An Assessment Rubric for a Resident Training Program in Surgery: A Single-Institution Experience.

Using a Collaborative Action Research model, our research team established a one-month clinical resident training program for first- and second-year clinical residents. We created and implemented an assessment rubric to assess the residents' progress toward independent practice in surgery, and thereby, to evaluate the program itself. The program included training in three areas: basic techniques and procedures in the operating room, surgical ward management, and academic activities. The rubric measured the residents' performance according to three achievement levels: Level 1 (demonstration), Level 2 (active help) and Level 3 (passive help). The program and rubric implementation began in June 2019 and continued until March 2020, when the program outcomes and shortcomings were analyzed. Among nineteen clinical residents, a total of nine clinical residents participated in the study. Most participants reached achievement Level 3 for their performance of basic techniques in the operating room. Finally, we discussed ideas for improvement and drafted plans for an improved rubric to complete the action research cycle. Our research team found the rubric to be a useful tool in evaluating the status of the new clinical resident training program.

Expanding on the professional role of dental hygienists as key managers of medical-dental and hospital-dental clinic collaboration in a local Japanese hospital without a dentistry department: From a questionnaire survey after a web seminar.

INTRODUCTION: Perioperative oral management (POM) was introduced into the Japanese universal health insurance system in 2012. Collaboration with dental clinics is important for hospitals without a dentistry department. A dental hygienist newly assigned as a member of the patient flow management centre led a seminar to promote collaboration via the web. This study represents the first step to explore the possible role of the hospital-based dental hygienist in the field of regional medical-dental cooperation of POM by assessing their willingness to participate in providing this type of care by a survey. METHODS: The rate of attendees' satisfaction and the current problems of the collaboration for POM were evaluated through a questionnaire survey after the web seminar. RESULTS: All respondents reported satisfaction with the web seminar although it was the first experience of an online seminar for half of the respondents. All hospital dentists, but only 47.8% of dentists working at clinics, had participated in POM. Dental hygienist tended to show greater desire to participate in POM than dentists. All respondents appreciated the role played by the dental hygienist as a key manager of medical-dental collaboration between the hospital and local clinics. CONCLUSION: The hospital-based dental hygienist can play a role in planning and management of web seminars for POM, to raise awareness and promote regional medical-dental cooperation of POM.

Incarcerated Amyand's Hernia.

A 76-year-old Japanese man was transferred to our hospital to undergo rehabilitation after traffic accident-related injuries. Seven days post-admission, he presented with abdominal pain and an 8-cm lump in the right inguinal region. He was diagnosed with an incarcerated inguinal hernia and underwent elective surgery the day after manual reduction. He had a normal vermiform appendix which was observed to have adhered to the right indirect hernia sac. An appendectomy and hernia repair using lightweight mesh were performed. We discuss the surgical management of this rare incarcerated Amyand's hernia and the relevant literature.

[Experiences and Problems Related to the Acceptation of Terminal Cancer Patients in the Regional Hospital of a Depopulated Area].

We provided palliative care for 2 patients with terminal rectal and esophageal cancer in the regional hospital of a depopulated area. Insufficient health resources, utilization of healthcare support services, lack of opportunities among medical staff for receiving education about palliative care, the building of relationships with concerned medical traders, and the building of trust with patients were found to be the problems that need to be addressed in the future.

A Rare Case of Gastrojejunocutaneous Fistula after Percutaneous Endoscopic Gastrostomy.

We report a rare case of fistulation to the jejunum after percutaneous endoscopic gastrostomy (PEG). An 85-year-old man with previous cerebral infarction and swallowing disturbance underwent PEG. Nine months later, he developed a high fever and discharge around the gastrostomy button. He was diagnosed with aspiration pneumonia, and administered antibiotic therapy. Examination showed digestive fluid around the gastrostomy button. Gastrointestinal contrast-enhanced CT revealed a gastrojejunocutaneous fistula. The button was removed, and the fistula closed naturally. PEG was performed again. The patient's postoperative course was uneventful. Gastrojejunocutaneous fistula should be considered in cases involving increased discharge from a gastrostomy fistula.

Totally laparoscopic colectomy with intracorporeal anastomosis for colonic liposarcoma: A case report.

Liposarcoma is a type of soft tissue sarcoma. Primary colonic liposarcomas are extremely rare. An 86-year-old man with diarrhea and anorexia visited our outpatient clinic at Okayama City Hospital. Colonoscopy and computed tomography imaging revealed a large submucosal tumor in the descending colon with a maximum diameter of approximately 10 cm. He underwent totally laparoscopic left hemicolectomy with intracorporeal anastomosis. The histopathological diagnosis was a well-differentiated liposarcoma without lymph node metastases. The patient's postoperative course was uneventful. We herein report a rare case of totally laparoscopic colectomy with intracorporeal anastomosis in an elderly patient with colonic liposarcoma.

An experience of total laparoscopic partial colectomy with intracorporeal triangulating anastomosis in an obese patient with descending colon cancer.

A 68-year-old woman was transferred to the emergency room of Okayama City Hospital because of worsening epigastric pain. After the examination, she was diagnosed with descending colon cancer, and laparoscopic colectomy was planned. However, exteriorization of the bowels to produce anastomosis was difficult because the rich adipose tissue of the mesocolon hardly stretched, and the abdominal wall was thick as the patient was obese. Therefore, an intracorporeal triangulating end-to-end anastomosis was performed. The colon was divided at 10 cm either side from the tumor using an endoscopic linear stapler. After the resection of the stumps with staples, the posterior walls were tied with stay sutures and then stapled with an endoscopic linear stapler. The anterior wall was stapled twice in the same manner, and the intracorporeal anastomosis was completed. The patient's postoperative course was uneventful. This technique provided an alternative intracorporeal anastomotic technique as troubleshooting in laparoscopic colectomy.

Effective management of an advanced gastric cancer patient by TS-1 combined chemotherapy using nasojejunal tube and successful transfer to home care after percutaneous transesophageal gastro-tubing (PTEG): a case report.

A 67-year-old woman with debilitation and massive ascites was admitted to our hospital and diagnosed with stage IV scirrhous gastric cancer with peritoneal dissemination. After successful nasojejunal tube feeding because of oral intake disability, TS-1 combined with paclitaxel chemotherapy was selected. TS-1 at 80mg/m2 was given daily via nasojejunal tube for 2 weeks, followed by a 1-week rest, and paclitaxel at 50mg/m2 was administered intravenously on day 1 and 8. There were no serious side effects. After 4 cycles, a partial response was observed and percutaneous transesophageal gastrotubing (PTEG) was placed. After the fifth cycle, she was transferred to her home and received chemotherapy in an outpatient clinic. After 7 cycles, the disease progressed, and TS-1 combined with low-dose cisplatin was administered for 3 cycles. However, the patient died 16 weeks after discharge. PTEG was useful not only for a route of TS-1 administration, but also for receiving chemotherapy at home to maintain her quality.

Is the diameter or chirality distribution of single-walled carbon nanotubes selected in the synthesis process?

Based on recent theoretical photoluminescence intensity calculations, the population densities of sixteen semiconducting single-walled carbon nanotubes grown by alcohol catalytic chemical vapor deposition were estimated for two different temperatures. The profiles of population density merely as functions of tube-diameter or chiral angle are found to be widely scattered. However, systematic profiles are detectable when separately split into (2n + m), (n + 2m) and (n - m) family arrays. Apart from these well-knit family behaviors, the population densities of the group of nanotubes forming another three possible series [viz. constant-n, constant-m and constant-(n + m)] also show evidence of good correlations. Hence, a two-dimensional chiral-zone selective growth principle is hypothesized.

Efficacy and tolerability of weekly paclitaxel in combination with high-dose toremifene citrate in patients with metastatic breast cancer.

Toremifene citrate is expected to prevent drug resistance in cancer patients by inhibiting p-glycoprotein activity. The safety and efficacy of combination therapy with high-dose toremifene citrate and paclitaxel were investigated. Between December 2003 and June 2004, 15 women with a mean age of 53 years old with metastatic breast cancer were enrolled. The administration schedule was 80 mg/m2 of paclitaxel given on Days 1, 8, and 15, and 120 mg/day of toremifene citrate orally administered starting on Day 18. On Days 32 and 39, paclitaxel was concurrently administered again. Toxicities, response rate, and time to treatment failure were assessed. All patients had been treated with endocrine or chemotherapy. Grade 3 leukopenia occurred in 2 patients on the administration of paclitaxel alone, and grade 3 febrile neutropenia occurred in 1 patient given the combination therapy. There was no grade 3 or greater non-hematological toxicity. There was no complete response and 1 partial response, producing a response rate of 6.7%. Median time to treatment failure was 2.7 months. Combination therapy of paclitaxel and toremifene was safe and well tolerated with minimal toxicity. Further clinical trials targeting patients with functional p-glycoprotein are warranted.

Unusual abscesses associated with colon cancer: report of three cases.

