Kobe Journal of Medical Sciences最新文献

Eicosanoid modulation by butyrate has been reported in various cells and conditions. Recently, comprehensive analyses of lipid mediators using liquid chromatography/tandem mass spectrometry has been reported. We hypothesized that tributyrin, a prodrug of butyrate, may attenuate LPS-induced liver injury in rats by suppressing the production of pro-inflammatory lipid mediators and/or by inducing anti-inflammatory specialized proresolving mediators. To test this, groups of Wistar rats were orally administered tributyrin (1 g/kg body weight) or vehicle 1 h before intraperitoneal injection of LPS. The livers were collected at 0, 1.5, 6, and 24 h later and analyzed: lipid mediators were profiled by liquid chromatography/tandem mass spectrometry; expression of cyclooxygenase-2, 5-lipoxygenase (LOX), 12/15-LOX, and leukotriene (LT) A₄ hydrolase, and nuclear translocation of 5-LOX were evaluated by western blot analysis; and induction of liver injury was assessed by immunostaining for 8-hydroxy-2'-deoxyguanosine, an indicator of oxidative DNA damage. We found that tributyrin treatment attenuated LPS-induced production of pro-inflammatory LTB₄ (p < 0.05) and decreased oxidative stress levels in the liver. Tributyrin also attenuated the nuclear translocation of 5-LOX in response to LPS, suggesting a possible mechanism for the LTB₄ reduction. LPS-induced changes in other lipid mediators were not significantly affected by tributyrin treatment up to 24 h after LPS injection. Our results suggest that oral tributyrin administration protects against endotoxemia-associated liver damage by reducing production of the pro-inflammatory eicosanoid LTB₄.

Aim: Effective intervention is necessary for improving the social functioning of patients with severe mental illness (SMI). We examined the effects of home-visit occupational therapy (OT) using a Management Tool for Daily Life Performance (MTDLP) that was designed to support patients in completing their desired daily life activities. The control group were treated by home-visit OT without using MTDLP.

Method: In this multicenter randomized controlled trial, 60 participants included adults aged 18-65 with an ICD-10 diagnosis of F2 (i.e., schizophrenia, schizotypal and delusional disorders) or F3 (i.e., mood [affective] disorders) and who utilized one of the 20 psychiatric outreach teams in Japan. Participants were randomly assigned into two groups: MTDLP (n = 29), control (n = 31). Home-visit OT was provided to both groups, once a week, for four months. A repeated-measures analysis of variance was conducted to compare changes in participants' social functioning using the Global Assessment of Functioning (GAF) and the Social Functioning Scale (SFS).

Results: The GAF scores of the MTDLP group improved significantly greater than those of the control group. No significant change in SFS total scores was found between the groups; however, the Employment/Occupation scores (an SFS subscale) of the MTDLP group significantly improved compared to the controls.

Conclusion: These findings suggest that MTDLP can increase the social functioning of people with SMI more so than controls. Thus, home-visit OT using MTDLP that is intensively focused on the patient's desires and implemented in the real-world environment appears to contribute to improvements in social functioning.

Few studies have focused on the inhalation instruction in pharmacies which have the crucial role on the inhalation instruction. The aim of this study is to evaluate the level of knowledge and the degree of interest for asthma inhalation instruction methods among pharmacists receiving prescription from clinics. We conducted questionnaire surveys to chief pharmacists of 39 consecutive pharmacies belonging to HANSHIN Dispensing Pharmacy in Hyogo, Japan at July 2011. We obtained valid responses from 35 pharmacies. Among them, 14 pharmacies dealt with prescriptions mainly from the clinics (clinic pharmacies) and 21 pharmacies dealt with prescriptions originated from hospitals (hospital pharmacies), including 13 pharmacies that dealt with prescription filled by respiratory physicians (specialty hospital pharmacies). Although the inhalation instruction at the first visit was provided at every pharmacy, only 54.3% of all pharmacies provided inhalation instructions after the second visit. Compared to 0% of the clinic pharmacies, 40% of the specialty hospital pharmacies visually checked the patient's inhalation procedure after the second visit. Visual confirmation of the inhalation technique, especially in the clinic pharmacies, might play an important role in maintaining treatment adherence.

