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"Welcome to OBGYN World!" A novel recruitment event for medical students organized by the Japan Society of Obstetrics and Gynecology. Since 2012, the number of doctors in Japan who specialize in obstetrics and gynecology has shown a decreasing trend. To increase the number of doctors majoring in obstetrics and gynecology, the Japanese Trainees in Obstetrics and Gynecology subcommittee developed a new recruitment event called Welcome to OBGYN World! (WOW!); the aim of this event was to focus on lower grades of medical students. The present report describes the content of WOW! and the results of a post-event questionnaire administered to participating students and tutors. WOW! was held online in order to avoid the risk of Coronavirus Disease 2019 infection for participants. Sixty of the 82 medical schools nationwide (73.2%) participated in this event. Overall, there were 285 participating students, ranging from first to fourth grade in medical school, and 106 tutors were involved to teach material at the event. In the post-event questionnaire survey, 97.6% (248/254) and 100% of the participants stated they now had a high degree of interest in obstetrics and gynecology and found the specialty attractive, respectively. Furthermore, 93.6% (90/94) of the tutors stated that WOW! had helped recruitment activities in their universities. Based on this outcome, members of the Japanese Trainees of Obstetrics and Gynecology subcommittee will now try to increase the number of doctors specializing in obstetrics and gynecology by holding WOW! annually.

Objectives: To investigate the association between online ac-tivities and the number of new obstetrics and gynecology senior residents. Methods: A nationwide web-based, self-administered anon-ymous survey was conducted to investigate recruitment and clerkship activities during the coronavirus disease 2019 pan-demic. An online questionnaire was sent to 576 obstetrics and gynecology training institutions in Japan between De-cember 21, 2020, and January 31, 2021. Overall, 334 institu-tions that gave valid responses were included (response rate: 58.0%). Multivariate logistic regression analysis examined the association between online activities, including recruitment and clerkship activities, and the number of new obstetrics and gynecology senior residents in 2021. The stratified analysis by implementing face-to-face activities was conducted to clarify the association.Results: The number of new senior residents increased in 187 facilities (56.0%) and decreased in 147 facilities (44.0%). The facilities that implemented face-to-face and online activities were 185 (55.4%) and 120 (35.9%), respectively. In multivariate logistic regression analysis, an increased number of new obstetrics and gynecology senior residents was significantly associated with face-to-face activities (adjusted odds ratio (AOR)=2.58, 95% confidence interval (CI): 1.11-5.97, p

Purpose Textbook outcome (TO) has been used to define achievement of multiple “ideal” or “optimal” surgical and postoperative quality measures from the patient’s perspective. However, TO has not been reported for their impact on survival in elderly, including CRC surgery. This study determined whether TO is associated with long-term outcomes after curative colorectomy in patients with colorectal cancer (CRC). Methods Patient who underwent curative surgery over 75 years old for CRC between March 2005 and December 2016. TO included five separate: surgery within 6 weeks, radical resection, Lymph node (LN) yield ≥ 12, no stoma, and no adverse outcome. When all 5 short-term quality of care parameters were realized, TO was achieved (TO). If any one of the 5 parameters was not met, the treatment was not considered TO (nTO). Results TO was realized in 80 patients (43.0%). Differences in surgical-related characteristics, and pathological characteristics according to TO had no statistically significant differences in baseline characteristics, except for Lymph node dissection. The Kaplan–Meier curves for OS and RFS association between TO and nTO had significantly poor 5-year OS and 5-year RFS compared with the TO groups (OS, 77.8% vs. 60.8%, P

