Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Non-neutralizing Autoantibodies against Granulocyte-macrophage Colony-stimulating Factor in Patients with Systemic Lupus Erythematosus
Get PDFGranulocyte-macrophage colony-stimulating factor (GM-CSF) is a pleiotropic cytokine that differentiates myeloid cells, mediates tissue damage, and regulates immune response. We previously reported a case of systemic lupus erythematosus (SLE) complicated by pulmonary alveolar proteinosis (PAP) with neutralizing anti-GM-CSF antibodies (Ab). In the present study, we examined the existence of anti-GM-CSF Ab in connective tissue disease (CTD), including SLE without PAP, its neutralizing activity, and the associated clinical features.
Subjects were active SLE, dermatomyositis (DM)/polymyositis (PM), and vasculitis. Enzyme-linked immunosorbent assay was developed to detect anti-GM-CSF Ab. The neutralizing activity of anti-GM-CSF Ab was examined to check if it blocked the increase in GM-CSF stimulated CD11b expression on neutrophils. Anti-GM-CSF Ab was detected in the sera from 44/63 (69.8%) SLE, 23/49 (46.9%) DM/PM, and 14/27 (51.8%) vasculitis patients. Neutralizing activity was not detected in sera with anti-GM-CSF Ab from patients with SLE without PAP, DM/PM, and vasculitis. In SLE, the absence of anti-GM-CSF Ab was associated with serum low complement. A possible association was found between the presence of the Ab and pulmonary involvement in SLE. In summary, non-neutralizing anti-GM-CSF Ab was frequently found in connective tissue diseases, including SLE. The association between the antibody and the clinical features in SLE suggested the possibility that non-neutralizing anti-cytokine antibodies could modify the disease phenotype.journal articl
Pre-hospital Adrenaline via the System of Dispatching a Physician; Outcomes among Patients with Cardiac Arrest
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We evaluated whether pre-hospital adrenaline with a dispatched physician is associated with higher proportion of return of spontaneous circulation after out-of-hospital cardiac arrest, compared to pre-hospital care without physician presence. We conducted a retrospective observational study of patients with out-of-hospital cardiac arrest in Japan. Included were patients who were at least 18 years of age, were transported to hospitals by emergency medical service personnel of the Hiroshima City Fire Services between July 2 2018 and December 31 2021, and were administered pre-hospital adrenaline. Data were obtained from transport records written by emergency medical service personnel and medical records created by dispatched physicians from Hiroshima Prefectural Hospital. The primary outcome was the return of spontaneous circulation after out-of-hospital cardiac arrest. We performed multivariable logistic regression analysis using the propensity score as an explanatory variable. Among analyzed 464 patients, 317 patients received resuscitation by "emergency medical service personnel" group, and 147 patients received resuscitation by "emergency medical service personnel and a dispatched physician" group. The time from emergency call to first administration of adrenaline with the presence of a dispatched physician was significantly shorter compared to absence of a pre-hospital physician [25.0 minutes vs. 28.0 minutes, (95% confidence interval: -4.37 to -0.48)]. Adjusted odds ratio of the primary outcome did not differ significantly between groups (1.20; 95% confidence interval: 0.61 to 2.36). The system with a dispatched pre-hospital physician was associated with significantly shorter time to the first pre-hospital administration of adrenaline compared with absence of a pre-hospital physician. There was no significant difference in patient outcomes.journal articl
Comparison of Long Fusion Terminating at Lower Lumbar versus the Sacrum and Ilium in Corrective Surgery for Adult Spinal Deformity: A Propensity Score Analysis
Get PDFIntroduction: Lumbosacral fusion is a recommended and effective treatment for patients with adult spinal deformity. The optimal spinal fusion termination location has been widely discussed because it substantially affects postoperative quality of life. However, there is no consensus on whether termination should be at the lumbar spine or at the sacrum and ilium. The study aim was to compare differences in clinical outcomes between a pelvic fixation group and non-pelvic fixation group.
Methods: This was a single-center observational study. Participants were 127 patients (mean age 67.4 years) who had undergone surgery for adult spinal deformity. The L group comprised 33 patients with the lowest instrumented vertebra at L4; the SI group comprised 94 patients with the lowest instrumented vertebra at the sacrum and pelvis. Propensity score analysis was used to exclude confounding factors and match patient backgrounds. Analyzed covariates were age, body mass index, preoperative Cobb angle, and SRS-Schwab adult spinal deformity classification parameters of pelvic tilt, sagittal vertical axis, pelvic incidence minus lumbar lordosis, and fixed upper end height.
