[Differences in perceptions between healthcare professionals and caregivers when accepting patients on insulin therapy to elderly care facilities].

AIM: To clarify the problems with accepting patients on insulin therapy at elderly care facilities. METHODS: We conducted a questionnaire on staff awareness of diabetes before accepting the first diabetic patient on insulin therapy at our elderly care facility. Once the patient was admitted, we held diabetes classes for staff based on their needs. Six months later, we conducted a questionnaire again to confirm the staff's awareness concerning patients on insulin therapy. RESULTS: In the initial questionnaire, nurses were negative about acceptance while caregivers were positive. Once the patient was admitted, staff struggled to deal with his frequent symptoms. A diabetes specialist held diabetes classes for staff to ensure the patient could enjoy a stable life. Gradually, the staff developed a better collaborative system and performed appropriate care. In the second questionnaire conducted six months later, there was a decrease in excessive optimistic opinions among caregivers. However, nurses still tended to be reluctant about acceptance while caregivers were positive, a trend similar to the initial evaluation. CONCLUSION: In this study, we noted differences in the perceptions of nurses and caregivers regarding the acceptance of patients on insulin therapy. Mitigating this difference is necessary to ensure the safety of patients. It is essential to institutionalize diabetes education in long-term care facilities, allow educated caregivers to measure blood glucose levels, select patients with treatment policies suitable for a given facility, ensure that doctors deliver accurate instructions, and maintain close communication to build a better medical care cooperation system.

Correlation Between DNA Methylation of TRPA1 and Chronic Pain States in Human Whole Blood Cells.

OBJECTIVES: Neuro-immune interactions with functional changes in the peripheral blood cells including changes in the transient receptor potential ankyrin 1 (TRPA1) appear to play a pivotal role in the development of chronic pain in humans. The aim of this study was to examine the association between TRPA1 DNA methylation in whole blood cells and the pain states in chronic pain patients. METHODS: After collecting blood samples from 12 chronic pain patients, the authors measured DNA methylation levels in whole blood cells. Significant associations between the patient's demographic data and the chronic pain states were determined by a multiple linear regression analysis that used age, body mass index, pain duration, depression, anxiety, cognitive impairment, activities of daily living, neuropathic pain, and pain states as the dependent variables, and the TRPA1 DNA methylation levels as the independent variables. RESULTS: Multiple regression analysis revealed a significant correlation between increases of the methylation levels of the CpG island in the TRPA1 gene and increases in the number of neuropathic pain symptoms, which were evaluated using the Douleur Neuropathique 4 (DN4) questionnaire. Decreases in the TRPA1 mRNA expression were also significantly related to increases in the DN4 score. The presence of a burning sensation, which is one of pain symptoms in the DN4 questionnaire, was significantly correlated with the increase in DNA methylation level of TRPA1. CONCLUSIONS: TRPA1 DNA methylation levels in whole blood cells appear to be associated with pain symptoms in chronic pain patients.

Phylogeny of epilachna, henosepilachna, and some minor genera of phytophagous ladybird beetles (coleoptera: coccinellidae: coccinellinae: epilachnini), with an analysis of ancestral biogeography and host-plant utilization.

Ladybird beetles in the tribe Epilachnini include notorious crop pests and model species studied intensively in various fields of evolutionary biology. From a combined dataset of mitochondrial (ND2) and nuclear (28S) DNA sequences, we reconstructed the phylogeny of 46 species of Epilachnini from Asia, Africa, America, and the Australian region: 16 species in Epilachna, 24 species in Henosepilachna, and one species each in Adira, Afidenta, Afidentula, Afissula, Chnootriba, and Epiverta. In our phylogenetic trees, both Epilachna and Henosepilachna were reciprocally polyphyletic. Asian Epilachna species were monophyletic, except for the inclusion of Afissula sp. Asian and Australian Henosepilachna species likewise formed a monophyletic group, excluding H. boisduvali. African Epilachna and Henosepilachna species did not group with their respective Asian and American congeners, but were paraphyletic to other clades (Epilachna species) or formed a separate monophyletic group (Henosepilachna species) together with Chnootriba similis. The American Epilachna species were monophyletic and formed a clade with American Adira clarkii and Asian Afidentula manderstjernae bielawskii; this clade was the sister group to Asian and Australian Henosepilachna, but was distant from Asian Epilachna. Chnootriba was embedded in the African Henosepilachna clade, and Afissula in the Asian Epilachna clade. Epiverta, which is morphologically unique, was the sister group to Asian Epilachna, although with weak support. From reconstructions of biogeographical distribution and host-plant utilization at ancestral nodes, we inferred an African origin for the common ancestor of the species studied, and found the frequency of host shifts to differ greatly between the two major lineages of Epilachnini examined.

