A case of non-invasive serous adenocarcinoma at unilateral fimbria with spread to the peritoneal/uterine cavity: case report

Recently, fimbriae have been identified as a possible arising site for the pelvic serous carcinoma (PSC) both in BRCA-positive and BRCA-negative women. Although non-invasive (intraepithelial) serous adenocarcinoma of the fimbria has been found in specimens obtained from prophylactic salphingo-oophorectomies in BRCA-positive women, there has not been any case report in clinical situation, since this type of tumor is usually detected after stromal invasion/widespread dissemination. We describe a 67-year-old woman with non-invasive serous adenocarcinoma located solely in the left fimbria. This case may suggest the benefit of endometrial cytology and detailed gross examination of fimbria for the early detection of fimbrial carcinoma. This case may provide evidence suggesting fimbrial intraepithelial adenocarcinoma is one cause of PSC

Orbital Emphysema Causing Syncope

Orbital emphysema is an abnormal condition in which air is present within the orbit. We report a rare case of a 19-year-old man who suffered syncopic attacks caused by sniffles following orbital emphysema as a result of trauma. Treating rhinitis is important in patients with orbital emphysema, and patients with cardiac disorders in addition to those with this condition must be warned about the risks of sniffles, sneezing, or nose blowing

Professional identity components of novice public health nurses working for local government agencies

本研究は，新任保健師の保健活動の体験に基づく内容から職業的アイデンティティの構成要素を明らかにすることを目的とした．保健師経験2年目の新任保健師7名を対象に，職業的アイデンティティの意識を尋ねるための個別面接調査及び集団面接調査を実施し，帰納的アプローチによる質的記述的分析を行った． 分析の結果，新任保健師の職業的アイデンティティの構成要素として【力量不足の自覚】，【役割遂行への責任感】，【他者からの評価による存在価値の確認】，【活動の振り返りから得た自信】，【職業への誇り】，【目標のある自己研鍾】の6つのカテゴリーを得た．新任保健師の職業的アイデンティティを形成するためには，自身の保健活動を上司や先輩保健師と共に省察し，先輩保健師や住民等支援対象者，関係機関に支えられることにより，保健師として成長するための明確な目標をもって積極的に自己研績を行う事が重要である事が推察された．The purpose of this study was to clarify components that constitute novice public health nurses' professional identity acquired through their work experiences. Semi-structured 60-minute interviews were conducted on 7 novice public health nurses with work experience of 2 years for administrative agencies. Qualitative descriptive analysis by an inductive approach identified 6 categories pertaining to their professional identities: [1] awareness of a lack of professional competence, [2] sense of responsibility in pursuing their occupational role, [3] awareness of their worth based on evaluation by others, [4] professional confidence obtained through review of their actions, [5] sense of pride in their profession and their adaptability to the environment, and [6] clear goals for self-improvement based on their experiences. It is important for novice public health nurses to devote themselves positively to the profession with clear aims to improve their skills and attitude for development of professional identity. This can be achieved through reflection on their healthcare activities together with the advice and support from supervisors and/ or senior colleagues, and through their work experiences with local citizens.本研究は平成24-27年度厚生労働科学研究費補助金若手研究（B)（課題番号：24792556)助成の一部として実施しました

Elastin Variants in Two Angiographic PCV Subtypes

Objective To compare the association of elastin (ELN) gene variants between two different angiographic phenotypes of polypoidal choroidal vasculopathy (PCV). Methods We included 411 treatment-naïve PCV patients and 350 controls in the present study. PCV was classified into two phenotypes (152 Type 1 and 259 Type 2) according to the presence or absence of feeding vessels found in indocyanine-green angiography. Single nucleotide polymorphisms (SNPs) in the ELN region including rs868005, rs884843, rs2301995, rs13239907 and rs2856728 were genotyped using TaqMan Genotyping Assays. Results In the allelic association analyses, rs868005 showed the strongest association with Type 2 PCV (allelic odds ratio 1.56; p = 7.4x10-6), while no SNP was significantly associated with Type 1 PCV. Genotype association analyses revealed the significant association of rs868005 with Type 2 PCV in log additive model and predominant model (odds ratio 1.75; p = 1.5x10-6 and odds ratio 1.60; p = 0.0044, respectively), but not with Type 1 PCV. These findings were further corroborated by another control group in the literature. Conclusions There may be significantly different associations in genetic variants of elastin between two angiographic phenotypes of PCV

