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尿細胞診における従来法とLBC導入後の比較検討
Get PDF【はじめに】尿細胞診では細胞剥離が起こりやすく判定に影響することが多い。当院では従来、引きガラス法と二回遠心法を併用して標本を作製していたが、2016年3月からLBCを導入し、引きガラス法と併用している。今回はLBC導入前後の細胞診成績を比較検討した。【方法】2014年3月から2018年3月までに当院において行った尿細胞診は4502例であった。そのうち組織診断がなされた332例について、二回遠心法とLBC法(BDシュアパス)との細胞診成績の比較検討を行った。【結果】LBC導入前に比べ導入後で有意な差がみられたものは、細胞診でclassIIと判定された症例のうち組織診でInvasive urothelial carcinomaと診断された症例と検体不適正例であった。感度・特異度・正診率を比較した結果では、感度と正診率は上昇したが、特異度は大きく低下していたことが分かった。【考察】LBC導入により感度が上昇した要因として、細胞剥離の減少が考えられる。しかし、より多くの細胞を保持できる反面、変性したわずかな尿路上皮細胞を拾い上げてしまっていることが特異度の低下につながったと考えられる
N-ブチル-N-（4-ヒドロキシブチル）ニトロソアミン誘発膀胱癌マウスモデルを用いた膀胱内化学療法による局所及び全身の免疫応答
Get PDFIntravesical bacillus Calmette-Guerin (BCG) treatment is the most common therapy to prevent progression and recurrence of non-muscle invasive bladder cancer (NMIBC). Although the immunoreaction elicited by BCG treatment is well documented, those induced by intravesical treatment with chemotherapeutic agents are much less known. We investigated the immunological profiles caused by mitomycin C, gemcitabine, adriamycin and docetaxel in the N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN)-induced orthotopic bladder cancer mouse model. Ninety mice bearing orthotopic bladder cancer induced by BBN were randomly divided into six groups and treated with chemotherapeutic agents once a week for four weeks. After last treatment, bladder and serum samples were analyzed for cell surface and immunological markers (CD4, CD8, CD56, CD204, Foxp3, and PD-L1) using immunohistochemistry staining. Serum and urine cytokine levels were evaluated by ELISA. All chemotherapeutic agents presented anti-tumor properties similar to those of BCG. These included changes in immune cells that resulted in fewer M2 macrophages and regulatory T cells around tumors. This result was compatible with those in human samples. Intravesical chemotherapy also induced systemic changes in cytokines, especially urinary interleukin (IL)-17A and granulocyte colony stimulating factor (G-CSF), as well as in the distribution of blood neutrophils, lymphocytes, and monocytes. Our findings suggest that intravesical treatment with mitomycin C and adriamycin suppresses protumoral immunity while enhancing anti-tumor immunity, possibly through the action of specific cytokines. A better understanding of the immunoreaction induced by chemotherapeutic agents can lead to improved outcomes and fewer side effects in intravesical chemotherapy against NMIBC.博士（医学）・甲第695号・平成31年3月15日Copyright: © 2017 Hori et al. This is an open access article distributed under the terms of the Creative Commons Attribution License(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Effectiveness of a childbirth preparation program aiming to raise awareness about the need to prepare physically and to clarify perceptions regarding the options available for childbirth among young women: a quasi-randomized control study.
No full text【目的】青年期女性に対して、出産に向けての身体づくりの必要性や出産場所、出産方法の選択肢に関するプログラムを行い、出産に対する意識や認識への効果を明らかにする。【方法】18-24歳の女子学生を対象に、準ランダム化比較試験(層別ランダム化)を行った。介入群はパンフレット配布と講義、演習の前後、対照群はパンフレット配布の前後にアンケート調査を行った。評価指標としてVAS(visual analogue scale)を用いた。【結果】出産方法への関心の項目で、介入群が対照群に比べて得点が上昇し、有意差が見られた(f=4.282, p=0.048)。健康に関する項目では、全項目で両群に得点の上昇が見られた。【考察】講義や体験を通して、出産に対する意識や認識に変化が見られたことから、講義や演習が出産への関心を高めるために効果的であると考える。しかし、講義や体験を行うことは、現実的に困難な場合もある。今回、パンフレット配布によっても、意識や認識の変化に効果が見られたため、パンフレット配布も有効な支援と考える。OBJECTIVES: The aim of the present study was to assess the effectiveness of a childbirth preparation program aiming to raise awareness about the need to prepare physically and to clarify perceptions regarding the options available for childbirth, such as the type and place, among young women. METHODS: The participants in the present quasi-randomized control study (stratified randomization) were female university students aged between 18-24 years. All women in the intervention group were given information leaflets. Questionnaire surveys were administered before and after a lecture and practical training. The women in the control group were asked to complete a questionnaire survey before and after being given the information leaflets. A visual analog scale (VAS) was used for the assessments. RESULTS: The VAS scores for items regarding interest in child delivery methods were significantly increased in the intervention compared with the control group (f=4.282, p=0.048). ln addition, the VAS scores for all questionnaire items related to health increased in both groups. DISCUSSION: Changes were observed in the participants' awareness and perception of childbirth after the lecture and practical experience. These results suggest that childbirth preparation program implemented in the present study was effective for increasing interest towards childbirth. However, in reality, offering lectures and practical training may be difficult at times. Therefore, distributing information leaflets may be useful for improving awareness and perceptions about childbirth