フランスの在宅入院制度(HAD)からみたわが国の地域包括ケアシステムにおける訪問看護師の役割と課題

　地域包括ケアシステムの構築には, 地域で生活を営むための生活視点を踏まえた医療への転換や医療・看護・介護・福祉の連携を含めた地域づくりが重要であると考える．フランスの在宅入院制度（HAD）では，多職種がチームとして連携し在宅医療（ケア）の推進に取り組み，地域で生活する療養者の生活を支え，適切な在宅医療（ケア）を提供している．フランスの医療制度は，日本の医療制度と類似する面が多い．2025 年に地域包括ケアシステムの実働を目指し，都道府県単位によるシステム構築が急速に進められている．厚生労働省内閣官房：地域医療構想の策定（2015）によると, およそ26 万床の療養病床を在宅医療へ移行することが挙げられている．また，日本看護協会の平成28 年度重点政策・重点事業（和田, 2016）の4 つの主軸において，先ず「地域包括ケアシステムの構築と推進」を挙げ，その内容として①看護がつなぐ地域包括ケアの推進，②在宅・施設等の長期療養者を支える看護の機能強化を明確にしている．フランスの医療制度，文化，国民性等が違うためフランスの在宅入院制度（HAD）における訪問看護師の役割と業務をそのまま，わが国の在宅看護における訪問看護師の役割として適用することは不可能であるが，訪問看護師の重層的な構造化が必要であり，それぞれの階層ごとに訪問看護師の役割と業務を明確にする必要がある．また，それぞれの階層に応じた訪問看護師に求められる能力を明確にする必要があると考える．　地域で生活する療養者の生活の質を維持し向上するためには, 看護職間で情報共有や看護ケアに関しシームレスに看護が提供できる仕組み作りが必要であり，看看連携システムの構築が重要であると考える．また，地域包括ケアシステムにおいて仕組みづくりと医療・看護・介護・福祉に携わる多職種との人づくりを含めた地域づくりを担う役割が訪問看護師に求められていると考える

Xanthogranuloma of the intrasellar region presenting in pituitary dysfunction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Differentiation of cystic mass lesions of the sellar and parasellar regions may pose a diagnostic dilemma for physicians, neurosurgeons, radiologists and pathologists involved in treating patients with these entities. A considerable number of tumors previously identified as craniopharyngiomas may, in fact, have been xanthogranulomas. We report a case of pituitary dysfunction caused by xanthogranuloma of the intrasellar region.</p> <p>Case presentation</p> <p>A 47-year-old man of Japanese descent presented to our institution with a tumor located exclusively in the intrasellar region which manifested as severe hypopituitarism. MRI revealed a clearly defined intrasellar mass that was heterogeneously hyperintense on T1-weighted images and markedly hypointense on T2-weighted images. We preoperatively diagnosed the patient with Rathke's cleft cyst or non-functioning pituitary adenoma. Although the tumor was completely removed using a transsphenoidal approach, the improvement of the patient's endocrine function was marginal, and continued endocrine replacement therapy was needed. Postoperatively, a histological examination revealed the tumor to be a xanthogranuloma of the intrasellar region. His visual field defects and headache improved.</p> <p>Conclusion</p> <p>Because diagnosis depends on surgical intervention and xanthogranulomas of the intrasellar region are very rare, the natural history of xanthogranuloma is still unknown. Therefore, this entity is difficult to diagnose preoperatively. We suggest that xanthogranuloma should be included in the differential diagnosis, even in the case of sellar lesions, to formulate appropriate postoperative management and improve endocrine outcomes.</p

Met Kinase Inhibitor E7050 Reverses Three Different Mechanisms of Hepatocyte Growth Factor-induced Tyrosine Kinase Inhibitor Resistance in EGFR Mutant Lung Cancer

PURPOSE: Hepatocyte growth factor (HGF) induces resistance to reversible and irreversible epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in EGFR mutant lung cancer cells by activating Met and the downstream PI3K/Akt pathway. Moreover, continuous exposure to HGF accelerates the emergence of EGFR-TKI-resistant clones. We assayed whether a new Met kinase inhibitor, E7050, which is currently being evaluated in clinical trials, could overcome these three mechanisms of resistance to EGFR-TKIs. EXPERIMENTAL DESIGN: The effects of E7050 on HGF-induced resistance to reversible (gefitinib), irreversible (BIBW2992), and mutant-selective (WZ4002) EGFR-TKIs were determined using the EGFR-mutant human lung cancer cell lines PC-9 and HCC827 with an exon 19 deletion, and H1975 with an T790M secondary mutation. PC-9 cells were mixed with HGF-producing fibroblasts, MRC-5 cells, and subcutaneously inoculated into SCID mice and the therapeutic effects of E7050 plus gefitinib were assayed. RESULTS: E7050 circumvented resistance to all of the reversible, irreversible, and mutant-selective EGFR-TKIs induced by exogenous and/or endogenous HGF in EGFR mutant lung cancer cell lines, by blocking the Met/Gab1/PI3K/Akt pathway in vitro. E7050 also prevented the emergence of gefitinib-resistant HCC827 cells induced by continuous exposure to HGF. In the in vivo model, E7050 plus gefitinib resulted in marked regression of tumor growth associated with inhibition of Akt phosphorylation in cancer cells. CONCLUSIONS: A new Met kinase inhibitor, E7050, reverses the three HGF-induced mechanisms of gefitinib resistance, suggesting that E7050 may overcome HGF-induced resistance to gefitinib and next-generation EGFR-TKIs