The role of forensic psychiatric nursing in foreign nations

本論文は,諸外国における司法精神看護(forensic psychiatric nursing)について文献学的に概観し,司法精神看護の役割について明らかにすることを目的とした｡司法精神看護師の役割としては,法的知識と看護の知識を持った上で,犯罪者が法廷に出る前の精神症状のアセスメントをし,適切な治療やケアを受けることができるように調整していくこと､また性的暴力を受けた被害者を検査し､フォローアップケアを行うこと等があった｡司法精神看護の対象は,重大な罪を犯した精神障害者(触法精神障害者)だけでなく,触法精神障害者の家族,被害者が含まれていた｡触法精神障害者に対しては,投薬,薬の効果･副作用の教育,社会的能力のトレーニングを行い,触法精神障害者の家族や犯罪被害者に対しては,感情のアセスメント,心理的危機介入,行動面等の評価を行う役割を担っていた｡This paper overviews the role of forensic psychiatric nursing, focusing on the situation overseas. Forensic nursing is primarily involved with the investigation and evaluation of an individual's mental state to determine whether the criminal justice system or the health care system most equitably meets their needs. From an American perspective, Lynch describes different areas of forensic nursing. 'Clinical forensic nursing' involves the application of clinical and scientific knowledge to questions of law and the criminal and civil investigation of survivors of traumatic injury and also includes court-related issues associated with patient treatment. The American system also utilizes a 'sexual assault nurse examiner,' this role is concerned with the clinical examination of sexually assaulted victims and the employment of therapeutic interventions to enable the process of healing. In the UK, this area of work has primarily emerged within the criminal justice system with specially trained police officers engaging with adult individuals who have been the victims of sexual assault, and working in partnership with medical interventions and investigation. Another specialty in the UK is 'forensic psychiatric nursing', concerning the assessment of criminal defendants before their court hearing. In the area of forensic nursing, the subjects are offenders with mental disorders, their families, and victims. The important roles in forensic psychiatric nursing are summarized as follows: assessment of mood and psychiatric symptoms, medication management, risk management, training in social skills, crisis intervention, and evaluation of behavioral or mental disorder

The significance of therapy in a private room to patientsin acute psychiatric wards

本研究は,全個室病棟で療養する精神疾患患者を対象に,患者自身が考える個室環境の意味を明らかにすることを目的とした｡個室に2週間以上療養し,インタビューの協力が得られた患者は7名であった｡患者にとっての個室環境の肯定的意味は,自分だけの空間を確保できることから,他者との距離の調節の場,プライバシーが保護される場,自由裁量が拡大される場であると捉えていた｡また,休養や睡眠が確保できる場,症状をコントロールできる場であるという治療的意味や,個室を自己洞察の場ととらえ,他者の影響を受けずに自分らしさを再獲得するためという意味が示された｡一方,個室環境の否定的意 味として,寂しさや不安が挙げられ,話しかけられる存在を身近に見出しにくい個室においては,わからないことや不安なことを尋ねにくく,人間関係を築くきっかけがつかみにくいことが示された｡This study sought to clarify the significance of therapy provided in a private room to hospitalized mentally ill patients, by determining through interview and observation their thoughts and feelings about such an experience. Subjects were 7 mentally ill patients resident in a ward of private rooms. Few patients requested a private room on admission and their reasons for this were considered to include admissions on an involuntary basis, for medical treatment or for custodial care, or because psychiatric status did not enable them to state an intention to have a private room. The results showed that most patients hoped for treatment in a private room regardless of whether or not they had requested it, and that the offer of using such a facility was important to them because most patients who experienced such a therapeutic environment requested it thereafter. Thus, once a patient recognized the availability of therapy in a private room and its benefits, they wanted to use it or to use it more. Patients were found to request use of a private room to preserve privacy, rest in a therapeutic environment promote circumspection, and see themselves as independent of others around, with the affirmative meaning of using a private room as "a place to preserve my privacy ", "a place to take a rest", "a place to gain insight into myself", and "a place to control my condition". Patients reported a negative meaning of "a place to feel loneliness and anxiety"

Simulation-based medical education in clinical skills laboratory

Clinical skills laboratories have been established in medical institutions as facilities for simulation-based medical education (SBME). SBME is believed to be superior to the traditional style of medical education from the viewpoint of the active and adult learning theories. SBME can provide a learning cycle of debriefing and feedback for learners as well as evaluation of procedures and competency. SBME offers both learners and patients a safe environment for practice and error. In a full-environment simulation, learners can obtain not only technical skills but also non-technical skills, such as leadership, team work, communication, situation awareness, decision-making, and awareness of personal limitations. SBME is also effective for integration of clinical medicine and basic medicine. In addition, technology-enhanced simulation training is associated with beneficial effects for outcomes of knowledge, skills, behaviors, and patient-related outcomes. To perform SBME, effectively, not only simulators including high-fidelity mannequin-type simulators or virtual-reality simulators but also full-time faculties and instructors as professionals of SBME are essential in a clinical skills laboratory for SBME. Clinical skills laboratory is expected to become an integrated medical education center to achieve continuing professional development, integrated learning of basic and clinical medicine, and citizens’ participation and cooperation in medical education

Autonomic Nervous System Changes in Term Infants during Early Skin-to-skin Contact (SSC) : Examination of SSC Effectiveness and the Influence of Meconium-stained Amniotic Fluid

Article信州医学雑誌 67(2): 91-103(2019)journal articl

Crystal Structure of the Complex between Calyculin A and the Catalytic Subunit of Protein Phosphatase 1

AbstractThe crystal structure of the catalytic subunit of the protein phosphatase 1 (PP1), PP1γ, in complex with a marine toxin, calyculin A, was determined at 2.0 Å resolution. The metal binding site contains the phosphate group of calyculin A and forms a tight network via the hydrophilic interactions between PP1 and calyculin A. Calyculin A is located in two of the three grooves, namely, in the hydrophobic groove and the acidic groove on the molecular surface. This is the first observation to note that the inhibitor adopts not a pseudocyclic conformation but an extended conformation in order to form a complex with the protein. The amino acid terminus of calyculin A contributes, in a limited manner, to the binding to PP1γ, which is consistent with findings from the studies of dose-inhibition analysis