看護師の異文化間看護能力の向上へ影響を与える教育上の因子

滋賀医科大学修士（看護学）令和6年度thesi

Comfortable Seatbelts for Pregnant Women with Twins in Japan: A Cross-Sectional Observational Study on Seatbelt Usage

滋賀医科大学博士（医学）Optimal seatbelt practices for pregnant women with twins at different gestational ages remain uncertain. To offer recommendations for a comfortable seatbelt system, this cross-sectional observational study explored seatbelt usage and driving habits among women with twins across various pregnancy stages through an online survey that explored driving conditions and comfortable seatbelts at different stages of pregnancy. Women who drove daily before their pregnancy with twins decreased their driving frequency as the pregnancy progressed. Correct seatbelt usage was lower and no seatbelt usage was higher among pregnant women with twins than those with singleton pregnancies. They adapted their seatbelt-wearing techniques to minimise pressure on the chest in the first and third trimesters and the abdomen from the second trimester onwards. The comfortable seatbelts were those that could alleviate belt pressure, featuring waist belts to reduce pressure, wider belts to avoid localised pressure, and shoulder belts resembling a backpack type. When wearing a seatbelt, avoiding pressure on the thorax and abdomen is key for pregnant women with twins. This study suggests that the suitability of driving for pregnant women with twins in their last trimester and the reliability of seatbelts designed for such women should be further examined and validated.令和6年度doctoral thesi

Continuous Increase in Podocyte Numbers in the First 36 Months of Life - Insights from Forensic Autopsies in Japanese Children

滋賀医科大学博士（医学）Abstract Background: Podocyte depletion is a critical factor in glomerulosclerosis development. While podocyte numbers per glomerulus typically decline with age in adults, they are hypothesized to increase during childhood. However, studies on podocyte number progression in childhood have been limited. Methods: This retrospective analysis examined forensic autopsy cases of Japanese children without kidney disease, aged under 192 months, between April 2010 and March 2023. Podocytes were identified using immunostaining with an anti-transducin-like enhancer of split 4 antibody and p57. Podometric parameters were estimated using the correction factor method, allowing estimation from a single histologic section. Results: This study included 68 cases with a median age of 9 months (interquartile range [IQR], 4–78). All podometric parameters correlated with age. Children younger than 36 months displayed significantly fewer podocyte numbers per glomerulus (median, 517; IQR, 483–546) compared to those aged 36 months and older (median, 616; IQR, 595–649; p<0.001). Regression analysis revealed a significant age-related increase in podocyte numbers per glomerulus in children under 36 months (slope, 3.76; p<0.001; 95% confidence interval [CI], 2.34–5.19), but not in those aged 36 months and older (slope, 0.25; p=0.16; 95%CI, −0.10–0.61). Additionally, the change in the slope at 36 months was significant (p<0.001; 95% CI, 1.02–2.49); however, this increase did not appear linked to podocyte division. Conclusions: Podocyte numbers per glomerulus increased from birth until 36 months and then stabilized. These findings could facilitate the development of novel treatments for chronic kidney disease caused by glomerulosclerosis and contribute to pediatric kidney health research.This version of the article has been accepted for publication, after peer review and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s00467-024-06644-7令和6年度doctoral thesi

O-GlcNAc modification in endothelial cells modulates adiposity via fat absorption from the intestine in mice

滋賀医科大学博士（医学）Heliyon. 2024 Jul 14;10(14):e34490.令和6年度thesi

Metabolic analysis of three-dimensional cultured gastrointestinal cancer cells suggests that L-arginine inhibits tumor growth by affecting the urea cycle

滋賀医科大学博士（医学）Pathobiology. 2024 Dec 10:1-17.令和6年度thesi

滋賀医大病院ニュースTOPICS Vol.96 (2025/9)

滋賀医大病院ニュース第69号別冊 膵がん克服のために / 岩下　拓司othe

O-GlcNAc modification in endothelial cells modulates adiposity via fat absorption from the intestine in mice

滋賀医科大学博士（医学）Introduction Endothelial cells have a crucial function in transporting and exchanging various nutrients. O-GlcNAcylation, mediated by O-GlcNAc transferase (OGT), involves the addition of N-acetylglucosamine to proteins and serves as an intracellular nutrient sensing mechanism. However, the role of O-GlcNAcylation in endothelial cells remains poorly understood. Objective This study investigated the role of O-GlcNAcylation in endothelial cells. Methods Endothelial-cell-specific Ogt -knockout mice (Ogt-ECKO) were generated by crossing Ogt-floxed mice (Ogt-flox) with VE-Cadherin Cre ERT2 mice. Ogt-ECKO mice and Ogt-flox control mice were subjected to a normal or high-fat diet, and their body weight, glucose metabolism, and lipid metabolism were examined. Results Ogt-ECKO mice exhibited reduced body weight compared with Ogt-flox control mice under a high-fat diet. Lipid absorption was significantly impaired in Ogt-ECKO mice. Changes in the intercellular junctions of small intestinal lacteal endothelial cells from a button-like to a zipper-like configuration were observed. Furthermore, Ogt-ECKO mice showed decreased expression of VEGFR3. The administration of a nitric oxide donor restored lipid absorption and reversed the morphological alterations in Ogt-ECKO mice. Conclusions These findings demonstrate the critical role of O-GlcNAcylation in endothelial cells in lipid absorption in the intestine through the modulation of lacteal junction morphology. These results provide novel insight into the metabolic regulatory mechanisms under physiological conditions and have implications for the development of new therapeutic strategies for obesity.令和6年度doctoral thesi

