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保健師学生が認識した保健師の看護過程の特徴 看護師と対比して
Full text link本研究は学生が認識した保健師の個別支援における看護過程の特徴を看護師と対比して明らかにすることを目的とした。保健師学生11名のレポートを質的記述的に分析し、看護師18カテゴリ、保健師21カテゴリを生成した。看護師は入院から退院までの短期間で集中した関わり、保健師は生涯を通した長期的な関わりという時間軸の違いがみられた。看護師は治療と回復を最優先としたケア、保健師は家族と生活を優先したケアが特徴であり、共通点は対象者との信頼関係が基盤となることであった。学生は保健師の看護過程の特徴として、幅広く柔軟な情報収集の枠組みで、人生に寄り添い、地域での生活に即した支援を考えること、QOLの評価と継続支援の判断を行うと認識していた。今後は、地域での生活のアセスメント枠組み構築と思考プロセスを磨く教授方法の必要性が示唆された
Digiral PCR-based plasma cell-free DNA mutation analysis for early-stage pancreatic tumor diagnosis and surveillance （デジタルPCRを用いた遺伝子変異解析による膵腫瘍の早期診断とサーベイランス）
Full text linkBackground: Cell-free DNA (cfDNA) shed from tumors into the circulation offers a tool for cancer detection. Here, we evaluated the feasibility of cfDNA measurement and utility of digital PCR (dPCR)-based assays, which reduce subsampling error, for diagnosing pancreatic ductal adenocarcinoma (PDA) and surveillance of intraductal papillary mucinous neoplasm (IPMN).
Methods: We collected plasma from seven institutions for cfDNA measurements. Hot-spot mutations in KRAS and GNAS in the cfDNA from patients with PDA (n = 96), undergoing surveillance for IPMN (n = 112), and normal controls (n = 76) were evaluated using pre-amplification dPCR.
Results: Upon Qubit measurement and copy number assessment of hemoglobin-subunit (HBB) and mitochondrially encoded NADH:ubiquinone oxidoreductase core subunit 1 (MT-ND1) in plasma cfDNA, HBB offered the best resolution between patients with PDA relative to healthy subjects [area under the curve (AUC) 0.862], whereas MT-ND1 revealed significant differences between IPMN and controls (AUC 0.851). DPCR utilizing pre-amplification cfDNA afforded accurate tumor-derived mutant KRAS detection in plasma in resectable PDA (AUC 0.861-0.876) and improved post-resection recurrence prediction [hazard ratio (HR) 3.179, 95% confidence interval (CI) 1.025-9.859] over that for the marker CA19-9 (HR 1.464; 95% CI 0.674-3.181). Capturing KRAS and GNAS could also provide genetic evidence in patients with IPMN-associated PDA and undergoing pancreatic surveillance.
Conclusions: Plasma cfDNA quantification by distinct measurements is useful to predict tumor burden. Through appropriate methods, dPCR-mediated mutation detection in patients with localized PDA and IPMN likely to progress to invasive carcinoma is feasible and complements conventional biomarkers.博士（医学）旭川医科大
The feasibility of circulating tumor DNA analysis as a marker of recurrence in triple-negative breast cancer （トリプルネガティブ乳癌における，血中循環腫瘍DNAの遺伝子解析と再発マーカ―としての可能性に関する検討）
Full text linkTriple-negative breast cancer (TNBC) has a poorer prognosis than other breast cancer subtypes; therefore, identifying markers of early recurrence is important. The present study aimed to establish a liquid biopsy protocol for droplet digital PCR-based detection of frequently mutated genes in patients with TNBC. Tumor DNA from 36 patients with TNBC who relapsed within 2 years after surgical resection was retrospectively analyzed. Somatic mutational profiles were evaluated using targeted sequencing to identify frequently mutated genes and genes associated with molecularly targeted therapies. The association between genetic alterations and associated protein phosphorylation was investigated using immunohistochemical analysis. Recurrent hot spot mutations in the plasma were monitored over time. Mutation-specific probes were used to successfully detect mutations in the blood samples of patients who were positive for PIK3CA H1047R and AKT1 E17K mutations. Somatic mutations in AKT1 (14.9%) and PIK3CA (25.5%) were frequently identified in the data. Robust phosphorylation of AKT and S6RP was more common in tumors with PIK3CA H1047R and AKT1 E17K mutational background than in tumors with wild-type PIK3CA and AKT1. In conclusion, the present study evaluated a high-sensitivity detection system for frequently mutated genes that was also applicable for cell-free DNA. The PI3K/AKT pathway was revealed to be activated in patients harboring PIK3CA H1047R and AKT1 E17K mutations; therefore, the PI3K/AKT pathway may be a promising candidate for targeted therapy in these patients.博士（医学）旭川医科大
