Successful management of tracheo-innominate artery fistula with endovascular stent graft repair

AbstractTracheo-innominate artery fistula is a highly lethal complication after tracheostomy. A 37-year-old man who had undergone a tracheostomy 14 years earlier because of dysphagia after brain surgery had a tracheo-innominate artery fistula with exsanguinating hemorrhage from his tracheostomy site. After temporary control of the bleeding, a stent graft was implanted in the innominate artery through the brachial artery. The patient recovered uneventfully and remained well 14 months after the procedure, with no sign of infection. Endovascular stent grafting may be the treatment of choice for patients with tracheo-innominate artery fistula. (J Vasc Surg 2001;33:1280-2.

ハクサンコザクラの保全生物学: 遺伝的変異と集団の遺伝的分化

[論文] Articl

カンゴ キョウイク ニ オケル フクスウ ノ キョウイク キカン ガ カンヨスル ユニフィケーション ノ トリクミ ト カノウセイ

看護学士課程増加に伴い，教育と看護実践の乖離に対する問題を解決するためにユニフィケーションが授業に取り入れられるようになった．これまで国内で報告されてきたユニフィケーションを取り入れた授業実践からは，学生だけでなく関係者それぞれに看護職の専門職としての自覚と自律性促進，専門的能力の発揮機会の獲得，大学における共同研究の推進，効果的な継続教育といった効果があることが示されている．例えば，先行研究では，大学の看護学部の演習に病院の救命センターの看護師が参加することは，演習に対する学生の満足感が高くなり，救急看護への興味関心も変化することが報告されている．しかしながら，教育機関と医療機関とでの取り組みは報告されているが，複数の教育機関が関与するユニフィケーションについては報告されていない．そこでA大学看護学部2年生の必修科目である「成人看護学Ⅱ」の演習に，ユニフィケーションの取り組みとして，A大学の教員以外に，臨床看護師，他の大学の看護教員，看護系大学院生が教員として参加する授業を設計・実施した．ユニフィケーションを取り入れた演習では，臨床経験や教育経験の豊富な教員の参加は，学生の学習目標を達成する後押しとなったと考えられた．また，臨床看護師が演習に参加することは，新人看護師のレディネスを把握することにつながっていた．他の教育機関の教員が演習に参加することは授業参観の機会となり，自身の授業改善の示唆を得ることにつながっていた．看護系大学院生にとってはプレFD（Faculty Development）としての機能を果たす可能性が示唆された．また，複数の教育機関が関与することで，学生や医療機関，教育機関に様々な可能性をもたらすと考えられた．ユニフィケーションを取り入れた演習は学習目標達成の促進，新人看護師のレディネスの把握，授業参観の機会といった様々な効果が期待できる．しかし，他の授業に取り入れる，あるいは継続していくためには，教育機関と医療機関，教育機関同士の協力が必要である．今後もユニフィケーションを取り入れた授業実践が教育機関を超えて多くの分野で行われることを期待したい．Unification is incorporated into classes to bridge the gap between nursing education and practice as the number of bachelor’s degree programs increases. Such classroom practices have been reported in Japan, and are expected to be effective not only for the students but also for the people concerned in promoting awareness and autonomy as nurses, gaining opportunities to demonstrate professional skills, promoting joint research at universities, and effective continuing education. For example, previous studies have reported that the participation of hospital emergency center nurses in university nursing department exercises increases students’ satisfaction with the exercises and changes their interest in emergency nursing. Although previous studies have reported initiatives between educational and medical institutions, there are no reports on unification involving multiple educational institutions. Therefore, we designed and implemented a class in which clinical nurses,teachers from other facilities, and graduate students in nursing participated in this activity as part of “Adult Nursing II,” a compulsory subject at the Faculty of Nursing of A University, as instructors. In the unification exercise, the participation of instructors with extensive clinical and educational experience encouraged students to achieve their learning goals. Moreover, the participation of clinical nurses helped understand the readiness of the freshers, and that of faculty members from other educational institutions provided an opportunity to observe the class, leading to suggestions for improving them. The exercise could function as a pre-FD (Faculty Development) for nursing graduate students. Moreover, the involvement of multiple educational institutions is expected to bring various possibilities to students and medical and educational institutions. Exercises that incorporate unification can have various effects, such as promotion of achievement of learning goals, understanding of readiness of the freshers, and opportunities to observe classes. However, cooperation between institutions and medical and/or educational institutions is necessary to incorporate unification into other classes or to continue it. We hope that unification will be practiced in many fields beyond educational institutions.教育実践レポー

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362