重症痙縮に伴う睡眠障害と髄腔内バクロフェン療法による改善
重症痙縮6例（脳性麻痺，外傷，脳卒中）に髄腔内バクロフェン（ITB）療法を行い，術前後の痙縮をmodified Ashworth scale（mAS）で，睡眠時間をウェアラブル睡眠記録装置で測定した．mASスコアは2.85から2.31へ改善した．睡眠時間は7.5時間から8.8時間に，深睡眠時間は0.5時間から3.4時間に，それぞれ有意に延長した．痙縮患者は睡眠時間と深度が確保できていないことと，それらがITB療法によって改善したことが示された．ITB療法の調節にはmASと睡眠時間が指標になり得る．...
Saved in:
| Published in | 小児の脳神経 Vol. 49; no. 1; pp. 13 - 17 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本小児神経外科学会
2024
日本小児神経外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0387-8023 2435-824X |
| DOI | 10.34544/jspn.49.1_13 |
Cover
| Abstract | 重症痙縮6例（脳性麻痺，外傷，脳卒中）に髄腔内バクロフェン（ITB）療法を行い，術前後の痙縮をmodified Ashworth scale（mAS）で，睡眠時間をウェアラブル睡眠記録装置で測定した．mASスコアは2.85から2.31へ改善した．睡眠時間は7.5時間から8.8時間に，深睡眠時間は0.5時間から3.4時間に，それぞれ有意に延長した．痙縮患者は睡眠時間と深度が確保できていないことと，それらがITB療法によって改善したことが示された．ITB療法の調節にはmASと睡眠時間が指標になり得る． |
|---|---|
| AbstractList | 重症痙縮6例（脳性麻痺，外傷，脳卒中）に髄腔内バクロフェン（ITB）療法を行い，術前後の痙縮をmodified Ashworth scale（mAS）で，睡眠時間をウェアラブル睡眠記録装置で測定した．mASスコアは2.85から2.31へ改善した．睡眠時間は7.5時間から8.8時間に，深睡眠時間は0.5時間から3.4時間に，それぞれ有意に延長した．痙縮患者は睡眠時間と深度が確保できていないことと，それらがITB療法によって改善したことが示された．ITB療法の調節にはmASと睡眠時間が指標になり得る． 「要旨」重症痙縮6例 (脳性麻痺, 外傷, 脳卒中) に髄腔内バクロフェン (ITB) 療法を行い, 術前後の痙縮をmodified Ashworth scale (mAS) で, 睡眠時間をウェアラブル睡眠記録装置で測定した. mASスコアは2.85から2.31へ改善した. 睡眠時間は7.5時間から8.8時間に, 深睡眠時間は0.5時間から3.4時間に, それぞれ有意に延長した. 痙縮患者は睡眠時間と深度が確保できていないことと, それらがITB療法によって改善したことが示された. ITB療法の調節にはmASと睡眠時間が指標になり得る. |
| Author | 野村, 貞宏 石原, 秀行 藤井, 奈津美 井本, 浩哉 藤附, 駿輔 |
| Author_xml | – sequence: 1 fullname: 野村, 貞宏 organization: 山口大学医学部附属病院てんかんセンター – sequence: 1 fullname: 井本, 浩哉 organization: 山口大学医学部附属病院てんかんセンター – sequence: 1 fullname: 藤井, 奈津美 organization: 山口大学医学部附属病院てんかんセンター – sequence: 1 fullname: 藤附, 駿輔 organization: 山口大学医学部附属病院てんかんセンター – sequence: 1 fullname: 石原, 秀行 organization: 山口大学医学部脳神経外科 |
| BookMark | eNo9kEtLw0AUhQepYH0s_RmpM3MnyWThQsQXCG4quBum04kmtIkkunDZ1BeI4EItioKuFERd1IWC_2assf_C0IqLew7cy_kO3HFUiuJIIzRNcAWYzdhMmG5HFeZViCAwgsqUgW1xyjZKqIyBuxbHFMbQVJqGGGMAwhhnZVTtH53mnaO8c5W_v5jW09fnm2kd5rf3-c1d__qm99I1rcf-0_7PwXnv8MC0z0z2atrPpn1hsgfT7uZX2Xf3ogia7NhkJ9_nH73L_Uk06stGqqf-fAKtLy5U55et1bWllfm5VSukjs2tek0pl0lf217dJlTWfaWVdmucYuk6DoB0wfFcH9PijpXPMFPUppJ4NZCSY5hAS0NuU9cDJRtx1AgiLcJ4N4mKXqFimsYq0IJiygTGzMOkMCiGDMRlwMF2eEGaHZLCdEduarGdBE2Z7AmZ7ASqUSCL5wrmCTIQ-N-rLZmIUMIvA5uRWw |
| ContentType | Journal Article |
| Copyright | 2024 一般社団法人日本小児神経外科学会 |
| Copyright_xml | – notice: 2024 一般社団法人日本小児神経外科学会 |
| CorporateAuthor | 山口大学医学部附属病院てんかんセンター 山口大学医学部脳神経外科 |
| CorporateAuthor_xml | – name: 山口大学医学部脳神経外科 – name: 山口大学医学部附属病院てんかんセンター |
| DOI | 10.34544/jspn.49.1_13 |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 2435-824X |
| EndPage | 17 |
| ExternalDocumentID | co2socie_2024_004901_003_0013_00174383568 article_jspn_49_1_49_13_article_char_ja |
| GroupedDBID | ABDBF ABJNI ALMA_UNASSIGNED_HOLDINGS JSF MOJWN RJT |
| ID | FETCH-LOGICAL-j2658-dbcc74afe59d512adfcece7b820a76633a73697f029d50cf404c252a19b3aa803 |
| ISSN | 0387-8023 |
| IngestDate | Thu Jul 10 16:10:11 EDT 2025 Wed Sep 03 06:31:10 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | true |