Purpose Textbook outcome (TO) is a composite quality measurement of short-term outcomes for evaluating surgical procedures. We investigated whether TO can be used to predict outcomes after curative gastric cancer (GC) surgery in older adults. Methods We retrospectively analyzed 465 consecutive patients who underwent curative gastrectomy for GC from 2005 to 2017. Among these, 141 advanced-age patients were eligible. The patients were divided into two groups: those who achieved TO (a-TO group) and those who failed to achieve TO (f-TO group). In accordance with previous reports, TO consisted of eight metrics. We evaluated the association between TO and long-term survival. Results TO was achieved 73 (52%) patients. The patients in the f-TO group had a significantly higher body mass index (P = 0.01), longer surgery time (P = 0.03), and more blood loss (P = 0.001). The metric with the lowest achievement rate was “no postoperative severe complication.” The patients in the f-TO group had significantly shorter overall survival than those in the a-TO group (P = 0.03). Multivariable Cox regression analyses of overall survival revealed that an American Society of Anesthesiologists physical status classification of 3 (hazard ratio [HR], 2.97; 95% confidence interval [CI], 1.68–5.26; P = 0.0002), presence of lymph node metastasis (HR, 1.86; 95% CI, 1.03–3.35; P = 0.04), and f-TO (HR, 1.82; 95% CI, 1.04–3.19; P = 0.03) were significantly associated with poor overall survival. Conclusion TO can be used to predict outcomes after curative GC surgery in patients of advanced age.

The coronavirus disease 2019 (COVID-19) pandemic can affect children’s well-being through mothers’ avoidance of health checkups for children due to media portrayal of the disease. This study investigated the association between the type of information source for COVID-19 received by mothers and the avoidance of their children’s health checkups. The study was an online-based survey, and the participants comprised 5667 postpartum women with children aged under 2 years during the study period. We analyzed the analytic sample and three groups of women with children aged 0–3 months, 4–6 months, and 6 months or older according to the timing of children’s health checkups in Japan. Among the participants, 382 women (6.7%) avoided their children’s health checkups. Multivariate logistic regression analysis revealed that mothers with children over 6 months who used magazines as an information source about COVID-19 tended to avoid their children’s health checkups (adjusted odds ratio (aOR): 3.19; 95% confidence interval (CI): 1.68–6.05) compared with those who did not. In contrast, those using public websites were less likely to avoid their children’s health checkups (aOR 0.58, 95% CI 0.43–0.77). This study showed that specific types of information source on COVID-19 could have varying effects on mothers’ decisions about their children’s health checkups.

Aim The Ministry of Health, Labour, and Welfare of Japan proposed a regulation of overtime work as a reform in work style. However, the regulation may deteriorate the quality of medical services due to the reduction in training time. Thus, the study aimed to reveal perceptions in terms of generation gaps in views on self-training and overtime work, among members of the Japan Society of Obstetrics and Gynecology (JSOG). Methods A web-based, self-administered questionnaire survey was conducted among members of the JSOG. In total, 1256 respondents were included in the analysis. Data were collected on age, sex, experience as a medical doctor, location of workplace, work style, the type of main workplace, and number of full-time doctors in the main workplace. The study examined the attitudes of the respondents toward overtime work and self-training. The respondents were categorized based on experience as a medical doctor. Results According to years of experience, 112 (8.9%), 226 (18.0%), 383 (30.5%), 535 (42.6%) doctors have been working for ≤5, 6-10, 11-19, and ≥ 20 years, respectively. Although 54.5% of doctors with ≤5 years of experience expected the regulation on working hours to improve the quality of medical services, those with ≥20 years of experience expressed potential deterioration. After adjusting for covariates, more years of experience were significantly related with the expectation of deterioration in the quality of medical services. Conclusions The study revealed a generation gap in the views about self-training and overtime work among obstetricians and gynecologists in Japan.

We investigated cervical parameters predictive of vaginal delivery in elective labor induction among women at 40-41 gestational weeks.This Japanese prospective single-center cohort study was conducted between July 2019 and June 2020. We enrolled women with an uncomplicated singleton pregnancy who underwent labor induction at 40-41 gestational weeks. We analyzed background characteristics and cervical parameters, including Bishop score, cervical length, posterior cervical angle, and changes in cervical parameters before and after cervical dilatation. The endpoint was the rate of vaginal delivery.Of 142 eligible participants, all 24 multiparous women underwent vaginal delivery. Among the nulliparous women (n = 118), the following categories showed significantly higher rates of vaginal delivery: Bishop scores of ≥6 before and after dilatation, compared with Bishop score 6 (adjusted prevalence ratio (aPR) [95% confidence interval (CI)]; 1.58 [1.17-2.13] and 1.56 [1.13-2.14], respectively) and cervical length of10 and 10-20 mm before dilation, compared with cervical length of30 mm (aPR [95% CI]; 1.47 [1.00-2.15] and 2.13 [1.42-3.18], respectively). The posterior cervical angle and other background characteristics showed no significant associations. Furthermore, women with cervical lengths of ≥20 mm before and20 mm after dilatation showed a higher rate of vaginal delivery, compared to cervical length of ≥20 mm even after dilatation (aPR [95% CI]; 1.95 [1.19-3.20]).High Bishop score, short cervical length, and changes in cervical length with dilatation are potential independent predictors of vaginal delivery following elective labor induction in nulliparous women at 40-41 gestational weeks.

