Adjuvant and post-recurrent treatment patterns in patients with resectable gastric cancer in japan: a retrospective database cohort study.

BACKGROUND: This study examined temporal shifts in adjuvant therapy patterns in Japanese patients with resectable gastric cancer (GC) and treatment patterns of first-line and subsequent therapy among those with recurrent disease. METHODS: This retrospective analysis of hospital-based administrative claims data (April 1, 2008 to March 31, 2022) included adults (aged ≥ 20 years) with GC who started adjuvant therapy on or after October 1, 2008 (adjuvant cohort) and patients in the adjuvant cohort with disease recurrence (recurrent cohort), further defined by the time to recurrence (≤ 180 or > 180 days after adjuvant therapy). RESULTS: In the adjuvant cohort (n = 17,062), the most common regimen during October 2008-May 2016 was tegafur/gimeracil/oteracil potassium (S-1; 95.7%). As new standard adjuvant regimen options were established, adjuvant S-1 use decreased to 65.0% and fluoropyrimidine plus oxaliplatin or docetaxel plus S-1 use increased to 15.0% and 20.0%, respectively, in September 2019-March 2022. In the recurrent cohort with no history of trastuzumab/trastuzumab deruxtecan treatment (n = 1257), the most common first-line regimens were paclitaxel plus ramucirumab (34.0%), capecitabine plus oxaliplatin (CapeOX; 17.0%), and nab-paclitaxel plus ramucirumab (10.1%) in patients with early recurrence, and S-1 plus oxaliplatin (26.3%), S-1 plus cisplatin (15.3%), CapeOX (14.0%), S-1 (13.2%), and paclitaxel plus ramucirumab (10.8%) in those with late recurrence. CONCLUSIONS: This study demonstrated temporal shifts in adjuvant treatment patterns that followed the establishment of novel regimens, and confirmed that post-recurrent treatment patterns were consistent with the Japanese Gastric Cancer Association guideline recommendations.

A new scope warmer/cleaner for laparoscopic surgery: a disposable hot pack.

BACKGROUND: Fogging and staining of a laparoscope lens negatively impact surgical visualization. We hypothesized that the disposable hot pack could not only warm but also clean laparoscopes. Hence, this study verified and developed the disposable hot pack with anti-fogging and cleaning function. MATERIAL AND METHODS: The laparoscope was inserted into a swine abdominal cavity for five minutes. Then, the laparoscopic tip was heated with 65 °C saline or the folded disposable hot pack with nonwoven fabric coated surfactant for ten seconds (n = 15). Also, a laparoscopic tip with dirt was wiped with the prototype or conventional gauze for 10 s (n = 10). The dirt, fogging, and temperature of the laparoscopic tip were respectively evaluated after the laparoscope was inserted into the abdominal cavity. RESULTS: The laparoscopic tip temperature five minutes after insertion into the abdominal cavity was similar (31.1 °C vs 31.2 °C, p = 0.748) and there was no fogging in both methods. The conventional gauze had significantly less temperature of the laparoscopic tip after cleaning and higher fogging occurrence than the prototype (29.5 °C vs 34.0 °C, p < 0.001, 30% vs 0%, p = 0.030, respectively), although there was no dirt left after both methods. CONCLUSION: The disposable hot pack has a strong potential as an anti-fogging and cleaning device for use during laparoscopic surgery.

Mechanism underlying lens fogging and its countermeasure in laparoscopic surgery.

BACKGROUND: During laparoscopic surgery, visualization is fogged due to the influence of temperature. Fogging on the laparoscopic lens heightens the difficulty of the procedure. Therefore, the aim of this study was to analyse thermodynamics in laparoscopy. MATERIAL AND METHODS: A temperature sensor was attached to the laparoscopic tip and the abdominal cavity of five swine under general anaesthesia. The laparoscope was inserted into the abdominal cavity for five minutes after heating its tip with 65 °C saline for 10-300 s. The defogged laparoscope was wiped at room temperature for 10-300 s. Then, the laparoscope was inserted into the abdominal cavity for five minutes. RESULTS: The temperature five minutes after insertion was similar for the 10-300 s heating durations (approximately 32.0 °C). There was no fogging when the laparoscope was wiped for 10-30 s. Two fogging events occurred when it was wiped for 60 s (temperature difference: -3.5 °C, -4.6 °C). Five fogging events were observed immediately after insertion when it was wiped for 300 s. CONCLUSION: This study showed that the heating time was more than ten seconds to prevent fogging. We found that fogging occurred when the laparoscopic tip temperature was 3.5 °C lower than the abdominal cavity temperature.

