Identification of illness representational patterns and examining differences of self-care behavior in the patterns in chronic kidney disease.

Self-care behavior is considered important for preventing the progression of chronic kidney disease (CKD). Although lifestyle interventions are popular, they have not been sufficiently effective. According to studies on other chronic diseases, illness representation has been found to formulate a pattern, and self-care behavior could differ depending on the pattern, which suggests difference in self-care behavior based on illness representation. This study examined what kind of illness representational patterns exist among CKD patients and whether there is a difference in self-care behavior depending on the pattern. A survey was conducted from the beginning of June to the end of October 2019 on 274 CKD patients who were either outpatients or hospitalized at general hospitals in Western Japan. The Illness Perception Questionnaire-Revised was used to assess illness representation and the Japanese Chronic Kidney Disease Self-Care scale was used to assess self-care behavior. Two-stage cluster analysis was used to identify clusters. Cluster features were examined using analysis of variance and Tukey HSD tests. Differences in self-care behavior scores among identified clusters were investigated. Two hundred and forty-four questionnaires were received, and 212 were analyzed. Participants were aged 64.9±12.9, and the estimated glomerular filtration rate was 33.7±15.8. Three clusters were identified: Cluster 1 represented the difficulty of making sense of the changed condition caused by the disease and easily falling into misunderstanding; Cluster 2 represented patients with disease conditions that impacted their daily life and emotional responses; Cluster 3 represented the controllability and understandability of the disease. Total self-care behavior scores indicated a significant difference between Cluster 1 (52.1 ± 9.7) and Cluster 3 (57.7 ± 8.2). In conclusion, we showed that three representational patterns exist among CKD patients. In addition, a difference was found in self-care behavior depending on the illness representational pattern, suggesting the need to focus on illness representation.

Comparison of serum sIL-2R and LDH levels in patients with intravascular large B-cell lymphoma and patients with advanced stage diffuse large B-cell lymphoma.

Intravascular large B-cell lymphoma (IVL) is a rare type of lymphoma characterized by tumor growth selectively within the vessels. The 5th edition of the World Health Organization classification defines IVL as a large B-cell lymphoma, the same as diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS). Since the clinical manifestations of IVL are nonspecific, the diagnosis is time-consuming, and the course is often fatal. Serum soluble interleukin-2 receptor (sIL-2R) and serum lactate dehydrogenase (LDH) levels are known to be elevated in a variety of lymphomas. However, the mechanism of sIL-2R elevation in B-cell lymphomas is not fully understood. In this study, we analyzed the serum level of laboratory findings, including sIL-2R and LDH, as well as the presence of B symptoms in 39 patients with IVL, and compared them with 56 patients with stage IV DLBCL. Both sIL-2R and LDH levels were significantly higher in IVL than in DLBCL (p = 0.035 and p = 0.002, respectively). In IVL, there were no significant differences in both sIL-2R and LDH levels between patients with and without B symptoms (p = 0.206 and p = 0.441, respectively). However, in DLBCL, both sIL-2R and LDH levels were significantly higher in the presence of B symptoms (p = 0.001 and p < 0.001, respectively). The high sIL-2R and LDH levels in IVL may be related to the peripheral blood microenvironment, but further studies are needed to verify this.

Health-Related Quality of Life in Patients on Home Oxygen Therapy with Telemonitoring.

Home oxygen therapy (HOT) is an important treatment for patients with chronic respiratory diseases. Recently, telemonitoring of HOT has been become available. In the present study, we examined whether telemonitoring of HOT could improve health-related quality of life (HRQOL). Twelve patients receiving HOT participated in this study. The oxygen flow rates, use of the oxygen concentrator, and the values of percutaneous arterial oxygen saturation measured by each patient with a pulse oximeter were checked using a telemonitoring system for a period of one month. Interventions based on the results obtained were carried out in order to optimize oxygen use in this patient cohort. We evaluated the results of the SF-36 questionnaire before the initiation of telemonitoring and at 3 months after completion of the study. We identified significant improvements in SF-36 sub-scores after completion of this intervention. We conclude that telemonitoring may be a useful method to improve HRQOL.

A Multifaceted Evaluation on the Penetration Resistance of Protective Clothing Fabrics against Viral Liquid Drops without Pressure.

