Nivolumab Versus Gemcitabine or Pegylated Liposomal Doxorubicin for Patients With Platinum-Resistant Ovarian Cancer: Open-Label, Randomized Trial in Japan (NINJA)

PURPOSE: This phase III, multicenter, randomized, open-label study investigated the efficacy and safety of nivolumab versus chemotherapy (gemcitabine [GEM] or pegylated liposomal doxorubicin [PLD]) in patients with platinum-resistant ovarian cancer. MATERIALS AND METHODS: Eligible patients had platinum-resistant epithelial ovarian cancer, received ≤ 1 regimen after diagnosis of resistance, and had an Eastern Cooperative Oncology Group performance score of ≤ 1. Patients were randomly assigned 1:1 to nivolumab (240 mg once every 2 weeks [as one cycle]) or chemotherapy (GEM 1000 mg/m2 for 30 minutes [once on days 1, 8, and 15] followed by a week's rest [as one cycle], or PLD 50 mg/m2 once every 4 weeks [as one cycle]). The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), overall response rate, duration of response, and safety. RESULTS: Patients (n = 316) were randomly assigned to nivolumab (n = 157) or GEM or PLD (n = 159) between October 2015 and December 2017. Median OS was 10.1 (95% CI, 8.3 to 14.1) and 12.1 (95% CI, 9.3 to 15.3) months with nivolumab and GEM or PLD, respectively (hazard ratio, 1.0; 95% CI, 0.8 to 1.3; P = .808). Median PFS was 2.0 (95% CI, 1.9 to 2.2) and 3.8 (95% CI, 3.6 to 4.2) months with nivolumab and GEM or PLD, respectively (hazard ratio, 1.5; 95% CI, 1.2 to 1.9; P = .002). There was no statistical difference in overall response rate between groups (7.6% v 13.2%; odds ratio, 0.6; 95% CI, 0.2 to 1.3; P = .191). Median duration of response was numerically longer with nivolumab than GEM or PLD (18.7 v 7.4 months). Fewer treatment-related adverse events were observed with nivolumab versus GEM or PLD (61.5% v 98.1%), with no additional or new safety risks. CONCLUSION: Although well-tolerated, nivolumab did not improve OS and showed worse PFS compared with GEM or PLD in patients with platinum-resistant ovarian cancer

看護師の筋・骨格系のフィジカルアセスメントに関する実態調査

報告Reports　本研究は、看護師の筋・骨格系のフィジカルアセスメントに関する知識と実践について質問紙による実態調査を行った。対象は、総合病院勤務の看護師322 名とし、回収数は120 名（37.3％）であった。その結果、112 名（93.3％）の看護師は、フィジカルアセスメントを学んだ経験があった。必要な形態・機能の知識では、「四肢の動脈」を除くすべての項目で「まったくわからない」または「なんとなくわかる」と回答した者が４割以上を占めていた。フィジカルアセスメントの実践では、「臨床での活用の頻度」と「検査：MMT」などに関連を認めた。フィジカルアセスメントを活用している者の方が知識を持ち、実践できる傾向にあった。「実践できない」が最も多かった項目は、「検査：筋トーヌス」27.5％であった。このことから、フィジカルアセスメントに必要な形態・機能の知識を教授する研修が必要である。「臨床での活用の頻度」と関連を認めた「MMT の実践」などは、臨床場面で正確に修得できる可能性がある

分割型実習で学生が看護過程を展開するための教育方略

その他Miscellaneous　看護学教育の基礎教育課程では、学生が看護を学問として初めて学修し、看護専門職者を目指すものとして知識、態度を育成することが求められる。看護過程を展開する技術は看護実践能力の基盤となる技術として位置づけられ、根拠のある看護実践の基本として修得すべき技術である。2017年度基礎看護学領域において、ディプロマポリシーを踏まえ科目概要を見直すこととなった。そこで、基礎看護学実習Ⅱでは、学生が対象を受け持ち、対象の療養生活を理解し、対象に必要な日常生活援助のための計画を立案することに目標を変更した。学生の学修目標達成のため、教育方略を検討し、実習施設との調整を経て教育方略を変更した経緯を報告する

Genes Involved in Systemic and Arterial Bed Dependent Atherosclerosis - Tampere Vascular Study

BACKGROUND: Atherosclerosis is a complex disease with hundreds of genes influencing its progression. In addition, the phenotype of the disease varies significantly depending on the arterial bed. METHODOLOGY/PRINCIPAL FINDINGS: We characterized the genes generally involved in human advanced atherosclerotic (AHA type V-VI) plaques in carotid and femoral arteries as well as aortas from 24 subjects of Tampere Vascular study and compared the results to non-atherosclerotic internal thoracic arteries (n=6) using genome-wide expression array and QRT-PCR. In addition we determined genes that were typical for each arterial plaque studied. To gain a comprehensive insight into the pathologic processes in the plaques we also analyzed pathways and gene sets dysregulated in this disease using gene set enrichment analysis (GSEA). According to the selection criteria used (>3.0 fold change and p-value <0.05), 235 genes were up-regulated and 68 genes down-regulated in the carotid plaques, 242 genes up-regulated and 116 down-regulated in the femoral plaques and 256 genes up-regulated and 49 genes down-regulated in the aortic plaques. Nine genes were found to be specifically induced predominantly in aortic plaques, e.g., lactoferrin, and three genes in femoral plaques, e.g., chondroadherin, whereas no gene was found to be specific for carotid plaques. In pathway analysis, a total of 28 pathways or gene sets were found to be significantly dysregulated in atherosclerotic plaques (false discovery rate [FDR] <0.25). CONCLUSIONS: This study describes comprehensively the gene expression changes that generally prevail in human atherosclerotic plaques. In addition, site specific genes induced only in femoral or aortic plaques were found, reflecting that atherosclerotic process has unique features in different vascular beds