Stress urinary incontinence (

) is a common and bothersome problem among middle-aged women. Various animal models of have been developed to study the pathophysiological process involved in , such as vaginal distention, pudendal nerve injury, or ovariectomy. We have also reported cerebral infarction rats induce not only bladder overactivity, but also . Leak point pressure measurements are the most commonly used methods to evaluate the urethral dysfunction in animal models. Originally, we have developed microtransducer-tipped catheter measurements of urethral activity during sneezing. Extensive our basic research has clarified potential strategies for pharmacotherapy of in the central nervous system. Therapeutic targets include adrenergic and serotonergic (5-HT) receptors in the spinal cord projected from neurons in the locus coeruleus and raphe nucleus, respectively, which stimulate pudendal nerve innervating the external urethral sphincter. Activation of α₁-adrenoceptors, 5-HT_2C, or 5-HT₇ receptors enhances the reflex at the spinal cord level whereas pre- or postsynaptic α₂-adrenoceptors and/or 5-HT_1A receptors inhibit the reflex. In addition, we have reported that stimulation of the spinal μ-opioid receptors may be a new candidate for the treatment of . Thus, we review the recent advances in basic research and potential targets for pharmacotherapy of in the central nervous system.

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（目的）術前のprolapse reduction stress testing（PRST）陰性例に対してlaparoscopic sacrocolpopexy（LSC）を行い、術後stress urinary incontinence（

）の罹患率とリスク因子について検討することを目的とした。

（方法）本研究は後方視的な観察研究である。Pelvic organ prolapse（POP）に対して術前にPRST を行い、術後

の有無を確認した。82 例を対象とし、術後3 ヶ月、12 ヶ月時点に質問票（ICIQ-SF）を用いて術後 を評価した。

（結果）LSC の術後3 ヶ月、術後12 ヶ月の

罹患率は、術前 がある症例では43.2%、37.8%、術前 がない症例では24.4%、13.3% であった。術後 のリスク因子は、術前の（OR4.03、95%CI;1.26-12.9、P=.018）、ステージ3-4 の膀胱瘤（OR5.31、95%CI1.65-17.1、P=.005）、出産数（OR.387、95%CI.15-.997、P=.049）であった。

（結論）LSC 術前にPRST 陰性例であっても術後

のリスクについて説明し、段階的手術を提供していくことが必要である。

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[Purpose] This review article is designed to expose physiotherapists to a physiotherapy assessment of stress urinary incontinence () and the treatment and possibly preventive roles that they might play for women with . Specifically, the goal of this article is to provide an understanding of pelvic floor muscle function and the implications that this function has for physiotherapy treatment by reviewing articles published in this area. [Methods] A range of databases was searched to identify articles that address physiotherapy for , including the Cochrane Library, Medline, and CINAHL. [Results] According to the articles identified in our databases research, greater improvements in occur when women receive a supervised exercise program of at least three months. The effectiveness of physiotherapy treatment is increased if the exercise program is based on some principles, such as intensity, duration, resembling functional task, and the position in which the exercise for pelvic floor muscles is performed. Biofeedback and electrical stimulation may also be clinically useful and acceptable modalities for some women with . [Conclusion] We concluded that the plan for physiotherapy care should be individualized for each patient and include standard physiotherapy interventions.

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Objectives: Duloxetine, a serotonin and noradrenaline reuptake inhibitor, has been approved for the treatment of stress urinary incontinence () in women in the European Union, but not in the United States or Japan where newer drugs are under development. The present urodynamic study in women with was performed to evaluate the effect of duloxetine on urethral function and to determine an appropriate method for making go/no-go decisions in early clinical studies of new drugs under development for treatment.
Methods: A randomized, double-blind, single-dose, two-period crossover study of 40 mg duloxetine was conducted in 10 women with (≥1 episode/wk). The urethral pressure profiles at rest and during coughing, Valsalva leak point pressure, and leakage in a 20-min pad test were measured before and 6 hr after administration of duloxetine or placebo.
Results: Although a single oral dose of duloxetine did not affect Valsalva leak point pressure or leakage in a pad test, this drug significantly increased the mean and maximal urethral closure pressures at rest calculated over the entire urethra, compared with placebo. During coughing, duloxetine significantly increased the mean closure pressure and the change from baseline in maximal amplitude of negative closure pressure spike in the distal third of the urethra, compared with placebo.
Conclusions: The facilitatory effect of duloxetine on urethral closure function was confirmed in women with , suggesting the usefulness of the method used in this urodynamic study. Thus, the proposed method is potentially useful to reduce attrition rate by providing decision-making data in early clinical studies of new drugs being developed for treating .

