| 1.
学位論文 |
学位
|
藤盛, 成裕
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成3年3月20日; 学位記番号:医博甲第830号
|
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| 2.
学位論文 |
学位
|
越前屋, 竹寅
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成3年3月20日; 学位記番号:医博甲第838号
|
||||
| 3.
学位論文 |
学位
|
三尾, 和久
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成3年3月20日; 学位記番号:医博甲844第号
|
||||
| 4.
学位論文 |
学位
|
田村, 太志
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成3年3月20日; 学位記番号:医博甲第861号
|
||||
| 5.
学位論文 |
学位
|
長谷川, 善枝
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成3年3月20日; 学位記番号:医博甲第865号
|
||||
| 6.
学位論文 |
学位
|
清水, 俊夫
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成3年3月20日; 学位記番号:医博甲第873号
|
||||
| 7.
学位論文 |
学位
|
野村, 進二
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成3年6月25日; 学位記番号:医博乙第629号
|
||||
| 8.
学位論文 |
学位
|
大竹, 進
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成3年3月4日; 学位記番号:医博乙第617号
|
||||
| 9.
学位論文 |
学位
|
四ツ柳, 高敏
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成4年3月24日; 学位記番号:医博甲第877号
|
||||
| 10.
学位論文 |
学位
|
塩谷, 一春
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成4年3月24日; 学位記番号:医博甲第918号
|
||||
| 11.
学位論文 |
学位
|
早狩, 誠
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成4年3月26日; 学位記番号:医博乙第647号
|
||||
| 12.
学位論文 |
学位
|
立花, 義康
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成4年3月26日; 学位記番号:医博乙第656号
|
||||
| 13.
学位論文 |
学位
|
砂川, 佳昭
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成4年9月25日; 学位記番号:医博乙第659号
|
||||
| 14.
学位論文 |
学位
|
副島, 靖雄
概要:
授与大学:弘前大学; 学位種類:医学博士; 授与年月日:平成4年9月25日; 学位記番号:医博乙第660号
|
||||
| 15.
学位論文 |
学位
|
佐々木, 正則
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成5年3月24日; 学位記番号:医博甲第946号
|
||||
| 16.
学位論文 |
学位
|
清野, 景好
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成5年3月24日; 学位記番号:医博甲第972号
|
||||
| 17.
学位論文 |
学位
|
横山, 佳明
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成5年3月22日; 学位記番号:医博乙第669号
|
||||
| 18.
学位論文 |
学位
|
村田, 暁彦
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成6年3月23日; 学位記番号:医博甲第987号
|
||||
| 19.
学位論文 |
学位
|
櫻庭, 実
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成6年3月23日; 学位記番号:医博甲第1009号
|
||||
| 20.
学位論文 |
学位
|
十束, 英志
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成6年3月23日; 学位記番号:医博甲第1023号
|
||||
| 21.
学位論文 |
学位
|
葛西, 治千代
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成6年3月25日; 学位記番号:医博乙第693号
|
||||
| 22.
学位論文 |
学位
|
細川, 雅史
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成7年3月23日; 学位記番号:医博甲第1081号
|
||||
| 23.
学位論文 |
学位
|
金, 奉均
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成7年3月23日; 学位記番号:医博甲第1084号
|
||||
| 24.
学位論文 |
学位
|
加藤, 裕昭
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成7年3月23日; 学位記番号:医博乙第704号
|
||||
| 25.
学位論文 |
学位
|
柳谷, 仁志
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成7年3月23日; 学位記番号:医博乙第709号
|
||||
| 26.
学位論文 |
学位
|
金城, 学
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成7年9月26日; 学位記番号:医博乙第719号
|
||||
| 27.
学位論文 |
学位
|
高瀬, 洋
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成7年9月26日; 学位記番号:医博乙第722号
|
||||
| 28.
学位論文 |
学位
|
鈴木, 裕子
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成8年3月22日; 学位記番号:医博甲第1098号
|
||||
| 29.
学位論文 |
学位
|
富田, 卓
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成8年3月22日; 学位記番号:医博甲第1118号
|
||||
| 30.
学位論文 |
学位
|
工藤, 育男
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成8年3月26日; 学位記番号:医博乙第730号
|
||||
| 31.
学位論文 |
学位
|
大塚, 博徳
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成8年3月26日; 学位記番号:医博乙第736号
|
||||
| 32.
学位論文 |
学位
|
篠崎, 直子
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成9年9月16日; 学位記番号:医博乙第766号
|
||||
| 33.
学位論文 |
学位
|
寺田, 明功
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成9年9月16日; 学位記番号:医博乙第767号
|
||||
| 34.
学位論文 |
学位
|
戸館, 雅大
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成9年9月16日; 学位記番号:医博乙第777号
|
||||
| 35.
学位論文 |
学位
|
石亀, 昌幸
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成9年9月16日; 学位記番号:医博乙第779号
|
||||
| 36.
学位論文 |
学位
|
鈴木, 千恵子
概要:
授与大学:弘前大学; 学位種類:博士（医学）; 授与年月日:平成10年3月25日; 学位記番号:医博甲第1208号
|
||||
| 37.
学位論文 |
学位
|
矢越, ちひろ
概要:
本文公開は雑誌掲載より10年後以降可
|
||||
| 38.
学位論文 |
学位
|
浜野, 学
|
||||
| 39.
学位論文 |
学位
|
石橋, 剛士
|
||||
| 40.
学位論文 |
学位
|
甲斐, 知彦
概要:
出版社の意向により論文本文はリポジトリ掲載不可
|
||||
| 41.
学位論文 |
学位
|
笠井, 里津子
|
||||
| 42.
学位論文 |
学位
|
福井, 真司
|
||||
| 43.
学位論文 |
学位
|
本田, 勝義
|
||||
| 44.
学位論文 |
学位
|
金澤, 佐知子
|
||||
| 45.
学位論文 |
学位
|
照井, 一史
|
||||
| 46.
学位論文 |
学位
|
細井, 一広
|
||||
| 47.
学位論文 |
学位
|
工藤, 淳子
|
||||
| 48.
学位論文 |
学位
|
狭戸尾, 真梨子
|
||||
| 49.
