Showa University Academic Resource Repository / 昭和大学学術業績リポジトリ
Not a member yet
3721 research outputs found
Sort by
口腔腫瘍切除後の下顎骨欠損に対する再生治療
Get PDF口腔腫瘍切除後の下顎欠損に対しては，審美性と機能性を確保するために下顎の連続性を回復する必要がある．従来，下顎骨欠損の連続性を回復するために，再建プレート，遊離骨移植，血管柄付き遊離骨移植などが用いられてきた．近年では，CTデータを用いて骨切り部位を決定し，血管柄付き遊離骨移植片や骨髄海綿骨細片（particulate cancellous bone and marrow：PCBM）を用いた再建プレートとカスタムメイドのチタンメッシュトレーを用いて下顎骨再建が行われている．本論文では，微小血管吻合を伴う遊離腓骨皮弁と，腸骨稜から採取したPCBMを用いたカスタムメイド・チタンメッシュトレーを用いた下顎骨の再建について解説する．departmental bulletin pape
Effect of mastication on adult hippocampal neurogenesis in mice
Get PDFThe number of neurons in the brain increases over time, even in adults. This phenomenon, known as “neurogenesis”, is associated with neural stem cells present only in the dentate gyrus of the hippocampus. However, the frequency of neurogenesis is regulated by various factorsand mastication has been suggested as one such factor. In the present study, we examined the effects of varying the input of masticatory stimulation on neural stem cells using feed with different degrees of hardness. Male C57BL/5 mice were used in a comparative study. After weaning at 3weeks old, experimental mice were fed a soft or hard diet for 4 or 11weeks. To study the dynamic behavior of neural stem cells, the expression of two markers （nestin, a neural stem/progenitor cell marker; and doublecortin, a microtubule-associated protein） was quantitatively analyzed via immunostaining, whereas gene expression was analyzed by real-time polymerase chain reaction （RT-PCR）. Immunostaining-based quantification and gene expression analysis by RT-PCR revealed the decreased expression of markers in the hippocampus in the soft diet group compared to that in the hard diet group. Based on these results, the repression of neurogenesis by a soft diet was associated with changes in neural stem cells in the hippocampus and the frequency of neurogenesis.departmental bulletin pape
Incidence and clinical characteristics of hepatic steatosis following pancreatectomy
Get PDFHepatic steatosis following pancreatic resection is a growing concern. Pancreatic enzyme replacement effectively treats the problem; however, the risks of hepatic steatosis remain unknown. In this study, we evaluated the risks of hepatic steatosis on 104 patients who underwent pancreatic surgery. Moreover, the effect of pancrelipase administration at 900mg/day, one of the pancreatic enzyme replacement therapies, on hepatic steatosis was evaluated. Twenty-one patients （20％） developed hepatic steatosis following pancreatic surgery. Low neutrophil-to-lymphocyte ratio （NLR）（p＝0.027） was identified as a risk factor for postoperative hepatic steatosis in the 104 participants following pancreatectomy. Particularly, in the 62 participants who underwent pancreaticoduodenectomy, younger age （p＝0.045）, lymphocyte-to-monocyte ratio （p＝0.029）, and lymph node metastasis （p＝0.026） were identified as risk factors for postoperative hepatic steatosis. Of the 10 patients with newly developed liver steatosis following pancreatoduodenectomy who could be evaluated, 6 improved with pancrelipase dose escalation, whereas 4 improved without escalation. In conclusion, this study suggested that immune-nutritional parameters including low NLR or high NMR can be closely associated with risk factors for hepatic steatosis following pancreatic surgery. Pancrelipase administration following pancreatic surgery may be optimal with doses starting at 900mg/day and increased when steatosis occurs.departmental bulletin pape
Retrospective study of involuntary admission by order of the prefectural governor for individuals attempting self-harm and suicide
