医学生物学一般問題 ( 問題用紙 1 枚解答用紙 2 枚 )

Transcription

1 平成 26 年度大学院医学研究科博士課程入学試験 (1 回目 ) 医学生物学一般問題 ( 問題用紙 1 枚解答用紙 2 枚 ) 以下の問題 1 問題 4のうち二つの問題を選択して解答しなさい一つの問題につき1 枚の解答用紙を使用しなさい紙面不足の場合は裏面を使用してもよい問題 1 抗体とは特定のタンパク質などの分子 ( 抗原 )を認識して結合する働きをもつ B リンパ球の産生する糖タンパク分子であるヒトでは総遺伝子数が約 2 万数千個免疫グロブリンに関連する遺伝子が数個と限られているにもかかわらず無数の抗原に対する抗体を産生することができるこの機序について説明しなさい問題 2 最近発展したがんの新しい治療法について知るところを述べなさい問題 3 Polymerase chain reaction(pcr)の原理および応用について述べなさい問題 4 次の文章を読んで以下の問に答えなさい先進諸国の中で日本は依然として結核罹患率の高い国である日本の 2010 年の人口 10 万人あたりの罹患率は 18.2 であり米国 4.1 ドイツ 4.8 イタリア 4.9 オーストラリア 6.3 スウェーデン 6.8 フランス 9.3 英国 13.0 に比べ高い値を示している日本では結核患者の高齢化が進んでおり新規登録結核患者の半数以上は 70 歳以上の患者が占めている結核罹患率の地域差は大きく首都圏中京地域近畿地域等の大都市で高い問結核は我が国最大の再興感染症とされるがその考えられる理由および背景について説明しなさい

2 平成 26 年度大学院医学研究科博士課程入学試験 (1 回目 ) 日本人 - 英語問題 1 次の文章は Health Care Information Technology: Progress and Barriers と題する論文の一部であるこの文章を読んで問 1~ 問 7に答えなさい (1)In the 3 decades since the term medical informatics was first used, individuals working at the intersection of information technology (IT) and medicine have developed and evaluated computer applications aiming to improve health and health care. The road to successful use of IT in medicine has not been easy, with examples of failures in both computer systems and networks. However, a variety of applications from the field of medical informatics have matured in recent years. Fueled by several factors including increased emphasis on ensuring patient safety and preventing medical error, as well as development of new biotechnologies such as gene microarrays, (2) the need for informatics applications in health care has become apparent to the larger community. Informatics is この poised 部分 to に have 掲載されている a major impact 文章については in patient-clinician communication. In the Clinical Crossroads 著作権 article 法上の in 問題 this から issue 掲載 of するができません JAMA, Slack demonstrates the value that patient-physician のでご can 了承 have 願います in improving patient care, and also catalogs the incomplete but encouraging underlying evidence. As with many applications of IT, the technology can improve the existing situation but also empower clinicians and patients to think more fundamentally about how innovation can lead to changes in the way medicine is practiced. Slack also emphasizes that informatics can help physicians better incorporate into clinical practice one of the most underused resources in medicine, the patient, whose help is greatly enhanced through this new technology. Although the case for adoption of improved health care informatics appears quite compelling, (3) significant barriers to its use remain, particularly with regard to the electronic health record (EHR). These include cost, technical issues, system interoperability, concerns about privacy and confidentiality, and lack of a well-trained clinician informatics workforce to lead the process. Certainly the biggest impediment is financial, which results from misalignment of costs and benefits. A recent report suggested that ambulatory EHRs, particularly when augmented with clinical decision support tools, have a substantially positive return on investment for the health care system as a whole. (4) However, those who are expected to pay for such systems, namely physicians and other practice organizations, only see 11% 1

