チイキ ホウカツ イリョウ ジッシュウ ノ ジュコウセイ ノ トクセイ ト ソノ キョウイク コウカ ニ カンスル ケンキュウ

全国的に地域枠入学者による医学部定員増加が行われている.それに伴い医学部では,より良い地域医療教育の導入が求められている.そこで本研究は,地域医療を目指す学生の特性を知るとともに地域医療教育の効果を学生の自己評価点とSOC (Sense of Coherence) 得点の地域教育導入前後比較により検討することを目的とした.調査対象は,獨協医科大学医学部第1学年おける地域包括医療実習受講生の16名( 男子9名,女子7名:平均年齢18.9±1.0歳) と非受講生の1年生98名( 男子66名,女子32名:平均年齢19.9±1.7歳) である.平成22 年7 月15 日に対象者全員に対して研究の説明を行い,文書による研究参加への同意を得た後,行動規範26項目の自己評価 (7 点満点) とSense of Coherence (SOC) 29 項目及び生活習慣に関する質問12 項目に回答する自記式アンケート調査を行った.さらに,平成22 年12 月11 日に,受講生のみを対象に7 月15 日に施行したものと同一のアンケート調査を行った.地域包括医療実習I 受講生は,非受講生に比較して,家族と同居しているもの,現在運動をしていないものが多かった.また,学習態度の自己評価点とSOC 処理可能感の得点が有意に高かった.地域包括医療実習I の実習前後の変化を検討したところ,生活態度の自己評価が終了時には有意に上昇していた.しかしSOC 把握可能感の得点が有意に低下していた.地域医療教育導入前後でほとんどの項目で大きな変化はなかったが,生活態度の行動変容に良い効果が得られた.また,把握可能感が低下していたため,面接などで適切な支援が必要である.The quotas of students who wish to be involved in communitymedicine have increased in medical schools in Japan.Accordingly, programs focused on community medicineare required in medical education. In this study weaimed to identify the characteristics of medical studentswho pursue community medicine. We also aimed to evaluatethe effects of the local community medical educationcourse for medical students by examining changes in thescores of self-evaluation of standards of conduct and in thescores of sense of coherence (SOC) before and after thecourse.Participants were 16 first-year students (9 men, 7 women;mean age, 18.9±1.0 years) at Dokkyo Medical Universitywho took the comprehensive community medicinepractice course( community medicine course students) and98 students (66 men, 32 women;mean age, 19.9±1.7years) who did not take the course( non-community medicinecourse students).Information on the study was provided on July 15, 2010,and written informed consent was obtained from all participants.A self-evaluation questionnaire comprising 26 itemsregarding standards of conduct, each to be rated on a seven-point scale, and a questionnaire comprising 29 items ofSOC and 12 items of lifestyle were used. Both questionnaireswere completed by all participants on July 15, 2010and by the community medicine course students on DecemberThe percentage of students who lived with their familiesand the percentage of students who did not regularly exerciseat the time of the questionnaire survey were higher inthe community medicine course students than in the noncommunitymedicine course students. In addition, the selfevaluationscore for attitude toward leaning and the SOCscore for sense of manageability were significantly higher inthe community medicine course students than in the noncommunitymedicine course students. In the communitymedicine course students, the self-evaluation score for attitudetoward life was significantly increased, while the SOCscore for sense of comprehensibility significantly decreasedby the end of the course.The comprehensive community medicine practice coursehad a positive effect on student attitude toward life, andpreferable behavioral modifications were observed, althoughscores for most items remained unchanged by the end ofthe course. Our findings revealed a decrease in sense ofcomprehensibility, indicating that appropriate student support,such as consultation, is necessary

イガクセイ トシテ テキセツ ナ コウドウ ヤ タイド オ ジコ ヒョウカ スル トキニ エイキョウ スル セイカツ シュウカン カンレン インシ ノ ケントウ : ダイ1ガクネン カラ ダイ2ガクネン エノ ジコ ヒョウカ テン ノ ヘンカ オ チュウシン ニ

