A critical review of health services in Japan

Japan was the first Asian country to introduce social insurance measures and it has expanded them during the last few decades. The first social insurance law was passed in 1922, dealing with worker's health insurance, and it was followed by the National Health Insurance in 1938, Seamen's Insurance in 1939, and Employees' Pension Insurance in 1921. However, these were seldom widely available in actual practice because of the characteristics of public assistance which limited them to the poor.</p

放射線エネルギーの違いによる喉頭癌における吸収線量の影響

We investigated the usefulness of Gafchromic MD-55 film (Nuclear Associates, Inc.) for measuring the radiation doses on the radiotherapy of laryngeal cancers. Since larynx has thin wedge-shaped structure in anterior neck adjacent to airway, the radiation doses to the lesion may be diminished because of build-up and build-down. So, the dose has been measured with conventional measuring systems such as thermoluminescent dosimetry (TLD). However, it was not possible to evaluate the dose distribution correctly using TLD, because it is impossible to float a TLD chip in an air cavity. In this study, we employed Gafchromic MD-55 film as a dosimeter, for it can be set on the area of interest and with a measurability of dose range of 3 to 100 Gy, though it has no energy dependency. And this radiometer is composition near the soft tissue of the human body. The dose distributions to larynx were investigated with this film using neck phantom under each radiation beam energy of 4, 6 and 10 MV x-rays. Our neck phantom is made from acrylic resin and simulates a normal larynx on the basis of image information of computed tomography (CT). Moreover we observed secondary build-up and build-down curves in tissue in the vicinity of air cavities, especially at 10 MV x-rays. These findings suggest that patients with TI-T2 glottic cancers with anterior commissure invasion may receive more effective treatment with 4 MV x-rays rather than with 6 MV and 10 MV x-rays.Tl声門癌に対して放射線治療を単独で行うのは確立している方法である｡しかし,頚部は解剖学的に複雑であり,前方に薄いⅤ字形で,喉頭が気道に隣接している構造を持つので,病巣への線量はbuild-upとbuild-downの影響による線量低下が生じることが考えられる｡すなわち,放射線エネルギーの選択が喉頭癌の局所的制御に影響を及ぼすと言える｡この影響は,より高い放射線エネルギーでは,それに伴いより強く起きるということが基礎実験にて報告されている｡また,それらの線量測定は,熱ルミネセンス線量計(TLD)のような従来の測定システムで測定されていた｡しかし,空気空洞へTLD を単体 で浮かせ線量を正確に測定し評価を行うのは困難である｡本研究において,我々は Gafchromic MD-55 film (Nuclear Associates, Inc.)を使用し測定した｡ Gafchromic MD-55 film は,フィルムタイプ線量計でありエネルギー依存性がなく,3～100 Gyを測定可能であり,アクリル製頸部ファントムの空気組織境界面及び,空洞部に線量計を容易に精度良く配置することが可能である｡また,この線量計は人体の軟部組織に近い組成である｡そこで, 4, 6および10MVの各エネルギーでこの線量計を用いてエネルギーの違いによる,頸部ファントムを用いて喉頭の線量評価を行った｡その結果,我々は,特に放射線エネルギー10MVで頸部ファントムにおける,前部組織-組織空洞境界面-空洞部の一連したbuild-upおよびbuild-downを線量計で評価することができた｡これらの研究の結果､前交連浸潤を有するT1-T2に相当する声門癌患者は,放射線エネルギー6MVおよび10MVではなく,4MVを用いることによって,より効果的な放射線治療を行えると推測できる

Increase of DC-LAMP+ mature dendritic cell subsets in dermatopathic lymphadenitis of mycosis fungoides

Background: Little is known about the immunological milieu of the skin-draining lymph nodes (LNs) in mycosis fungoides (MF). Objectives: We studied dendritic cell (DC) subsets in the dermatopathic lymphadenitis of MF patients. Methods: We immunohistochemically examined DC subsets and their distribution in 16 LN samples from 14 patients with MF (N1 LN, eight patients; N2, four; and N3, four), and we compared them with non-metastatic sentinel LNs from eight patients with melanoma. Results: The number of S-100 protein+ DCs was markedly increased in the LNs from the MF patients and the major component was DC-LAMP+ mature DCs in the outer and paracortex areas, where DC-SIGN+ immature DCs were relatively decreased in proportion. In contrast, DC-SIGN+ cells were relatively increased in proportion compared to DC-LAMP+ cells in the medulla. Although no significant difference was observed in the proportions of CD1a+ or Langerin+ DCs among the N1, N2, and N3 nodes, CD163+ M2-type macrophages were increased in number in the N2 and N3 nodes. Conclusions: Our observations indicate that mature DCs accumulate in the outer and paracortex areas in dermatopathic lymphadenitis and M2-type macrophages might increase in number during disease progression

Suitability on the densitometry systematize in Laser Densitometer Model 1710 for Gafchromic MD-55-2 film

