名古屋学芸大学

OBJECTIVE:Although nutritional and exercise interventions in mixed populations of non-dialysis and dialysis chronic kidney disease patients can improve muscle health, no study has specifically targeted dialysis patients or assessed their dietary intake. This systematic review and me-ta-analysis examined whether combined interventions improve physical performance, nutritional status, dietary intake, and quality of life (QOL) in adults receiving dialysis. METHODS:Following the PRISMA 2020 statement (PROSPERO CRD42024543470, registered on May 16, 2024), PubMed, Ichushi Web, and Web of Science were searched to September 30, 2024 for randomized, cluster-randomized, or crossover trials comparing combined nutrition plus exercise with sole either alone or with no intervention in adults (≥18 years) on hemodialysis or peritoneal dialysis. Favorable outcomes included physical performance, skeletal muscle mass, body mass index, energy and protein intake, QOL, and mortality, whereas the unfavorable outcome was gastrointestinal symptoms. Random-effects meta-analyses calculated mean differences (MDs) with 95% confidence intervals (CIs). RESULTS:Eight trials with 231 hemodialysis patients were eligible; seven contributed to quantitative synthesis. Nutritional interventions involved mainly oral supplements, and exercise (resistance, aerobic, or neuromuscular electrical stimulation) was performed two to three times/week for 3-12 months. Combined therapy significantly improved the 6MWT distance (MD 45.17 m, 95% CI 12.60-77.75), gait speed (MD 0.09 m/s, 95% CI 0.02 to 0.17), and TUG time (MD -1.44 s, 95% CI -2.63 to -0.25). No significant differences were observed in the Sit-to-Stand test, lean body mass, BMI, intake, or QOL. CONCLUSIONS:Compared with nutritional intervention alone, combined nutrition and exercise intervention was associated with improved physical performance outcomes in hemodialysis patients but showed no clear benefit for dietary intake, body composition, or QOL. The certainty of evidence was very low for all outcomes.

The gut microbiota forms a complex ecosystem through metabolic interdependence (cross-feeding). However, conventional fecal metabolomics typically quantifies only total metabolite pools, making it difficult to distinguish extracellular-enriched metabolite pools from predominantly cell-associated ones, and thus limiting reconstruction of in situ metabolic networks. Here, we quantified fecal metabolites in paired fractions from the same specimen: an undisrupted fraction representing the extracellular pool and a strongly bead-beaten fraction representing the total pool; the intracellular pool was defined as the difference between total and extracellular measurements. Stool samples from 63 healthy individuals were analyzed for short-chain fatty acids, polyamines, and water-soluble vitamins, and the results were integrated with shotgun metagenomic profiles of species composition and functional genes. Vitamins exhibited two distinct behaviors. Adenosylcobalamin (a vitamin B12 coenzyme) was detectable only after disruption, and together with thiamine (B1) and niacin (B3) was classified as an intracellular-retained type (Type 1). In contrast, biotin (B7) and pantothenate (B5) showed higher extracellular proportions (Type 2). Integrative analyses further indicated that Type 1 thiamine was negatively associated with Blautia, consistent with intensive microbial utilization, whereas Type 2 biotin was strongly positively associated with Alistipes, suggesting links to ecological niches shaped by luminal pH and fermentation modes (carbohydrate vs protein fermentation). Fraction-resolved quantification provides a practical operational framework to differentiate extracellular from cell-associated metabolite pools, helping reconcile metagenomic potential with metabolomic reality and enabling deeper inference of cross-feeding structure in the gut ecosystem.

BACKGROUND:Neurodevelopmental disorder traits are associated with a range of psychosocial difficulties, yet the longitudinal processes linking these traits to mental health remain insufficiently explored. This study examined developmental associations among autism spectrum disorder (ASD) traits, attention-deficit/hyperactivity disorder (ADHD) traits, social maladjustment, and mental health from childhood through adolescence. METHODS:Longitudinal data were drawn from 9,619 students across 11 grade cohorts in mainstream classrooms. Cross-lagged structural equation modeling was used to estimate independent longitudinal associations among ASD traits, ADHD traits, social maladjustment, and mental health, while controlling for confounding factors. ASD and ADHD traits were modeled simultaneously to clarify their unique developmental patterns. RESULTS:ASD traits were consistently associated with later internalizing problems and peer difficulties. ADHD traits were associated with later internalizing and externalizing problems, as well as academic challenges and strained teacher-parent relationships. These associations differed by trait type, suggesting distinct developmental pathways. Several bidirectional associations also emerged: poorer mental health was associated with subsequent social maladjustment, which was subsequently linked to persistent developmental difficulties. CONCLUSIONS:The findings indicate that social maladjustment is involved in the longitudinal associations between developmental disorder traits and mental health and may shape developmental trajectories. These results highlight the need for comprehensive support approaches that consider peer relationships, learning environments, and family-school relationships.

Introduction A substantial proportion of patients spend their final days in intensive care units (ICUs), where ICU nurses are tasked with providing end-of-life care in critical situations. When patients express a preference to spend their final days at home, direct discharge from the ICU may be appropriate. However, this process presents significant risks and complexities. Objectives The aims of this review were to investigate the prevalence of transfer from ICUs to home and to explore and summarise known facilitators and barriers to this process, as well as its impacts on patients, families, and healthcare systems. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. MEDLINE via PubMed, CINAHL, PsycINFO, and Igaku Chuo Zasshi (a Japanese local database) were searched for relevant studies published through September 2024, and their characteristics and details were extracted. Results A total of 28 studies met the inclusion criteria. The studies were conducted in various countries and included qualitative, quantitative, and mixed-method designs. The intervention procedures related to transferring patients home to die were categorised into seven main areas, including symptom management and palliative care. We identified 21 factors as facilitators of transfer home to die, such as opportunities for consultation with relevant parties, while 11 factors were identified as barriers, with limited local medical resources being the most common. Eleven positive effects were reported, most frequently related to the mental and physical well-being of family members, whereas negative effects included rapid deterioration in the patient’s condition. Conclusions End-of-life care is influenced by individual beliefs and culture, hospital systems, and the patient’s home environment. ICU nurses play an important role as coordinators, intervening early to adjust the environment and support a safe transition home.