Do Tapping and Massaging during Tourniquet Application Promote Dilation of Forearm Cutaneous Veins? A Pilot Quasi-Experimental Study

Successful insertion of a peripheral intravenous catheterization requires that veins be sufficiently dilated. This study aimed to clarify the venous dilation effect of including tapping or massaging to the application of a tourniquet at the cutaneous veins of healthy adults' forearms. This was a quasi-experimental study of 30 healthy adult volunteers. Each participant underwent all three venous dilation procedures, which included the tourniquet application (Control condition), the tourniquet application and tapping the participant's forearm (Tapping condition), as well as the tourniquet application combined with massaging the participant's forearm (Massage condition). To clarify the venous dilation effects, venous indices were measured, namely the venous diameter (mm), depth (mm), and palpation score. After applying all venous dilation procedures, the venous diameter and palpation score significantly increased. However, no significant difference was observed between the control condition and each intervention condition. The depth in the control and tapping conditions decreased significantly in contrast to the Massage condition. Moreover, a subgroup (nine participants with a venous diameter less than 3 mm after the control condition) had similar results. This study found that additional tapping or massaging after tourniquet application could be less effective in promoting dilation in the forearm veins of healthy adults. Future studies should examine the efficacy and effectiveness of venous dilation in a wide target population while considering intervention methods.

Validity and reliability of the Japanese version of the Nursing Performance Instrument

AIM

Work performance of nurses is a critical aspect that concerns the safety of both nurses and patients, but also secondarily influences nurses' turnover due to serious fatigue and burnout. Monitoring nursing performance as well as fatigue is important for appropriate safety management of patients and nurses, and the development of a monitoring tool is essential. The Nursing Performance Instrument (NPI) can provide comprehensive and brief monitoring of nursing performance. This study aimed to verify the validity and reliability of a Japanese version of the NPI (NPI-J).

METHODS

A cross-sectional study was conducted on nurses who work in inpatient care across five Japanese hospitals. We considered appropriate factor numbers with parallel analysis and the Velicer's minimum average partial test. The construct validity was evaluated using exploratory factor analysis, confirmatory factor analysis (CFA), and Pearson's correlation analysis. Cronbach's alpha was calculated for the internal consistency.

RESULTS

A three-factor model eventually showed acceptable fit indices in the CFA. Moreover, the correlation results among the three factors indicated discriminant validity comparable to the original NPI. The correlation results with acute fatigue, chronic fatigue, and burnout verified convergent validity. Internal consistency was insufficient.

CONCLUSION

The NPI-J demonstrated acceptable construct validity. This instrument can assess nurses' perceptions of their performance by measuring each item. Future work on the reliability of the sub-concepts will require additional items or reliability testing based on generalizability theory and item response theory.

Effects of differences in wiping pressure applied by nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations

AIM

To clarify the actual condition and examine the effects of differences in wiping pressure applied by clinical nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations.

METHODS

For the purposes of the present quasi-experimental interventional study, "wiping pressure" was defined as the "force applied vertically to the skin surface during bed baths." Two types of bed baths, one using ordinary wiping (pressure: 23-25 mmHg) and the other using weak wiping (pressure: 12-14 mmHg), were performed on the forearms (right and left) of 30 healthy adult men and women, and the effects on transepidermal water loss, stratum corneum hydration, cleanliness, and subjective evaluations were examined.

RESULTS

The results showed no differences between ordinary and weak wiping pressure in regard to the effects on skin barrier function and cleanliness. In terms of subjective evaluations, a significant association was seen between wiping pressure and the "sensation of having dirt removed" (P = .036). Regarding "degree of pain," some participants reported that the wiping pressure felt "slightly painful" under both conditions (ordinary: 31.1%; weak: 10.7%), while some with sensitive skin reported feeling pain even during weak wiping pressure.

CONCLUSIONS

The results of the present study suggest that skin assessments should be performed before and after bed baths, and that wiping pressure should be controlled and evaluated while considering the patient's feelings.

Association between sleep and fatigue in nurses who are engaged in 16 h night shifts in Japan: Assessment using actigraphy

AIM

To determine the association between sleep and fatigue in nurses who are working in a two-shift system, including 16 h night shifts.