| Issue | 1 |
| Language | Japanese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j2658-dbcc74afe59d512adfcece7b820a76633a73697f029d50cf404c252a19b3aa803 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/jspn/49/1/49_13/_article/-char/ja |
| PageCount | 5 |
| ParticipantIDs | medicalonline_journals_co2socie_2024_004901_003_0013_00174383568 jstage_primary_article_jspn_49_1_49_13_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 20240000 |
| PublicationDateYYYYMMDD | 2024-01-01 |
| PublicationDate_xml | – year: 2024 text: 20240000 |
| PublicationDecade | 2020 |
| PublicationTitle | 小児の脳神経 |
| PublicationTitleAlternate | 小児の脳神経 |
| PublicationYear | 2024 |
| Publisher | 一般社団法人 日本小児神経外科学会 日本小児神経外科学会 |
| Publisher_xml | – name: 一般社団法人 日本小児神経外科学会 – name: 日本小児神経外科学会 |
| References | [1] Albright AL, Barron WB, Fasick MP, Polinko P, Janosky J: Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 270: 2475-2477, 1993. [22] Seshadri DR, Li RT, Voos JE, Rowbottom JR, Alfes CM, Zorman CA, Drummond CK: Wearable sensors for monitoring the physiological and biochemical profile of the athlete. NPJ Digit Med 2: 72, 2019. [6] Brennan PM, Whittle IR: Intrathecal baclofen therapy for neurological disorders: a sound knowledge base but many challenges remain. Br J Neurosurg 22: 508-519, 2008. [14] Kraus T, Gegenleitner K, Svehlik M, Novak M, Steinwender G, Singer G: Long-term therapy with intrathecal baclofen improves quality of life in children with severe spastic cerebral palsy. Eur J Paediatr Neurol 21: 565-569, 2017. [15] Kulkarni S, Jadhav TS: Prevalence of sleep disorders in children with cerebral palsy; a questionnaire-based observational study. J Pediatr Neurosci 16: 269-272, 2021. [25] Thompson AJ, Jarrett L, Lockley L, Marsden J, Stevenson VL: Clinical management of spasticity. J Neurol Neurosurg Psychiatry 76: 459-463, 2005. [5] Boster AL, Adair RL, Gooch JL, Nelson ME, Toomer A, Urquidez J, Saulino M: Best practices for intrathecal baclofen therapy: dosing and long-term management. Neuromodulation 19: 623-631, 2016. [4] Boman K: Effect of emotional stress on spasticity and rigidity. J Psychosom Res 15: 107-112, 1971. [20] Sadowska M, Sarecka-Hujar B, Kopyta I: Cerebral palsy: current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatr Dis Treat 16: 1505-1518, 2020. [2] Badaru UM, Hassan AM, Ahmad RY, Nuhu JM, Lawal IU: Prevalence, pattern and impact of sleep disturbance on quality of life and exercise participation among children with cerebral palsy in Kano city. Sleep Sci 14: 348-356, 2021. [3] Bohannon RW, Smith MB: Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67: 206-207, 1987. [10] Hill CM, Parker RC, Allen P, Paul A, Padoa KA: Sleep quality and respiratory function in children with severe cerebral palsy using night-time postural equipment: a pilot study. Acta Paediatr 98: 1809-1814, 2009. [23] Solaro C, Lunardi GL, Capello E, Inglese M, Messmer Uccelli M, Uccelli