Relationship between lymphangiogenesis and exudates during the wound-healing process of mouse skin full-thickness wound

金沢大学医薬保健研究域保健学系We considered the relationship among exudate, wound area, angiogenesis, lymphangiogenesis, and reepithelialization during wound healing. Full-thickness wounds were made on the dorsum of mice. The weight of exudate absorbed into the dressing as well as the wound area was determined daily. Sections of the wounds were stained with anti-LYVE-1 and CD31 antibodies. Indian ink was injected into the wound for observing the movement of the exudate on days 3, 5, and 7 after wounding. New epithelium completely covered the wound on day 11. The quantity of exudate peaked on day 1, and then rapidly decreased until it was undetectable on day 11. Most of the Indian ink injected into the wound was retained within the wound and did not flow into the surrounding tissue. New blood vessels showed a uniform distribution in the granulation tissue on day 5. New lymphatics appeared in the granulation tissue approximately 2 days later than the blood vessels and they were distributed toward the center of the granulation tissue on day 11. Thus, reduction of exudate from the wound appears to be related to blood vessels, not lymphatics. However, increasing lymphatics may play a role in the late phase of the wound-healing process. © 2009 by the Wound Healing Society

看護学生が感じている在宅看護論臨地実習における困りごと

本研究は，在宅看護論臨地実習において学生が感じている困りごとを明らかにすることを目的とした．調査対象は，Ｋ短期大学で在宅看護論臨地実習を終了した3年次生10人であった．調査内容は基本属性と①実習環境，②訪問，③療養者理解，④人間関係，においての困りごととし，半構造化面接を実施した．その結果，①実習環境においては【実習施設が遠いことによる弊害】の他4カテゴリー，②訪問においては【病院とは異なる看護介入】の他2カテゴリー，③療養者理解においては【指導者の指導に混乱】の他5カテゴリー，④人間関係においては【指導者への声のかけにくさ】の他4カテゴリーが抽出された．今回，在宅看護論臨地実習における困りごとが明らかになったが，他領域と共通する困りごとも混在していた．今後は在宅看護論特有の困りごとを整理し明らかにすることで，在宅看護論臨地実習の充実が図れるものと考える

The clinical impact of macrophage polarity after Kasai portoenterostomy in biliary atresia

IntroductionBiliary atresia (BA) is a cholestatic hepatopathy caused by fibrosing destruction of intrahepatic and extrahepatic bile ducts, and its etiology has not been clearly revealed. In BA, liver fibrosis progression is often observed even after Kasai portoenterostomy (KPE), and more than half of cases require liver transplantation in their lifetime in Japan. Macrophages play an important role in liver fibrosis progression and are classically divided into proinflammatory (M1) and fibrotic macrophages (M2), whose phenotypic transformation is called “macrophage polarity.” The polarity has been reported to reflect the tissue microenvironment. In this study, we examined the relationship between macrophage polarity and the post-KPE clinical course.Materials and methodsThirty BA patients who underwent KPE in our institution from 2000 to 2020 were recruited. Multiple immunostainings for CD68, CD163, CK19, and α-SMA were carried out on liver biopsy specimens obtained at KPE. ROC curves were calculated based on each clinical event, and the correlation with the clinical data was analyzed.Results and discussionThe M2 ratio, defined as the proportion of M2 macrophages (CD163-positive cells), was correlated inversely with the occurrence of postoperative cholangitis (AUC: 0.7602). The patients were classified into M2 high (n = 19) and non-high (n = 11) groups based on an M2 ratio value obtained from the Youden index ( = 0.918). As a result, pathological evaluations (Metavir score, αSMA area fraction, and CK19 area fraction) were not significantly different between these groups. In mild liver fibrosis cases (Metavir score = 0–2), the M2 non-high group had a significantly lower native liver survival rate than the high group (p = 0.02). Moreover, 4 out of 8 cases in the M2 non-high group underwent early liver transplantation within 2 years after KPE.ConclusionsNon-M2 macrophages, including M1 macrophages, may be correlated with postoperative cholangitis, and the M2 non-high group in mild liver fibrosis cases had a significantly lower native liver survival rate than the high group, requiring early liver transplantation in this study. Preventing advanced liver fibrosis is a key factor in improving native liver survival for BA patients, and liver macrophages may play important roles in liver homeostasis and the promotion of inflammation and fibrosis

老年看護学実習の目標達成度に及ぼす学生の意識と病棟間での学習経験の差

本研究の目的は，老年看護学実習における学生の意識と目標達成との関連を明らかにすることと，病棟間での学習経験の差の有無を確認することとした．Ａ短期大学看護科3年次生114人を対象とし，病棟実習終了後自記式質問紙調査を実施した．調査内容は，実習中の思い，実習目標達成状況，学習経験自己評価尺度で構成した．分析方法として，実習中の思いと目標達成状況との有意差検定にはｔ検定，実習病棟と学習経験評価との関連には，一元配置分散分析を実施した．質問紙の回答は86人から得られ，一部記述欠損を除く80人を分析対象とした．結果として，実習中の思いと目標達成状況では，ポジティブ感情が2個以上ある人はそれ未満の人と比べて目標達成できたと評価している得点が有意に高かった（t（78）＝3.73，p＜.05）．また，ネガティブ感情が全くなかった人は，ネガティブ感情がある人に比べて目標達成できたと評価している得点が有意に高かった（t（78）＝3.81，p＜.05）．病棟間での学習経験評価の差には，有意差はみられなかった．以上より，ストレスフルな臨地実習では，ポジティブ感情が持てるような働きかけが重要であることが示唆された