学位論文 |
学位
|
奥村, 俊樹 ; 高橋, 一平 ; 沢田, かほり ; 大久保, 礼由 ; 齋藤, 勇起 ; 北川, 直子 ; 福井, 真司 ; 狭戸尾, 真梨子 ; 矢野, 智彦 ; 梅田, 孝 ; 中路, 重之
概要:
糖尿病でない一般住民において、骨密度と糖代謝の関係をその機序も含めて疫学的に調査・検討した。対象は、2011 年度岩木健康増進プロジェクト・プロジェクト健診参加者の529名であった。骨密度は踵骨の音響的骨評価値（OSI、Osteo ono-
…
Assessment Index）により評価した。血液検査で血糖、HbA1c、C-peptide（インスリンの分泌量を反映）及びAGEs（advanced glycation endproducts）を測定した。その結果、閉経後女性においてOSI のZ 値（OSI の年齢補正値）はHbA1c 及びC-peptide と正の相関関係を示したが、AGEs とは関連はみられなかった。また血糖、HbA1c はC-peptide と正の相関関係を示したが、AGEs とは関連はみられなかった。すなわち、糖尿病でない閉経後女性において、血糖の高い状態が続くとインスリンによる骨形成が促進されるが、骨形成の抑制作用を持つAGEs の産生量には影響を及ぼさないため、相対的に骨形成が優位となり骨密度が上昇する可能性が考えられた。
続きを見る
|
||||
| 50.
学位論文 |
学位
|
三輪, 孝士
|
||||
| 51.
学位論文 |
学位
|
伊東, 良
|
||||
| 52.
学位論文 |
学位
|
岩渕, 健輔
|
||||
| 53.
学位論文 |
学位
|
佐藤, 弘道
|
||||
| 54.
学位論文 |
学位
|
徳田, 糸代
|
||||
| 55.
学位論文 |
学位
|
徳安, 秀正
|
||||
| 56.
学位論文 |
学位
|
山本, 博
|
||||
| 57.
学位論文 |
学位
|
鴨井, 舞衣
概要:
出版社版本文リンクhttp://onlinelibrary.wiley.com/doi/10.1111/aji.12356/abstract
|
||||
| 58.
学位論文 |
学位
|
黒岩, 純
|
||||
| 59.
学位論文 |
学位
|
高田, 典和
概要:
出版社が本文の公表を許可していないため、本文は掲載しない。
|
||||
| 60.
学位論文 |
学位
|
近澤, 真司
|
||||
| 61.
学位論文 |
学位
|
王, 汝南
概要:
ダウン症児は巨核芽球性白血病(DS-AMKL)のリスクが高い.DS-AMKL ではほぼ全例でGATA1 遺伝子変異があり,N 末端領域を欠くGATA1s だけが発現する.非ダウン症例(non-DS-AMKL)にはこの変異は稀である.最近我々
…
は,19 例中1 例のnon-DS-AMKL にインフレーム欠失を見出した.患児は出生時より白血球増多を認め,生後1 ヶ月時にAMKL と診断された.芽球の核型は46,XY であった.変異確認の際,第3エクソンのスプライシングを起こす別の欠失を認め,両変異は同アレルに座位していた.この変異体(#135)の転写活性化能は60%に減弱していた.完全長GATA1発現レトロウィルスの導入でDS-AMKL 細胞株KPAM1 の増殖が著しく抑制されたが,GATA1s や#135 では緩やかな抑制だった.これらの結果は#135 変異体がnon-DS-AMKL 発症に関与していることを示している.<br />出版社版http://repository.ul.hirosaki-u.ac.jp/dspace/handle/10129/5431
続きを見る
|
||||
| 62.
学位論文 |
学位
|
秋元, 直樹
概要:
掲載誌体力・栄養・免疫学雑誌, 26(1), p.22-32, 2016
|
||||
| 63.
学位論文 |
学位
|
柴田, 信行
概要:
掲載誌体力・栄養・免疫学雑誌 26(1),p.33-39, 2016
|
||||
| 64.
学位論文 |
学位
|
小室, 輝明
概要:
掲載誌体力・栄養・免疫学雑誌, 26(1), p.40-48, 2016
|
||||
| 65.
学位論文 |
学位
|
関根, 陽平
概要:
掲載誌：体力・栄養・免疫学雑誌,26, 177-184, 2016
|
||||
| 66.
学位論文 |
学位
|
鷹野, 都
概要:
掲載誌体力・栄養・免疫学雑誌 25(3), p.230-238, 2015
|
||||
| 67.
学位論文 |
学位
|
速水, 史郎
概要:
掲載誌消化と吸収, 37(3), p.238-241, 2015日本消化吸収学会 発行\nこの論文の利用は著作権の範囲内に限られます。
|
||||
| 68.
学位論文 |
学位
|
Yano, Tomohiko
概要:
掲載誌:体力・栄養・免疫学雑誌, 25, p.221-229, 2015
|
||||
| 69.
学位論文 |
学位
|
飯塚, 浩史
概要:
掲載誌:体力・栄養・免疫学雑誌, 27, p.137-143, 2017
|
||||
| 70.
学位論文 |
学位
|
小野, 真実
概要:
掲載誌 体力・栄養・免疫学雑誌 27(1): 25-34, 2017.
|
||||
| 71.
学位論文 |
学位
|
棟方, 理
概要:
掲載誌:体力・栄養・免疫学雑誌, 27, 128-136, 2017
|
||||
| 72.
学位論文 |
学位
|
金子, 美由紀
概要:
掲載誌 体力・栄養・免疫学雑誌 27(1): 18-24, 2017
|
||||
| 73.
学位論文 |
学位
|
中川, 悟
概要:
掲載誌 炎症と吸収 39巻2号 掲載予定
|
||||
| 74.
学位論文 |
学位
|
宮澤, 邦昭
概要:
掲載誌 炎症と吸収 39巻2号 掲載予定
|
||||
| 75.
学位論文 |
学位
|
小川, 武志
概要:
掲載誌：体力・栄養・免疫学雑誌, 27, p.42-50, 2017
|
||||
| 76.
学位論文 |
学位
|
溝口, 絵里加
概要:
掲載誌 体力・栄養・免疫学雑誌 27(1): 35-41, 2017
|
||||
| 77.
学位論文 |
学位
|
廣瀬, かほる
概要:
掲載誌：体力・栄養・免疫学雑誌, 27, p.144-151, 2017
|
||||
| 78.
