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日本における公的医療保険制度と混合診療
Get PDFapplication/pdfSummaryThe Japanese public medical insurance system and lifting of the ban on mixed medical
care are historically reviewed.The fundamental issue of medical insurance is how to secure financial resources to compensatefor the increase in medical expenses. In the future, Japan’s low socio–economic growth due to a declining population caused by a falling birth rate and other factors is unlikely to offset the growth in medical expenditure due to the introduction of medical care for the old persons and advanced medical technology and new drugs. To estimate national
medical expenses by financial resources, they are divided into three categories, i.e., insurance
premiums, public expenses (taxes), and patients’ expenses. However, issues of burden–sharing and ratio should be continuously discussed.Regarding the issue of the total lifting of the ban on mixed medical care, safety and effectiveness should be secured by the non–insured associated medical expenses system with the universal medical insurance system maintained, to facilitate insurance listing for continued improvement of the quality of medical care (safety and effectiveness), access (fairness),and cost (efficiency).However, the issue of financial resources for medical expenses has generally been discussed with the issue of mixed medical care, because maintaining the universal insurance system (social profit) conflicts with receiving advanced medical care (personal profit).journal articl
多発性骨髄腫患者における骨吸収抑制剤関連顎骨壊死の保存的治療に成功した1例
Get PDFapplication/pdfSummary.Bone resorption inhibitors,such as bisphosphonates and denosumab,are widely used to treat bone lesions caused by disorders of bone metabolism,multiple myeloma,and bone metastases from solid tumors,and the occurrence of antiresorptive agentrelated osteonecrosis of the jaw (ARONJ) is increasing.Currently,surgical treatment is recommended;however,case reports are sparse and there is no established global consensus on treatment.We report the case of a 75–year–old female patient with osteonecrosis of the mandible following bisphosphonate administration for the treatment of multiple myeloma,who was cured by conservative treatment alone.The patient had multiple myeloma and,therefore,had been receiving bisphosphonates for about 24 months prior to her first visit to Matsumoto Dental University Hospital.During periodontal treatment,the patient underwent extraction of the left mandibular wisdom tooth.About 6 months later,bone exposure was observed in the same area,and coexisting osteomyelitis of the jaw was diagnosed.Conservative treatment involving oral hygiene instructions,several doses of antibacterial agents,and frequent rinses was chosen for the bone exposure.About 6 months after the start of such treatment,the decayed bone had disappeared,and after 7 months,the mucosa had completely sealed.Disappearance of the findings of osteomyelitis was assessed by MRI.The infection tended to spread during the clinical course of the disease,but improved with conservative treatment alone,and the exposed area of bone has since epithelialized.We reaffirmed the importance of collaboration and sharing information on the medical history and medications between physicians and dentists while treating patients with primary diseases indicated for bisphosphonates.journal articl
骨形成抑制因子であるスクレロスチン欠損マウスにおけるBMP-2誘導性異所性骨の解析
Get PDF松本歯科大学大学院歯学独立研究科博士（歯学）学位申請論文;健康増進口腔科学講座（主指導教員:吉成 伸夫教授）application/pdfothe
間葉系幹細胞の骨芽細胞分化における細胞老化の影響
Get PDF松本歯科大学博士（歯学）2022甲第250号application/pdf[要旨]加齢に伴い, 骨量が減少し骨髄脂肪が増加することが知られている．この原因として，細胞老化が骨芽細胞への分化を抑制し，脂肪細胞への分化を促進するためであると考えられている．しかし，細胞老化が間葉系間質細胞の骨芽細胞への分化を抑制する機構は，十分に解明されていない．我々は骨髄間質系株化細胞であるST2細胞の骨芽細胞分化に及ぼす細胞老化の影響を検討した．ST2細胞を55回以上継代し，細胞老化を誘導した．この継代数55回以上 (late passage) のST2細胞の性質を継代数8回以下 (early passage) の ST2細胞と比較した．Late passage ST2細胞はearly passage ST2細胞と比較し，顕著な細胞増殖の低下を示した．また，老化マーカーであるSenescent-Associated β-Gal (SA-β-Gal) 染色陽性を示した．リアルタイムPCR解析の結果late passage ST2細胞は老化マーカーp16 mRNA，p21 mRNAの発現が増加し，Lamin B1 mRNAの発現が減少した．これらの結果からlate passage ST2細胞は細胞老化を呈することが示唆された．次に，ST2細胞を石灰化誘導培地で培養すると，late passage ST2細胞は石灰化不全を示した．Early passage ST2細胞をWnt3aで刺激するとアルカリホスファターゼ活性が誘導された．一方，late passage ST2の培養では，Wnt3aによるアルカリホスファターゼ活性の誘導が低下した．Wnt3a誘導性が減少する原因を検討するためにWnt/β-カテニンシグナル阻害因子の遺伝子発現を調べるとlate passage ST2細胞においてDkk1 mRNAの発現が上昇した．CHIR99021を用い，Wnt/β-カテニンシグナルを活性化させると継代数にかかわらずアルカリホスファターゼ陽性細胞が増加した．late passage ST2細胞へsi-Dkk1を導入するとDkk1 mRNAの発現量が減少しWnt3aへの感受性が改善された．他の老化誘導方法 (p16あるいはH-Ras G12Vの過剰発現) を行ったST2細胞において老化マーカーやDkk1 mRNA発現の上昇が確認できた．また，p16やH-Ras G12Vの過剰発現による細胞老化誘導されたST2細胞においてWnt3aによるアルカリホスファターゼ活性の誘導は低下した．以上の結果から細胞老化を誘導されたST2細胞はDkk1の発現が上昇し，Wnt誘導性のアルカリホスファターゼの発現が低下することで骨芽細胞への分化が抑制される可能性が示唆された．doctoral thesi
クワドヘリックスにおける歯の移動メカニクス-有限要素法シュミーション-
Get PDF松本歯科大学大学院歯学独立研究科博士（歯学)学位申請論文;硬組織疾患制御再建学講座（主指導教員:岡藤 範正教授）application/pdfothe
う蝕リスクを視覚的に示した口腔衛生指導が唾液SM 菌レベルの低下に効果的だった1 症例
Get PDFapplication/pdfSummary In this case, a high dental caries risk was identified in the initial examination was initiated to reduce and dental plaque control SM bacteria levels in saliva. The effect of reducing SM bacteria levels in saliva was confirmed, and this effect continued even after 6 months. It was suggested that dental plaque control using visual materials such as specific guidance on tooth surface cleaning methods, phase-contrast microscopy, and SM bacteria culture results was effective to maintain patient motivation. It was found that this method has a marked effect not only on grasping the test values but also on the motivation of the patient.journal articl
