GLS following high-dose chemotherapy

Background Cardiac amyloidosis (CA) is a secondary form of cardiomyopathy where abnormal accumulation of amyloid protein in the myocardial interstitium causes cardiac hypertrophy and myocardial fibrosis. If primary CA advances to heart failure, most patients do not survive for very long after the diagnosis. Case summary A 40-year-old man was admitted to our hospital for dyspnoea, progressive anaemia, and decreased appetite. He has diagnosed with amyloid light-chain (AL) amyloidosis. Although BD treatment (bortezomib + dexamethasone) and medical treatment were started, there was no sign of improvement. Then, high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (auto-PBSCT) was initiated. Pretreatment echocardiography revealed typical findings of CA, such as ventricular wall thickening, valvular thickening, diastolic dysfunction, and pericardial effusion. Global longitudinal strain (GLS) was significantly reduced, and bull's-eye mapping showed typical apical sparing. After auto-PBSCT, GLS gradually improved and was almost normal after 2 years. Other echocardiographic parameters, functional status, and laboratory data also showed that there was significant regression of CA. Discussion Although the prognosis in primary CA is extremely poor, we achieved long-term survival in a patient with effective high-dose chemotherapy and auto-PBSCT. Global longitudinal strain may be a useful marker of prognosis, regression, and recovery

Extravasated platelet aggregation in the livers of rats with drug-induced hepatic sinusoidal obstruction syndrome

13301甲第4590号博士（医学）金沢大学博士論文本文Full 以下に掲載：MOLECULAR MEDICINE REPORTS 15 pp.3147-3152 2017. SPANDIDOS PUBRICATIONS. 共著者：MIKI HIRATA, HIDEHIRO TAJIMA, TOMOHARU MIYASHITA, TAKASHI MIYATA, SHINICHI NAKANUMA, ISAMU MAKINO, HIRONORI HAYASHI, KATSUNOBU OYAMA, HIROYUKI TAKAMURA, ITASU NINOMIYA, SACHIO FUSHIDA, HIROKI NAKATA, SHOICHI ISEKI, SHINICHI HARADA, TOMOHIKO WAKAYAMA, TETSUO OHT

コ系の意味の再分析 : 指示詞体系における新たな最小の意味的対立

秋田大学Akita University本稿の目的は，自然談話データに基づいて日本語指示詞コ系の直示用法を再分析し，その意味的特徴を明らかにすることである。分析においては，Levinson（2000），Enfield（2003）が提示した指示詞体系における新たな最小の意味的対立という概念を用いる。先行研究では，コ系・ア系は一貫して，話し手から「近」，「遠」という意味的対立を示すと記述されてきた。しかし，コ系とア系が用いられている場面をみると，コ系は様々な位置にある対象を指し，空間的に柔軟性を持つのに対し，ア系は常に発話空間で一定の位置にある対象のみを指す。このコ系とア系の非対称的な分布事実に基づき，本稿では，コ系の近接性は意味ではなく，より強い意味を持つア系の存在により生じる会話の推意であると主張する。この分析は，Enfield（2003）がラオ語指示決定詞nii4とnan4に対して行った分析と一致する。This paper provides an analysis of the Japanese demonstrative pronoun ko- in its deictic use, based on spontaneous interaction data. The concept of new minimal semantic contrast introduced by Levinson (2000) and applied by Enfield (2003) is used as the framework of analysis. In contrast to previous accounts of ko- and a-, in which ko- encodes [+proximal] and a- encodes [-proximal], distributional findings show that the indicating ranges of ko- and a- are asymmetrical. While a- indicates only referents that are in a certain location, ko- has flexibility with regard to the spatial location of its referents and is also conceivable in contexts where a- is used. The present discussion reasons that ko- does not encode any spatial information, and shows that the proximity of ko- is not determined by semantic meaning, but by conversational implicature. This reasoning corresponds with the nature of the Lao demonstrative determiner system analyzed by Enfield (2003)

Germline pathogenic variants of 11 breast cancer genes in 7,051 Japanese patients and 11,241 controls

