The Tohoku journal of experimental medicine
-
Tohoku J. Exp. Med. · Jan 2020
Absence of Relatives Impairs the Approach of Nurses to Cardiopulmonary Resuscitation in Non-Cancer Elderly Patients without a Do-Not-Attempt-Resuscitation Order: A Vignette-Based Questionnaire Study.
A Do-Not-Attempt-Resuscitation (DNAR) order solely precludes performing cardiopulmonary resuscitation (CPR) following cardiopulmonary arrest. A patient's personal status is known to influence a range of clinical practices, not only CPR, when a DNAR order is given. We assessed whether the absence of supporting relatives or a diagnosis of dementia can influence nurses' perceptions of clinical practices for elderly patients with non-malignant and chronic diseases. ⋯ No significant differences were observed between the dementia and control vignettes. Absence of contactable relatives and resultant lack of communication can diminish the perception of nurses regarding the provision of CPR, even when a DNAR does not exist. This result suggests a necessity for comprehensive training all medical staff about issuance of DNAR orders and what care should be provided thereafter.
-
Tohoku J. Exp. Med. · Jan 2020
ReviewEndometrial Immunity for Embryo Implantation and Pregnancy Establishment.
The uterus is an organ for raising the fetus, and its lumen is lined by the endometrium. The endometrium is an important site for the implantation and maturation of fertilized eggs. The endometrium undergoes repetitive proliferation, maturation (decidualization), and exfoliation changes every menstrual cycle. ⋯ Immunity for the establishment of pregnancy is not simple because multiple immunocompetent cells are involved in establishing and maintaining pregnancy. To understand the immune mechanisms associated with the establishment of pregnancy, we have to learn about each immune cell. This review, therefore, discusses the roles and distribution of the immunocompetent cells inside the uterus during menstruation and early pregnancy.
-
Tohoku J. Exp. Med. · Jan 2020
Case ReportsAn Early-Onset Neuronopathic Form of Acid Sphingomyelinase Deficiency: A SMPD1 p.C133Y Mutation in the Saposin Domain of Acid Sphingomyelinase.
Acid sphingomyelinase (ASM) is a lysosomal hydrolase that degrades sphingomyelin into ceramide and phosphocholine. Recent crystallographic studies revealed the functional role of the N-terminal ASM saposin domain. ASM deficiency due to mutations in the ASM-encoding sphingomyelin phosphodiesterase 1 (SMPD1) gene causes an autosomal recessive sphingolipid-storage disorder, known as Niemann-Pick disease Type A (NPA) or Type B (NPB). ⋯ These results suggest that the proper three-dimensional structure of saposin domain may be essential for ASM catalytic activity. Thus, p. C133Y is associated with complete loss of ASM activity even with stable protein expression and proper subcellular localization.
-
Tohoku J. Exp. Med. · Jan 2020
Clinical TrialIncremental Shuttle Walk Distance as an Indicator for Functional Exercise Capacity of Pre-Surgical Patients with Nontuberculous Mycobacterial Lung Disease.
The incidence of nontuberculous mycobacterial lung disease (NTMLD) is increasing worldwide, the number of lung surgeries is increasing accordingly. The disease is progressive and is characterized by exertional intolerance, respiratory dysfunctions, and impaired health-related quality of life (HRQOL). Treatment comprises multidrug antibiotic treatment combined with lung resection. ⋯ HRQOL assessed by SGRQ scores was correlated with ISWD (r < -0.4, p < 0.05). Multiple regression analysis showed that ISWD was significantly associated with leg muscle strength and with HRQOL. In conclusion, ISWD is useful to evaluate the exercise capacity among pre-surgical patients with NTMLD.
-
Tohoku J. Exp. Med. · Jan 2020
A Nationwide Survey of Obstetric Care Status on Japan's Islands, with Special Reference to Maternal Transport to the Mainland.
Safe obstetric care is a worldwide requirement. In Japan, a reduced number of obstetricians has prompted the centralization of obstetric facilities, and Japan's islands are expected to experience problems in handling deliveries. Although many pregnant women "move" to the mainland at later gestational weeks, "transport" from the island to the mainland may be occasionally needed when disorders manifest before the "move." Other women plan within-island deliveries; however, transport is required when complications arise. ⋯ Transport was mainly in response to threatened preterm labor. Adverse weather was the most frequent factor affecting transport reliability. Our findings may contribute to a more detailed understanding of the state of obstetric care on Japan's islands.