3 of that return on investment. The rest goes to those who typically do not pay for EHRs directly, such as insurers, laboratories, and patients. A variety of approaches have been proposed, such as revolving loan funds and pay for performance schemes that reward data capture (only possible with use of an EHR), which then enables physicians to measure and improve quality in their practices. A variety of technical issues pose additional barriers to more widespread adoption of health IT. Implementing an EHR in a clinical setting is (5) much more complicated than connecting a computer to the Internet or installing software from a CD-ROM. Systems must conform to the workflow of a practice or the workflow must be modified in a way such that the system does not impede it. Experience with well-designed systems shows, for example, that ambulatory EHRs need not derail the clinical この部分に掲載されている文章については workflow. However, physician offices, particularly small practices and those in rural or 著作権法上の問題から掲載するができません underserved areas, need simple and inexpensive solutions to obtain the benefits of のでご了承願います EHRs. An additional impediment is the very real concern about privacy and confidentiality. Physicians, other health care professionals, and health care organizations must be vigilant in protecting patient privacy. However, privacy issues exist whether the medical record is paper or electronic. (6) In fact, as outlined in an Institute of Medicine report on this topic, paper-based records are at least as insecure as electronic ones, and probably more so. Unfortunately, perfect security will never be achieved because human curiosity will derail even the best security methods. Health care professionals must work to instill a culture that demands privacy and confidentiality. Even if the financial and technical issues surrounding the use of health care IT are solved, a workforce capable of leading its implementation must be developed. Physician-informatics leaders must guide the effort in concert with others in health care, with appropriate knowledge and skill in informatics to lead efforts in all health care settings. These individuals need not necessarily be full-time informaticians or require extensive training, but they must understand the worlds of both medicine and IT. Other IT professionals including health information managers, health science librarians, and representatives from other fields are needed to assist in this process. The optimal preparation and workforce for this effort will need to be determined. Despite these formidable challenges, it is possible that patients, as described by Slack, can be empowered to play an integral role in their health care and to manage their information. (7) Health care IT is not a panacea for all that ails medicine, but it has the potential to improve the quality of care as well as the personal experience for patients. 2

4 出典 :William Hersh, MD. JAMA. 2004; 292 (18): 問 1 で答えなさい下線部 (1)について In the 3 decades に何が起こったのか要約して日本語問 2 い下線部 (2)について the need とは何かなぜ生じたのか日本語で答えなさ ( 次頁に問 3 問 4が記載されています) 3

5 問 3 さい下線部 (3)について significant barriers とは何か具体的に日本語で答えな問 4 下線部 (4)を和訳しなさい ( 次頁に問 5 問 6が記載されています) 4

6 問 5 さい下線部 (5)について much more complicated とは何故か日本語で説明しな問 6 下線部 (6)を和訳しなさい ( 次頁に問 7が記載されています) 5

7 問 7 説明しなさい下線部 (7)についてどのようなことを意味しているのか日本語で分りやすく 6

8 平成 26 年度大学院医学研究科博士課程入学試験 (1 回目 ) 日本人 - 英語問題 2 次の文章はある科学論文の introduction であるこの文章を読んで問 1 問 6に答えなさい Alzheimer s disease (AD) is an age-dependent neurodegenerative disorder that causes a chronically progressive decline in cognitive functions. Because of the increasing longevity of many populations around the world, AD is a medical problem of mounting social and economic impact. The disease is associated with a characteristic combination of morphological CNS alterations, including deposition of amyloid proteins in parenchymal plaques and cerebral blood vessels, intraneuronal formation of neurofibrillary tangles, loss of presynaptic terminals and neuronal subpopulations, and reactive gliosis. The severity of these alterations varies widely and specifically across different areas of the brain, suggesting that AD preferentially affects certain types of neural elements or that these elements are particularly susceptible to the disease. Loss of synaptophysin-immunoreactive (SYN-IR) presynaptic terminals and the number of neurofibrillary tangles in specific brain regions correlate well with cognitive decline in AD. In contrast, the relationship between amyloid plaques and clinical manifestations この or neurodegenerative 部分に掲載されている changes 文章については remains controversial. (1) This is puzzling in light of different 著作権法上 lines の問 of 題から evidence 掲載するができません implicating the amyloid-β protein precursor (APP) and its のでご metabolites 了承願います in the pathogenesis of AD. Mutations in genes encoding APP or presenilins 1 or 2 have been linked to autosomal dominant forms of familial AD (FAD), and these mutations increase the production of APP-derived Aβ peptides, either total Aβ or Aβ ending at residue 42 (Aβ42). A variety of Aβ preparations elicit neurotoxicity in cultures of neural cells or tissue sections, and acute injections of fibrillar Aβ into the brain induce significant neuronal loss in aged rhesus monkeys. Several transgenic mouse models have been developed to further elucidate the pathogenic role of APP/A in vivo. Although low-level neuronal expression of wild-type or FAD-mutant human APP (happ) did not result in the formation of typical AD-like amyloid plaques, it did elicit age-related deficits in spatial learning and memory. High-level neuronal expression of FAD-mutant happ resulted in the brain region-dependent development of several AD-like CNS alterations, including typical neuritic plaques, reactive gliosis, and loss of SYN-IR presynaptic terminals and neuronal subpopulations. Many of these findings have been confirmed and extended in independent models expressing FAD-mutant happ in the absence or presence of FAD-mutant presenilins. In some happ transgenic models, behavioral impairments or loss of neurons correlated with the extent of amyloid deposition. In others, behavioral impairments, synaptic transmission deficits, and loss of SYN-IR presynaptic terminals and microtubule-associated protein 2-IR neurons clearly preceded plaque formation, raising the possibility that happ or Aβ can induce structural and functional neuronal deficits independent of plaque formation. These discrepancies underline the need for a systematic comparison of Aβ levels, plaque formation, and neurodegeneration in 7