METHODS

Sixty-one nurses were assessed on their sleeping and napping over 9 days, using actigraphy and a sleep diary. Work-related feelings of fatigue were measured by using the "Jikaku-sho shirabe" questionnaire and the Cumulative Fatigue Symptoms Index.

RESULTS

The main night-time sleep started after 00:00 hours in half of the participants and the average start and end times were significantly delayed among the participants in their 20s, compared to those in their 40s . Although ~90% of the participants napped during and/or after a night shift, only 50.8% napped for >2 h during their shift and 32.8% napped in the morning after a night shift. In the high-fatigue group, significantly more nurses went to sleep after 00:25 hours than before 00:26 hours the night after a night shift. Furthermore, those nurses who napped for >2 h during their night shift exhibited a significantly lower rate of some cumulative fatigue symptoms, compared to those who did not. In addition, a combination of napping in the morning after a night shift and beginning the following night-time sleep before 00:26 hours were associated with a significant decrease in fatigue symptoms.

CONCLUSIONS

Naps at an appropriate time and of an appropriate duration, along with the practice of beginning the night-time sleep early after a night shift, might relieve cumulative mental fatigue in nurses who are working 16 h night shifts.

Repeated intra-articular injections of acidic saline produce long-lasting joint pain and widespread hyperalgesia

BACKGROUND

Synovial fluid in inflamed joint shows a drop in pH, which activates proton-gated ion channels in nociceptors. No studies have ever tried to develop and characterize acid-induced joint pain.

METHODS

Rats were injected intra-articularly with pH 4.0 acidic saline twice, 5 days apart. Pain-related behaviour tests including weight-bearing asymmetry, paw withdrawal threshold and knee compression threshold were conducted. To clarify the roles of proton-gated ion channels, rats were injected intra-articularly with selective antagonists for ASIC1a, ASIC3 and TRPV1 on day 5 (before the second injection) or on day 14. Underlying peripheral and central pain mechanisms were evaluated using joint histology, interleukin-1β concentrations in the synovium, single-fibre recording of the knee afferent and expression of phosphorylated cyclic adenosine monophosphate-responsive element-binding protein (p-CREB) in the spinal dorsal horn.

RESULTS

Repeated injections of acidic saline induced weight-bearing asymmetry, decrease in paw withdrawal threshold and knee compression threshold bilaterally, which lasted until day 28. Early administration of ASIC3 antagonist reduced the bilateral and long-lasting hyperalgesia. Neither articular degeneration nor synovial inflammation was observed. C-fibre of the knee afferent was activated by acidic saline, which was attenuated by pre-injection of ASIC3 antagonist. p-CREB expression was transiently up-regulated bilaterally on day 6, but not on day 14.

CONCLUSION

We developed and characterized a model of acid-induced long-lasting bilateral joint pain. Peripheral ASIC3 and spinal p-CREB played important roles for the development of hyperalgesia. This animal model gives insights into the mechanisms of joint pain, which is helpful in developing better pain treatments.

Point mutation of C-terminal region of CD20 molecule predicts rituximab-induced complement-dependent cytotoxicity and clinical response to rituximab in non-Hodgkin’s lymphoma

7563

Background: Although rituximab is commonly used as induction and maintenance therapy for malignant lymphoma, some patients become refractory to treatment and the mechanism of resistance is unclear. The aim of this study was to investigate the relationship between CD20 mutations and rituximab resistance. Methods: To investigate whether CD20 mutations affect response to rituximab, fresh CD19+ lymphoma cells were isolated from the lymph nodes, or bone marrow of 68 patients with NHL. The cells were subsequently sorted by flow cytometry. RNA was prepared from the isolated cells and RT-PCR was performed. The PCR products were sequenced, subcloned into an expression vector pTARGET, transfected into K562 cells. CD20 expression was examined by flow cytometry and laser scanning confocal microscopy. Results: In all 68 patients, overall response rate (CR+CRu+PR) to rituximab was 91.2% (62/68), but t four cases became PD after PR. DNA sequence analysis revealed that point mutations were mostly observed in three CD20 domains - extracellular/cytoplasmic domains, the third transmembrane domain and the C-terminal cytoplasmic domain. Two cases had point mutations in extracellular/cytoplasmic domains, one patient had point mutations in the transmembrane domain, four cases showed point mutations in the C-terminal cytoplasmic domain and six cases had non-specific CD20 mutations, which did not affect CD20 expression. 56 patients showed no mutations of CD20 gene. CD20 expression was very weak in patients with point mutations in the C-terminal cytoplasmic domain, whereas expression was increased in patients with point mutations in the transmembrane domain. Conclusions: Point mutations in CD20 may cause rituximab resistance and identification of CD20 mutations upon diagnosis may help to predict a patient’s response to rituximab.

