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Activated partial thromboplastin time‑based clot waveform analysis enables measurement of very low levels of factor IX activity in patients with severe hemophilia B
Get PDFThe precise measurement of very low levels of factor IX activity (FIX:C < 1 IU/dL) is essential for understanding clinical
severity and risk of inhibitor development in patients with severe hemophilia B (Pw-SHB). However, such measurement
sensitivity has not yet been achieved. We aimed to establish a measurement method using clot waveform analysis (CWA).
Residual FIX:C by adding anti-FIX monoclonal antibody, FIX:C by adding recombinant (r)FIX to the commercial Pw-SHB
plasmas, and FIX:C in our Pw-SHB were determined by CS-2000i™/CS-2400™, followed by analysis of CWA parameters.
The presence of anti-FIX antibody in the commercial Pw-SHB plasmas significantly decreased coagulation potential compared
to its absence. The addition of rFIX to these innate plasma samples produced significant changes in three parameters
upon adding FIX:C at 0.1–1 IU/dL, supporting the presence of trace FIX:C in Pw-SHB. Therefore, appropriate FIX-depleted
plasma containing minimum residual FIX:C was chosen from reference curves of FIX:C (0.01–1 IU/dL). Among patients
with untreated Pw-SHB, two had FIX:C 0.6–0.7 IU/dL and two had lower than detectable levels using FIX-depleted plasma.
One of the latter had detectable trough levels post-rFIX administration. In conclusion, CWA enabled measurement of very
low levels of FIX:C using appropriate FIX-deficient plasma.博士（医学）・乙第1528号・令和4年12月22
A Concept Analysis of Intimacy After Cancer Building between the Wife with Female- Specific Cancer and her Husband
Get PDF目的:本研究の目的は、女性特有のがんに罹患した妻と夫の「がん罹患以降の親密性の獲得」の概念分析を行うことであり、がん患者が夫との関係性を維持しよりよい生活を送るための看護実践の基礎資料とする。
方法:分析方法は、Rodgersの概念分析の方法を参考とし、先行要件、属性、帰結に関する記述から内容分析を行った。
結果:分析対象文献は30件であった。先行要件は【がん罹患による妻の精神的苦痛】、【妻のがん罹患による夫の苦悩と不安】の2つが抽出された。
属性は【妻と夫の相手を支えようという各々の姿勢】、【妻と夫の双方に相乗効果をもたらす循環】、【夫婦の協同への努力】の3つが抽出された。
そして、帰結は【妻の自分らしさの回復】、【夫から与えられる心の安寧と感謝】、
【妻にとって重要なサポートの継続】、【夫婦の紳の獲得】、【満ち足りた生活の獲得】の5つと、妻と夫が「親密性の獲得」ができなかった場合、
【妻を支える役割により夫が感じる重圧】、【妻として役割を果たせないことへの申し訳なさ】、【夫への失望】の3つが抽出された。
考察：女性特有のがんに罹患した妻と夫との「がん罹患以降の親密性の獲得」とは、「【妻と夫の相手を支えようという各々の姿勢】をとることで、
【妻と夫の双方に相乗効果をもたらす循環】が生まれ、【妻と夫の協同の努力】を継続する」と再定義された。
一方で、妻と夫が親密性を獲得できなかった場合、夫は妻を支えることに重圧を感じ、妻は夫への失望や妻としての役割を果たせないことに申し訳なさを感じていた。
女性特有のがんに罹患した妻が、がん診断後から治療を受け生活を送る中で、前向きに生きていくためには夫の支えは必要不可欠であり、そのために夫との問に親密性を獲得することが重要である。
女性特有のがんに罹患した妻と夫の「がん罹患以降の親密性の獲得」の先行要件、属性、帰結は、患者とその夫が親密性を獲得するために必要な支援を明確にし、
より効果的な支援につなげることができると考える。したがって、今回の概念分析の結果は看護実践で有用な概念であることが示唆された。PURPOSE:The purpose of this research is to analyze the concept of intimacy building
between the wife with female-specific cancer and her husband. Moreover,it aims to
examine the possible applicability of this concept in nursing practice for improving the
quality of life of such couples by fostering intimacy. METHODS:Rodgers'(2000)
approach to concept analysis was used to review the literature,and the contents were
qualitatively analyzed for attributes,antecedents,and consequences. RESULTS:
Thirty articles were analyzed.The attributes of intimacy building between the wife
with female-specific cancer and her husband were classified into two categories,
including“The wife's mental distress due to cancer.”The antecedents of intimacy
building between them were in three categories,including“The attitudes of the wife
and the husband trying to support each other.”The consequences of intimacy building
between them were in five categories,including“A sense of well-being and gratitude
given by the husband.”Moreover,if the wife and her husband could not build intimacy between them,the consequences were in three categories,including“The pressure felt
by the husband due to the role of supporting the wife.”
