Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Student Learning Through Interviews With Outpatients as a Pre-Clinical Assignment for Basic Nursing Practice
Full text link【目的】 看護学部1 年生が，身近な外来通院者を対象としたインタビューの実施で得られた学びを明らかにする．本研究結果は，オンライン実習やハイブリッド型の実習など，臨地だけではない実習方法や事前課題の在り方を検討する基礎資料となる．
【方法】 身近な外来通院者にインタビューできた看護学部1 年生70 名の事前課題レポート「インタビューを通して学んだこと」に記述されている内容を，質的帰納的に分析した．なお，「学び」を「インタビューを通して，学生が，知り，考え，勉強したこと，こうありたいと願うこと」と定義した．
【結果】 学びとして【病を抱え通院することは苦痛が伴う】，【外来通院に希望を見出す】，【患者・家族へ働きかける】，【患者にとって看護師の存在は大きい】，【患者を知ろうとする姿勢をもつ】，【適切な看護を実践する】，【課題を通して自分が成長できたと思う】が抽出された．
【結論】 「外来通院者の健康レベルや生活様式，気持ちを理解する，外来看護師の役割を理解する」ことを目的とした身近な外来通院者へのインタビューは，外来通院者の思いや外来看護師の役割を理解する一助となっていた．外来看護師に求められている多職種連携の視点を深められるよう，今後も継続した教育が必要である．departmental bulletin pape
APC Mutations in Prior Hepatitis B Virus-infected Non-cancerous Tissues and Their Association with Hepatocellular Cancer Recurrence
Full text linkBackgrounds The molecular mechanisms by which prior hepatitis B virus infection leads to hepatocellular carcinoma are not established. This study aimed to elucidate these mechanisms by investigating the gene mutation profiles associated with the development of hepatocellular carcinoma in patients with prior hepatitis B virus infection. Methods Surgical specimens were resected in our department. We analyzed cancerous and non-cancerous liver tissues from three groups: (1) patients with hepatocellular carcinoma following prior hepatitis B virus infection, (2) patients with hepatocellular carcinoma during active hepatitis B virus infection, and (3) patients with a history of prior hepatitis B virus infection but without hepatocellular carcinoma. DNA extracted from the tissues was screened for mutations potentially associated with carcinogenesis. Results Patients who developed hepatocellular carcinoma after a prior hepatitis B virus infection exhibited mutation profiles similar to those of patients with active hepatitis B virus infection in cancerous and noncancerous areas. This similarity suggests that no unique gene mutations are associated with hepatocellular carcinoma development in the context of prior hepatitis B virus infection. However, patients with APC mutations in non-cancerous liver tissues have a higher likelihood of hepatocellular carcinoma recurrence than those without such mutations. Conclusions Our findings indicated that APC mutations play a significant role in the development of hepatocellular carcinoma in patients with a history of hepatitis B virus infection. Further studies are required to elucidate the role of this gene in hepatitis B virus-associated carcinogenesis.journal articl
Endocrine Secretory Granule Structures Form in the Presence of Granule-content Substances under REST-knockout and PROX1-expressing Conditions
Full text linkEndocrine secretory granules (ESGs) are intracellular organelles specific to endocrine/neuroendocrine cells, yet their precise mechanism of formation remains elusive. In our previous study, we successfully induced the formation of ESG structures in the nonendocrine lung cancer cell line H1299 by knocking out the REST gene, forcibly expressing PROX1, and inducing the expression of pro-opiomelanocortin (POMC), an ESG component. However, it is unclear whether ESG structures can form in the presence of intragranular contents other than POMC. In this study, we analyzed whether ESG structures form when calcitonin (calcitonin-related polypeptide α, CALCA variant 1) and vasopressin (arginine vasopressin, AVP), both of which are peptide hormones, are forcibly expressed in experimental systems described in previous studies. The forced expression of calcitonin in H1299 cells resulted in the formation of ESG structures under simultaneous REST knockout and forced PROX1 expression conditions. In cells that express vasopressin, ESG structures form under REST knockout conditions. Moreover, PROX1 overexpression led to the formation of a greater number of ESG structures. These results suggest that ESG structures form after the forced expression of any granulecontaining substance in H1299 cells under REST knockout and forced PROX1 expression conditions.journal articl
Decreased Striatal Dopamine Transporter Uptake in Progressive Supranuclear Palsy with Pure Akinesia with Gait Freezing
Full text linkPure akinesia with gait freezing (PAGF) is a clinical phenotype of progressive supranuclear palsy (PSP).Typical PSP is called PSP-Richardson’s syndrome (PSP-RS), which is characterized by frequent falls, vertical gaze palsy and axial rigidity. A diagnosis of PSP-PAGF is often difficult as PSP-PAGF lacks core clinical features of PSP-RS. Decreased striatal accumulation in dopamine transporter (DAT) scan contributes to the diagnosis of parkinsonian syndrome including PSP, but its findings of PSP-PAGF have not been well studied. We here report 2 patients with PSP-PAGF who showed decreased striatal specific binding ratio (SBR) on DAT scan. Abnormal SBRs on DAT scan could be observed in the early stage of PSP-PAGF, which may be helpful in diagnosis.journal articl