Two resonators with different radii were separately excited in a complex cavity to demonstrate super multi-frequency operations of a gyrotron. A demountable gyrotron was constructed and driven by 15-kV, 0.4-A annular electron beams. The magnetic field strength was varied from 4 to 8 T to excite a series of transverse electric modes in each resonator. In the frequency range of 120 – 220 GHz, 13- and 9-mode oscillations at the fundamental harmonics were identified in the first and second resonators, respectively. Furthermore, backward wave oscillations of these modes allowed continuous frequency variation. Even if two resonators oscillate at the same time with different frequencies, most of them can be independently excited by regulating the velocity pitch and/or injection radius of the electron beam. As a result, 27% of frequencies from 120 to 220 GHz became available with a single gyrotron. This is the largest frequency occupation reported so far in this frequency range. The frequency gaps between neighboring modes were less than 10 GHz. The maximum output power obtained for each mode was more than 28 W.

A sub-THz, second harmonic, multifrequency gyrotron, Gyrotron FU CW GVII, which radiates Gaussian beams, was developed. This device was designed to change the frequency in a stepwise manner in the range from 270 to 420 GHz. In this paper, we present the first experiments conducted using this gyrotron. Nine modes were selected for this study. The oscillation frequency of the selected modes was measured using a heterodyne system. The profiles of the Gaussian beams converted from the modes were assessed using an infrared camera, and the power of these beams was measured using a power meter. The oscillations of the nine second harmonic modes were successfully measured, and Gaussian beams converted from seven oscillation modes were observed. Four second harmonic modes, TE8,5, TE6,5, TE5,4, and TE2,6, oscillated in a single mode. The power of the beams ranged from 0.2 to 77 W. Even in the case of spurious oscillation of fundamental modes, the beams converted from the second harmonic modes could be separated from the fundamental mode beams by taking advantage of the different radiation directions emitted through the gyrotron window.

Background Transomental hernias are a rare type of internal hernia. We report two cases of successful cases of laparoscopic repair. One required laparotomy due to concern for intestinal viability. Case presentation The first patient was a 67-year-old man who presented with abdominal pain and vomiting. He had no history of laparotomy or abdominal injury. Computed tomography suggested small bowel obstruction and possible intestinal strangulation. Emergent laparoscopy found approximately 200 cm of small bowel was strangulated around the greater omentum. The strangulation was released laparoscopically, but because of the color of the strangulated bowel, laparotomy was performed to evaluate viability. The involved portion of intestine was not resected. The patient experienced transient postoperative paralytic ileus and was discharged on postoperative day 14. The second patient was a 56-year-old man who presented with abdominal pain. Abdominal computed tomography revealed dilatation of the small intestine and a closed loop suggesting ileus due to intestinal strangulation. An emergency laparoscopy found a transomental hernia, and the strangulation was released laparoscopically. Recovery was uneventful, and the patient was discharged on postoperative day 6. Conclusion Transomental hernia can be successfully treated laparoscopically. In cases where bowel viability is a concern, laparotomy should not be hesitated.

To clarify the association between gestational weight gain (GWG) and pregnancy outcomes in underweight women with twin pregnancies in Japan.This retrospective study derived data from the Japan Society of Obstetrics and Gynecology perinatal database between 2007 and 2015. We included 5049 underweight (pre-pregnancy body mass index [BMI]18.5 kg/mIn underweight group, high GWG was associated with significant risk reductions in both twins being SGA, at least one twin being SGA, very preterm birth, and extreme preterm birth, while a risk increase was observed in preeclampsia. Compared to women with GWG of 0.25-0.30 kg/week, the risk of preeclampsia was significantly higher in women with GWG0.35 kg/week. No association was observed between GWG and cesarean delivery. These associations were similar in the normal-weight group.Underweight women with twin pregnancies showed an inverse association between GWG and SGA or preterm birth. The risk of preeclampsia was higher in women who gained0.35 kg/week.