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Prolonged vertigo and dizziness are good indications for Kampo treatment. An analytical study of the effect of Kampo-medicines on 30 patients with prolonged vertigo or dizziness was carried out, and the following results were obtained:
1) Every male patient was successfully cured with “” medicine*.
2) Female patients more than about 70 years of age were also cured with “” medicine.
3) Female patients with menstrual disorders, or uterine and ovarian diseases were cured with a combination of “” and “Ketsu” medicine**.
4) Younger females with vertigo or dizziness at the time of menstruation were treated succesfully with “Ketsu” medicine only.
5) Patients wtih psychosomatic symptoms in addition to vertigo or dizziness required “Ki” medicine*** in combination with “” or “Ketsu” medicine.
These results have contributed to finding the most effective Kampo-medicine for patients suffering from prolonged vertigo and/or dizziness.
*“” medicine: medicine for regulating body fluids.
**“Ketsu” medicine: medicine for regulating blood and the water metabolism of the body.
***“Ki” medicine: medicine for regulating vital energy in the body.

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当院では2017 年から腹腔鏡下仙骨腟固定術（laparoscopic sacrocolpopexy: LSC）を導入し、2019 年3 月までに実施した7 例において高率にde novo

（stress urinary incontinence）を発症した。その原因は子宮頸部および前腟壁に固定したメッシュの張力（メッシュテンション）が過剰であり、尿道の屈曲が過度に直線化されることが原因と考えた。今回、綿棒を用いて尿道の角度を計測する方法（modified Q tip Test; mQT）を考案し、これに基づいてメッシュテンションを調節することで術後に増悪する やde novo を予防できるか検討した。当院で2019 年5 月から11 月まで施行したLSC6 例において子宮頸部および前腟壁を頭側に牽引する際に外尿道口に綿棒を挿入し、綿棒の水平からの角度を0 ～+30°かつ全腟長が5cm 以上になるようにメッシュテンションを調節した。mQT 導入前の7 例（conventional 群）とmQT 導入後の6 例（mQT 群）において術前と術後 3 ヶ月でInternational Consultation on Incontinence Questionnaire-Short Form（ICIQ-SF）およびProlapse QOL questionnaire（P-QOL）日本語暫定版を取得し、これらを比較した。conventional 群において術前後のICIQ-SF score は4.6 ± 5.3（以下、平均値± SD）→8.0 ± 6.2 と増悪傾向であったが、mQT 群では6.3 ± 5.3 →4.0 ± 3.7 と改善していた。conventional 群で術前に を認めた1 例中1 例で症状が持続、術前に のない6 例中4 例でde novo を認めたが、mQT 群では術前に を認めた4 例中2 例で症状が消失、術前に を認めなかった2 例中1 例でde novo を認めた。mQT 導入により尿失禁症状が改善傾向にあり、本法に基づくメッシュテンションの調節が の改善に寄与する可能性が示唆された。

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A new type of intellectual property right ( generis right), providing a second layer of database protection, has been proposed by the European Union in their Database Directive and by the World Intellectual Property Organization for their Database Treaty. Possible impacts of this new legal protection under the generis right on the development of science is discussed. The proposal of the generis right has been motivated to protect databases that lack originality in the selection or arrangement of information therein even though substantial amounts of time, efforts, or financial investment are required for their acquisition or production. The proposed right would include, in addition, protection of data themselves from which the databases have been produced. Thus, any new legislation designed to establish the generis right would have potentially adverse effects on the conduct and, therefore, development of science. An alternative approach based on prohibition against misappropriation would be preferable, since this type of protection is compatible with both the public's interest and the producer's economic return. A practical way is discussed of establishing a principle of full and open access to data that are obtained by use of public funds, namely, of establishing a "common right" to scientific data or databases.

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[Purpose] The purpose of this study was to devise a new urinary incontinence exercise using co-contraction of both the transverse abdominal muscle (TA) and pelvic floor muscle (PFM) and examine the intervention effect in middle-aged women with stress urinary incontinence (). [Subjects] The subjects were fifteen women with who were divided into two groups: the TA and PFM co-contraction exercise group (n=9) and the control group (n=6). [Methods] Participants in the exercise group performed TA and PFM co-contraction exercise. The thickness of the TA was measured before and after 8 weeks of exercise using ultrasound. The thickness of the TA was measured under 4 conditions: (1) at rest, (2) maximal contraction of the TA, (3) maximal contraction of the PFM, and (4) maximal co-contraction of both the TA and PFM. [Results] There were no significant differences among the results of the control group. In the exercise group, the cure rate of was 88.9% after the intervention. There were significant differences in the thickness of the TA during maximal co-contraction of both the TA and PFM after the intervention. [Conclusion] The TA and PFM co-contraction exercise intervention increases the thickness of the TA and may be recommended to improve in middle-aged women.

