In stereotactic body radiotherapy （SBRT）, extracranial primary tumors or metastases are treated with
high doses of radiation in a few fractions. The precise and accurate delivery of multiple radiation beams to the target
maximizes tumor cell death while keeping the dose to the surrounding normal tissue to a minimum. Much of the
technology to overcome the barriers to applying this treatment to moving tumors was developed in Japan. This
review defines SBRT and presents the history of its technical development for safe and effective administration, as
well as the clinical results of using SBRT to treat early-stage non-small cell lung cancer and lung metastases.
The purpose of this study was to clarify the factors influencing caregiver burden 1 month after hospitalized in the convalescent ward by investigating the difference between the expected and actual amount of care provided by family caregivers.
Thirty-one pairs of care receivers and caregivers were participated in this study. Multiple regression analysis was performed with J-ZBI_8, an examination which the burden of caregiving as dependent variable and information obtained from care recipients and caregivers as independent variables. As a result, the average value of J-ZBI_8 was 6.5 ± 5.3 points. 61% of the family caregivers’ actual care was harder than they predicted before discharge. Results showed that the difference between the expected and actual amount of care provided by family caregivers (
β=0.471, P=0.002), and caregivers’ hours of sleep per day (
β=0.404, P=0.006) were related to caregiver burden. In addition, the Functional Independence Measure items of memory, comprehension, social interaction and bowel management, and the frequency of hospital visits were factors relating with the difference between the expected and actual amount of care provided by family caregivers (adjusted R2=0.460, P=0.040).
This research highlights the importance of how to handle symptoms and excretion due to dementia before discharge and increasing the frequency of hospital visits by caregivers, which might help to create a more realistic image of caregiving after hospitalization, thereby reducing caregivers’ burden.
The aim of this study was to clarify the knowledge and practical abilities required by professional
nurses, nursing students, and nursing teachers, to provide appropriate radiological nursing care in a radiationdisaster.
To examine this, a semi-structured interview survey was conducted with 14 experts involved in radiationdisaster
nursing or radiation-related-medical care. The survey contained three questions concerning radiationdisaster
nursing: （1） What knowledge and practical abilities are required by nursing professionals? （2） What
basic knowledge is required by nursing students? （3） What knowledge and experience are required by nursing
teachers? After transcribing comments using KH Coder （188.8.131.52） software, we performed quantitative-text mining
analysis. Hierarchical cluster analysis showed that, for question one, the experts prioritized knowledge of “health
effects of radiation and addressing patients’ anxiety,” “the role of nurses,” and “radiological nursing.” For question
two, “radiological nursing,” “radiation protection basics,” “radiation emergency medicine,” “role of nursing,” etc., were
prioritized. Finally, for question three “knowledge of nuclear power plant accidents,” “disaster prevention drills, dose
measurements, etc., performed at hospitals,” “radiation nursing and correspondence with inhabitants,” “radiation
fundamentals,” etc., were prioritized. The findings show that future disaster-nursing education should incorporate
We examined the effects of personal characteristics and learning motivation on nursing students’ professional identity. In total, 1,892 students were targeted from the first to the fourth year of nursing at six nursing universities in Japan; we employed a self-administered questionnaire. The questionnaire measured professional identity and personal characteristics such as occupational motivation, having a professional role model, and self-esteem. To evaluate learning motivation, we used items assessing intrinsic, identified, introjected, and external regulation based on the self-determination theory. The data from 625 participants were analyzed using structural equation modeling. Occupational motivation from “nursing interest,” having a professional role model, self-esteem, identified regulation, and intrinsic regulation had direct positive effects on the professional identity of students of all school years. “Nursing interest,” having a professional role model, and self-esteem had indirect effects on professional identity through intrinsic regulation and identified regulation. However, occupational motivation from “a stable job,” external regulation, and introjected regulation had no significant effect on professional identity. The personal characteristics that affected participants’ professional identity differed according to school years. The results indicate that autonomous learning motivation, such as identified regulation and intrinsic regulation, are critical in the establishment of nursing students’ professional identity.
Objectives: We have created a new triage tag using the Anoto Live Digital Pen（Anoto K.K., Tokyo, Japan）. We introduced this new triage tag and assessed whether this new triage system using digitized information entered via a digital pen can be used as an information-gathering tool during disasters. Methods: We assessed our new triage tag by sending a PC digital data, which was useful and accurately transmitted in tabletop and ﬁeld studies. In the ﬁeld study, we assessed the accuracy of three categories of digitized data: check boxes, numeric characters, and letter characters. Results: We could collect data from 39 simulated patients in the field study. The simulated patients’ information entered on the handwritten triage tag was quickly digitized and transmitted, and a chronologic list could be made. Assessment of the accuracy of the digitized data for each category was check box, 100.0%; numeric characters, 68.2%; and letter characters, 44.0%. Conclusions: This new triage system using digitized information entered via a digital pen has some problems with the recognition of letter and numeric characters. However, it almost exactly digitized the data, and it may be a useful device during disasters in the future.
