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カンゴ カテイ ノ テンカイ ニ カカワル ドウニュウ キョウイク エノ バーチャル リアリティ キョウザイ ノ カイハツ ト ソノ カツヨウ カノウセイ ノ ヒョウカ : ウィズ コロナ ジダイ ノ キョウイク ジッセン エノ トリクミ
Get PDF看護過程の展開に関わる教育用にバーチャルリアリティ（VR）教材を開発し，教育への使用可能性について検討した．看護学科1年生60名を対象に，傷病によるベッド上臥床患者の入院生活場面での困りごとをアセスメントする課題を提示し，患者目線での臥床体験が可能なVR映像の視聴前後で，気づきの項目数とその内容を比較した．VR教材視聴前の紙面での患者情報のみでは平均6項目であったのに対し，VR教材視聴後には「ベッドから見える景色が変わらず意欲の低下につながる」など学内の講義・演習科目だけでは気づきにくい内容を含む平均7項目が新たに追加された．このことから，気づきの量・質ともにVR教材視聴前にはなかった視点が加えられ，アセスメント技術の獲得に繋がったと考える．また，VR教材に関する学生の自己評価は，学修効果（3項目）では平均4.7〜4.9点，学修意欲（2項目）では平均4.6点といずれも5点満点中で高値を示すなど一定の教育効果が認められた．このことから，開発したVR教材は看護過程の展開に関する教育において活用可能と考える．departmental bulletin pape
Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion?
Get PDFObjectives:
Acute type A aortic dissection with coronary malperfusion syndrome is rare but associated with high mortality. Multi-organ malperfusion is an independent predictor of acute type A aortic dissection. Coronary malperfusion requires treatment, but it is not feasible to treat all malperfusions. The adequacy of "central repair and coronary artery bypass grafting" for patients with coronary and other organ malperfusion is unknown.
Methods:
Of the 299 patients who underwent surgery between 2008 and 2018, 21 patients with coronary malperfusion, who received cental repair with coronary artery graft bypass, were analyzed retrospectively. They were divided; into Group M (n = 13, coronary and other organ malperfusion) and Group O (n = 8, coronary malperfusion only). The patient background, surgical content, details of malperfusion, surgical mortality and morbidity, and long-term outcome were compared.
Results:
There was no difference in operation time (205 ± 30 vs. 266 ± 88, p = 0.49), but the time from arrival to circulatory arrest tended to be shorter in Group M (81 vs. 134, p = 0.05). Among Group M, cerebral malperfusion was the most common at 92%. Two of the three cases with mesenteric malperfusion died. The mortality of Group M and Group O was 13% and 15% (P = 0.85), respectively. There was no difference in long-term mortality (p = 0.62).
Conclusions:
Central repair and coronary artery bypass grafting is a sufficiently acceptable treatment for patients with acute type A aortic dissection and multi-organ malperfusion, including coronary malperfusion.journal articl
Medication adherence and health-related quality of life among people with diabetes in Bangladesh : A cross-sectional study
Get PDFIntroduction:
Good adherence to anti-diabetic medications is an important protective factor for decreasing diabetes-related complications and disabilities but its association with health-related quality of life (HRQoL) is understudied. The current study aimed to assess an association between medication adherence to anti-diabetic drugs and HRQoL among people with diabetes in Dhaka city, Bangladesh.
Methods:
We conducted a cross-sectional study among 480 people with diabetes aged between 50 and 70 years, who attended a tertiary-level hospital in Dhaka city. We used the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L) to measure HRQoL and Morisky Medication Adherence Scale to assess the level of medication adherence to anti-diabetic drugs. Multivariable logistic regression was performed to assess the significance of relevant factors.