9 transgenic この部分に掲 lines 載されている expressing 文章については wild-type 著 or 作権 FAD-mutant 法上の問題から forms 掲載するができませんので of happ at comparable levels. Here, we report the results of such an analysis. ご了承願います出典 :Mucke L, et al, J. Neurosci., 20(11): , 問 1 本文中から読み取れるAlzheimer s disease(ad) 病理を英語で記載しなさい問 2 下線部 (1)を和訳しなさい ( 次頁に問 3 問 5が記載されています) 8

10 問 3 本文中から読み取れるADの原因遺伝子を全てあげなさい問 4 下線部 (1) 中の太字 (its metabolites)はどのような分子か答えなさい問 5 ADの認知機能低下 ( 症状 )とよく一致して変化する病理所見はなにか英語で答えなさい ( 次頁に問 6が記載されています) 9

11 問 6 本文中に述べられている研究の背景を理解しこの研究をした目的および理由を日本語で答えなさい 10

12 平成 25 年 1 月期論文博士外国語試験日本人 - 英語問題 1 次の文章は Health Care Information Technology: Progress and Barriers と題する論文の一部であるこの文章を読んで問 1~ 問 8に答えなさい (1)In the 3 decades since the term medical informatics was first used, individuals working at the intersection of information technology (IT) and medicine have developed and evaluated computer applications aiming to improve health and health care. The road to successful use of IT in medicine has not been easy, with examples of failures in both computer systems and networks. However, a variety of applications from the field of medical informatics have matured in recent years. Fueled by several factors including increased emphasis on ensuring patient safety and preventing medical error, as well as development of new biotechnologies such as gene microarrays, (2) the need for informatics applications in health care has become apparent to the larger community. Informatics is この poised 部分 to に have 掲載されている a major impact 文章については in patient-clinician communication. In the Clinical Crossroads 著作権 article 法上の in 問題 this から issue 掲載 of するができません JAMA, Slack demonstrates the value that patient-physician のでご can 了承 have 願います in improving patient care, and also catalogs the incomplete but encouraging underlying evidence. As with many applications of IT, the technology can improve the existing situation but also empower clinicians and patients to think more fundamentally about how innovation can lead to changes in the way medicine is practiced. Slack also emphasizes that informatics can help physicians better incorporate into clinical practice one of the most underused resources in medicine, the patient, whose help is greatly enhanced through this new technology. Although the case for adoption of improved health care informatics appears quite compelling, (3) significant barriers to its use remain, particularly with regard to the electronic health record (EHR). These include cost, technical issues, system interoperability, concerns about privacy and confidentiality, and lack of a well-trained clinician informatics workforce to lead the process. Certainly the biggest impediment is financial, which results from misalignment of costs and benefits. A recent report suggested that ambulatory EHRs, particularly when augmented with clinical decision support tools, have a substantially positive return on investment for the health care system as a whole. (4) However, those who are expected to pay for such systems, namely physicians and other practice organizations, only see 11% 1

13 of that return on investment. The rest goes to those who typically do not pay for EHRs directly, such as insurers, laboratories, and patients. A variety of approaches have been proposed, such as revolving loan funds and pay for performance schemes that reward data capture (only possible with use of an EHR), which then enables physicians to measure and improve quality in their practices. A variety of technical issues pose additional barriers to more widespread adoption of health IT. Implementing an EHR in a clinical setting is (5) much more complicated than connecting a computer to the Internet or installing software from a CD-ROM. Systems must conform to the workflow of a practice or the workflow must be modified in a way such that the system does not impede it. Experience with well-designed systems shows, for example, that ambulatory EHRs need not derail the clinical この部分に掲載されている文章については workflow. However, physician offices, particularly small practices and those in rural or 著作権法上の問題から掲載するができません underserved areas, need simple and inexpensive solutions to obtain the benefits of のでご了承願います EHRs. An additional impediment is the very real concern about privacy and confidentiality. Physicians, other health care professionals, and health care organizations must be vigilant in protecting patient privacy. However, privacy issues exist whether the medical record is paper or electronic. (6) In fact, as outlined in an Institute of Medicine report on this topic, paper-based records are at least as insecure as electronic ones, and probably more so. Unfortunately, perfect security will never be achieved because human curiosity will derail even the best security methods. Health care professionals must work to instill a culture that demands privacy and confidentiality. Even if the financial and technical issues surrounding the use of health care IT are solved, a workforce capable of leading its implementation must be developed. Physician-informatics leaders must guide the effort in concert with others in health care, with appropriate knowledge and skill in informatics to lead efforts in all health care settings. These individuals need not necessarily be full-time informaticians or require extensive training, but they must understand the worlds of both medicine and IT. Other IT professionals including health information managers, health science librarians, and representatives from other fields are needed to assist in this process. The optimal preparation and workforce for this effort will need to be determined. Despite these formidable challenges, it is possible that patients, (7) as described by Slack, can be empowered to play an integral role in their health care and to manage their information. (8) Health care IT is not a panacea for all that ails medicine, but it has the potential to improve the quality of care as well as the personal experience for patients. 2

