Issues in the vaccination recommendation for nursing students : consideration from an image research by the Semantic Differential Method

背景：看護学生に対して小児感染症とB型肝炎の免疫抗体価を検査し，免疫を持たない感染症について予防接種の指導を行った．しかし，予防接種が必要であると認識しながらも，実際に予防接種を受けるという行動に結びついた学生は少なかった．そこで，予防接種に対する態度を規定する要因を明らかにするためにイメージ調査を行い，予防接種を推奨する上での課題を明らかにした． 方法：看護学生１０４名を対象とした．集合質問紙調査法により予防接種の指導前後と長期休暇をはさんだ２ヵ月後に予防接種などに関するイメージ調査を行った．イメージ調査にはSD法（Semantic Differential Method）を用い，コンセプトは「予防注射」，「看護師」，「私」，「風疹」，「B型肝炎」の６つとした． 結果：予防注射に対するイメージについて指導前と指導後で比較すると「安い－高い」，「簡便な－面倒な」はマイナスの方向に有意に変化した（p＜０．０１）．「看護師」と「私」のイメージを比較すると，「健康な－病弱な」（p＜０．０１），「抵抗力がある－無防備な」（p＜０．０１）は「看護師」の方が有意にプラスイメージで，逆に「病気にならない－病気になる」（p＜０．０１），「安全な－危険な」は「私」の方が有意にプラスイメージであった．学生は看護師よりも病気にならず安全と感じ，同時に，看護師は学生よりも健康で抵抗力があるが病気になりやすいと矛盾した論理をもっていた．「私」についてのイメージは指導の前後で変化しなかった． 結論：接種率を向上させるためには，受診方法の改善や費用の助成等を行って，予防接種についてのハードルを低くし，環境面からアプローチする必要がある．また，学生は自分が免疫を持たないことを認知しながらも，自己の健康を過信し，自己矛盾を抱えていた．学生が自分自身の健康に対する意識を変え，自己矛盾に気づくよう教育することが今後の課題である．Background : An investigation of immune antibody titer against pediatric infectious diseases and hepatitis B was conducted to nursing students. They were then instructed to vaccinate against communicable diseases they were not yet immunized against. Although they recognized the importance of vaccination, only few actually vaccinated themselves. Consequently, an image research was conducted to find factors determining the attitude toward vaccination. This has clarified issues in vaccination recommendation. Methods : Group questionnaire surveys were conducted to the subjects of 104 nursing students before and after an instruction on vaccination and after 2 months sandwiching vacation. For an image research, the Semantic Differential Method was employed, setting five concepts of : Vaccination, Nurse, Self, Rubella, and Hepatitis B. Results : In the comparison of images to vaccination before and after the instruction, the responses to the questions, “Cheap-Expensive” and “Simple-Complicating,” changed significantly in a negative direction, （p＜ 0.01）after the instruction. Between the concepts of “Nurse” and “Self,” the responses to “Healthy-Sickly” （p ＜0.01）and “Resistant-Vulnerable”,（p＜0.01）were positive in “Nurse”, whereas the responses to “Uneasily sickened-Easily sickened” （p＜0.01） and “Safe-Risky” were positive in “Self.” This represented a contradiction in the subjects’ logic : while the students thought they were uneasily sickened and felt safer than nurses, nurses were seen as healthier and more resistant then the students but easily sickened. Their images toward “Self” did not change from before to after the instruction. Conclusion : The enhancement of vaccination rate requires an environmental approach to the barrier to vaccination, for example, by improving consultation methods and by financial support. Furthermore, the nursing students represented self- contradiction ; although they realized they lacked certain immunity, they were overconfident about their health. What remains to be seen is the education to enable them to change their attitude toward their own health and realize their self- contradiction

Cryptosporidiosis in a transplant recipient with severe intractable diarrhea : Detection of Cryptosporidium oocysts by intestinal biopsies

Disseminated Cryptosporidium infection results in manifestations similar to those of graft‐versus‐host disease (GVHD), which hampers the detection of Cryptosporidium infection after allogeneic hematopoietic stem cell transplantation. Surveillance of oocysts on the surface of intestinal epithelial cells is needed for early and appropriate detection of Cryptosporidium infection in transplant recipients on immunosuppressants with severe intractable diarrhea. We present the first case of Cryptosporidium meleagridis infection in Japan after allogeneic cord blood transplantation

