Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Career Support Efforts at Nursing Universities：Support for 1st and 2nd Grade
Get PDF【目的】 2 年間のクラス担任教員とキャリア支援担当教員の協働による第1・2 学年へのキャリア支援の取り組みを振り返り，課題を考察する．
【方法及び結果】 キャリア支援担当教員が学生全員に対して実施するキャリアガイダンスとクラス担任教員が学生一人ひとりに実施する面談を組み合わせて定期的に支援を行った．また，学生への定期的なアンケートの実施や目指す看護師像を可視化できるオリジナルのワークシートを作成した．入学時は具体的な将来像を語れる学生はほぼいなかったが，第2 学年になった3 セメスターの時点では，約1 割の学生が具体的に働きたい職場や得たい資格について語ることが出来るようになった．しかし，約1 割の学生が将来像について回答することが出来ず，約8 割の学生が具体的に働きたい職場や対象者，提供したいケアが未だ曖昧であった．
【考察】 今回のキャリア支援では，学生は面談やアンケート，キャリアガイダンスを契機にして学内での学びと臨地実習で経験したことを内省・概念化し，学生自身が自己の将来像を再検討・再構築したのではないかと推察する．そして，これをクラス担任教員とキャリア支援担当教員が協働して定期的に繰り返すことで徐々に将来像の具体化に繋がっていったことが取り組みの成果である．特にキャリアシートによって目標の抽象度を可視化することは，学生自身が自己の目標の抽象度を把握しやすくなったと考える．これから更なる学内での学びや臨地実習を通して，自らの将来像を明確化していく段階であるため，将来像を描けていない学生や曖昧な学生が目的をもって将来のキャリアを考えていけるように支援していく必要がある．
【結論】 2 年間のクラス担任教員とキャリア支援担当教員の協働によるキャリア支援を振り返った結果，第2 学年になった3 セメスターの時点では約8 割の学生が具体的な目標を挙げられていない実態が明らかになった．departmental bulletin pape
Inherited Renal Tubular Disorders of the Distal Nephron: Implications for the Pathophysiologic Mechanisms of Blood Pressure and Water/Electrolyte Homeostasis Abnormalities
Get PDFThe distal nephron is the portion of the nephron that extends from the ascending limb of Henle to the collecting duct. This article summarizes some of the physiological functions of the distal nephron, with particular emphasis on the physiological functions of transepithelial transport of sodium, potassium, and chloride. The pathophysiology of the following diseases with dysfunction of the distal nephron is reviewed. (1) Liddle
syndrome: a familial disorder with clinical manifestations very similar to primary aldosteronism but with reduced aldosterone secretion. (2) Bartter syndrome/Gitelman syndrome: a group of disorders presenting with renal sodium and potassium wasting. (3) Type II pseudohypoaldosteronism: a group of inherited hypertensive disorders with sodium retention due to the hyperactivity of the newly discovered WNK (with no lysine
kinase 4)-NCC (Na⁺-Cl⁻- cotransporter) signaling cascade. Beginning with the identification of the causative genetic abnormalities, rapid progress has been made in understanding the pathogenesis of these diseases at the molecular and cellular levels, resulting in the identification of new regulatory mechanisms of electrolyte transport in the kidney.journal articl
Total Neoadjuvant Therapy for Rectal Cancer: the Case Report
Get PDFWe report a case of advanced rectal cancer that could be radically resected after total neoadjuvant therapy (TNT). A 65-year-old man underwent TNT for lower rectal cancer. The patient received a short course of chemoradiation therapy (CRT) at a total dose of 30 Gy to the pelvic area, including lateral lymph nodes, in fractions of 3 Gy administered five times a week over 10 days (days 1-5 and 8-12). The CRT was given in combination with S-1 at a dose of 80 mg twice daily on all days of radiotherapy. After CRT, the patient was scheduled to receive two cycles of S-1 + oxaliplatin (SOX) therapy. SOX was administered over 3 weeks (130 mg/m² oxaliplatin on days 20 and 41, and 80 mg oral S-1 on days 20-33 and 41-54). Robotically-assisted laparoscopic low anterior resection was performed on day 77. Histopathological findings showed only a small amount of residual tumor (residual tumor volume of less than 5%), and the radial margin was negative. There were no severe adverse events, postoperative complications, or functional disorders. These findings demonstrated the effectiveness and safety of TNT with short-term irradiation for rectal cancer. This regimen may be a new candidate for neoadjuvant treatment of previously untreated rectal cancer.journal articl
Strategy for Maintenance Therapy for Transplant-eligible and Non-eligible Patients with Multiple Myeloma
Get PDFMultiple myeloma (MM) is a hematological malignancy originating from plasma cells producing immunoglobulin. Introducing high-dose melphalan therapy followed by auto stem cell transplantation (ASCT) and novel drugs has improved the survival of patients with MM. The importance of maintenance therapy after induction therapy has been investigated to obtain a long duration of progression-free survival (PFS) after induction therapy. The role of maintenance therapy in MM is to inhibit disease progression after induction therapy without physical and financial burden for patients. Physical burden mainly refers to the side effects of treatment. Preventing relapse with minimum burden is beneficial. Here, we review the updated progress of maintenance therapy for transplant-eligible and -ineligible patients with MM. The results of clinical studies about maintenance therapies using thalidomide, lenalidomide, bortezomib, and ixazomib are demonstrated. The possible choice of treatment based on these results is suggested, and the utility of drug combination as a maintenance therapy is discussed. Furthermore, we describe the outline of the clinical trial we just commenced. We started an ixazomib maintenance therapy for transplant-ineligible patients intolerant to lenalidomide (IMTIL) study (UMIN000048285) to determine the efficacy and safety of ixazomib maintenance therapy in transplant-ineligible patients with MM who cannot be treated with standard doses of lenalidomide due to adverse reactions or frailty during or after induction therapy. In addition, the relationship between the efficacy of ixazomib in maintenance therapy and driver mutation and immune status is assessed.journal articl
