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The patient was a 63-year-old man with biopsy Gleason score of 4＋5 prostate cancer with an initial prostate specific antigen level of (PSA) 51.2ng/ml. On imaging examination, extracapsular invasion, rectal invasion, and pararectal lymph node metastasis were found (cT4N1M0). After 4 years of androgen deprivation therapy, PSA decreased to 0.631ng/ml, and then increased gradually to1.2ng/ml. Computed tomographic scan showed that the primary tumor had shrunk and lymph node metastasis had disappeared; so salvage robot-assisted resection of the prostate (RARP) was performed for non-metastatic castration-resistant prostate cancer (m0CRPC). Since PSA decreased to an undetactable level, hormone therapy was terminated at 1 year. The patient remained recurrence-free for 3 years after surgery. RARP may be effective for m0CRPC, enabling discontinuation of androgen deprivation therapy.

Ⅰ 論文, Ⅰ ARTICLES

当院では2020年9月より医師,歯科医師,薬剤師,看護師,歯科衛生士,言語聴覚士,管理栄養士等の多職種により構成された摂食・嚥下支援チームを稼働させた.チーム稼働から約1年が経過し,2020年9月から2021年8月までの期間に介入した症例について年齢,性別,依頼元診療科,原疾患,歯科治療や口腔ケアの必要性の有無,嚥下内視鏡検査の所見,チーム介入前後における摂食状況（Functional Oral Intake scale ; FOIS）の変化について調査し,検討を行った.対象症例は,62例,平均年齢は74.0±10.7歳,男女比は男性40例,女性22例で男性が多かった.依頼元は15診療科であり,原疾患は神経・筋疾患が27％,頭頸部癌が21％,消化管疾患が15％であった.口腔ケアや歯科治療などが必要と考えられた症例は45例であり,その内訳では口腔ケアが34例と最も多かった.嚥下内視鏡検査（以下VE）における兵頭スコア4項目の合計点の平均は4.1であった.また,VEでの誤嚥頻度は62例中25例（40.3%）であった.摂食・嚥下支援チームの介入前後で比較し,34症例（54.8％）においてFOISの上昇を認めた.調査の結果,摂食・嚥下障害は多様な要因で生じていると考えられ,多職種により,摂食嚥下機能を正しく評価し、適切な訓練や食形態を選択することが重要であると考えられた.また,口腔ケアや歯科治療が必要であった症例は多く,チームに歯科医療従事者が参加している意義が示された.チームは院内での存在も確立しつつあり,今後もさらに活動を充実させていく予定である.

II シンポジウム記録『引揚・追放・残留：戦後国際民族移動の比較研究』刊行記念シンポジウム『引揚・追放・残留：戦後国際民族移動の比較研究』刊行記念シンポジウム, 開会挨拶：外村 大／編者挨拶：蘭 信三／第一部 コメント：塩出浩之・錦田愛子・成田龍一・野村真理・西 成彦／第二部 総合討論／閉会挨拶：川喜田敦子／司会：飯島真里子・川喜田敦子, II Symposium „Repatriierung, Vertreibung und Zurückbleiben. Internationale vergleichende Studie über ethnische Bevölkerungsverschiebungen nach dem Zweiten Weltkrieg“

From April 2007 to April 2018, we performed lymph node dissection in 305 cases of laparoscopic radical prostatectomy and 202 cases of robot-assisted radical prostatectomy at our hospital, and there were 68 cases with positive lymph node metastasis (pN1). Of these 68 cases, we examined retrospectively 62 cases in which extended lymph node dissection (ELND) was performed. The median number of removed lymph nodes was 25 (interquartile range [IQR] ; 18-34) and the median number of metastatic lymph nodes was 1 (IQR ; 1-3). Postoperative prostate-specific antigen (PSA) recurrence was observed in 40 of the 62 patients. The median time to PSA recurrence was 24 months. After univariate analysis, PSA at initial diagnosis (iPSA) of 10 ng/ml or more, pathological Gleason score (pGS) of 8 or more, total number of lymph node metastases of 2 or more, and positive surgical margin (RM＋) were found to be riskfactors of PSA recurrence. In multivariate analysis, iPSA of 10 ng/ml or more, pGS of 8 or more and RM＋ were independent riskfactors of PSA recurrence (p＜0.05). In the cases without riskfactors such as iPSA≥10, pGS≥8, and RM＋, immediate postoperative adjuvant therapy may be avoided even with pN1.

Herein we present simple methods to prevent postoperative inguinal hernia (IH) after extraperitoneal and transperitoneal robot-assisted radical prostatectomy (RARP). Among 275 patients who underwent RARP between January 2014 and December 2016 at our institution, we evaluated 143 and 115 patients who underwent extraperitoneal-RARP (e-RARP) and transperitoneal-RARP (t-RARP), respectively, after excluding those with intraoperative detection of IH (17 patients). In the e-RARP group, all 143 patients (286 groins) underwent an IH prevention procedure. In the t-RARP group, the first 22 patients (44 groins) did not undergo an IH prevention procedure, whereas 29 patients (37 groins) with patent processus vaginalis (PPV) among the last 93 patients underwent the procedure. The IH prevention procedure during e-RARP included release of the vas deferens from the peritoneum and spermatic cord, and peritoneal dissection of the spermatic cord at the internal inguinal ring. The IH prevention procedure during t-RARP included release of the vas deferens from the peritoneum and spermatic cord, complete circumferential dissection of the peritoneum around the PPV at the level of the internal inguinal ring, and ligation of the PPV with a Hem-o- Loc○R clip. In the e-RARP group, postoperative IH occurred in 3 of the 143 patients (1.9%) during the follow-up period of 22.0±9.2 months. In the first subgroup of t-RARP, postoperative IH developed in 4 of the 22 patients (18%) during the follow-up period of 33.1±12.1 months, whereas in the last t-RARP group, postoperative IH developed in 3 of the 93 patients (3.3%) during the follow-up period of 20.1±8.6 months. Different IH prevention procedures performed in patients undergoing e-RARP and t-RARP were simple and effective in preventing postoperative IH.

Sixty eight patients had robot-assisted radical prostatectomy (RARP) from January 2016 to April 2017 with estimated blood loss of less than 500 ml. We compared the postoperative complication rates and the length of hospital stay between 34 of these patients who had pelvic drain placement (PD group), and the remaining 34 patients who had no drain placement (ND group). The approach was intraperitoneal in 25 patients in each group. The PD and ND groups were comparable for age (69.5 vs 70 yrs, P=0.459), clinical Gleason Score (6/7/≧8) 2/17/15 vs 3/8/23 (P=0.077), clinical stage (1c/2/3) 3/25/6 vs 1/25/8 (p=0. 539), operative time (311 vs 309 min, P=0.868), and estimated blood loss (p=0.166). The PD group had significantly higher median PSA level than the ND group (8.01 vs 6.25 ng/ml, P=0.023). Incidence of 30- day overall complications in the PD group (35 events) was lower than that in the ND group (38 events). All complications were classified as Clavien Dindo grade I. The postoperative hospital stay was 8 days in the PD group and 7 days in the ND group, showing no prolongation in the ND group. Pelvic drainage may be omitted after RARP without increasing postoperative complications or prolonging the hospital stay.

特集

We evaluated the safety of laparoscopic radical cystectomy (LRC) during initial phases and its learning curve in a Japanese multicenter cohort by studying 436 patients who underwent LRC with no robot assistance at 10 institutions in Japan. We divided the patients into three groups according to cumulative surgical volume at each institution (first 10 cases, 11-30 cases, after 31 cases in each institution), and compared perioperative and pathologic variables among the three groups. The first, second, and third groups included 100, 166, 170 patients, respectively. The preoperative variables were similar in the three groups except for the rate of neoadjuvant chemotherapy. The methods of LRC procedure, such as urinary diversion, the extent of lymph node dissection, and concomitant urethrectomy or nephroureterectomy, were similar in the three groups. Mean operative time was 629, 562 and 531 minutes, respectively, and mean blood loss was 755, 650 and 435 ml, respectively. Both values decreased over time with the institution's experience. There was no significant difference among the three groups in the rate of positive surgical margin, the number of retrieved lymph nodes, and the rate of intra- and postoperative complications. LRC was safely performed during initial phases with an acceptable complication rate and without compromising oncological results, although operative time was longer and blood loss increased.

Traumatic adrenal injury is quite rare. From January 2008 to March 2018, out of 287 patients with genitourinary trauma, 23 patients (8%) were diagnosed with traumatic adrenal injury at Kobe City Medical Center General Hospital. We retrospectively reviewed the medical records and assessed the traumatic category, image findings and outcome. All 23 patients were bluntly injured. The causes of traumatic adrenal injury were motor vehicle accident (11 patients : 48%) and falls (9 patients : 39%). The majority of injuries occurred on the right side (18 patients : 78%). Associated injuries occurred in all 23 patients, most frequently in the liver (57%) and ribs (57%). Extravasation of contrast materials was identified on computed tomography (CT) in 4 patients (17%). Although 22 patients (96%) were conservatively managed, only 1 patient was treated by transcatherter arterial embolization because of hypotension. One patient died of intraabdominal bleeding. To our knowledge, the present study is the largest on traumatic adrenal injury in Japan.

A 76-year-old man with a history of hypertension was admitted with high fever and left scrotal pain. Laboratory findings revealed high serum C-reactive protein levels. The left epididymis appeared to be swollen on computed tomography. The patient was diagnosed with bacterial epididymitis and treatment with antibiotics was initiated. Despite treatment, his left scrotal pain and fever did not improve. Additionally, he developed right scrotal and posterior neck pain. For histopathological diagnosis, a left high orchiectomy was performed and the findings revealed thickened arteriolar walls with infiltration of inflammatory cells around the testis, leading to a final diagnosis of systemic polyarteritis nodosa. Treatment with steroids led to complete resolution of the patient’s systemic pain and inflammation.

A 63-year-old man with microscopic hematuria underwent contrast-enhanced CT, which showed multiple bilateral renal masses. Percutaneous biopsy results indicated renal oncocytosis. The tumors remained unchanged for 3 years. Renal oncocytosis is a very rare tumor, but it is an established disease entity characterized by numerous oncocytic tumors and diffuse (sporadic) renal parenchymal epithelial oncocytic changes on an analysis histopathology. Although renal oncocytosis can be sporadic or part of Birt-Hogg-Dube syndrome (BHDS), our case did not associate with BHDS because of absence of lung cyst.

Charlotte Brontëの『ジェーン・エア』(Jane Eyre, 1847)は出版当初から傑作として高く評価された一方, 話の展開が不自然, また主人公Janeの行動が不自然で一貫性がないといった批判がなされてきた. 特に, Janeが一度Rochesterの元を去りながら, ある日突然遠く離れた彼の呼び声を聞き, 彼のもとに戻って結婚するという筋書きには反発が多い. これらの批判はJaneの行動原理が正しく理解されていないことに起因する. 本稿では, Janeの行動原理を分析する手掛かりとして, 第12章で彼女が口にする"power of vision"という表現に注目し, このvisionの力こそがJaneの求めるものであり, Rochesterとの結婚がその願望を充足させるという仮説を立てる. ここでのvisionは従来視覚の意味で捉えられてきたが, 本稿ではこれに留まらず, 予示, 想像という別の解釈を導入する. これにより, Janeの行動は一貫して不思議な予示の力に導かれていること, また, 彼女の成長は作者Charlotte Brontëの想像力の表現の発展と呼応していることが示される. JaneがRochesterと結婚するのは, 彼となら彼女が求めていたvisionの共有が叶うからであり, またそれは, 読者とvisionを共有したいという作者本人の欲求に根差すものである., Charlotte Brontë's Jane Eyre(1847) has been accused of depicting Jane's behavior unnaturally and inconsistently. In particular, the scenario where Jane, who once left Rochester, suddenly hears his voice calling her out of nowhere and returns to him has been criticized strongly. These criticisms tend to be based on a misunderstanding of Jane's principles. This paper focuses on "a power of vision which might overpass that limit" that Jane yearns for in Chapter 12, subsequently hypothesizing that Jane desires the "power of vision" and her marriage to Rochester grants that desire. Conventionally, this "vision" has been comprehended as "eyesight, " but this paper will explore other connotations ; "prophecy" and "imagination." These interpretations will demonstrate that Jane consistently follows mystical foretelling throughout her life and her development as a story-teller parallels the progress of Charlotte Brontë's own imaginative expressions. Jane returns to Rochester because he alone can share the vision with her ; this is rooted in Brontë's desire to share the vision with readers. Rochester's loss of eyesight should be interpreted as a means of sharing the vision with Jane rather than as a punishment for his transgressions.

We report the surgical procedures and perioperative outcomes of off-clamp, non-renorrhaphy robotassisted partial nephrectomy (RAPN) in 7 out of 76 patients who underwent RAPN with off-clamp and nonrenorrhaphy between February 2015 and August 2017. The approach was chosen depending on the location of the tumor. Tumor enucleation was performed by using sharp incision and blunt dissection. For hemostasis, the soft-coagulation system was used and TachoSil○R was placed on the resection bed. As a rule, renorrhaphy was not performed. Median (range) patient age was 67 years (40-79), tumor size ; 14 mm (12-18), operative time ; 139 minutes (102-166), console time ; 51 minutes (41-75), estimate blood loss ; 10 ml (0-100). No patients required a perioperative blood transfusion. Median (range) tumor intraparenchymal depth was 10.4 mm (4.3-15.5) and distance from urinary collecting system was 9.3 mm (4.1-13.0). Pseudoaneurysm and urine leakage were not observed. No complications classified as Clavien-Dindo grade higher than grade 1 appeared. No cases had a positive surgical margin. Median (range) estimated glomerular filtration rate (eGFR) change rate at 3 months after surgery was 0% (−12.7-14.5). Off-clamp, non-renorrhaphy RAPN with the soft-coagulation system and TachoSil® is a feasible and safe procedure for patients carefully selected among those with superficial tumors.

学校評価の制度化過程を検討し、制度化の背景と制度的意図を明らかにすることに目的がある。そこで、中央教育審議会における審議を中心に検討を行った。検討の結果、学校評価そのものが議論の中心ではなく、戦後に構築され今日まで続く教育行政や教育の在り方を、今日的に改善・改革することを審議の中で目指していた。また、学校評価は政策評価や管理評価を同時に行うような事態に陥っており、評価論として整理する必要性が明らかになった。, 研究ノート(博士資格論文)(Note(Doctoral qualification thesis))

三木市の中心部には、国史跡、歴史街道、町屋及び神社仏閣等に加え、刃物製作などの伝統産業、特色のある商店、共同洗濯場などのコミュニティ施設、鉄道や橋梁といった構築物等、古い時代から近年に至るまでの歴史が生み出した様々な文化資源が蓄積している。 しかしながら現状では、これらの歴史文化資源は、必ずしも一般市民や外来者に十分に認識されているとは言い切れない。そこで、より多くの人々がそれらの歴史文化資源に触れることのできる機会を設けて、それらを新たな視点のもとに活用していくことが、三木市の魅力を高め、一般市民と共に持続的なまちづくりを進めていく上で、たいへん重要な課題のひとつとなっている。 本研究ではこのような認識のもと、三木市の中心部に存在する歴史文化資源に関する基礎的な調査を行なった上で、2011 年から2019 年まで毎年、「ミキシル」と名付けた三木のことをより多くの人に知ってもらうための親子参加型イベントを中心とした催しを、2 月または3 月に実施してきた。本報告は、9 年間にわたって継続開催してきたこのイベントの企画内容と実施結果を取りまとめたものである。, In the central area of Miki city, there exist various historical heritages. Following the national historic site of ancient Miki castle, historic streets, old merchant houses, temples and shrines, public outside washing places, a distinctive railroad bridge, and the industry of iron tools, all characterize the history and the culture of the city. However, the value and the richness of these elements are not recognized widely enough by the citizens and the visitors. Thus, promotion to increase awareness of the people to these heritages has been one of the important subjects of the city to bring forward the urban reorganization and the community building. With this understanding, we have organized and implemented annual events named "Mikishiru" (which means to know the city of MIKI) for the past 9 years. The main participants of the events have been children and their parents, the players of the society of next generation. This is the documentation of the events and related activities, reviewing the process of the development year by year.

We report the incidence and characteristics of lymphoceles after robot-assisted radical prostatectomy (RARP). Computed tomography was performed on 79 patients one month after RARP or when symptoms appeared. The lymphocele was defined as a cystic lesion over 10 mm in diameter. Symptomatic and asymptomatic lymphoceles were identified in 25% (20/79) of all cases, and in 40.9% (18/44) of the cases with lymph node dissection (LND). Symptomatic lymphoceles were identified in 2.5% (2/79) of all cases. Lymphoceles were significantly associated with LND, pathological stage over T3, longer period of indwelling drain tube, and higher volume fluid of drain tube (p

A 61-year-old man with a left renal mass, which was detected by ultrasound during a routine health examination, was referred to our department. The patient had a surgical history of two pneumothorax operations, and the patient's brother also had a history of pneumothorax surgery. A case of Birt-Hogg-Dubé (BHD) syndrome was suspected based on patient history. The pathological diagnosis of the resected tumor, which used robot-assisted laparoscopic partial nephrectomy, was determined to be chromophobe renal cell carcinoma (grade 2, pT1a). BHD syndrome was confirmed by genetic testing, where a nonsense mutation of exon 9 in the FOLLICULIN (FLCN) gene was detected. The patient is currently alive 10 months after surgery.

第14回宇宙環境シンポジウム (2017年11月6日-8日. 神戸大学先端融合研究環統合研究拠点コンベンションホール), 神戸市, 兵庫県, 形態: カラー図版あり, Physical characteristics: Original contains color illustrations, 資料番号: AA1730013025, レポート番号: JAXA-SP-17-006

市場リスクを伴う資産は適切なタイミングでの売却により，継続保有よりも大きな利益を獲得できる．商社は従来より鉱山事業経営に参画しリアルオプションを用いて，採掘量・コストをコントロールし利益の最大化を図っている．従来はリアルオプション適用に際して裁定機会を表せず，鉱山の売却は考慮されなかった．本研究では，銅鉱山を対象として銅価格のボラティリティを考慮し，鉱山の最適売却タイミングを決定するための数値計算モデルを構築する．その上で，このモデルを応用し商社が鉱山事業の売却に際して迅速で的確な意思決定を行うためのフレームワークを提示する．これにより，商社は鉱山売買に時間的制約を伴う状況下でも迅速に意思決定を行い，売却先との条件交渉を優位に進められるため，本モデルは実務面で高い応用性・有用性を発揮する．By selling assets with market risk at the optimal time, there are possibilities that we can earn more profits than holding them continuously. General trading and investing companies called “Shosha” have been participating in mining business and using real options to maximize profits by controlling the amounts and costs of mining. However, it has not been possible to consider an arbitrage opportunity in applying real options, so selling mines has not been taken into account. In this research, we consider the volatility of copper prices for copper mines, build a numerical calculation model for determining the optimal time of selling mines and present a framework that Shosha can apply rapid and accurate decision-making in mining business. This enables them to make decisions quickly even under circumstances involving temporal restrictions on selling mines, and to advance the condition negotiations with the seller dominantly, so this model can demonstrate high applicability and usefulness on the practical side .

St John is a young, stoic pastor in Charlotte Bronte's Jane Eyre (1847). Thus far, little attention has been paid to him and his proposal to Jane. In this paper, we argue that St John's view of marriage and wealth comes from his Calvinist philosophies; to do so, we refer to Max Weber's book of economic sociology, The Protestant Ethic and the Spirit of Capitalism (1904-05). According to Weber, Calvinists consider their labor as a vocation, and approve of wealth as the result of working hard for God. Applying this logic to St. John, a typical Calvinist, it can be said that his proposal is based on Jane's wealth, rather than his love for her. In conclusion, St. John is a character who represents Charlotte's dislike for Calvinism.

Many card games are described in Jane Austen's Pride and Prejudice (1813). This paper focuses on those card games and reveals that Austen uses the games to explain the players' personalities. Furthermore, we interpret the card games as a metaphor for games of love between the players. According to this hypothesis, it can be said that Elizabeth changes her attitude toward card games based on her eagerness for love.

著者らは無線通信機能がある携帯端末と複数の受信専用普及型ソフトウェア無線装置(SDR)を組み合わせることで通信相手が発する電波の到来方向を検知するシステムの実現を目指している．搬送波の位相情報を利用し到来方向を検知するためには，複数アンテナで電波を受信し，各アンテナと位相差検知回路の経路上の周波数変換器のクロック及び位相が同一である必要がある．しかし，普及型SDR装置を複数用いる場合，各SDR装置で生じる位相オフセットをキャンセルせねばならない．更に到来方向検知精度の劣化の原因となるマルチパスの対策も講じる必要がある．本論文では，2入力2出力スイッチをアンテナとSDR装置の間に挿入し，入力信号を切り替えて簡単な信号処理で位相オフセットをキャンセルできるモノパルススイッチングを提案し，その有効性を実験で検証し，到来方向検知誤差が3.0°以内で動作することを確認した．マルチパスの対策としては，複素モノパルスとモノパルススイッチングを組み合わせた複素モノパルススイッチングを提案する．複素モノパルス比の複素平面上の位置を確認することで，マルチパスの影響が大きいタイミングを検知・回避できることを実験により示した．, The authors target the realization of AoA estimation system by plugging in two commercial off the shelf (COTS) software defined radio (SDR) modules on a mobile terminal. The simultaneous usage of two COTS SDRs suffers from the phase offset occurred in each SDR even after we synchronize the clock. To cancel the phase offset, we propose Monopulse Switching, which produces two sets of phase measurements with a double pole and double throw (DPDT) switch implemented between each antenna and SDR module, in this paper. A simple signal processing of the two sets IQ data cancels the phase offset. The AoA estimation accuracy of Monopulse Switching is evaluated both in wired and wireless environments to reveal we can achieve 3.0 degree accuracy. We also quantify the AoA accuracy degradation stemming from the inevitable multiphase and propose to apply a complex monopulse combined with Monopulse Switching to detect and eliminate the degraded measurements.

Recently, holmium laserenucleation of the prostate (HoLEP) was associated with less bleeding compared with transurethral resection of prostate. Since 2012, we have performed HoLEP for benign prostatic hyperplasia (BPH) under continuous oral antithrombotics (OA). Between October 2004 and March 2015, 54 patients with BPH underwent HoLEP while on OA at our hospital. Eight patients underwent HoLEP without OA cessation and 46 patients with temporary OA cessation. No significant between-group difference was observed in age, prostate volume, transitional zone prostate volume, operation time, resection weight, resection weight per minute, urethral catheter duration, Hb decrease on day 1 post- HoLEP, hospital stay after HoLEP, bleeding intraoperative rate, bleeding rate after HoLEP and transfusion rate. None presented embolic complications. HoLEP was safe without OA cessation. However, highvolume BPH patients without OA cessation required intraoperative transfusion. Thus, high-volume BPH patients may benefit from OA cessation.

Urosepsis is not uncommon and sometimes causes a critical condition including death. We retrospectivelyanaly zed the risk factors for mortalityin urosepsis. We treated 80 patients as urosepsis from 2010 to 2014 in our hospital. Five patients (6%) died within 30 days of hospitalization. The median age of the patients who died of urosepsis was 92 years (range, 83-95 years). The main causes of urosepsis were complicated pyelonephritis in 4 patients and emphysematous pyelonephritis in one. In the subgroup analysis of elderly patients over 75 years old, bad performance status and lower serum albumin were significantlyrelated to mortality(p ＝0.033, 0.046). The elderlypatients, especiallywith bad performance status and lower serum albumin, are more likelyto die.

Symposium

名古屋大学農学部は、｢科学的素養｣、｢論理的思考力｣、｢総合的に分析する力｣を身に付けることを教育目標に掲げて、「食・環境・健康」を基盤とした教育プログラムの実施とグローバル化への対応を行っている。前回の学部カリキュラム改編から10年が経ち、学生の成績の二極化、科目間の内容重複、授業項目の順番・配置見直しの必要性といった問題が指摘されてきた。さらに、学部学生の大学院進学率が8割に達しようとする現状も踏まえ、学部・大学院を合わせた6年一貫教育を念頭に置いた学部カリキュラムの改編を進めている。その改編案では、専門教育を進める上で最低限必要となる基礎的知識を1、2年次に全学生が習得することを目指して、基礎科目の必修化を進めた。3年次には、様々な学問領域につながる専門科目の講義と実験実習とともに、学んだ専門知識をより深化・発展させて4年次の卒業研究への橋渡しとなるような科目を設けている。そのため、各学科独自の多様なプログラムが設けられ、学生が大学院や就職先でより活躍できることを期待したカリキュラム改編となった。, The School of Agricultural Sciences of Nagoya University seeks to develop individuals with knowledge and training in agricultural sciences, capable of contributing to society through their humane attitude toward all living organisms, comprehensive decision-making abilities, and creative problem-solving skills. It has been 10 years since the last reformation of the undergraduate curriculum, and some issues such as the polarization in student achievement and the redundancy in the course contents have been pointed out. Moreover, given the current situation that almost 80% of undergraduate students attend graduate schools, the curriculum committee has been promoting the reform of academic programs with educational continuity at universities and graduate schools in mind. In the new academic program, many basic subjects have been made compulsory in an effort to make all first- and second-year students acquire basic knowledge needed for advanced education. Third-year students must take many special subjects and laboratory exercise, including the subjects that act as a bridge to graduation work in the fourth year. Each department offers a wide variety of programs and improves curriculums in order to develop students capable of working in graduate schools and places of employment.

第13回宇宙環境シンポジウム (2016年11月1日-2日. 情報通信研究機構 本部 国際会議室), 小金井市, 東京, The 13th Spacecraft Environment Symposium (November 1-2, 2016. National Institute of Information and Communications Technology), Koganei, Tokyo, Japan, 形態: カラー図版あり, Physical characteristics: Original contains color illustrations, 資料番号: AA1630038028, レポート番号: JAXA-SP-16-010

第13回宇宙環境シンポジウム (2016年11月1日-2日. 情報通信研究機構 本部 国際会議室), 小金井市, 東京, The 13th Spacecraft Environment Symposium (November 1-2, 2016. National Institute of Information and Communications Technology), Koganei, Tokyo, Japan, 形態: カラー図版あり, Physical characteristics: Original contains color illustrations, 資料番号: AA1630038030, レポート番号: JAXA-SP-16-010

Adrenal corticotropin (ACTH) -independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing’s syndrome. Bilateral adrenalectomy is the treatment of choice, but lifetime steroid replacement is essential. Here we report a case of AIMAH whose hyperglycemia was improved following unilateral adrenalectomy. A 42-year-old woman with serious intellectual disability and intractable epilepsy presented with polydipsia. Casual blood glucose and hemoglobin A1c (HbA1c) were 322 mg/dl and 8.5%, respectively. The cortisol level was high and ACTH level was low. Abdominal computed tomography and magnetic resonance imaging revealed unsuspected macronodular enlargement of bilateral adrenal glands (left 8 cm, right 4 cm in maximal diameter) and she was diagnosed with AIMAH. Both adrenal glands showed intense 131 I-adosterol accumulation predominantly in the left side and left-unilateral laparoscopic adrenalectomy was performed. Both insulin and oral antidiabetic drugs could be cancelled postoperatively, and HbA1c decreased to 5.7%. Steroid was not replaced but she never experienced adrenal crisis. We conclude that unilateral adrenalectomy is a safe and effective treatment for certain cases of AIMAH.

地方都市を対象として、地域の調査や分析などによる課題の抽出を行い、環境デザイン、建築、まちづくりなどからの解決策の実践的な提案を行ない、少子高齢化社会や持続可能型社会に向けた地方都市の創生（地域再生）のあり方を提言するデザイン手法論を研究することを目的とする。岡山県瀬戸内市長島の国立ハンセン病療養所の保存と再生をテーマとし、地域の現地調査・分析、現地WS などを踏まえて、長島全体の将来計画を提案する。また、瀬戸内海沿岸地帯・島嶼部の視点から、長島を拠点とした裳掛地区全体のまちづくり構想も提案する総合的な地域再生デザインである。長島未来プロジェクト（本研究）は、両園の将来構想を基調に「長島全体の将来構想」に係る環境デザインからの構想計画を提案すること及びその実現に向けた活動に取り組むこと、並びに今後、長島の将来構想を計画へと具体化する段階で関係者の議論に供することにより、構想の実現に資することを目的とする。更に、長島を拠点として瀬戸内沿岸地域・島嶼部一帯が連携した地域再生の取組みを進めることにより、“長島入所者の想い”を未来につなぎ、瀬戸内沿岸・島嶼部一帯の活性化に寄与することに本プロジェクトの意義がある。, The aim of the research is to, at first, based on the surveysand analysis of the study area, detect the challenges, which will be followed by practical proposal of the solutionstrategy that encompasses environmental design,architecture as well as community development. The practical proposal of our research is a design methodology which tackles with phenomena of regional city revitalization in the context of low birth rate, aging society and sustainable society. Under the topic of preservation and regeneration of the National Hansen's Disease Sanatorium in Nagashima (Setouchi City, Okayama Prefecture) and based on regional field survey, analysis, workshops etc. we will propose future plan of Nagashima Island as a whole. Furthermore, from the point of view of the Seto Inland Sea coastal zone and the islands, and with Nagashima Island as a base, the entire district of Mokakechiku will be included in the comprehensive community development plan within the regional city revitalization design concept.The research of Nagashima Mirai Project encompasses several main objectives. First is the proposal of the environmental design conceptual plan based on the theme of “Future vision of Nagashima as a whole“, followed by the implementation activities and the inclusion of the stakeholders by sharing the findings of the research during the realization of the plan phases, and lastly by advancing and promoting the regional revitalization of Seto Inland Sea coastal zone and the islands, our research project is to bring forth the “Nagashima residents’ spirit” and tie it to Nagashima’s future.Main research project and its objectives are devised to make a significant contribution to revitalization of Seto Inland Sea coastal zone and the islands zone as whole.

We report a rare case of a traumatic dislocation of the penis. The patient was a 39-year-old man who was ambulanced to our hospital because of a motorbike accident. He was diagnosed to have a pelvic fracture. He was admitted to our department because of his urinary retention and lower abdominal pain. Only the penile skin was left as the genital organ, and neither the penis nor the glans penis was palpable. As the computed tomography scan of the abdomen revealed the dislocation of the penis under the skin in the foreside of the pubic bone, urinary retention due to the traumatic dislocation of the penis was diagnosed, and a percutaneous cystostomy was performed. After improvement of his general condition, the patient was transferred to our department for the evaluation of the perineal region, including the lower urinary tract, and for the treatment of the traumatic dislocation of the penis. First, as hematoma and abscess in the left spermatic cord were suspected by magnetic resonance imaging of the pelvic region, removal of the hematoma and abscess in the left spermatic cord as well as an anterograde cystoscopy were performed under lumbar anesthesia, and the absence of urethral injury was confirmed. After infection control, repositioning of the penis was jointly performed with the Department of Plastic Surgery of our hospital under general anesthesia. After the operation, spontaneous urination was observed and erectile function was observed to be normal.

We compared the efficacy of naftopidil monotherapy with combination therapy using tamsulosin hydrochloride and solifenacin succinate in the treatment of lower urinary tract symptoms (LUTS) with overactive bladder (OAB) secondary to benign prostatic hyperplasia (BPH). Thirty one patients were enrolled in a randomized crossover study. Fourteen patients were initially prescribed naftopidil 75 mg (N) for 8 weeks, followed by tamsulosin 0.2 mg and solifenacin 5 mg (TS) for 8 weeks (group N) ; another 17 were initially prescribed TS, followed by N (group TS). The efficacy variables were the changes in international prostate symptom score (I-PSS), quality of life (QOL) score, overative bladder symptom score (OABSS), and post-void residual (PVR) urine volume. After the study, a questionnaire survey was carried out about the choice of treatment. After treatment with each agent, total I-PSS, storage symptom score, QOL score and OABSS except for the daytime frequency were significantly improved from baseline. PVR was significantly increased after TS treatment. There were no significant differences between the two treatments except for PVR. As a result of the questionnaire survey, 13 patients chose N and 17 chose TS. In conclusion, N monotherapy can be expected to have an equal effect in the treatment of LUTS with OAB secondary to BPH in comparison with TS combination therapy.

本稿では，彗星の近赤外線スペクトルにおいて1μm波長帯で主な輝線を生じるCN分子を取り上げ，その発光モデルの詳細化について検討した結果を報告する。1μm波長帯はこれまでにくわしいサーベイがされておらず，京都産業大学神山天文台に設置された世界屈指の感度を誇る近赤外線高分散分光器WINEREDを用いた未同定分子のサーベイが進行中である。そうした未同定分子（CN分子の同位体を含む）は微弱な輝線を有すると考えられるため，その検出には，主な輝線を発するCN分子の同定と除去が必要となる。そこで，高精度な実験室分光データを元にした彗星CN分子輝線モデルの構築を行った。, In this study we discuss about emission lines caused by CN radicals in cometary coma. We have a plan to survey cometary emission lines（including unidentified lines）in 1-micron wavelength region by the high-sensitivity and high-resolution near-infrared spectrometer WINERED equipped with the 1.3m-Araki telescope in Koyama Astronomical Observatory, Kyoto-Sangyo University, Japan. In the target wavelength region（0.9 - 1.3 microns）emission lines from CN radicals are prominent and to be subtracted in order to search for weaker emission lines（isotopologues of CN and other complex molecules）. Accurate emission model for CN in cometary coma has been developed based on the recent laboratory studies and theoretical works., 9, KJ00010262519, P, 研究活動報告, Activity Reports

Oncocytic papillary renal cell carcinoma isa variant of papillary renal cell carcinoma (PRCC). We herein report two cases treated with retroperitoneoscopic partial nephrectomy. Histologically, tumor cells of both cases exhibit round and regular nuclei with CK7 positive areas in the cytoplasm typical of TYPE1 PRCC and eosinophilic granular cytoplasm with E-cadherin positive areas in the cytoplasmic membrane, which indicates TYPE2 PRCC. Out of 46 cases reported in the literature, only one died of disease, which revealsitslow malignant potential.

第12回 宇宙環境シンポジウム（2015年11月16日-18日. 北九州国際会議場 国際会議室）, 北九州市, 福岡県, The 12th Spacecraft Environment Symposium (November 16-18, 2015. International Conference Room, Kitakyushu International Conference Center), Kitakyushu, Fukuoka, Japan, 形態: カラー図版あり, Physical characteristics: Original contains color illustrations, 資料番号: AA1630004018, レポート番号: JAXA-SP-15-012

第12回 宇宙環境シンポジウム（2015年11月16日-18日. 北九州国際会議場 国際会議室）, 北九州市, 福岡県, The 12th Spacecraft Environment Symposium (November 16-18, 2015. International Conference Room, Kitakyushu International Conference Center), Kitakyushu, Fukuoka, Japan, 形態: カラー図版あり, Physical characteristics: Original contains color illustrations, 資料番号: AA1630004021, レポート番号: JAXA-SP-15-012

第12回 宇宙環境シンポジウム（2015年11月16日-18日. 北九州国際会議場 国際会議室）, 北九州市, 福岡県, The 12th Spacecraft Environment Symposium (November 16-18, 2015. International Conference Room, Kitakyushu International Conference Center), Kitakyushu, Fukuoka, Japan, 形態: カラー図版あり, Physical characteristics: Original contains color illustrations, 資料番号: AA1630004017, レポート番号: JAXA-SP-15-012