京都大学 / 新制・論文博士 / 博士(医学) / 乙第13586号 / 論医博第2306号 / 新制||医||1070(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川口 義弥, 教授 波多野 悦朗, 教授 齋藤 潤 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Cryptorchidism is a male congenital disorder with an unspecified, multifactorial etiology. This review evaluated the strength of select factors in the development of cryptorchidism to better understand its etiology. The strength of relationship between factors and their respective functions during testicular descent was evaluated. Factors evaluated in the causal pathway include the signaling mechanisms Desert Hedgehog (DHH), Insulin-like Hormone 3 (INSL3) and Platelet-Derived Growth Factor (PDGF), as well as sex hormone regulation (androgen: estrogen ratio, aromatase expression). Articles supporting a factor in testicular descent were evaluated and scored. These scores were summed to create the “Step Score” for each step in the causal pathway. An arrow system was developed which ranked the strength of each pathway step as either “weak”, “moderate” or “strong”. Thus, step scores and the strength of factors in the pathological pathway were determined: DHH (15-moderate), PDGF (10-weak), INSL3 (24-strong) and Androgen: Estrogen ratio, Aromatase (23-strong). The pathological pathway produced by this review represents a literature based perspective of the research regarding cryptorchidism etiology. Literature indicates that prenatal exposure to endocrine disrupting chemicals in animals and humans may lead to abnormal genital development. Recently, prenatal maternal cigarette smoke was demonstrated to be a risk factor for cryptorchidism. This controversial finding was explored in the context of endocrine disrupting chemicals. However, literature has provided very little evidence in support of this hypothesis and more research is needed to better evaluate prenatal maternal smoking as a risk factor for undescended testis.

Preventing diabetic foot ulcers among patients diagnosed with diabetes is an important element of care as diabetic foot ulcers present major medical, psychosocial and economic threats. In addition, about 20% of the diabetic foot ulcer cases will ultimately require amputation and cause greater mortality rates. The purpose of this literature review was to evaluate cellphone use to promote diabetic foot care practices among patients with diabetes. Six electronic databases were searched for articles which included text messaging and or phone interventions geared at improving foot care practices. A total of 14 articles dated 2009-2019 met the inclusion criteria and were included in the review. Cellphone use for text messaging and phone calls to advance diabetic foot care practices appears to be promising. Cellphone interventions among clients diagnosed with diabetes were found to have higher adherence with foot examinations, more frequent foot checks, and better overall performance score of diabetic foot ulcer preventive behaviors. This literature review supports cellphone use for text messaging and phone calls to improve diabetic foot care practices. Particularly among populations with health disparities and limited access to healthcare cellphone improves access to care, is uncomplicated and presents a cost-effective approach to improving diabetic foot care practices.

Background - Type 2 Diabetes Mellitus (T2DM) is a growing crisis that can lead to more problems if left untreated. One of these problems includes diabetic nephropathy or Chronic Kidney Disease (CKD). While there have been many advances in the field of treating CKD with medication, there are currently no medications with the capability of stopping the progression of or reversing diabetic nephropathy; however, recent studies have shown that diabetic nephropathy can be stopped and even reversed through dietary interventions. One of these studies went through the effects of a low protein diet on diabetic nephropathy and found very promising results. This meta-analysis was designed to explore the effects of a Low Carbohydrate Diet (LCD) on diabetic nephropathy. Methods - An electronic search of PubMed and Google Scholar was conducted. To be considered eligible the studies had to contain (‘carbohydrate’ OR ‘carbohydrates’) AND (‘diet’ OR ‘diets’) AND (‘type 2’) AND (‘diabetes’ OR ‘diabetic’) AND (‘ketogenic’). The studies also had to measure Estimated Glomerular Filtration Rate (eGFR) and Glycated Hemoglobin (HbA1c). Statistics and calculations were performed by Review Manager version 5.3 while risk of bias was assessed using the Robvis ‘risk of bias’ tool. Findings - 262 potential articles were identified by the search and 10 studies matched the search criteria with a total of 921 participants (450 were given the LCD and 471 were given control diets). Analysis of the total Standardized Mean Difference (SMD) for the eGFR studies showed that there was no difference between the LCD and the control (total SMD: -0.00; 95% CI, -0.20 to 0.19; P = 0.97). Analysis of the serum creatinine showed similar results (SMD: 0.13; 95% CI, -0.12 to 0.38; P = 0.31). The total SMD for the HbA1c (SMD: -0.29; 95% CI, -0.55 to -0.03; P = 0.03) showed that there was a lowering of the HbA1c in the LCD and not in the control diet. Conclusion - In this meta-analysis there was no connection found between eGFR/serum creatinine and percent carbohydrates in the diets indicating the LCD did not negatively affect the kidneys. HbA1c was found to be lower in the LCD than in the control which points to a LCD possibly leading to the reversal of T2DM which would remove the main cause of diabetic nephropathy.

No description available.

No description available.

No description available.

No description available.

No description available.

No description available.