Causes and consequences of stress generation: Longitudinal associations of negative events, aggressive behaviors, rumination, and depressive symptoms.

The present study examined the causes and consequences of stress generation in university students in Japan. A two-wave longitudinal study with an 8- or 9-week interval was conducted in the fall of 2020. Undergraduate and graduate students at four universities in Japan (N = 201) completed self-report measures assessing experiences of negative interpersonal dependent events, negative non-interpersonal events, and negative independent events at two times. At the same time, they also responded to measures of aggressive behaviors, trait rumination, and depressive symptoms. Path analyses revealed that baseline aggressive behaviors were positively associated with an increase in subsequent negative interpersonal dependent events, even after controlling for the influences of negative interpersonal dependent events, rumination, and depressive symptoms at baseline. However, aggressive behaviors were not significantly associated with subsequent negative non-interpersonal dependent events or negative independent events. These findings suggest that aggressive behaviors may have been a factor leading to interpersonal stress generation. Furthermore, all categories of negative event experiences predicted an increase in subsequent depressive symptoms, but not subsequent rumination, and rumination was not significantly associated with subsequent depressive symptoms. This research extends previous studies on the causes and consequences of stress generation conducted in the US by using specific measures of aggressive behaviors and including a non-restricted sample of university students in Japan. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-022-02859-9.

[Examination of the effects of a role-playing training program for the improvement of planning and management skills of public health nurses].

Objectives　The Japan Health Insurance Association (JHIA) conducts training in each branch facility to improve the ability of public health nurses (PHNs). The headquarters of the PHNs of JHIA and the researchers conducted a training program for leaders of PHNs at each JHIA branch. The goal of the program was to create a training plan using role-play to acquire facilitation skills. This study aimed to examine the effects of training.Methods　The study was designed in accordance with the Instructional Designs. The training goals were as follows: (1) understanding the role of facilitation and the facilitator in the debriefing session after the role-play, (2) understanding facilitation techniques, (3) being confident in performing as facilitators in the debriefing session; and (4) conducting the debriefing sessions using facilitation skills. The evaluation of the training was based on the Kirkpatrick model from the viewpoint of confidence in using facilitation, knowledge of facilitation, and conduct of training and utilization of facilitation technology. Questionnaire evaluations were conducted three times before the training, immediately after the training, and three months after the training. In August 2016, 4.5 hours of training were conducted in one day.Results　There were 79 participants in the training group. The mean points of knowledge and confidence were 2.6-3.6 before training, 6.3-7.9 after training, and 6.0-6.9 at 3 months after training. The participants rated their interest in three questions of the training as high as 8.1-8.6. In addition, 64.6% of participants held a role-play session at each branch within three months of the initial training. In the role-play session planned by the participants, the practitioners implemented the explanation of the purpose and the rules at each branch 96.1% and 98.0%, respectively. Participants who had attended facilitation training prior to our program scored higher points of knowledge and confidence before and after three months. Three months after the training, 79 participants responded to the question of the role of the facilitator in role-playing. The descriptions were categorized into "opinions on the basics and planning of role-play training" and "opinions on the roles in retrospectives."Conclusion　The participants evaluated the training contents and the materials used as appropriate, and their knowledge and confidence in facilitation improved after the training. To maintain and improve facilitation skills, the educational system needs to implement training using role-playing at each branch consistently.

Loop-mediated isothermal amplification for the rapid detection of Gardnerella vaginalis.

The aim of this study was to develop a method for the rapid detection of Gardnerella vaginalis, which is proposed to play a key role in the pathogenesis of bacterial vaginosis. Specific loop-mediated isothermal amplification (LAMP) primers were designed and used to detect target DNA within 45 min under isothermal conditions. Comparative screening indicated that the LAMP assay is superior to PCR in terms of rapidity, and is equivalent in sensitivity and specificity. This LAMP assay can be used for rapid screening and detection of G. vaginalis in vaginal samples; the limit of detection is 10 fg DNA.

Culture Supernatants of Lactobacillus gasseri and L. crispatus Inhibit Candida albicans Biofilm Formation and Adhesion to HeLa Cells.