Healthcare workers should wear appropriate personal protective clothing (PPC) on assuming the risk of exposure to various pathogens. Therefore, it is important to understand PPC performance against pathogen penetration. Currently, standard methods to evaluate and classify the penetration resistance of PPC fabrics with pressure using synthetic blood or phi-X174 phage have been established by the International Organization for Standardization (ISO). However, the penetration of viral liquid drops (VLDrop) on the PPC without pressure is also a major exposure route and more realistic, necessitating further studies. Here, we evaluated the penetration resistance against VLDrop without pressure using phi-X174 phage on woven and nonwoven fabrics of commercially available PPC classified by the ISO, and analyzed in detail the penetration behaviors of VLDrop by quantifying the phage amounts in leak-through and migration into test fabrics. Our results showed that some nonwoven test fabrics had nearly the same penetration resistance against VLDrop, even if the ISO resistance class differed. Furthermore, the results revealed that the amount of leakage through the fabrics was correlated with the migration amount into the fabric, which was related to fluid-repellency of fabrics, suggesting the effectiveness for penetration resistance. Our study may facilitate more appropriate selection for PPC against pathogen penetration.

Increased adhesion of methicillin-resistant Staphylococcus aureus to the surface of personal protective clothing damaged by friction during nursing action.

BACKGROUND: Health care workers wear protective clothing when caring for patients with infectious diseases. However, during the action of patient care, the generated contact pressure may damage the surface of the protective clothing. METHODS: Fabrics of protective clothing were damaged by a machine using a force similar to the contact pressure that occurs during nursing care. A total of 50 µL of blood containing methicillin-resistant Staphylococcus aureus (MRSA) (5 × 106 colony-forming units/mL) was dropped onto the pressed or rubbed fabrics. After removing the blood, the residual bacterial count on the surface of the clothing was measured. RESULTS: In the undamaged fabrics, the number of adherent MRSA was significantly higher on class 6 protective clothing than on the other tested clothing. The number of adherent MRSA significantly increased on the rubbed surgical gown and rubbed class 3 protective clothing than on the undamaged clothing. CONCLUSIONS: Because the damaged fabrics of protective clothing may cause bacterial carryover, health care workers should pay attention to preventing self-contamination when doffing the protective clothing.

Potential Risk of Virus Carryover by Fabrics of Personal Protective Gowns.

Personal protective gowns and coveralls are classified based on barrier efficiency that validates protection from fluid penetration under certain pressures. Materials standardized in this system have been found suitable for emergency medical practices confronting highly contagious diseases. Nevertheless, adhesion of blood, and body fluids from virus-infected patients to the surface of protective clothing still imposes a risk of pathogen transmission in the process of doffing, or undressing. We performed a small-scale experiment to test the possibility of infectious virus carryover on the surface of different fabrics used in commercially available protective gowns. Application of a lentivirus vector that expresses green fluorescent protein allowed easy monitoring of infectious viral loads on fabrics. Results indicate that fabrics of level-3 surgical gowns serve better to reduce virus transmission compared to fabrics of chemical protective clothing with the same or higher barrier efficiency. Analysis of sliding angles provided indexes of fluid repellency, which were inversely related to virus carryover potentials. Droplets of infectious body fluids may easily roll off fabrics with water-repellent finishing. Thus, virus carryover is a measurable risk factor to be considered for better choice of personal protective clothing.

Difficulties in the daily life of patients with osteoarthritis of the knee: scale development and descriptive study.

AIM: The aim of this study was to develop an instrument to assess difficulties in daily life experienced by patients with osteoarthritis of the knee and to investigate factors influencing difficulties in daily life. BACKGROUND: Osteoarthritis of the knee is commonly associated with clinical symptoms and disabilities. No scale has been available to assess the comprehensive and subjective difficulties felt in daily life by patients affected in social and cultural lifestyle. Therefore, little is known about difficulties in osteoarthritis of the knee patients and supportive care necessary for them. DESIGN: A scale development and descriptive study. METHODS: The participants consisted of 362 patients with osteoarthritis of the knee. The scale development involved several phases including item development, reliability testing, criterion-related validity testing and construct validity testing. RESULTS: The exploratory factor analysis included three domains: 'suffering in social life', 'hardship in activities in daily life' and 'apprehension about the future life'. A confirmatory factor analysis confirmed validity of the construct, with a demonstrated good fit between the factor structure of the new scale and the observed data. Difficulties in daily life scores were significantly influenced by pain, loss of balance, muscle weakness, stiffness and swelling. CONCLUSION: We developed a reliable and valid scale for the measurement of difficulties in daily life experienced by patients with osteoarthritis of the knee. It is important for healthcare professionals to understand these difficulties in daily life experienced by patients with osteoarthritis of the knee and to educate patients with practical information and self-management strategies. RELEVANCE TO CLINICAL PRACTICE: This new scale could provide useful information to guide clinical practice in assessing and managing difficulties in daily life experienced by patients with osteoarthritis of the knee.