学位論文 |
学位
|
黒澤, 繭子
概要:
Nurses work 23.4 hours of overtime on average per month, which is 13.2 hourslonger than the monthly average for general workers. It has been reported thatcontinuous work of more than 8 hours, which is the general length of working
…
hours,increases fatigue and decreases attention and work efficiency in nurses. The purpose ofStudy I is to clarify the current status of the working environment and chronic fatiguefor nurses in clinical care, and Study II is to test the association between workingconditions during day shifts and chronic fatigue in nurses.Study I: An anonymous self-administered questionnaire was sent to 2,753 nursesworking at 117 general hospitals with 300 or more beds located in eastern Japan,including Tokyo and 13 prefectures. Consent to participate in the survey was obtainedin advance. The questionnaire included questions on basic attribute information,working environments, and signs of chronic fatigue. Out of 1,779 respondents, 1,676females were included in the analysis. The results found that nurses were likely to haveaccumulated chronic fatigue if they were aged in twenties, worked 20 hours or more ofovertime per month, and worked 3 shifts; conversely, nurses were less likely to haveaccumulated chronic fatigue if they were aged in their fifties, worked 10 hours or lessof overtime per month, and worked only day shifts.Study II: The amount of physical activity and salivary amylase levels were measuredfor 3 days in 18 females out of 23 nurses working at General Hospital A. Also, the samequestionnaire survey as used in Study I was conducted. Nurses were divided into thefollowing 2 groups: outpatient nurses working only day shifts and ward nurses working 3shifts. The results showed that the average number of steps per day was approximately9,500, which was similar in the two groups. Salivary amylase levels did not differsignificantly between the two groups, although they were lower in the evening than in themorning in the outpatient nurses and higher in the evening than in the morning in the wardnurses.Nurses work under conditions of accumulated fatigue, which leads to chronic fatigueunless they can sufficiently recover. Therefore, it is considered that systematicenvironmental control, in which the circumstances of nurses, such as their ages and workschedules, are taken into account, is necessary for reducing chronic fatigue amongstnurses. In addition, it is also important to identify task completion times and for nurses tohave breaks in order to not accumulate fatigue.
続きを見る
|
||||
| 79.
学位論文 |
学位
|
髙橋, 純平
概要:
[Introduction]Physical therapists must often ascertain whether hemiparetic patients can walk independently. However, no
…
criteria exist, so decisions are often left to individual physical therapists.The study procedures were the following. (1) Investigation of methods used by physical therapists to assess walking independence of hemiparetic stroke patients, and walking-independence related factors (Chapter 1)(2) Exploration of how physical therapists ascertain whether a hemiplegia patient can walk independently in a ward or not (Chapter 2)(3) Evaluation of the reliability and validity of a scale to assess walking independence of hemiplegia patients (Chapter 3)[Chapter 1] Review of determination of walking independence in hemiparetic stroke patients. [Method] English-language and Japanese-language studies were identified through searches of MEDLINE and ICHUSHI through December 2011. [Result] Inclusion criteria were satisfied by 39 trials. The test batteries used to determine walking independence were FIM, FAC, and doctors and physical therapistdecisions. Factors related to walking independence were walking ability, lower extremity function of the affected side, cognitive disorder, and higher cerebral dysfunction. However, their values and significance were not defined. [Conclusion] Results of this review suggest that determination of walking independence in stroke patients is used for qualitative evaluation. Therefore, comprehensive evaluation scales are necessary for physical therapists to ascertain walking independence clearly.[Chapter 2] Clinical reasoning of physical therapists regarding in-hospital walking independence of patients with hemiplegia.[Methods] The subjects were 15 physical therapists with experience of stroke patients’ rehabilitation. We interviewed them using semi-structured interviews related to the criteria of the states of walking in the ward of hemiparetic patients. The interviews were transcribed in full, and the texts were analyzed by coding and grouping.[Results] From the results of the interviews, PTs determined patients’ independence of walking in hospital by observation of behavior during walking or treatment. The majority of PTs focused on the patients’ state during walking, higher brain function, and their ability to balance. In addition, they often asked ward staff about patients’ daily life, and self-determination.[Conclusions] We identified the items examined by physical therapists when determining the in-hospital walking independence of stroke patients. Further investigation is required to examine which of these items are truly necessary.[Chapter 3] Reliability and validity of a scale to assess walking independence of hemiplegia patients[Methods] Subjects were 7 hemiparetic stroke patients and 14 physical therapists. We evaluated stroke patients using the check list presented in Chapter 2. Additionally, we asked PTs about the importance of items using a questionnaire. Intra-rater andinter-rater reliability were measured, as was internal consistency.[Results] The intra-rater coefficient and internal consistency exhibited good reliability, but the inter-rater coefficient was low. Results of the questionnaire, items related to crouching and walking over different levels were not important determinants of walking independence.[Conclusions] We identified the intra-rater reliability and scale validity. Results show that items related to squat and gait must be re-examined.
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| 80.
学位論文 |
学位
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松嶋, 美正
概要:
【Introduction】The increase rate of the elderly people population in Japan is prominent worldwide. So-called "baby-boom g
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eneration" becomes elderly people; follow it, and the elderly people population increases until 2042. Therefore, as for the medicine, the medical care, the elderly people measures in the field of care, the need will increase still more in future.However, it will be necessary for the contents of the measures to reconsider it. The recent elderly people have the report to become younger as compared with previous elderly people. It is the increase of so-called "healthy" elderly people. These elderly people occupy approximately 80% of the elderly people population in 2020. Therefore, we think that the measures of these elderly people come in a stage to reconsider it.In previous research, the gait speed of healthy elderly people increased, but there is the report that association with the fall was found in by the variability of the gait cycle.As for the gait, it is found that rhythm is formed in CPG in the spinal cord. Also, in the study of the tapping task on rhythm, a neurologic model is built. The study on these two rhythm is different in the method, but iscommon at the point where cerebellum plays an important role in.Examinations of the tapping task are used for the patients with cerebellar disease well.There are more studies in the variability of the movement by tapping than a gait. The movement becomes late, and, for elderly people, the variability of the movement increases to secure a large number of joints smooth movement. It is assumed that the variability of this movement is caused by a central function by the aging and regressive change of the peripheral structure (muscle, nerves, sensory receptor, joint).However, as for the variability of these movements, various tapping tasks are used, and the method is not common. Also, it is complicated and thinks these tasks that there is room to examine it to apply to elderly people. Therefore, a purpose of this study is to determine whether movement varies by a simple tapping task in elderly people.Objectives: We examined the effects of age on the speed and variability of continuous tapping movement of the hands and feet over 3 min.Methods: Tapping speed and variability of tapping interval during 3-min self-paced tapping tasks for the index finger and ankle-toe were compared between groups of 20 young people and 20 active elderly people.Results: No effect of age on tapping speed was found, but the variability of tapping interval decreased with age. Both groups showed no correlation between speed and variability, and the speed of the ankle-toe task was slower than that of the index finger task. There was a correlation between variability of the index finger task and that of the ankle-toe task in the elderly group. Movement speed was slower in the second half of the 3-min task time in both groups, but there was no difference in the degree of variability.Conclusions: Variability in self-paced single-joint tapping movement of the hands andfeet may reflect regressive changes in the mechanisms of internal rhythm formation. In addition, for clinical screening, it is useful to conduct the task for a min and half or more to evaluate any changes in movement speed and variability.Key words: elderly, self-paced tapping, speed, variability, cerebellum
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| 81.