Pathogenic variants in highly penetrant genes are useful for the diagnosis, therapy, and surveillance for hereditary breast cancer. Large-scale studies are needed to inform future testing and variant classification processes in Japanese. We performed a case-control association study for variants in coding regions of 11 hereditary breast cancer genes in 7051 unselected breast cancer patients and 11,241 female controls of Japanese ancestry. Here, we identify 244 germline pathogenic variants. Pathogenic variants are found in 5.7% of patients, ranging from 15% in women diagnosed <40 years to 3.2% in patients ≥80 years, with BRCA1/2, explaining two-thirds of pathogenic variants identified at all ages. BRCA1/2, PALB2, and TP53 are significant causative genes. Patients with pathogenic variants in BRCA1/2 or PTEN have significantly younger age at diagnosis. In conclusion, BRCA1/2, PALB2, and TP53 are the major hereditary breast cancer genes, irrespective of age at diagnosis, in Japanese women

サイケツ ヲ ウケル 1サイ ノ コドモ ト オヤ ヘノ エンジョ ナイヨウ

背景 小児看護領域において, 子どもの権利条約の批准後, プレパレーションの概念が広まった. しかし, 小児専門病院の看護師に比べ, 総合病院の看護師のプレパレーションの認識は低く, プレパレーションの実践の普及がされていない実態がある. さらに, 採血を受ける子どもに関する研究は多いが, 自己の思考により物事をみることができない発達段階である2歳未満の年少の子どもを対象とした研究は少ない. 目的 採血を受ける1歳の子どもとその親への援助内容を明らかにする. 方法 全国の小児外来を標榜する総合病院131施設の外来に勤務する看護師のうち, 子どもの採血に関わる786名を対象に質問紙調査を行い, 自由記述の内容を分析しカテゴリー化した. 結果および考察 282名 (回収率35.8%) から回答が得られた. 看護師のプレパレーションの認知は, 知っている51.1%, 知らない45.0%であり先行研究より認識が高まっていた. しかし, 親の付き添いがないと回答した看護師は66.5%であり, さらに子どもの姿勢は寝かされ, 身体の抑制を受けながら採血を受けていたことが明らかとなった. 自由記述の内容分析では, 1歳の子どもと親への援助内容から看護師は, 子どもの発達段階に応じた援助ができていたが, 親が付き添う採血のケアモデル提示が少ないことが明らかとなった. 結論 看護師が, 1歳の子どもの発達段階に応じた援助を行うために, 子どもの権利およびプレパレーションの概念を学習する機会の提供が必要である. さらに, 親が付き添う採血のケアモデルの提示をする必要があることが示唆された.Background Nurses\u27 awareness of preparation at general hospitals is lower than that of nurses at specialist pediatric clinics, which has impeded the spread of preparation being put into practice throughout Japan. Although many studies have investigated children undergoing blood collection, few have examined young subjects aged less than two years.Objective This study aimed to clarify the state of blood collections conducted on one-year-old patients and support offered to parents.Methods A questionnaire survey targeting 786 outpatient nurses who routinely collected blood from pediatric patients at 131 general hospital facilities nationwide was conducted. Free comments were analyzed and content was categorized.Results/Discussion Answers were received from 282 nurses (recovery rate: 35.8%). It was found that nurses\u27 awareness of preparation had increased from that reported in previous studies to 51.1%. However, 66.5% of nurses reported that parents did not accompany children during blood collection. Analysis of free comments revealed that although nurses were offering parents support in accordance with children\u27s developmental stage, few care models incorporating parental attendance during blood collection had been presented.Conclusions Opportunities to study the concepts of child rights and preparation need to be provided so that nurses can give support in accordance with the developmental stage of one-year-old children undergoing blood collection. Results also suggested that a care model incorporating parental attendance during blood collection needs to be presented