Results:
The mean age of the participants was 59.0 (standard deviation [SD], 7.0) years. The majority of the participants (74%) had a lower level of medication adherence. The mean value of (EQ-5D-5L) was 2.0 (SD, 1.0). The percentage of severe disability in different domains were 6.7% for mobility, 3.5% for self-care, 11.9% for usual daily activities, 11.9% for pain/discomfort and 11.3% for anxiety. After adjusting for age, sex, years of education, household expenditure, hypertension, duration of diabetes, glycemic status and multi-morbidities; low adherence to anti-diabetic medication was inversely associated with pain (OR, 0.26; 95% CI, 0.08-0.80; p = .036), and positively associated with anxiety (OR, 7.18; 95% CI, 1.03-9.59; p = .043).
Conclusions:
Low medication adherence to anti-diabetic drugs was associated with anxiety and pain among the EQ-5D-5L indexes measured in people with diabetes in Dhaka, Bangladesh.journal articl
Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan - Shiga Stroke and Heart Attack Registry
Get PDFBackground:
Acute aortic dissection (AAD) is a life-threatening cardiovascular disease, with a reported incidence rate ranging from 2.5 to 7.2 per 100,000 person-years in several population-based registries in Western countries, but epidemiological data are lacking in Japan.Methods and Results: The Shiga Stroke and Heart Attack Registry is an ongoing multicenter population-based registry of cerebro-cardiovascular diseases. We enrolled patients who developed AAD, defined by any imaging examination method from 2014 to 2015 in Shiga Prefecture. Death certificates were used to identify cases that were not registered at acute care hospitals. The incidence rates of AAD were calculated by age categories and adjusted using standard populations for comparison. We evaluated differences in patient characteristics between Stanford type A-AAD and type B-AAD subtypes. A total of 402 incident cases with AAD were analyzed. The age-adjusted incidence rates using the 2015 Japanese population and the 2013 European Standard Population were 15.8 and 12.2 per 100,000 person-years, respectively. Compared with cases of type B-AAD, those with type A-AAD were older (75.0 vs. 69.9 years, P=0.001) and more likely to be women (62.3% vs. 28.6%, P<0.001).
Conclusions:
Population-based incidence rates of AAD in Japan appear to be higher than in previous reports from Western countries. Incident cases with type A-AAD were older and female predominance.journal articl
Exploratory Study of Serum Lactoferrin and Anti-Lactoferrin Antibody Concentrations in Patients with Endometriosis.
Get PDFapplication/pdfEndometriosis is a disease that is characterized by the ectopic presence of the endometrium or its similar cells. A high prevalence of patients with autoimmune diseases has been reported among patients with endometriosis although the cause of endometriosis remained unknown. Recently, the anti-lactoferrin antibody is reported to be highly detected in autoimmune diseases. This study focused on lactoferrin and anti-lactoferrin antibodies to explore the pathology of endometriosis. Lactoferrin is a substance that regulates inflammation and is produced by neutrophils. Anti-lactoferrin antibody is a type of perinuclear antineutrophil cytoplasmic antibody. The serum lactoferrin and anti-lactoferrin antibody levels were compared among patients with or without endometriosis, revealing significantly higher levels in patients with endometriosis. Additionally, a decreased serum anti-lactoferrin antibody level was observed after surgical endometriosis resection. The receiver operating characteristic curve analysis determined the reference values for the serum lactoferrin and anti-lactoferrin antibody levels. Patients whose serum level exceeded the reference anti-lactoferrin antibody value were significantly higher in more than 40% of cases in the endometriosis group. The rate is comparable to that of autoimmune diseases. This is the first report that anti-lactoferrin antibody is frequently observed in patients with endometriosis, adding a new perspective to the understanding of the pathology of endometriosis although precisely elucidating the mechanism by which lactoferrin and anti-lactoferrin antibody appear in endometriosis in the future is necessary.Journal Articlejournal articl
シンケイ リンパシュショウ デ サイハツシタ チュウスウ シンケイケイ ゲンパツ アクセイ リンパシュ ノ 1ショウレイ