学位論文 |
学位
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中江, 秀幸
概要:
【Introduction】The aim of the present study is to assess effective physical therapy interventions onhome-care patients wi
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th Parkinson’s disease through the following: understanding howthey practice therapeutic exercises; clarifying the characteristics of their physicalfunctions and situation of physical activity; and elucidating the effects of therapeuticexercises on their physical functions and situation of physical activity.The study procedures were following:(1) To conduct a visit survey on how home care patients with Parkinson’s disease usenursing care insurance and practice therapeutic exercises (Chapter 1: Step1).(2) To investigate the relationship between problems in daily living and the practice ofself-exercise in patients with Parkinson’s disease (Chapter 2: Step2).(3) To demonstrate the characteristics of physical function and 24-h activity in home-carepatients with Parkinson’s disease compared with healthy elderly people (Chapter 3:Step3).(4) To understand what kind of impacts two-month interventions on home-care patientswith Parkinson’s disease through self-exercise and individual therapeutic exerciseshave on their physical functions and situation of physical activity (Chapter 4: Step4).【Step1】 Research on exercise therapy in home-care patients with Parkinson’sdisease: Results of home-visit survey on the use of domiciliary service andthe implementation of self-practiceObjective: This study aimed to obtain insight for the investigation of future interventionand measures by disclosing the conditions of understanding exercise therapy, includingself-exercise, and securing the opportunities as well as practical problems at home inhome-care patients with Parkinson’s disease.Method: Home-visit survey was conducted by an interview method in which aninvestigator visited the home of the subjects and interviewed them directly. The majoritems for the visit survey were the chief complaints in activity of daily living, applicationto long-term care insurance and self-practice was conducted in 15 home-care patientswith Parkinson’s disease.Results: The results revealed that the answers for chief complaints related to sit-to-standand gait performance such as “slow movement,” “difficulty in prompt action,” “easy tofall,” “leaning body,” and “walking in small steps” ranked high. When divided into twogroups based on the presence or absence of the certification of long-term care need, astatistically significant difference was observed in the number of answers of “easy to fall”as determined by χ2 test and in the fear of a fall as determined by t-test. As a result of χ2test with respect to the presence or absence of a habit of exercise therapy as self-practice,a significant difference was observed in the number of answers of “easy to fall” and“difficulty in toilet activities.” A significant difference was also observed by t-test in theduration from onset, score on fear of a fall, and the Tokyo Metropolitan Institute ofGerontology Index of Competence.Conclusion: This result suggests that it is difficult to accustom exercise therapy asself-discipline in severe patients with difficulty in maintaining standing position, turningaround, and visiting the hospital, prolonged duration from onset, increase in the score onfear of a fall, and reduction in activities such as those represented by the TokyoMetropolitan Institute of Gerontology Index of Competence.【Step2】 Problems with Daily Living and Performing Home Exercise in JapaneseHome-care Patients with Parkinson’s DiseaseObjective: We investigated the relationship between problems in daily living such asfalls and the practice of self-exercise in patients with Parkinson’s disease in Japan, toshow the requirements for their effective and sustainable home exercises.Methods: An anonymous questionnaire was sent by mail to 159 Parkinson’s diseasepatients who were members of the Miyagi Prefecture Branch of the Japan Parkinson’sDisease Association. The questionnaire included questions on Parkinson’s diseasesymptoms, chief complaints, history of falls, use of the nursing care insurance program,and performance of exercise therapy.Results: The questionnaire response rate was 62.3%. Falls had been experienced by 38subjects (44.2%) during the month before the survey and by 52 (60.5%) during the 6months before the survey. More than half (52.3%) of subjects had never undergoneexercise therapy at a medical institution, and those who continued to undergo exercisetherapy accounted for only 12.8% of all subjects. Thirty-three subjects (38.4%) did notundergo exercise therapy on a regular basis in any setting.Conclusion: To prevent a decrease in activity due to disuse muscular atrophy, it isimportant to establish more effective self-exercise for home-care Parkinson’s diseasepatients so that they can do these exercises on a regular basis.【Step3】 Comparison of Physical Function and Activity in Home-care Patients withParkinson’s Disease and Healthy Elderly PeopleObjective: To compare physical function and 24-h activity in home-care patients withParkinson’s disease with those in healthy elderly people.Methods: Physical function (range of motion, muscle strength, activities of daily living,gait, and balance) was measured in 10 home-care patients with Parkinson’s disease (PDgroup) and 10 healthy elderly subjects (healthy group). As an indicator of the amount ofphysical activity per day, a triaxial accelerometer was used to measure the 24-h totalimpulse value; simultaneously, behavior recorders were used to measure 24-h posture.Results: The healthy group scored significantly higher in activities of daily living,walking speed, and balance. No significant difference was observed between groups interms of range of motion, muscle strength, cadence, amount of physical activity per day,and number of postural changes. However, the PD group spent significantly more timeper day standing and in a supine position.Conclusion: In the PD group, the amount of physical activity per day was comparable tothat in the healthy elderly group, despite the decreased levels of activity caused by theirimpaired performance in activities of daily living. Range of motion and muscle strengthmay have been maintained by these patients’ self-exercise and by training at day-carecenters. Our results suggest the importance of practicing postural transfers from thestanding and supine positions and of intervention and guidance that aim to improveimpaired performance in daily living.