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Examining the Nursing Workforce Shortage in Vietnam : Implications for Nursing Education
Get PDFThis study examines the nursing human resource crisis in Vietnam that emerged in the wake of the COVID-19 pandemic. A literature review encompassing policy documents, statistics, reports, guidelines, news, media, and academic publications was conducted. Even before the pandemic, Vietnam grappled with a nursing shortage, with a nurse-to-population ratio significantly below the global average. The shortage of nurses jeopardizes nurse-to-patient ratios, patient safety, and equitable access to high-quality healthcare services. The nursing human resource crisis in Vietnam is further exacerbated by the limited capacity of nursing education institutions. Without substantial investments in nursing education, projections indicate that Vietnam may face a crisis of lacking nursing professionals in the near future. The post-COVID-19 nursing crisis in Vietnam underscores the urgent need for reforms in nursing education. Policy interventions should prioritize strategic workforce planning and increased financial investments in nursing education and training programs.journal articl
Sugar coordinates plant defense signaling
Get PDFPathogen recognition triggers energy-intensive defense systems. Although successful defense should depend on energy availability, how metabolic information is communicated to defense remains unclear. We show that sugar, especially glucose-6-phosphate (G6P), is critical in coordinating defense in Arabidopsis. Under sugar-sufficient conditions, phosphorylation levels of calcium-dependent protein kinase 5 (CPK5) are elevated by G6P-mediated suppression of protein phosphatases, enhancing defense responses before pathogen invasion. Subsequently, recognition of bacterial flagellin activates sugar transporters, leading to increased cellular G6P, which elicits CPK5-independent signaling promoting synthesis of the phytohormone salicylic acid (SA) for antibacterial defense. In contrast, while perception of fungal chitin does not promote sugar influx or SA accumulation, chitin-induced synthesis of the antifungal compound camalexin requires basal sugar influx activity. By monitoring sugar levels, plants determine defense levels and execute appropriate outputs against bacterial and fungal pathogens. Together, our findings provide a comprehensive view of the roles of sugar in defense.journal articl
再生医療について
Get PDFUnder the titleʻAbout regenerative medicineʼ, I gave a lecture on the basics of regenerative medicine, developments in the field of ophthalmology and regenerative medicine initiatives at the University of Tokushima Hospital to members of the public with an interest in regenerative medicine.
Regenerative medicine refers to medical treatment that uses cells and artificial materials to regenerate damaged functions of biological tissues and organs that have suffered functional impairment or dysfunction. The aim is to restore the function of organs that are no longer able to fulfil their role due to disease by replenishing cells and tissues. This new approach makes it possible to treat diseases and injuries that have been difficult to treat with conventional therapies. Regenerative medicine is a rapidly advancing field of medicine with the potential to improve our health and quality of life.
In the field of ophthalmology, regenerative medicine research in the cornea and retina is advancing. Autologous cultured epithelial cell sheets harvested and cultured from the oral mucosa are being transplanted into corneas that have become opaque due to corneal epithelial dysfunction such as ocular pemphigoid. Clinical trials are also underway to transplant retinal photoreceptor cells and retinal pigment epithelium differentiated from iPS cells.
