看護学生の看護の認識

看護学生は入学初期から学習する看護学や，日常生活の中で多様な体験や経験を積むことにより，看護に対する見方・考え方を変えながら，自らの看護観を形成していく．今回，看護学生が入学時と，１年間看護学やその関連科目，教養科目などを学習した１年終了時における看護の見方・考え方について学生の記述内容を分析した．その結果，看護学生は入学後１年間の学習や経験などが加味され，看護に関する認識を新たにしたり深めたりしていた．この認識の変化には，専門科目である看護学概論や看護理論の影響が大きいと考えられた．なぜならば看護学生は，１年間に学習した看護学概論や看護理論の科目の中で捉えた看護の考え方をベースに看護の認識を深めていた．Nursing students develop their own view of nursing through learning of nursing and accumulating diverse experiences during daily living after entering nursing school. The present study was undertaken to analyze the result of the descriptive survey designed to investigate changes in the students awareness of nursing during the first year of the nursing school (i.e., after one year of learning nursing, nursing-related subjects and subjects for general education). This survey revealed that the nursing students accumulated knowledge and experience and deepened thir awareness of nursing during the one year period. These changes in their awareness seem to be particularly related to education of nursing-specific subjects (introduction and theories of nursing). The students deepened their awareness of nursing on the basis of the views they learned from these nursing-specific subjects

An Accidental Ingestion Of A Hearing Aid Including A Litium-Ion Rechargeable Battery Which Resulted In Spontaneous Excretion

　認知機能障害がある高齢者は，異物誤飲を生じるリスクとなりうる．これは認知症の併存によって誤飲の事実を患者本人が認知していないことや異物誤飲による症状が非特異的，もしくは無症候性であることが多いことと関係している．このため認知機能障害のある高齢者において異物誤飲は発見が遅れる可能性がある．リチウムイオン充電式電池を内蔵した補聴器の誤飲が MRI の撮像を契機に発覚し，その後合併症なく自然排泄が得られた症例を経験したので報告する．症例は 82歳女性，尿路感染の診断で入院となった．入院時から不穏行動があり，感染症によるせん妄が疑われた．入院２日目に補聴器を紛失したと訴え捜索を行ったが発見できなかった．入院４日目に腰椎圧迫骨折の精査目的で行った MRI 検査において腹腔内に強いアーチファクトを認め，補聴器の誤飲が疑われた．腹部 CT 検査を行い，補聴器であることを確認した．補聴器が充電式であることやトライツ靭帯を超え横行結腸に存在していることから外科的摘出を行わず自然排泄を待つこととした．その後，異物・電池誤飲に伴う腸管症状をきたすことなく経過し，入院５日目に補聴器が自然排泄された．精神疾患患者や高齢患者など，誤飲を生じうる患者が嚥下可能なサイズの装着物を紛失した際には，Ｘ線検査を行うことで発見できる可能性がある．異物誤飲に伴う腸閉塞や腸管損傷に加え，補聴器に使用されている電池がボタン型電池であるのか内蔵型の充電式電池であるのかによって，誤飲に伴う合併症の有無を評価し，対応する必要がある .　Delirium during hospitalization in elderly patients is a risk factor for accidental foreign body ingestion. The patient may not be aware of the fact that he or she has ingested foreign bodies due to coexisting dementia, and the symptoms of foreign body ingestion are often nonspecific or asymptomatic, which may delay the detection of the accidental ingestion. We report a case in which an accidental ingestion of a hearing aid containing a rechargeable battery was detected with the opportunity of MRI imaging, and the patient underwent spontaneous elimination without complications. An 82-year-old woman was admitted to the hospital with a diagnosis of urinary tract infection and was suspected to have delirium due to the infection because of her disturbing behavior from the time of her arrival. On day 2 of admission, she reported that she had lost her hearing aid, and a search was conducted but failed to find it. On day 4, an MRI scan performed to investigate complications revealed strong artifacts in the abdominal cavity, which led us to suspect that the patient had swallowed a hearing aid by mistake. An abdominal CT scan was performed and confirmed to be a hearing aid. The patient did not have any intestinal symptoms associated with ingestion of a foreign body or battery, and spontaneous excretion of the battery was obtained on day 5. When patients with psychiatric disorders or elderly patients who is at risk of accidental ingestion lose a swallowable size equipment, radiographic examination may help detect in such cases. In addition to intestinal obstruction and damage to the intestinal tract associated with ingestion of foreign objects, the presence or absence of complications associated with ingestion of batteries due to button batteries or rechargeable batteries in hearing aids should be evaluated and discussed with each department regarding the appropriate response