【Step4】 Effects of Therapeutic Exercises by Home-care Patients with Parkinson’sDisease on Their Physical Functions and Situation of Physical Activity.Objective: The aim was to clarify how two-month interventions on home care patientswith Parkinson’s disease through self-exercise and individual therapeutic exercises affecttheir physical functions, daily amount of activity and posture dynamics.Methods: With 10 home-care patients with Parkinson’s disease as a target, we conductedphysical therapy intervention that consisted of 2-months self-exercise and individualtherapeutic exercise. Before and after the intervention status of implementation ofself-exercise, state of fall, and fear of falling were heard from the patients. In addition,physical functions (range of motion, muscle strength, activities of daily living, gait, andbalance) of the patients were also evaluated. As an indicator of the amount of physicalactivity per day, a triaxial accelerometer was used to measure the 24-h total impulsevalue; simultaneously, behavior recorders were used to measure 24-h posture.Results: The interventions made statistically significant improvements in the following:increase in both the number and duration of self-exercise, decrease in chief complaints,and mitigation of the fear of falling down. As for physical functions, significant increaseswere noted with respect to the following: angle of shoulder joint flexion and trunkextension, hip flexor muscle strength, and knee extensor muscle strength. However, nosignificant changes were recognized in the following indicators: FunctionalIndependence Measure, walking speed and cadence, Timed Up and Go test, FunctionalReach Test and Functional Balance Scale. Whereas indicators for the amount of physicalactivity, such as total impulse and the number of posture change did not changesignificantly, the amount of activity significantly increased due to decrease in the durationof recumbent position per day and increase in the ratio of sitting position.Conclusion: The interventions made as part of the study seemingly had the followingeffects: habituation of self-exercise; improvements in the joint range of motion, lowerlimb muscle strength, and balance in upright position; and reduction in the duration ofrecumbent position.【Summary】The results of the study suggest the importance of further rehabilitation measures forhome-care patients with Parkinson’s disease. As one example of such measures, it isconsidered necessary to increase the opportunities for home-care patients withParkinson’s disease to receive direct coaching from medical professionals and practicetherapeutic exercises, thus making the following possible: provision of therapeuticexercises through individual nursing care insurance depending on the symptoms andseverity of each patient; and interventions that help patients to conduct self-exercise on aregular basis. Also, the study suggests that interventions including individual therapeuticexercises and coaching on self-exercise have the following effects: habituation oftherapeutic exercises, increase in flexibility and lower limb muscle strength, and decreasein the duration of incumbent position. However, the effects of the interventions were notsignificant enough with respect to increase in the amount of activity and the number ofposture change, and decrease in the duration of uptight position. Also, while the durationof incumbent position decreased, that of sitting position was prolonged. It is necessary toconsider effective intervention methods for these phenomena from now on.
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| 82.
学位論文 |
学位
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家入, 章
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| 83.
学位論文 |
学位
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松嶋, 弥生
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| 84.
学位論文 |
学位
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蝦名, 智子
概要:
近年、酸化ストレスが様々な疾患の発症や妊娠高血圧症候群、妊娠糖尿病などの病態に関与していることが示唆されている。しかしながら、胎児期における酸化ストレスの評価は十分とは言えず、胎児期の酸化ストレスと出生後の疾患との関連についての詳細の多くは
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不明である。本研究では、胎児期の状態を反映する臍帯血に着目し、DNA酸化損傷マーカーである8-hydroxy-2'-deoxy- guanosine（8-OHdG）を指標に胎児の酸化ストレス状態と妊娠・分娩に関与する各種母子因子との関連性について検討した。臍帯血中の8-OHdGは0.1～1.39 ng/mLであり、母体の喫煙群では、非喫煙群に比較し8-OHdG値は高く有意差が認められた（0.33 vs. 0.42 ng/mL, P < 0.05）。また、胎盤重量及び出生体重1kg当たりの胎盤重量との間に正の相関を認められた（r = 0.343, P =0.007, r = 0.368, P =0.004）。さらに、母体「過体重／肥満」群では、臍帯血中の8-OHdGと胎盤重量に強い正の相関が認められた（r = 0.778, P < 0.05 ）。しかし、母体の年齢、在胎週数、児の性別、分娩所要時間などに関する要因との関連性は認められなかった。本研究から、正期産で出生した健康な児において、①子宮内の胎児も一般成人と同程度の酸化ストレス状態であること、②母体の喫煙は胎児の酸化ストレスを増大させる因子となる可能性があること、③肥満妊婦では、胎盤の増大は胎児の発育を促進する一方、酸化ストレスを増大させる可能性があることが示唆された。胎児期の酸化ストレス関連因子の解明は、生まれてくる子どもの将来の疾患を予防するために有益な情報になることが期待される。
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| 85.
学位論文 |
学位
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吉岡, 治彦
概要:
In this study, my purpose is to clarify whether Ultraviolet- and Visible- Light Microscopic Spectroscopy method (UV-Vis
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MS) is a useful technique for discrimination of non-cancer cells and cancer cells. This manuscript is composed of three chapters.In the first chapter, we examined the usefulness of UV-MS on unstained cells by liquid-based cytology (LBC). Cultured cells were used as the samples: 100 non-cancer cells and 200 cancer cells. On UV-MS, transmittance data at 260, 280, 300, 320, and 340 nm were extracted from the transmittance spectrum of 260-350 nm UV wavelengths and analyzed. As a result, The transmittance was lower in cancer than in non-cancer cells at all wavelengths (p <0.01).Thus, it was revealed that substance in cancer cells that absorbs ultraviolet light is rich. The result of discriminant analysis showed that determine predictive value was 96.3% (Z = 0.61 × 300 nm transmittance -44.02).In the second chapter, we examined the usefulness of Vis-MS on Papanicolaou stained cells by liquid-based cytology (LBC). The cells of the same type in the first chapter were smeared on a glass slide. On Vis-MS, transmittance data at 530, 580, 630 nm from the transmittance spectrum of400-650-nm Vis, and 530 nm/580 nm and 630 nm/560 nm transmittance ratio were extracted and analyzed. As a result, the transmittance at 580 nm was lower in cancer than in non-cancer cells (p <0.01). 530 nm/580 nm transmittance ratio was high in cancer than in non -cancer cells (p <0.01), and 630 nm/560 nm transmittance ratio was lower in cancer than in non-cancer cells (p <0.01). Binominal logistic regression analysis showed that the variables do not have a multicollinearity. Using the forward chapter method, 580 nm transmission values and 630 nm / 580 nm transmittance ratio were selected. Binomial logistic regression equation was obtained and the determine predictive value was 96.3%.The last chapter, I examined the usefulness of UV-Vis MS on tissue section. Samples were well- (G1) and poorly (G3) differentiated types of endometrial endometrioid adenocarcinoma. We analyzed the wavelength of 320 nm, 260 nm, 280 nm, and 300 nm on unstained samples by UV-MS. In the same area of the same section, we analyzed the wavelength of, 560 nm, 520 nm, and 540 nm on the HE stained samples by the Vis-MS. We investigated that cononical correlation analysis was useful for determination of the G1 and G3. As a result, it was suggested that the nuclear color changes in G3 was caused by ultraviolet absorbing material unspecified.In conculsion, it was clarified that UV-Vis MS is an objective and effective tool for discrimination of cancer cells. We will apply and develop it as an objective index for the diagnosis and prognosis of patients with various cancers.