Purpose: Retinoic acid-inducible gene-I（RIG-I）is a member of cytoplasmic viral sensors which plays an important role in inﬂammation of biliary epithelial cells（BECs）. The aim of this study is to examine if RIG-I and C-X-C motif chemokine 10（CXCL10）are involved in the etiology of human biliary atresia（BA）. Methods: Immunohistochemical study was performed on surgically resected tissues obtained（June 1994 to March 2016） from 30 infants with BA and non-inﬂamed hepatic tissues from 7 infants with hepatoblastoma. A semiquantitative scoring system was designed to evaluate the staining with an antibodies to the RIG-I and CXCL10. The expression of RIG-I and CXCL10 in HuCCT1 cholangiocarcinoma cell line were studied by western blotting, ELISA and RT-PCR analyses. Results: Intense immunoreactivity for RIG-I and CXCL10 was detected in BECs in tissues resected from BA patients. The expression of RIG-I and CXCL10 in the hilar tissue was significantly stronger than in the hepatic tissue. Transfection of HuCCT1 cells with poly（I:C）, a synthetic analog of viral dsRNA, induced the expression of RIG-I, and knockdown of RIG-I inhibited the induction of CXCL10 in HuCCT1 cells transfected with poly（I:C）. Conclusion: These results suggest that RIG-I-CXCL10 cascade may be involved in the etiology of human BA.
Aim: The purpose of this study was to develop a “questionnaire on involvement” for new graduate nurses,
to measure the impact of support systems that the nurses recognized as helping them achieve socialization. The study
also aimed to verify the questionnaire’s reliability and validity. Methods: Social learning theory was used as the conceptual framework to construct a draft questionnaire containing
42 items. After examining its content validity, the questionnaire was used as the basis of a paper-based survey for 999
new graduate nurses. The reliability and validity of the questionnaire were examined using Cronbach’s α coefficient, a
factor analysis, and calculated correlations with the workplace social support scale and the burnout scale. Results: The data provided by 216 participants were analyzed （valid response rate: 76.1%）. Based on the factor
analysis results, the questionnaire was reconstructed; the final version consisted of 21 items associated with 3 factors.
The Cronbach’s α coefficient for the 21 items as a whole was 0.93. The data showed a positive correlation with the
workplace social support scale and a negative correlation with the burnout scale. Conclusion: The present study confirmed the reliability, construct validity, and criterion-related validity of the
questionnaire on involvement described above. New graduate nurses recognize that involvement provides a support
system that promotes socialization; the questionnaire has proven useful in measuring involvement.
It has been reported that an association between gut microbiota and obesity, and changes in the composition
of gut microbiota have been reported with aging. The aim of this study is clarify the relationship between obesity
and gut microbiota as a function of age. Furthermore, the impact of lifestyle factors（alcoholic drink and smoking） on
gut microbiota were discussed. Fecal samples from 1082 healthy Japanese adults aged 19‒90 years who participated
in the Iwaki Health Promotion Project in 2014 were analyzed by using 16S rDNA gene-targeted sequencing. The
participants were stratified into six age groups: ≤39, 40‒49, 50‒59, 60‒69, 70‒79 and ≥ 80. The participants with a body
mass index（BMI） of < 25 kg/m² were classified as non-obese, and those with a BMI of ≥ 25 kg/m² were classified as
obese. Changes in the composition of gut microbiota with age were different between the obese and non-obese groups.
Bacterial diversity decreased with age at the phylum level, however, this diversity was not observed at the class
level. The abundances of certain gut microbiota, such as Bacteroidetes and Firmicutes, were different between the obese
and non-obese groups. There were no significant differences in alcoholic and smoking habits. Bacterial diversity was
different with age between the obese and non-obese group. The composition of Bacteroidetes and Firmicutes changed
with increasing age in the obese group.