カゾク ガ ツキソッタ バアイ ノ ヨウジ ノ サイケツ ニ タイスル タイショ コウドウ ノ カンサツ ブンセキ

背景 1994年に児童の権利に関する条約をわが国が批准してから, 小児看護領域では子どもの権利の保障としてプレパレーションの概念が広まった. 特に認知能力や言語的表現力が未熟な幼児に対して, 身体的苦痛が伴う検査や処置では子どもの理解力に応じたプレパレーションの実施が重要であることが明らかにされている. しかし検査や処置の場面構成は医療者が主体であるため, 採血場面に親の付き添いを除外する施設が多い. そのため親から分離された幼児は, 不安の増大により処置室への入室も困難な状態を引き起こす. 親が採血に付き添う場合に, 子どもがどのような反応や行動をとるかは明らかにされていない. 目的 家族が付き添う幼児後期の子どもの採血場面をビデオに録画し, 子どもと家族の相互の関係性から対処行動を明らかにする. 方法 小児外来で家族が付き添って採血を受ける幼児後期の子どもが, 採血を受けて退室するまでの行動をビデオに録画し, 採血終了後に家族へ半構成的面接を行った. 結果 採血前は【緊張の高まり】【誘導を受け入れる】【抵抗する】【自分なりの方法で心の準備をする】の4カテゴリーと8サブカテゴリー, 採血中は【誘導を受け入れる】【自分なりの方法で取り組む】【苦痛を表現する】【緊張をとく】の4カテゴリーと8サブカテゴリー, 採血後は【終了を行動する】【緊張がとける】【満足感を得る】の3カテゴリーと5サブカテゴリーが抽出された. 結論 採血場面に家族が付き添った幼児後期の子どもは, 家族が寄り添うことで安心を得ることができ, 調整能力を発揮し, 子どもは自分なりの方法で立ち向かうことができる. また採血中は痛みや苦痛をその場で受け止めてもらえる家族の存在により, 子どもは少しずつ緊張をとくことができる. さらに家族からの称賛により子どもは満足を得ることができ, 早期に日常の姿に戻ることができた.Background Japan ratified a treaty about the Child Rights in 1994, a general idea of preparation spread out as security of the rights of children in the child care region. For the infants that cognitive ability and verbal power of expression are immature, it is revealed that enforcement of preparation which accepted the understanding of children is important by testing and the treatment that physical pain is associated with. However, as for the scene constitution of testing and the treatment, there are many institutions excluding the attendant of the parent in the drawing blood scene because a medical person is the main constituent. Therefore the infants isolated from a parent cause a state having difficulty in admission to the dressing room by an increase of the anxiety. When a parent goes with drawing blood, it is uncertain what kind of response and behavior children take. Also, it is uncertain what kind of response and behavior children take when a parent goes with drawing blood.Purpose We determine coping behavior from the mutual relations of children and the family by shooting the drawing blood scene of the infants whom a family attends with a video camera.Methods We recorded behavior before undergoing drawing blood, and being discharged from the infants who underwent drawing blood with a family in pediatric outpatient department on a video .And had an interview to a family

Extravasated platelet aggregation in the livers of rats with drug-induced hepatic sinusoidal obstruction syndrome

Oxaliplatin-based chemotherapy plays an important role in the treatment of colorectal liver metastases. Oxaliplatin, however, causes sinusoidal obstruction syndrome (SOS), which is characterized by portal hypertension, splenomegaly, thrombocytopenia, and liver dysfunction. SOS is diagnosed histopathologically by disruption of the sinusoidal endothelium, collagen deposition, fbrosis especially around zone 3, dilatation of the sinusoidal space and congestion. This study assessed the characteristics of a rat model of SOS. SOS was induced in rats by administration of monocrotaline (MCT). Blood chemistries and macroscopic and microscopic fndings were compared in rats administered MCT and vehicle (control group). Levels of expression in the liver of CD41, P-selectin, rat endothelial cell antigen-1, CD34, and cleaved caspase-3 were analyzed immunohistochemically. Moreover, livers of these rats were analyzed by electron microscopy. Macroscopically, MCT-treated rats showed accumulation of bloody ascites and blue liver and were diagnosed with SOS histologically. Serum concentrations of aspartate aminotransferase (P=0.003), alanine aminotransferase (P=0.008), total-bilirubin (P=0.012), direct-bilirubin (P=0.007), indirect-bilirubin (P=0.003), lactate dehydrogenase (P<0.001) and hyaluronic acid (P=0.016) were signifcantly higher, and platelet counts signifcantly lower (P=0.004), in MCT-treated than in control rats. The livers of MCT-treated rats were immunohistochemically positive for CD41 and P-selectin, suggesting platelet aggregates; for rat endothelial cell antigen-1 and CD34, suggesting sinusoidal endothelial disorder; and for cleaved caspase-3, suggesting hepatocyte apoptosis. Electron microscopic fndings revealed platelet aggregation in the space of Disse in the MCT group. Extravasated platelet aggregation in Disse\u27s space may be involved in the development of SOS