Results: Prior to propensity score adjustment, group L showed better Scoliosis Research Society-22 (SRS-22) scores and less severe deformity than group SI on all radiographic measurements except Cobb angle. Propensity score adjustment analysis selected two groups of 22 patients each that had similar preoperative patient backgrounds and fixed upper end elevations. The two groups showed similar postoperative radiographic measurements and postoperative satisfaction. Both groups showed significant improvement on all SRS-22 domains. After propensity score matching, postoperative Function domain scores were significantly higher in the L group than in the SI group.
Conclusions: The findings generally support previous research indicating that SI and L patients have similar health-related quality of life. However, the results of the between-group comparisons indicate that the L group showed superior function to the SI group.journal articl
Sepsis Caused by Streptococcus Pneumoniae in an Infant Who had Received a History of Pneumococcal Vaccination： Report of Three Infant Cases
Get PDF肺炎球菌は乳幼児の鼻腔に無症候性に定着する．乳幼児期は侵襲性肺炎球菌感染症発症のリスクが高い．そのため，国内では乳児肺炎球菌ワクチンが定期接種化されている．我々は沈降 13 価肺炎球菌結合型ワクチンの接種歴がある児に発症した肺炎球菌敗血症を 3 例経験した．症例 1 は 1 歳 11 か月の男児．発熱と意識障害で入院．血液培養から肺炎球菌（血清型 12F）が検出された．症例 2 は 1 歳 5 か月の男児．発熱で入院し血液培養から肺炎球菌（血清型 15）が検出された．症例 3 は 1 歳 3 か月の男児．ネフローゼ症候群で入院．翌日の血液培養から肺炎球菌（血清型 10）が検出された．3 例で検出された血清型はいずれも沈降 13 価肺炎球菌結合型ワクチンで予防できない型であった．近年，本邦で発生する侵襲性肺炎球菌感染症の多くが，ワクチン非含有血清型である．従って，多くの型をカバーする新型ワクチンが開発されても，血清型の置換によるワクチン非含有血清型による肺炎球菌感染が問題となる．このため乳幼児の発熱は，肺炎球菌ワクチン接種歴のみで肺炎球菌感染症を否定することはできない．今後は，国内感染血清型の疫学的動向を注視していく必要がある．Streptococcus pneumoniae colonizes asymptomatically in the nasal passages of infants and young children. Infants are at high risk for invasive pneumococcal infections. Therefore, infant pneumococcal vaccine has become a routine vaccination in Japan. We have experienced three cases of pneumococcal sepsis in children who had been previously vaccinated with 13-valent pneumococcal conjugate vaccine. Case 1 was a 23 months old boy. He was admitted to the hospital with fever and impaired consciousness, and blood culture revealed Streptococcus pneumoniae serotype 12F. Case 2 was a 17 months old boy. He was hospitalized for fever and blood culture detected Streptococcus pneumoniae serotype 15. Case 3 was a 15 months old boy. He was admitted with a diagnosis of nephrotic syndrome. The next day, blood culture revealed Streptococcus pneumoniae serotype 10. A serotype that cannot be prevented by the 13-valent vaccine in our 3 cases. In recent years, many of the invasive pneumococcal infections occurring in Japan have been of vaccine-negative serotypes. Therefore, even if new vaccines covering many types are developed, pneumococcal infection due to serotype substitution remains a problem. Fever in infants cannot be ruled out as pneumococcal infection based solely on vaccination history. In the future, epidemiological trends in domestic serotypes of infection should be closely monitored.journal articl
Details of Patients Hospitalized with COVID-19 in a University-affiliated Core Hospital and the Changes in Anti-SARS-CoV-2 Antibody Titers of the Physicians Exclusively Responsible for Their Treatment
Get PDFIntroduction: This study clarifies medical care and outcomes for patients hospitalized with COVID-19 and evaluates SARS-CoV-2 infection risk in healthcare professionals, to contribute to appropriate responses in future outbreaks of emerging infectious diseases.
Methods: In total, 585 patients with COVID-19 were classified by disease severity, and laboratory test findings and treatments were examined. Serum IgG antibodies against SARS-CoV-2 spike protein (IgG S antibodies) and those against nucleocapsid protein (IgG N antibodies) were measured in 21 expert respiratory physicians.
