Showa University Academic Resource Repository / 昭和大学学術業績リポジトリ
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薬学基礎と薬物治療を関連付けた演習科目による学生の意識変化
Get PDF医療の進歩に伴い，薬剤師の役割が多様化し，薬学教育における課題も増加している．その1つとして，薬学基礎と薬物治療の間にあるギャップを埋めることが挙げられる．基礎科目と専門科目の学びを体系的かつ継続的に促進するために，昭和大学薬学部では，2年生を対象に「薬学基礎から薬物治療へ 演習」を2021年度から導入した．本研究では，本演習科目が学生の意識に与える影響を評価することを目的とし，昭和大学薬学部の2年生にアンケート調査を実施した．その結果，学生はこの演習科目を通じて，薬学基礎と薬物治療の関連性を意識できるようになり，学修意欲も向上することが示唆された．また，グループ学修の取り組みが知識の深化に寄与したことが明らかとなった．このような学びの過程は，学生が薬剤師として求められる実践的スキルを身につける基盤となることが期待される．今後は，本演習科目を受講した学生の学修意欲がどのように継続しているのか，さらに臨床実習への影響がどの程度現れるかについてなど，さらに検証を進める必要がある．また，本演習の教育効果を最大化するための最適な方法に結び付けていくとともに，教育の質向上を目指した多角的な研究を引き続き実施していく必要がある．このような取り組みを通じて，基礎知識と専門的実践スキルを結びつける薬学教育モデルの一端を構築していきたい．departmental bulletin pape
下顎骨骨折患者に対し，インダイレクトボンディングシステムを用いて顎間固定用ブラケットを装着した1症例
Get PDF下顎骨骨折が発生した場合，顎骨の偏位に伴う従来の咬合関係が喪失されるため，上下顎歯列の咬合関係を回復させる必要がある．そのために，上下顎骨を顎間固定する．昭和大学歯科病院では顎骨骨折時にサージカルブラケットと線副子を用いた顎間固定を行なっている．サージカルブラケットの装着には，患者歯列の1歯1歯に直接ブラケットを装着するダイレクトボンディング法を用いており，その後，線副子固定のためにステンレススチールワイヤーを患者の歯列に沿うように屈曲する必要がある．両者ともに熟練した技術の他，開口状態を長く維持させることが必須となる．以上のことから，顎骨骨折患者に対し，従来の方法は大きな負担となっており，加えて長いチェアタイムが懸念されている．そこで，インダイレクトボンディングシステムを用いてサージカルブラケットを装着し，チェアタイムの短縮を検討したので報告する．本症例は69歳女性，両側下顎頸部の骨折に伴い，顎間固定を行うこととなったため，インダイレクトボンディングシステムにてサージカルブラケットを装着し，線副子固定を行ったところ，チェアタイムは30分程度であった．ダイレクトボンディング法では50分程度のチェアタイムを必要とするため，大幅な時間の短縮を行うことができた．今回はアルジネート印象材を用いて印象採得を行い，作業用模型の作製を行った．近年のIOS（インターオーラルスキャナー），および3Dプリンターの技術の向上に伴い，下顎骨骨折におけるデジタルワークフローの整備が行われれば，光学印象を用いて作業用模型を作製し，本報告の様にインダイレクトボンディングシステムを用いることで，更なる患者負担を軽減することが期待される．departmental bulletin pape
Vaginal douching may prevent preterm delivery in singleton pregnant women with a short cervix and lower genital tract inflammation
Get PDFTo determine the effectiveness of vaginal saline douching in patients with a short cervix and subclinical cervical infection. Pregnant women at 16-26 gestational weeks with a cervical length of ≤25mm were randomized into the bed rest therapy without vaginal douching （BR group） and the bed rest therapy with vaginal douching （VD group）. Patients in the BR group had no asymptomatic vaginal infection, whereas those in the VD group developed an asymptomatic vaginal infection. The BR group was allowed a 2-week bed rest, and the VD group was provided bed rest and vaginal douche with 500ml saline for 32 weeks. The other treatment measures were standardized. The primary and secondary endpoints were premature birth （weeks of delivery） and transition to the “rescue arm” defined as the rate of tocolytic drug use, respectively. We analyzed 30 and 35 cases in the BR and VD groups, respectively, including those transitioning to the “rescue arm.” Patient background and delivery outcomes, including mean delivery time, weeks from allocation to delivery, birth weight, and neonatal outcomes, did not significantly differ. The VD group had a longer gestational period than the BR group （up to 32 gestational weeks）. The VD group had a significantly higher 70-day pregnancy extension effect than the BR group （p＜0.05）. Moreover, the VD group （10 cases ［28.6％］） showed a lower but nonsignificant tendency to transition to the “rescue arm” than the BR group （12 cases ［40.0％］）. In patients with a short cervix, cervicitis, or vaginitis, vaginal saline douching may prolong the gestational period and reduce preterm births, thereby improving maternal and neonatal outcomes.departmental bulletin pape
Febuxostat inhibits airway inflammation and lung fibrosis in a mouse model of lipopolysaccharide-induced lung injury
Get PDFReduced adenosine triphosphate （ATP） levels due to mitochondrial dysfunction induces lung injury in acute respiratory distress syndrome （ARDS）. Considering that febuxostat improves mitochondrial dysfunction and reduces ATP consumption, its effects were investigated in a mouse model of lipopolysaccharide （LPS） -induced lung injury. Male C57BL/6 mice were intratracheally stimulated with LPS. Febuxostat was administered for 4 or 10 days, and LPS stimulation was performed on Day 3 of febuxostat treatment. At 24 h or 7 days after LPS stimulation, we collected mouse bronchoalveolar lavage fluid （BALF） for determination of cell count and inflammatory cytokine levels and lung tissue for histopathological analysis of fibrosis. BALF total cell and neutrophil counts were significantly lower in the LPS＋febuxostat group than in the LPS-only group at 24 h after LPS stimulation and returned to the same levels as those in the control group in both the LPS-only and LPS＋febuxostat groups at 7 days after LPS stimulation. In addition, the percentage of collagen deposition areas in the entire lung field was greater in the LPS-only group than in the control group. Notably, febuxostat treatment reduced lung fibrosis in the LPS-stimulated group. Seven days after LPS stimulation, interleukin （IL） -8 production in the BALF was suppressed in the LPS＋febuxostat group but not in the LPS-only group. Febuxostat suppressed lung inflammation and prevented lung fibrosis by reducing IL-8 involvement in fibrosis in a mouse model of LPS-induced lung injury. These findings suggested that febuxostat may improve ARDS-associated lung injury.departmental bulletin pape
