Drilling of deep ice core exceeding 800,000 years for reconstructing past climate

第7回極域科学シンポジウム/横断セッション:[IL]極域科学における学術の大型研究計画について12月2日（金）国立極地究所 3階セミナー

Factors That Influence the Occupational Identity of Student Nurses in Their Final Year of University Education

〔目的〕看護大学の最終学年である4 年次生の職業的アイデンティティに影響する要因を明らかにした。 〔方法〕7 大学の看護学生4 年次生477 名を対象とし、4 年次の全ての実習を終えた時期に自己記入式質問紙調査を行った。調査項目は、性別、年齢、職業的アイデンティティ（4 因子32 項目7 件法）、職業モデルの存在、学習への主体性、特性的自己効力感（23 項目5 件法）、首尾一貫感覚（Sense of Coherence：SOC、3 項目7 件法）とした。分析対象者は、調査票未記入・未完了者および社会人経験をもつ25 歳以上を除外した431 名であった。分析は、職業的アイデンティティを従属変数とし、職業モデルの存在、学習への主体性、特性的自己効力感、SOC の4 項目を独立変数として、stepwise 法による重回帰分析を行った。 〔結果〕分析に投入した4 項目すべてが、職業的アイデンティティに有意な影響を持つ変数として採択され、調整済みR2 は0.294 であった。 〔考察〕看護大学生の職業的アイデンティティの向上のために、学生が主体的に学習活動に取り組む姿勢を育成すること、学生にとってよい職業モデルが獲得できるよう支援することが必要である。また、ストレス対処能力を身につけ、自己効力感を育むといった内的特性に着目した教育が重要である

Report of two cases of advanced renal cell carcinoma and our experience at Mito Saiseikai General Hospital

過去10年間に水戸済生会総合病院において経験した腎細胞癌症例9例に関する統計学的考察を行い, 併せて著明な下大静脈腫瘍血栓を認め血栓除去を施行した症例と, 転移性骨病変を主訴とし, 99mTcリン酸化合物による全身骨シンチグラムで発見された腎摘および開胸による肋骨腫瘍摘除を行った症例を供覧したA tumor thrombus in the vena cava (infrahepatic) was identified in a 70-year-old male with chronic obstructive lung disease, and right nephrectomy and thrombectomy were performed successfully. Therefore, he enjoyed good health for 6 months until he developed bone metastasis in the vertebrae and upper gastrointestinal bleeding. In another case of a 51-year-old male who presented with a mass in the posterior part of the chest; the biopsy specimen of the mass was reported to at least resemble renal-cell carcinoma. Subsequently, he underwent right nephrectomy and thoracotomy to remove the mass. He has since led an uneventful life without tumor recurrence. In our hospital from 1971 to 1980, 9 cases of renal-cell carcinoma have been experienced, including the above 2 cases. Their average age was 49.4 years, with ages ranging from 34 to 70 years. Seven patients presented with gross hematuria, and 2 patients, with flank pain. All 9 cases, all of whom underwent radical nephrectomy, were diagnosed pathologically as having renal cell carcinoma. The right side was involved in 3 cases, and the left, in 6 cases. The upper pole of the kidney was involved in 2 cases the middle in 1 case, and the lower in 5 cases. The mean 5-year survival rate was 69.2% and was closely associated with the tumor stage

Bilateral Distal Anterior Cerebral Artery Aneurysms in a Mirror Position

We report a rare case of ruptured bilateral distal anterior cerebral artery aneurysm (DACAAN) in a mirror position. They are joined with another incidental aneurysm. This patient,61-year-old woman, showed no vascular anomaly, severe atherosclerosis, nor systemic disease except hypertension. All aneurysms are performed successful surgical treatment. The incidence is rare, but aneurysms in this position suggest some features for consideration of pathogenesis of cerebral aneurysms. We reviewed several concerned literature and discussed the pathogenesis

Study on the Acceptance of “Learning Stories” in Germany

ニュージーランドで開発された保育アセスメント「学びの物語（Learning Stories）」は，世界各国の保育現場に導入されている。本稿では，ドイツにおける「学びの物語」受容の特質を明らかにするために，ドイツ版「学びの物語」プロジェクトとドイツで実際に作成された「学びの物語」に関する先行研究の分析を行なった。その結果，ドイツにおける「学びの物語」受容の特質として（１）政策主導で「学びの物語」の導入が図られたこと，（２）「学びの物語」導入の強調点が「学び」あるいは「学びの体系的な観察・記録」にあること，（３）保育現場では導入の意図が部分的に達成されているものの，園や保育者の保育観・教育観を反映しながら多様な形で「学びの物語」が実践されていることが明らかとなった。ドイツ保育アセスメント学びの物語観察と記録乳幼児期の学

産科病棟で緊急帝王切開術を行うための体制作り

othe

Cardiac Migration of Peritoneal Catheter : A Rare Complication of Ventriculo-Peritoneal Shunting