ヨウジ ゼンキ ノ コドモ ガ ウケル サイケツ ニ ドウセキ スル ハハオヤ ノ ストレス

背景 近年,小児看護領域において急速にプレパレーションという概念が普及してきた.医療処置を受ける子どもにプレパレーションを提供し,その効果を最大に引き出すためには,子どもが最も信頼している母親の存在が重要である.しかし,我が国では,母親が同席し泣き叫ぶ子どもをみることで不安が増大する,また子どもは母親が助けてくれないことによって不審感をもつなどを理由に,同席を推奨する施設は少ない.目的 幼児前期の子どもの採血に同席した母親27名を対象に,唾液中アミラーゼ(AMY値),STAI(状態不安得点)の測定及び母親へのインタビューを行い,子どもが受ける採血に同席する母親のストレスを明らかにすることを本研究の目的とした.結果及び考察 AMY値と状態不安得点は採血前から10分後に有意に低下したが,採血前の状態不安得点は標準レベルであった.また,母親は採血に同席することについて【一緒が安心】と感じていた.子どもが不安や恐怖で泣くことがあっても,子どもの年齢や過去の経験から予測可能な子どもの反応であり,心の準備ができていたことから【泣くことの受容】に繋がったと考えられる.結論 子どもが受ける採血に同席した母親のAMY値と状態得点からは,これまで医療者の間で信じられてきた同席による母親の不安の増大は否定された.しかしながら,母親は採血時の姿勢について【抱っこの難しさ】も感じているため,単に同席を勧めるだけでなく,安全性の高い固定法や幼児期前期に有効なディストラクションを具体的に示し,母親が自信をもって採血に臨めるよう支援することが重要である.Background Mothers are the persons who are often the most trusted individual by their children and their presence is important when preparing children for medical treatment that can be invasive,painful or generally frightening.This concept is often referred to as "preparation" and is at the heart of caring for the parent and child; as both go through the procedure,one as the patient the other as comforter and safe trusted presence for the child.In Japan,however,few hospitals agree with the concept of preparation that believing mothers may become increasingly anxious as they see their children crying and children may mistrust their mothers for failing to help.This paper seeks to examine stress levels of mothers who are participating in a preparation procedure of drawing blood. Method 27 mothers of children aged 1-3 years who were present when blood samples were taken from their children,agreed to participate in the research project.Informed consent was given for this research by the participants A sample of saliva was taken pre and post procedure and examined for salivary amylase(AMY) levels which are stress indicators.An increase would indicate higher stress and a decrease would indicate lower stress.A State-Trait Anxiety Interview (STAI)was also performed per and post procedure a high score would indicate high anxiety.A low score would indicate low score. Findings Salivary AMY levels and STAI scores decreased significantly 10 min after the blood sampling compared with before,STAI scores before blood sampling were normal,and mothers also felt reassured if they were present while the blood was being drawn. Discussion Mothers felt reassured when they were present while the blood was being drawn.Even if children cried due to anxiety or fear,mothers considered this reaction predictable because of the child\u27s age and their own experience; because the mothers were prepared for it as a result,they were able to tolerate the crying remaining calm and giving reassurance to the child.These findings go against the widespread belief among medical professionals that mothers become more anxious if they are present during treatment.However,mothers also found it difficult to hold their children during the blood drawing,so in addition to recommending that they be present,physicians must assist mothers in facing blood sampling with confidence,by teaching them how to hold the child still in a safe manner and showing them effective ways of distracting infants