Get PDFFor individuals attempting suicide and self-harm, appropriate assessment and treatment interventions are essential to prevent reattempts. Patients involuntarily admitted to a psychiatric hospital by order of the prefectural governor frequently experience severe psychiatric symptoms and face several problems and difficulties. This retrospective study involved surveying 412 patients who were involuntarily admitted to our hospital from January 1, 2010 to March 31, 2022 by order of the prefectural governor for self-harm or suicide attempts. Of these, 98 patients continued treatment at our facility （“our hospital group”） and 314 patients were transferred to other psychiatric facilities （“other hospital group”）. The occurrence of suicide reattempt, readmission, administrative involuntary admission, and mortality rate associated with suicide reattempt following discharge were analyzed as prognostic factors. This study aimed to compare the prognostic factors of the two groups and evaluate their characteristics and differences. Compared with patients in the “other hospital group,” those in “our hospital group” had a significantly longer length of stay and more social services, tended to live alone or in a facility following discharge, and had a significantly higher readmission rate. Furthermore, the rate of mortality caused by suicide was lower in “our hospital group” than in the “other hospital group,” although not statistically significant. Our data did not reveal any differences in the prognosis of patients in both groups. However, despite the requirement for better adjustment to environmental conditions following discharge in “our hospital group,” the use of social services and readmission might be effective interventions. Our findings indicated that the characteristics in “our hospital group” are probably associated with improved prognosis.departmental bulletin pape
Maxillary-sinus ballooning for orbital floor fracture repair: short-term evaluation of enophthalmos and oculomotor dysfunction
Get PDFMaxillary-sinus ballooning is used for two weeks to support the reconstructed orbital floor following blowout fractures. This study sought to assess the degree of enophthalmos and oculomotor dysfunction prior to and following balloon removal, as well as the support provided by the balloon. Patients who had orbital floor fracture reconstruction with maxillary-sinus ballooning between July 1, 2015, and June 30, 2018, and completed follow-up two weeks after balloon removal were eligible. The evaluation items included the type of fracture, balloon indwelling duration, degree of enophthalmos in the operated and fellow eyes before and after balloon removal, Hess Area Ratio （HAR％）, and changes in balloon volume from insertion to removal. We studied 64 eyes from 64 patients （44 men and 20 women; average age 38.9±14.7 years）. Open and closed fractures were found in 55 and 9 patients, respectively. The open- and closed-fracture groups had an average balloon indwelling duration of 11.6±2.1 and 12.6±1.6 days, respectively. The degree of enophthalmos before and after balloon removal in the two groups was 0.18±0.33mm and −0.11±0.29mm （p＝0.16） and 0.06±1.01mm and −0.39±0.88mm （p＝0.45）, respectively. The degree of enophthalmos was similar between the groups before and after balloon removal. The pre- and postoperative HAR％ in the open- and closed-fracture groups were 52.2％±24.6％ and 80.3％±26.4％, （p＜0.0001）, respectively, and 58.0％±26.9％ and 84.1％±23.0％ （p＝0.01）. The average change in balloon volume was 22.9％±35.8％, with 15 cases showing volume reduction ≥50％ from insertion to removal. There was no significant difference in enophthalmos between cases with ≥50％ and ＜50％ leakage of balloon contents. Short-term evaluations demonstrated the efficacy of maxillary-sinus ballooning within 2 weeks in reconstructing the orbital floor following a blowout fracture without enophthalmos and oculomotor dysfunction. Long-term evaluation should be clarified in future studies.departmental bulletin pape