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) causes severe pain that cannot be controlled well by common analgesic drugs. This is a first case report of intractable mandibular pain due to ARONJ that was eliminated by a continuous mandibular nerve block. A 72-year-old woman with osteoporosis had been administered bisphosphonate. One year after extraction of her tooth, she was diagnosed as having ARONJ. Jaw pain was so severe that she was unable to open her mouth and eat. We performed a continuous mandibular nerve block through an indwelling catheter with levobupivacaine for pain management. After the procedure, her rest pain was markedly improved, and the pain induced by opening her mouth disappeared. We conclude that a continuous mandibular nerve block may be helpful in the management of ARONJ.

Macropinocytosis is a highly conserved cellular process of endocytosis by which extracellular fluid and nutrients are taken up into cells through large, heterogeneous vesicles known as macropinosomes. Growth factors such as epidermal growth factor (EGF) can induce macropinocytosis in many types of cells, although precise mechanism underlying EGF-induced macropinocytosis remains unclear. In the present studies we have shown the involvement of S1P signaling in EGF-induced macropinocytosis in COS7 cells. First, EGF-induced macropinocytosis was strongly impaired in sphingosine kinase isozymes, SphK1 or SphK2-depleted cells, which was completely rescued by the expression of the corresponding wild-type isozyme but not the catalytically inactive one, suggesting the involvement of sphingosine 1-phosphate (S1P) in this phenomenon. Next, we observed that EGF-induced macropinocytosis was strongly inhibited in S1P type 1 receptor (S1P1R)-knockdown cells, implying involvement of S1P1R in this event. Furthermore, we could successfully demonstrate EGF-induced trans-activation of S1P1R using one-molecular fluorescence resonance energy transfer (FRET) technique. Moreover, for EGF-induced Rac1 activation, a step essential to F-actin formation and subsequent macropinocytosis, S1P signaling is required for its full activation, as judged by FRET analysis. These findings indicate that growth factors such as EGF utilize receptor-mediated S1P signaling for the regulation of macropinocytosis to fulfil vital cell activity.

Background: Cigarette smoking is known to be a significant risk factor associated with non-alcoholic fatty liver disease (NAFLD). We aimed to examine the association between smoking status and the severity of fatty liver with regard to sex and smoking cessation.

Methods: In total, 13,466 subjects (6,642 males and 6,824 females) who had undergone abdominal ultrasonography for health check-up, multivariable logistic regression analysis was retrospectively conducted to assess the association between smoking status and the prevalence of NAFLD stratified by sex after adjusting for other potential confounders.

Results: Male sex (odds ratio [OR] 3.27, 95% confidence interval [CI] 3.00-3.57) and smoking history (former smoker: OR 1.23, 95% CI 1.10-1.38, current smoker: OR 1.31, 95% CI 1.17-1.47) were significantly associated with NAFLD. In males with a smoking history, an increased pack-year was strongly associated with the prevalence and severity of NAFLD (prevalence of moderate to severe fatty liver: Pack-year from 0.01 to 9.99, 21.3%; Pack-year from 10.00 to 19.99, 27.2%; Pack-year ≥20.00, 33.7%; P<0.0001), although the prevalence of moderate to severe fatty liver was inversely associated with the duration of smoking cessation (more than 10 years vs. within 5 years, OR 0.71, 95% CI 0.53-0.96). In female subjects, light current smoking was negatively associated with NAFLD (current smoker with a pack-year from 0.01 to 9.99 vs. never smoker, OR 0.41, 95% CI 0.19-0.76).

Conclusions: Smoking status and pack-year were strongly associated with the prevalence and severity of NAFLD, especially in Japanese males. However, smoking cessation improved NAFLD in this population.

