The Role of Echocardiography in the Management of Patients Undergoing a Ventricular Assist Device Implantation and/or Transplantation

Heart transplantation (HTx) is a curative treatment for patients with advanced heart failure (HF); however, since transplant opportunities are severely limited due to donor shortage, the left ventricular assist device (LVAD) has become a standard therapy for patients awaiting HTx. The role of echocardiography as a primary imaging modality to monitor the allograft function in transplant recipients as well as to optimize LVAD settings in LVAD recipients has been expanding. The purpose of this review is to highlight the clinical role of echocardiography in the management of patients undergoing LVAD implantation and/or HTx. In particular, we overview (1) how to detect LVAD malfunction and device-associated complication in LVAD recipients and (2) echocardiographic assessments of cardiac allograft rejection in transplant recipients

教室外での英語学習を支援するための広島大学英語Can-Doリストの拡充

本論文は，広島大学外国語教育研究センターが開発した広島大学英語Can-Do リストについて，有効性を高めるために実施した再調査とその結果を報告する。本リストは，学生による目標設定と自主学習の支援ツールとして広島大学の英語教育に貢献することを目指して開発が開始され，その後もデータ収集を継続していた。前回発表されたリストは単年のデータのみに基づくものであったが，このリストの期待される役割の大きさを考えると，複数年のデータ収集による追加の検討が必要である。そこで，2016年から2019年にかけて新たに収集したデータで再調査を行った。しかし，残念ながら，この再調査ですべての問題点を解消することはできなかったため，今後もリストの修正を継続すべきであると考える。今後，検討すべき点を二つ指摘する。一つは，分析する得点帯の範囲である。今回の調査では，TOEIC® Listening & Reading IP テストのスコア800点以上および295点以下に該当する学生が少なく，分析から除外した。これらの得点帯に該当する学生は少ないと判断し，このまま除外とするのか，それとも，得点帯の拡大を目指すのか，今後さらに検討する必要がある。もう一つは，前回調査と同様にIIBC が開発した既存のリストを用いてCan-Do 分析を行ったことである。次回以降の調査では，リストにCan-Do ステイトメントの追加や削除を施し，精緻化や修正が必要である。We report on a re-survey of the Hiroshima University English Can-Do List, developed by the Institute for Foreign Language Research and Education at Hiroshima University, and the results of the survey conducted to improve the validity of the list. The development of this list was initiated with the aim of contributing to English language education at Hiroshima University as a tool to support students’ goal setting and self-access learning, and data collection has continued since then. The previously published list was based on only one year of data, but given the expected role of this list, additional studies based on multi-year data collection are desirable. Therefore, a re-survey was conducted with newly collected data from 2016 to 2019. Unfortunately, however, this re-survey did not resolve all the remaining challenges, and we believe that the list should continue to be revised in the future. We suggest two issues that should be explored in the future. One is the range of score bands to be analyzed. In this study, a small number of students who scored 800 or above and 295 or below on the TOEIC® Listening & Reading IP Test were excluded from the analysis. Further study is needed to determine whether to exclude students in these score ranges, given the small number of students who fall in these ranges, or to expand the range of scores. The other issue is that, as in the previous survey, a can-do analysis was conducted using an existing list provided by the International Institute for Business Communication (IIBC). In the next and subsequent surveys, the list will need to be refined and modified by adding or deleting can-do statements.This work was supported by the Japan Society for the Promotion of Science (JSPS) Grant-in-Aid for Scientific Research (B), Grant Number JP19H01283

授業研究を通した教師の実践力の向上 : 授業観の変容に着目して

本稿の目的は，広島大学附属東雲中学校で展開されている授業研究を通して，その研究に携わる教師の実践力が向上する様相を考察することである。そのために，まず，東雲中学校で展開されている授業研究は，本時の目標に迫る要因を複数特定する研究であることなどを述べた。そして，教師の実践力のうち，授業を前提とした教材に関する知識に視点をあてて，エピソード分析により８つの要素を抽出・構造化して，東雲中学校のＡ教諭の授業観が変容する様相を示すことにより，授業研究を通して教師の実践力が向上したことを明らかにした

A Case of Long Partial Response to Combination Therapy of Bevacizumab and Capecitabine for Liver Metastases of Rectal Cancer

A 69-year-old female visited our department with a diagnosis of rectosigmoid cancer and multiple hepatic metastases (stage IV). Abdominal CT revealed multiple metastatic lesions in the bilateral lobes of the liver. The primary lesion was considered to be resectable, and high anterior resection of the rectum was performed. After the operation, 6 courses of therapy with bevacizumab (BV) and modified FOLFOX6 were performed. CT showed a partial response, and tumor marker levels became normal. After a total of 11 courses of this therapy, grade 3 peripheral neuropathy developed, and the therapy was changed to BV and capecitabine (Cape). After 6 courses of this therapy, CT showed the maintenance of partial response, and tumor marker levels were also within the normal range. BV and Cape therapy may be useful not only for reducing peripheral neuropathy, but also as a maintenance therapy in patients requiring the suspension of oxaliplatin administration due to peripheral neuropathy