Conditional deletion of Npt2b in phosphate transport

Background Hyperphosphatemia is common in chronic kidney disease and is associated with morbidity and mortality. The intestinal Na+-dependent phosphate transporter Npt2b is thought to be an important molecular target for the prevention of hyperphosphatemia. The role of Npt2b in the net absorption of inorganic phosphate (Pi), however, is controversial. Methods In the present study, we made tamoxifen-inducible Npt2b conditional knockout (CKO) mice to analyze systemic Pi metabolism, including intestinal Pi absorption. Results Although the Na+-dependent Pi transport in brush-border membrane vesicle uptake levels were significantly decreased in the distal intestine of Npt2b CKO mice compared with control mice, plasma Pi and fecal Pi excretion levels were not significantly different. Data obtained using the intestinal loop technique showed that Pi uptake in Npt2b CKO mice was not affected at a Pi concentration of 4 mM, which is considered the typical luminal Pi concentration after meals in mice. Claudin, which may be involved in paracellular pathways, as well as claudin-2, 12, and 15 protein levels were significantly decreased in the Npt2b CKO mice. Thus, Npt2b deficiency did not affect Pi absorption within the range of Pi concentrations that normally occurs after meals. Conclusion These findings indicate that abnormal Pi metabolism may also be involved in tight junction molecules such as Cldns that are affected by Npt2b deficiency

Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis

Objective: The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration. Design: We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson. Results: Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I2=74.6%) and 5.7 (2.5 to 15.3, I2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1). Conclusion: Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified

The whole blood transcriptional regulation landscape in 465 COVID-19 infected samples from Japan COVID-19 Task Force

「コロナ制圧タスクフォース」COVID-19患者由来の血液細胞における遺伝子発現の網羅的解析 --重症度に応じた遺伝子発現の変化には、ヒトゲノム配列の個人差が影響する--. 京都大学プレスリリース. 2022-08-23.Coronavirus disease 2019 (COVID-19) is a recently-emerged infectious disease that has caused millions of deaths, where comprehensive understanding of disease mechanisms is still unestablished. In particular, studies of gene expression dynamics and regulation landscape in COVID-19 infected individuals are limited. Here, we report on a thorough analysis of whole blood RNA-seq data from 465 genotyped samples from the Japan COVID-19 Task Force, including 359 severe and 106 non-severe COVID-19 cases. We discover 1169 putative causal expression quantitative trait loci (eQTLs) including 34 possible colocalizations with biobank fine-mapping results of hematopoietic traits in a Japanese population, 1549 putative causal splice QTLs (sQTLs; e.g. two independent sQTLs at TOR1AIP1), as well as biologically interpretable trans-eQTL examples (e.g., REST and STING1), all fine-mapped at single variant resolution. We perform differential gene expression analysis to elucidate 198 genes with increased expression in severe COVID-19 cases and enriched for innate immune-related functions. Finally, we evaluate the limited but non-zero effect of COVID-19 phenotype on eQTL discovery, and highlight the presence of COVID-19 severity-interaction eQTLs (ieQTLs; e.g., CLEC4C and MYBL2). Our study provides a comprehensive catalog of whole blood regulatory variants in Japanese, as well as a reference for transcriptional landscapes in response to COVID-19 infection

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target

Carriers of HLA-DRB1*04:05 have a better clinical response to abatacept in rheumatoid arthritis

Abstract HLA-DRB1 shared epitope risk alleles are the strongest genetic risk factors for rheumatoid arthritis (RA) and potential biomarkers for treatment response to biological disease-modifying antirheumatic drugs (bDMARDs). This study aimed to investigate the association between treatment response and individual HLA-DRB1 alleles in RA patients receiving different bDMARDs. We recruited 106 patients with active RA who had started abatacept, tocilizumab, or TNF inhibitors as a first-line bDMARDs. We examined the relationship between Simplified Disease Activity Index (SDAI) improvement at 3 months and HLA-DRB1 allele carriage. The results revealed that the HLA-DRB1*04:05 allele, a shared-epitope allele, was significantly associated with better SDAI improvement only after abatacept treatment (SDAI improvement 28.5% without the allele vs 59.8% with allele, p = 0.003). However, no significant association was found with other treatments. Both multivariate linear regression and mediation analysis confirmed that the HLA-DRB1*04:05 allele was independently associated with abatacept treatment response, regardless of anti-CCP antibody titers. The study concluded that in patients with RA receiving their first-line bDMARD treatment, carrying the HLA-DRB1*04:05 allele was associated with better SDAI improvement specifically in abatacept-treated patients. These disease-risk HLA alleles have the potential to serve as genomic biomarkers for predicting treatment response with co-stimulation blockage therapy