能源电力区块链典型应用场景下的标准化研究

区块链技术凭借其开放、共享、协同的技术形态与构建能源互联网和建设新型电力系统的战略目标高度契合，成为能源电力转型的重要技术基础，能源电力区块链领域标准的缺失，使得区块链技术的应用和推广缺乏有效的规范和指导，严重制约了能源电力区块链的发展。首先，全面梳理国内外区块链技术及其在能源电力领域应用的标准化现状，指出现状不足。其次，分析区块链技术与碳交易、绿电交易、分布式交易等低碳化典型应用场景的匹配性，然后，按照GB/T 12366—2009《综合标准化工作指南》梳理提炼出典型应用场景中的标准化需求以及标准化对象。最后给出标准研制的思路与路径，为提升能源电力区块链技术应用的标准化、规范化水平提供参考

Two cases of male infertility with pathological dilatation of ejaculatory duct

射精管の異常拡張を呈する男性不妊症の2例。経尿道的な精丘部の切開によって1例に精液所見の改善をみ妊娠にも成功したTwo cases of male infertility with pathological dilatation of ejaculatory duct are reported. In both cases, the dilatated wall of the ejaculatory duct was incised at the vermontanum with a cold knife endoscopically. After the incision, the findings of semen analysis of one case improved markedly and his wife became pregnant. In another case, semen analysis was not improved. Transurethral incision seemed to be a useful modality for the treatment of pathological dilatation of ejaculatory duct

STATISTICAL CONSIDERATION OF AUTOPSY CASES OF UNIDENTIFIED BODIES IN NARA PREFECTURE DURING THE LAST HALF DECADE

The authors made statistica1 observations of medico-1egal autopsy cases of unidentified bodies in the Department of Legal Medicine, Nara Medica1 University School of Medicine, during the last half decade(2009-2013). This study revealed that cases of unidentified bodies have been increasing. DNA tests, tooth appraisal, and finger prints were common methods for persona1 identification. The bodies discovered in their own houses accounted for the large part of total unidentified death and they were left unattended for a long period. A decomposed or skeletonized body was the primary cause of the unidentified cases. "Unknown" was more frequent than any other cause of death among the unidentified bodies. Determining the cause of death is essential for exact mortality statistics and improvement of pub1ic hea1th. Therefore, administrative supports and regiona1 partnerships are very important to reduce unattended death. Since autopsies for unidentified cases are more complicated than for identified cases, increasing the staff size in the Department of Legal Medicine is an urgent issue to cope with the increasing number of autopsy cases

トウイン ニオケル セツジョ フノウ キョクショ シンコウ ショクドウガン ノ チリョウ セイセキ

【背景】遠隔転移のない切除不能局所進行食道癌に対する標準治療は根治的化学放射線療法(CRT)だが，近年Docetaxel/5-FU/ Cisplatin 療法をはじめとした導入化学療法（ICT）からの外科的切除の有用性が報告されている．今回，当院での切除不能局所進行食道癌に対する治療成績について検証した．【対象と方法】2016年から2019年の期間で，当院で治療した切除不能局所進行食道癌9例(リンパ節T4bも含む)を対象とした．【結果】男性：6例，女性：3例．年齢：中央値 64（41-78）歳．腫瘍主占居部位：Ut/Mt/Lt=1/7/1．浸潤臓器:気管/左主気管支/大動脈=2/4/3，cN0/1/2=1/3/5，初回治療: ICT/CRT=7/2であった．初回治療別に検証すると，奏効率:ICT/CRT=5(71.4%)/0(0%)であり，ICTにて奏効が得られた5例は根治切除可能と判断し，4例（80％）でR0切除が得られた．術後合併症は，縫合不全0例，肺炎1例(20%)，反回神経麻痺2例(40%)であった．術後在院日数中央値は16日(13-21)であった．R0切除4例は全例1年以上の生存が得られているが，2例で再発(リンパ節再発1例，肺・リンパ節再発1例)を認めた．R1切除例はCRTを追加し，術後2年無再発生存中である．根治切除を施行していない4例の初回治療からの1年生存率は25％と予後不良であった．【結語】切除不能局所進行食道癌であってもICTを組み入れることでconversion surgeryが安全に施行され，高いR0切除率が得られ，予後の延長に寄与する可能性がある．Background:Recently, the usefulness of surgical resection after induction chemotherapy (ICT) including Docetaxel / 5-FU / Cisplatin therapy for locally advanced esophageal cancer has been reported. Methods:Nine patients with locally advanced unresectable esophageal cancer who underwent multidisciplinary treatment in our hospital from 2016 to 2019 were eligible for this study. Results:The patients’ characteristics included a median age of 64 years; the male/female ratio of 6/3; Tumor main occupancy site Ut / Mt / Lt = 1/7/1; Invading adjacent organs: trachea / left main bronchus / aorta; 2/4/3, Lymph node metastasis (0/1/2); 1/3/5, and initial treatment ICT / CRT; 7/2. Response rate of ICT were 71.4% (5 cases) and that of CRT were 0%. Four patients (80%) of 5 patients who responded to ICT were underwent R0 resection. Postoperative complications were anastomotic leakage in 0 cases, pneumonia in 1 case (20%), and recurrent nerve paralysis in 2 cases (40%). The median length of hospital stay after surgery was 16 days. All 4 cases of R0 resection had survived for 1 year or more. The 1-year survival rate from the initial treatment of 4 patients who did not undergo radical resection was 25%. Conclusion:Conversion surgery after ICT for locally advanced unresectable esophageal cancer may contribute to a high R0 resection rate and better clinical outcomes