A, Mancardi GL: An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis patients. Neurology 51: 609-611, 1998. [8] Fonseca P, Ross M, Cerny A, Anderer P, van Meulen F, Janssen H, Pijpers A, Dujardin S, van Hirtum P, van Gilst M, et al: A computationally efficient algorithm for wearable sleep staging in clinical populations. Sci Rep 13: 9182, 2023. [9] Giurgiu M, Ketelhut S, Kubica C, Nissen R, Doster AK, Thron M, Timm I, Giurgiu V, Nigg CR, Woll A, et al: Assessment of 24-hour physical behaviour in adults via wearables: a systematic review of validation studies under laboratory conditions. Int J Behav Nutr Phys Act 20: 68, 2023. [7] Carskadon M, Dement W: Normal human sleep: An overview. In: Kryger MH, Roth T, Dement WC（eds）: Principles and Practice of Sleep Medicine 4th ed. Philadelphia, Elsevier Saunders, 2005, pp 13-23. [16] Matre DA, Sinkjaer T, Svensson P, Arendt-Nielsen L: Experimental muscle pain increases the human stretch reflex. Pain 75: 331-339, 1998. [17] Migovich M, Ullal A, Fu C, Peters SU, Sarkar N: Feasibility of wearable devices and machine learning for sleep classification in children with Rett syndrome: a pilot study. Digit Health 9: 20552076231191622, 2023. [13] Kimoto Y, Oshino S, Tani N, Hosomi K, Khoo HM, Fujita Y, Miura S, Iwata T, Emura T, Matsuhashi T, et al: Characteristics of changes in intrathecal baclofen dosage over time due to causative disease. Neurol Med Chir（Tokyo）, 2023（online ahead of print）. [24] Subotic-Kerry M, Werner-Seidler A, Corkish B, Batterham PJ, Sicouri G, Hudson J, Christensen H, O’Dea B, Li SH: Protocol for a randomised controlled trial evaluating the effect of a CBT-I smartphone application（Sleep Ninja（R））on insomnia symptoms in children. BMC Psychiatry 23: 684, 2023. [18] Mohon RT, Sawyer K, Pickett K, Bothwell S, Brinton JT, Sobremonte-King M, DelRosso LM: Sleep-related breathing disorders associated with intrathecal baclofen therapy to treat patients with cerebral palsy: a cohort study and discussion. NeuroRehabilitation 48: 481-491, 2021. [27] Xue B, Licis A, Boyd J, Hoyt CR, Ju YS: Validation of actigraphy for sleep measurement in children with cerebral palsy. Sleep Med 90: 65-73, 2022. [19] Penn RD, Kroin JS: Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1: 1078, 1984. [11] Hornby TG, Tysseling-Mattiace VM, Benz EN, Schmit BD: Contribution of muscle afferents to prolonged flexion withdrawal reflexes in human spinal cord injury. J Neurophysiol 92: 3375-3384, 2004. [12] Hutson JA, Snow L: Sleep assessments for children with severe cerebral palsy: a scoping review. Arch Rehabil Res Clin Transl 2: 100087, 2020. [26] Whiting S, Buoncristiano M, Gelius P, Abu-Omar K, Pattison M, Hyska J, Duleva V, Music Milanovic S, Zamrazilova H, Hejgaard T, et al: Physical activity, screen time, and sleep duration of children aged 6-9 years in 25 countries: an analysis within the WHO European childhood obesity surveillance initiative（COSI）2015-2017. Obes Facts 14: 32-44, 2021. [21] Sandella DE, O’Brien LM, Shank LK, Warschausky SA: Sleep and quality of life in children with cerebral palsy. Sleep Med 12: 252-256, 2011. |
| References_xml | – reference: [9] Giurgiu M, Ketelhut S, Kubica C, Nissen R, Doster AK, Thron M, Timm I, Giurgiu V, Nigg CR, Woll A, et al: Assessment of 24-hour physical behaviour in adults via wearables: a systematic review of validation studies under laboratory conditions. Int J Behav Nutr Phys Act 20: 68, 2023. – reference: [23] Solaro C, Lunardi GL, Capello E, Inglese M, Messmer Uccelli M, Uccelli A, Mancardi GL: An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis patients. Neurology 51: 609-611, 1998. – reference: [5] Boster AL, Adair RL, Gooch JL, Nelson ME, Toomer A, Urquidez J, Saulino M: Best practices for intrathecal baclofen therapy: dosing and long-term management. Neuromodulation 19: 623-631, 2016. – reference: [6] Brennan PM, Whittle IR: Intrathecal baclofen therapy for neurological disorders: a sound knowledge base but many challenges remain. Br J Neurosurg 22: 508-519, 2008. – reference: [12] Hutson JA, Snow L: Sleep assessments for children with severe cerebral palsy: a scoping review. Arch Rehabil Res Clin Transl 2: 100087, 2020. – reference: [24] Subotic-Kerry M, Werner-Seidler A, Corkish B, Batterham PJ, Sicouri G, Hudson J, Christensen H, O’Dea B, Li SH: Protocol for a randomised controlled trial evaluating the effect of a CBT-I smartphone application（Sleep Ninja（R））on insomnia symptoms in children. BMC Psychiatry 23: 684, 2023. – reference: [1] Albright AL, Barron WB, Fasick MP, Polinko P, Janosky J: Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 270: 2475-2477, 1993. – reference: [14] Kraus T, Gegenleitner K, Svehlik M, Novak M, Steinwender G, Singer G: Long-term therapy with intrathecal baclofen improves quality of life in children with severe spastic cerebral palsy. Eur J Paediatr Neurol 21: 565-569, 2017. – reference: [3] Bohannon RW, Smith MB: Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67: 206-207, 1987. – reference: [26] Whiting S, Buoncristiano M, Gelius P, Abu-Omar K, Pattison M, Hyska J, Duleva V, Music Milanovic S, Zamrazilova H, Hejgaard T, et al: Physical activity, screen time, and sleep duration of children aged 6-9 years in 25 countries: an analysis within the WHO European childhood obesity surveillance initiative（COSI）2015-2017. Obes Facts 14: 32-44, 2021. – reference: [20] Sadowska M, Sarecka-Hujar B, Kopyta I: Cerebral palsy: current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatr Dis Treat 16: 1505-1518, 2020. – reference: [19] Penn RD, Kroin JS: Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1: 1078, 1984. – reference: [21] Sandella DE, O’Brien LM, Shank LK, Warschausky SA: Sleep and quality of life in children with cerebral palsy. Sleep Med 12: 252-256, 2011. – reference: [8] Fonseca P, Ross M, Cerny A, Anderer P, van Meulen F, Janssen H, Pijpers A, Dujardin S, van Hirtum P, van Gilst M, et al: A computationally efficient algorithm for wearable sleep staging in clinical populations. Sci Rep 13: 9182, 2023. – reference: [4] Boman K: Effect of emotional stress on spasticity and rigidity. J Psychosom Res 15: 107-112, 1971. – reference: [7] Carskadon M, Dement W: Normal human sleep: An overview. In: Kryger MH, Roth T, Dement WC（eds）: Principles and Practice of Sleep Medicine 4th ed. Philadelphia, Elsevier Saunders, 2005, pp 13-23. – reference: [11] Hornby TG, Tysseling-Mattiace VM, Benz EN, Schmit BD: Contribution of muscle afferents to prolonged flexion withdrawal reflexes in human spinal cord injury. J Neurophysiol 92: 3375-3384, 2004. – reference: [10] Hill CM, Parker RC, Allen P, Paul A, Padoa KA: Sleep quality and respiratory function in children with severe cerebral palsy using night-time postural equipment: a pilot study. Acta Paediatr 98: 1809-1814, 2009. – reference: [27] Xue B, Licis A, Boyd J, Hoyt CR, Ju YS: Validation of actigraphy for sleep measurement in children with cerebral palsy. Sleep Med 90: 65-73, 2022. – reference: [16] Matre DA, Sinkjaer T, Svensson P, Arendt-Nielsen L: Experimental muscle pain increases the human stretch reflex. Pain 75: 331-339, 1998. – reference: [18] Mohon RT, Sawyer K, Pickett K, Bothwell S, Brinton JT, Sobremonte-King M, DelRosso LM: Sleep-related breathing disorders associated with intrathecal baclofen therapy to treat patients with cerebral palsy: a cohort study and discussion. NeuroRehabilitation 48: 481-491, 2021. – reference: [17] Migovich M, Ullal A, Fu C, Peters SU, Sarkar N: Feasibility of wearable devices and machine learning for sleep classification in children with Rett syndrome: a pilot study. Digit Health 9: 20552076231191622, 2023. – reference: [25] Thompson AJ, Jarrett L, Lockley L, Marsden J, Stevenson VL: Clinical management of spasticity. J Neurol Neurosurg Psychiatry 76: 459-463, 2005. – reference: [13] Kimoto Y, Oshino S, Tani N, Hosomi K, Khoo HM, Fujita Y, Miura S, Iwata T, Emura T, Matsuhashi T, et al: Characteristics of changes in intrathecal baclofen dosage over time due to causative disease. Neurol Med Chir（Tokyo）, 2023（online ahead of print）. – reference: [22] Seshadri DR, Li RT, Voos JE, Rowbottom JR, Alfes CM, Zorman CA, Drummond CK: Wearable sensors for monitoring the physiological and biochemical profile of the athlete. NPJ Digit Med 2: 72, 2019. – reference: [2] Badaru UM, Hassan AM, Ahmad RY, Nuhu JM, Lawal IU: Prevalence, pattern and impact of sleep disturbance on quality of life and exercise participation among children with cerebral palsy in Kano city. Sleep Sci 14: 348-356, 2021. – reference: [15] Kulkarni S, Jadhav TS: Prevalence of sleep disorders in children with cerebral palsy; a questionnaire-based observational study. J Pediatr Neurosci 16: 269-272, 2021. |
| SSID | ssj0003314484 ssib044760907 ssib000871981 ssib058494427 |
| Score | 2.3402617 |
