びまん性肺胞出血症候群における予後因子としてKL-6の有用性についての検討

Background: Diffuse alveolar hemorrhage syndrome is a life threatening condition with diverse etiologies. Sensitive prognostic markers for diffuse alveolar hemorrhage have not been well investigated. Serum KL-6 is a biomarker for various interstitial lung disease associated with disease activity and prognosis. The purpose of the present study was to evaluate the clinical utility of serum KL-6 level as a prognostic marker for diffuse alveolar hemorrhage. Methods: We retrospectively collected 41 consecutive patients clinically diagnosed as having diffuse alveolar hemorrhage who were admitted to the Intensive Care Unit of Hiroshima University Hospital between 2004 and 2011. Correlation between prognosis and age, sex, laboratory findings including serum KL-6, radiological findings, ventilatory modes or therapeutic regimens were evaluated. Results: Baseline and peak serum KL-6 levels were significantly higher in non-survivors compared with survivors. An increase in KL-6 levels during the initial week was associated with a subsequent deterioration of the oxygenation index. Higher baseline KL-6 levels and higher peak KL-6 levels were strongly correlated with death. With a cut-off level of 700 U/mL for peak KL-6, the sensitivity, specificity and accuracy for non-survival were 75%, 85% and 78%, respectively. In the multivariate analysis, only the peak KL-6 level ?700 U/ml was an independent poor prognostic factor for diffuse alveolar hemorrhage. Conclusions: Peak serum KL-6 level ?700 U/ml may become a clinically useful marker of poor prognosis for diffuse alveolar hemorrhage.広島大学(Hiroshima University)博士(医学)Philosophy in Medical Sciencedoctora

Pediatric cardiorespiratory failure successfully managed with venoarterial-venous extracorporeal membrane oxygenation: a case report

Background: Venoarterial-venous extracorporeal membrane oxygenation (VAV ECMO) configuration is a combined procedure of extracorporeal membrane oxygenation (ECMO). The proportion of cardiac and respiratory support can be controlled by adjusting arterial and venous return. Therefore, VAV ECMO can be applicable as a bridging therapy in the transition from venoarterial (VA) to venovenous (VV) ECMO. Case presentation: We present an 11-year-old girl with chemotherapy-induced myocarditis requiring extracorporeal cardiorespiratory support. She showed progressive hypotension, tachycardia, hyperlactemia, and tachypnea under support of catecholamines. Echocardiography showed severe left ventricular hypokinesis with an ejection fraction of 30 %. She was placed on VA ECMO with a drainage catheter from the right femoral vein (19.5 Fr) and a return catheter to the right femoral artery (16.5 Fr). Extracorporeal circulation was initiated at a blood flow of 2.0 L/min (59 mL/kg/min). On day 31, although cardiac function had improved, persistent pulmonary failure made weaning from VA ECMO difficult. We planned transition from VA ECMO to VAV ECMO to ensure gradual tapering of extracorporeal cardiac support while evaluating cardiopulmonary function. An additional return cannula (13.5 Fr) was inserted from the right internal jugular vein, which was connected to the circuit branch from the original returning cannula. We then gradually shifted the blood from the femoral artery to the right internal jugular vein over 24 h. She was successfully switched from VA to VV ECMO via VAV ECMO. Conclusions: VAV ECMO might be an option in ensuring oxygenation to the coronary circulation and allowing time to adequately evaluate cardiac function during transition from VA to VV ECMO. Further investigations using larger cohorts are necessary to validate the efficacy of VAV ECMO as a bridging therapy in the transition from VA to VV ECMO.This work was supported by a JSPS KAKENHI Grant (Number JP 16K09541)

ギノウ ・ テーマベツ コウギ ト モギ ジュギョウ ヲ トリ イレタ キョウジュホウ ジュギョウ -タコクセキ タンキ ケンシュウ 「 モジ ・ ゴイ シドウホウ 」 ヲ レイ ト シテ-

多国籍短期研修では、教授法授業に対する研修参加者のニーズ・レディネスや目標設定の多様性を前提として教授法のカリキュラムデザインをする必要がある。ここでは、2003年度冬短期と2004年度夏短期の比較的日本語運用力が高いBコースの教授法授業における、技能・テーマ別講義と模擬授業を取り入れた授業実践を報告する。前半に行われた技能・テーマ別講義では、教室活動や教材とそれらの背後にある理論のつながりを意識させることを目指した。前半講義の例として、「文字・語彙指導法」の授業の内容・方法と、研修参加者による事前のニーズ調査と事後の授業評価結果を報告する。また、後半の模擬授業の事例や模擬授業後の調査結果を紹介し、模擬授業が研修参加者自身による教授実践の振り返りにどう作用しているか、また前半の講義と後半の模擬授業が一つの流れとして機能しているか否かについて考察する。When designing the curriculum for the teaching methodology class of the Short-Term Courses for multinational Japanese language teachers, we need to give special consideration to the diversity of participantteacher needs, readiness and objectives. This paper reports a practice of teaching methodology class for teachers who are proficient in the Japanese language. This class includes lectures on teaching language skills and other related topics. Lectures in the first half of the class set its goal of raising awareness of association between classroom activities / teaching materials and background theories. We focus on a lecture, ‘Teaching Japanese Script and Vocabulary’, as an example, and report its contents and procedures and evaluation of this lesson from participant-teachers. Moreover, one lesson demonstration and teacher’s reflection notes are examined to see how a teacher intakes new pedagogical knowledge and applies it into their teaching context, and how the class works to promote the teacher’s reflection on their teaching practice