Current Status and Future of Reconstructive Surgery: Development of Novel and Artificial Flaps
Get PDFRecent advances in reconstructive surgery, such as microvascular free flap transfer, have contributed to the development of other surgical specialties to achieve improved performance of surgery. Although microvascular free flap transfer is one of the most frequently used methods, it has several limitations and shortcomings, such as donor-site morbidity and insufficient flap function. We refined conventional methods of free flap transfer and developed various types of novel flaps to overcome these shortcomings. However, although many technical refinements are being developed, the restoration of complex organs to their original status remains difficult. We believe that there are two solutions for reconstruction of complex organs: 1) vascularized composite allotransplantation and 2) artificial flaps using regenerative medicine. In this article, we aimed to present the current status of reconstructive surgery and discuss its future.journal articl
Comparison of the Therapeutic Effects on the Renal and Life Prognosis in ANCA-associated Nephritis
Get PDFANCA-associated rapidly progressive glomerulonephritis has been treated with steroid pulse therapy (mPSL pulse), cyclophosphamide pulse therapy (IVCY), rituximab (RTX), and plasma exchange (PE), but the differences in renal and life outcomes are not fully understood. To determine the long-term prognostic impact of plasma exchange in ANCA-associated rapidly progressive glomerulonephritis, we conducted a retrospective observational study with stratification by treatment modality to determine the prognostic impact of plasma exchange in ANCA-associated rapidly progressive glomerulonephritis. Eighty patients with ANCA-associated glomerulonephritis who underwent renal biopsy at our hospital were divided into 5 groups, and the renal and life prognosis were evaluated. IVCY and RTX significantly improved renal survival compared with steroid therapy and PE. PE and PSL oral groups did not improve renal prognosis, but survived without death during the observation period. PE is introduced in patients requiring hemodialysis at biopsy to rapidly reduce ANCA levels with favorable life prognosis.journal articl
Differences in Intraocular Lens Surface Properties and Lens Epithelial Cell Behavior
Get PDFPosterior capsule opacification is a common complication following cataract surgery. However, its incidence varies depending on the type of intraocular lens (IOL) used. In this study, we analyzed the adhesion and movement of lens epithelial cells (LECs) in the early stages after cataract surgery by continuously observing LECs seeded on the surfaces of different types of IOLs. PY-60AD and XY1 hydrophobic acrylic IOLs were used. Each posterior surface was modified to increase the adhesion. The IOLs were placed in culture dishes with an exposed posterior or anterior surface (three each). LECs extracted from white rabbit lenses by trypsinization were seeded onto IOLs. LEC movement and shape were recorded by microscopy using a cell culture observation system after 6 h of contact between LECs and IOLs. The cumulative distance traveled was calculated from the LEC trajectories after comparing the shapes of the LECs. We observed that LECs were more likely to adhere to XY1 modified posterior surface. The speed of LEC movement decreased after adhesion. These findings support the conclusion that increasing the adhesiveness of IOL surfaces inhibits the LEC movement.journal articl
An Autopsy Case of Disseminated Carcinomatosis of the Bone Marrow Caused by Early Gastric Cancer
Get PDFA 57-year-old male with low back pain and hyperphosphatasemia was diagnosed as disseminated carcinomatosis of the bone marrow (DCBM) originating from cancer of unknown primary. Although an iliac bone marrow biopsy showed cancer metastasis, gastrointestinal endoscopy, imaging studies, tumor markers tests, and immunohistochemistry of the biopsy material failed to identify the primary tumor. Five courses of carboplatin and paclitaxel (CBDCA/PTX) therapy and two courses of gemcitabine (GEM) therapy were performed for cancer of unknown primary, but there was no therapeutic effect, and the patient died after the treatment during about 7 months. Autopsy revealed signet-ring cell carcinoma of the stomach, which was an early cancer limited to the small part of the antrum. Tumor size was 5 millimeters, the depth of submucosal invasion was about 500 micrometers, and neither vascular nor lymphatic infiltration was found. Reportedly, the most common primary tumor of DCBM is gastric cancer, most of which are advanced cancers. However, as in the present case, early cancer could be the cause. Besides, DCBM is known to develop long after surgery. Thus, the gastric cancer patients, especially when histological subtype is poorly differentiated adenocarcinoma or signet-ring cell carcinoma, should be followed up with reference to serum ALP and FDP, considering the rare occurrence of DCBM.journal articl
