[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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　Background：The purpose of this study was to clarify the extent of the involvement of sympathetic nerves and heat—induced vasodilation in renal microcirculatory changes during whole—body passive heating. 　Methods：Renal cortical blood flow, heart rate, systolic blood pressure, and NOS3mRNA, etc. were measured and compared when TRPV4 was inhibited or beta receptors were blocked and rectal temperature was maintained at 37℃ or 40℃ in mice. 　Results：Passive thermothermia under TRPV4 inhibition significantly decreased renal cortical blood flow by approximately 18.5％（p＜0.05）, accompanied by a decrease in NOS3mRNA expression. However, there was no change in cardiac workload；passive hyperthermia under β—receptor blockade significantly decreased cardiac workload and significantly decreased renal cortical blood flow by approximately 14.4％（p＜0.05）. 　Conclusion：Our results suggest that sympathetic and thermotropic vasodilation are equally involved in the regulation of renal microcirculation.

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　The frequency of cognitive impairment among hemodialysis patients is significantly higher than in the general population. Behavioral and Psychological Symptoms of Dementia（BPSD）are commonly observed in individuals with dementia, and these symptoms can include agitation, aggression, anxiety, depression, hallucinations, and sleep disturbances. For elderly hemodialysis patients who have difficulty with oral administration of drugs, managing BPSD that induce trouble to take rehabilitation can be a challenging issue. In such situations, the transdermal administration of blonanserin shown to be effective. The use of blonanserin transdermal patches led to an improvement in the symptoms of BPSD in an elderly hemodialysis patient and enabled rehabilitation and hemodialysis treatments.

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　Purpose：Nursing intervention using the“Guidelines for Decision—making Support in Daily and Social Life of People with Dementia”was performed on a heart failure patient with frailty who refuses dialysis. Permission was obtained from my institution for reporting. 　Case：Patient A is a dementia—free woman in her 70s with recurrent heart failure. Her pleural effusion did not improve with treatment, and dialysis therapy was proposed, which she refused. Upon readmission, decision—making support was provided regarding the introduction of dialysis. 　Results：In the intention forming support, past illness experiences, family relationships, and thoughts about dialysis were listened to, and understanding of the disease condition was promoted. In the intention expressing support, we encouraged the patients to express their hopes for their future life, because we believed that disease management would lead to psychological health and motivation. In the intention realizing support, she understood that prevention of hospitalization and discharge would lead to maintenance and improvement of physical function, based on her experience of losing her own role due to repeated hospitalization and discharge. As a result, A expressed her desire to learn more about dialysis therapy. 　Conclusion：Decision—making support with awareness of the process, regardless of the presence or absence of dementia, promoted A’s physical and psychological awareness and helped her understand the necessity of dialysis therapy.

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