V-shaped dislocations in a GaN epitaxial layer on GaN substrate

In this study, V-shaped dislocations in a GaN epitaxial layer on a free-standing GaN substrate were observed. Our investigation further revealed that the V-shaped dislocations were newly generated at the interface in the epilayer rather than propagated from the GaN substrate. V-shaped dislocations consist of two straight parts. The straight parts of the V-shaped dislocations were separated from each other in the m-direction and tilted toward the step-flow direction of the GaN epitaxial layer. The V-shaped dislocations are continuous single dislocations having a Burgers vector component of 1a and an intrinsic stacking fault between their straight parts

ADAMTS13によるvon Willebrand因子の切断増加は、本態性血小板血症患者における後天性von Willebrand症候群の発症に強く寄与する。

Background: Patients with essential thrombocythemia (ET) often experience bleeding associated with acquired von Willebrand syndrome (AVWS) when the platelet count is markedly increased. Objective: We investigated whether von Willebrand factor (VWF) degradation is enhanced in patients with ET. Methods: Seventy patients with ET underwent VWF multimer (VWFM) analysis and measurement of VWF-related parameters. We calculated the VWFM index, defined as the ratio of intensities of a patient's molecular weight-categorized VWFMs, and those of a healthy subject's, using densitometric analysis. VWF degradation product (DP) was measured via ELISA using a monoclonal antibody that specifically recognizes Y1605 at the C-terminal boundary, which is exposed following ADAMTS13-mediated cleavage of the Y1605-M1606 bond of the VWF A2 domain. Results: Patients with higher platelet counts had a significantly reduced high molecular weight (HMW)-VWFM index and an increased VWF-DP: VWF antigen (Ag) ratio compared to those with lower platelet counts. On multivariate analysis, the VWF-DP/ VWF:Ag ratio was an independent predictor of the HMW-VWFM index. Patients who underwent cytoreductive therapy had a significantly higher HMW-VWFM index and lower VWF-DP/ VWF:Ag ratio than those who did not. Among individual patients, there was also a significant increase in the HMW-VWFM index and a decrease in the VWF-DP/ VWF:Ag ratio after cytoreductive therapy compared to pre-therapy values. Conclusion: In patients with ET, an increased platelet count is associated with enhanced cleavage of VWF at the Y1605-M1606 bond, primarily by ADAMTS13, leading to AVWS. Cytoreductive therapy reduces the platelet count, prevents excessive VWF cleavage, and improves VWFM distributions.博士（医学）・甲第881号・令和5年3月15

Shortened cataract surgery by standardisation of the perioperative protocol according to the Joint Commission International accreditation: a retrospective observational study

OBJECTIVES: To investigate the impact of standardisation of the perioperative protocol based on the Joint Commission International (JCI) accreditation guidelines for operating time in cataract surgery. DESIGN: Retrospective observational study. SETTING: Single centre in Japan. PARTICIPANTS: Between March 2014 and June 2016, 3127 patients underwent cataract surgery under topical anaesthesia including 2581 and 546 patients before and after JCI accreditation, respectively. PRIMARY AND SECONDARY OUTCOMES: We compared three time periods, comprising the preprocedure/surgery time (pre-PT), PT and post-PT, and total PT (TPT) of cataract surgery between patients before and after JCI accreditation, by regression analysis adjusted for age, sex and cataract surgery-associated confounders. RESULTS: The main outcomes were pre-PT, PT, post-PT and TPT. Pre-PT (19.8+/-10.5 vs 13.9+/-8.5 min, p \u3c 0.001) and post-PT (3.5+/-4.6 vs 2.6+/-2.1 min, p \u3c 0.001) significantly decreased after JCI accreditation, while PT did not significantly change (16.8+/-6.7 vs 16.2+/-6.3 min, p=0.065). Consequently, TPT decreased on average by 7.3 min per person after JCI accreditation (40.1+/-13.4 vs 32.8+/-10.9 min, p \u3c 0.001). After adjusting for confounders, pre-PT (beta=-5.82 min, 95% CI -6.75 to -4.88), PT (beta=-0.76 min, 95% CI -1.34 to -1.71), post-PT (beta=-0.85 min, 95% CI -1.24 to -0.45) and TPT (beta=-7.43 min, 95% CI -8.61 to -6.24) were significantly shortened after JCI accreditation. CONCLUSION: Perioperative protocol standardisation, based on JCI accreditation, shortened TPT in cataract surgery under local anaesthesia