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研究論文, Original article, 医療療養型病床は，長期にわたる医学的管理のもと，療養生活や機能回復などを行う．リハビリテーション対象者の特徴を捉えることは，効果的な介入を行う上で重要である．リハビリテーション対象者28 名に対し，健康関連QOL と認知機能，栄養状態，ADL を横断的に調査した．結果はいずれも低値であり，ADL は最大〜中等度介助が多い傾向であった．健康関連QOL との関連では，高齢で，同居人が多い患者ほど健康関連QOL が高い値を示した．その人らしい生活を継続もしくは獲得する介入には，多職種による身体機能，摂食嚥下機能，ADL 維持向上に加え，作業療法では病棟内での役割獲得，家族とのコミュニケーションの工夫を行う必要性があることが示唆された．, In long-term care beds, patients receive long-term medical management in the form of medical care and therapy to promote functional recovery. An understanding of the characteristics of rehabilitation patients in long-term beds is important for providing effective intervention. We conducted a cross-sectional survey of the health-related quality of life, cognitive function, nutritional status, and activity of daily living (ADL) in 28 inpatients undergoing rehabilitation. The results showed that all of these values were low. With regard to ADL, patients tended to require moderate to maximum assistance. In relation to health-related quality of life, the older the patient and the more people they lived with, the higher the health-related quality of life. In addition to intervention by multidisciplinary teams to improve the physical function, swallowing function, and maintenance of ADL, the roles of occupational therapy in the ward need to be determined and ways of communicating with family members should be devised.

研究論文, Original Articles, 本研究の目的は，わが国のリハビリテーション専門職の臨床実習において，臨床実習指導者が考えるクリニカル・クラークシップの問題点を文献的に明らかにすることであった．対象論文は，医学中央雑誌とメディカルオンラインに掲載されており，キーワード検索に該当した原著論文であった．検索キーワードは，「クラークシップ」OR 「参加型」AND 「実習」とした．その結果，キーワード検索により 215 論文が抽出され，対象論文は，除外基準に該当した論文を除く5 論文であった．5 論文内の記載で多く認められたクリニカル・クラークシップの問題点は，「学生が患者の全体像を把握しにくい」，「臨床実習指導者が学生の理解度を把握しにくい」，「臨床実習指導者の負担が増加する」であった．臨床実習指導者が，なぜ上記の問題点をクリニカル・クラークシップの問題点と考えやすいのか，養成校の教員は原因を分析し，対策を講じる必要がある．, The purpose of this literature review was to clarify the issue of clinical clerkship on clinical practicum of rehabilitation professionals in Japan. The authors searched Centra Revuo Medicina Web and Medical Online. A literature review was conducted using the search term“Clerkship” OR “"On the Job Training” AND “Clinical Practicum”. In total, 215 studies were identified and 5 studies were selected and analyzed. The issue with the clinical clerkship were "It was difficult for students to understand the patients", "It was difficult for clinical educator to understand the students' level of understanding”, "The burden on clinical educator increased”. The instructors in the training institutions for rehabilitation professionals need to analyze the issue of clinical clerkship and take their action.

Animation for a metasurface hologram was achieved using a cinematographic approach. Time-lapsed images were reconstructed using sequentially arranged metasurface hologram frames. An Au rectangular nanoaperture was adopted as a meta-atom pixel and arrayed to reproduce the phase distribution based on the help of a Pancharatnam–Berry phase. We arrayed 48 hologram frames on a 2-cm2 substrate and measured and assessed the retardation of fabricated meta-atoms to reconstruct the holographic image, successfully demonstrating the movie with a frame rate of 30 frames per second.