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| 86.
学位論文 |
学位
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三上, 佳澄
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| 87.
学位論文 |
学位
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小池, 祐士
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| 88.
学位論文 |
学位
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佐藤, 彰博
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| 89.
学位論文 |
学位
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藤原, 健一
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| 90.
学位論文 |
学位
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吉野, 浩教
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| 91.
学位論文 |
学位
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會津, 桂子
概要:
Aim:Recently, it has become increasingly necessary for nurses to possess a high level of clinical judgment, due to advan
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ces in medical technology and changes in the types of diseases experienced by aged patients. Therefore, high-level assessment skill education has become an extremely important part of nursing students’ education. This study therefore aims to clarify the effect of structural knowledge education based on cognitive sciences theory for advancement in nursing students’ assessment skills.Method: Participants were 17 third-year university students and 55 second-year universitystudents majoring in nursing. Examinations for assessment skill and level of structural knowledge were conducted for the 17 third-year students individually. The experiments included a nursing-scene task, free-recall task, and sorting task. Experiments were conducted before and after their clinical practice. Each student’s level of structural knowledge was calculated from the free-recall and sorting task responses, and each student's assessment skill was calculated from the nursing-scene task responses.Examinations for assessment skill and level of structural knowledge after the structural knowledge education were conducted for the 55 second-year students, who were divided into an intervention group (n=19) and a control group (n=36). The experiments included pre-examination, structural knowledge education, self-study about diabetes, and post-examination. The pre & post-examinations included a production task, concept-map task, and nursing-scene task about diabetes. Educational sessions lasting 40–90 minutes were conducted 5 times for intervention group participants individually. During the educational sessions, participants studied lung cancer or liver cirrhosis to understanding the relation between the knowledge and the clinical scene by making concept map. Both intervention group and control group participants conducted self-study about diabetes with post-examinations conducted afterward. Each student’s level of structural knowledge was calculated from concept-map task responses, and assessment skill was calculated from nursing-scene task responses.Results:Third-year students’ level of structural knowledge was significantly higher after clinical practice (p < .01). When comparing assessment skills in relation to levels of structural knowledge, the high-structured group (n = 5) had significantly higher scores in nursing problems than the low-structured group (n = 5) (p < .001). Intervention group participants’ level of structural knowledge was significantly higher after education (p<.001), and significantly higher than that of the control group participants (p<.001). When comparing assessment skills between the intervention group and control group, the intervention group had significantly higher scores in nursing problems than the control group (p < .05). The intervention group’s scores in nursing problems were also significantly higher after education (p<.001), although the control group’s scores in nursing problems did not differ pre- and post-examination.Discussion:The intervention group participants’ level of structural knowledge was significantly higher after examinations. Students with structural knowledge appeared to make assessments by using their knowledge and understanding the situation comprehensively.These results clarified that studying information while understanding the relationship between the contained knowledge and a clinical scenario facilitates the development of students’ assessment skills.
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| 92.
学位論文 |
学位
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成田, 句生
概要:
We made “The manual of driving resumption for stroke survivors (Aomori-version)”(the manual), and investigated its use f
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or 7 months with targeted occupationaltherapists (OTs) in Aomori prefecture. Seventy-seven OTs participated in theinvestigation. Six among the 77 OTs reported to have used the manual. The strokesurvivors treated by these 6 OTs increased significantly than before. It was a 11.2 -foldincrease. They answered that each item of the manual was useful. Sixty-five among 71OTs who didn’t use the manual reported that they had no chance to use it.Approximately 90% of them stated, “would like to use it if I had a chance.” Each item ofthe manual was given more affirmative comments than negative ones by them. Fromthese results, it was suggested that the usefulness of the manual regarding the easinessto start treating of driving resumption for stroke survivors, although the number of OTwas small. We think this manual has a generality for use all over Japan in spite of beingan Aomori-version.
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| 93.
学位論文 |
学位
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北林, 司
概要:
This study evaluated stress experienced by rescue team members during a simulated search and rescue operation in a confi
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ned space and determine if wireless communication reduces stress. A total of 57 rescue team members of X prefecture participated. The stress visualization indices were ptyalin (i.e., salivary amylase), salivary cortisol, autonomic nervous system response, visual analog scale, and a short version of the Profile of Mood States. The subjects were randomized to perform a simulated search in a confined space without or with communication, and the stress indices were compared between the two groups.Stress was observed in the form of changes in ptyalin level, visual analog scale scores including impression of the subjects, and autonomic nervous system responses. Statistical analysis showed that the “with communication” group exhibited significantly lower stress than the “without communication” group. Thus, wireless communication is recommended to reduce the stress experienced by rescue team members working in confined spaces.
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| 94.
学位論文 |
学位
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石川, 純也
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| 95.
