Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Western Fashion Exhibitions in Japan: A Study on Dress Construction and Historical Transformation in the 19th Century
Full text linkIn order to achieve one of the research goals of “A Study of Cross-dressing as Female Strategies in Modern England”, the author visited two fashion exhibitions: one held by Akira Hasegawa, a European antique garment researcher, and the other by KCI (the Kyoto Costume Institute) to study the general fashion history and dress construction and transformation in the West, especially in the 19th century. This report presents the findings and future research tasks based on these visits.departmental bulletin pape
Physiological and Pathophysiological Implications of Tight Junctions in the Liver
Full text linkThe liver is the primary organ for processing nutrients, detoxifying xenobiotics, and excreting bile acids. These essential physiological functions are intricately associated with the structural composition of hepatic tissues. Hepatocytes, the main functional cells of the liver, interconnect to form a complex three-dimensional network of hepatic cords that extends from the periphery to the center of the hepatic lobules. Within these hepatic cords, neighboring hepatocytes create intercellular channel-like structures known as bile canaliculi. These canaliculi serve as pathways through which bile acids are secreted and eventually transported into bile ducts. Tight junctions are integral components of cellular structures that act as barriers and regulate the movement of molecules between cells. In the liver, tight junctions play a crucial role in maintaining the structural integrity of the tissue and in regulating the passage of molecules and ions across hepatocytes and other cells. In addition, tight junctions are essential for establishing and maintaining the polarity of hepatocytes. Because of these important roles, the dysfunction of tight junctions is associated with several liver diseases. In this review, the physiological significance of tight junctions in the liver and their implications in hepatic diseases are described.journal articl
Survey of Oral Diseases in Myaungmya District, Republic of the Union of Myanmar
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We conducted a survey on the actual conditions of oral diseases and oral hygiene in Myaungmya district in the remote delta region of Republic of the Union of Myanmar (Myanmar). The total number of subjects surveyed was 1277, 770 aged 12 and older, 507 aged under 12, 583 males, and 694 females. The prevalence of dental caries and gingivitis were 65.4% and 52.9%, respectively in total subjects. The prevalence of dental caries and gingivitis were 62.9% and 53.0%, respectively in two schools attended by children aged 3-17 years. The prevalence of dental caries and gingivitis was 82.4% and 52.1%, respectively, among the villagers, including both infants and the elderly. In each school, early caries of C1 and C2 were predominant, while advanced caries of C3 and C4 were present in a significant number of subjects, although they were progressively less common than those of C1 and C2. The elderly villagers also had a large number of missing teeth. The prevalence of malocclusion was 9.9%, 95 patients (7.4%) had dental crowding, 32 (2.5%) had mandibular prognathism and maxillary prognathism. After recognizing the situation of the oral health condition in Myanmar, we can take appropriate measures for children in Myanmar to maintain oral functions and oral hygiene that support the overall health.journal articl
Prognosis of Extremely Premature Infants and Very-Low-Birth-Weight Infants
Full text link極低出生体重児・超低出生体重児および超早産児は，出生後の様々な問題点に対してNICU での集中管理が必要である．これらの児は2007 年以降，出生数が年々減少傾向であり，その原因として出生数全体の減少の影響，産科の妊娠継続技術の向上，多胎の減少が考えられる．超低出生体重児および超早産児の生存退院率は年々上昇しているが，退院後の3 歳時全国調査によれば，脳性麻痺・視覚障害・聴覚障害・知的障害（発達遅滞）の合併が大きな問題である．特に脳性麻痺・視覚障害・知的障害については在胎週数が短いほどその合併率が高いことが報告されている．さらに，自閉症スペクトラム障害などの発達障がいの合併率も高い．極低出生体重児・超低出生体重児で出生した児では，これらの神経学的合併症についての経時的な長期フォローアップが必要である．6 歳以降の知能指数については，9 歳時は6歳時に比べて知能指数が上昇しているという報告がいくつかある．また，神経学的合併症の他にも，DOHaD 仮説を踏まえた青年期～成人期の慢性腎臓病・インスリン抵抗性・高血圧にも注意が必要である．