Angiopoietin-like protein (ANGPTL)8 is a liver- and adipocyte-derived protein that controls plasma triglyceride (TG) levels. Most animal studies have used mouse models. Here, we generated an Angptl8 KO rat model using a clustered regulatory interspaced short palindromic repeat (CRISPR)/CRISPR-associated protein 9 (Cas9) (CRISPR/Cas9) system to clarify the roles of ANGPTL8 in glucose and lipid metabolism. Compared with WT rats, Angptl8 KO rats had lower body weight and fat content, associated with impaired lipogenesis in adipocytes; no differences existed between the groups in food intake or rectal temperature. Plasma TG levels in both the fasted and refed states were significantly lower in KO than in WT rats, and an oral fat tolerance test showed decreased plasma TG excursion in Angptl8 KO rats. Higher levels of lipase activity in the heart and greater expression of genes related to β-oxidation in heart and skeletal muscle were observed in Angptl8 KO rats. However, there were no significant differences between KO and WT rats in glucose metabolism or the histology of pancreatic β-cells on both standard and high-fat diets. In conclusion, we demonstrated that Angptl8 KO in rats resulted in lower body weight and plasma TG levels without affecting glucose metabolism. ANGPTL8 might be an important therapeutic target for obesity and dyslipidemia.

To elucidate the clinical implication of ghrelin, we have been trying to generate variable models of transgenic (Tg) mice overexpressing ghrelin. We generated Tg mice overexpressing des-acyl ghrelin in a wide variety of tissues under the control of β-actin promoter. While plasma des-acyl ghrelin level in the Tg mice was 44-fold greater than that of control mice, there was no differences in the plasma ghrelin level between des-acyl ghrelin Tg and the control mice. The des-acyl ghrelin Tg mice exhibited the lower body weight and the shorter body length due to modulation of GH-IGF-1 axis. We tried to generate Tg mice expressing a ghrelin analog, which possessed ghrelin-like activity (Trp3-ghrelin Tg mice). The plasma Trp3-ghrelin concentration in Trp3-ghrelin Tg mice was approximately 85-fold higher than plasma ghrelin (acylated ghrelin) concentration seen in the control mice. Because Trp3-ghrelin is approximately 24-fold less potent than ghrelin, the plasma Trp3-ghrelin concentration in Trp3-ghrelin Tg mice was calculated to have approximately 3.5-fold biological activity greater than that of ghrelin (acylated ghrelin) in the control mice. Trp3-ghrelin Tg mice did not show any phenotypes except for reduced insulin sensitivity in 1-year old. After the identification of ghrelin O-acyltransferase (GOAT), we generated doubly Tg mice overexpressing both mouse des-acyl ghrelin and mouse GOAT in the liver by cross-mating the two kinds of Tg mice. The plasma ghrelin concentration of doubly Tg mice was approximately 2-fold higher than that of the control mice. No apparent phenotypic changes in body weight and food intake were observed in doubly Tg mice. Further studies are ongoing in our laboratory to generate Tg mice with the increased plasma ghrelin level to a greater extent. The better understanding of physiological and pathophysiological significance of ghrelin from experiments using an excellent animal model may provide a new therapeutic approach for human diseases.

The cost effectiveness of occupational therapy for subacute stroke patients is unclear in the extant literature. Consequently, this study determined the cost effectiveness of the occupation-based approach using Aid for Decision-Making in Occupation Choice (ADOC) for subacute stroke patients compared with an impairment-based approach.We conducted an economic evaluation from a societal perspective alongside a pilot randomized controlled trial, with a single blind assessor for participants in 10 subacute rehabilitation units in Japan. The intervention group received occupation-based goal setting using ADOC, with interventions focused on meaningful occupations. The control group received an impairment-based approach focused on restoring capacities. For both groups, occupational-therapy intervention was administered more than five times per week, for over 40 min each time, and they received physical and speech therapy prior to discharge. The main outcomes were quality-adjusted life years (QALYs) and total costs. Further, sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results.The final number of participants was 24 in each of the two groups. In terms of QALYs, the intervention group is significantly higher than the control group (p = 0.001, difference 95% CI: 0.002-0.008) and total costs are not statistically significant. Applying a willingness-to-pay threshold of JPY 5 million/QALY, the probability of the occupation-based approach using ADOC being cost effective was estimated to be 65.3%.The results show that the occupation-based approach is associated with significantly improved QALYs and has potential cost effectiveness, compared with the impairment-based approach.

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus and is caused by insulin insufficiency. Hypothermia is defined as a core temperature of less than 35°C and is sometimes accompanied by DKA. We report two patients with diabetes who were admitted for DKA accompanied by hypothermia.