Combined Chest Wall Resection for Complex Aspergilloma
Full text linkChronic progressive pulmonary aspergillosis, complex aspergilloma, sometimes results in lethal hemoptysis and surgery is a choice of treatment when intervention of arterial embolization failed. We conducted a left upper lobectomy with combined resection of chest wall for a patient suffering from life-threatening hemoptysis without any postoperative morbidity. This method may be an option of surgery for benign lung disease with thickened pleura adhere to chest wall and expected massive bleeding during operation.journal articl
Comparison and Molecular Localization Analysis of Porcine and Human Skin Lipids by High-resolution Imaging Mass Spectrometry
Full text linkLipidomics research has accelerated in recent years because of advances in mass spectrometry technology. Imaging mass spectrometry (IMS) is a powerful technique to obtain comprehensive molecular information for identification of lipids and their localization in tissues to explore the underlying pathogenesis of skin diseases, including atopic dermatitis, asteatosis, and ichthyosis. The aim of this study was to compare and perform molecular localization analysis of porcine and human skin lipids by high-resolution matrix assisted laser desorption/ ionization (MALDI)-IMS using 9-Aminoacridine (9AA) matrix. 9AA was vapor-deposited onto the thinly sliced skin samples as a matrix to promote ionization of the analyte molecule following laser irradiation. We successfully visualized various skin lipids of both species localized in three different skin layers (stratum corneum, viable epidermis, and dermis) by this method. Molecules with peaks at m/z 465.305, 474.361, and 659.394 were mainly localized in the stratum corneum, those with peaks at m/z 184.076, 273.042, 378.159, 570.228, and 579.228 were localized in the viable epidermis, and those with peaks at m/z 607.361, 615.201, 659.192, 687.545, and 703.571 were localized in the dermis in both species. However, peaks at m/z 465.305 and 659.394 were assigned to cholesterol sulfate and were localized exclusively in the stratum corneum in porcine skin, but abundant in the granular layer in human skin. In conclusion, we performed MALDI-IMS using 9AA matrix and found most of the lipid molecules in porcine and human skin showed similar distributions. However, there were some differences including the localization of cholesterol sulfate.journal articl
Usefulness of SPECT/CT to Detect Residual Thyroid Differentiated Carcinoma after Radioablation
Full text linkIn the absence of distant metastasis after total thyroidectomy for differentiated thyroid cancer, 131I ablation with a dose of 30 mCi is performed. However, a single dose of 131I is not always sufficient, and re-dosing is becoming increasingly common. Difficulties are associated with using conventional 131I whole-body scintigraphy to detect residual thyroid tissue (thyroid bed) in the head and neck region and assess treatment efficacy. Post-treatment imaging with whole-body scintigraphy was performed on the present cases after the first administration of 131I, and with whole-body scintigraphy and single photon emission computed tomography/computed tomography after the second administration. In case 1, 131I flowed into the gap between a tooth and crown, and non-specific uptake was observed on single photon emission computed tomography/computed tomography. In case 2, saliva containing 131I adhered to dentures in the oral cavity, and whole-body scintigraphy indicated uptake in the lesion; however, this was confirmed as a false positive by single photon emission computed tomography/computed tomography. In case 3, the uptake of 131I in the thyroglossal duct pathway was confirmed by single photon emission computed tomography/computed tomography. Therefore, single photon emission computed tomography/computed tomography was useful for detecting non-specific uptake in the head and neck region.journal articl
Efficacy of Bispectral Index (BIS) for Detecting Cerebral Hypoperfusion Caused by Pneumoperitoneum and Steep Trendelenburg Position during Robotic-assisted Laparoscopic Surgery: A Case Report