Background: In hemiplegia cases having upper and lower extremity disorders, arm swing is seldom the priority of consideration. One of the reasons is that the purpose of arm swinging has not yet been clarified. Objective: To investigate the effect of arm swing on walking abilities of hemiplegia case. Method: 17 hemiplegia stroke patients participated in this study. The subjects performed a 10m walking test randomly with 4 different conditions of arm swing while the time, steps taken and pelvic fluctuation were measured. The 4 conditions were: 1) normal gait, 2) single arm restricted gait, 3) both arm restricted gait, and 4) maximum arm swing gait. The outcomes were analyzed by multiple comparison with a significance level of less than 5%. Results: There were no significant differences in gait parameters between the conditions of arm swing. Thus, the subjects were sorted based on their severity of hemiplegia (Brunnstrom recovery stage). In medium severity of hemiplegia cases (Brunnstrom stageⅢ-Ⅳ), the patients tended to, when swinging only the non-paralyzed arm have a greater velocity and step length. On the other hand, in low severity of hemiplegia cases (Brunnstrom stageⅤ), the patients showed the same tendencies as the healthy adults showed in a previous study. Conclusions: It may have an impact on walking abilities if stroke patients swing their non-hemiplegia side arm while wearing an arm sling but this needs further investigation.
Background: It remains uncertain whether snow shoveling has eﬀects on long-term prognosis in patients with acute myocardial infarction（AMI）. Patients/Methods: Consecutive 355 patients who underwent emergency percutaneous coronary intervention within 24 hours of the AMI onset during the winter months（November to March）between 2008 and 2014 years were retrospectively studied. Results: Of the 355 patients, 36（11%）had snow shoveling-related AMI, deﬁned as the AMI onset during or within 6 hours after snow shoveling. These patients suﬀered fewer adverse cardiovascular events than the non-snow shoveling AMI patients during a median follow-up period of 3.8 years. Notably, snow shoveling did not aﬀect the events for patients with left ventricular ejection fraction（LVEF)
> 40% at the acute phase, but it was a significant better predictor of events for those with LVEF ≥ 40%. Conclusion: Snow shoveling may have important clinical implications for the AMI onset and the prognostic outcome in snowy areas.
Background: Endothelin（ET）is a strong vasoconstrictor that plays important roles in the pathogenesis and progression of cardiovascular remodeling. ET receptor（ET-R）antagonists have recently become established as a drug essential for treating pulmonary arterial hypertension（PAH）.
β-arrestin was originally identiﬁed as a regulator of G-protein coupled receptor recycling, but it recently became apparent that
β-arrestins act as scaﬀolds in their own signaling pathway. In this study, we examined the role of
β-arrestin in ET-R signaling and explored its possible role in the pathogenesis of PAH. Methods and Results: The knockdown of
β-arrestin2 in human kidney embryonic 293 cells resulted in enhanced extracellular signal-regulated kinase（ERK）1/2 phosphorylation in response to ET. Confocal microscopy showed that, in the absence of stimulation, transiently transfected green ﬂuorescent protein-tagged epidermal growth factor receptors（EGFRs）were located on the plasma membrane, whereas they were internalized in response to ET, as shown by their redistribution into cellular aggregates. Pretreatment with Ro318425（a protein kinase C inhibitor）or AG1478（an EGFR antagonist）suppressed ERK1/2 phosphorylation in response to ET. Conclusions: β-arrestins and EGFR transactivation are involved in ET-R signaling. These new insights may contribute to elucidating further layers in the pathogenesis of PAH.
Background: We conducted a single-center retrospective study with propensity score matching to clarify which anesthetic agent, i.e., thiopental or propofol, provides better outcomes for newborns and women undergoing elective and/or urgent cesarean section with general anesthesia. Methods: We collected maternal and fetal data (n=935) using obstetric and anesthetic charts of cesarean sections with general anesthesia between 1994 and 2013. After 1:1 propensity score matching with maternal age, body mass index, gestational period, fetal weight, type of surgery, pre-eclampsia, and fetal/maternal indication, we compared thiopental to propofol (n=392) regarding the following outcomes. The fetal primary outcome was their well-being evaluated by Apgar score (APS). The maternal primary outcome was the patient's hemodynamic changes due to tracheal intubation or delivery. Results: The only APS at 1 min was significantly higher in the thiopental group. The other fetal outcomes such as APS at 5 minutes, the umbilical cord blood pH, and proportion of neonatal asphyxia after birth were similar between two groups. Regarding maternal outcomes, propofol significantly suppressed the increase in the patients' blood pressure from anesthetic induction to the delivery. Conclusions: Our results indicate that propofol induction may be a first choice for cesarean section with general anesthesia.
