Initial Experience of Percutaneous Extraction of Infected Cardiac Implantable Electric Devices Using Excimer Laser

Article信州医学雑誌 63(2):103-108 (2015)journal articl

Catheter ablation of non-inducible atrial tachycardia after surgical repair of heart disease

We present a patient with non-inducible atrial tachycardia (AT) after atriotomy for surgical repair of heart disease who underwent ablation successfully. Using a 3-D mapping system, we presumed the atriotomy site on the lateral right atrial wall by searching for linear double potentials (DP) during sinus/paced rhythm from the coronary sinus, but it was evaluated incompletely. We could verify the edges of the atriotomy scar precisely by pacing from close to the linear DP lesion and the opposite site. After ablation between the presumed atriotomy scar and the inferior vena cava and cavotricuspid isthmus, no AT recurred without anti-arrhythmic drugs.ArticleHEART AND VESSELS. 27(1):114-118 (2012)journal articl

High concentrations of omega-3 fatty acids are associated with the development of atrial fibrillation in the Japanese population

The favorable effect of fish oils rich in n-3 polyunsaturated fatty acids (PUFAs) on the development of atrial fibrillation (AF) is controversial. The relationship between the serum concentrations of n-3 PUFAs and the incidence of AF is unclear; therefore, in the present study, we aimed to elucidate this relationship. We evaluated the serum concentrations of n-3 PUFAs in 110 patients with AF, 46 patients with ischemic heart disease (IHD) and no AF, and 36 healthy volunteers. Thirty-six patients had a history of IHD (IHD-AF group) and 74 did not (L-AF group). The eicosapentaenoic acid (EPA) levels in the L-AF group were higher than those in the IHD-AF and control groups (117 +/- A 64, 76 +/- A 30, and 68 +/- A 23 mu g/ml, respectively); the docosahexaenoic acid (DHA) levels showed the same pattern (170 +/- A 50, 127 +/- A 27, and 126 +/- A 35 mu g/ml, respectively). In both the L-AF and IHD-AF groups, the EPA levels in patients with persistent and permanent AF were higher than those in patients with paroxysmal AF (L-AF 131 +/- A 74 vs. 105 +/- A 51 mu g/ml; IHD-AF 82 +/- A 28 vs 70 +/- A 33 mu g/ml). Multivariate analysis showed that cases of AF were associated with higher levels of EPA but not DHA. In this Japanese population study, the EPA and DHA levels in patients with L-AF were higher than those in normal subjects. In particular, the EPA level was associated with the incidence of AF. These findings suggest that an excess of EPA might be a precipitating factor of AF.ArticleHEART AND VESSELS. 28(4):497-504 (2013)journal articl

公衆衛生看護学実習の実習経験内容と目標到達度の分析

【目的】 本学の健康看護支援論実習（公衆衛生）（以下，公衆衛生看護学実習）実習施設は，9箇所の県保健所，19箇所の県内市町，2箇所の事業所など多岐に渡り，実習先によって体験する内容に偏りがある 8）．施設の保健事業活動特性等を踏まえて，学生が等しく実習目標を到達できるように調整することは，大学にとって重要な課題である．そこで本研究では，実習施設の違い，経験した事業，実習時期が，学生個々の実習目標到達度に差異が生じるのか，関連傾向を分析することで効果的な実習に向けて配慮すべき事項を検討することを目的とした．【方法】 対象；B大学4年次公衆衛生看護学実習経験録及び自己評価表・最終レポート105名分．方法；①実習項目の単純集計，②実習方法別経験の有無及び実習施設別の目標到達度の相違分析，③学生の最終レポートより質的手法を用いて学生の“実習での学び”の抽出を行った．【結果】 対象学生107名，回収数105名（回収率98.1％）．①「家庭訪問」「健康教育」「健診/ 検診」「健康相談」「産業保健実習」の〈見学〉，「健康教育」の〈実施〉，「健診/ 検診」の〈事後カンファレンス参加〉は経験率8割以上，それ以外は経験率6割未満であった．②実習項目「地域組織活動」の〈参加〉で有意差が認められた．その他の実習項目は，実習項目の経験有無と目標到達度の平均値に統計的な有意差はなかった．③地区組織活動に参加した学生の最終レポートより【保健師の役割】【住民の変化・成長】【グループ活動の効果】が抽出された．【考察・結論】 「地区組織活動」に参加した学生は，参加しなかった学生に比べ，目標到達度が高められていた．一方，その他の実習項目においては，経験できない状況であっても，等しく学べていた．これは，資料の閲覧や担当保健師からの説明，学生同士の学びの共有など，他の方法で学びを得られるよう大学と施設で環境調整したことで実習目標が到達できていたと言える