A premium class electric vehicle (EV) needs high drive system efficiency, low motor noise and limp-home capability of the traction drive when there is a component failure. A dual inverter fed open winding interior permanent magnet synchronous motor (DIF-OW-IPMSM) drive system satisfied all the above needs. In this paper, a new algorithm of inverter open-circuit fault diagnosis and fail-safe action strategy for the DIFOW-IPMSM drive system are proposed and presented to prove its high reliability. The proposed new algorithm is verified by suitable simulation and experimental results, and the safe limp-home capability of the DIF-OW-IPMSM drive system is demonstrated.

The dual inverter fed open winding interior permanent magnet synchronous motor (DIF-OW-IPMSM) is a promising traction drive system configuration for a high power and high efficiency electric vehicle. In this paper, a new PWM switching strategy of the inverters is presented when the motor is operating in the medium and high speed region. The PWM switching strategy consists of operating one of the inverters in the low switching frequency 1 pulse (square wave) mode and the other inverter in the high switching frequency specialized continuous pulse width modulation (SCPWM). The new PWM strategy has been verified from suitable simulation and experimental results in the medium speed range. Finally, a dual inverter configuration with a hybrid combination of Si IGBT inverter and SiC MOSFET inverter is recommended for a premium class electric vehicle to improve the drive system efficiency.

The reduction in the use of neonatal intensive care units (NICUs) during the COVID-19 outbreak has been reported, but whether this phenomenon is widespread across countries is unclear. Using a large-scale inpatient database in Japan, we analysed the intensive neonatal care volume and the number of preterm births for weeks 10–17 vs weeks 2–9 (during and before the outbreak) of 2020 with adjustment for the trends during the same period of 2019. We found statistically significant reductions in the numbers of NICU admissions (adjusted incidence rate ratio (aIRR), 0.76; 95% CI, 0.65 to 0.89) and neonatal resuscitations (aIRR, 0.37; 95% CI, 0.25 to 0.55) during the COVID-19 outbreak. Along with the decrease in the intensive neonatal care volume, preterm births before 34 gestational weeks (aIRR, 0.71) and between 34 0/7 and 36 6/7 gestational weeks (aIRR, 0.85) also showed a significant reduction. Further studies about the mechanism of this phenomenon are warranted.

Pulse granuloma, a benign granulomatous lesion, develops due to foreign body reactions to food particles. This rare entity occurs occasionally in the abdominal cavity. However, it has never been reported as a pelvic mass or a recurrent case. A 37-year-old woman with a medical history of pelvic granulomatous lesions treated in Thailand, was admitted for abdominal pain. Imaging study revealed a pelvic complex cyst and disseminated nodules. Ovarian cancer or tuberculous peritonitis was suspected. The appearance at laparotomy was an inflammatory mass encased in adhesions; therefore, only biopsy was performed. The pathology diagnosis was pulse granuloma. The pathology report from Thailand was obtained only after her discharge, suggesting that the previous granulomatous lesion contained vegetable matter. This report demonstrates that pulse granuloma can present as a pelvic mass and may relapse. For complex cystic lesions with solid components in the pelvis, pulse granuloma should be considered as a differential diagnosis.

Background The prevalence of acute lower gastrointestinal bleeding has been increased including colonic diverticulitis and angioplasty. However, appendiceal bleeding is extremely rare. Case presentation We present a case of lower gastrointestinal bleeding from the appendix in an elderly male who presented with melena. Appendiceal bleeding was diagnosed using lower gastrointestinal endoscopy, and laparoscopic appendectomy was performed. The patient did not have melena postoperatively, and was discharged 6 days after the surgery. Conclusion It is important to distinguish appendiceal bleeding from lower gastrointestinal bleeding and to treat it as soon as possible with less invasiveness.

A 59-year-old female was referred to our hospital due to abnormal upper gastrointestinal(GI)findings in July 2019. Endoscopy showed an advanced type Ⅱ tumor at the esophagogastric junction. The bioptical diagnosis was adenocarcinoma. Computed tomography(CT)and positron emission tomography(PET)revealed a swollen lymph node and abnormal accumulation. Total gastrectomy and Roux-en-Y reconstruction were performed. The final diagnosis was esophagogastric junctional cancer and follicular lymphoma. The chance of encountering double cancer is likely to increase. It is vital to prioritize treatment and determine an appropriate treatment plan according to the clinical stage and prognosis in patients with double cancer.

