妊娠中の血中鉛濃度と出生児体格との関連について：子どもの健康と環境に関する全国調査（エコチル調査）

京都大学新制・論文博士博士(医学)乙第13438号論医博第2237号新制||医||1054(附属図書館)京都大学大学院医学研究科医学専攻(主査)教授 川上 浩司, 教授 滝田 順子, 教授 万代 昌紀学位規則第4条第2項該当Doctor of Medical ScienceKyoto UniversityDFA

Effect of Radiological Countermeasures on Subjective Well-Being and Radiation Anxiety after the 2011 Disaster: The Fukushima Health Management Survey

After the Fukushima Daiichi Nuclear Power Station accident in 2011, concerns about radiation exposure and decline in subjective well-being have been reported. To tackle these problems, various countermeasures in relation to radiation have been implemented. In this study, we comprehensively evaluated the effects of radiological countermeasures on subjective well-being (e.g., satisfaction with life (SWL) and emotional well-being) and radiation anxiety, through a questionnaire survey targeting Fukushima residents (N = 1023). Propensity scores matching was applied to evaluate significant effects of radiological countermeasures on subjective well-being and radiation anxiety. Among the radiological countermeasures, thyroid examination, whole body counter, and air dose monitoring showed the highest proportions of participation, utilization, and useful evaluation, suggesting a high degree of public attention focused on these countermeasures. The basic survey was associated with significant increases in SWL and self-rated health (SH). Thyroid examination was significantly associated with not only a reduction in radiation anxiety but also an increase of emotional stress, suggesting the importance of careful design of system and detailed communication. Food inspection was associated with deterioration in SH. Those who utilized explanatory meetings showed increases in sadness, worry, and radiation anxiety, indicating that additional attention is required of the experts and authorities involved in explanatory meetings

The effects of the herbal medicine Daikenchuto (TJ-100) after esophageal cancer resection, open-label, randomized controlled trial

Background Daikenchuto (TJ-100), a traditional Japanese herbal medicine, is widely used in Japan. Its effects on gastrointestinal motility and microcirculation and its anti-inflammatory effect are known. The purpose of this prospective randomized controlled trial was to investigate the effect of TJ-100 after esophagectomy in esophageal cancer patients. Methods Forty patients for whom subtotal esophageal resection for esophageal cancer was planned at our institute from March 2011 to August 2013 were enrolled and divided into two groups at the point of determination of the operation schedule after informed consent was obtained: a TJ-100 (15 g/day)-treated group (n = 20) and a control group (n = 20). The primary efficacy end-points were maintenance of the nutrition condition and the recovery of gastrointestinal function. The secondary efficacy end-points were the serum C-reactive protein (CRP) level and adrenomedullin level during the postoperative course, the incidence of postoperative complications, and the length of hospital stay after surgery. Results We examined 39 patients because one patient in the TJ-100 group was judged as having unresectable cancer after surgery. The mean age of the TJ-100 group patients was significantly older than that of the control group patients.The rate of body weight decrease at postoperative day 21 was significantly suppressed in the TJ-100 group (3.6% vs. the control group: 7.0%, p = 0.014), but the serum albumin level was not significantly different between the groups. The recovery of gastrointestinal function regarding flatus, defecation, and oral intake showed no significant between-group differences, but postoperative bowel symptoms tended to be rare in the TJ-100 group. There was no significant between-group difference in the length of hospital stay after surgery. The serum CRP level at postoperative day 3 was 4.9 mg/dl in the TJ-100 group and 6.9 mg/dl in the control group, showing a tendency of a suppressed serum CRP level in the TJ-100 group (p = 0.126). The rate of increase in adrenomedullin tended to be high postoperatively, but there was no significant difference between the two groups. Conclusions TJ-100 treatment after esophageal cancer resection has the effects of prompting the recovery of gastrointestinal motility and minimizing body weight loss, and it might suppress the excess inflammatory reaction related to surgery

Association of Physical Performance and Pain With Fear of Falling Among Community?Dwelling Japanese Women Aged 65 Years and Older

Our aim was to explore the association of physical performance and pain with fear of falling among community-dwelling Japanese women. The subjects were 278 women aged 65 years and over. We collected information on fear of falling, painful joints, comorbidities, falls in the previous year, and cataracts. Walking time (distance of 6 m), chair stand time (5 times), grip strength, the timed up and go test (TUG), and functional reach were measured. The prevalence of fear of falling was 36.3%, and it increased with age, but it was not significant (P=0.081). Multivariate logistic regression analysis showed that poor physical performance (longer walking time, longer chair stand time, weaker grip strength, and longer TUG) and pain (low back, and upper and lower extremity pain) were significantly associated with fear of falling after adjusting for age, body mass index, comorbidities, falls in the previous year, and cataracts. Maintaining physical functioning and managing pain may be important for elderly women with fear of falling