Upward lesion orientation on an endoscopic monitor is an independent factor affecting difficulty of colorectal endoscopic submucosal dissection: a retrospective study
Get PDFTo investigate the association between lesion orientation on the endoscopic monitor and colorectal endoscopic submucosal dissection （ESD） difficulty. We performed ESD for 406 consecutive colorectal tumors between January 2019 and August 2024. Multivariate logistic regression analysis was conducted on the following factors related to difficult ESD and incomplete ESD: tumor size （≥40mm or ＜40mm）, lesion location （right or left colon）, lesion orientation on the endoscopic monitor （upward or downward）, submucosal fibrosis （F0/1 or F2）, tumor invasion depth （Tis, T1a, or T1b）, and operator’s experience in colorectal ESD （beginner ［＜20 cases］ or nonbeginner ［≥20 cases］）. Procedures requiring ≥120min indicated difficult colorectal ESDs. The mean tumor size was 28.9±15.4mm, and the mean procedure time was 82.6±64.1min. Tumor size≥40mm （odds ratio ［OR］, 9.30; 95％ confidence interval ［CI］, 4.93-18.00; p＜0.001）, upward lesion orientation on the endoscopic monitor （OR, 3.79; 95％ CI, 2.06-7.04; p＜0.001）, and severe fibrosis （OR, 7.42; 95％ CI, 2.97-19.00; p＜0.001） were independent factors that increased colorectal ESD difficulty. Meanwhile, severe fibrosis （OR, 3.52; 95％ CI, 1.11-10.45; p＝0.033）, T1b invasion depth （OR, 3.30; 95％ CI, 1.07-9.34; p＝0.039）, and beginner operator （OR, 2.97; 95％ CI, 1.25-7.25; p＝0.035） were independent factors contributing to incomplete ESD. In addition to known intrinsic factors, such as large tumor size and fibrosis, the upward orientation of the lesion on the endoscopic monitor was identified as an independent factor that increased the difficulty of colorectal ESD.departmental bulletin pape
Three cases of severe drug-induced liver injury caused by abiraterone acetate in advanced metastatic prostate cancer
Get PDFAbiraterone acetate is used to treat high-risk hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer. However, drug-induced liver injury is a complication of abiraterone acetate administration. Drug-induced liver injury can be categorized as hepatocellular, cholestatic, or mixed type based on the R ratio derived from the ratio of alanine aminotransferase to alkaline phosphatase. Case 1: An 87-year-old man experienced liver injury caused by abiraterone acetate treatment of metastatic hormone-sensitive prostate cancer. Grade 4 aspartate aminotransferase and alanine aminotransferase increasing were observed for 6 weeks after treatment. The R ratio was 27.5; therefore, the drug-induced liver injury was diagnosed as the hepatocellular type. Case 2: A 66-year-old man experienced liver injury caused by abiraterone acetate treatment of metastatic castration-resistant prostate cancer. Four weeks after treatment, Grade 3 aspartate aminotransferase, Grade 4 alanine aminotransferase, and Grade 3 γ-glutamyl transpeptidase increasing were observed. The R ratio was 7.0; therefore, the drug-induced liver injury was diagnosed as the hepatocellular type.Case 3: A 74-year-old man experienced liver injury caused by abiraterone acetate treatment of metastatic hormone-sensitive prostate cancer. Four weeks after treatment, Grade 3γ-glutamyl transpeptidase and Grade 3 alkaline phosphatase increasing were observed. The R ratio was 0.4; thus, the drug-induced liver injury was diagnosed as cholestatic type. Severe drug-induced liver injury is a potential complication of abiraterone acetate therapy. Monitoring of liver function is recommended at least every 2 weeks for the first 3 months of treatment.departmental bulletin pape
Quantitative analysis of chest computed tomography of COVID-19 pneumonia using a software widely used in Japan
Get PDF昭和大学博士(医学)2024年度doctoral thesi