A dual inverter-fed open winding interior permanent magnet synchronous motor employing a dual battery source is found to be a promising drive system configuration for a high-power premium class electric vehicle. From the standpoints of high drive system efficiency and low motor acoustic noise, in this paper, selection of different optimum PWM switching modes according to the vehicle driving states is proposed for such a drive system configuration. Suitable simulation and experimental results for the motor drive system with 65 kW are presented to validate the proposed selection of different optimum PWM switching modes based on the vehicle driving states.

To clarify the correlation between preeclampsia and parity and to identify protective factors against preeclampsia in multiparous women with systemic lupus erythematosus (SLE).We conducted a single-center, retrospective chart review study of 85 pregnant women. We used multiple logistic regression analysis to assess the association between parity and preeclampsia in women with SLE, and described the detailed clinical courses and management of four women with a history of severe preeclampsia and of a woman who experienced preeclampsia during her latest pregnancy.Multiparity was significantly associated with a low risk of preeclampsia (adjusted odds ratio: 0.08; 95% confidence interval: 0.01-0.95). One multiparous woman without a history of preeclampsia developed preeclampsia during her latest pregnancy; she had critical risk factors for preeclampsia, including chronic kidney disease and hypertension, and was not administered aspirin. In contrast, four multiparous women with a history of severe preeclampsia received adequate medications; they did not develop recurrent preeclampsia and delivered live newborns.Multiparity and maintenance therapy for SLE before and during pregnancy and preventive treatment for preeclampsia may improve outcomes in subsequent pregnancies.

In this study, we examined the prevalence of iron deficiency anaemia (IDA) among young women between the ages of 20-44 living in Shanghai, China, and Tokyo, Japan with a particular emphasis on investigating its possible links with body mass index (BMI). Shanghai data were obtained from annual health check-up records conducted between May and September 2016 (n=2,006). Tokyo data were from health examinations of employees working in dispensing pharmacies between July and February 2017 (n=877). Anaemia prevalence was found to be 14.8% and 11.4% in Shanghai and Tokyo, respectively. The proportion of women with a BMI of

For the spherical kagome system {W 72 V 30 }, which is a magnetic cluster with 30 V 4+ ions, recent experimental and theoretical studies on the magnetization process at low temperatures have indicated that Dzyaloshinskii-Moriya interaction is an important ingredient in this material. In this paper, we use microcanonical thermal pure quantum (mTPQ) states to calculate the temperature dependence of the magnetic susceptibility and compare our calculated results with an existing experimental susceptibility. These mTPQ states are generated to reproduce the smooth microcanonical ensemble, which is difficult from the canonical ensemble. We show that adequate choice of a parameter in the generation procedure of mTPQ states leads to the same temperature dependence as the canonical ensemble.

Second-harmonic 0.4-THz gyrotron with complex-cavity resonator with TE 8,3 -TE 8,5 mode conversion is studied. Cold-cavity electromagnetic parameters are simulated and start-oscillation current is calculated. The numerical results are compared with the experimental measurements.

A sub-THz second harmonic multi-frequency gyrotron with Gaussian beam output, Gyrotron FU CW GVII, has been developed. This gyrotron was designed to change the frequency stepwise in the range from 270 to 420 GHz. Oscillations of seven second-harmonic modes were successfully observed and Gaussian beam radiations converted from six oscillation modes were observed. Two second harmonic modes; TE 6,5 and TE 8,5 ; oscillated in a single mode. Even in case of simultaneous oscillation of fundamental modes, radiation beams converted from second harmonic modes can be separated from the fundamental mode beams by making use of the different radiation directions emitted from the gyrotron window.