A quantitative risk assessment of waterborne infectious disease in the inundation area of a tropical monsoon region

Flooding and inundation are annual events that occur during the rainy season in Cambodia, and inundation has a strong relationship with human health. This study simulated the coliform bacteria distribution using a hydraulic model and estimated the impact of inundation on public health using a dose–response model. The model parameters were calibrated using field survey data from Cambodia and obtained good agreement with the coliform group count distribution. The results suggest that the impact of inundation on human health is most noticeable in residential areas. The annual average risk of infection during medium-sized flood events is 0.21. The risk due to groundwater use ranges from 0.12 to 0.17 in inundation areas and reaches as high as 0.23 outside the inundation areas. The risk attributed to groundwater use is therefore higher than that for surface water use (0.02–0.06), except in densely populated areas at the city center. There is a high risk for infection with waterborne disease in residential areas, and the annual average risk during small flood events is 0.94. An assessment of possible countermeasures to reduce the risk shows that the control of inundation may bring more risk to public health in Cambodia. Shallower inundation water (<0.3 m) leads to a higher risk of infection, but if the depth is greater than 2 m, the risk is low in residential areas.The simulated results explain the spatial distributions of infection risk, which are vitally important for determining the highest priority places with relatively high risk and will be helpful for decision makers when considering the implementation of countermeasures

統合カリキュラムの保健師教育が卒業後の看護実践で役立っている内容 ─調査票の自由記載から─

【目的】 大学における看護基礎教育において保健師養成が選択制に移行する一方で，国が行う地域包括ケアシステムの推進に向けて，地域を包括的・継続的に捉えて看護を展開する看護職の育成が求められている．本研究においては，統合カリキュラムで保健師教育を学修した卒業生は，卒業後の看護実践において統合カリキュラムの学修がどのように役立っていると捉えているかを明らかにする．【方法】 統合カリキュラムの教育を受けたA 大学看護学部の卒業生732 名のうち，調査の協力に同意を得られた123名に郵送法による質問紙調査を実施した．調査内容は，保健師教育は看護実践に役立っていますか，についての選択肢の回答とその内容の自由記載を求めた．「役に立っている」と回答のあった者について内容分析の手法を用いて分析した．【結果】 回答した卒業生（以下，卒業生）84名のうち，看護実践に「役立っている」と回答したのは63 名で，役立っていると捉えた内容は【退院後の具体像をイメージした退院調整の実施】【看護を幅広く捉えて看護実践に活用】【地域や保健師等との連携】【病院と地域を意識した捉え方】【保健師活動の理解】【保健師業務の実践】【職業選択の広がり】の7 のカテゴリーであった．【結論】 卒業生の4 分の3は，保健師教育は看護実践に役立っていると捉えているが，内容は退院支援に関するものが多く，保健師活動に関するものはわずかであった．退院支援は看護師教育の学修内容でもあり，保健師教育のみの学びとは言い難い点がある．しかし，公衆衛生看護学実習を通して，保健師活動の理解が深まることで，地域における多職種との連携を理解していることが示唆され，地域のシステムづくりを学んで，在宅看護と公衆衛生看護の両者の視点から幅広い看護の提供に役立つ可能性が示された．また，看護師から保健師への転職者がおり，職業選択の広がりに役立っていることが示された

Identifying Core Regions for Path Integration on Medial Entorhinal Cortex of Hippocampal Formation

Path integration is one of the functions that support the self-localization ability of animals. Path integration outputs position information after an animal&rsquo;s movement when initial-position and movement information is input. The core region responsible for this function has been identified as the medial entorhinal cortex (MEC), which is part of the hippocampal formation that constitutes the limbic system. However, a more specific core region has not yet been identified. This research aims to clarify the detailed structure at the cell-firing level in the core region responsible for path integration from fragmentarily accumulated experimental and theoretical findings by reviewing 77 papers. This research draws a novel diagram that describes the MEC, the hippocampus, and their surrounding regions by focusing on the MEC&rsquo;s input/output (I/O) information. The diagram was created by summarizing the results of exhaustively scrutinizing the papers that are relative to the I/O relationship, the connection relationship, and cell position and firing pattern. From additional investigations, we show function information related to path integration, such as I/O information and the relationship between multiple functions. Furthermore, we constructed an algorithmic hypothesis on I/O information and path-integration calculation method from the diagram and the information of functions related to path integration. The algorithmic hypothesis is composed of regions related to path integration, the I/O relations between them, the calculation performed there, and the information representations (cell-firing pattern) in them. Results of examining the hypothesis confirmed that the core region responsible for path integration was either stellate cells in layer II or pyramidal cells in layer III of the MEC