Evaluation of myostatin as a possible regulator and marker of skeletal muscle-cortical bone interaction in adults.

INTRODUCTION: Bone mass was recently reported to be related to skeletal muscle mass in humans, and a decrease in cortical bone is a risk factor for osteoporosis. Because circulating myostatin is a factor that primarily controls muscle metabolism, this study examined the role of myostatin in bone mass-skeletal muscle mass interactions. METHODS: The subjects were 375 middle-aged community residents with no history of osteoporosis or sarcopenia who participated in a health check-up. Cortical bone thickness and cancellous bone density were measured by ultrasonic bone densitometry in a health check-up survey. The subjects were divided into those with low cortical bone thickness (LCT) or low cancellous bone density (LBD) and those with normal values (NCT/NBD). Bone metabolism markers (TRACP-5b, etc.), skeletal muscle mass, serum myostatin levels, and lifestyle were then compared between the groups. RESULTS: The percentage of diabetic participants, TRACP-5b, and myostatin levels were significantly higher, and the frequency of physical activity, skeletal muscle mass, grip strength, and leg strength were significantly lower in the LCT group than in the NCT group. The odds ratio (OR) of high myostatin levels in the LCT group compared with the NCT group was significant (OR 2.17) even after adjusting for related factors. Between the low cancellous bone density (LBD) and normal cancellous bone density (NBD) groups, significant differences were observed in the same items as between the LCT and NCT groups, but no significant differences were observed in skeletal muscle mass and blood myostatin levels. The myostatin level was significantly negatively correlated with cortical bone thickness and skeletal muscle mass. CONCLUSIONS: A decrease in cortical bone thickness was associated with a decrease in skeletal muscle mass accompanied by an increase in the blood myostatin level. Blood myostatin may regulate the bone-skeletal muscle relationship and serve as a surrogate marker of bone metabolism, potentially linking muscle mass to bone structure.

Realist Approach to Continuing Training of Physical Assessment Education to School Nurses (Yogo Teachers) in Japan.

BACKGROUND: As part of efforts to revitalize regional medical care, we implemented training in physical assessment for nurses and school nurses. We conducted a questionnaire survey using a realist approach to evaluate the training for school nurses that has been ongoing for 12 years. MATERIALS AND METHODS: The summer training held by the Toyama Prefecture School Nurse Association includes education on severity assessment (evaluation of consciousness and vital signs), auscultation (heart, respiratory, and bowel sounds), the Heimlich maneuver, a review of Basic Life Support, and case studies. Following the training, we conducted an online questionnaire survey with participating school nurses to assess the outcome of the program. RESULTS: A total of 122 people responded (response rate: 35.6%) with 109 (89%) indicating that the results of the training session met or exceeded their expectations. The most common outcome of the training was improvement in their own response capabilities, followed by increased trust in students/guardians and school staff members. The training also fostered a sense of responsibility among the participants, motivating them toward further self-improvement. Furthermore, within the school, it led to collaboration with other staff members, a review of the emergency system, and improvement of equipment, which was beyond our expectations. The findings suggest that continuous repetition of basic physical assessment education will form a community of practice and bring about collaboration and revitalization within the organization as well as the acquisition of knowledge and skills. CONCLUSIONS: Continuous training improved their ability to respond, earned the trust of students/parents and school staff, and motivated them to continue improving themselves. Furthermore, a community of practice was formed within the organization by continuing the training sessions.