CHIRYOKYOHI, withdrawing treatment in Neonatal Intensive Care Unite in Japan : A Concept Analysis <Review>

「わが国のNICUにおける治療拒否」について, 親-医療者問の話し合いの方法を導くために, Rodgersの方法を参考に概念分析した. その結果, 治療拒否には, 子どもが負う苦痛の正当性および人の幸福に関する信念の対立を含む「親-医療者間の不一致」と, 「医療パターナリズム」が含まれた。先行因子として, 「新生児の病状の特徴」, 「親の心理社会的状況と考え方の特徴」, 「意思決定過程の特徴」があった. 帰結は, 「決定者および決定機関」は4つに分類され, 「決定内容に伴う関係性の変化」が親-医療者間, 親子間に生じていた. 「治療拒否」は, 新生児の親のアドボカシーの観点から慎重に用いるべき概念であった. 「治療拒否」という概念は, 医療者が親と同等の立場に立ち, 意思決定過程に生じるジレンマを抱えた親の葛藤を理解し, 最後まで養育の責任を負う者としての親の意見を尊重する医療に変われば, 親の「治療選択」の概念に変わるだろうと考えられた. これらの結果をもとに, 新生児看護に対して1)緊急状況であっても親の意思決定過程へのケアを重視する, 2)看護者としての自己の態度を分析する, 3)合意にならない場合であっても親の人権を擁護し医療者間で建設的に協働する, 4)治療拒否という概念を慎重に用いる組織づくりをすることを提案した.This review aimed to clarify the concept of 'CHIRYOKYOHI', withdrawing treatment in neonatal intensive care unite in Japan, to facilitate discussion between parents and medical staff. This concept analysis is based on a literature review using Rodgers' evolutionary method. It was found that attributes were "disagreement between parents and medical staff", including disagreements on the validity of infant distress and conflict of beliefs about the definition of 'well-being', and "medical paternalism". Antecedents were "characteristics of infant disease condition", "parents' psychosocial situation and features of reaction" and "features of the decision making process". Consequences were "decision maker or decision institution" and "change in relationship as an outcome of decision" for patient-medical staff and parent-child relationships. Related concepts were "informed consent" and "shared decision making". A surrogate term for withholding and withdrawing of treatment was "choice of treatment". CHIRYOKYOHI is a concept that should be used cautiously from the parent advocacy perspective. If medical staff consider parents' viewpoints and recognized patients' dilemmas during the decision making process, and if medical care can be modified to respect parents' responsibility for their children and their opinions in decision making, CHIRYOKYOHI should be adopted as the 'choice of treatment'. Based on the above analysis, we propose that neonatal nursing 1) attach importance to parents' decision making process even in emergency situations, 2) analyze the own attitudes as a nurse, 3) advocate patients' human rights and collaborate with other medical staff in a constructive manner if there is a conflict, and 4) develop a system that carefully incorporates CHIRYOKYOHI

The STAT2 Activation Process Is a Crucial Target of Sendai Virus C Protein for the Blockade of Alpha Interferon Signaling

Sendai virus (SeV) C protein functions as an interferon (IFN) antagonist and renders cells unresponsive to both alpha/beta IFN (IFN-α/β) and IFN-γ. We have recently found the physical association of the C protein with signal transducer and activator of transcription 1 (STAT1) in infected cells. However, involvement of the C-STAT1 interaction in the blockade of IFN signaling has remained unclear. We generated here a series of C mutant proteins that retained or lost the STAT1-binding capacity and examined their effects on IFN-α signaling. All of the C mutant proteins with no STAT1-binding capacity lost the ability to inhibit the IFN-α response. In contrast, the C mutant proteins retaining the STAT1-binding capacity suppressed IFN-α-stimulated tyrosine phosphorylation of both STAT2 and STAT1 to various degrees. Remarkably, their anti-IFN-α capacities correlated well with the inhibitory effect on phosphorylation of STAT2 rather than STAT1. In infected cells, the levels of tyrosine-phosphorylated (pY) STAT2 were below the detection level irrespective of duration of IFN-α stimulation, whereas the levels of pY-STAT1 strikingly increased after long-term IFN-α stimulation. These results suggest that the STAT2 activation process is a crucial target for the blockade of IFN-α signaling. An in vitro binding assay with extracts from (STAT1-deficient) U3A and (STAT1-expressing) U3A-ST1 cells suggested the requirement of STAT1 for the C-STAT2 interaction. Furthermore, expression of STAT1 enhanced the inhibitory effect of the C protein on STAT2 activation in U3A cells. The C protein thus appears to participate in the inhibitory process for STAT2 activation through the STAT1 interaction

Knockout of the Sendai virus C gene eliminates the viral ability to prevent the interferon-α/β-mediated responses

AbstractSendai virus (SeV) renders cells unresponsive to interferon (IFN)-α. To identify viral factors involved in this process, we examined whether recombinant SeVs, which could not express V protein, subsets of C proteins (C, C′, Y1 and Y2) or any of four C proteins, retained the capability of impeding IFN-α-mediated responses. Among these viruses, only the 4C knockout virus completely lost the ability to suppress the induction of IFN-α-stimulated gene products and the subsequent establishment of an anti-viral state. These findings reveal crucial roles of the SeV C proteins in blocking IFN-α-mediated responses

Clinical value of fluorine-18α-methyltyrosine PET in patients with gliomas: comparison with fluorine-18 fluorodeoxyglucose PET

Abstract Background We investigated the relationship between metabolic activity and histological features of gliomas using fluorine-18α-methyltyrosine (18F-FAMT) positron emission tomography (PET) compared with fluorine-18 fluorodeoxyglucose (18F-FDG) PET in 38 consecutive glioma patients. The tumor to normal brain ratios (T/N ratios) were calculated, and the relationships between T/N ratio and World Health Organization tumor grade or MIB-1 labeling index were evaluated. The diagnostic values of T/N ratios were assessed using receiver operating characteristic (ROC) curve analyses to differentiate between high-grade gliomas (HGGs) and low-grade gliomas (LGGs). Results Median T/N ratio of 18F-FAMT PET was 2.85, 4.65, and 4.09 for grade II, III, and IV gliomas, respectively, with significant differences between HGGs and LGGs (p = 0.006). Both T/N ratio (p = 0.016) and maximum standardized uptake value (p = 0.033) of 18F-FDG PET showed significant differences between HGGs and LGGs. ROC analysis yielded an optimal cut-off of 3.37 for the T/N ratio of 18F-FAMT PET to differentiate between HGGs and LGGs (sensitivity 81%, specificity 67%, accuracy 76%, area under the ROC curve 0.776). Positive predictive value was 84%, and negative predictive value was 62%. T/N ratio of 18F-FAMT PET was not correlated with MIB-1 labeling index in all gliomas, whereas T/N ratio of 18F-FDG PET was positively correlated (r s  = 0.400, p = 0.013). Significant positive correlation was observed between T/N ratios of 18F-FDG and 18F-FAMT (r s  = 0.454, p = 0.004), but median T/N ratio of 18F-FAMT PET was significantly higher than that of 18F-FDG PET in all grades of glioma. Conclusions The T/N ratio of 18F-FAMT uptake has high positive predictive value for detection of HGGs. 18F-FAMT PET had higher T/N ratio, with better tumor-normal brain contrast, compared to 18F-FDG PET in both LGGs and HGGs. Therefore, 18F-FAMT is a useful radiotracer for the preoperative visualization of gliomas