菅沼 信彦

Abstract Uterus transplantation (UTx) has emerged as a revolutionary treatment for absolute uterine factor infertility, made possible by extensive preclinical research. Animal studies have played a pivotal role in advancing UTx to clinical practice. We highlight Japan's contribution, including non‐human primate research and regulatory progress, leading to its anticipated clinical implementation. The expansion of UTx in the Asia‐Oceania region underscores its global impact. Further refinements in surgical techniques, optimization of immunosuppressive regimens, and establishment of clear patient eligibility criteria will be crucial for ensuring the long‐term success and sustainability of UTx programs worldwide. This letter acknowledges the Swedish team's foundational efforts in establishing UTx as a viable reproductive technology.

Purpose: To analyze the usefulness of intravaginal insemination (IVI) for the infertility treatment in couples with sexual dysfunction before applying assisted reproductive technology (ART). Methods: Among 208 couples who presented sexual dysfunction, 144 couples underwent IVI procedures. The profiles of pregnant and non-pregnant patients were compared. Results: Of 144 patients, 58 women conceived successfully (40.3% pregnancy rate). Between the pregnant and non-pregnant cases, the husband's age and infertility period were significantly higher (P = .0104) and longer (P = .0027) in the unsuccessful cases than the successful ones. The husbands who could not impregnate had a significantly higher ratio of sperm abnormalities (P = .0048). Among the 57 successful cases who underwent IVI treatment, 38 (66.7%) patients became pregnant within 3 times of the procedure, while 48 (84.2%) patients conceived within 6 times. Conclusion: The authors can propose the following inclusion IVI criteria for couples with sexual dysfunction: (a) younger husband (36 years old or less) which may be most important, (b) infertility duration of 3 years or less, (c) normal sperm condition, and (d) IVI trial for 3 times (maximum of 6 times). Since IVI appears to be a simple, noninvasive, and inexpensive way for couples with sexual dysfunction, it can be attempted before ART application.

The objective of this study was to explore the factors associated symptoms of depression among pregnant women with gestational diabetes mellitus (GDM) in Japan. This cross-sectional study was conducted at a hospital in Toyota, Japan, from January 2015 to June 2016. Pregnant women who visited the hospital and were diagnosed with GDM in the second trimester were enrolled. We analyzed depression symptoms using the Centers for Epidemiological Studies Depression Scale (CES-D) and considered related factors of depression symptoms, such as dietary intake and daily walking. Dietary intake during the past month was assessed using a brief self-administered diet history questionnaire, and daily walking was assessed using an accelerometer. The prevalence rate for GDM was 8.8%, and 25 pregnant women with GDM were analyzed. The CES-D was not significantly correlated with pre-pregnancy BMI, postprandial plasma glucose, hemoglobin A1c, and the number of steps walked. In contrast, a significant negative correlation was observed between the CES-D score and intake of fish with bones, simmered fish, pickles, green leaves, mushrooms, and green tea. Furthermore, a significant positive correlation was found between Coke® and CES-D scores. For nutrient intake, a significant negative correlation was found between the CES-D score and vitamin K, folate, and β-carotene levels. The present study suggests that depression symptoms among pregnant women with GDM in the second trimester may be associated with diet.

【目的】わが国においては産科医不足により，周産期医療をとりまく環境は厳しくなっていることは周知の事実である．全国規模で分娩取り扱い施設数の減少は顕著であり，同時に助産師不足も指摘されている．その原因として，絶対的な数不足と同時に就業場所の偏在が問題化している．本研究では，助産師の職域や職能，勤務の現状，職能発揮に関する評価を多角的に調査し，この原因究明を目的とした．【方法】京都府下の分娩取り扱い施設（36病院，33診療所）の助産師，医師，看護師を対象としてアンケート調査を行った．その結果を病院と診療所の間で比較検討した．【成績】24病院（助産師190名，医師71名，看護師128名），11診療所（助産師39名，医師10名，看護師47名）から回答が得られた．助産師業務の理想的な勤務時間配分（妊娠期，分娩期，産褥期，新生児期，婦人科，その他の各期に従事する時間）は，助産師の回答では両施設とも分娩期が30％前後で大きな差異はみられなかったが，実際の勤務時間配分では病院20.7％，診療所43.2％と，明らかな差が認められた．病院では医師，看護師ともに助産師と同様であったが，診療所の医師では26.2％と助産師と異なっていた．また助産師が満足している点は，両施設とも他職種からもほぼ同様と推察されていた．一方，不満足な項目においては，助産師は両施設ともに「妊婦への保健指導」など妊産婦への関わりが不十分な点を挙げており，病院の医師，看護師も助産師の不満を大筋で理解していた．しかし診療所の医師では「施設の規模」「福利厚生」，看護師では「勤務体制」「緊急時のケア」など，助産師業務そのものよりも勤務環境に不満があると類推し，助産師が不満とする点への理解が乏しかった．【結論】助産師の偏在化は，現在の助産師業務などに対する助産師自身の評価と他職種からみた評価との相違によって起こっている可能性が示唆され，助産師が不満に思う点やニーズを，他職種が正確に把握することが解決の糸口になるのではないかと推測された．〔産婦の進歩61（2）：90-98，2009（平成21年5月）〕