A 65-year-old male patient presented with a chief complaint of abdominal pain. Abdominal computed tomography (CT) showed slight intestinal dilation and obstruction of the upper right quadrant of the small intestine, while ectopic gastric mucosal scintigraphy revealed abnormal accumulation in agreement with the CT-identified structure. The cause of bowel obstruction was diagnosed as Meckel’s diverticulum; the patient was referred for surgery. A small laparotomy was performed with a 35-mm skin incision to the center of the navel. Once a lap disk was attached, a laparoscope was inserted to visualize the abdominal cavity. The small intestine that includes the structure was pulled out from the umbilicus to the outside of the peritoneal cavity and partially resected. On the pathological tissue findings, the patient was diagnosed with Meckel’s diverticulum. We report our experience with single-lap laparoscopic surgery for a case of intestinal obstruction caused by Meckel’s diverticulum and review pertinent literature.

Japan's universal health-care system means that it is a very safe country in which to give birth. Perinatal outcomes in Japan are excellent, with low infant mortality and neonatal mortality. However, childbirth remains a challenge for many Japanese women, who are faced with a scarcity of places to give birth, limited availability of analgesia and social norms that favour natural birth. The number of birth facilities in Japan continues to decrease as fewer children are born. The numbers of qualified medical staff remain inadequate, with a continuing lack of female physicians, perpetuated by a pervasive negative gender bias. Recruitment efforts are underway, but few doctors want to specialize in obstetrics or gynaecology. Furthermore, around half of female obstetricians and gynaecologists in Japan's male-dominated medical system stop practising when they have their own children. The difficulty of obtaining analgesia during labour is another problem. Although low uptake of labour pain relief in Japan is said to be due to cultural influences, the root of the problem is a lack of qualified anaesthesiologists and the inflexibility of a system that will not allow other staff to be trained to administer labour analgesia. Problems with labour anaesthesia have been linked to 14 maternal deaths since 2010. Japanese policy-makers need to act to renovate the nation's obstetric facilities, reorganize regional perinatal care systems, train more obstetricians and anaesthesiologists, promote task-shifting and better integrate biomedical and traditional, non-medical care for pregnant women.Le système de soins de santé universel du Japon en fait un pays très sûr pour les accouchements. Les résultats en matière de santé périnatale au Japon sont excellents, avec une mortalité infantile et une mortalité néonatale faibles. Néanmoins, l’accouchement reste problématique pour de nombreuses Japonaises, qui doivent faire face à un manque d’établissements adaptés pour les accouchements, à une disponibilité limitée de l’analgésie et à des normes sociales qui favorisent les accouchements naturels. Le nombre de maternités au Japon ne cesse de baisser, à mesure de la diminution du nombre de naissances. Les effectifs en personnel médical qualifié restent inappropriés, avec une pénurie persistante de femmes médecins, perpétuée par des préjugés négatifs généralisés liés au genre. Des efforts de recrutement sont en cours, mais peu de médecins souhaitent se spécialiser en obstétrique ou en gynécologie. Par ailleurs, dans le système médical japonais dominé par les hommes, près de la moitié des femmes obstétriciennes et gynécologues cessent de pratiquer dès qu’elles ont elles-mêmes des enfants. La difficulté à bénéficier d’une analgésie obstétricale pendant l’accouchement constitue un autre problème. Même si, au Japon, le faible recours au soulagement de la douleur pendant le travail est généralement imputé à des influences culturelles, le fond du problème est une pénurie d’anesthésistes qualifiés et le manque de souplesse d’un système qui ne permet pas de former d’autres professionnels de santé pour pouvoir pratiquer l’analgésie obstétricale. Les problèmes liés à la réalisation d’une analgésie obstétricale ont donné lieu à 14 décès maternels depuis 2010. Au Japon, les décideurs politiques doivent agir pour rénover les installations obstétricales du pays, réorganiser les systèmes régionaux de santé périnatale, former davantage d’obstétriciens et d’anesthésistes, promouvoir le transfert des tâches et mieux intégrer les soins biomédicaux et les soins traditionnels, non médicaux, pour les femmes enceintes.El sistema universal de atención sanitaria de Japón hace que sea un país muy seguro para dar a luz. Los resultados perinatales en Japón son excelentes, con baja mortalidad infantil y mortalidad neonatal. Sin embargo, el parto sigue siendo un problema para muchas mujeres japonesas, que se enfrentan a la escasez de lugares para dar a luz, la limitada disponibilidad de analgesia y las normas sociales que favorecen el parto natural. El número de centros de maternidad en Japón sigue disminuyendo a medida que nacen menos niños. El número de personal