Surgical repair of severe mitral valve regurgitation complicated by incomplete cor triatriatum

AbstractA 69-year-old woman with exertional dyspnea was referred emergently to our hospital for further evaluation. Transthoracic echocardiography showed severe mitral valve regurgitation and moderate tricuspid regurgitation, which were thought to be the main cause of her heart failure. An electrocardiogram showed paroxysmal atrial fibrillation. Mitral and tricuspid repair and pulmonary vein isolation were scheduled. Intraoperative transesophageal echocardiography revealed a fibromuscular diaphragm and multiple ostia in the left atrium, strongly suggesting cor triatriatum. After left atriotomy, an incomplete transverse membrane was identified in the chamber. The membrane was resected and the mitral valve was repaired; then a tricuspid annuloplasty was performed, and the pulmonary veins were isolated bilaterally. Her postoperative course was uneventful. Cor triatriatum is a rare congenital anomaly, and in some cases is associated with mitral regurgitation. In patients with severe mitral regurgitation, we recommend preoperative transesophageal echocardiography to obtain a correct diagnosis. We should evaluate carefully moderate to severe mitral regurgitation without pulmonary hypertension or left atrial dilatation taking cor triatriatum into consideration.<Learning objective: Cor triatriatum is a rare congenital anomaly and in some cases is associated with mitral regurgitation. In patients with severe mitral regurgitation, preoperative transesophageal echocardiography is recommended to get a correct diagnosis. We should evaluate carefully moderate to severe mitral regurgitation without pulmonary hypertension or left atrial dilatation taking cor triatriatum into consideration.

Calcineurin-GATA-6 pathway is involved in smooth muscle–specific transcription

Intracellular calcium is one of the important signals that initiates the myogenic program. The calcium-activated phosphatase calcineurin is necessary for the nuclear import of the nuclear factor of activated T cell (NFAT) family members, which interact with zinc finger GATA transcription factors. Whereas GATA-6 plays a role in the maintenance of the differentiated phenotype in vascular smooth muscle cells (VSMCs), it is unknown whether the calcineurin pathway is associated with GATA-6 and plays a role in the differentiation of VSMCs. The smooth muscle–myosin heavy chain (Sm-MHC) gene is a downstream target of GATA-6, and provides a highly specific marker for differentiated VSMCs. Using immunoprecipitation Western blotting, we showed that NFATc1 interacted with GATA-6. Consistent with this, NFATc1 further potentiated GATA-6–activated Sm-MHC transcription. Induction of VSMCs to the quiescent phenotype caused nuclear translocation of NFATc1. In differentiated VSMCs, blockage of calcineurin down-regulated the amount of GATA-6-DNA binding as well as the expression of Sm-MHC and its transcriptional activity. These findings demonstrate that the calcineurin pathway is associated with GATA-6 and is required for the maintenance of the differentiated phenotype in VSMCs

長崎県における高次脳機能障害者とその家族に対する社会福祉士･精神保健福祉士の役割 ―脳外傷『ぷらむ』長崎におけるﾎﾞﾗﾝﾃｨｱ活動を通しての学生の気づきから―

本稿では､高次脳機能障害当事者と家族の会である脳外傷『ぷらむ』長崎に対して行ってきた長崎国際大学のﾎﾞﾗﾝﾃｨｱ活動について概観し､さらに学生が体験したものを基盤に､高次脳機能障害当事者と家族の会に対する社会福祉士･精神保健福祉士の役割を考察した｡具体的には､脳外傷『ぷらむ』長崎へのﾎﾞﾗﾝﾃｨｱ活動を通して学生が感じたものを後日ｱﾝｹｰﾄ形式で記述してもらい､分析を試みた｡その結果､権利擁護的な視点､生活ﾓﾃﾞﾙへの立脚､傾聴姿勢での共感的理解､家族支援への意識､ﾗﾎﾟｰﾙ形成､自己覚知と他者理解等､社会福祉士･精神保健福祉士に重要な視点やｽｷﾙに気づくことができている点が明らかとなった｡ただ､本稿での分析結果はあくまでも本学学生ｱﾝｹｰﾄを中心としたものであるため､障害当事者･家族の視点が欠けている｡今後の課題としては､ﾎﾞﾗﾝﾃｨｱ受け入れに関する障害当事者･家族からの意見や感想の聞き取りも重要であり､次稿ではそれらを実施することで新たな知見を得ていきたい｡In this paper, the authors provide an overview of volunteer activities for NOUGAISHOU “PLUM” NAGASAKI, conducted by Nagasaki International University. In addition to the activities that students experienced, the role of certified social workers and psychiatric social workers is discussed

救護施設利用者の自立支援における心理的ﾆｰｽﾞについての一考察

本研究は､救護施設における現状を踏まえた上で､利用者と施設職員にどのような心理的ﾆｰｽﾞがあるのかを探索することを目的としたものである｡救護施設の現状としては､社会情勢が揺れ動く中生活保護法のうえに成り立つ救護施設において､利用者の自立支援を促すためには様々な阻害要因が横たわっていることが窺えた｡施設利用者については､その背景的要因を踏まえた上での心理的支援､とりわけ個別支援計画の作成や地域生活移行における心理的支援の必要性が示唆された｡施設職員については､福祉施設全般としてﾒﾝﾀﾙﾍﾙｽへの啓発や職務に対する客観的理解および裁量度､利用者についての理解､ﾁｰﾑでの相互の意思確認などの重要性が示唆された一方､救護施設自体の特性を考慮した上での支援については検討の余地が残されていることも明らかとなり､今後の課題が示された｡This report considered the present state of public assistance institutions and the psychological needs of the people in such facilities. Now, public assistance institutions exist under the Livelihood Protection Law. Therefore, it was understood that people\u27s self-reliance is checked by various factors. For people in facilities, it was suggested that the psychological supports based on a background factor is necessary. Especially, it was suggested that the psychological supports on designing individual support programs and the relocation from residential institutions to community living are necessary. Otherwise, for workers in facilities, it was suggested that mental-health education and objective understanding for their own jobs and the degree of discretion of their jobs and understanding about people in facilities and mutual intentions check in a team are important in all over social welfare institutions. On the other hand, it was indicated that the discussion about the support of public assistance in stitutions is insufficient. Future research topics are shown

Rho ROCK ケイロ ワ シンキン サイボウ ヒダイ ニ オイテ extracellular signal-regulated kinase GATA-4 ノ カッセイカ ニ キヨスル

京都大学0048新制・課程博士博士(医学)甲第10068号医博第2578号新制||医||823(附属図書館)UT51-2003-H489京都大学大学院医学研究科内科系専攻(主査)教授 中尾 一和, 教授 野間 昭典, 教授 北 徹学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA