〈査読論文〉《稲妻を持つアレクサンドロス》とエフェソスのアルテミス神殿 : ―肖像表現と設置場所に関する一考察

[付記]本研究は、平成29年度科学研究費補助金（若手研究B）の研究課題（課題番号17K13357「硬貨におけるアレクサンドロス大王の肖像研究―異民族への理解と配慮」、研究代表者：中村友代）を受けて行った研究成果の一部である。著作権保護のため、すべての掲載図版に墨消し処理を施しています

乳癌術前化学療法において腋窩リンパ節転移が陰性化するための効果予測因子の検討

Purpose: We investigated the role of tumor-infiltrating lymphocytes (TILs) in pretreatment primary breast cancer to predict pathological response to neoadjuvant chemotherapy (NAC) in patients with clinical node-positive disease (cN +). Methods: The subjects of this study were 60 patients with cN + , who received NAC followed by breast surgery with axillary lymph node dissection (ALND). We conducted a semi-quantitative assessment of TILs in pretreatment primary tumors and their association with clinicopathological factors and axillary lymph node metastasis. Results: We observed a higher number of TILs in tumors with negative hormone receptors, positive human epidermal growth factor receptor 2, or high Ki67. TILs were associated with a favorable response to NAC in primary tumors. The rate of axillary pathologic complete response (Ax-pCR) was significantly higher in patients with a high number of TILs than in patients with a low number of TILs (72.0% versus 17.1%, p < 0.001). In multivariable analysis, a high number of TILs was a significant predictor of Ax-pCR as well as of pCR of the primary tumor after NAC. Importantly, all patients with HER2-positive tumors in the high TILs group showed Ax-pCR on ALND. Conclusion: TILs in pretreatment primary breast cancer had the potential to predict therapeutic efficacy of NAC in patients with clinical node-positive disease.博士（医学）・乙第1498号・令和3年3月15日© Springer Nature Singapore Pte Ltd. 2020This is a post-peer-review, pre-copyedit version of an article published in Surgery today. The final authenticated version is available online at: https://doi.org/10.1007/s00595-020-02157-6

Characteristics and behavior of dissolved organic matter in the Kumaki River, Noto Peninsula, Japan

Dissolved organic matter (DOM) in river water was studied to understand the transport behavior of DOM in a small watershed with forest and paddy fields. Field experiments were conducted under normal flow conditions in the Kumaki River, which is located in the central part of the Noto Peninsula in Japan, during the period 2009-2010. The concentrations and structural properties of fulvic acid-like components, which are the major components of DOM, were determined using three-dimensional excitation-emission matrix spectroscopy and high-performance size-exclusion chromatography. The relative fluorescence intensity for fulvic acid-like components at an excitation wavelength of 305-335 nm and an emission wavelength of 425-440 nm increased from the upper forest area to the lower paddy field area and increased seasonally in this river system in the following order: winter, autumn, spring, summer. Fulvic acid-like components with a higher molecular weight were observed in the summer samples. These results suggest that higher precipitation and agricultural activity in the summer season increase the amount of fulvic acid-like components with higher molecular weight that are transported from the watershed into the river. © 2014 The Japanese Society of Limnology

Acute intraabdominal hemorrhage from an aneurysm on uterine artery

A 36-year-old woman was underwent emergency laparotomy for acute intraabdominal hemorrhage, but bleeding points were not found. Abdominal pains continued after the laparotomy, and rupture of aneurysm on uterine artery was found in angiography. An transcatheter arterial embolization was done for the uterine artery, and the aneurysm was found to disappear in 4-day-after the angiography. Rupture of an aneurysm on uterine artery should be considered for the causes of acute intraabdominal hemorrhage

FMD and eGFR Slope in Males and Females

Aims: It is known that there are sex differences in vascular endothelial function and the development of chronic kidney diseases; however, it remains unclear whether sex differences influence the association between vascular endothelial function and renal prognosis. Methods: To clarify the relationship between vascular endothelial function and longitudinal eGFR changes in male and female patients with cardiovascular risk factors, we retrospectively evaluated 341 patients (176 males and 165 females) with cardiovascular risk factors in whom vascular function was assessed by flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV) and in whom 24-month longitudinal eGFR values were recorded after the vascular function examinations. Associations of values of FMD and baPWV with values of eGFR slope were statistically analyzed. Results: Simple regression analysis showed that the value of FMD was positively associated with eGFR slope in females (p=0.001) and non-smoking males (p=0.033) but not in smoking males. Multiple regression analysis showed that the value of FMD remains a positive contributor for eGFR slope in females (p=0.001) and non-smoking males (p=0.045) but not in smoking males. In contrast, values of baPWV had no significant association with eGFR slope regardless of sex and cigarette smoking. Conclusions: In individuals with cardiovascular risk factors, evaluation of vascular endothelial function enables prediction of renal prognosis in females and non-smoking males

レゾルシル酸ラクトンLL-Z1640-2の成人T細胞白血病/リンパ腫に対する治療効果

Adult T-cell leukaemia/lymphoma (ATL) remains incurable. The NF-κB and interferon regulatory factor 4 (IRF4) signalling pathways are among the critical survival pathways for the progression of ATL. TGF-β-activated kinase 1 (TAK1), an IκB kinase-activating kinase, triggers the activation of NF-κB. The resorcylic acid lactone LL-Z1640-2 is a potent irreversible inhibitor of TAK1/extracellular signal-regulated kinase 2 (ERK2). We herein examined the therapeutic efficacy of LL-Z1640-2 against ATL. LL-Z1640-2 effectively suppressed the in vivo growth of ATL cells. It induced in vitro apoptosis and inhibited the nuclear translocation of p65/RelA in ATL cells. The knockdown of IRF4 strongly induced ATL cell death while downregulating MYC. LL-Z1640-2 as well as the NF-κB inhibitor BAY11-7082 decreased the expression of IRF4 and MYC at the protein and mRNA levels, indicating the suppression of the NF-κB-IRF4-MYC axis. The treatment with LL-Z1640-2 also mitigated the phosphorylation of p38 MAPK along with the expression of CC chemokine receptor 4. Furthermore, the inhibition of STAT3/5 potentiated the cytotoxic activity of LL-Z1640-2 against IL-2-responsive ATL cells in the presence of IL-2. Therefore, LL-Z1640-2 appears to be an effective treatment for ATL. Further studies are needed to develop more potent compounds that retain the active motifs of LL-Z1640-2