ショクドウ アカラシア ガッペイ シンコウ ショクドウガン ニ タイシテ キョウクウキョウ シュジュツ オ セコウシタ 1レイ

症例は80歳，男性．40年前より嚥下困難感を自覚，食道アカラシアを診断され，内科的治療を受けていた．2018年吐血を主訴に近医を受診し，上部消化管内視鏡検査にて切歯から40 cmの部位に2型食道癌を認め当院紹介受診となった．食道透視検査では，Sigmoid type，Grade IIIの食道アカラシアであり，食道癌 Lt, type2, Squamous cell carcinoma, cT3 cN1 cM0, cStage IIIと診断し手術を行った．術式は，胸腔鏡下食道亜全摘，2領域リンパ節郭清，胸骨後胃管再建，腸瘻造設術を施行し，手術時間は359 min，出血量300 mLであった．周術期に合併症を認めず，術後16日目に退院となった．術後より経口摂取量は増加し，術後3カ月で3 kgの体重増加を認めた．術後5年経過し，無再発生存中である． 　今回我々は，病脳期間40年の食道アカラシアに合併した食道癌症例に対して胸腔鏡下手術を施行した．食道アカラシア合併食道癌の手術では，アカラシアによる慢性炎症のため，剥離層の同定が困難であることが多い．また，拡張した食道により視野確保に難渋するため，特に胸腔鏡手術では食道の取り回しには注意が必要とされる．本症例のように病悩期間が長い症例では，高齢で併存疾患も存在することも多い．手術適応については慎重に判断しなければならないが，我々は低侵襲を目的に胸腔鏡下手術を施行し，治癒し得た症例を経験したため報告する．A 80-year-old male, with a 40 years history of esophageal achalasia which had been diagnosed by dysphagia and treated with a endoscopic balloon dilatation. Esophagography showed a dilated esophagus, 8.0 cm in maximal diameter, with food residue, indicating a sigmoid-type achalasia. Upper gastrointestinal endoscopy for hematemesis showed an elevated lesion in the middle thoracic esophagus. Biopsy specimens from the lesion revealed squamous cell carcinoma. Thoracoscopic subtotal esophagectomy and two-field lymph node dissection with a gastric tube through the retrosternal route. On histopathology, a squamous cell carcinoma which invaded the muscular layer was diagnosed. The patient remains clinically well and alive without tumor recurrence 24 months after we performed surgery. 　We described a case of esophageal cancer with achalasia that was treated by thoracoscopic surgery. In esophageal cancer surgery with achalasia, massive fibrosis is present around esophagus due to chronic inflammation. Thoracoscopic surgery provides better visualization of the layer in mediastinum. This surgical procedure is useful for recognition of vessels, nerves, and other components.departmental bulletin pape

Association of Respiratory Functional Indices and Smoking with Pleural Movement and Mean Lung Density Assessed Using Four-Dimensional Dynamic-Ventilation Computed Tomography in Smokers and Patients with COPD

滋賀医科大学博士（医学）Purpose: To correlate the ratio of the non-dependent to dependent aspects of the maximal pleural movement vector (MPMVND/D) and gravity-oriented collapse ratio (GCRND/D), and the mean lung field density (MLD) obtained using four-dimensional (4D) dynamic-ventilation computed tomography (DVCT) with airflow limitation parameters and the Brinkman index. Materials and methods: Forty-seven patients, including 22 patients with COPD, 13 non-COPD smokers, and 12 non-smokers, with no/slight pleural adhesion confirmed using a thoracoscope, underwent 4D-DVCT with 16 cm coverage. Coordinates for the lung field center, as well as ventral and dorsal pleural points, set on the central trans-axial levels in the median and para-median sagittal planes at end-inspiration, were automatically measured (13-17 frame images, 0.35 seconds/frame). MPMVND/D and GCRND/D were calculated based on MPMV and GCR values for all the included points and the lung field center. MLD was automatically measured in each of the time frames, and the maximal change ratio of MLD (MLDCR) was calculated. These measured values were compared among COPD patients, non-COPD smokers, and non-smokers, and were correlated with the Brinkman index, FEV1/FVC, FEV1 predicted, RV/TLC, and FEF25-75% using Spearman's rank coefficients. Results: MPMVND/D was highest in non-smokers (0.819±0.464), followed by non-COPD smokers (0.405±0.131) and patients with COPD (-0.219±0.900). GCRND/D in non-smokers (1.003±1.384) was higher than that in patients with COPD (-0.164±1.199). MLDCR in non-COPD smokers (0.105±0.028) was higher than that in patients with COPD (0.078±0.027). MPMVND/D showed positive correlations with FEV1 predicted (r=0.397, p=0.006), FEV1/FVC (r=0.501, p<0.001), and FEF25-75% (r=0.368, p=0.012). GCRND/D also demonstrated positive correlations with FEV1 (r=0.397, p=0.006), FEV1/FVC (r=0.445, p=0.002), and FEF25-75% (r=0.371, p=0.011). MPMVND/D showed a negative correlation with the Brinkman index (r=-0.398, p=0.006). Conclusion: We demonstrated that reduced MPMVND/D and GCRND/D were associated with respiratory functional indices, in addition to a negative association of MPMVND/D with the Brinkman index, which should be recognized when assessing local pleural adhesion on DVCT, especially for ventral pleural aspects.令和6年度doctoral thesi

Fibroblast Activation Protein-α Expression in Cancer-Associated Fibroblasts Shows the Poor Survival of Colorectal Cancer via Immune-Mediated Pathways

滋賀医科大学博士（医学）Annals of Surgical Oncology. 2025 Mar;32(3):1941-1952.令和6年度thesi