14 出典 :William Hersh, MD. JAMA. 2004; 292 (18): 問 1 で答えなさい下線部 (1)について In the 3 decades に何が起こったのか要約して日本語問 2 い下線部 (2)について the need とは何かなぜ生じたのか日本語で答えなさ ( 次頁に問 3 問 4が記載されています) 3

15 問 3 さい下線部 (3)について significant barriers とは何か具体的に日本語で答えな問 4 下線部 (4)を和訳しなさい ( 次頁に問 5 問 6が記載されています) 4

16 問 5 さい下線部 (5)について much more complicated とは何故か日本語で説明しな問 6 下線部 (6)を和訳しなさい ( 次頁に問 7 問 8が記載されています) 5

17 問 7 下線部 (7)について as described by Slack とは何を意味しているのか日本語で答えなさい問 8 説明しなさい下線部 (8)についてどのようなことを意味しているのか日本語で分りやすく 6

18 平成 25 年 9 月期論文博士外国語試験日本人 - 英語問題 2 次の文章はある科学論文の introduction であるこの文章を読んで問 1 問 7に答えなさい Alzheimer s disease (AD) is an age-dependent neurodegenerative disorder that causes a chronically progressive decline in cognitive functions. Because of the increasing longevity of many populations around the world, AD is a medical problem of mounting social and economic impact. The disease is associated with a characteristic combination of morphological CNS alterations, including deposition of amyloid proteins in parenchymal plaques and cerebral blood vessels, intraneuronal formation of neurofibrillary tangles, loss of presynaptic terminals and neuronal subpopulations, and reactive gliosis. The severity of these alterations varies widely and specifically across different areas of the brain, suggesting that AD preferentially affects certain types of neural elements or that these elements are particularly susceptible to the disease. Loss of synaptophysin-immunoreactive (SYN-IR) presynaptic terminals and the number of neurofibrillary tangles in specific brain regions correlate well with cognitive decline in AD. In contrast, the relationship between amyloid plaques and clinical manifestations この or neurodegenerative 部分に掲載されている changes 文章については remains controversial. (1) This is puzzling in light of different 著作権法上 lines の問 of 題から evidence 掲載するができません implicating the amyloid-β protein precursor (APP) and its metabolites in the pathogenesis of AD. Mutations in genes のでご了承願います encoding APP or presenilins 1 or 2 have been linked to autosomal dominant forms of familial AD (FAD), and these mutations increase the production of APP-derived Aβ peptides, either total Aβ or Aβ ending at residue 42 (Aβ42). A variety of Aβ preparations elicit neurotoxicity in cultures of neural cells or tissue sections, and acute injections of fibrillar Aβ into the brain induce significant neuronal loss in aged rhesus monkeys. Several transgenic mouse models have been developed to further elucidate the pathogenic role of APP/A in vivo. Although low-level neuronal expression of wild-type or FAD-mutant human APP (happ) did not result in the formation of typical AD-like amyloid plaques, it did elicit age-related deficits in spatial learning and memory. High-level neuronal expression of FAD-mutant happ resulted in the brain region-dependent development of several AD-like CNS alterations, including typical neuritic plaques, reactive gliosis, and loss of SYN-IR presynaptic terminals and neuronal subpopulations. Many of these findings have been confirmed and extended in independent models expressing FAD-mutant happ in the absence or presence of FAD-mutant presenilins. In some happ transgenic models, behavioral impairments or loss of neurons correlated with the extent of amyloid deposition. In others, behavioral impairments, synaptic transmission deficits, and loss of SYN-IR presynaptic terminals and microtubule-associated protein 2-IR neurons clearly preceded plaque formation, raising the possibility that happ or Aβ can induce structural and functional neuronal deficits independent of plaque formation. These discrepancies underline the need for a systematic comparison of Aβ levels, plaque formation, and neurodegeneration in 7

19 transgenic この部分に掲 lines 載されている expressing 文章については wild-type 著 or 作権 FAD-mutant 法上の問題から forms 掲載するができませんので of happ at comparable levels. Here, we report the results of such an analysis. ご了承願います出典 :Mucke L, et al, J. Neurosci., 20(11): , 問 1 本文中から読み取れるAlzheimer s disease(ad) 病理を英語で記載しなさい問 2 下線部 (1)を和訳しなさい ( 次頁に問 3 問 5が記載されています) 8