Three cases of colon cancer accompanied by unusual abscess formation are reported. Case I : A 77-year-old man was diagnosed with a paracolic abscess formation behind the cecum and a swollen appendix by computed tomography (CT) scan. Case II : An 85-year-old woman was diagnosed with an abscess formation of the right iliopsoas muscle, a swollen appendix, and a thickened right colon wall by CT scan. After antibiotic therapy failed, both patients underwent ileocecal resection urgently under suspicion of appendicitis, but cecal cancer around the entrance to the appendix caused secondary appendicitis in both cases. Case III : A 50-year-old woman was diagnosed with sigmoid colon cancer with an abscess formation in the pelvic cavity concomitant with ovarian tumor. A Hartmann procedure was performed, and a pathological examination revealed that a subserosal abscess behind the sigmoid colon cancer perforated the rectum with abscess formation. All cases were definitively diagnosed intraoperatively. The cancer recurred in cases I and III. We emphasize that precise surgical evaluation has an important role in the diagnosis of these complicated diseases. In addition, surgery affords the patient the best chance of recovery, and in these advanced cases radical treatment is recommended as early as possible.

Synthesis of isochromene esters utilizing 1,6-addition of nucleophiles to benzopyranylidenetungsten(0) complexes.

[reaction: see text] A concise method for the preparation of isochromene carboxylates has been developed by the regioselective 1,6-addition of various nucleophiles such as Grignard reagents, alkoxide, and cyanide onto benzopyranylidenetungsten(0) complexes, followed by iodine oxidation of the addition intermediates.

Non-palpable ductal carcinoma in situ (DCIS) with microinvasion arising in a radial scar presenting with spiculation alone on mammograms: a case report.

A case of ductal carcinoma in situ (DCIS) with microinvasion arising in a radial scar of the breast is presented. A 57-year-old woman visited our hospital with bloody discharge from her left nipple. There were no abnormal findings on cytology, carcinoembryonic antigen (CEA) level of nipple discharge was <500 ng/ml, and mammograms were normal. After 2 years of careful periodic follow-up, spiculation without a central core appeared on mammograms. The CEA level of the nipple discharge increased to 1,000 ng/ml. Ductgraphy showed a connection between the duct with the discharge and the center of the spiculation. Since these findings suggested malignancy, she underwent segmentectomy of the breast, and pathological examination showed a radial scar and DCIS with microinvasion in the ducts within the radiating bands of fibrous tissues. We discuss the characteristics of a radial scar and its relationship to breast cancer based on our experience and a review of the literature.

[Retrospective evaluation of the safety of pamidronate administration at the dose of 90 mg/day/month in Japanese breast cancer patients with bone metastasis].

The Japanese Ministry of Health, Labor and Welfare approved the use of pamidronate in November 2004 at a dose of 90 mg/day/month especially for Japanese breast cancer patients with lytic bone metastasis. But no safety data have been shown for these Japanese patients thus far. Therefore, we evaluated the safety of pamidronate treatment for breast cancer patients with bone metastasis at the dose of 90 mg/day/month since July 1, 2004 until Dec 31, 2004, retrospectively, in our institute, the Shikoku Cancer Center. No definite severe side effects were detected in these patients, including renal dysfunction and thrombocytopenia. In addition, there were no definite alternations in hemoglobin titers, platelet counts, BUN, serum creatinine and potassium levels in one month and 3 months after beginning the treatment except for significant alternations in RBC counts in one month and in the serum calcium level 3 months later (p=0.03). Improvements of clinical symptoms or data due to bone metastases, i.e., bone pain or elevation of tumor markers, were obtained in 91% of patients. As a conclusion, pamidronate administration at the dose of 90 mg/day/month was safe for Japanese breast cancer patients with bone metastasis.

The transfection of thymidylate synthase antisense suppresses oncogenic properties of a human colon cancer cell line and augments the antitumor effect of fluorouracil.

5-Fluorouracil (5-FU), a fluoropyrimidine analogue, is one of the most commonly used anticancer drugs for the treatment of gastrointestinal malignancies. Some studies reported that the cytotoxicity of fluoropyrimidines is mediated, in large part, by inhibition of the thymidylate synthase (TS), an essential DNA synthetic enzyme. The aim of this study was to determine if antisense TS technology could augment the chemosensitivity of human cancer cells to 5-FU. The full length coding region of TS cDNA was inversely cloned into the eukaryotic expression vector pCDL81 and transfected into DLD-1 cells. The expression and activity of TS were significantly suppressed in the antisense TS transfected cells. Interestingly, the transfection of antisense TS alone inhibited the cellular growth in vitro. The chemosensitivity to 5-FU was significantly increased in the transfected cells. The 50% inhibition values of 5-FU on DLD-1/anti-TS were approximately one forth that on parental cells. The augmentation of chemosensitivity to 5-FU was also confirmed in a nude mice model. The tumor growth of DLD-1/anti-TS cells was suppressed significantly more than that of DLD-1 cells by the 5-FU. The expression and activity of TS in human colon cancer cells were effectively inhibited by TS antisense treatment and the effect of 5-FU to cancer cells can be augmented. The antisense TS technology could be promising for treatments of gastrointestinal cancers.