浸潤性乳癌の腫瘍浸潤リンパ球におけるCD8/FOXP3陽性effector型制御性T細胞比は治療効果に関連する

広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

The State of the Applicants to Our Midwife Training

Nursing students taking the entrance examination for our midwifery training program in the academic year 1992-1993 were evaluated with regard to what motivated them to apply to our program and their plans after graduation. The results were as follows : 1. The wish of the nursing students themselves was the decisive factor in their decision to apply. 2. Our investigation revealed that 10% of the nursing students decided to take up midwifery after graduation from nursing school; 25% decided to do so before their entrance to nursing school : and 65% made up their minds while they were still at nursing school. 3. The applicants planned to work as professional midwives for a long time after their completion of the midwifery training program. 4. Junior college graduates, after receiving authorization from the National Institution of Academic Degrees, were motivated to apply to our midwifery training program for the explicit purpose of acquiring a bachelor's degree

危機に立つ助産師教育

Midwifery education in Japan falls far short of the international standard with respect to the course requirements and the length of the clinical training. Student midwives in Japan are required to assist ten deliveries during the designated two-month clinical practicum, a difficult task to satisfy due to Japan's low birthrate. In contrast, midwifery education in Western countries takes between 12 and 48 months to finish and the E.U. standard requires students to assist at least 40 deliveries during their clinical training. Midwifery training in Japan had been traditionally offered as a non-degree certificate program at private institutions. However, four-year universities have started to offer the program as an elective program. At four-year universities, some midwifery course requirements have been deleted and the length of the clinical training has been shortened because of the congested curriculum. Serious discussion is necessary regarding the improvement of midwifery education in Japan.日本の助産師教育はその期間の短さ,臨床訓練の不十分さで国際的に大変見劣りしている｡国際化の中で卒業生が海外で活躍する機会も大幅に増えている現在,先進国として世界的基準に恥じない教育実践が求められる｡これは国内のより質の高い助産師へのニーズにも合致することである｡わが国の助産師教育課程は昭和23年に制定された保健婦助産婦看護婦法に基づいている｡この法律は戦後間もないGHQの指導下に産声を上げた｡制定当時のアメリカには助産師制度はなく,助産師の教育期間は6ヶ月以上とされ今日に至っている｡しかし,今日の欧米では助産師教育期間は12～48ヶ月(実習は8～33ヶ月)とされ,日本の2倍以上である｡分娩介助数も日本の10例程度に対し,EU基準では最低40例が義務付けられており,高度な助産技術の習得を目指している｡従来,わが国における助産師教育の主流は看護師教育を終了した者を対象とした1年課程の助産師学校養成所および短期大学専攻科における専門的な助産学教育であった｡この課程では指定規則の基準に加えて,各校独自に助産師教育の充実を図る努力が行われてきた｡しかし,近年の看護学教育の急速な4年制大学化に伴い, 4年制大学における助産師教育は最低の指定基準を満たすために,助産学専門科目の一部は選択科目として位置付けられ,その他は看護学の科目に読み替えられる事となった｡この様な状況の中で,今後の助産師教育をどう国際的基準に合わせていくか,真剣な議論が必要である

Electrical Cell-substrate Impedance Sensing (ECIS)法を用いた培養細胞の微細挙動の定量的評価法 - 細胞-細胞間隙と細胞-電極間隙の評価 -

We have proposed a mathematical model for the micro-dynamics for cultured cells measured with ECIS system for the detection of nanometer-order dynamics of cells cultured on a small gold electrode and could separately evaluate cell-to-cell distance (A) and cell-to-substrate distance (h). For wide applications of this method, we constructed mathematical models which express cell-to-electrode impedances for some kinds of confluent conditions. Based on this mathematical model, we defined new parameters S(A) and S(h) in order to evaluate cell-to-cell distance and cell-to-substrate distance. As the application, we investigated the effect of X-irradiation to bovine aortic endothelial cell (BAEC). We analyzed the micro-dynamics of cells from the impedance of BAEC before and after X-irradiation. It was proved that the stimulation of 100 Gy X-irradiation to the BAEC resulted in the large scale of increase in the cell-to-cell distances (A), and the slight increase in the cell-to-substrate distances (h) accompany with continuous fluctuations.[背景] Electrical Cell-substrate Impedance Sensing (ECIS)は培養細胞の電気的計測により,その微細挙動を評価する工学的手法である｡我々はECISを用いてこの微細挙動を細胞-細胞間隙と細胞-電極間隙に分離して推定することが可能な数学的モデルを提案してきた｡本研究ではこの数学的モデルを使用して,Ⅹ線を照射した牛大動脈内皮細胞(bovine aortic endothelial cell : BAEC)の微細挙動の経時変化を評価した｡ [方法と結果] ECISシステム(Model 1600R Applied BioPhysics)を用いてBAECのコンフルエント到達前後で計測を行い,数学的モデルを構築した｡このモデルは細胞の微細挙動を検出するために重要な周波数レンジである1-10kHzにおいて測定結果とよく一致し,Cole-Cole円弧則に従う｡さらに細胞-細胞間距離Aの増減に対応する校正定数S(A)と細胞-電極間距離hの増減に対応する校正定数S(h)を導入し,ベクトルインピーダンスの変化に対応した値を算出することで細胞の微細挙動を評価することとした｡次に本法によりX線(150kV, 100Gy)を照射したBAECの微細挙動を評価した｡Ⅹ線照射細胞では時間経過と共に抵抗成分の変化が支配的なインピーダンスの減少が確認された｡この現象はS(A)の大きな増加とS(h)の微小な減少をもたらした｡このパラメータの変化は細胞間隙が拡大したことを示しており,Ⅹ線照射による細胞内損傷により細胞密度が低下したと考えられた｡ [結論] 本法は培養細胞の微細動態の変化を細胞-細胞間隙と細胞-電極間隙に分けてリアルタイムに定量評価することが可能であり,各臓器の細胞レベルでの薬物の治療効果や Ⅹ線に対する耐性の評価に適応できるものと考える