Spinal cord stimulation for treatment of leg pain associated with lumbar spinal stenosis.

OBJECTIVE: Spinal cord stimulation (SCS) is expected to have analgesic effects in patients with neuropathic pain, ischemic pain, or mixed pain. The type of leg pain caused by lumbar spinal stenosis (LSS) is considered as mixed pain, which is expected to respond to SCS. However, there is no established view on the usefulness of SCS in the management of this type of pain. Therefore, we aimed at evaluating the efficacy of SCS against leg pain associated with LSS. MATERIALS AND METHODS: Data were collected retrospectively for the period from January 2003 to December 2011 from 91 patients with LSS-associated leg pain enrolled to the SCS trial. SCS implantation was performed in patients who responded to the trial and desired to receive this therapy. RESULTS: The response rate (percentage of patients showing 50% or greater alleviation of pain) in the trial was 65% (59/91 patients). SCS implantation was performed on 41 patients. The percentage of patients who showed a good response (definition is SCS continued for one year or longer after implantation) was 95% (39/41). CONCLUSION: SCS seemed to be effective against leg pain associated with LSS. Thus, SCS should be actively adopted in indicated patients as a method of treatment intermediate between conservative therapy and surgical therapy.

Neonatal alloimmune thrombocytopenia caused by an antibody specific for a newly identified allele of human platelet antigen-7.

BACKGROUND: Neonatal alloimmune thrombocytopenia (NAIT) is a neonatal disorder characterized by maternal alloimmunization against fetal platelet (PLT) antigens inherited from the father. A healthy 30-year-old Japanese woman (Hit) gave birth to her second child after an uneventful pregnancy. Nine hours after birth, the infant presented with severe petechiae and a PLT count of 6 x 10(9)/L. STUDY DESIGN AND METHODS: To elucidate the maternal cause of NAIT in the infant, serologic and genetic studies, including PLT genotyping and sequence-based analysis, were conducted. Additionally, serologic screening for the new PLT antigen was performed. RESULTS: Serum from the NAIT infant's mother contained antibodies directed against a human PLT antigen (HPA) of the newborn. Using five-cell-lineage flow cytometry, we localized the antigen to a PLT glycoprotein (GP). Subsequent monoclonal antibody immobilization of PLT antigen assay and PLT immunofluorescence inhibition experiments localized the antigen to the GPIIIa subunit of the GPIIb/IIIa complex. GPIIIa localization was confirmed by sequence-based typing studies, which identified a 1297C>T (407proline>serine substitution) mutation on the ninth exon of the GPIIIa gene. This mutation identified the third allele of HPA-7. Anti-Hit(a) reacted with mutated GPIIIa-transfected cells but not with stable transfectants expressing wild-type GPIIIa. Serologic screening for Hit(a) in the Japanese population revealed a phenotypic frequency of approximately 0.0015. CONCLUSIONS: We identified a new third allele of HPA-7, which is characterized by a 1297C>T mutation in the GPIIIa gene. This 1297C>T allele was found in 0.15% of the Japanese population. An antibody against this antigen could be the cause of severe NAIT.

[Measurement of clinical pain intensity: quantitative sensory testing].

