A Functional Polymorphism in B and T Lymphocyte Attenuator Is Associated with Susceptibility to Rheumatoid Arthritis

Inhibitory coreceptors are thought to play important roles in maintaining immunological homeostasis, and a defect in the negative signals from inhibitory coreceptors may lead to the development of autoimmune diseases. We have recently identified B and T lymphocyte attenuator (BTLA), a new inhibitory coreceptor expressed on immune cells, and we suggest that BTLA may be involved in the development of autoimmune diseases using BTLA-deficient mice. However, the role of BTLA in the pathogenesis of autoimmune diseases in humans remains unknown. We, therefore, examined the possible association between BTLA and rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren's syndrome (SS) by conducting a case-control genetic association study. We found that 590C single-nucleotide polymorphism (SNP) of BTLA gene was significantly associated with susceptibility to RA, but not to SLE or SS. Furthermore, RA patients bearing this 590C SNP developed the disease significantly earlier than the patients without this allele. We also found that BTLA with 590C allele lacked the inhibitory activity on concanavalin A- and anti-CD3 Ab-induced IL-2 production in Jurkat T cells. These results suggest that BTLA is an RA-susceptibility gene and is involved in the protection from autoimmunity in humans

被災地に派遣された養護教諭の支援活動に関する研究(第5報)－派遣養護教諭と受入養護教諭の協働への影響－

Interviewed you targeting at the accepting school nurses whom the “thought” that I held for a dispatched school nurse transformed affirmatively and investigated it.It is intended to clarify influence on collaboration between dispatched and accepting school nurses.While performing support activities through collaboration with dispatched school nurses, the accepting school nurse noted [the qualities and abilities dispatched school nurses are required to have], developed [awareness as an accepting school nurse through support activities], and realized [challenges of dispatch management]. Among these, [the qualities and abilities dispatched school nurses are required to have] may have been a factor influencing these emotional challenges in the accepting school nurse

ゴウリュウブ ケッセキ Confluence Stone ノ 1チケンレイ

Confluence stone is a rare disease that is difficult to diagnose before surgery and thattend to accompany intraoperative biliary tract injury and postoperative stenosis, unexpectively.We have report a case of confluence stone.The patient was 67-year-old woman. During treatment for cholecystolithiasis at anotherhospital, she had upper abdominal pain three times without fever up and jaundice. Shewas reffered to our hospital for a detailed examination. Ultrasonography, CT and endoscopicretrograde cholangiopancreatography (ERCP) allowed a diagnosis of common bileduct stenosis caused by confluence stone. Laparotomy was then performed. No malignancywas shown despite of seveve cholecystitis. Thus cholecystectomy was carried out,then the biliary stenosis was repaired by patch graft method.It is known that confluence stone arise biliostasis with the progression of chroniccholecystitis. Therefore, in cases of severe chronic cholecystitis we should consider thepossibility of the confluence stone and take care of the biliary tract injury and postoperativestenosis