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This paper is the investigation for Seong Yup village and folk houses in Cheju island. The purpose of this study is to find out the some characteristics concerning spatial composition for the Feng- thought. The summary is as follows : 1)The village has been built up by two axes under influence of the Feng- thought. 2)There are two center points by two center axes. It is a point for functional constitution, and one more point has a ratio of geometric constitution. 3)Folk houses built up by a position relation of a main building and a gate. And, it was to add to the mark of the Feng- when decided an arrangement house. Accordingly, the rule gave luck and bad luck. We are understood that there was a apportionment 75% at a position of luck. 4)There is the south, south-south-eastern direction of the house that is a apportionment 74% in the village. This orientation is toward main mountain of Feng-. Therupon the folk house can to receive insolation and sunshine equally a day from day. 5)Spatial compositions of the village and folk houses were influenced the Feng- thought in the history of the past. It was connected with the natural environment and culture in the period.

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腹圧性尿失禁（

）は，中年女性にみられる一般的疾患で，生活の質を著しく損なう．一方で，臨床的に，あまり有効な薬剤はない．妊娠，出産に伴う女性特有の成因に起因し，尿道過可動と内因性括約筋不全の二つに大別される．腹圧尿失禁の病態，創薬開発にあたって，直接的，間接的陰部神経損傷モデルが使用されている．私達は以前，脳梗塞ラットも尿禁制反射が減弱していることを報告した．評価法として，リークポイント圧測定や尿道マイクロチップ法があり，私たちは後者にくしゃみ刺激を利用する独自の評価方法を確立した．実際，中枢にはの標的が数多く存在することが明らかとなってきている．特に，ノルエピネフリン，セロトニン（5-HT）が標的で，陰部神経核（オヌフ核）周囲に存在するα₁受容体，5-HT_2C，5-HT₇が尿禁制反射を増強，α₂，5-HT_1Aが減弱することが明らかとなっている．さらに，脊髄オピオイドμ受容体が尿禁制反射を増強することを，弱オピオイドであるトラマドールを用いて報告した．このように，脊髄にはの新たな創薬開発の標的となる受容体が数多く存在する．

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this study proposes the bi-level model between the airline and market competitors to develop strategies for decision-making problem of planning scheduled flight on route. At the same time, this problem should consider the measurement of decision-making aspects, which involves the profits of airline management, the competition of market share, the current capacity of airline routes and travel demand. In the TNA study case, one outcome shows that if the airline profits as the upper level and airline market share as the lower level, the strategies will allocate new scheduled flights on new routes for the highest passenger load factor of air routes. Another outcome shows that if market share of the airline as the upper level and airline profits as the lower level, the strategies will still allocate adding scheduled flights on existing routes for the highest market share rate of air routes. Both outcomes demonstrate these strategies will take profits for airline.

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骨盤臓器脱（Pelvic organ prolapse、以下POP）術後に腹圧性尿失禁（Stress urinary incontinence、以下

）が増悪すること、あるいは新規に出現することは周知である。腹腔鏡下仙骨腟固定術（Laparoscopic sacrocolpopexy、以下LSC）でも同様で、特にメッシュ固定時の過緊張が要因の場合は中部尿道スリング手術の効果も低く、難治性でメッシュ再固定による減張術を余儀なくされる。今回、LSC 術後 に対し、メッシュ再固定術を施行した症例を経験した。症例は65 歳女性、2 妊2 産。膀胱瘤主体の子宮下垂の診断でLSC（前方メッシュ）を施行したものの、術後3 ヶ月ごろより が出現し、薬物療法にも効果がなく、半年経過後も持続した。 膀胱鏡にてメッシュ過緊張所見を認めたため、メッシュ延長法による減張術を施行し、症状は軽快した。メッシュ過緊張による難治性 に対してメッシュアーム延長による減張術は有効な手技と思われ、最適なテンションを確認する方法として、術中膀胱鏡併用は有用である。

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This article aims to examine the succession of '' which is an important aesthetic idea and has played an important role in the geisha community. The article is based on the life story by a former domestic worker who used to work in Kamishitiken, one of the five geisha communities of Kyoto during the period of high economic growth in Japan. Japan achieved an unexampled high level of economic growth from the 1950's through the 1970's. But some suspect that Japanese people may have lost a high cultural standard of living after the economic growth. Geisha streets located in the Kyoto city border are appreciated nowadays since they are clearly contrasted with the changed urban areas due to the economic growth. According to the worker's narratives she had to work hard as a part of the geisha community and the '' had been lost its cultural value during the period of rapid changes but it seems that '' had been not succeeded even in the geisha streets by the end of the economic growth.