Maternal glycosuria during pregnancy as a risk factor for obesity in female offspring of reproductive age
Get PDFWe examined the effects of maternal glycosuria during pregnancy on obesity in female offspring of reproductive age （Offspring-Re）. Data from Maternal and Child Health Handbooks maintained by the mothers of Offspring-Re at the time of their births were used in this single-center study. Offspring-Re with records of maternal glycosuria during pregnancy and pre-pregnancy body mass index （BMI） were recruited. Positive maternal glycosuria during pregnancy was defined as having at least one recorded （＋） or higher in the handbook. Obesity in Offspring-Re was defined as a pre-pregnancy BMI of ≥25kg/m2. To estimate the effect of maternal glycosuria on obesity in Offspring-Re, logistic regression analysis was performed. Of the 313 Offspring-Re included, maternal glycosuria was positive and negative in 45 and 268, respectively. The incidence of obesity in Offspring-Re was 13.3％ and 2.6％ in the positive and negative maternal glycosuria groups, respectively （p＝0.005）, and increased with the degree of maternal glycosuria （p＝0.0001）. Multiple logistic regression analysis revealed that positive maternal glycosuria during pregnancy was a significant risk factor for obesity in Offspring-Re, even after adjusting for maternal pre-pregnancy BMI, gestational weight gain, and maternal high blood pressure during pregnancy （adjusted odds ratio, 5.50; 95％ confidence interval, 1.55-19.15; p＝0.010）. Collectively, these findings indicate that maternal glycosuria during pregnancy is a risk factor for obesity in Offspring-Re.departmental bulletin pape
人工膝関節全置換術後の深部静脈血栓症に対する早期理学療法介入の有用性
Get PDF深部静脈血栓症（以下DVT）は人工膝関節全置換術（Total Knee Arthroplasty：以下TKA）術後の合併症として発生頻度が高く，肺塞栓症（以下PE）を引き起こし，重篤な症状を来す事もある為，予防の重要性が指摘されている．近年，術後早期の理学療法介入によりDVTが減少したとの報告が散見されているが，本邦での報告は未だ少ない．当院では2017年よりDVT・PE予防として手術当日からの早期理学療法介入を実施している．本研究は，TKA手術当日の理学療法介入によるDVT予防に対する有用性を検討する事とDVT発症に関与すると思われる背景因子の検討を行う事を目的とする．2017年から2021年までに昭和大学藤が丘病院にてTKAを施行された319例を対象とし，患者カルテから患者背景，手術情報，手術当日の理学療法介入の有無，術後の超音波画像診断により下肢DVTの有無を抽出し，DVT発生の有無を理学療法介入群と非介入群で比較し，さらにDVT発生に関与する因子の検討を行った．結果は，片側TKAのDVT発生率は介入群が有意に低値を示した．両側TKAにおいても介入群が有意に低値を示した．またロジスティック回帰分析によりDVT発生因子として当日リハビリ介入の有無と性別が抽出された．手術後のDVTの多くは術直後から翌日までに形成されていると報告されており，術後不動となる時間に理学療法介入を行うことによって滞った血流を改善し，血栓形成の予防につながった事が示唆された．departmental bulletin pape
Reconstruction Filterの違いが3D Rotational Angiographyにおける血管径計測に及ぼす影響
Get PDF頭部IVRの急速な進歩に伴い，さまざまな種類の頭蓋内ステントが使用されており，また巨大動脈瘤に対してのみ可能なフローダイバーターステント治療（FD）は，5mm以上の動脈瘤に適応が広がり，今後FD治療の増加が予測される．FD治療においては，留置したステントの血管壁への圧着が重要であり，正確な血管径の計測によるステントサイズの選択が治療成功の鍵とされている．血管計測を行う際には，3DRA画像により，Stent留置部の血管構築を正確に把握した上で，3次元再構成画像，digital subtraction angiography（DSA）の2次元画像をもとに，計測を行い，留置部の血管径，想定留置長から使用するデバイスの径と長さが選択されている．本研究では，3DRA画像における再構成関数Reconstruction Filter（RF）を変化させた際の脳動脈瘤径および血管径の計測に関する影響について，DSAでの2D画像計測も含めて検討を行った．計測を行う際には，2D計測では計測対象をアイソセンターに配置撮影を行うことで測定誤差が少なくなる．3DRAでの3D計測は，過大評価の傾向を示すため，高周波数成分を強調するような再構成関数で再構成を行い，また閾値を変更するなど画像の鮮鋭化を行うことで測定誤差を小さくすることが可能となる．departmental bulletin pape
新カリキュラムの概要
Get PDF昭和大学医学部では，医学教育を社会の進歩に合わせて進化させるために，2020年度の新入生から新カリキュラムを導入しました．新カリキュラムは，初年次から診療の基本的技能を学び，2年次後期から4年次前期まで週に1日の見学型臨床実習を取り入れました．4年次の夏に共用試験に合格すると，6年次の夏までの約2年間，診療参加型臨床実習に取り組みます．授業は基礎医学に続いて基礎・臨床統合教育を導入し，いずれもアクティブ・ラーニングを主体にしています．ひとコマは90分から65分に短縮し，出席はとりません．学生は予めオンデマンド講義（1コマ20分）を視聴してから授業に参加します．学生を信頼し，教育職員が責任を持って国際的レベルの医学教育を導入した結果，新カリキュラムで学んだ学生はモチベーションが高く自律的に学修する習慣を獲得しています．
昭和大学医学部の学生と教育職員は，日本一です！departmental bulletin pape