学位論文 |
学位
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山口, 平
概要:
造血組織内のニッチェと呼ばれる特殊な微小環境に存在している造血幹細胞は，自己複製能及び多分化能といった幹細胞特有の機能を有しており，放射線などの酸化ストレスに対して非常に高い感受性を示す．その幹細胞特性は細胞内ミトコンドリアの生合成，ミトコ
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ンドリア由来の活性酸素種を制御することで維持されている．造血幹細胞の幹細胞特性の維持や分化の進行におけるミトコンドリアの重要性は近年明らかにされつつあるが，その造血幹細胞の分化/増殖過程に及ぼす電離放射線の影響と細胞内ミトコンドリアの関連性についての多くは不明のままである．本研究では，X線照射ヒト胎盤/臍帯血由来CD34陽性造血幹/前駆細胞の分化・増殖過程における放射線応答と，細胞内活性酸素種、ミトコンドリア機能及びその関連遺伝子の発現について評価した．先ず，放射線ばく露ヒト造血幹/前駆細胞の分化・増殖におけるROSの役割について検討した(第一章)．造血幹/前駆細胞の分化・増殖を誘導するサイトカイン存在下では，X線照射造血幹/前駆細胞は増殖能とクローン形成能を劇的に減少させた．その時の細胞内活性酸素種は，非照射造血幹細胞内と比較して培養時間経過とともに有意に増加した一方，細胞内ミトコンドリアやミトコンドリア由来の活性酸素種は非照射造血幹細胞内と比較して有意な増加は示さなかった．DNA損傷は，X線照射直後に最も多く確認され培養時間経過とともに減少したが損傷の残存が認められた．次に，ミトコンドリアDNA及びその転写関連遺伝子，抗酸化酵素遺伝子の発現と造血幹/前駆細胞の放射線応答との関連を検討した(第二章)．ミトコンドリア電子伝達系全体の律速段階となっている複合体1のタンパク質をコードする遺伝子の発現は，照射細胞と非照射細胞間で有意な差は認められず同等のレベルを示した一方，ミトコンドリアDNAのゲノム安定性や抗酸化ストレスに関わる遺伝子の発現が上昇しており，放射線によるミトコンドリアの機能異常を抑制，緩和している可能性が示唆された．本研究の結果，放射線ばく露ヒト胎盤/臍帯血由来CD34陽性造血幹/前駆細胞の分化/増殖過程において，ミトコンドリア生合成及びミトコンドリア由来活性酸素種の異常生成は抑制されており，放射線による細胞のDNA損傷及び持続的な細胞内活性酸素種の異常産生が幹細胞機能破綻を引き起こしている可能性が示唆された．
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| 96.
学位論文 |
学位
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前田, 浩志
概要:
Using a murine model, we investigated whether allogeneic umbilical cord blood cell (UCBC) transplantation facilitates immune reconstitution with functional maturity in comparison with bone marrow cell (BMC) transplantation. UCBCs and
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BMCs prepared from green fluorescent protein (GFP)-transgenic C57BL/6 (H-2b) mice were transferred into BALB/c (H-2d) mice that had been subjected to lethal total body X-ray irradiation. Although UCBC-transplanted mice showed poorer survival than BMC-transplanted mice for the same number of transplanted cells, increasing the number of transplanted UCBCs improved survival with an increase of donor-derived GFP+ cell engraftment. Flow cytometric analysis revealed development of GFP+ immune cells of donor origin, including T cells, B cells, monocytes, and granulocytes, in the peripheral blood of both sets of recipient mice. Furthermore, the functional maturity of T and B cells involved in adaptive immunity following allogeneic UCBC- and BMC-transplantation was assessed in T- and B-deficient RAG2-/- BALB/c mice. Both sets of recipients showed complete rejection of third-party C3H (H-2k) skin grafts and antibody responses to the T cell-dependent antigen, 2,4,6-trinitrophenyl-keyhole limpet hemocyanin, with immunoglobulin class switching. These results suggest that UCBCs have essentially the same ability as BMCs to reconstitute a functional adaptive immune system, even in an allogeneic environment.
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| 97.
学位論文 |
学位
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清水, 真由美
概要:
【Objective】This study attempted to grasp how incidents happen in nursing jobs, and focused on drug administration, durin
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g which incidents happen most frequently. In order to clarify the causes of incidents in the different drug administration processes, depending onthe years of experience as a nurse, and years spent in the ward at the time of the incident, two studies were conducted.StudyIClarifying the situations where incidents occur【Method】For the advanced treatment hospital A in Japan, the study analyzed reports on 5357 incidents submitted by the ward nursing staff between 2012 and 2014, and conducted analysis for different work contents, on incident situation and the cause of incident, according to the nurse’s years of work experience and the years spent in the ward when the incident occurred.【Result】Out of the 5,357 cases, 38.5% of the incidents occurred pharmaceutical services an 25.9% drainage tube related services. For all years of work experience, “insufficient checking”was the most frequent cause of incident. For those with less than 2 years of work experience as a nurse the most frequent cause was “psychological state”, and for those with more than 11 years experience “misjudge.” The most common points with insufficient checking were, for pharmaceutical ervices, “prescription and order sheet,” for drain related services, “the connecting parts.”Study ⅡClarifying the causes for incident occurrence for drug administration processes【Method】Out of the 1,173 incident reports related to oral medicine, the study analyzed 510 cases where nurses used drug distribution carts for administering medicine after meals. The study divided the drug administration process into 4 stages and for each stage, analyzed the incident frequency according to years of experience as a nurse and years spent in the ward, and causes on the part of the involved party.【Result】Many incidents occurred in the preparation stage, and the cause for incident in all processes were related to “insufficient checking.”For those with more than 11 year experience as a nurse, occurrence was strongly related to “physical state”at the preparation and drug administration stage, and for those with less than 2 years spent at the ward, occurrence was strongly related to “psychological state.” Regardingcauses on the part of the involved party, occurrence was related to “assumption” for all stages, and instruction receipt stage “overlooking,” for preparation stage "failure to take notice" for drug distribution stage “forgetfulness,” and for drug consumption stage “lack of confirmation.”【Conclusion】Incidents occurred frequently in drugs and drain related tasks, one of the reasons likely being that the study took place in an advanced treatment hospital. Incident frequency for “insufficient checking”was 60%, suggesting the need for immediate measures. Regarding drug administration, incidents were related to the nurse’s psychological state in cases where the nurse transferred from a different ward shortly before the incident. This suggests that improvement of such working environment would be an effective measure. Additionally, it is also necessary to simplify the complicated drug administration procedures and to alleviate the nurses’ psychological burden.
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| 98.