médico cualificado sigue siendo insuficiente, con una continua falta de mujeres médicas, perpetuada por un prejuicio de género negativo generalizado. Los esfuerzos de reclutamiento están en marcha, pero pocos médicos quieren especializarse en obstetricia o ginecología. Además, alrededor de la mitad de las obstetras y ginecólogas del sistema médico japonés dominado por los hombres dejan de ejercer cuando tienen sus propios hijos. La dificultad para obtener analgesia durante el trabajo de parto es otro problema. Aunque se dice que la baja aceptación del alivio del dolor del trabajo de parto en Japón se debe a influencias culturales, la raíz del problema es la falta de anestesiólogos calificados y la inflexibilidad de un sistema que no permitirá que otro personal esté capacitado para administrar la analgesia del trabajo de parto. Los problemas con la anestesia del trabajo de parto se han relacionado con 14 muertes maternas desde 2010. Los responsables de formular políticas en Japón deben actuar para renovar las instalaciones obstétricas del país, reorganizar los sistemas regionales de atención perinatal, capacitar a más obstetras y anestesiólogos, promover el cambio de tareas e integrar mejor la atención biomédica y la atención no médica tradicional para las mujeres embarazadas.إن وجود نظام عالمي للرعاية الصحية في اليابان يعني أنها دولة آمنة للغاية لعمليات الولادة. حيث تكون النتائج المتعلقة بالفترة المحيطة بالولادة في اليابان ممتازة، مع انخفاض معدل الوفيات لكل من الرضع والأطفال حديثي الولادة. ورغم ذلك، إلا أن الولادة لا تزال تمثل تحدياً للعديد من النساء اليابانيات، اللاتي يواجهن ندرة في أماكن الولادة، وتوافر محدود لمستلزمات التخدير، وكذلك التقاليد الاجتماعية التي تفضل الولادة الطبيعية. يستمر عدد مرافق الولادة في اليابان في الانخفاض بالتوازي مع انخفاض عدد الأطفال الذين يولدون. كذلك لا يزال عدد الطواقم الطبية المؤهلة غير كاف، مع نقص متواصل في الطبيبات الإناث، والذي أدى إليه التحيز السلبي بناء على الجنس. لا زالت هناك جهود جارية، إلا أن القليل من الأطباء يرغبون في التخصص في طب التوليد أو أمراض النساء. وفضلاً عن ذلك، فإن قرابة النصف من الطبيبات الإناث في طب التوليد وأمراض النساء في النظام الطبي الياباني الذي يخضع لسيطرة الذكور، يتوقفن عن ممارسة المهنة عندما يلدن أطفالهن. تمثل صعوبة الحصول على التخدير أثناء الولادة، مشكلة أخرى. على الرغم من القول بأن انخفاض معدل الحصول على مسكنات لآلام الولادة في اليابان هو بسبب المعتقدات الثقافية، فإن أصل المشكلة يعود لعدم وجود أطباء التخدير المؤهلين وعدم مرونة النظام الذي لا يسمح بتدريب العاملين الآخرين على التخدير قبل الولادة. تم الربط بين مشكلات التخدير أثناء الولادة وبين 14 حالة وفاة للأمهات منذ عام 2010. يحتاج واضعو السياسات اليابانيون إلى السعي لتجديد مرافق الولادة في الدولة، إعادة تنظيم نظم الرعاية الإقليمية في الفترة المحيطة بالولادة، وتدريب المزيد من أطباء التوليد وأطباء التخدير، والتشجيع على تغيير المهام، وتحسين التكامل بين الطب الحيوي والرعاية التقليدية غير الطبية للنساء الحوامل.日本的全民医疗体系保证了在该国分娩的安全。日本的围产儿预后很好，婴儿死亡率和新生儿死亡率都很低。然而，对多数日本妇女来说，分娩仍是一种挑战，她们面临着医院床位紧张、分娩镇痛措施有限以及该国更倾向于自然生产的社会准则。随着日本新生儿数量的下降，该国可提供分娩措施的医疗机构数量也在持续下降。可以胜任的医务人员数量不足，由于社会上普遍存在的负面性别偏见，一直以来，女医生的数量尤其匮乏。人才招募方面的努力仍在持续，但很少有医生想专攻妇产科。此外，在日本男性占主导地位的医疗体系中，约一半的女性妇产科医生在有了自己的孩子后停止执业。另一大难题是分娩过程中难以进行镇痛措施。尽管将日本社会对分娩镇痛的接受度低归结为文化影响，但其根源在于缺乏可以胜任的麻醉师，以及僵化的医疗体系（不允许其他工作人员接受分娩镇痛培训）。自 2010 年以来，分娩镇痛带来的问题已经与 14 例产妇死亡相关。日本的相关政策制订者需采取行动，修复全国范围内可提供分娩措施的医疗机构，重新组织区域性的围产儿医疗体系，培训更多的产科医生和麻醉师，促进任务交付原则，将生物医学和传统的非医疗保健相结合，为孕产妇提供更好的护理。.Всеобщая система здравоохранения в Японии построена таким образом, что роды в этой стране отличаются высоким уровнем безопасности. Уровень благоприятных перинатальных исходов в Японии крайне высок, а смертность новорожденных и младенцев очень низкая. Однако для многих японок роды остаются проблемой из-за того, что количество родильных домов ограниченно, возможности обезболивания невелики, а социальные нормы поддерживают естественное родоразрешение. Количество родильных домов в Японии продолжает сокращаться в связи с падением рождаемости. Сохраняется проблема нехватки квалифицированного медперсонала, постоянно недостает женщин-врачей. Эта ситуация сохраняется из-за всеобъемлющего гендерного неравенства в стране. Конечно, предпринимаются усилия по привлечению кадров, но очень немногие врачи проявляют желание специализироваться в области акушерства и гинекологии. Кроме того, примерно половина акушерок и женщин-гинекологов, работающих в системе здравоохранения Японии, где доминируют мужчины, уходит из профессии с появлением у них собственных детей. Еще одна проблема — это сложности с обезболиванием при родах. Хотя низкий уровень обезболивания при родах обычно объясняют культурными особенностями Японии, проблема коренится в недостатке квалифицированных анестезиологов и в ригидности системы, которая не разрешает другому медперсоналу пройти обучение и выполнять обезболивание во время родов. Проблемы с обезболиванием при родах связывают с гибелью 14 рожениц с 2010 года. Высшему руководству Японии следует предпринять меры по обновлению национальной сети родильных домов, реорганизовать региональные системы перинатальной помощи, обучить больше акушерского персонала и анестезиологов, поощрять многозадачность персонала и лучше объединять биомедицинские и традиционные, немедицинские способы ухода за беременными женщинами.