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(目的) 経尿道的前立腺レーザー核出術（HoLEP）は近年広く施行されているが，以前より手術の難度や術後の腹圧性尿失禁の発症が問題となっている．我々はMRIを用いHoLEP術後に出現する腹圧性尿失禁に膜様部尿道長が影響するかを検討した．

(対象と方法) 2013年7月から2019年4月までに前立腺肥大症の診断でHoLEPを303例に施行した．そのうち109例が当院で術前にMRIを撮影していた．認知症で評価不能であった例，術前にすでに失禁を認めていた例，MRIの撮影時に尿道カテーテルが留置されていた例を除外し，残りの計83例を対象とした．臨床因子，MRI関連因子，手術関連因子と術後腹圧性尿失禁との関連を多変量解析で検討した．

(結果) 術後腹圧性尿失禁は19例（22.9％）に見られ，平均14週で改善した．膜様部尿道長は平均17.2mmであった．単変量解析でMRIのTZ volume（＞40ml），膜様部尿道長（≦17mm），手術時間（＞100分），核出時間（＞50分）が術後腹圧性尿失禁と関連する因子であった．多変量解析では膜様部尿道長（P＜0.0001）と手術時間（P=0.023）が独立した有意な因子であった．

(結論) HoLEP術後に腹圧性尿失禁は一過性に発症することがあるが3カ月程度で消失した．術後に発症する腹圧性尿失禁の予測に術前MRIでの膜様部尿道長は有用であった．

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人工尿道括約筋（AUS）植込後の患者の30～50％が，腹圧性尿失禁（

）の再発や感染のために再手術を必要とすることが報告されている．最近の報告ではの再発の最も多い原因はAUSの機械的故障であることが指摘されている．今回，AUSの機械的故障に対して尿道の操作をせずにAUS交換術を施行した症例を報告する．症例は63歳の男性．ロボット支援腹腔鏡下前立腺全摘除術後の重症に対してAUS植込術を行った．術中，カフを膨らませAUSが正常に作動することを直視下に確認したが，術後7週間目にAUSを作動させてもは改善しなかった．尿道鏡で尿道が括約されていないことが確認され，CTでチューブの連続性の欠如及びバルーンの縮小がみられた．再手術の際，チューブは接続部で外れていることが判明した．圧力媒体の補充と尿道鏡により，圧力調整バルーンが漏れていないこととカフが尿道を閉塞させることを確認した．その後，コントロールポンプの交換とチューブの再接続のみでAUS交換術は完了した．術後直ちにAUSを作動させ，の改善を確認した．3カ月後には患者は良好な禁制状態を享受している．AUS交換術時に機械の故障箇所が特定できれば，尿道の操作を加えずに部分的な交換のみで手術が完了し，尿道損傷のリスクを回避することができる．

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　HoLEP (holmium laser enucleation of prostate) における周術期合併症の1つである一過性の腹圧性尿失禁 (stress urinary incontinence;

) を予防する工夫として, 前立腺部尿道12時にある腺組織を有しない前葉線維筋性間質 (anterior fibromuscular stroma ; AFS) を温存するHoLEP術式を紹介した. この術式は, 前立腺部尿道の11時から1時の粘膜を帯状に残るように切開し, AFSを温存する方法である. 膀胱頸部から尖部まで核出する境界線が明確になることで, 術式が簡略化して初心者でもオリエンテーションを付けやすいという利点があり, また尖部剝離操作の際に愛護的操作を意識するようになり, 発生率が低下した.

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Urinary incontinence (UI) has considerable impacts on quality of life (QOL), and the incidence of UI increaseswith age. UI is classified based on pathophysiology into stress urinary incontinence (

), urgency urinary incontinence (UUI), overflow incontinence and functional urinary incontinence. alone is the most common amongfemales with UI, followed by mixed urinary incontinence (MUI) of and UUI and UUI alone. In this article,the pathophysiology and treatment of UI are described and discussed.

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　2009年6月から2011年1月までに当科でホルミウムレーザー前立腺核出術（holmium laser enucleation of the prostate：HoLEP）を施行した135例のうち，105例に尖部順行性切除法（anteroposterior dissection HoLEP）での核出術を施行した．この術式は，手順が比較的単純であり，腺腫の大きさを問わず手術を完遂でき，さらに術後合併症の1つである腹圧性尿失禁（stress urinary incontinence：）のリスクを低減させる効果が期待できると考えられている^1）．今回我々は，尖部順行性切除法において技術的に一番難解な「前立腺側葉12時の剥離」を標準化すべくその手技の検討を行った．結果として，すべての症例で12時からの剥離面への到達が可能であり，標準化できる手技だと考えられた．また，術後1カ月目のも有意に減少しており，術後早期ののリスクも軽減しうる術式だと思われた．

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