No significant financial relationships to disclose.

Complete nucleotide sequence and the genome organization of Patchouli mild mosaic virus RNA1

The nucleotide sequence of the RNA1 of Patchouli mild mosaic virus (PatMMV) has been determined. It contains 5,957 nucleotides excluding the 3'-terminal poly(A) tail and contains a single long open reading frame (ORF) of 5,613 nucleotides extending from nucleotide 235 to 5847. The predicted polyprotein encoded by the long ORF is 1,870 amino acids in length with a molecular weight of 210 kD. The conserved residues of RNA-dependent RNA polymerase, cysteine protease, purine NTP-binding domain and a cofactor for viral protease are present in a 210-kD polyprotein. As PatMMV RNA showed high sequence identity (81-97%) with BBWV-2 RNA, PaMMV may be one strain of BBWV-2.

Gastropod arginine kinases from Cellana grata and Aplysia kurodai. Isolation and cDNA-derived amino acid sequences

Arginine kinase (AK) was isolated from the radular muscle of the gastropod molluscs Cellana grata (subclass Prosobranchia) and Aplysia kurodai (subclass Opisthobranchia), respectively, by ammonium sulfate fractionation, Sephadex G-75 gel filtration and DEAE-ion exchange chromatography. The denatured relative molecular mass values were estimated to be 40 kDa by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The isolated enzyme from Aplysia gave a Km value of 0.6 mM for arginine and a Vmax value of 13 micromole Pi min(-1) mg protein(-1) for the forward reaction. These values are comparable to other molluscan AKs. The cDNAs encoding Cellana and Aplysia AKs were amplified by polymerase chain reaction, and the nucleotide sequences of 1,608 and 1,239 bp, respectively, were determined. The open reading frame for Cellana AK is 1044 nucleotides in length and encodes a protein with 347 amino acid residues, and that for A. kurodai is 1077 nucleotides and 354 residues. The cDNA-derived amino acid sequences were validated by chemical sequencing of internal lysyl endopeptidase peptides. The amino acid sequences of Cellana and Aplysia AKs showed the highest percent identity (66-73%) with those of the abalone Nordotis and turbanshell Battilus belonging to the same class Gastropoda. These AK sequences still have a strong homology (63-71%) with that of the chiton Liolophura (class Polyplacophora), which is believed to be one of the most primitive molluscs. On the other hand, these AK sequences are less homologous (55-57%) with that of the clam Pseudocardium (class Bivalvia), suggesting that the biological position of the class Polyplacophora should be reconsidered.

Complete nucleotide sequence of the genome organization of RNA2 of patchouli mild mosaic virus, a new favavirus

The complete nucleotide sequence and the genome organization of the RNA 2 of a patchouli mild mosaic virus (PaMMV) was determined. The sequence consists of 3591 nucleotides and contains a single long open reading frame sufficient to code for 118 K protein. Three proteins of 52 K, 44 K and 22 K could be encoded by the PaMMV RNA 2 genome. Our analysis of the N-terminal sequences of two species of coat protein (CP) allowed precise location of the CP cistrons within the polyprotein. 44 K and 22 K proteins are the coat proteins. The positions of the cleavage sites are Gln/Ala between 44 K and 22 K coat proteins and Gln/Gly between 52 K and 44 K proteins. Comparison of PaMMV RNA 2 with comoviral and nepoviral RNA 2 showed no sequence similarity. These results as well as previous serological studies strongly suggest that PaMMV is a member in the genus Fabavirus.