Novel Heterogenous CHS1 Mutations Identified in Five Japanese Patients with Chediak-Higashi Syndrome.

Chediak-Higashi syndrome (CHS) is a rare, autosomal recessive disorder characterized by oculocutaneous albinism, recurrent bacterial infections and progressive neurological dysfunction. We demonstrate novel heterogenous mutations of CHS1, the responsive gene of CHS, identified in five Japanese patients with CHS. Patients 1, 2, and 3 were siblings, and they had albinism of the skin and hair. They all had a heterogenous two-base deletion (c.5541-5542 del AA, p.Q1847fsX1850) in exon 18. Patient 4 had a heterogenous single-base insertion (c.3944-3945 ins C, p.T1315fsX1331) in exon 10. The patient exhibited severe early-onset phenotype and suffered from hemophagocytic lymphohistiocytosis. Patient 5 had two heterogenous nonsense mutations; c.7982C>G, p.S2661X in exon 30 and c.8281A>T, p.R2761X in exon 31. The patient suffered from infections in childhood and had visual disturbance and albinism of the skin and hair. The CHS1 mutations described here have not been reported previously.

Effect of a thiol proteinase inhibitor, E-64-d, on susceptibility to infection with Staphylococcus aureus in Chediak-Higashi syndrome (beige) mice.

We previously reported that abnormally down-regulated protein kinase C (PKC) activity is responsible for the impaired cellular function of natural killer cells and polymorphonuclear cells (PMNs), and the giant granule formation in fibroblasts in the beige mouse, an animal model of Chediak-Higashi syndrome. Here, we examine the effect of oral or intraperitoneal administration of E-64-d, which protects PKC from calpain-mediated proteolysis, on the impaired cellular function in PMNs from beige mice. We found that oral administration of E-64-d (12.5 mg/kg body weight per day) for three consecutive days, significantly improved the abnormally increased concanavalin A (Con A) cap formation and the decreased lysosomal enzyme activity in beige PMNs. In addition, E-64-d significantly improved the delayed bactericidal activity against Staphylococcus aureus. In contrast, E-64-d at the same dose did not affect these cellular functions in PMNs from C57BL/6J mice. We confirmed that the abnormal down-regulation of PKC after Con A stimulation was eliminated in PMNs from E-64-d-treated beige PMNs. We then examined whether the administration of E-64-d to beige mice improved the susceptibility to experimental infection with S. aureus (2x10(8)/mouse). Both intraperitoneal and oral administration of E-64-d to beige mice resulted in a significant increase in survival, whereas E-64-d at the same dose did not alter the survival rate in normal mice. These results suggest that the administration of E-64-d may be effective against severe bacterial infection in Chediak-Higashi syndrome.

Development of the chronic obstructive pulmonary disease activity rating scale: reliability, validity and factorial structure.

The purpose of the present study was to develop the Chronic Obstructive Pulmonary Disease (COPD) Activity Rating Scale (CARS) to measure life-related activity in patients with COPD, and to confirm its reliability and constructive validity in a factorial structure model. The subjects consisted of 114 patients with COPD. An 88-item life-related activity list, generated previously from a literature review, was administered. The secondary structural model consisted of four factors with 12 items. The results of the confirmatory factor analysis by structural equation modeling showed the fit criteria to be statistically significant. The internal consistency of the 12 items was highly reliable (Cronbach's alpha = 0.924). The CARS score was correlated with pulmonary function tests, breathlessness, and the health-related quality of life (QOL) scales in Pearson correlation coefficient. The results suggest that the COPD Activity Rating Scale is a valid scale for the assessment of life-related activity in patients with COPD.