Results: Multiple comparison analysis showed significant differences in body mass index (BMI), white blood cell count (WBC), neutrophil count (Neut), lymphocyte count, lactate dehydrogenase (LDH), C-reactive protein, hemoglobin A1c, ferritin, Krebs von den Lungen-6, and D-dimer depending on disease severity. There were significant differences in BMI, WBC, Neut, LDH, and D-dimer between the severe and critical groups. Times from onset to admission and to start of treatment both increased according to severity and were significantly longer in the critical group. Among critical patients requiring ventilation, times from onset to admission, to start of remdesivir, and to start of systemic steroid therapy were significantly longer in those who died. Serum IgG S and IgG N antibody measurements in the 21 respiratory physicians did not indicate direct SARS-CoV-2 transmission from patients.
Conclusion: We identified laboratory test items predicting severe and critical COVID-19 and demonstrated the importance of prompt administration of antiviral and anti-inflammatory agents after symptom onset. SARS-CoV-2 transmission to medical professionals may be prevented by adherence to wearing personal protective equipment.journa
Spontaneous Gastric Perforation in an Adolescent with Severe Motor and Intellectual Disabilities: A Case Report
Get PDFSpontaneous gastric perforations are rare in adolescents. Here, we report the case of a 15-year-old boy with severe motor and intellectual disabilities (SMID) who was diagnosed with spontaneous gastric perforation. Due to his original condition and poor peristalsis caused by antiepileptic drugs, gas formation in the stomach and intestines was severe since infancy. After a femoral fracture at the age of 14 years and 5 months, the patient experienced reduced food intake and weight. He transferred to our hospital with shock vital due to severe peritonitis caused by gastric perforation. Immediately, he underwent an emergency laparotomy and partially resected with margins at the site of gastric perforation at the age of 15 years and 1 month. The cause of the gastric perforation was not identified by pathology. Intraoperative ascites culture detected Candida albicans. He was administered a long-term antifungal treatment for enteric mycosis with high β-D-glucan levels. Two months after the surgery, he was discharged. The detailed mechanism of gastric perforation is unclear but increased lumen pressure in the gastrointestinal tract has generally been speculated. In our case, we considered that the gastric perforation was caused by intestinal immunocompromise with Candida albicans overgrowth, associated with increased lumen pressure owing to the transverse position of the stomach. Therefore, deflation using gastrostomy may have been effective in relieving excess luminal pressure. Adequate nutritional evaluation and gastrostomy should be considered in patients with SMID, who have massive intestinal gas formation and gastric bubbles.journal articl
Creation of educational programs including videos in chronic care nursing exercises and educational practices ─Education that expands and deepens the understanding of the target audience─
Get PDF【目的】 看護の初学者である学生は，慢性期看護学の看護過程及び看護技術を学習するにあたり，対象者への想像を膨らませることが要となる．対象者への理解を促すことを目指した動画教材を作製し，それを含む教育プログラムを作成した．本稿では，作成した教育プログラムと教育実践の成果について報告する．
【作成した教育プログラム】 A 大学看護学部の第 3 学年の必修科目である慢性期看護学演習（全 9 コマ）において，糖尿病の教育入院を受ける対象者への看護過程及び看護技術を教授する．紙面上の情報に加えて，対象者役と看護師役がやりとりをする「疾患の経過と病いの体験を聴く場面」，「足病変のフィジカルアセスメントを行う場面」，「自己血糖測定の説明を行う場面」の 3 種類の動画と，「看護師間でカンファレンスを行う場面」を 2 つ，合計 5 つの Chapter を作製し，これらの教材を動画共有サイトにアップロードをした．紙面情報及び動画を用いて看護過程を展開することを個人学習と課した．この個人学習を基盤とし，授業時間ではグループ活動を中心に学生同士が討議する形式をとった. 教員は学習進度に合わせた授業の進行と，必要に応じてグループ活動のファシリテートをした．
【教育実践とその評価】 2019 年度に教育プログラムを作成し，授業を行った．履修生は 85 名であり，学生の学習成果物を二次利用し，教材及び授業全体を振り返った．授業序盤は対象者の心理状態を客観的に捉える傾向が見られた．しかし，グループ学習による学生同士のディスカッションにより，学生自らが生活体験を基盤にして対象者への理解を拡げていた．グループ学習の後に繰り返し動画を視聴することで，対象者の容姿や看護師に向けられる視線，ベッド周囲の環境などから対象者を捉え直していた．対象理解を深めるひとつの方法として，学生の生活体験による視点の拡がりをつくるとともに，動画教材を活用した授業の有効性が示唆されたdepartmental bulletin pape