Patients with chronic obstructive pulmonary disease (COPD) need to maintain proper eating behavior in order to maintain muscle mass and prevent weight loss. In this study, we measured the effects of a support program on patient attitude, social influences, and self-efficacy and aimed to positively change their dietary behavior. We recruited male patients from two Japanese outpatient clinics and assigned each to an intervention or a control group. The intervention group participated in a support program and was assisted in acquiring knowledge and skills related to adopting and maintaining suitable eating behavior. Data were gathered through medical records, patient interviews, self-assessment questionnaires, and anthropometric measurements. The follow-up period was approximately 15 weeks. The final sample comprised 22 participants, with 11 each in the intervention and control groups. In the intervention group, the body weight was maintained. However, there were statistically significant improvements in energy intake and dietary measures such as eating fresh foods, compared with the control group. The intervention was observed to increase both meal suitability and energy intake among participants. Future support programs should also incorporate participants' physical activity levels, and the effects should be studied over a longer period.

We report the case of a 37-year-old male with autism spectrum disorder who was hospitalized for chronic elbow dislocation. He had suffered a posterior elbow dislocation 5 months ago. His elbow dislocation was easily reduced, but the reduction position could not be maintained. Severe varus and valgus instabilities were observed in his right elbow. He was diagnosed with chronic elbow dislocation due to bilateral collateral ligament dysfunction and was surgically treated. Bilateral ligament reconstruction using the bilateral palmaris longus (PL) tendon combined with a temporary ulnohumeral joint fixation was performed. Cast immobilization was applied for 6 weeks. One year after surgery, his range of motion was -15° in extension, 140° in flexion, 80° in pronation, and 90° in supination. He did not face any problems in daily activities.

We aimed to evaluate the risk factors for febrile urinary tract infection (fUTI) following ureterorenoscopic lithotripsy (URSL) for upper urinary tract stones. We retrospectively reviewed the data of 109 patients with upper urinary tract stones who underwent URSL at our hospital from October 2016 to March 2019. We divided the patients into two groups: those who developed fUTI after URSL (fUTI group) and those who did not (non-fUTI group). The retrospectively collected data, including age, sex, body mass index (BMI), mobility, diabetes mellitus, operative duration, preoperative ureteral stent placement, number of stones, stone diameter, CT value of stone, stone location, preoperative UTI, preoperative urine culture, preoperative pyelonephritis, and stone-free status were compared between the two groups. Postoperative fUTI occurred in three of the 109 patients (2.8%). Comparing the two groups, a significant risk factor for developing fUTI after URSL was a low BMI. However, in our study, only three cases developed fUTI after URSL; thus, a multivariate analysis could not be performed. One of the three cases in which fUTI occurred was accompanied by anorexia nervosa and an extremely low BMI of 11 kg/m². In summary, even though we had only 3 fUTI patients and did not perform multivariate analysis, our data suggested a significant risk factor for developing fUTI was a low BMI. Increasing the sample size, and further study seem desirable.

This literature review explored the factors promoting interprofessional collaborative practice for the child maltreatment prevention in Japan. We searched the Japanese database of ICHUSHI-web, focusing on studies published between 1990 and 2015. The studies were examined for methodological quality using the critical appraisal checklists. We initially identified 161 articles and finally selected eight studies that met the selection criteria and were analyzed. The Collaborative Practice Circle based on the Interprofessional Education for Collaborative Patient-Centered Practice framework, was used as a conceptual framework to analyze the data and to discuss the review findings. Data analysis continued until categories were saturated using content analysis. Five categories as interactional factors, two categories as organizational factors and three categories as systemic factors were identified. The findings revealed that interactional factors were composed of practical competencies and experiences of professionals. Our findings also indicate that educational programs for improving practical competencies of professionals at the individual level and establishing a system of training and human resource development at the organizational level are required. Further research is warranted to examine the impact the challenges outlined in the interactional factors, the organizational interventions and support for clients.