目的:プロフェッショナリズムの育成を医学教育に導入することを前提に医学生の低学年時の行動に対する自己評価の変化とそれに影響する因子を検討した.調査対象:2010 年の獨協医科大学医学部第1 学年の学生92 名(男子57 名,女子35 名)調査方法:2010 年7 月の1 年次と2011 年8 月に2 年次の2 回にわたって行動規範に関する自己評価表および国民健康・栄養調査に基づき作成した生活習慣調査アンケート調査を施行したその得点に影響する生活習慣関連因子を検討した.結果:1 年次から2 年次で自己評価が有意に向上したのは,「他者の人権や人格を尊重し,積極的かつ友好的にコミュニケーションをとり,分かりやすく説明する技術や態度の習得」「常に予習・復習を欠かさないなど学習習慣」「積極的に新しい知識や技能を吸収しようとする能動的な学習態度」であった.一方,2 年次で有意に自己評価が低下していたのは「講義や実習を欠席しない」「他人のものを盗用したり,データをねつ造したりしてレポートを作成しない」「与えられた課題や宿題等の提出期限を守っている」などであった.1 年次の低い自己評価に影響した項目は,男子,喫煙経験,朝食欠食,睡眠で休養がとれていないこと,睡眠補助剤の使用であった.さらに,1 年次の喫煙経験は2 年次の低い自己評価にも影響した.結論:不健康なライフスタイルが行動や態度の自己評価に影響することが判明したことより,生活習慣の変容は,行動の自己評価を向上させる可能性が示唆された.ObjectiveThe purpose of this study was to investigate factors associatedwith the professionalism of medical students, andspecifically their fitness to practice.SubjectsSubjects were 92 first-year students (57 men, 35 women)at Dokkyo Medical University School of Medicine.MethodsA 26-item self-report questionnaire on fitness to practiceand a 12-item self-report questionnaire on lifestyle werecompleted by the medical students at Dokkyo Medical University,once in their first year in July 2010 and again intheir second year in August 2011.ResultsFitness to practice scores were significantly higheramong second-year than first-year students regarding"friendly and positive communication with others while respectingtheir individual differences and human rights","learning earnestly through preparation and review beforeand after lectures", and "willingness to learn". Conversely,fitness to practice scores were significantly lower amongthe second-year than first-year students regarding "unexcusedabsence from lectures or clinical practice"," submissionof plagiarized or falsified reports", and" missed submissiondeadlines". The factors associated with lower selfassessmentscores among first-year students were beingmale, smoking experience, skipping breakfast, poor qualityof sleeping and sleeping pill usage. Furthermore, smokingexperience among first-year students was associated withlower self-assessment scores of fitness to practice in thesecond year.ConclusionThe results suggest that the early adoption of healthybehaviors had a positive influence on fostering educationalprofessionalism among medical student

HISTOLOGICAL OBSERVATION OF THE SUBMANDIBULAR GLAND WITH SPECIAL REFERENCE TO THE FOCAL LYMPHOCYTIC IN FILTRATION

Focal lymphocytic infiltration of the submandibular gland was investigated on the autopsy cases. The materials examined were 340 cases without the collagen diseases and 28 cases with collagen diseases. Of the 28 cases with collagen diseases, 20 were systemic lupus erythematosus, 2 with the coexistence of systemic lupus erythematosus and Sjögren’s syndrome, 4 with rheumatoid arthritis and 2 with progressive systemic sclerosis. Among the cases without the collagen diseases, the focal lymphocytic infiltration was seen in 154 cases (74%) of 209 males and in 94 cases (71%) of 131 females. All 28 cases with collagen diseases had a focal lymphocytic infiltration. The incidence of grade 3 or severe infiltration was 4% in the males and 14% in the females in the cases without the collagen diseases, 65% in the 20 cases with systemic lupus erythematosus, 50% in the 4 cases with rheumatoid arthritis and 50% in the 2 cases with progressive systemic sclerosis. No cases of very severe infiltration were found, which were seen in the classical Sjögren’s syndrome, in both cases with and without the collagen diseases. Hyperplastic change in the ductal cells, which can be called an epimyoepithelial island, was found in 23% of the cases with collagen diseases. These observations suggest that the focal lymphocytic infiltration is a focal sign of the immunologic disorder of the submandibular gland in the collagen disease

