吸入ステロイド (ICS)/長時間作用型気管支拡張薬(LABA) による喘息治療の普及により，喘息死は著しく減少し，多くの患者は健常者と変わらない日常生活を送れるようになった．喘息死の減少と今日の喘息コントロール状況は，世界的に見ても良好なレベルにあり，このような喘息診療における医療提供体制において，本邦ガイドラインが果たした役割は大きい．アレルギー学会から刊行されている日本の喘息ガイドラインである「喘息の予防・管理ガイドライン」は，理想として無症状を完全なコントロール状態として位置付けており，治療ステップ 1 から吸入ステロイド薬 (ICS) の低用量を推奨している．本邦ガイドラインが，海外のガイドラインにくらべて高い治療管理レベルを目指してきたことで，今日，日本の喘息診療は，海外に比べて，コントロール状態の良好な患者割合が高く，喘息死亡が少ない状態を達成できている．本稿では，最新の診療ガイドラインに基づいて，現在の喘息診療について概観する．

Despite substantial declines in gastric cancer incidence, the incidence of adenocarcinoma of the esophagogastricjunction (AEG) has been rising remarkably worldwide and is drawing considerable attention as well as concern.However, the optimal extent of esophagogastric resection for this tumor entity, especially Siewert type II tumorslocated at the true cardia, remains highly controversial. Given the uncertainty about the optimal extent of prophylactic lymph node dissection, both subtotal esophagectomy and extended total gastrectomy have been advocatedfor this tumor entity. A recent Japanese questionnaire-based national retrospective study showed that completenodal clearance along the distal portion of the stomach offered marginal survival benefits for patients with AEGless than 4 cm in diameter. A prospective nationwide multicenter study accurately identified the distribution oflymph node metastases from advanced AEG, suggesting that it is not recommended to completely dissect lymphnode stations along the distal portion of the stomach. Total gastrectomy might be employed less frequently andconsequently replaced by subtotal esophagectomy or extended proximal gastrectomy in clinical practice.

Colorectal cancer surgery in Japan is performed based on lymphatic drainage from the primary tumor site. D3lymph node resection is undertaken with central ligation at the root of feeder arteries following dissection alongembryologically fused fascia between the mesenteric plane and the parietal plane without any injury to the mesentery. With the advent of the Japanese Classification and Guidelines for the Treatment of Colorectal Cancer, thisD3 procedure, which consists of en bloc resection of regional lymph nodes in the lymphatic drainage area, wasestablished as a standardized surgery and has contributed to achieving good prognoses. Total mesorectal excisionand complete mesocolic excision with central vascular ligation are recognized as optimum procedures for colorectal cancer and improved outcomes, especially in Europe, are basically consistent with the concept of D3 resection.In addition, colorectal cancer surgery, which was once thought to be a well-established technique, has undergonea major transformation in recent years with the development of laparoscopic and robotic surgery. The transanalapproach is also being used in rectal surgery. This article describes the transition and progress of colorectal cancersurgery, including recent topics.

The number of child abuse cases continues to increase year by year in Japan. Abused children may visit anymedical department, not just pediatric departments. Medical doctors and medical professionals in any clinical department are expected to have basic knowledge of the current way of thinking about child abuse and precautionsat the first visit.

Intervertebral disc degeneration, a major cause of chronic low back pain, is caused by irreversible changes inthe nucleus pulposus cells that make up part of the disc. In recent years, regenerative medicine for intervertebraldisc degeneration through the administration of mesenchymal stem cells (MSCs) and cytokines has been performed. Dedifferentiated fat (DFAT) cells are MSC-like multipotent cells that can be prepared by ceiling cultureof mature adipocytes. In this study, we investigated the effect of intravenous injection of DFAT cells in a ratintervertebral disc degeneration model induced by caudal needle puncture. Radiographic analysis revealed thatintravenous administration of DFAT cells significantly suppressed the narrowing of the intervertebral disc gap.Histological examination revealed that intravenous administration of DFAT cells increased the number of microvessels surrounding the cartilage endplate and intervertebral disc cartilage matrix. Since DFAT cells can becollected and prepared in a minimally invasive procedure even in elderly individuals, DFAT may be an attractivecell source for treating intervertebral disc degeneration.