医療の高度化に伴い,放射線治療分野においても急速な技術革新が行われている｡QOL(Quality of Life)を考慮に入れた治療が求められる多くの場合,放射線治療が大きな選択肢の一つであることは言うまでもない｡このような状況下の中で,正常組織に影響を与えず病巣に限局した放射線を照射する技術が開発され,外照射においては,欧米に習い我が国でも研究段階から臨床へ移り変わろうとしている｡その際に,投与線量評価を欠かすことができないが,従来から使用されているいずれの線量計も新しい治療法に対応しきれていない｡そこで,フィルムタイプ線量計, Gafchromic MD-55-2 film の開発により,いくつかの問題が解決されてきている｡しかし,この線量計を精度良く測定する濃度測定器が必要になるが,現段階において規格化されたガイドラインが存在しないのが現状である｡そこで本研究では,当施設で保有しているⅩ線フィルム線量測定用 Laser Densitometer Model 1710 を用いて Gafchromic MD-55-2 fllm による線量測定を行い,問題点の抽出を行うとともに線量測定精度の考察を行った｡For the medical advancement, the speedy technical innovation is performed also in the radiotherapy. When patients can search for QOL (Quality of Life), the radiation therapy is one of the choices. The radiation therapy system for limited irradiation to lesion without affecting normal tissue has been developed over several years. On the technology of external irradiation in our country, the level is improving to clinical stage from study grade. In such things, a new requirement will come out also as for the measuring method of the medication dose. However, conventional various radiometers have many problems to the dosimetry of the new radiotherapy method. Gafchromic MD-55-2 film, which has new form of radiochromic film based on poly-diacetylene and has been introduced for medical applications recently, is expected to solve some problems. Now, in clinical usage of this film, there is no comprehensive guideline for densitometry system and it's calibration yet. So, in this paper, the densitometry of Gafchromic MD-55-2 film was performed with Laser Densitometer Model 1710 for general-purpose film dosimetry system. And then, problems in the densitometry were extracted and the accuracy of dosimetry was investigated

Characteristic of GAFCHROMIC XR TYPE T dosimetry film

医療の高度化に伴い,近年では長時間のⅩ線透視を行うInterventional Radiology(IVR)手技が頻繁に行われ,副作用としての難治性放射線皮膚障害例の報告が増加している｡確定的影響である放射線皮膚障害はしきい値を超えると発症し,線量に依存して障害の程度が重篤となるため,患者被曝線量の測定が重要である｡しかし,IVRでは照射部位が多彩で,焦点-皮膚間距離が不安定なため,その測定方法は確立されていない｡本研究では,近年IVR等低エネルギー線量測定用フイルムとして開発されたCAFCHROMIC XR TYPE T について性能評価を行い,患者皮膚入射面の被曝線量測定への応用の可能性について検討した｡その結果,線量特性,線質特性,ネット値の安定性に良好な特性を示し,臨床に使用可能であったので報告する｡In recent years, interventional radiology (IVR) using which uses prolomged fluoroscopy has been performed frequently in clinical radiology. Also, reports of radiation skin injuries whose symptoms occur after IVR has been also increasing. These symptoms will become worse if the radiation induced skin injuries are caused by doses which are above the designated threshold, and the grade of injuries are dependent on dose. Therefore, it is important that patient skin dose is measured correctly. But when perfoming IVR, irradiation is complex pricedure, and there is a measurement error with an unfixed source-to-skin distance. So. in this paper, characteristics of GAFCHROMIC XR TYPE T (which are film for low energy X-rays) are performed. Then, they are decided whether the application to the skin surface incidence dose measurement whoud be posible. From these results usefull data can be obtainned; for exanmpe film characteristics, energy factors and stability of sensivility

DNAX-activating protein 10 (DAP10) membrane adaptor associates with receptor for advanced glycation end products (RAGE) and modulates the RAGE-triggered signaling pathway in human keratinocytes.

The receptor for advanced glycation end products (RAGE) is involved in the pathogenesis of many inflammatory, degenerative, and hyperproliferative diseases, including cancer. Previously, we revealed mechanisms of downstream signaling from ligand-activated RAGE, which recruits TIRAP/MyD88. Here, we showed that DNAX-activating protein 10 (DAP10), a transmembrane adaptor protein, also binds to RAGE. By artificial oligomerization of RAGE alone or RAGE-DAP10, we found that RAGE-DAP10 heterodimer formation resulted in a marked enhancement of Akt activation, whereas homomultimeric interaction of RAGE led to activation of caspase 8. Normal human epidermal keratinocytes exposed to S100A8/A9, a ligand for RAGE, at a nanomolar concentration mimicked the pro-survival response of RAGE-DAP10 interaction, although at a micromolar concentration, the cells mimicked the pro-apoptotic response of RAGE-RAGE. In transformed epithelial cell lines, A431 and HaCaT, in which endogenous DAP10 was overexpressed, and S100A8/A9, even at a micromolar concentration, led to cell growth and survival due to RAGE-DAP10 interaction. Functional blocking of DAP10 in the cell lines abrogated the Akt phosphorylation from S100A8/A9-activated RAGE, eventually leading to an increase in apoptosis. Finally, S100A8/A9, RAGE, and DAP10 were overexpressed in the psoriatic epidermis. Our findings indicate that the functional interaction between RAGE and DAP10 coordinately regulates S100A8/A9-mediated survival and/or apoptotic response of keratinocytes