学位論文 |
学位
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奈川, 英美
概要:
We conducted an observational gait assessment and examined the relationship of gait deviations with physical function an
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d walking ability. A total of 57 stroke patients admitted to a rehabilitation unit, who could walk unaided or under close supervision, were enrolled in the study (37 men; 20 women; 62.2±11.2 years of age; elapsed time since the onset of stroke: 90.9±39.9 days). We combined and partially modified several assessment forms used for gait evaluation. With regard to physical functions, we assessed: lower limb paralysis, sensory impairment, lower limb spasticity, range of motion, lower limb muscle strength, lower limb weight-bearing, and standing balance. We conducted a 10-meter walk test to assess patients’ walking ability. In order to identify variables that affect the total gait assessment score, a multiple regression analysis was performed. The following parameters were statistically associated with gait deviations: 10 meter walk time (standard partial regression coefficient=0.68), affected side hip abductor strength (–0.23), ankle plantar flexor spasticity (0.18), and maximum weight-bearing rate on the unaffected side (0.16). We established the relationship of gait deviations with physical function and walking ability.
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| 99.
学位論文 |
学位
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牧野, 美里
概要:
[Chapter 1] Review of backward walkingPurpose: The purpose of this study was to review existing literature on gait analysis and physical therapy related to backward walking (BW).Methods: English language and Japanese language studies
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were identified throughsearches of CiNii, PubMed and the Internet.Results: Fifty-five studies were identified.Conclusion: While some studies concluded that the joint movement patterns in BW and forward walking (FW) are similar, several studies reported that these patterns in BW and FW are different.[Chapter 2-1]Comparison of forward walking and backward walking in healthy young adultsPurpose: The purpose of this study was to compare the characteristics of BW and FW in healthy young adults.Subjects: Fourteen healthy young adults.Methods: Subjects were required to walk over a 5-m walkway at a self-selected pace.Results: Walking speed, stride length, and cadence were significantly lower in BW than in FW. The peak hip extension, knee flexion, ankle plantar flexion, and the peak hip and 77 knee joint moments were also significantly lower in BW.Conclusion: We conclude that BW is not a simple reverse reproduction of FW.[Chapter 2-2]Effects of ankle push-off during backward walking on ankle and hip jointsPurpose: The purpose of this study was to investigate the differences in the kinetic and kinematic factors of different ankle push-offs during BW.Subjects: Fourteen healthy young adults.Methods: Subjects were required to walk over a 5-m walkway at a self-selected paceunder three conditions: Natural Push-off BW, Increased Push-off BW, and DecreasedPush-off BW.Results: Walking speed and stride length increased in the order of Decreased Push-offBW, Natural Push-off BW, and Increased Push-off BW. The peak value of the hipextension angle was higher in Increased Push-off BW than in Decreased Push-off BW.Conclusion: Ankle push-off can help increase the walking speed and improve thepropulsive force of the ankle joint in BW. Hip joint movement plays an important role in BW to accommodate for the disadvantage ankle strategies have in this type of walking.[Chapter 3]Motion analysis of backward walking in stroke patients with hemiplegiaPurpose: The purpose of this study was to investigate the features of BW in strokepatients with hemiplegia.Subjects: Nine stroke patients.Methods: Participants performed FW and BWalong a 5-m walkway. Walking speed and stride length were self-selected.Results: On the paretic side, walking speed, stride length, and cadence were significantlylower in BWthan in FW. Peak hip extension was significantly lower in BW, and peak hip flexion moment, knee extension moment, and both ankle dorsiflexion and plantar flexion 78 moments were lower in BW.Conclusion: Unlike FW, BW requires conscious extension of the hip joint, which isdifficult for stroke patients with hemiplegia. Therefore, the range of hip joint movementwas smaller in BW, and walking speed and stride length were decreased. The peak ankle plantar flexion moment was significantly lower in BW than in FW, and it was difficult to generate propulsion power in BW. These difficulties also affected the walking speed.
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| 100.
学位論文 |
学位
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三浦, 利彦
概要:
The purpose of this study is to examine the appropriate setting pressure of MI-E for Duchenne muscular dystrophy which i
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s a model disease of neuromuscular disease and to ascertain the influence on cough function. Furthermore, we investigated the effect of NPPV and manual and mechanical assisted coughing on rate of oral intake and respiratory complications.Chapter 1 : Duchenne muscular dystrophy In Duchenne muscular dystrophy, Epidemiology, pathology of respiratory insufficiency, changes in respiratory management in recent noninvasive ventilation and life prolonging effect were described based as a review based on previous research and our study.Chapter2 : Decreased cough function, use and effect of manual and mechanical assisted coughing in Duchenne muscular dystrophy. Position of MI-E in various airway clearance techniques will be explained based on the airway clearance guidelines in Europe and the United States. In addition, we summarized the outline, adaptation, effect and risk of cough function evaluation and manual and mechanical assisted coughing in Duchenne muscular dystrophy based on previous studies. Chapter3 : Validation of optimum setting condition pressure in MI-E use by cough peak flow We examined the appropriate pressure setting condition of MI-E for Duchenne muscular dystrophy by cough peak flow and maximum insufflation capacity. As a result, the pressure of MI-E showed a tendency higher than 270 L/min, which is said to be effective for excretion of secretions even at ±40cmH2O, which was recommended as in the past. However, in order to more effectively perform airway clearance and to obtain a value close to 360 L/min which is a normal value of CPF, it is necessary to consider the use of MI-E at ±50cmH2O to 60cmH2O pressure. Chapter4 : Rate of oral intake and effects of mechanical insufflation-exsufflation on pulmonary complications in patients with Duchenne muscular dystrophy[Purpose] In Duchenne muscular dystrophy, it increases risks of difficulties of expectoration of secretion, asphyxia, aspiration pneumonia because of decreased cough function.The aim of this study is to prove that manually assisted coughing or mechanical insufflation-exsufflation prevents pulmonary complication and contribute to continue oral intake safely and continue rate of oral intake in Duchenne muscular dystrophy.[Subjects and Methods] We investigated the status of using ventilator, manually assisted coughing or mechanical insufflation-exsufflation , and oral intake or not. In addition, we inspected the frequency of fever (over 37℃) needed antibiotics from medical records for index of respiratory tract infection, and compared with every period of using mechanical insufflation-exsufflation from respiratory evaluation on cough peak flow .[Results] 58 patients participated in this study. There were 45 Full-time noninvasive positive pressure ventilation patients. 43 in 45 Full-time noninvasive positive pressure ventilation patients (95.6%) avoided tracheostomy and continued noninvasive positive pressure ventilation because they continued oral intake without tracheal intubation due to the respiratory acute exacerbation by asphyxia or aspiration pneumonia.[Conclusion]Duchenne muscular dystrophy patients can continue oral intake safely while preventing pulmonary complication by using manually assisted coughing or mechanical insufflation-exsufflation.
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