Delivery Assistance Techniques

The delivery assistance laboratory is one of the most important part of the professional curriculum in the training program for midwives. The educational significance of 10 cases of delivery assistance was reviewed. The technical standards of the students improved with accumulation of experience in the assistance of deliveries. Evaluation of the methods in which the students were assessed with regard to technical improvement in delivery assistance was performed. Of the total number of 136 students of midwifery registered at our school in the past 7years, 50 who were able to assist successively in 3-10 cases of normal childbirth were evaluated in this study with regard to their acquisition of skills needed to assist in deliveries. Fourteen technical items related to the assistance of delivery in its second and third stages were assessed. An evaluation standard consisting of 3 grades, namely "able to perform", "somehow able to perform", and "not able to perform" regarding the above mentioned 14 technical items were used to assess the mastery of delivery assistance techniques by the students. Our results showed that as the students accumulated experience in delivery assistance, self-assessment ratings of "able to perform" increased on the average. The accumulation of skill concerning the management of the neonate immediately after birth, the instruction of patients regarding the application of abdominal pressure, and the assistance during crowning was specially evident. In contrast, although self-assessment ratings of "able to perform" with regard to "assistance of the mother immediately after giving birth" and "assistance immediately after the delivery of the fetal head" did increase, its rate of increase was small

Factors involved in the movement of the center of mass in healthy women

妊娠中の体形変化は姿勢変化をもたらし、このためにおこる重心移動がマイナートラブルを起こす原因となることが考えられる。そこで、健康女性37人を対象に、重心動揺を起こす因子と考えられる体型要因に着目した基礎的研究を行い、以下の結果を得た。1）重心動揺測定項目の中で、重心動揺距離、包絡面積、重心動揺面積の項目は開眼時より閉眼時が有意に数値が大きく、X軸方向動揺平均、Y軸方向動揺平均の項目は、開眼時と閉眼時とで差がなかった。2）ロンベルグ姿勢での開眼及び閉眼重心動揺検査では、座高、下肢長に正の相関が、肥満度に負の相関があるこが示唆された。During the period of pregnancy, movement of the center of mass due to changes in the posture results from the changes in the body form, and this may cause minor troubles. In this study, we examined body form factors which may be involved in the movement of the center of mass in 37 healthy womem, and obtained the following results. 1) In the examination items of the movement of the center of mass, the moving distance of the center of mass, the envelope area and the area of moving of the center of mass were significantly larger when measured with the eyes open than when measured with the eyes closed, while there were no differences in the means of moving in the x-axis direction and in the y-axis direction whether the eyes were open or closed. 2) The moving examinations of the center of mass in the Romberg's posture with open or closed eyes suggested positive correlations with the sitting height and the length of the inferir limb and a negative correlation with the obesity level

The way to a Bachelor's degree : state of graduates from advanced course of midwifery, School of Health Sciences Okayama University

平成4年に岡山大学医療技術短期大学部専攻科助産学特別専攻は学位授与機構に認定された。5年目を迎えた今年、現在までを見直すために、平成4年度から平成7年度までの入学生80名のうち、短期大学部の卒業生51名を対象とし、アンケート調査を実施した。その結果以下のことがわかった。学位授与機構への申請経験者は6名（11.8％）で、その内2名は現在申請中である。2名が合格し、看護学士の学位を取得していた。現在取得に向けて学修中の者は17名（33.3％）で、学修成果の作成に関して困っている者が多かった。取得の意志はあるが休止中の者は25名（49％）で、主な理由は仕事が忙しいことであった。取得の意志がない者は7名（13.7％）であった。In 1992, Advanced Course of Midwifery, School of Health Sciences Okayama University was recognized by National Institution for Academic Degrees. This year, the fifth from its recognition, we performed a questionnaire survey in 51 junior college graduates among the 80 individuals who took the course from 1992 to 1995 reevaluate the program. Six graduates (11.8%) had applied for a degree to the National Institution for Academic Degrees including 2 whose applications were under evaluation. The applications had been accepted in 2 of them (3.9%), and they had received the degree of Bachelor of Nursing. Seventeen graduates (33.3%) were studying with the hope to obtain the degree, but many of them had difficulty with preparation of the reports of the results of their learning and training. Twenty five (49%) had the hope to obtain the degree but were not making preparations, primarily because they were occupied by work. Seven (13.7%) had no desire to obtain the degree

Time needed for practice of the conduct of labor

近年の急激な少子・高齢化による人口構造の歪みは、益々の出生率の低下を来たしている。この現状の中での分娩介助実習は非常に厳しい状況にある。そのため、当専攻科では平成元年（1989年）より分娩介助実習場所を2施設から3施設として分娩介助実習に対応している。7年間の平均をみると、学生1人当たり10.7回の分娩介助に要する時間は476時間にのぼる。このうち、正規の実習時間外における拘束時間は184時間であった。The shifting of the population structure with the recent rapid decrease in births and increase in aged people is causing a further decrease in the birth rate. Under these circumstances, practice of the conduct of labor is encountering great difficulties. For this reason, our non-degree postgraduate school increased the fields for practice of the conduct of labor from 2 to 3 institutions in 1989. During the past 7 years, a mean of 476 hours was spent on practice of the conduct of labor in a mean of 10.7 cases per student, and 184 of these hours were outside the regular practice hours