Busulfan for lymphoma with CNS involvement

The prognosis of relapsed or refractory lymphoma with central nervous system (CNS) involvement remains poor because of the lack of anticancer drugs with sufficient CNS penetration. [Case 1] A 65-year-old man was diagnosed with Stage IV mantle cell lymphoma. After two courses of chemotherapy and autologous hematopoietic stem cell (HSC) collection, urinary retention with fever developed. Cerebrospinal fluid analysis revealed leptomeningeal involvement, which was refractory to high-dose methotrexate therapy. Autologous peripheral blood stem cell transplantation (ASCT) was performed, followed by intravenous busulfan (ivBU), cyclophosphamide, and etoposide ; thereafter, no relapse has been detected for over six years. [Case 2] A 40-year-old woman with right lower hemiplegia was diagnosed with primary CNS lymphoma. Although four courses of high-dose methotrexate therapy were administered, the cerebral tumor increased in size. HSCs were collected after methotrexate therapy, and ASCT was performed in addition to conditioning using ivBU, cyclophosphamide, and etoposide, followed by whole-brain and local boost irradiation. She achieved complete remission, but relapsed two years after ASCT. High-dose ivBU-containing conditioning regimens with ASCT may be useful for refractory B-cell lymphoma with CNS involvement

高齢者アセスメント表の看護基礎教育への適用 : 演習後のアンケート結果{1996～1997}(その1)

4年制の看護大学生を村象に、高齢者アセスメント表を適用し演習終了後に調査を実施した。1996年（調査I）と1997年（調査II）の2年間の調査を検討した結果、次のことが明らかになった。1）高齢者アセスメント表の難易度は、調査Iの結果が有意に「容易」と回答した者が多かった。（p<0.01） 2）高齢者アセスメント表の記入による効果は、いずれも共通して順位1位として、（2）潜在的な問題の把撞ができるをあげていた。2位以下は異なっていた。調査IIの（1）ニーズが把握しやすいが、調査1の同じ項目に比べて有意に高かった。（p<0.05） 3）問題領域選定表の難易度は、調査IIの結果が有意に「容易」と回答した者が多かった。（p<0.05） 4）問題領域別検討指針の有効性は、調査IIが有意に理解できたと回答した者が多かった。（p<0.05） 5）詳細検討用紙の難易度・問題領域別検討指針の理解度・ケアプランの難易度は、調査Iと調査IIの結果には有意な差はみられなかった

ドウケイ コツズイ イショク ガ チョコウ シタ サイジュウショウ サイセイ フリョウセイ ヒンケツ ノ 1レイ

Aplastic anemia is a bone marrow failure caused by severely curtailed hematopoietic stem cells （HSCs） and dysregulation of ambient immune cells. Immumo-suppressive conditioning followed by allogeneic HSC transplantation is currently a mainstay in treatment for patients at a younger age or those refractory to conventional immunosuppressive remedies. Syngeneic HSC transplantation appears to be promising, but has been very rarely performed ; therefore, its impact on a long-term outcome as well as the best preparative measures for HSC engraftment and immune amelioration are still largely unknown. Here, we reported a successful and beneficial syngeneic HSC transplantation for a refractory case with very severe aplastic anemia. A 30-year-old female presented high fever after tooth extraction, and was diagnosed with very severe aplastic anemia. Cyclosporine and anti-thymocyte globulin were initiated, but showed no hematological effects. After obtaining an informed consent, she underwent bone marrow transplantation from a genetically identical twin following an non-myeloablative conditioning regimen consisted of cyclophosphamide （750mg/m２, 4 days）, fludarabine phosphate （25mg/m２, 4 days）. Cyclosporine was given for acute GvHD prophylaxis. Her neutrophils recovered over 500/μl on 12 days after the transplantation, and her blood counts have been maintained in a normal range over 7 years thereafter. Although a fate of HSCs from a genetically identical twin and an immune response of ambient cells in the bone marrow in recipients remains largely unknown, from the present case and previously reported cases, we dare to recommend immunoablative conditioning and acute GvHD prophylaxis in syngeneic HSC transplantation for a refractory case with aplastic anemia for better engraftment and sustained onward recovery of hematopoiesis

The impact of human leukocyte antigen mismatch on recipient outcomes in living‐donor liver transplantation