Full text linkPneumoperitoneum and steep Trendelenburg position may cause cerebral abnormalities during roboticassisted laparoscopic surgery. Previous studies indicated that cerebrovascular autoregulation and the intracranial pressure might be affected by pneumoperitoneum and steep Trendelenburg position. These changes may affect cerebral blood flow, leading to the change of bispectral index (BIS) value. We report a case of a 60-year-old woman who underwent robotic-assisted laparoscopic surgery under general anesthesia, in whom the cause of the decrease in the BIS might be due to pneumoperitoneum and steep Trendelenburg position during surgery. After induction of anesthesia, the BIS value had been stable at 50-60. About 3.5 h after the start of surgery, the BIS started to decrease gradually, and about 5.5 h after surgery, it decreased to around 10-15. The fascial congestion signs (edema of the bulbar conjunctiva and the face, dark red color on the face) were identified. After releasing pneumoperitoneum and deep Trendelenburg position, BIS value increased. Pneumoperitoneum and steep Trendelenburg position may affect the cerebral blood flow and the BIS value, especially during a prolonged surgery. The BIS may be a useful monitor to detect cerebral abnormalities, caused by pneumoperitoneum and steep Trendelenburg position.journal articl
Infectious Diseases Related to Pregnant Women
Full text linkCOVID-19 以降，妊娠中の感染症への関心が高まり，母体だけでなく胎児・新生児への影響が重要視されている．特に母子感染は出生児の健康に深く関与するため，予防・早期診断・適切な治療が不可欠である．日本では妊婦健診での感染症スクリーニング体制が整っているが，グローバル化やワクチン忌避の影響で新たな感染症リスクが顕在化している．無症候性感染や診断の難しさもあり，医療従事者には最新の知識と判断力が求められている．本稿では，妊娠中に重要となる感染症である風疹や麻疹，トキソプラズマ症，サイトメガロウィルス感染症，B 型肝炎ウィルス，C 型肝炎ウィルス，HIV 感染症，梅毒，百日咳，単純ヘルペスウィルス，パルボウィルスB19，COVID-19 について総合的に解説し，母子感染対策の現状と課題を明らかにする．Since the COVID-19 pandemic, there has been growing concern about infectious diseases during pregnancy, and the impact of these infections not only on the mother but also on the fetus and newborn is considered important. In particular, mother-to-child transmission is deeply involved in the health and future quality of life of the child, so prevention, early diagnosis, and appropriate treatment are essential. In Japan, a screening system for infectious diseases in prenatal checkups has been established；however, globalization, vaccine hesitancy, and other factors have led to the emergence of the risk of new infectious diseases. Due to asymptomatic infections and the difficulty of diagnosis, healthcare professionals are required to stay up-todate and exercise sound clinical judgment. This paper provides a comprehensive overview of key infections relevant to pregnancy ─ such as rubella, measles, toxoplasmosis, cytomegalovirus （CMV） infection, hepatitis B virus （HBV）, hepatitis C virus （HCV）, HIV infection, syphilis, pertussis, herpes simplex virus （HSV）, parvovirus B19, and COVID-19 ─ and discusses the current status and challenges of preventing mother-to-child transmission.journal articl
Hypoxic-Ischemic Encephalopathy and Hypothermia：Prognosis and Future Prospects
Full text link新生児の低体温療法は，低酸素性虚血性脳症の治療法として長年の研究と臨床試験を経て確立された．1950年代に初めて報告されたものの，当時は「新生児を冷やすことは危険」とされ，その有効性が認められなかった．しかし，1990 年代以降，低体温が神経保護効果を持つ可能性が議論され始め，2000 年代には欧米で実施された無作為化比較試験によってその有効性が証明された．2010 年には国際的なガイドラインで推奨され，日本でも導入が進んだ．低体温療法の作用機序は，脳の代謝活動を抑制し，エネルギー消費を最小限にすることで細胞死を軽減することにある．また，炎症性サイトカインの産生を抑え，興奮毒性の制御や血液脳関門の保護に寄与することで，長期的な神経学的予後を改善することが期待される．当院では2007 年に低体温療法を導入し，治療を開始．これまでに48 例の低酸素性虚血性脳症患者に施行し，死亡率の改善を確認している．しかし，後遺症の課題が残り，約3 割の患者が神経学的な障害を抱えている．今後の展望として，軽症低酸素性虚血性脳症患者への適応拡大や，臍帯血幹細胞治療との併用が検討されている．また，国内レジストリによる長期的なフォローアップ研究が進行しており，低体温療法のさらなる発展と標準化が期待される．本研究では，当院における低体温療法の治療の歴史・経過と予後を検討し，今後の新生児医療における課題について考察する．Neonatal hypothermia therapy has been established as a treatment for hypoxic-ischemic encephalopathy following extensive research and numerous clinical trials. Although initially reported in the 1950s, the practice of cooling newborns was considered hazardous at the time, and its therapeutic efficacy was not recognized. From the 1 9 9 0 s onward, however, the potential neuroprotective effects of hypothermia began to receive attention, and its effectiveness was later demonstrated in randomized controlled trials conducted in Europe and the United States during the 2000s. In 2010, international guidelines began recommending the therapy, prompting its gradual adoption in Japan. The mechanism of action involves suppressing cerebral metabolic activity and minimizing energy consumption, thereby reducing neuronal cell death. It is also believed to improve long-term neurological outcomes by inhibiting inflammatory cytokine production, modulating excitotoxicity, and protecting the integrity of the blood-brain barrier. At our hospital, hypothermia therapy was introduced in 2007, and has since been administered to 48 patients with HIE, with confirmed reductions in mortality rates. Nonetheless, neurological sequel remains a concern, as approximately 30% of patients continue to experience neurological impairments. Looking ahead, future directions include expanding the indications to encompass cases of mild HIE and exploring combination therapies, such as those involving umbilical cord blood stem cells. Long-term follow-up studies are currently being conducted using a national registry, and further development and standardization of hypothermia therapy are anticipated. This study reviews the historical context, clinical implementation, and outcomes of hypothermia therapy at our institution, and discusses the remaining challenges in neonatal care.journal articl