トウイン ニオケル キョウクウ キョウカ ショクドウ セツジョ ノ ドウニュウ ト タンキ チリョウ セイセキ ノ ケントウ

【背景】食道癌に対する胸腔鏡手術は本邦で広く行われており、施設ごとに手術手技の定型化がなされている.胸腔鏡下手術の利点として拡大視効果や緻密な手術操作が可能となることが挙げられるが、当院でも2016年より腹臥位胸腔鏡下食道手術を導入し、出血の少ない安全かつ確実な郭清を目指し、定型化に向けてその手技を刷新している.【対象と方法】】2016年4月から2019年4月までに当院で施行した胸腔鏡下食道切除38例につき、その短期成績を検討した.【結果】男:女＝32:6、年齢中央値 66歳(41-76)、cStage I / II / III / IVa: 17 / 6 / 13 / 2であった.胸腔内出血量中央値は10ml(0-53)、胸部操作時間中央値は192分(97-478)、胸腔内郭清リンパ節個数中央値は17個(1-42)であった.術後合併症は、縫合不全3例(7.9％)、反回神経麻痺7例(18.4％)、肺炎12例(31.6％)であった.術後在院日数中央値は19日(11-38)であった.導入期からの前半19例では反回神経麻痺を6例(31.6％)に認めたが、後半19例では１例(5.2％)であった(p=0.036).【結語】当院における胸腔鏡下食道切除術は安全に導入、施行可能であった.手術手技が定型化されることで反回神経麻痺を少なくする郭清が可能になると考えられた.Background: Thoracoscopic esophagectomy (TE) is increasingly being used worldwide in patients with esophageal cancer. In this study, we investigated the clinical short-term outcomes of TE performed in patients placed in the prone position. Method: We investigated the surgical and clinical outcomes in 38 patients with esophageal cancer who underwent TE at our hospital between April 2016 and April 2019. Results: Of the 39 patients investigated, 32 were men. Median patient age was 66 (range 41–76) years, the median intraoperative blood loss was 10 (0–53) mL, and the median operation time for thoracoscopy was 192 (97–478) min. The mean operation time for thoracoscopy in the latter group was significantly shorter than that in the former group (188 min vs. 232 min, p=0.013). The following postoperative complications were observed: 7 (18.4%) cases of recurrent nerve palsy, 3 (7.9%) cases of anastomotic leakage, 12 (31.6%) cases of pneumonia, and 0 (0%) cases of chylothorax. The incidence of recurrent nerve palsy was lower in the latter group than in the former group (5.2% vs. 31.6%, p=0.036). Conclusions: TE in the prone position is safe and feasible. As experience performing the procedure increases, the performance of the procedure stabilizes