| Snippet | 重症痙縮6例（脳性麻痺，外傷，脳卒中）に髄腔内バクロフェン（ITB）療法を行い，術前後の痙縮をmodified Ashworth... 「要旨」重症痙縮6例 (脳性麻痺, 外傷, 脳卒中) に髄腔内バクロフェン (ITB) 療法を行い, 術前後の痙縮をmodified Ashworth scale (mAS) で, 睡眠時間をウェアラブル睡眠記録装置で測定した. mASスコアは2.85から2.31へ改善した. 睡眠時間は7.5時間から8.8時間に,... |
| SourceID | medicalonline jstage |
| SourceType | Publisher |
| StartPage | 13 |
| SubjectTerms | baclofen cerebral palsy sleep spasticity |
| Title | 重症痙縮に伴う睡眠障害と髄腔内バクロフェン療法による改善 |
| URI | https://www.jstage.jst.go.jp/article/jspn/49/1/49_13/_article/-char/ja http://mol.medicalonline.jp/en/journal/download?GoodsID=co2socie/2024/004901/003&name=0013-0017j |
| Volume | 49 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | 小児の脳神経, 2024, Vol.49(1), pp.13-17 |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnR1Na9VAMJT2IogoKtYvenCPqUl2k-zixc17eRRBTy30FvJ5eGArtr1463v9EETw0FoqFfSkUKyHelDw38T22X_hzG7Sl5Yeai9h3uzszOxMkp3ZtzsxjAdpkaaOm8UmzN7UZH7BzMQqUpPGGSRiLPfsDM8OP33mTc2wJ7Pu7Mjoo8aupaXFZDJ9dea5kot4FXDgVzwl-x-ePWYKCIDBv3AFD8P1XD4moSCQzPM2CX0ifIQ1IAQCAScyJCGFaJHIgISMBC0SsArDPUXcJtJWQItICxkKiXDoYt-A1t05NgETDt054S4RDGmACcBIQ4mwFOAQ2akwsl03uXWTX2GQs9ITkKGHPysaraoi5rwGAqQBiYFAoQKEsmZUjcjAIryjVHJrTWw1fI46a3ESmkJlGSA7Xh6urRgqIW0ibLzvsGPgKHplCt4Z0gM_qfT1lNlamt5DtlJrCNLFkJ6jTyQbdlT0LuqDY_TQKQCjYiAoPKOjUKZiuqNAMwYdpWGL6K831ys3znDNVonjuJUFbcBRz1BxC9SYREAkbdhe6RZINRChbHU8vDPMe9qYajgMXYNNPhoRMXB3edWNJ2Rj0sFay1gUUMcHCudASG1yR--krWdNXWj2xNtBT4E2bQRT-lzu6WmaMpcxnKcXXsxNMjFpR3WnE5XPq-cqQrKIichWFxrVeDyXGHUhORpzfN92R40xGbSDTiO69W0xPFbNmO9ZYrjaAaG3YKwqgouBG6U2Y1wXnKusoKvyKn0fNrWFeLUL2RuW5bj8XP-jqivbNILT6avGlSqrnJBa5WvGSDe-bkwfrb8dbK0PtrYHP_fK5d0_v3-Uy2uDj58HO5-OPuwc7O2Xy1-Pdlf-rm4crK2W_Xdl73vZ_1b2N8vel7K_P9juHe5vQsey97rsvTnc-HXwfuWGMdMJp1tTZvURFbPrQHZhZkma-iwucldkENzHWZHmae4nEPnHPqQbNPapJ_zCcqDdSgtmMXh5O7EtEhrH3KI3jdG5-bn8ljEBsUhceFhfK8sYy9wkLawcbBo7TsIhDxg3PG2U6IWulBOd04PjxuMTRoyqd-xClM47OEnlET4_kdqmYGM5Y9yKqy4-llp2PX77orLvGJeQt15VvWuMLr5cyu9BnrGY3K_up38eD_F6 |
| linkProvider | EBSCOhost |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E9%87%8D%E7%97%87%E7%97%99%E7%B8%AE%E3%81%AB%E4%BC%B4%E3%81%86%E7%9D%A1%E7%9C%A0%E9%9A%9C%E5%AE%B3%E3%81%A8%E9%AB%84%E8%85%94%E5%86%85%E3%83%90%E3%82%AF%E3%83%AD%E3%83%95%E3%82%A7%E3%83%B3%E7%99%82%E6%B3%95%E3%81%AB%E3%82%88%E3%82%8B%E6%94%B9%E5%96%84&rft.jtitle=%E5%B0%8F%E5%85%90%E3%81%AE%E8%84%B3%E7%A5%9E%E7%B5%8C&rft.au=%E9%87%8E%E6%9D%91%2C+%E8%B2%9E%E5%AE%8F&rft.au=%E4%BA%95%E6%9C%AC%2C+%E6%B5%A9%E5%93%89&rft.au=%E8%97%A4%E4%BA%95%2C+%E5%A5%88%E6%B4%A5%E7%BE%8E&rft.au=%E8%97%A4%E9%99%84%2C+%E9%A7%BF%E8%BC%94&rft.date=2024&rft.pub=%E4%B8%80%E8%88%AC%E7%A4%BE%E5%9B%A3%E6%B3%95%E4%BA%BA+%E6%97%A5%E6%9C%AC%E5%B0%8F%E5%85%90%E7%A5%9E%E7%B5%8C%E5%A4%96%E7%A7%91%E5%AD%A6%E4%BC%9A&rft.issn=0387-8023&rft.eissn=2435-824X&rft.volume=49&rft.issue=1&rft.spage=13&rft.epage=17&rft_id=info:doi/10.34544%2Fjspn.49.1_13&rft.externalDocID=article_jspn_49_1_49_13_article_char_ja |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0387-8023&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0387-8023&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0387-8023&client=summon |