看護学生の実習前後におけるB型肝炎，水痘，風疹，麻疹抗体 価およびツベルクリン反応，MRSA鼻腔保菌の変化

Objectives: The first objective of this study was to examine the possible occupational risk of contracting hepatitis B virus (HBV), the varicella-zoster virus (VZV), rubella, measles, tuberculin skin test (TST) or methicillin-resistant Staphylococcus aureus (MRSA) among nursing students during clinical practice for patient\u27s care. The second objective was to investigate whether testing for the diseases increased student awareness of infection control.Methods: Sera from 56 nursing students before their clinical practice and post clinical practice were tested for the presence of HBV surface antigen(HBs), VZV, rubella and measles antibodies. The TST and the testing for the nasal carriage of MRSA were examined in 22 and 48 nursing students respectively. We also examined the effect of participation in immune status testing on the perception of nursing students for occupational infection control through the use of questionnaires.Results: After clinical practice, one student had a significant rise in the antibody titer to HBsAg. Except for HB, no significant difference was detected in the antibody titer to VZV, measles, rubella between sera from before and after the nursing practice of the nursing students. However, a (4.5%) rise from weak positive to strong positive in the in TST status was observed in one student. One student, who administered direct care to a MRSA carrier patient, contracted temporary nasal carriage of MRSA (2.2%).As for the nursing students\u27 perception, thirty-nine of fifty six students, or 69.6%, gave this affirmative answer to participation in this immune status testing for occupational infection control.本研究は，1年半にわたる看護実習における院内感染のリスクを査定し，看護教育において抗体価測定等の実施が感染予防の視点から看護学生に及ぼす効果を検討することを目的に行った.富山医科薬科大学（現富山大学）において，倫理審査委員会の承認を得，学生への説明と同意の下，56名の看護学生において実習開始前と1年半後の実習終了時にＢ型肝炎ウイルス抗体価，小児ウイルス感染症（水痘，風疹，麻疹）抗体価，ツベルクリン反応，ＭＲＳＡの鼻腔内保菌状態の変化，および意識調査を行った.その結果，実習前後で比較し，Ｂ型肝炎ウイルス抗体価において4倍以上の抗体価の上昇があった学生が1名（1.8%）みられた.ツベルクリン反応は実習前後での比較は22名に行い，実習前後で弱陽性から強陽性になった学生が1名（4.5%）いたが，発症はしていなかった.ＭＲＳＡの鼻腔内保菌状態については，48名に行い，黄色ブドウ球菌の保菌率には差がなかったが，ＭＲＳＡについては，実習後１名（2.1%）に一時的な保菌が認められた.意識調査においては，自由回答で56人中39人（69.6%）が「自分の抗体価を知ることができた」，「感染予防に対する意識が高まった」などの肯定的な回答を示した.以上から，実習中のＢ型肝炎ウイルス，結核菌，ＭＲＳＡに関しての暴露が示唆され，抗体価等の検査は学生の感染予防への意識を高める効果があった.実習時の感染については，教育機関として健診活動を強化し，学生への感染予防教育を推進する必要がある

Specialized Pro-Resolving Mediators Do Not Inhibit the Synthesis of Inflammatory Mediators Induced by Tumor Necrosis Factor-α in Synovial Fibroblasts

Background : Tumor necrosis factor (TNF)-α, a proinflammatory cytokine, is involved in the pathogenesis of rheumatoid arthritis (RA). The omega-3 unsaturated fatty acid-derived metabolites resolvin (Rv) D1, RvE1, and maresin-1 (MaR1) have been reported as anti-inflammatory lipid mediators and are known as specialized pro-resolving mediators (SPMs). In this study, we aimed to investigate the anti-inflammatory effects of SPMs on TNF-α-induced responses in synovial fibroblasts. Methods: We investigated the effects of SPMs on gene expression and/or production of cyclooxygenase-2 (COX-2), microsomal prostaglandin E synthase-1 (mPGES-1), interleukin (IL)-6, and matrix metalloproteinase (MMP)-3, which are involved in TNF-α-induced synovitis in RA or OA synovial fibroblasts, by quantitative real-time PCR. We also investigated the effects of SPMs on the mitogen-activated protein kinase (MAPK) signaling pathway by western blotting. Anti-inflammatory effects of SPMs were evaluated by applying SPMs to cultured synovial fibroblasts, followed by TNF-α stimulation. Results: The induction of COX-2, mPGES-1, IL-6, and MMP-3 by TNF-α in synovial fibroblasts was not suppressed by omega 3-derived SPMs regardless of their origin such as RA or OA. SPMs had no effect on lipid mediator receptor gene expression induce by TNF-α and did not inhibit the TNF-α-activated MAPK signaling pathway. The production of COX-2 and IL-6 protein was significantly decreased by p38 inhibitor. Conclusion: Despite reports on the anti-inflammatory effect of omega 3-derived SPMs, its anti-inflammatory effect on TNF-α-induced responses was not observed in synovial fibroblasts. The reason may be that SPMs have no suppressive effect on p38 activation, which plays an important role in the production of inflammatory cytokines in synovial fibroblasts

AMH producing purely cystic virilizing adult granulosa cell tumor in 17 years old girl: a case report and review of literatures