Very-low-birth-weight infants （VLBWI），extremely-low- birth-weight infants （ELBWI），and extremely premature infants require intensive care after birth to deal with various problems. Since 2007, the number of births of these infants has been decreasing year by year, and this is thought to be due to the overall decrease in the number of births, improvements in obstetric pregnancy continuation techniques, and a decrease in multiple births. The survival and discharge rate of ELBWI and extremely premature infants is increasing year by year, but according to a nationwide survey of infants at age 3 after discharge, the comorbidity of cerebral palsy, visual impairment, hearing impairment, and intellectual disability （developmental delay） are major problems. It has been reported that the comorbidity rate of cerebral palsy, visual impairment, and intellectual disability is particularly high the shorter the gestational age. In addition, the comorbidity rate of developmental disorders such as autism spectrum disorder is also high. Long-term follow-up of these neurological complications over time is necessary for infants born as VLBWI and ELBWI. There are several reports that IQ increases at age 9 compared to age 6 after age 6. In addition to neurological complications, attention should also be paid to chronic kidney disease, insulin resistance, and hypertension in adolescent and adulthood by considering DOHaD hypothesis.journal articl
The Struggles of Japanese Youth：Suicide and Comprehensive Support for Junior and Senior High School Students in the Post-COVID World
Full text link日本の若者の自殺率は国際比較でも高く，若者の孤立を防ぐためのメンタルヘルス支援の充実が喫緊の課題である．その背景には，家庭内や友人関係の問題以外に，学業，社会的プレッシャー，インターネット依存，自殺助長サイトなど，複数の要因が複雑に絡み合っている．日本のサブカルチャーも若者の心理に影響を与えている．小説，マンガ，アニメ，J-POP における孤独や絶望をテーマとした作品は，若者に共感を呼び起こすが，同時に自己否定的な思考を助長する要因にもなる．こうした社会文化的な背景とともに，コロナウイルス感染症2019 による社会的制約や孤立感が若者の無気力や心理的負担を大きくした．その結果，アフターコロナでも小中高生の自殺が高止まりし，不登校児童が増加している．自傷行為やオーバードーズは，ストレスを一時的に緩和する手段として用いられる反面，心理的孤立や脳内物質の変動を背景にエスカレートする危険性がある．一方，児童精神医療や学校教育では，心理士の配置不足や従来の道徳教育の限界といった課題が残る．法的にも，SNS の自殺助長サイトに対する規制強化やアクセス制限が求められている．本総説では，国内外の事例を参考に，若者の自殺予防に対する包摂的支援体制の構築，メンタルヘルス教育の拡充，SNS リテラシーの向上を提言し，社会全体で若者を複眼的に支える必要性を強調する．Japan’s youth suicide rate is notably high even in international comparisons, highlighting the urgent need for enhanced mental health support to prevent adolescent isolation. Beyond familial and peer relationship issues, factors such as academic stress, societal pressures, internet addiction, and suicide-promoting websites intricately intertwine. Japan’s subculture also influences youth psychology； works in novels, manga, anime, and J-pop that depict loneliness and despair evoke empathy yet may reinforce self-critical thoughts. The COVID-19 pandemic exacerbated societal constraints and feelings of isolation among youth, leading to increased lethargy and psychological burden post-pandemic. Consequently, adolescent suicides and school absenteeism have risen. Self-harm and overdose serve as temporary coping mechanisms but carry risks of escalating psychological isolation and neurochemical imbalances. Challenges persist in child psychiatric care and school education due to insufficient psychologists and limitations of traditional moral education. Legal measures calling for stricter regulations and access restrictions on social media suicide-promoting sites are warranted. This review advocates for a comprehensive support system based on domestic and international cases, emphasizing the need for expanded mental health education and improved social media literacy to uphold youth support across society.journal articl
Targeting PHGDH Improves Antitumor Action of LAT1 Inhibitor on Pancreatic Cancer
Full text linkL-type amino acid transporter 1 (LAT1) is predominantly expressed in a wide variety of cancer cells and plays a pivotal role in providing the amino acids required for cancer growth. LAT1 inhibition has attracted considerable attention as a novel strategy for cancer therapy. However, cancer cells can cope with nutrient deprivation, which reduces the efficacy of LAT1 inhibitor. Herein, we report that phosphoglycerate dehydrogenase (PHGDH) diminishes the antitumor effects of LAT1 inhibition. LAT1 inhibitor upregulated PHGDH in MIA PaCa-2 human pancreatic cancer cells. Furthermore, the antitumor effects of LAT1 inhibitor on MIA PaCa-2 were enhanced when combined with PHGDH inhibitor. Our results suggest novel strategy to improve the efficacy of LAT1 inhibitor in cancer therapy by targeting the nutrient starvation response.journal articl
Prognostic Analysis of Surgical Intervention for Trisomy 18 Syndrome in Dokkyo Medical University