Efficiency of Human Epiphyseal Chondrocytes with Differential Replication Numbers for Cellular Therapy Products

The cell-based therapy for cartilage or bone requires a large number of cells; serial passages of chondrocytes are, therefore, needed. However, fates of expanded chondrocytes from extra fingers remain unclarified. The chondrocytes from human epiphyses morphologically changed from small polygonal cells to bipolar elongated spindle cells and to large polygonal cells with degeneration at early passages. Gene of type II collagen was expressed in the cells only at a primary culture (Passage 0) and Passage 1 (P1) cells. The nodules by implantation of P0 to P8 cells were composed of cartilage and perichondrium. The cartilage consisted of chondrocytes with round nuclei and type II collagen-positive matrix, and the perichondrium consisted of spindle cells with type I collage-positive matrix. The cartilage and perichondrium developed to bone with marrow cavity through enchondral ossification. Chondrogenesis and osteogenesis by epiphyseal chondrocytes depended on replication number in culture. It is noteworthy to take population doubling level in correlation with pharmaceutical efficacy into consideration when we use chondrocytes for cell-based therapies

Phosphorus-insufficient maternal milk is associated with ectopic expression of collagen I and female-specific bony changes in infant mouse cartilages

Excessive phosphorus intake causes diseases such as hyperphosphatemia and hypocalcaemia, but the effect of dietary insufficiency of phosphorus is unclear. Here, we explored the effect of phosphorus dietary insufficiency on tissue growth and maintenance by using C57BL/6J mice fed a low phosphorus diet, which contained 18.5% of the phosphorus of a normal diet. We demonstrated that the phosphorus content in the maternal milk of mother mice was significantly reduced due to the consumption of a low phosphorus diet, which further resulted in bone deformation in infant mice in a female-specific manner. Polarizing microscopic analysis of low-phosphorus milk (LPM)-induced bone deformation resulted in unusually formed crystals inside cartilage. Furthermore, immunohistochemical analysis revealed ectopic expression of collagen I in the region where crystals were ectopically formed. Electron microscopic analysis showed morphological features similar to bone tissues. Immunochemical analysis demonstrated that the amount of interleukin-6 (IL-6), a cytokine known to trigger osteoclast formation, was significantly reduced in the maternal milk of mice fed the low-phosphorus diet. Our results suggest that phosphorus intake from maternal milk is involved in infant cartilage formation

Tumorigenicity-associated characteristics of human iPS cell lines.

Human induced pluripotent stem cells (hiPSCs) represent promising raw materials of human cell-based therapeutic products (hCTPs). As undifferentiated hiPSCs exhibit intrinsic tumorigenicity properties that enable them to form teratomas, hCTPs containing residual undifferentiated hiPSCs may cause tumor formation following transplantation. We first established quantitative and sensitive tumorigenicity testing of hiPSCs dissociated into single cells using NOD/Shi-scid IL2Rγnull (NOG) mice by inhibiting apoptosis of hiPSCs with a Rho kinase inhibitor. To examine different features in tumorigenicity of various hiPSCs, 10 commonly available hiPSC lines were subjected to in vivo tumorigenicity testing. Transplanted hiPSC lines showed remarkable variation in tumor incidence, formation latency, and volumes. Most of the tumors formed were classified as immature teratomas. However, no signs of malignancies, such as carcinoma and sarcoma, were recognized in the tumors. Characteristics associated tumorigenicity of hiPSCs were investigated with microarray analysis, karyotype analysis, and whole exome sequencing. Gene expression profiling and pathway analysis supported different features of hiPSC lines in tumorigenicity. hiPSC lines showed chromosomal abnormalities in some lines and 61-77 variants of cancer-related genes carrying effective nonsynonymous mutations, which were confirmed in the COSMIC databases. In this study, the chromosomal abnormalities and cancer-related gene mutations observed in hiPSC lines did not lead to the malignancy of tumors derived from hiPSCs. Our results suggest that the potential tumorigenicity risk of hCTPs containing residual undifferentiated hiPSCs is dependent on not only amounts of undifferentiated hiPSCs but also features of the cell lines used as raw materials, a finding that should be considered from the perspective of quality of hCTPs used