Extant side-necked turtles consist of three families: Chelidae, Pelomedusidae, and Podocnemididae. The lasttwo families (the subject of this study) include five genera, three of which are endemic to Africa (Pelomedusa andPelusios) and Madagascar (Erymnochelys), while the other two (Podocnemis and Peltocephalus) are restrictedto South America. This study was undertaken to determine the molecular relationships of side-necked turtlesbased on the primary and tertiary structures of α^A, α^D, and β globin chains as deduced by cDNA sequencing and amachine-learning algorithm for protein structure prediction, AlphaFold2. Analyses of the globin primary structures of four species from different genera provide three major insights. (1) The genera Pelomedusa and Pelusiosmight be endemic taxa that diversified in Africa after the Gondwana separation. (2) Although the extant species ofErymnochelys and Podocnemis are restricted to Africa and South America, respectively, they are closely related toeach other, and thus, these genera apparently diversified during the breakup of Gondwana. Thus, the colonizationof the ancestral population of Podocnemis unifilis in South America might have coincided with continental drift.(3) The divergence times of the four species based on globin genealogy were estimated to have begun 120–11million years ago (mya), which generally coincides with the break-up of Gondwana 135–65 mya. In addition,tertiary structures predicted by AlphaFold2 were compared using a PyMOL overlaying technique. An in-depth examination of the four α^A globin chains revealed considerable consistency among species, and a similar pattern wasobserved for α^D and β globin chains. Additionally, species-specific differences were recognized among the primarystructures, and their higher-order structures (i.e., tertiary structures) were consistent, offering new information onthe molecular phylogeny of side-necked turtles.

Measles is a vaccine-preventable disease but occasionally it poses a risk of serious and life-threatening illnesswith a high rate of communicability if contracted by unvaccinated persons. At the end of the Edo period (1603–1867) in 1862, a major outbreak of measles occurred. At that time, many ukiyo-e (color woodblock prints) artworks were produced called “measles pictures”, which described how to deal with measles. In the present study,we examined 4 ukiyo-e prints owned by Nihon University Medical Archives. Pictorial motives, as well as texts,were investigated carefully and then compared with other ukiyo-e prints of the same theme from that time. Thecontents of the 4 ukiyo-e prints were consistent with those of other paintings owned by different institutions,indicating that there was a common understanding among the general public about the pathogenesis of measlesand food regimens to help recovery. All of the paintings have an entertaining aspect typical of ukiyo-e prints aswell as a system for sharing information among the general public, suggesting that the publishers were seekingcommercial success and that the readers had a certain minimum level of knowledge, reading ability, and economicbackground.

Bowen 病は，表皮内の扁平上皮癌であり肛門周囲での発生は稀である．症例は 53 歳女性．内痔核，粘膜脱に対して，1 年 4 カ月前に他院で ALTA 療法と粘膜切除術を受けたが，肛門の痛みと腫脹が改善せず，当院を受診した．ALTA 療法後の外痔核と裂肛に伴う見張り疣の術前診断で手術を行ったが，術後病理診断で肛門部Bowen 病と診断された．ALTA 療法後に診断された報告はない．ALTA 療法後の難治性疼痛治療中に診断された肛門部 Bowen 病を経験したので報告する．

症例は 78 歳女性．既往に関節リウマチあり，ステロイドを長期投与中．胆石症に対して腹腔鏡下胆嚢摘出術を施行した．術後 1 年 6ヵ月後に右上腹部に疼痛を認めた．腹部単純 CT 検査で右上腹部のポートサイトヘルニアと診断，有症状のため手術となった．手術は臍からのアプローチの単孔式で行いメッシュリペアとした．5mm ポートサイトに生じた遅発型ポートサイトヘルニアを来した症例を経験したので，文献的考察を加えて報告する．