The University of Tokushima Hospital has a regenerative medicine cell conditioning centre with standards approved by the Ministry of Health, Labour and Welfare, which makes it possible to carry out cell conditioning that requires advanced techniques. With the participation of doctors from the departments of gastroenterology and transplant surgery, plastic surgery, respiratory and collagen medicine, haematology, etc., this system enables cell transplantation therapy and clinical trials, the next generation of cutting-edge medicine, to be carried out. Researchers and medical professionals are working together towards the development of regenerative medicine while addressing safety and ethical issues.journal articl
網膜の再生医療
Get PDFThe advent of iPS cells by Yamanaka et al. has accelerated the clinical application of regenerative medicine. In the field of retinal diseases in ophthalmology, we conducted the first-in-human transplantation using the autologous iPS cell-derived retinal pigment epithelial cell sheet for age-related macular degeneration in 2014. Since then, we have been conducting clinical research, aiming for more general treatments, and have now entered the stage of verifying its effectiveness. For photoreceptor degenerative diseases, we conducted a transplantation of iPS cell-derived retinal organoids containing photoreceptor cells in 2020 and have just confirmed the feasibility and safety of the treatment. For retinal organoid transplantation, it is also important to determine whether the graft can be functionally integrated into the neural network, and further study is needed on how to evaluate the function as well after transplantation in humans. Furthermore, the pathological condition and environment of the recipient eye are crucial in transplantation therapy, and in the future, it will be necessary to consider therapy indications based on the specific disease pathology.journal articl
ゲノム技術の進歩とゲノム医療
Get PDFIn recent years, genome technology has made dramatic progress. Genome analysis technology began with the development of the Sanger method, and the advent of next-generation sequencers has made it possible to obtain vast amounts of genome information very rapidly. We have always explored for the causative genes of genetic diseases by the latest technologies. Identification of causative genes requires a large number of genome samples. To date, we have accumulated a huge number of genome samples, including 900 for amyotrophic lateral sclerosis（ALS）, 4,000 for spinocerebellar degeneration（SCD）, 750 for Parkinsonʼs disease, and 2,000 for dystonia. In order to efficiently identify the causative genes, we have also developed a genetic analysis method using single nucleotide polymorphisms. Utilizing these techniques, we have identified several causative genes as follows : OPTN and LRP12, causing ALS ; CACNA1G and HSD17B4, causing SCD ; and TWNK, causing Perrault syndrome. Furthermore, we have contributed to the elucidation of pathogenesis through functional analysis of these causative genes.
Clinical genomics is a medical field that provides services based on genome information. Clinical genomics is expected to be used not only for the diagnosis of rare diseases, but also for the development of new treatment methods, the selection of better therapeutic drugs, and lifestyle advice tailored to the individualʼs constitution. In addition, genomic research is being actively conducted not only on conventional monogenetic diseases, but also on polygenic diseases. The demand for clinical genomics is likely to increase further in the future. Tokushima University Hospital was one of the first hospitals in Japan to engage in clinical genomics, and in December 2022, the Department of Clinical Genetics was renamed the Clinical Genomics Center. We will continue to expand the functions of the Clinical Genomics Center in preparation for the coming era of personal genome.journal articl
片側頸部を標的とした強度変調回転照射における線量制約の検討
Get PDFThis study aimed to estimate the prevalence and rate of contralateral neck metastasis following unilateral neck volumetric-modulated arc therapy （VMAT）, and to determine the relevant dose constraints for at-risk organs in head and neck cancer patients undergoing unilateral neck VMAT. We enrolled 33 patients with head and neck cancer who underwent unilateral neck VMAT between 2015 and 2021. The prescribed dose to the high-risk planning target volume （PTV） was 60 to 70Gy, and the dose to the low-risk PTV was 50Gy2 （biological equivalent dose of 2Gy） with simultaneous integrated boost. Four patients had contralateral neck metastasis; however, these patients were salvaged. We evaluated the dose to the at-risk organs at virtual contralateral neck VMAT treatment planning, which allowed the effective dosage of PTV in all 33 patients. The average maximum doses to the spinal cord and brain stem were 12.8Gy and 11.1Gy, respectively. The average mean dose to the ipsilateral parotid gland of previously treated unilateral neck VMAT plan was 5.0Gy. The relevant dose constraints to the spinal cord, brain stem, and ipsilateral parotid gland of the unilateral neck VMAT plan were 32.2Gy, 42.9Gy, and 21.0Gy, respectively, in our department.journal articl
The role of thymic epithelium in thymus development and age-related thymic involution
Get PDFThe establishment of an adaptive immune system is critical for protecting our bodies from neoplastic cancers and invading pathogens such as viruses and bacteria. As a primary lymphoid organ, the thymus generates lymphoid T cells that play a major role in the adaptive immune system. T cell generation in the thymus is controlled by interactions between thymocytes and other thymic cells, primarily thymic epithelial cells. Thus, the normal development and function of thymic epithelial cells are important for the generation of immunocompetent and self-tolerant T cells. On the other hand, the degeneration of the thymic epithelium due to thymic aging causes thymic involution, which is associated with the decline of adaptive immune function. Herein we summarize basic and current knowledge of the development and function of thymic epithelial cells and the mechanism of thymic involution.journal articl