DISUCUSSION:Intimacy building between the wife with female-specific cancer and
her husband,defined as“a circulation that has a synergistic effect on both the wife and
husband,”occurred.Further,“efforts for cooperation between wife and husband”
continued through “the attitudes of the wife and the husband trying to support each
other.”Moreover,if they could not build intimacy,they experienced anxiety and
pressure.Therefore,the support of the husband was vital in improving the wife's life. It
is suggested that these findings are useful for the nurses who provide support in such
situations
[Case Reports]A case of primary signet ring cell carcinoma of the lung with pleural metastasis
No full textPrimary signet ring cell carcinoma is a rare subtype of lung adenocarcinoma，but it is extremely invasive and has a poor prognosis. Diagnosis mainly requires immunohistochemical analysis of tissue biopsies and genetic mutations.It is important to exclude metastatic signet ring cell carcinoma from other organs. We describe a case of primary signet ring cell carcinoma of the lung with pleural dissemination，together with a review of the literature
反復的な督励が口頭指導下の心肺蘇生法に与える効果に関する無作為化シミュレーション研究
Get PDFBackground: Current guidelines emphasize the assistance of the emergency dispatcher in bystander cardiopulmonary resusitation (CPR). Its quality, however, has varied across cases. Objective: To determine the effect of repetitive coaching by dispatchers using verbal encouragement on the quality of lay-rescuer CPR. Methods: We conducted a dispatch-assisted CPR (DACPR) simulation study. Participants with no CPR training within the previous year were assigned randomly to 1 of 2 DACPR simulations. One was the No Coaching Group: callers were told to perform CPR and the dispatcher periodically confirmed that the caller was performing CPR. The second group was the Coaching Group: the dispatcher repetitively coached, encouraged, and counted aloud using a metronome. Participants performed CPR for 2 min under instruction from the study dispatcher. Parameters including chest compression depth, rate, and chest compression fraction were recorded by video camera and CPR manikin. Results: Forty-nine participants 20 to 50 years of age were recruited, and 48 completed the simulation (Coaching Group, n = 27; No Coaching Group, n = 21). The chest compression fraction was higher in the Coaching Group (99.4% vs. 93.0%, p = 0.005) and no participants interrupted chest compression more than 10 s in this group. When comparing the average depth of each 30-s period in each group, the depth increased over time in the Coaching Group (40.9 mm, 43.9 mm, 44.1 mm, and 42.8 mm), while it slightly decreased in the No Coaching Group (40.6 mm, 40.1 mm, 39.4 mm, and 39.8 mm). Conclusions: Repetitive verbal encouragements augmented chest compression depth with less-hands off time. Continuous coaching by dispatchers can optimize lay-rescuer CPR.博士（医学）・甲第852号・令和4年9月28日© 2022 Elsevier Inc.© 2022 The Author(s). Published by Elsevier Inc.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
レンバチニブは実験的肝線維症において肝星細胞の活性化と類洞毛細血管化を阻害することにより肝線維化を抑制する。