Enzyme modification by polymers with solubilities that change in response to photoirradiation in organic media

We have synthesized a hybrid subtilisin the solubility of which can be regulated by photoirradiation through coupling with a photoresponsive copolymer that carries spiropyran groups in its side chains. The copolymer was synthesized by polymerization of methacrylate, methacrylic acid, and spiropyran-carrying methacrylate. It was then covalently bonded to the amino groups of subtilisin Carlsberg via its carboxyl groups using a carbodiimide coupling agent. The hybrid subtilisin was perfectly soluble in toluene and efficiently catalyzed transesterification. After ultraviolet irradiation, the hybrid subtilisin precipitated and was easily and quantitatively recovered by centrifugation. Recovered hybrid subtilisin, resolubilized by visible light irradiation, retained its original transesterification activity even after several cycles of precipitation and solubilization.

[Chromatic studies of porcelain veneered crown. Influence of the dentin porcelain on the color of opaque porcelain fused on the metal substructure]

The metals for porcelain fusing used in this study were gold alloys and nickel-chromium alloys. Chromatic characteristics were compared between samples of 0.1, 0.2 and 0.3 mm thickness. The dentin porcelain was fused on the opaque surface. Chromatic analyses were then carried out at each stage of 0.1 mm-incremental reductions of the dentin thickness starting from 0.5 mm. In conclusion, the metallic color was not sufficiently hidden by opaque porcelain 0.1 mm thick for both the gold alloy and nickel-chromium alloy samples. The metallic color was sufficiently hidden by opaque porcelain of 0.2 mm thick for the gold alloy sample but was not sufficiently for the nickel-chromium alloy sample.

[Chromatic studies of porcelain veneered crown. Application of ceramco opaque porcelain]

Chromatic characteristics were compared between the porcelain fused metal substructures using a gold alloy and a nickel-chromium alloy with or without superficially sprayed with gold alloy. From the stand point of the hiding efficiency for the metallic color of the substructure by opaque porcelain fusing, the gold alloy and the sprayed nickel-chromium alloy were superior to the nickel-chromium one as a metal for the porcelain-fused-to-metal crown. The likeness in color of the gold alloy and the sprayed one was also shown. As the conclusion, the application of wire explosion spraying technique which combines the advantages of the gold alloy and the nickel-chromium one appears to be quite useful for providing an excellent substructure for porcelain-fused crowns.

An Integrated CAD/CAPP System with “Know-hows” on Machining Accuracies of Parts

An prototype of an integrated CAD/CAPP system named CIMS has been developed. The sequence of machine tools and the machining sequence are determined by the CIMS based on the models of the parts designed by the CAD system. A modeling system was developed to construct the models of the parts which include both the geometrical information and the technological information of the accuracy, the surface roughness and the material. Since the machining sequence is influenced by the accuracy of the part, a systematic method was proposed to describe the know-hows which give the relations between the machining accuracies and the machining sequences. A procedure was proposed to determine the sequence of machine tools and the machining sequence by applying the know-hows. The system developed is able to generate suitable process plan which is almost the same as ones designed by the experienced process planners.

Semisynthetic beta-lactam antibiotics. II. Effect on antibacterial activity of ureido N-substituents in the 6-[(R)-2-[3-(3,4-dihydroxybenzoyl)-1- ureido]-2-phenylacetamido]penicillanic acids

The synthesis and the relationship between in vitro and in vivo activities of 6-[(R)-2-[3-(3,4-dihydroxybenzoyl)-3-R1-1-ureido]-2- phenylacetamido]penicillanic acids having C2 approximately 8 alkyl or substituted alkyl groups as the substituents (R1) are described. In this series, 6-[(R)-2-[3-(3,4-dihydroxybenzoyl)-3-(3-hydroxypropyl)-1-ureido] -2-phenylacetamido]penicillanic acid (1b, AO-1100) showed the most potent protective effect on mice in experimental Pseudomonas aeruginosa infections, although it did not have the strongest in vitro activity among the penicillins we synthesized.