大学教員の授業及び学生生活において支援が必要な大学生に対する意識と取り組みに関する調査

大学など高等教育機関で発達障がいの学生は増加しており，中でも自閉症スペクトラムに代表される社会性の発達障がいが問題となっている。しかし学業面で問題がない学生は，学生相談等の支援につながりにくい。よって，大学教育で自閉症スペクトラムの大学生の存在に配慮した社会性やコミュニケーション能力の育成を目的とするカリキュラムの開発を検討する。その基礎資料を得るため本研究では，大学教員を対象に配慮や支援が必要な大学生に対する意識と取り組みについて調査を行った。その結果，発達障がいの知識の中でも自閉症スペクトラムの知識をあまり持たない教員が多かった。また自閉症スペクトラムの知識の程度によって，支援が必要な学生の存在への気づきや支援の取り組み状況に違いがみられた。学生の支援を進めていく上で，大学教員の発達障がいの学生に関する知識及び支援に関する情報提供が重要であることが示唆された

Administration of micafungin as prophylactic antifungal therapy in patients undergoing allogeneic stem cell transplantation

Objective: Invasive fungal infection is one of the major causes of death in neutropenic patients undergoing allogeneic stem cell transplantation (SCT). Although prophylactic antifungal therapy with fluconazole (FLCZ) has become the standard care for these patients, there remains a need for more effective and cost-beneficial alternative drugs. Patients and Methods: We conducted a prospective study to evaluate the usefulness of the administration of micafungin (MCFG) as a prophylactic antifungal therapy for patients undergoing allogeneic SCT. The results were compared with previous data for patients who had received FLCZ. Results: A total of 44 patients who underwent allogeneic SCT were enrolled in the study. Data from 29 patients who received allogeneic SCT using prophylactic FLCZ before this study were used as historical control data. Underlying diseases included acute leukemia (n=16), non-Hodgkin’s lymphoma (n=11), myelodysplastic syndrome (n=6), and others (n=11) in the MCFG group and acute leukemia (n=18), chronic myelogenous leukemia (n=6), and others (n=5) in the FLCZ group. The median durations of administration of MCFG and FLCZ were 36 and 34 days, respectively. Prophylactic success, defined as the absence of proven, probable, and possible invasive fungal infection (IFI) until the end of prophylactic therapy was achieved in 36 (87.8%) of the 41 evaluated patients in the MCFG group and in 65.5% of the patients in the FLCZ group (p=0.038). No patients in the MCFG group showed proven or probable IFI, whereas proven or probable IFI was observed in 3 patients in the FLCZ group. Four patients in the MCFG group required dose escalation due to febrile neutropenia. Although one patient in the MCFG group required the discontinuation of MCFG due to allergic skin eruption (grade 2), none of the other patients in either group required dose reduction due to adverse effects. Conclusions: Although the study design was not a prospective randomized trial, our results indicate that the administration of MCFG at a daily dose of 100 mg is promising for prophylactic antifungal therapy in patients undergoing allogeneic SCT

Fifteen‐year survival and conditional survival of women with breast cancer in Osaka, Japan: A population‐based study

Abstract Background In recent years, the survival of patients with breast cancer has improved. However, few published studies have a longer than 10‐year follow‐up. Conditional relative survival (CRS), which is relative survival (RS) of patients who have survived beyond a certain period after diagnosis, is useful for assessing excess mortality among long‐term survivors compared with the general population. Methods This was a retrospective observational cohort study. Population‐based cancer registry data in Osaka, Japan were used to determine 15‐year RS and 5‐year CRS of women with breast cancer diagnosed between 2001 and 2002 and followed up for at least 15 years. Fifteen‐year RS and age‐standardized RS (ASR) were calculated by Ederer II and cohort methods. Five‐year CRS according to age group and extent of disease (localized, regional, and distant) was estimated for every year from diagnosis to 10 years. Results In the cohort of 4006 patients, the ASR declined progressively, the 5‐year ASR being 85.8%, 10‐year ASR 77.3%, and 15‐year ASR 71.6%. The overall 5‐year CRS exceeded 90% at 5 years after diagnosis, reflecting a small excess mortality compared with the general population. The 5‐year CRS of patients with regional and distant disease did not reach 90% within 10 years of follow‐up (89.4% for regional and 72.9% for distant disease 10 years after diagnosis), indicating that these patients had substantial excess mortality. Conclusion Long‐term survival data can help cancer survivors plan their lives and receive better medical care and support

