Methodology of Designing Learning Games for Problem Solving

学習への動機付けを高める一つの方法として学習ゲームが注目されているが，その作成法についてはほとんど論じられていないのが現状である．本研究では，問題解決演習を対象とした学習ゲームの作成法として問題組込み法を提案する．これは，記憶学習を対象とした学習ゲームを作成するプロパティ交換法を拡張したものである．プロパティ交換法では，既存カードゲームのカードと記憶したい概念を交換することによって学習ゲームを作成するが，問題組込み法では，既存カードゲームのカードと問題を交換することによって学習ゲームを作成する．問題組込み法では，この交換の際，問題と解答の関係をより詳細に考慮しなければならない．本論文では，問題組込み法の基本的な手順の説明に加え，問題と解答の組合せ方についてより詳細に述べる．また，その応用例として，問題解決演習を対象とした学習ゲームを自動生成するシステムについても報告する

Vesicocutaneous fistula formation during treatment with sunitinib malate: Case report

<p>Abstract</p> <p>Background</p> <p>The oral multi-kinase inhibitor sunitinib malate improves the survival of patients with gastrointestinal stromal tumors (GIST) after the disease progresses or intolerance to imatinib mesylate develops. Urinary fistulae arising during treatment with sunitinib for GIST have not been described.</p> <p>Case presentation</p> <p>We describe a 62-year-old female patient diagnosed with unresectable GIST that involved the abdominal wall, urinary bladder wall, bowel, mesentery and peritoneum in the pelvic cavity. Intestinocutaneous fistulae developed on a surgical lesion after orally administered imatinib was supplemented by an arterial infusion of 5-flurouracil. Sunitinib was started after the patient developed resistance to imatinib. On day 4 of the fourth course of sunitinib, a widely dilated cutaneous fistula discharged large amounts of fluid accompanied by severe abdominal pain. Urinary communication was indicated based on the results of an intravenous injection of indigo carmine. Computed tomography findings suggested a small opening on the anterior urinary bladder wall and fistulous communication between the bladder and abdominal walls bridged by a subcutaneous cavity. The fistula closed and the amount of discharge decreased when sunitinib was discontinued. Therefore, sunitinib might have been associated with the development of the vesicocutaneous fistula in our patient.</p> <p>Conclusion</p> <p>This is the first description of a vesicocutaneous fistula forming while under sunitinib treatment. Clinicians should be aware of the possible complication of vesicocutaneous fistula formation during treatment with molecular targeting agents in patients with extravesical invasion and peritoneal dissemination of GIST.</p