Tokyo Junshin University

Bile acids are a category of steroids biosynthesized from cholesterol in the liver. Inborn errors of their metabolism are inherited in an autosomal recessive manner, resulting in enzyme deficiencies affecting the bile acid biosynthetic pathway. These defects in the pathway cause accumulation of unusual bile acids or bile alcohols. Unusual bile acids are highly cytotoxic, causing injury to the liver. These unusual bile acids damage hepatocytes, resulting in cholestatic liver injury beginning in infancy. Except for cerebrotendinous xanthomatosis and some secondary defects, various inborn errors of bile acid metabolism (IEBAM) have been reported from Japan, affecting eight patients including three with 3β-hydroxy-Δ5 -C27 -steroid dehydrogenase/isomerase deficiency, three with Δ4 -3-oxosteroid 5β-reductase deficiency, one with oxysterol 7α-hydroxylase deficiency, and one with bile acid-CoA: amino acid N-acyltransferase deficiency. Distinctive laboratory findings in patients with 3β-hydroxy-Δ5 -C27 -steroid dehydrogenase/isomerase deficiency, Δ4 -3-oxosteroid 5β-reductase deficiency, and oxysterol 7α-hydroxylase deficiency include normal serum γ-glutamyltransferase and total bile acids concentrations despite presence of cholestasis (elevated serum direct bilirubin) from infancy. Pediatricians and pediatric surgeons who suspect a case of IEBAM should obtain urinary and serum bile acid analyses using gas or liquid chromatography-mass spectrometry as well as genetic analyses. Available treatments include oral cholic acid, chenodeoxycholic acid, glycocholic acid, and ursodeoxycholic acid; fat-soluble vitamin supplementation; and liver transplantation. Early diagnosis and treatment can offer a good outcome.

Abstract Background: Few studies have provided detailed analyses of sustained evaluations during manual interventions, and their physiological and psychological effects are not well known. Moreover, no studies have evaluated the effects of conversation in combination with intervention. We investigated the effects of conversation and hand-mediated therapy on the autonomic nervous systems and moods of both recipients and practitioners. Methods: Participants were university students (n=30). Two different interventions were included: one in which conversation was maintained during massage, and the other without conversation. Outcomes were heart rate variability (HRV) measurements and the Profile of Mood States Second Edition (POMS2), which were analyzed using repeated-measures analysis of variance, multiple comparisons, the difference between means test, the Friedman test, and the Wilcoxon signed-rank test. Intervention I data measured was from October 2016 to September 2017 whereas Invention II data was measured from January 2019 to March 2019. The study data was analyzed from October 2017 to October 2019. Results: After 15 min of rest, both negative and positive mood states were significantly reduced. In the presence of conversation, sympathetic nerve activity significantly increased, and a significant decrease in negative mood states was observed in POMS2, as well as a rising tendency for positive mood states. In massage recipients, a significant increase in parasympathetic nervous activity was noted when conversation was absent; however, when conversation was present, there was an increase in sympathetic nervous activity and a decrease in parasympathetic nervous activity, but only the decline in the mean heart rate (MHR) was significant. All negative items significantly declined in POMS2. The mean value of sympathetic activity in the group of practitioners was significantly higher after the intervention than before, regardless of the presence or absence of conversation. In the presence of conversation, all negative POMS2 items significantly declined. Conclusion: Hand-mediated therapies suppressed conversation-mediated sympathetic nervous system activity. The absence of conversation produced a more pronounced relaxation effect in the massage recipient. In terms of mood, the relaxation effect was more powerful in the presence of conversation. Furthermore, in the presence of conversation, a mood-based relaxation effect on the practitioner was confirmed. Trial registration: None

Elobixibat, a novel inhibitor of apical sodium-dependent bile acid transporter for treating chronic constipation, increases colonic bile acid concentrations, stimulating bowel function. However, it is not clear which bile acids are altered, or whether altered gut microbiota are associated with functional effects that may alter bowel function. To investigate the effects of elobixibat on changes in the faecal concentrations of total and individual bile acids and in faecal microbiota. This was a prospective, single-centre study. After baseline period, patients received 10mg daily of elobixibat for 2weeks. We evaluated the effects on bowel function, changes in faecal bile acid concentrations and composition of gut bacteria, before and after elobixibat administration. In the 30 patients analysed, the frequency of pre- and post-treatment bowel movements per fortnight was 7 and 10 (P<0.001), respectively. The pre-treatment faecal bile acid concentration increased significantly from 10.9 to 15.0µg/g stool post-treatment (P=0.030), with a significant increase in faecal deoxycholic acid (pre-treatment 3.94µg/g stool to post-treatment 5.02µg/g stool, P=0.036) and in glycine-conjugated deoxycholic and chenodeoxycholic acids. Shannon index was significantly decreased, but there were no significant changes at the genus and phylum levels. Short term treatment with elobixibat increased the concentrations of total bile acids and deoxycholic acid and decreased the diversity of faecal microbiota. The biological effects of elobixibat are associated with its effects on secretory bile acids, rather than the structural changes of an altered faecal microbiota.

The research objective is to clarify the awareness of nursing care workers how they perceive “Individuality” of users and what they actually do to respect “individuality” when providing cares. We had semi-structured interview among 20 nursing care workers who worked at care welfare facilities over three years. We prepared verbatim and qualitatively analyzed data using inductive approach. As a result, we had 52 codes, 13 sub-categories and 6 categories, and found that nursing care workers provide essential care “now” and “here” for individual users. The word, “individuality” includes the consistency sought when providing cares and the uniqueness of individual nursing care workers with a certain balance, and this shows unique relationship of users and nursing care workers.