A case of a middle-aged patient with a ventricular septal defect complicated by severe pulmonary hypertension-stepwise surgical repair with pulmonary vasodilators-

We report a case of ventricular septal defect (VSD) in which we attempted to treat pulmonary arterial hypertension (PAH) with the goal of VSD closure in an adult with suspected Eisenmenger syndrome in childhood. Four years previously (age 41 years), she was referred to our department due to repeated hemoptysis requiring further treatment of PAH. We started combination therapy with several pulmonary vasodilators. Two years later, her pulmonary vascular resistance (PVR) was improved but still not at the level where VSD closure was possible. To control the increased PA flow resulting from intensive PAH treatment and to reduce the risk of hemoptysis, we performed pulmonary artery banding (PAB). As the risk of hemoptysis decreased, a prostacyclin analog was introduced, and the dose was increased. More than 1 year after PAB, active vasoactivity testing became positive, suggesting that the pulmonary vascular lesion was now “reversible”. We performed VSD closure and atrial septal defect creation even though her PVR was still high. After the operation, her exercise capacity was remarkably improved. We suggest that stepwise surgical repair with pulmonary vasodilators is an important treatment option for select patients with VSD with severe PAH.Learning objectiveAdvances in pulmonary arterial hypertension (PAH) treatment have led to the use of a “treat-and-repair” strategy to close the intracardiac shunt after PAH treatment in select patients with adult congenital heart disease. In our case, ventricular septal defect (VSD) closure was achieved with stepwise surgical repair and a combination of pulmonary vasodilators, even though long-standing severe PAH with persistent hemoptysis remained. Even after a long period of exposure to high blood flow, this strategy may reduce pulmonary vascular resistance and permit eventual closure of the VSD

介護実習施設と介護福祉士養成施設との連携における現状―介護実習指導者と実習生、介護福祉士養成施設の専任教員との三者間連携の重要性―

本研究の目的は、長崎国際大学（以下、本学とする）において行われた「介護の講演会」において介護福祉士養成施設教員、実習生、介護実習指導者の介護実習における三者の語りをもとに、その連携の現状と課題を明らかにすることである。介護福祉士の養成においては、養成施設の教員と実習施設の介護実習指導者が連携して介護実習を行うことが望ましいとされている。それにより、介護の専門職である介護福祉士としての専門性を獲得することが出来ると考えられており、介護福祉士の養成カリキュラムの中でも特に重要な科目として介護実習が位置付けられている。三者の語りを分析した結果、それぞれの介護実習に対する概念図を作成し、それを踏まえて介護実習における三者の関係性を示す概念図を作成した。結論として、介護福祉士養成校教員と介護実習指導者は、実習生が介護福祉士としての専門性の獲得するために、介護技術や認知症ケアを実践するための思考過程を重要視した指導と連携を行っていると仮説を立てた

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Electron microscopy in dermatology : basic and clinical research /

Proceedings of the joint meeting for the Japanase society for ultrastructural cutaneous biology and the Society for cutaneous ultrastructure research, Nara, Japan, 24-27 October, 199

Amphibole–melt disequilibrium in silicic melt of the Aso-4 caldera-forming eruption at Aso Volcano, SW Japan

Abstract The most recent and largest caldera-forming eruption occurred at ~ 90 ka at Aso Volcano, SW Japan, and is known as the “Aso-4 eruption.” We performed chemical analyses of amphibole phenocrysts from Aso-4 pyroclasts collected from the initial and largest pyroclastic unit (4I-1) of the eruption to infer the composition–temperature–pressure conditions of the melt that crystallized amphibole phenocrysts. Each amphibole phenocryst is largely chemically homogeneous, but inter-grain chemical variation is observed. Geothermometry, geobarometry, and melt–SiO2 relationships based on amphibole single-phase compositions reveal that most amphibole phenocrysts were in equilibrium with hydrous melt comprising ~ 63–69 wt% SiO2 ($${\text{SiO}}_{2}^{\text{melt}}$$ SiO2melt ) at 910–950 °C, although several grains were crystallized from more mafic and higher-temperature melts (~ 57–60.5 wt% SiO2 and 965–980 °C). The amphibole temperatures are comparable with those previously estimated from two-pyroxene geothermometry, but are much higher than temperatures previously estimated from Fe–Ti oxide geothermometry. The estimated $${\text{SiO}}_{2}^{\text{melt}}$$ SiO2melt contents are lower than that of the host melt in the 4I-1 pyroclasts. Chemical and thermal disequilibrium between the amphibole rims and the host melt, as well as intra-grain homogeneity and inter-grain heterogeneity of amphibole compositions, suggests that these amphiboles were incorporated into the host melt immediately prior to the caldera-forming eruption. Our results suggest that the amphibole phenocrysts, and perhaps some of the pyroxene and plagioclase phenocrysts, were derived from a chemically and thermally zoned crystal mush layer that had accumulated beneath the chamber of the host 4I-I melt. Amphibole geobarometry indicates a crystallization depth of ~ 13.9 ± 3.5 km, which is consistent with the present-day magma chamber depth beneath the volcano as inferred from geophysical observations. The results suggest that the depth of the post-caldera magma plumbing system is strongly influenced by a relic magma reservoir related to a previous caldera-forming eruption