Get PDF【緒言】神経リンパ腫症は中枢神経または末梢神経への悪性リンパ腫細胞の浸潤によるリンパ節外悪性リンパ腫と考えられる稀な病態である。今回中枢神経系原発悪性リンパ腫の治療後完全寛解後に末梢神経浸潤にて再発を認め、化学療法と自己末梢血幹細胞移植にて完全寛解を得られた症例を経験したので報告する。【症例】50代男性、20XX年に中枢神経系原発悪性リンパ腫と診断、標準的な治療として大量メソトレキセート療法3回施行にて部分寛解、救援療法としてカルボプラチン、エトポシド療法3回と全脳照射(39.6Gy)を施行し完全寛解となった。9ヶ月後、歩行障害、右上肢麻痺、両下肢・右上肢の感覚障害と疼痛を認めた。頭部および脊椎造影MRIに異常所見はなかった。FDG-PET/CTにて右腕神経叢と脊椎神経根に異常集積を認めた。神経リンパ腫症が強く疑われた。脳脊髄液の細胞診とフローサイトメトリー(FCM)にて中枢神経系原発悪性リンパ腫の再発と診断。神経リンパ腫症と診断した。リツキシマブ、メトトレキサート、ビンクリスチン、プロカルバジン併用療法(R-MPV療法)、髄腔内化学療法、およびブスルファン、チオテパ併用(BU/TT)自己末梢血幹細胞移植を施行し完全寛解に至った。【結論】脳脊髄液細胞診とFCM、FDG-PET/CTを併用することで、神経リンパ腫症の診断が可能となった。中枢神経系原発悪性リンパ腫の再発としての末梢神経の神経リンパ腫症ついては確立された治療法はないことを考えると本症例はR-MVP療法とそれに続くBU/TT併用自己末梢血幹細胞移植の有用性を示唆するものである。[Introduction] Neurolymphomatosis is a rare extranodal malignant lymphoma caused by infiltration of malignant lymphoma cells into the peripheral or central nerves. We report a case of neurolymphomatosis as a relapse of primary central nervous system malignant lymphoma. He achieved complete remission with disappearance of neurological symptom by the combination of chemotherapy and autologous peripheral blood stem cell transplantation. [Case] A 50s-year-old male patient was diagnosed as primary central nervous system malignant lymphoma. His disease achieved partial remission with three courses of high-dose methotrexate therapy as induction therapy. The subsequent salvage therapy with carboplatin/etoposide and whole-brain irradiation (39.8Gy) led him complete remission. Nine months later, he developed gait disorder, right upper extremity paralysis, sensory disturbance and pain in both lower extremities and upper right extremities. There were no abnormal findings on head and spine imaging MRI. However, PET-CT scan demonstrated abnormal uptake of FDG in the right brachial plexus and spinal nerve roots. The cerebrospinal fluid cytology and flow cytometry confirmed the diagnosis of neurolymphomatosis as a recurrence of primary central nervous system malignant lymphoma. He underwent R-MPV therapy, intrathecal chemotherapy, and autologous peripheral blood stem cell transplantation with a preconditioning of busulfan and thiotepa, resulting in complete remission of neurolymphomatosis with disappearance of neurological symptoms. [Conclusion] The cerebrospinal fluid cytology and flow cytometry together with PET-CT enabled us to make a diagnosis of neurolymphomatosis. Given that there are no established treatments for neurolymphomatosis of the peripheral nerves as a recurrence of primary central nervous system malignant lymphoma, this case suggests the possible efficacy of the R-MPV therapy followed by autologous peripheral blood stem cell transplantation with busulfan and thiotepa.departmental bulletin pape
Immunohistochemical and clinicopathological study regarding nardilysin on extramammary Paget's disease
No full textIt has been reported that nardilysin (NRDC), a metalloendopeptidase which regulates various growth factors and cytokines, is associated with malignancies in a conflicting manner, in which it promoted gastric, hepatocellular, and colorectal cancers and suppressed pancreatic ductal adenocarcinoma. However, it has not been investigated how NRDC is associated with cutaneous malignancies for now. Immunohistochemical staining has revealed that NRDC expression is observed in all extramammary Paget's disease (EMPD) cases. Notably, other cutaneous malignancies including basal cell carcinoma, squamous cell carcinoma, and eccrine porocarcinoma, did not show increased NRDC expression in immunohistochemistry. EMPD typically presents several types of lesions including nodules, and positive staining of NRDC on EMPD was observed regardless of the type of lesions. Examination using samples taken from nodular lesions showed that some cases showed heterogenous NRDC expression within each lesion. We also found that NRDC staining was weaker in the marginal parts of EMPD lesion than in the central parts in several cases, and tumor cells tend to be distributed beyond the macroscopic skin lesions in these cases. It was speculated that decreased NRDC expression in the marginal zones of the skin lesions may be associated with the ability of tumor cells to produce the cutaneous manifestation of EMPD. This study suggests that NRDC may be associated with EMPD like other malignancies reported previously.Journal Articlejournal articl
In vivo analysis of aggregation propensity of low levels of mislocalized TDP-43 on cytopathological and behavioral phenotype of ALS/FTLD.