Background: Androgen-producing granulosa cell tumor in adolescent girl is rare condition and clinical characteristics are not fully elucidated. Case presentation: Seventeen years old girl complained of secondary amenorrhea was referred to our out-patient consultation. Markedly elevated serum testosterone, LH, and AMH levels were noted. Mild hirsutism and clitoromegaly were presented. Transabdominal ultrasonography and MRI revealed cystic mass occupied pelvic cavity probably originated from left ovary. Right ovary showed polycystic appearance. Laparoscopic left ovarian cystectomy was performed. After the surgery, her menstruation resumed along with normalized hormonal parameters, and clinical hyperandrogenism were improved. Since the scarcity of cellular lining of inner cyst wall, definitive pathological diagnosis was difficult. After the consultation with gynecological pathologist, the tumor was diagnosed as sex cord stromal tumor, highly suspicious for adult granulosa cell tumor. Residual left salpingo-oophorectomy was performed by additional laparoscopic surgery. Her serum testosterone and AMH levels were remained low with regular menstrual cycles and no evidence of recurrence. Conclusions: Androgen-producing cystic granulosa cell tumor is rare gynecological disorders, which need both gynecologic oncological and endocrinological approach. Its clinical manifestations may bring some clues to the pathogenesis of ovulatory dysfunctions, such as polycystic ovary syndrome

Significance of p53-Binding Protein 1 Nuclear Foci in Cervical Squamous Intraepithelial Lesions: Association With High-Risk Human Papillomavirus Infection and P16INK4a Expression

As p53-binding protein 1 (53BP1) localizes to the sites of DNA double-strand breaks and rapidly forms nuclear foci (NF), and itspresence may be an indicator of endogenous genomic instability (GIN). We previously showed that 53BP1 NF in cervical cellsincrease with neoplastic progression, indicating the significance of 53BP1 expression for the estimation of malignant potential during cervical carcinogenesis. This study aimed to further elucidate the impact of 53BP1 expression as a biomarker for cervical squamous intraepithelial lesion (SIL). A total of 81 tissue samples, including 17 of normal cervical epithelium, 22 of cervical intraepithelial neoplasia (CIN) 1, 21 of CIN2, and 21 of CIN3, from patients positive for high-risk human papillomavirus (HR-HPV)were used for double-label immunofluorescence of 53BP1 and Ki-67/p16INK4a expression and HR-HPV in situ hybridization. We analyzed associations between 53BP1 expression type with parameters such as CIN grade, HR-HPV infection status, p16INK4a expression, and CIN prognosis. Expression type of 53BP1 was significantly associated with histological grade of CIN and HR-HPV in situ hybridization signal pattern (P < .0001). There was a significant correlation between 53BP1 and p16INK4a expression levels(r ? .73, P < .0001). However, there was no association between 53BP1 expression type and CIN prognosis. We propose that 53BP1 expression type is a valuable biomarker for SIL, which can help estimate the grade and GIN of cervical lesions reflecting replication stress caused by the integration of HR-HPV to the host genome

Resolvin E1 Inhibits Osteoclastogenesis and Bone Resorption by Suppressing IL-17-induced RANKL Expression in Osteoblasts and RANKL-induced Osteoclast Differentiation

【Background】 Resolvin E1 (RvE1) derived from the ω-3 polyunsaturated fatty acid eicosapentaenoic acid is known to be a potent pro-resolving lipid mediator that prevents chronic inflammation and osteoclastogenesis. We investigated the inhibitory effects of RvE1 on osteoclastogenesis and bone resorption to clarify its therapeutic potential for rheumatoid arthritis (RA). 【Methods】 Receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclast differentiation was assessed with tartrate-resistant acid phosphatase staining. RANKL-induced bone resorption was assessed by the measurement of pit formation using calcium phosphate-labeled fluorescent polyanionic molecules in RAW264.7 cells as osteoclast precursors. The effects of RvE1 on the RANKL-induced mRNA expression of osteoclast-specific genes and transcriptional factors such as c-fos and nuclear factor of activated T cells c1 (NFATc1) in RAW264.7 cells were measured by quantitative real-time PCR. The distribution of NFATc1 induced by RANKL was evaluated by immunofluorescence staining in RAW264.7 cells. To analyze the mechanism of the inhibitory effect of RvE1 on osteoclastogenesis, we measured IL-17-induced RANKL mRNA expression in MC3T3-E1 osteoblast cells treated with RvE1 using quantitative real-time PCR and determined the level of prostaglandin E2 (PGE2) production by enzyme-linked immunosorbent assay. 【Results】 RvE1 significantly suppressed RANKL-induced osteoclast differentiation and bone resorption. RvE1 inhibited the RANKL-induced mRNA expression of osteoclast-specific genes along with the transcription factors NFATc1 and c-fos. Moreover, NFATc1 translocation from the cytoplasm to the nucleus of RAW264.7 cells was suppressed following RvE1 treatment. RvE1 also inhibited IL-17-induced RANKL mRNA expression and PGE2 production in MC3T3-E1 cells. 【Conclusion】 RvE1 inhibited osteoclastogenesis and bone resorption by suppressing RANKL-induced NFATc1 and c-fos expression in osteoclasts and IL-17-induced RANKL expression through the autocrine action of PGE2 in osteoblasts. Our data suggest RvE1 as a new therapeutic target of RA