Clinical impact of cycling the administration of antibiotics for febrile neutropenia in Japanese patients with hematological malignancy

Despite the availability of newer classes of antibiotics, infection with multi-drug-resistant bacteria is a serious problem. To suppress the appearance of multi-drug-resistant bacteria and to avoid severe infection derived from febrile neutropenia (FN), we conducted cycling administration of antibiotics for FN in patients with hematological malignancy. The treatment protocol consisted of the administration of four antibiotics each for three months in one year. The above regimen was repeated for 4 years. A total of 193 patients were registered in the protocol. Mean duration of administration of cycling antibiotics was 5.9 days (range: 1-16 days). Frequency of FN before the study and during the study was unchanged until the third year but decreased significantly in the fourth year. Frequency of detection of multi-drug-resistant bacteria in the first year was the same as that before the study was started but dramatically decreased after the second year. Bacteriological treatment success rates were similar in each trimester and each year. Effective rate was not statistically different in each trimester and each year. We conclude that cycling administration of antibiotics in patients with FN is useful for suppressing the appearance of multi-drug-resistant bacteria and for obtaining excellent clinical efficacy

Cytological findings of pre-invasive bronchial lesions detected by light-induced fluorescence endoscopy in a lung cancer screening system

Lung cancer is a global epidemic and the number one cause of death among all cancers,with a very high morbidity.A new strategy for the treatment of lung cancer is the detection and eradication of pre-invasive bronchial lesions before they become invasive carcinomas.We conducted a detailed investigation into the use of fluorescence broncho-scopy in the detection of pre-invasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy.We also studied the distinctive cytological findings in the sputum specimens corresponding to the pre-invasive bronchial lesions.Sputum examinations were performed by mass screening a high-risk group of participants.From 1997 to 1999,61 participants with sputum cytology suspicious or positive for malignancy were referred to our institute,and were examined with both white-light and fluorescence bronchoscopy.For the cytological findings,the collection of sputum was performed in the early morning.Conventional white-light examinations were first performed,and areas with abnormal findings were recorded for subsequent biopsy.Fluorescence bronchoscopy examinations were then carried out.Biopsy specimens for a pathological examin-ation were taken from all the suspicious or abnormal areas discovered by the white-light bronchoscopy,or fluorescence bronchoscopy examination, or both.The laser-induced fluor-escence bronchoscopic examination showed a high sensitivity for invasive carcinoma,carcinoma in situ,as well as severe,moderate,and mild dysplasia.In the sputum cytological findings,a thickened cytoplasm and slight hyperchromasia were frequently observed in the mild dysplasias compared with the squamous cells without atypia.Hyperchromasia and an Orange G(OG)-philic cytoplasm of squamous cells were frequently observed in the moderate compared with the mild dysplasias.A thickened cytoplasm,a nuclear pleomorphism,a thickened nuclear rim,a coarse chromatin,an uneven chromatin distribution,and an OG-philic cytoplasm were frequently observed in the carcinomas in situ and severe dysplasias compared with the moderate dysplasias.We found that the use of fluorescence bronchoscopy in addition to convectional white-light examination can enhance the detec-tion and localization of pre-invasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy.Sputum cytology is therefore a potential approach to diagnosing pre-invasive bronchial lesions

Relationship between Preexisting Anti-Varicella-Zoster Virus (VZV) Antibody and Clinical VZV Reactivation in Hematopoietic Stem Cell Transplantation Recipients

Reactivation of latent varicella-zoster virus (VZV), presenting as localized zoster or as disseminated infection, is a common and potentially serious complication in hematopoietic stem cell transplantation (HSCT) recipients. We retrospectively studied anti-VZV immunoglobulin G titers by the immune adherence hemagglutination method after HSCT and also studied VZV DNA by real-time PCR during clinical VZV reactivation using cryopreserved serum samples. No significant difference was found between anti-VZV titers in 13 patients with VZV infection (localized zoster in 11 patients and disseminated zoster in 2 patients) and in 13 subjects without VZV infection at each time point after HSCT. Preexisting anti-VZV titers of disseminated zoster cases tended to be lower than those of localized zoster cases (P = 0.10). Serum VZV DNA copy numbers at the onset of disseminated zoster cases tended to be higher than those of localized zoster cases (P = 0.09). A strong inverse correlation was found between preexisting anti-VZV titer and serum VZV DNA at onset (r = −0.90, P = 0.006). In HSCT recipients, preexisting antibody does not prevent the development of VZV reactivation but may contribute to decreased viral load at onset, resulting in a mild clinical course