Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Pollen-Food Allergy Syndrome （PFAS）
Get PDF花粉-食物アレルギー症候群（pollen-food allergy syndrome；PFAS）とは，花粉感作後に，花粉と交差抗原性を有する植物性食物を経口摂取してアレルギー症状を来す病態を指す1）．症状は主に口唇・口腔内の痒みや浮腫などであるが，時に全身症状やアナフィラキシーを来す．原因花粉はブナ目（カバノキ科，ブナ科），イネ科，キク科が多い．食品はモモやリンゴなどのバラ科の食物，スイカやメロンなどのウリ科の食物，キウイ，トマト，大豆．ピーナッツなどが多い．診断は詳細な病歴，花粉および被疑食品の感作状況を参考に行う．prick-to-prick test が補助診断として有用である．治療の基本は原因食品の除去であるが，加熱などの加工処理によって摂取可能な場合が多い．患者の症状や希望を考慮して方針を決める.journal articl
A case Report of a 2-month-old Girl with Infantile Epileptic Spasm Syndrome Who Exhibited a Favorable Response to Phenobarbital
Get PDF症例は生後 2 か月女児．入眠中 15～20 秒の周期で両上肢を瞬時に伸展し回外させるシリーズ形成性スパズムを認めた．脳波検査で異常放電は認めなかったが，フェノバルビタール（Phenobarbital：PB）投与開始後，発作は消失した．その後 PB の血中濃度依存性に発作が増減した．経過中に明らかなてんかん性異常波は認めず，PB 投与を継続し，生後 3 か月に退院した．乳児早期のシリーズ形成性スパズムは大田原症候群，乳児ミオクロニーてんかん，West 症候群との鑑別が重要である．原因が明らかでない乳児てんかん性スパズム症候群の初期治療に対し，PB を投与しつつ臨床経過を観察し，鑑別を進めることが重要と考えられたEarly infantile series-forming spasms are a form of epilepsy that is difficult to differentiate from other forms of infantile epilepsy, including Ohtahara and West syndrome and infantile myoclonic epilepsy. In this report, we present the case of a 2-month-old girl who was admitted to our hospital with recurring seizures, characterized by rapid extension of both upper limbs during sleep. The child exhibited recurrent episodes of series-forming spasms, lasting 15-20 seconds, involving simultaneous extension and rotation of both upper limbs. She was born without pseudopnea during a normal delivery. Sleep video electroencephalography（EEG）failed to establish Ohtahara or West syndrome, as no irregular discharge was identified. Treatment was initiated by the intravenous administration of phenobarbital（PB）. As the frequency of seizures increased and decreased in a concentration-dependent manner, the PB concentration in the blood was maintained at a consistently high level, resulting in cessation of seizures. Periodic EEG did not reveal any notable irregular epileptic waves, and the patient’s development was deemed satisfactory at the age of 6 months following continuous outpatient treatment. For the initial treatment of infantile epileptic spasm syndrome of an unknown cause, it is essential to observe the clinical course with simultaneous differentiation while administering PB.journal articl
Educational content of flight nurses in Japan：A national survey
Get PDF【目的】 本研究の目的は，フライトナースが独り立ちするまでに，各施設で行われている教育内容の実態を明らかにすることである．
【対象及び研究方法】 日本国内でドクターヘリを運航している全ての医療機関にアンケートの協力依頼を行った．研究協力の意思が示された 31 施設 190 名のフライトナースに対して，郵送法にてアンケートを配布した．返信のあった 92 名のうち，半数以上の項目が未回答であった 2 名を除外した 28 施設，90 名を本研究の分析対象とした．
【結果】 日本におけるフライトナース教育の実態として，未回答であった 1 施設を除いた全ての施設でOJT 教育を取り入れていた．フライトナースとして独り立ち後，災害対応，周産期患者の対応などの特殊事案を経験していたが，災害に特化した教育は 4 施設（14.3％），周産期に特化した教育は 4 施設（14.3％），新生児転院に特化した教育は 7 施設（25.0％），小児に特化した教育は 6 施設（21.4％）と特殊事案の教育の実施率は半数に満たなかった．また，シミュレーション教育を導入している施設は 15施設（53.6％）であった．教育期間は，10 日間から 1 年以上とバラつきがあった．ドクターヘリの機体に伴う搭乗人数の違いによる教育期間と 1 カ月の OJT 日数に有意差は認められなかった．
【結論】 フライトナースとして独り立ち後，災害対応，周産期患者の対応などの特殊事案を経験しているが，フライトナース教育として多くの施設でこれらの特殊事案についての教育は行われていなかった．一方特殊事案は，フライトナースの OJT 期間中に実際に経験する可能性が低いことから，フライトナースが講習会に参加し，自己研鑽する中で，知識，技術を習得していると推察された．OJT 教育期間中に経験できる可能性が低い特殊事案の教育には，標準的な教育プログラムに盛り込むと同時に各施設においてシミュレーション教育を取り入れるなどの対応が必要であると考えられた．［Aim］ This study aimed to clarify the education content and actual state of knowledge and skills training provided at each medical facility until flight nurses can practice independently.
［Subject and Method］ We requested participation in the questionnaire survey from medical institutions that operate medical helicopters in Japan. We analyzed 90 patients from 28 medical centers that participated in the study.
［Result］ Regarding flight nurse education in Japan, OJT was introduced in all the medical facilities surveyed. After beginning independent practice, flight nurses experienced exceptional cases such as disaster response and perinatal patient care. However, four （14.3％） facilities provided disaster-specific education；four （14.3％）, perinatal education；seven（25.0％），neonatal transportation； and seven （25.0％）, pediatric education. Six（21.4％） provided education on exceptional cases, which was less than a quarter of the total number of facilities. Fifteen facilities （53.6％） introduced simulation education. The duration of education varied from 10 days to ＞ 1 year.