Full text link周産期医療の進歩により，外科的疾患を合併した染色体異常症例の生命予後は向上しているが，生命予後不良な18 トリソミーにおける外科治療介入については，未だ明確なコンセンサスがなく，治療方針決定に難渋する．当院における18 トリソミー児を対象に，外科治療介入が生命予後に影響するかについて検討した．1986 年から2022 年に当院NICU に入院した18 トリソミー62 症例のうち，新生児期に転院した2 症例を除く60 症例を検討対象とした．症例数が均等になるように2 群に分類し， （1986 年～2006 年：A 群30 症例，2007～2022 年：B 群30 症例）， 診療録を基に後方視的に検討した．外科治療介入は， A 群4 症例（消化管手術），B群12 症例（心臓手術5 例，消化管手術7 例，髄膜瘤手術3 例）に行われた．1 か月未満の死亡例がA 群12 症例，B 群6 症例，1 年以上生存症例がA 群2 症例，B 群9 症例であった．Kaplan-Meier の生存曲線ではB 群で有意に生存率が高かった（p＝0.001）．自宅退院可能となったのは，A 群3 症例，B 群4 症例であり，術前に人工呼吸器管理が必要な症例や，食道閉鎖症など重症な合併症例は，両群とも予後不良であった．自宅退院を目標とした児の生活の質を向上させるために，どのような外科治療を行うかについて更なる検討が必要である．Trisomy 18（T18） syndrome is the second most common autosomal trisomy and is known for its severe prognosis. Therefore, there are still no established treatment guidelines for patients with T18 and it is difficult to decide on a treatment plan. This retrospective cohort study aimed to evaluate whether surgical interventions improved the prognosis of patients with T18 at our hospital. 62 patients with T18 admitted to our hospital, excluding two patients who were transferred between 1986 and 2022. The patients were divided into two groups around the year 2007（ group A：30 cases, group B：30 cases）. Surgical interventions were performed on 4 patients in group A （gastrointestinal surgery） and 13 patients in group B（ cardiac surgery in 5 cases, gastrointestinal surgery in 7 cases, and meningocele repair in 3 cases）. There were 12 deaths within 1 month in group A and 6 patients in group B. The survival time was more than 1 year for 2 patients in group A and 9 patients in group B. Kaplan-Meier survival curves showed that survival was significantly higher in Group B （p＝0.001）. Three patients in group A and four patients in group B were discharged home. Patients who required preoperative ventilatory management or had severe complications such as esophageal atresia had a poor prognosis in both groups. Further studies to determine what surgical treatment options should be selected to improve the quality of life of children with the goal of discharge to home.journal articl
Review for Research on Late Preterm Infants and Circumstances of Mothers
Full text link【目的】 国内における後期早産児に関する研究を概観し，研究動向を把握することを目的とした．
【方法】 医中誌Web 版を用いて「後期早産/AL」OR「late preterm/AL」と検索し，原著論文に絞って文献検索を行った．分析対象となった37 件を筆頭著者の所属別に分類し，年次推移をみた．さらに，医学研究と看護学研究に分類し，本文から研究目的，対象，方法，結果を把握した．看護学研究については本文を精読し，そのうち家族を対象とした研究の内容を質的に統合した．
【結果】 医学研究は29 件であり，後期早産（児）の疫学調査10 件，児の脳障害に関する指標5 件，前期破水3 件，児の長期予後2 件，母体ステロイド投与2 件，母体へのリトドリン投与，双胎妊娠管理，妊娠出産の満足度，母乳育児支援による早期退院，児へのパリビズマブ投与，児の血清リポ蛋白，次回分娩が各1 件であった．看護学研究は8 件であった．研究対象は，家族4 件，児2 件，助産師1件，医療機関1 件であった．母親を対象とした看護学研究より，後期早産児の母親の状況を示す7 カテゴリ〘思っていたのと異なり戸惑う〙〘言われるままに行動する〙〘試行錯誤する〙〘自責の念を抱く〙〘一喜一憂する〙〘安堵する〙〘前向きに考える〙が抽出された．
【結論】 後期早産児に関する国内の研究は医学研究が多く，看護学研究は発展途上にあることが示された．後期早産児の母親の状況は，出産前から退院後の生活に至るまで繰り返される戸惑いや試行錯誤に特徴づけられ，戸惑いや試行錯誤の内容として多く挙げられていたのは授乳に関することであった．今後，後期早産児とその家族への看護学的視点による研究を推進していく必要が示された．departmental bulletin pape
Transapical Transcatheter Aortic Valve Implantation for a Patient with Severe Iliac Artery Stenosis: Our Surgical Ingenuity for Frail Patients
Full text linkWe started transcatheter aortic valve implantation (TAVI) in 2018, and while accumulating 391 cases, we have developed a transapical approach that can be performed safely with good reproducibility, so we will introduce our surgical ingenuity in this case report. The case was an 85-year-old woman diagnosed with symptomatic severe aortic valve stenosis. Considering her age, surgical risk, and frailty, TAVI was indicated. Although the aortic annulus was small, her aortic root anatomy was suitable for TAVI. Because of occlusion and severe stenosis at the bilateral iliac arteries, a transapical approach was chosen. After 5th intercostal left thoracotomy, two horizontal mattress sutures of 3-0 prolene SH needles with felt were placed near the apex of the left ventricular anterior wall, in which the stiff wire was punctured and placed. After inserting the 18 Fr sheath, the SAPIEN3 23 mm is implanted uneventfully without peri-valvular regurgitation which was confirmed by transesophageal echocardiogram. The sheath was removed and the puncture site was closed with already placed 3-0 prolene sutures under ventricular tachycardia induced by temporary pacing in order to control blood pressure and wall tension at the apex. The postoperative course was uneventful and she was discharged to home a week after surgery.journal articl