Pain is a private internal event, the degree of which can not be evaluated directly by others. The measurement of the nociceptive pain threshold may apply to the evaluation of the degree of the pain. The instruments using mechanical and electrical stimulation are available for the clinical application. Thermotest allows the testing of quantitative evaluation of thermal thresholds such as heat, cold, and heat and cold pain sensation. A machine for the thermotest using radiant heat and contact heat is available in Japan. There is an instrument using puncturing stimulus and pressure stimulus for a mechanical stimulation. A puncturing stimulus is suitable for the clinical use with a handy instrument such as von Frey filaments and needle type algometry. In clinical practice, the pressure algometry is usually applied over a bony surface or over the muscle. The method seems to be well suited for the evaluation of pain in musculoskeletal disorders. The electrical stimulation test provides a quantitative measure of pain tolerance to a transcutaneous stimulation, neuroselective for large and small myelinated and unmyelinated nerve fibers. There are characteristics including advantages and faults in each method, and the method of measurement corresponding to the purpose and application is important.

Impact of multi-detector row computed tomography on the tactics of cardiovascular surgery: from qualitative evaluation to quantitative assessment.

OBJECTIVE: We assessed the role of multi-detector row computed tomography in cardiovascular surgery. METHODS: The efficacy of multi-detector row computed tomography was assessed concerning the graft patency of coronary artery bypass, arterial atheromatous degeneration, small vessel imaging, and left ventricular volume measurement. Images were reconstructed using both the volume-rendering and the maximum-intensity-profile methods. Arterial atherosclerotic degeneration was assessed by aortic wall volume and aortic calcification volume. RESULTS: In the assessment of bypass graft patency, multi-detector row computed tomography showed a 98% correct positive ratio with sensitivity and specificity of 98% and 100%, respectively. Atheromatous degeneration showed matching results in more than 70% of cases compared with intraoperative findings. More than 92% of arterial branches with diameters of 3 mm or greater were detected by preoperative multi-detector row computed tomography images, though only 6% of branches with diameters of 2 mm or less could be visualized. There was a positive linear correlation between left ventricular volumes determined by multi-detector row computed tomography and those calculated from cine angiography. CONCLUSION: Multi-detector row computed tomography clearly visualized coronary bypass grafts and aortic arterial branches, providing detailed vascular images. Atheromatous degeneration assessed by multi-detector row computed tomography was equivalent with intraoperative findings in more than 70% of cases. Left ventricular volumes measured by multi-detector row computed tomography correlated closely with those determined by cine-angiography. Multi-detector row computed tomography is an efficient and promising modality in cardiovascular surgery.

[Perioperative multivessel coronary vasospasm as a cause of cardiogenic shock immediately after off-pump coronary artery bypass grafting surgery: a case report].

Perioperative coronary vasospasm has been recognized as a possible cause of myocardial infarction or low output syndrome after open heart operations. A 57-year-old male suffered cardiogenic shock immediately after off-pump coronary artery bypass grafting surgery. Emergent angiography performed under intraaortic balloon pumping and percutaneous cardiopulmonary support revealed severe multivessel coronary vasospasm which was effectively treated with a high dose intracoronary administration of isosorbide dinitrate. Emergent angiography for patients with cardiogenic shock after open heart operation is feasible and effective for the diagnosis and treatment of perioperative coronary vasospasm.

A prospective randomized study of sternal closure: comparison of Mersilene tape versus standard wire closure.

BACKGROUND: To compare in a prospective randomized study Mersilene tape and standard metal wire for complications and pain upon sternal wound closure. METHODS: Sixty-four patients scheduled for cardiac surgery were prospectively randomized to undergo sternal closure using either Mersilene tape (n=30) or standard metal wire (n=34). The intensity of postoperative pain from the chest wound was assessed using a visual analogue scale (VAS) on the second and seventh postoperative days and one month after surgery. The examinations with chest X-ray and computed tomography (CT) one month after surgery were performed to evaluate the chest wound and sternum. Follow-up data on sternal and wound healing was assessed for up to one year. RESULTS: No deaths, sternal dehiscence or infection occurred in either group. No wound complications were observed in either group during the year following surgery. A review of data revealed that there was no difference in the intensity of postoperative pain according to the VAS between the two groups. Chest CT demonstrated that no patients in either group had cuts in the sternum. CONCLUSION: This prospective randomized study showed Mersilene tape sternal closure not to be more closely associated with increased complications or patient discomfort due to sternal wound than the standard wire closure.