Get PDFapplication/pdfMislocalization and aggregate formation of TAR DNA-biding protein of 43kD (TDP-43) in the cytoplasm are signatures of amyotrophic lateral sclerosis(ALS) and frontotemporal lobar degeneration (FTLD). However, the role of two cytopathologies in ALS/FTLD pathogenesis is unclear. This study aims to elucidate the difference in their causality of TDP-43 in ALS/FTLD in vivo, using transgenic mice expressing human TDP-43 with defective nuclear localizing signals in neurons (Cyto-TDP) and those with aggregation propensity (Cyto-aggTDP). The expression levels of both proteins are less than half of endogenous TDP-43. Despite the low amount of Cyto-aggTDP, the TDP-43 phosphorylation is more evident than Cyto-TDP. Histopathological study showed accelerated astrogliosis in the anterior cerebral cortex of both mice. Cyto-aggTDP mice demonstrated significant but faint loss of neurons in the perirhinal(PERI) and ectorhinal(ECT) areas and higher Iba1-staining in the spinal cord than aged control. Despite the lack of locomotor dysfunctions in both mice, the open-field test showed enhanced exploratory behavior, indicating that the perpetual mislocalization of TDP-43 may suffice to trigger FTLD behavior. Besides, the aggregation propensity of TDP-43 promotes phosphorylation, but its role in the clinicopathological phenotype may not be primary.Journal Articlejournal articl
Bile duct penetrating duodenal wall sign: a novel computed tomography finding of common bile duct stone impaction into duodenal major papilla
No full textPurpose:
Impacted common bile duct stones cause severe acute cholangitis. However, the early and accurate diagnosis, especially iso-attenuating stone impaction, is still challenging. Therefore, we proposed and validated the bile duct penetrating duodenal wall sign (BPDS), which shows the common bile duct penetrating the duodenal wall on coronal reformatted computed tomography (CT), as a novel sign of stone impaction.Purpose:
Impacted common bile duct stones cause severe acute cholangitis. However, the early and accurate diagnosis, especially iso-attenuating stone impaction, is still challenging. Therefore, we proposed and validated the bile duct penetrating duodenal wall sign (BPDS), which shows the common bile duct penetrating the duodenal wall on coronal reformatted computed tomography (CT), as a novel sign of stone impaction.Results:
A total of 40 patients (mean age 70.6 years; 18 female) were enrolled. The BPDS was observed in 15 patients. Stone impaction occurred in 13/40 (32.5%) cases. Overall accuracy, sensitivity, and specificity were 34/40 (85.0%), 11/13 (84.6%), and 23/27 (85.2%), respectively; 14/16 (87.5%), 5/6 (83.3%), and 9/10 (90.0%) for iso-attenuating stones; and 20/24 (83.3%), 6/7 (85.7%), and 14/17 (82.4%) for high-attenuating stones. Interobserver agreement of the BPDS was substantial (κ = 0.68). In addition, the BPDS was significantly correlated with the number of factors in the systemic inflammatory response syndrome (P = 0.03) and total bilirubin (P = 0.04).Conclusion:
The BPDS was a unique CT imaging finding to identify common bile duct stone impaction regardless of stone attenuation with high accuracy.Journal Articlejournal articl