On shock ignition (SI) scheme of inertial confinement fusion (ICF), a spherical shell target is compressed by relatively low intensity laser pulse irradiation, and hot spot is ignited by converging shock waves by high intensity laser pulse called “spike pulse”. The SI scheme is considered as a promising scheme to reduce the required drive laser energy for ignition. On the SI scheme, the strong shock by the spike pulse should be over 300 Mbar (=30 TPa). The key physics to produce such ultrahigh pressure is the contribution of hot electrons generated by parametric instabilities. The hot electron generation, transport, and their effects on shock wave parameters in various experimental conditions were explored. This paper focuses on experimental parameter of 0.527 μm (2ω) irradiation as spike pulse with/without pre-pulse irradiation conditions, and the experimental data was compared with one-dimensional hydrodynamic simulation. Experiments with pre-pulse irradiation that pre-compresses a target before the main pulse with producing more hot electrons generates a strong shock and hot electrons lead to an enhanced shock velocity. This fact indicates that the hot electron absorption per unit length in the target is increased leading to an enhanced shock strength.

Typical inertial confinement fusion (ICF) plasmas have ultra-high energy density state (UHEDs) with an energy density exceeding 1 × 108 Jcm−3, which corresponds to a pressure of beyond 1 Gbar. In previous investigation, it is suggested that such an UHEDs condition could be generated with a tabletop ultrahigh intensity laser, by irradiating onto a nanowire array. In this research, we have developed to observe the laser energy absorption and transport mechanism in nanowire array samples with x-ray free electron laser facility SACLA. We obtained time-resolved snapshots of x-ray shadowgraph image with very high temporal resolution. From the measured images, however, the UHEDs might be generated only on very thin portion of the target surface because the mean density of the nanowire array was large. On the other hand, we observed significant rear surface expansion in late timing, suggesting that large laser energy deposition was achieved for the nanowire array samples.