A市市民の健康習慣とはつらつ感の実態 2016年の調査から(第3報)

　A市市民の健康習慣とはつらつ感の実態を明らかにするため，年齢階級別かつ性別で市民3000 人を無作為に抽出し，郵送による自記式質問紙調査を行った．その結果，1248 件（回収率41.6%）を回収し，性別，年齢，はつらつ感の記載のないものを除外し，1207 件を分析対象とした（有効回答率96.7%）．はつらつ感は「毎日はつらつ」155 人（12.8%），「まあまあはつらつ」727 人（60.2%），「あまりはつらつとしていない」261人（21.6%），「はつらつとしていない」64 人（5.3%）であった．はつらつ群と非はつらつ群の2 群間で有意差がみられたのは，「心や精神の病気」，「主観的健康観」と，健康習慣では，「30 分以上の早歩き」「エスカレーター・エレベーターの使用」「運動不足の自覚」「運動する仲間」「主食・主菜・副菜のそろった食事」「家族や仲間との楽しい食事」「よく噛むことの心がけ」「食生活の問題意識」「地元の食材の利用」「定期的な体重測定」「自分のBMI の認識」「年1 回の健康診査の受診」「身近に相談できる人・環境」「睡眠による休養」「近所の人のお互いに助け合う気持ち」「近所の人との会話」等の30 項目であった．　A市市民がはつらつと生活するためには，適切な運動や栄養バランスの良い食事等を啓蒙するとともに，健康管理では体重管理や健康診査の受診の勧奨が重要であり，また，はつらつ感は心の状態が反映されていることが推察され，近所の人との会話やつながり等ソーシャル・キャピタルの醸成や心の健康支援の取り組みの充実が示唆された

Pneumonia Caused by Severe Acute Respiratory Syndrome Coronavirus 2 and Influenza Virus: A Multicenter Comparative Study

Background: Detailed differences in clinical information between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia (CP), which is the main phenotype of SARS-CoV-2 disease, and influenza pneumonia (IP) are still unclear. Methods: A prospective, multicenter cohort study was conducted by including patients with CP who were hospitalized between January and June 2020 and a retrospective cohort of patients with IP hospitalized from 2009 to 2020. We compared the clinical presentations and studied the prognostic factors of CP and IP. Results: Compared with the IP group (n = 66), in the multivariate analysis, the CP group (n = 362) had a lower percentage of patients with underlying asthma or chronic obstructive pulmonary disease (P < .01), lower neutrophil-to-lymphocyte ratio (P < .01), lower systolic blood pressure (P < .01), higher diastolic blood pressure (P < .01), lower aspartate aminotransferase level (P < .05), higher serum sodium level (P < .05), and more frequent multilobar infiltrates (P < .05). The diagnostic scoring system based on these findings showed excellent differentiation between CP and IP (area under the receiver operating characteristic curve, 0.889). Moreover, the prognostic predictors were different between CP and IP. Conclusions: Comprehensive differences between CP and IP were revealed, highlighting the need for early differentiation between these 2 pneumonias in clinical settings

The Impact of Maternal Prenatal Depressive Symptoms and Anxiety on Infant Birth Weight in Japanese Primiparous Women

Introduction: Depressive symptoms and anxiety are the most common mental health problems during pregnancy. The purpose of the present study was to investigate the association between each trimester’s maternal depressive symptoms, anxiety, and infant birth weight. Methods: We recruited pregnant women in their second trimester. Participants’ blood and saliva were collected in the second trimester to investigate plasma cortisol and saliva oxytocin levels. Participants completed self-reported questionnaires that included the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI) in the second and third trimesters. Hierarchical multiple linear regression was conducted using stepwise selection. Results: Eighty-one primiparas participated in the study. As the results of linear regression showed, gestational age, hypertensive disorders of pregnancy, weight gain during pregnancy, and depressive symptoms in the third trimester were associated with infant birth weight. Depressive symptoms in the third trimester predicted lower infant birth weight. In contrast, depressive symptoms in the second trimester, state anxiety, and trait anxiety in both the second and third trimesters did not predict infant birth weight. Similarly, maternal plasma cortisol and saliva oxytocin levels were not related to infant birth weight. Conclusion: Maternal depressive symptoms in the third trimester predicted lower infant birth weight. Mental health care for depressive symptoms in late pregnancy might be important for infant birth weight increases