Donor–recipient human leukocyte antigen (HLA) compatibility has not been considered to significantly affect liver transplantation (LT) outcomes; however, its significance in living-donor LT (LDLT), which is mostly performed between blood relatives, remains unclear. This retrospective cohort study included 1954 LDLTs at our institution (1990–2020). The primary and secondary endpoints were recipient survival and the incidence of T cell–mediated rejection (TCMR) after LDLT, respectively, according to the number of HLA mismatches at all five loci: HLA-A, HLA-B, HLA-C, HLA-DR, and HLA-DQ. Subgroup analyses were also performed in between-siblings that characteristically have widely distributed 0–10 HLA mismatches. A total of 1304 cases of primary LDLTs were finally enrolled, including 631 adults (recipient age at LT ≥18 years) and 673 children (<18 years). In adult-to-adult LDLT, the more HLA mismatches at each locus, the significantly worse the recipient survival was (p = 0.03, 0.01, 0.03, 0.001, and <0.001 for HLA-A, HLA-B, HLA-C, HLA-DR, and HLA-DQ, respectively). This trend was more pronounced when multiple loci were combined (all p < 0.001 for A + B + DR, A + B + C, DR + DQ, and A + B + C + DR + DQ). Notably, a total of three or more HLA-B + DR mismatches was an independent risk factor for both TCMR (hazard ratio [HR] 2.66, 95% confidence interval [CI] 1.21–5.87; p = 0.02) and recipient survival (HR 2.44, 95% CI 1.11–5.35; p = 0.03) in between-siblings. By contrast, HLA mismatch did not affect pediatric LDLT outcomes at any locus or in any combinations; however, it should be noted that all donor–recipient relationships are parent-to-child that characteristically possesses one or less HLA mismatch at each locus and maximally five or less mismatches in total. In conclusion, HLA mismatch significantly affects not only TCMR development but also recipient survival in adult LDLT, but not in children

臍帯血移植が奏効した肝脾型T細胞リンパ腫

Cord blood for transplant is collected from the umbilical cord and donated cord blood is tested, frozen and stored for future use. Cord blood stem cell transplantation（CBT）do not have to be as closely matched as bone marrow or peripheral blood stem cell transplantations, therefore we are able to perform CBT for refractory patients at optimal timing. Here, we report a ３３ years old woman with refractory hepatosplenic T-cell lymphoma（HSTL）who achieved complete response ; CR after unrelated CBT. She complained of fever and abdominal pain, she was diagnosed with HSTL. She was refractory to several chemotherapy regimens, we planned to allogenic transplantation for her. However, she had no HLA-matched sibling donors and we were not able to find favorable unrelated donors from Japan Marrow Donor Program. Therefore, we decided to perform CBT for her. We used fludarabine（１８０mg/m2）, busulfan（１２．８mg/kg）and melphalan（８０mg/m2） as conditioning regimens and we chose tacrolimus and MMF for graft versus host disease（GVHD） prophylaxis. On day ２２ after transplantation, her neutrophil count engrafted, she suffered from acute GVHD（skin, gastrointestinal tract, grade２）, she was improved by medical treatment. She achieved CR her disease status maintained over two years after CBT. HSTL is often refractory to chemotherapy, the clinical efficacy of hematopoietic stem cell transplantation may be expected. Our case suggests that CBT may be effective and feasible option for refractory HSTL who has no favorable HLA-matched donors

Novel antimyeloma therapeutic option with inhibition of the HDAC1-IRF4 axis and PIM kinase

Multiple myeloma (MM) preferentially expands and acquires drug resistance in the bone marrow (BM). We herein examined the role of histone deacetylase 1 (HDAC1) in the constitutive activation of the master transcription factor IRF4 and the prosurvival mediator PIM2 kinase in MM cells. The knockdown or inhibition of HDAC1 by the class I HDAC inhibitor MS-275 reduced the basal expression of IRF4 and PIM2 in MM cells. Mechanistically, the inhibition of HDAC1 decreased IRF4 transcription through histone hyperacetylation and inhibiting the recruitment of RNA polymerase II at the IRF4 locus, thereby reducing IRF4-targeting genes, including PIM2. In addition to the transcriptional regulation of PIM2 by the HDAC1-IRF4 axis, PIM2 was markedly upregulated by external stimuli from BM stromal cells and interleukin-6 (IL-6). Upregulated PIM2 contributed to the attenuation of the cytotoxic effects of MS-275. Class I HDAC and PIM kinase inhibitors cooperatively suppressed MM cell growth in the presence of IL-6 and in vivo. Therefore, the present results demonstrate the potential of the simultaneous targeting of the intrinsic HDAC1-IRF4 axis plus externally activated PIM2 as an efficient therapeutic option for MM fostered in the BM