［Conclusion］ Many facilities do not provide education on these particular cases as part of flight nurse education. Conversely, flight nurses are unlikely to experience exceptional cases during their OJT period, and flight nurses purportedly acquire this knowledge and skillset by participating in training sessions as well as self-improvement. Including exceptional cases during the OJT training period in the standard education program and incorporating simulation education at each facility are necessary.departmental bulletin pape
Relationship between awareness of community-based activities and support for such activities among municipal public health nurses in A prefecture
Get PDF【目的】 本研究は，A 県市町村保健師を対象とした地域組織活動育成支援の取り組みの優先度と意識および支援状況の関連を明らかにし，人材育成に必要な示唆を得ることを目的とした．
【方法】 A 県市町村保健師 752 名を対象とした．地域組織活動への意識 20 項目および支援状況 17 項目（郵送による自己記入式調査）の結果と，「取り組みの優先度」を 4 件法により高群・低群に分け，χ²検定を実施し（p＜0.05）分析した．
【結果】 優先度が高い保健師は，実施支援内容である「住民とともに活動」「活性化への支援」「組織化への支援」と関連が高く，優先度の高さは，住民とともに活動する地域組織活動の良さや必要性の理解，さらに，職場内での活動の理解につながっていた．
【考察】 保健師の地域組織活動への優先度を高めていくことが必要であり，地域の健康づくりへの視点の重要性が示唆され，職場内での共通理解を得ながら地域組織活動に積極的に関わる保健師の人材育成の在り方を検討していきたい［Objectives］ ：The main objectives of this study were to clarify the relationship between priority initiatives to support the development of community-based activities and awareness and support for such activities among municipal public health nurses in A prefecture, and to examine the requirements necessary for the development of human resources.
［Methods］ The analysis included 752 municipal public health nurses from A prefecture. The results for 20 items related to awareness of community-based activities and 17 items related to support for community-based activities （obtained via a self-administered survey mailed to the participants） were analyzed based on a 4-point rating scale of “priority initiatives” and classified in high and low priority groups. Data were analyzed using a chi-square test （p＜0.05）．
［Results］ A high priority among public health nurses in the high-priority group was highly correlated with “actively interacting with community residents”, “supporting the development of activities”, and “supporting the development of community organizations”. In addition, a high prioritywas associated with the understanding of the benefits and necessity of developing community-based activities together with local residents, as well as the understanding of such activities at one’s own workplace.
［Discussion］ The results of the study suggested the necessity for increasing the level of priority given to community-based activities among public health nurses as well as the importance of promoting health in local communities. Another important aspect to be considered is how to develop human resources among public health nurses who are actively involved in community-based activities, while gaining a general understanding of such activities at their workplacedepartmental bulletin pape
Decreased SIRT1 Impairs HIF-1α Nuclear Translocation in Alveolar Epithelial Cells: A Potential Mechanism of Emphysema Progression
Get PDFHypoxia-inducible factor 1 (HIF-1) is a crucial protein involved in cellular adaptation to low oxygen levels. We previously demonstrated impaired HIF-1α nuclear translocations cause impaired cellular adaptation to hypoxia in chronic obstructive pulmonary disease (COPD). However, the mechanism of impaired nuclear translocations of HIF-1α in COPD was not fully elucidated. We hypothesised that sirtuin (SIRT) 1, which is known to be decreased in the lungs of COPD patients, is involved in HIF-1α nuclear translocation. The objective of this study was to investigate the precise functions of sirtuin SIRT1 in relation to HIF-1α stabilization, nuclear translocation, and the subsequent modulation of vascular endothelial growth factor (VEGF) expression.
SIRT1 was knocked down by transfection with siRNA of SIRT1 to A549 cells, and the cells were cultured under hypoxic conditions (1% O2, 5% CO2, and 94% N2). HIF-1α proteins in nuclei and whole cell extracts were measured by SDS/PAGE Western blotting, and mRNA levels of HIF-1α, VEGF, and MMP (Matrix metalloproteinase) -9 were quantified by quantitative real-time PCR.
SIRT1 knockdown significantly decreased HIF-1α protein in nuclei under hypoxia without affecting the amount of HIF-1α mRNA or HIF-1α proteins in whole cells compared to control knockdown cells. Hypoxia- induced VEGF expression was suppressed by SIRT1 knockdown. Conversely, SIRT1 knockdown resulted in a further increase in MMP-9 transcription under hypoxic conditions.
In conclusion, the reduction of SIRT1 leads to impaired nuclear translocation of HIF-1α under hypoxia, subsequently decreasing VEGF expression, and promoting increased MMP-9 expression under hypoxic conditions. These mechanisms may potentially contribute to the progression of emphysema.journal articl
Campylobacter Enteritis Differentiated from Sarcocystis Food Poisoning due to Deer Meat Feeding：A Case Report
Get PDFSarcocystis属原虫は家畜や野生動物に寄生している．シカから検出されるSarcocystisについては，過去の食中毒事例から複数の虫種が報告されている．一方で，シカの腸内では腸管出血性大腸菌やカンピロバクターなどの食中毒菌が保有されている．我々は，シカ肉摂食後にSarcocystis食中毒と鑑別を要したカンピロバクター腸炎の症例を経験した．症例は8歳の男児．入院3日前にシカ肉の摂食歴があり，持参のシカ肉からサルコシストが検出され，一方便培養からはCampylobacter jejuniが検出し，カンピロバクター腸炎と診断した．適切にシカ肉が凍結保存されSarcocystis食中毒が回避されても，凍結前段階におけるシカ肉の処理法や摂食時の加熱調理温度によりCampylobacter jejuni感染による食中毒が問題となると考えられた．journal articl