symptoms: difficulty in falling asleep, frequent awakening at night and not feeling rested in the morning. The mean sleep duration was longer in men than in women (7.2 vs 6.8 h,
P<0.01), and women reported difficulty in falling asleep more frequently than men (22.4 vs 15.3%,
P<0.05). Sleep disturbances were associated with low educational attainment, retirement from work, higher body mass index (BMI), irregular bedtime, history of cardiovascular disease, arthritis or joint pain and prostatic hypertrophy, and lower subjective well-being in men, and the use of sleeping pills and depression in both genders, but not with marital status, residential status, smoking habits, exercise, limited instrumental activity of daily living, and past episode of such chronic diseases as hypertension and stroke. Our study suggests a close association of sleep disturbances among elderly Japanese with several medical/psychiatric health problems that are usually more prevalent in such an age group. Our findings emphasize the realistic need for clinicians to take underlying health problems into consideration when their patients complain of sleep-related symptoms.
InxGa1−xSb bulk crystal was grown using a GaSb (seed)/InSb/GaSb (feed) sandwich-structured system onboard the International Space Station (ISS). In order to investigate the transport phenomena ...especially in terms of interface shapes and dissolution heights, the dissolution process was simulated under a micro-gravity level of the ISS. Simulation results showed that the seed/melt interface was concave towards the seed due to the temperature distribution of the system. This prediction is in good agreement with the results of our previous experimental study.
When transformed cells were co-cultured with various densities of non-transformed BALB/c 3T3 A31-1-1 cells, the number of transformed cell foci decreased as the density of the A31-1-1 cells was ...increased. Under the condition of separate co-cultivation in which transformed cloned cells could not make contact with A31-1-1 cells, no inhibitory effect was induced. We examined with a dye-transfer assay the formation of heterologous gap-junctional intercellular communication (GJIC), links between the transformed cells and A31-1-1 cells before and after focus formation. Heterologous GJIC was observed almost always before, but almost never after, focus formation. Using time-lapse photography to record the fate of transformed cloned cells that did not form foci in the co-cultivation, it was noted that most of them were living, but did not proliferate. These results suggested that focus formation of transformed cloned cells was inhibited by contact with non-transformed A31-1-1 cells.
Of many classical t-complex lethal mutations, t^w5 is especially interesting because homozygous embryos die at the gastrulation stage when cell-cell interactions play salient roles. As a first step ...to understand the function of t^w5 mutation, we tried to determine the primary site of t^w5 gene action. To this end, we employed a histological study of homozygous embryos at E4.5 to E7.5 and analysis of t^w5 /t^w5 cell allocation in E6.5 aggregation chimeras. Homozygous embryos already smaller than their littermates by E6.5 were characterized by extensive death of embryonic ectoderm cells at E6.5 though phenotypes varied considerably among embryos. The extraembryonic ectoderm and visceral endoderm were much less affected in these embryos. The visceral embryonic endoderm in presumptive t^w5 /t^w5 embryos at E5.5 was unique in that individual cells contained smaller and less vacuoles. β-gal positive t^w5 /t^w5 cells were mostly restricted to the embryonic ectoderm in presumptive +/+ ⇔ t^w5 /t^w5 chimeras at E6.5. Homozygous cells were never detected in the extraembryonic ectoderm but they were occasionally found in the extraembryonic part of the visceral endoderm. Thus, it is likely that t^w5 mutation first affected nonepiblasts rather than epiblast cells. If so, extensive damages characterizing t^w5 /t^w5 epiblast at E6.5 should be induced secondarily by functionally abnormal nonepiblast tissues.
There is no direct evidence as to whether antiplatelet therapy should be discontinued or not when patients with cerebrovascular diseases undergo surgery or invasive examinations. We therefore ...examined the platelet aggregability as a marker for determining the adequate period to discontinue the antiplatelet agents. 22 patients who underwent surgery or examination were discontinued on antiplatelet agents (9 patients on aspirin and 13 patients on ticlopidine) for 14 days before the operation. The aggregability in the aspirin group was significantly increased on the 3rd day as compared to that before the discontinuance (14.0±8.5% vs. 48.1±31.2%; p<0.05). The aggregability in the ticlopidine group was significantly increased on the 14th day (19.5±11.4% vs. 58.4±30.8%; p<0.05). We conclude that it is desirable to pause aspirin for 3 days and ticlopidine for 2 weeks, in terms of the platelet aggregability.
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