Phase angle and extracellular water-to-total body water ratio estimated by bioelectrical impedance analysis are associated with levels of hemoglobin and hematocrit in patients with diabetes

Background: Anemia is one of the common complications of diabetes and is associated with mortality. Phase angle (PhA), ratio of extracellular water to total body water (ECW/TBW) and skeletal muscle mass index (SMI) estimated by bioelectrical impedance analysis (BIA) have been used as prognostic indicators for various chronic diseases and frailty. We aimed to clarify the clinical significance of PhA, ECW/TBW and SMI for anemia in patients with diabetes. Materials and methods: The values of PhA, ECW/TBW and SMI were estimated by a portable BIA device and blood samples were collected in 371 Japanese patients with diabetes. The relationships of PhA, ECW/TBW and SMI with hemoglobin (Hgb) and hematocrit (Hct) were statistically evaluated. Results: In simple linear regression analysis, PhA and SMI were positively correlated with Hgb and Hct levels in total subjects, male subjects and female subjects. In contrast, ECW/TBW was negatively correlated with Hgb and Hct levels regardless of sex. Multivariate regression analysis showed that both PhA and ECW/TBW but not SMI independently contributed to Hgb and Hct levels after adjustment of clinical confounding factors in both males and females. Conclusions: PhA and ECW/TBW but not SMI were associated with levels of Hgb and Hct in patients with diabetes. Therefore, aberrant values of PhA and ECW/TBW suggest a risk of anemia in diabetic patients

公衆衛生看護技術論演習及び実習のカリキュラム改正における保健師学生の実践力向上効果：ミニマム・リクワイアメンツを活用して

報告Reports　本学では、2009 年の保健師助産師看護師法の改正に伴い、2012 年度入学生以降、公衆衛生看護課程の学部選択制を導入し、厚生労働省の示す、保健師学生が保健師活動に求められる一定水準の技術習得を備えることができるよう公衆衛生看護技術論演習（以下、技術論演習）並びに公衆衛生看護学実習（以下、実習）カリキュラムの改正をおこなった。　保健師の援助技術において家庭訪問は、対象である住民の生活実態に迫るという、重要かつ象徴的活動方法である。しかし学生の実習では１例しか同行訪問を経験していないため、深刻な事例を担当することへの不安や戸惑いが大きく、新卒の保健師は訪問が苦手と報告されるように、学部教育の課題といえる。そこで本研究では、個人や家族を対象とした実践能力に焦点を絞り、授業評価の一環として、学生の卒業時の到達度を分析・評価し、学生指導の今後の課題や対策を検討すると共に、今後の学生指導への示唆を得ることを目的とした。　調査内容は、全国保健師教育機関協議会が卒業時までに必ず修得する最低限の技術として作成した、保健師教育におけるミニマム・リクワイアメンツ（以下、MR）の５つの実践能力のうち、「実践能力Ⅰ」個人・家族を対象とした地域の健康課題の明確化と計画・立案する能力に着目した。さらに行動目標を、演習並びに実習で実践可能な「家庭訪問」に焦点化し、自己評価が可能な12 の大項目、38 の行動目標項目を抽出して作成し、到達度を「十分達成できた」「おおよそ達成できた」「なんとか達成できた」「全く達成できなかった」の４件法で回答を求めた。分析対象者は、本学の看護学部公衆衛生看護課程を履修し、技術論演習及び実習修了後に自己評価を提出した学生74 名のうち本研究の参加同意を得た65 名であった。　技術論演習と実習終了後のMR 自己評価の結果を比較・分析したところ、全38 行動目標のうち、12 項目に有意な到達レベルの改善が認められた。　本研究により、本学の公衆衛生看護カリキュラム改正は、卒業時到達目標に到達ができ、学生の実践力向上に繋がることが示唆された

第3回「卒業生の保健師の集い」をふりかえって

その他Miscellaneou

Ａ大学における保健師学生の地域診断能力の評価：ミニマム・リクワイアメンツを活用して

報告Reports　本研究は「保健師教育におけるミニマム・リクワイアメンツ保健師教育機関協議会版（2014）（以下、MR）」を活用し、地域診断から事業化に関する技術の行動目標の達成度を、学生の自己評価を用いて実習後と総合演習後で比較し、実習・演習の教育評価を行うことを目的とする。到達割合の全28 小項目の平均は、84.4％（実習後）から、94.1％（総合演習後）と9.7 ポイント上昇した。28 小項目の到達割合を実習後と総合演習後で比較すると、実習後に９割に達しなかった小項目は22 項目（78.6％）あったが、総合演習後は全項目で上昇がみられ、28 項目すべてが9 割を超える到達割合を示した。実習後と総合演習後で到達割合に有意差があった小項目は、19 小項目（67.9％）であった。　以上の結果より、公衆衛生看護学実習後、学内で公衆衛生看護総合演習として地域診断のプロセスを再考し思考の整理をすることで、目標が達成ができ地域診断能力の向上につながったと思われる。そして実習、演習の連動した授業内容は評価を得たと考える