Vitamin A is essential for maintenance of homeostasis, and it also regulates various immune mechanisms.Listeria monocytogenes is a gram-positive bacillus that invades the cytoplasm of phagocytes and performs intracellular multiplication, and is often used as a tool for functional analysis of macrophages. In this study, we investigated the changes of macrophages under vitamin A deﬁciency（VAD）using L. monocytogenes. During L. monocytogenes infection, apoptosis was increased in CD11b-positive splenocytes of VAD mice compared with vitamin A sufficient（VAS） mice. A similar result was obtained with peritoneal exudate cells（PECs）. Significant increase of apoptosis due to the administration of Ro41-5253, an inhibitor of retinoic acid receptor, was also observed in the macrophage cell line RAW264.7. Furthermore, in VAD mice, the number of bacteria in the spleens and livers was signiﬁcantly increased. These results suggest that excessive apoptosis of macrophages occurs under VAD condition, leading to impaired host resistance to L. monocytogenes. Taken together, vitamin A contributes to the maintenance of homeostasis by regulating macrophage functions, indicating the importance of vitamin A supplementation.
Background: The number of aging patients with dementia has been increasing in several countries, and
a screening method for the early detection of dementia is needed. Objectives: The aim of this study was to evaluate
a simple smell identification test for its ability to detect cognitive decline. Subjects and Methods: A total of 659
participants from the 2016 Iwaki Health Promotion Project aged ≧ 40 years were included. Participants underwent
a smell identification test using three odorants, namely, India ink, Japanese cypress wood, and curry, out of the Odor
Stick Identification Test for the Japanese （OSIT-J） and mini-mental state examination （MMSE） to examine their
cognitive function. Results: In analysis of covariance, a statistically significant trend between the age and scores of the
three odorants and between the scores of the three odorants and MMSE scores was observed. In multiple regression
analysis, the MMSE scores significantly correlated with the scores of the simple smell identification test. From the
viewpoint of sensitivity and positive likelihood, the values were not sufficient for screening. Conclusions: A simple smell
identification test using three odorants might be useful for the early detection of dementia.
This study clarifies the age at which children can recognize for themselves the amount of food they have
eaten. The participants were Japanese children aged three to five years and Japanese adults, and the food eaten was
rice, a staple in Japanese diets. Participants used a food model to select the portion size closest to the amount that they
felt they had eaten. The food model had nine portion options for adults and six for children. The difference between
the portion amount selected from the food model and the amount actually consumed was measured to show the
difference in perception. The visual validity of the food model and lack of significant visual differences from the actual
food were confirmed, and no significant differences were found in perception of food amounts among adults or three
groups of children. Therefore, it was suggested that children are able to recognize the amount they have eaten from
around the age of three years old.
Background: Ultrasound-targeted microbubble destruction (UTMD) is a tool for gene delivery. There would be diversity of UTMD depending on selected genes. In this study, we challenged UTMD for angiogenesis to treat damaged heart after myocardial infarction. Methods: C57BL/6 female mice had undergone the left anterior descending artery ligation at Day (-7). The empty plasmid, green fluorescent protein (GFP) plasmid, vascular endothelial growth factor (VEGF) plasmid, or stem cell factor (SCF) plasmid was incubated with the lipid microbubble (DEFINITY®) solution. The microbubble solution with each plasmid was injected intravenously, and ultrasound was directed into the heart at Day 0. The protein expressions following gene transfection were evaluated by immunohistochemistry and biochemistry at Day 14. Myocardial perfusion and cardiac function were evaluated by myocardial contrast echocardiography (MCE) and echocardiography at Day 0 and Day 14. Results: GFP group showed GFP expression on the myocardium. In comparison with control, VEGF and SCF groups significantly increased VEGF (p
<0.05) and SCF (p
<0.05) in the heart. Capillary density by Factor VIII staining and arteriole density by a-SMA staining were significantly increased in VEGF (p
<0.001) and SCF (p
<0.001) groups compared with control, and the densities were also significantly higher in SCF group than those in VEGF group (p
<0.001). Myocardial flow volume by MCE significantly improved in VEGF and SCF groups compared with control (p
<0.05) and was higher in SCF than in VEGF group (p
<0.05); myocardial flow velocity was significantly higher in SCF group than that in control and VEGF groups (p
<0.05). In VEGF and SCF groups, the left ventricular contractility of %FAC and %EF significantly improved (p
<0.05), and the infarct size became significantly smaller than that of control (p
<0.05). Conclusions: It was demonstrated that UTMD with VEGF and SCF genes after MI induced angiogenesis to improve perfusion and cardiac function, and reduce infarct size, and that SCF induced angiogenesis of arteriole to improve not only flow volume but also flow velocity. UTMD might be a promising tool for cardiac repair following myocardial infarction.