Get PDFMolecular targeted agents are pharmacologically used to treat liver fibrosis and have gained increased attention. The present study examined the preventive effect of lenvatinib on experimental liver fibrosis and sinusoidal capillarization as well as the in vitro phenotypes of hepatic stellate cells. LX-2, a human stellate cell line, was used for in vitro studies. In vivo liver fibrosis was induced in F344 rats using carbon tetrachloride by intraperitoneal injection for 8 weeks, and oral administration of lenvatinib was started two weeks after initial injection of carbon tetrachloride. Lenvatinib restrained proliferation and promoted apoptosis of LX-2 with suppressed phosphorylation of extracellular signal-regulated kinase 1/2 and AKT. It also down-regulated COL1A1, ACTA2 and TGFB1 expressions by inhibiting the transforming growth factor-β1/Smad2/3 pathway. Treatment with lenvatinib also suppressed platelet-derived growth factor-BB-stimulated proliferation, chemotaxis and vascular endothelial growth factor-A production, as well as basic fibroblast growth factor-induced LX-2 proliferation. In vivo study showed that lenvatinib attenuated liver fibrosis development with reduction in activated hepatic stellate cells and mRNA expression of profibrogenic markers. Intrahepatic neovascularization was ameliorated with reduced hepatic expressions of Vegf1, Vegf2 and Vegfa in lenvatinib-treated rats. Collectively, these results suggest the potential use of lenvatinib as a novel therapeutic strategy for liver fibrosis.博士（医学）・甲第812号・令和4年3月15日© 2021 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License(https://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited
大腸 Sessile Serrated Adenoma/Polyps with Dysplasia における YAP 活性化に対する Clostridium perfringens のエンテロトキシンの役割
Get PDFSessile serrated adenoma/polyp with dysplasia (SSA/P-D) is an SSA/P with cellular dysplasia and has a higher risk of progressing to colon carcinogenesis. Previously, we reported that tight junction impairment by Clostridium perfringens enterotoxin (CPE) leads to activation of the transcriptional co-activator yes-associated protein (YAP) in oral squamous cell carcinoma. Here, we investigated whether CPE activates YAP to promote the malignant progression of SSA/P. E-cadherin expression was lower in the 12 cases with SSA/P-D examined than that in normal mucosa, SSA/P, or tubular adenoma (TA). Furthermore, intracellular translocation of claudin-4 (CLDN4) and nuclear translocation of YAP were observed. The CPE gene was detected in DNA extracted from SSA/P-D lesions, but not in SSA/P or TA. Treatment of the rat intestinal epithelial cell line IEC6 with low-dose CPE resulted in intracellular translocation of CLDN4 to the cytoplasmic membrane. Cytoplasmic CLDN4 showed co-precipitation with transcriptional co-activator with PDZ-binding motif, zonula occludens (ZO)-1, large tumor suppressor, and mammalian Ste20-like. Additionally, YAP co-precipitated with ZO-2 under CPE treatment led to decreased YAP phosphorylation and nuclear translocation. YAP activation promoted increase in nuclear TEA domain family member level, expression of cyclin D1, snail, vimentin, CD44, NS and decrease in E-cadherin levels, thereby inducing stemness and epithelial-mesenchymal-transition (EMT). The Hippo complex with the incorporation of CLDN4 increased stability. Upon low-dose CPE treatment, HT29 cells with BRAFᵛ⁶⁰⁰ᴱ gene mutation showed increased growth, enhanced invasive potential, stemness, and induced EMT phenotype, whereas HCT116 cells, which carry KRASᴳ¹³ᴰ gene mutation, did not show such changes. In an examination of 10 colorectal cancers, an increase in EMT and stemness was observed in CPE (+) and BRAF mutation (+) cases. These findings suggest that C. perfringens might enhance the malignant transformation of SSA/P-D via YAP activation. Our findings further highlight the importance of controlling intestinal flora using probiotics or antibiotics.博士（医学）・甲第819号・令和4年3月15日© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)