食道扁平上皮癌患者の化学療法効果と予後予測に関わるバイオマーカー

Background: The prognosis of patients with esophageal squamous cell carcinoma (ESCC) has been improved by multidisciplinary therapy with chemoradiotherapy and surgery, but it remains poor. Advanced stage, malignant potential, and chemo-resistance contribute to the poor prognosis. Here, we attempted to identify predictive factors of the response to chemotherapy and the prognosis of ESCC patients. Patients and Methods: We examined 51 ESCC patients who were treated with chemotherapy followed by radical surgery, and 23 patients who were treated with chemotherapy alone. We conducted quantitative reverse transcription polymerase chain reaction gene expression analysis using RNA extracted from 74 tumor tissue samples collected before chemotherapy and 67 tumor tissue samples collected after chemotherapy, focusing on PIK3CA, AKT-1, mTOR, 4E-BP1, p70S6K, PD-L1, and PD-L2. Results: The proportions of patients with high expressions of AKT-1 and PD-L1 before chemotherapy were significantly higher among the non-responders than among the responders (p=0.034, p=0.020, respectively). Multivariate analyses revealed that high PD-L1 expression before chemotherapy was associated with poor response to chemotherapy (odds ratio: 2.998; 95% CI: 1.043–8.619; p=0.042) and high p70S6K expression before chemotherapy was a poor prognostic factor (hazard ratio: 2.518; 95% CI: 1.058–5.988; p=0.037). In addition, the patients with high expression of PD-L1 and PD-L2 in the tumors after chemotherapy had significantly worse survival than those with low expression of these genes (p=0.012, p=0.007, respectively). Conclusion: These results demonstrated that PD-L1 and p70S6K in the primary ESCC tissues were related to a poor response to chemotherapy and poor prognosis, respectively

ショクドウガン ケイブ リンパセツ サイハツ ニヨル ショウジョウ ニ タイシテ カンワ ケア オ ジッセン シタ 2 ショウレイ

Our department aggressively performs initial treatment for esophageal carcinoma with multidisciplinary approaches, and not only positively treats patients with recurrence or metastasis but also manages those in an advanced stage by following the wishes of patients and their families as much as possible. However, many patients with esophageal carcinoma develop digestive tract and tracheal problems with progression of the disease, and the palliation of symptoms and continuation of home care often become difficult. In such patients, it is important to secure and maintain the route of hydration and nutrition when oral fluid and food intake becomes difficult, and to control respiratory symptoms for the promotion of home care and palliation of symptoms in the terminal stage. In this report, we present 2 patients managed by palliative care until death while supporting home care by maintaining enteral nutrition using gastrostomy for esophageal narrowing due to cervical lymph node recurrence, and controlling the cough reflex and dyspnea associated with the development of a cervical lymph node-tracheal fistula through morphine hydrochloride administration

Erlotinib デ induction therapy オ オコナッタ IIIAキ ヒショウサイボウ ハイガン ノ 1シュジュツレイ

［Background ］Erlotinib, epidermal growth factor receptor-tyrosine kinase inhibitor（EGFR-TKI）, is effective for advanced and metastatic non-small cell lung cancer（NSCLC）with EGFR mutation. However, the report of Erlotinib as induction therapy is rare. We report a surgical case of NSCLC with Erlotinib as induction therapy. ［Case ］A４１-years-old man, diagnosed left lung adenocarcinoma with EGFR mutation（exon１９deletion）, was referred to our hospital. CT showed that the tumor was ３５mm in S８ of the left lung and ＃７ lymphnode was swelling markedly（cT２aN２M０ stage ⅢA）. He took Erlotinib（１５０mg／day）for１２weeks at first because of EGFR mutation positive. The evaluation of Erlotinib was partial response in RESIST. He could take radical operation as lower lobe and lingual segment resection, because CT showed bulky ＃７got smaller significantly. There was no postoperative complication. The pathological finding was adenocarcinoma（papillary& acinartype）, PL０, v（＋）, ly（＋）, br（－）, pa（－）, pv（－）, Ef :１b,（ypT１aN２M０stage ⅢA）. He has taken adjuvant therapy（Erlotinib１５０mg／day）for２８weeks. There is no recurrence six months after operation. ［Conclusion ］It is possible that Erlotinib as induction-therapy is very effective in patients with EGFR mutation like this case ; however there is no evidence of EGFR-TKI as induction therapy. It is necessary to validate the effectiveness of Erlotinib as induction therapy

Glutamine protects small intestinal mucosa

Supportive therapy during chemotherapy has become essential, but effective preventive therapies to gastrointestinal mucosal injury are few. We investigated the efficacy of glutamine in rat anticancer drug-induced enteritis model. In this study, we used twenty male SD rats. They were divided into control, 5-fluorouracil (5-FU) (orally administered at 20mg/kg day), 5-FU+glutamine (1000 mg/kg/day) and 5-FU+glutamine+fiber and oligosaccharide (GFO[○R]) (1000 mg/kg/day) groups. All groups were sacrificed on day 6 and upper jejunums were excised. The jejunal villous height was measured in specimens. IgA level in jejunal washing solution, and serum diamine oxidase activity were also measured. The jejunal villous height was recognized as shorter in the specimen from 5-FU treated rats compared with 5-FU+glutamine treated rats (p<0.001). Serum diamine oxidase activity in 5-FU+glutamine group were significantly superior to that in 5-FU group (p=0.028). IgA level in jejunal washing solution tended to be higher in 5-FU+glutamine group than that in 5-FU group (p=0.076). On the other hand, serum diamine oxidase activity and IgA level in jejunal washing solution showed no significant difference between 5-FU+GFO and 5-FU treatment group. Our results suggest that glutamine showed protective effects on mucosal injury of small intestine in rat anticancer drug-induced enteritis model