A rare case of ventriculo- peritoneal shunt complication, such as a cardiac migration of the peritoneal catheter,is presented. The mechanism of the cardiac migration is thought that the peritoneal catheter might penetrate the right internal jugular vein initially and then venous flow could lead the catheter to the right atrium from the findings of the shunt revision operation

Preliminary results of atmospheric CH4 concentration during the Holocene reconstructed from the NEEM (Greenland) and Dome Fuji (East Antarctica) ice cores

第7回極域科学シンポジウム/横断セッション:[IG] アイスコア研究—これまでの成果と今後の展開12月2日（金） 国立極地研究所 2階大会議

Assessment of Hemodynamic Changes Due to Symptomatic Vasospasm in SAH Using SPECT and 123I-IMP

Eleven patients with symptomatic cerebral vasospasm following early surgery for ruptured aneurysm were examined postoperatively using single-photon emission computed tomography (SPECT) and N-isopropyl-123I-p-iodoamphetamine(IMP). IMP acquisitions were made 2 times after intravenous injection of 6mCi IMP. The early imaging was performed 10 minutes after injection, and the delayed imaging was obtained 5 hours after injection. In patients with reversible ischemia, moderate hypoactive areas due to vasospam were observed on the early image with incomplete redistribution on the delayed image, which were not detected by CT scan. Neurological recovery was accompanied by normalization of the early and delayed images. In patients with irreversible infarction, marked hypoactive or inactive areas due to vasospasm were revealed on the early image, without redistribution on the delayed image. Post-ischemic hyperactive areas were localized in the early or delayed images, which corresponded to the subacute infarcted area on the CT scan following the relaxation of cerebral vasospasm. Based on the above results of acute cerebral ischemia due to vasospasm, it is concluded that the early image indicates hemodynamic changes due to cerebral vasospasm, and the delayed image reveals a redistribution of IMP related to the functional reversibility of the acute ischemic brain tissue. In addition to that, it seemes important that chronology be taken into the consideration when regional brain perfusion and metabolic activity in patients with subacute infarcted area were evaluated by the early and delayed images of IMP SPECT

非アルコール性脂肪性肝炎の経過中に筋強直性ジストロフィーと診断された1例

症例は42歳女性で,弟に筋強直性ジストロフィーがある.脂肪肝と診断され,外来通院していたが,肝生検を施行され非アルコール性脂肪性肝炎(non-alcoholic steatohepatitis: NASH)と診断された.一方,今回入院の数年前より歩行が遅く,神経内科外来に紹介され精査目的で入院した.斧状顔貌を認めたが,grip myotoniaやpercussion myotoniaは明らかではなかった.四肢の筋力は正常だが, 歩行はやや緩徐であった.血液検査では総コレステロール,γGTP及びHOMA-IRの高値を認めた.針筋電図では,刺入時に急降下爆撃音が聴取された.遺伝子検査にてDMプロテインキナーゼ遺伝子のCTG反復配列が約1,300回と増幅を認めた.筋強直性ジストロフィーの家族歴,針筋電図検査,遺伝子検査から筋強直性ジストロフィー1型と確定診断した.筋強直性ジストロフィーは骨格筋の障害の他に,様々な臓器の障害をきたすことが知られているが,NASHを合併した報告例はごく少数である.近年NASHあるいは非アルコール性脂肪性肝疾患(non-alcoholic fatty liver disease: NAFLD)患者は急増しており,それらの中に筋強直性ジストロフィーが合併している場合があることも念頭に置くべきと考える.We report the case of a 42-year-old woman diagnosed with myotonic dystrophy during the clinical course of non-alcoholic steatohepatitis (NASH). She had been diagnosed fatty liver at age 33. When she was 40 years old, histopathological findings of a liver biopsy specimen indicated NASH. After that, she complained of gait disturbance. Brain CT and MRI revealed skull thickening, calcification of falx cerebri and atrophy of the lateral pterygoid muscles. She had a hatchet face. Her muscle strength was normal; she did not have grip myotonia nor percussion myotonia. On laboratory data, total cholesterol was 254 mg/dl, γGTP was 118 U/l, CK was 148 U/l, fasting plasma glucose was 103 mg/dl, fasting plasma insulin was 15.6 μU/ml, homeostasis model assessment-insulin resistance (HOMA-IR) was 3.967. A dive-bomber sound was heard on needle EMG. DM protein kinase gene analysis showed increase of CTG repeat. Occurrence of myotonic dystrophy during the clinical course of NASH is rare. NASH/non-alcoholic fatty liver disease (NAFLD) is strongly associated with insulin resistance. Insulin resistance in patients with myotonic dystrophy is highly prevalent and is due to a splicing abnormality of the insulin receptor in muscle tissue. In our patient, HOMA-IR was elevated and suggested an increase of insulin resistance. Thus, the risk of developing myotonic dystrophy should be considered in patients with NASH/NAFLD