トクシマシ イシカイ ニオケル ザイタク イリョウ エノ トリクミ

Japan is heading toward a super-aging society at a rate unparalleled with other countries. The vast increase in demand for medical treatment and care will exceed existing social resources by 2025 when the baby boom generation becomes older than 75 years. There are concerns that this may lead to the collapse of acute medical care, break out refugee Home Medical Care, and the loss of end-of-life care facilities in various areas. Therefore, Japan is promoting the establishment of a comprehensive community care system designed to allow elderly individuals to live in their own community with dignity for as long as possible. The development of home medical care is being promoted as the core component of this system. The Tokushima City Medical Association has assessed the possible risks associated with this super-aging society that should emerge at a relatively early stage. Furthermore, the development of home medical care for the public to support community medical care is regarded as the best means of tackling future challenges. Therefore, we set up the Home Care Cooperation Committee in 2008 and have worked to develop home care in Tokushima City. The Tokushima City Medical Association participated in the Home Medical Care Cooperation Base Service of commissioned projects by the Ministry of Health, Labour and Welfare as one of 105 institutions in whole country in 2012. Since 2013, we have already been implementing this with Tokushima City administration as a subsidized institution under the three year’s Home Medical Care Cooperation Base Service which was performed by the Tokushima prefecture. This base of operations incorporates the following five mandatory directives : 1. identify solutions to multidisciplinary cooperation issues, 2. develop a multidisciplinary cooperation system and a 24-h response system, 3. raise awareness among residents, 4. educate personnel engaged in home medical care, and 5. set up a consultation service for home medical care. Because of community demands for projects to be implemented in a more area-wise appropriate manner, the Tokushima Home Care Cooperation Committee was newly established following general consensus within the association. This committee was composed of 14members not limited to individuals from medical associations ; individuals from the local government and various professions involved in home medical care were recruited and made decisions regarding operating policies. The current major challenge in Tokushima City is the lack of a means to disseminate proposed solutions for home medical care throughout the entire community. Therefore, we are promoting the establishment of multiple working groups on home medical care to tackle this challenge in the future. In addition, we intend to summarize the various challenges and their solutions that we identified during the course of our operations, draw up guidelines on home medical care based on the agreement of the local government and various professions and disseminate these guidelines throughout the community. We aim to effectively operate and from multiple levels a mutual support system between doctors who have long been working in medical associations, a multidisciplinary, conscientious cooperation system to support patients, a streamlined cooperation system for hospital admission and discharge, and a patient information sharing system utilizing ICT. These systems will be operated in parallel with our base operations. We also aim to promote the future improvement of environments in which as many family doctors as possible can examine their patients at home with ease until their patient’s final breath. This should enable us to provide high-quality home medical care equally and widely throughout the community. We hereby report the home medical care initiatives and future projects of the Tokushima City Medical Association centered on the Home Medical Care Cooperation Based Project

産後1ヵ月の女性における睡眠障害，日中の眠気と睡眠に良好な生活習慣の関連

本研究の目的は，産後1ヵ月の女性における睡眠障害，日中の眠気と睡眠に良好な生活習慣との関連を検討することである。対象は2013年4月から2015年3月に近畿圏内のＡ病院で妊婦健診もしくは産後1ヵ月健診に訪れた計549名の女性に調査用紙を配布し，回収した481名（回収率87.6％）のうち重回帰分析で用いた従属変数と独立変数に欠損がない67名であった。産後1ヵ月の女性では，8割に睡眠障害，4割に過度の日中の眠気が認められその支援の重要性が再認識された。睡眠障害には「何事も完璧にしなければならないと考えず，8割方できたら上出来だと考えるようにする」，「睡眠時間が不規則にならないようにする」，「寝床でテレビを見たり，仕事，読書をしない」が，日中の眠気には「一人で悩みごとを抱え込まず，誰かに相談する」，「夜に30分程度の運動をする」，「何事も完璧にしなければならないと考えず，8割方できたら上出来だと考えるようにする」の生活習慣の関連が認められ，出産後の睡眠に対するアプローチを検討するうえで重要と示唆された。論

看護基礎教育におけるActive Learningの手法を用いた公衆衛生学教育の試み（第2報）

本研究は、Ａ大学看護学部の看護基礎教育で実施されたActive Leaning の手法を用いた公衆衛生学の演習プログラムの2 年目の取り組みを記述し、学生が捉えた公衆衛生学を学ぶ意義と看護職が禁煙対策に取り組む意義の2 つを明らかにすることを目的とした。対象は、2015 年度Ａ大学看護学部の学士課程に在籍した2 年次の学生であり、2 年目の演習は、大学におけるプライマリーインフォーマントとキーインフォーマントに対するインタビュー調査を実施した。その結果、学生は【看護・公衆衛生は全ての人々を対象とすることを実感する】こと、【看護学生として大学の健康増進・予防活動でできることがある】と感じることなどを公衆衛生学を学ぶ意義と捉えていた。また、看護職が禁煙対策に取り組む意義として【人々の生命を守るという看護職の使命を果たすことに繋がる】ことなどをあげており、演習が学生の主体性を高め、自身の看護観を深めることに寄与していることが示唆された