PURPOSE: Vulvovaginal candidiasis (VVC) is a common superficial infection of the vaginal mucous membranes caused by the fungus Candida albicans. The aim of this study was to assess the mechanisms underlying the inhibitory effects of the culture supernatants of Lactobacillus gasseri and L. crispatus, the predominant microbiota in Asian healthy women, on C. albicans biofilm formation. The inhibition of C. albicans adhesion to HeLa cells by Lactobacillus culture supernatant was also investigated. METHODS: Candida albicans biofilm was formed on polystyrene flat-bottomed 96-well plates, and the inhibitory effects on the initial colonization and maturation phases were determined using the XTT reduction assay. The expression levels of biofilm formation-associated genes (HWP1, ECE1, ALS3, BCR1, EFG1, TEC1, and CPH1) were determined by reverse transcription quantitative polymerase chain reaction. The inhibition of C. albicans adhesion to HeLa cells by Lactobacillus culture supernatant was evaluated by enumerating viable C. albicans cells. RESULTS: The culture supernatants of both Lactobacillus species inhibited the initial colonization and maturation of C. albicans biofilm. The expression levels of all biofilm formation-related genes were downregulated in the presence of Lactobacillus culture supernatant. The culture supernatant also inhibited C. albicans adhesion to HeLa cells. CONCLUSION: The culture supernatants of L. gasseri and L. crispatus inhibited C. albicans biofilm formation by downregulating biofilm formation-related genes and C. albicans adhesion to HeLa cells. These findings support the notion that Lactobacillus metabolites may be useful alternatives to antifungal drugs for the management of VVC.

[Development of the unexpected reality scale for childcare training].

This study aimed to develop a scale for unexpected reality for childcare training (Study 1) and examine the change and influence it exerts on the efficacy of preschool teachers (Study 2). In Study 1, the sample consisted of 571 university and junior college students enrolled in a childcare course. After exploratory factor analysis, four factors were extracted: "actual feelings for childcare as a field of study," "difficulties faced during involvement with children," "negative aspects of the childcare worker," and "severity of work." The study's scale was shown to be internally consistent and valid. In Study 2, the sample consisted of 122 junior college students enrolled in a childcare course. The results showed that the high-scoring groups of each unexpected reality subscales experienced less unexpected reality in the subsequent training session. Moreover, the results of multiple regression showed that preschool teacher efficacy was predicted positively by "actual feelings for childcare as a field of study" and negatively by "difficulties faced during involvement with children." Thus, we suggest that for effective pre- and post-guidance of childcare training, unexpected realities should be considered.

Impacts of demographic factors and the COVID-19 pandemic on job stress in Japanese childcare workers.

BACKGROUND: Japan has a shortage of childcare personnel, and the high levels of stress causing turnover in childcare workers must be urgently resolved. However, there is a lack of knowledge regarding the characteristics and influencing factors of job stress in Japanese childcare workers. OBJECTIVE: This study aimed to evaluate the job stress of childcare workers and explore the influence of demographic factors and the COVID-19 pandemic on such stress. METHODS: The data were collected through an Internet survey from 2,472 respondents. A 23-item version of the Brief Job Stress Questionnaire was used to measure occupational stress in childcare workers. The instrument is recommended in the stress-check program implemented as a mental health measure in workplaces in Japan. RESULTS: The percentage of childcare workers with high stress exceeded that of general workers. Multiple regression analyses showed that the only factor affecting all job stressors and social support was the fear of contracting COVID-19. Job stressors and the COVID-19 pandemic had a significant large effect on stress responses. Additionally, being married and having children moderated childcare workers' stress. CONCLUSIONS: This study provided basic data regarding job stress in Japanese childcare workers and compared them with those of other professionals. In the future, it will be necessary to clarify how stress is related to turnover intention and turnover in Japanese childcare workers to promote their career continuity.

Effects of pain management using nonsteroidal anti-inflammatory drug suppositories during brachytherapy for cervical cancer: A single-center prospective observational study.

INTRODUCTION: No standardized pain management protocol exists for intracavitary brachytherapy, and various methods of analgesia have been used in different countries and institutions. This study aimed to investigate the effects of pain management during intracavitary brachytherapy using nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen suppositories. METHODS: In this single-center, prospective, observational study, patients undergoing intracavitary brachytherapy for cervical cancer completed a questionnaire survey after each brachytherapy session, which comprised questions regarding pain intensity, satisfaction with analgesia, and desire for effective anesthesia. RESULTS: Data analysis was performed using data from 100 brachytherapy sessions of 27 patients. The median numerical rating scale (NRS; 0-10) score for each intracavitary brachytherapy session was 3-4. The median satisfaction scale score for analgesia (5-point scale, 1-5) for each session was approximately 4. Eight patients (29.6%) answered that they desired anesthesia more effective than suppositories at any session of brachytherapy. A comparison of the high (NRS ≥4) and low (NRS ≤3) NRS groups during the first session revealed that the high NRS group tended to have higher NRS scores and lower satisfaction with analgesia during all sessions. A positive correlation was observed between tumor size and the NRS score during the first brachytherapy session. CONCLUSIONS: The NRS score was approximately 3-4, and satisfaction with analgesia was approximately 4 out of 5 when NSAIDs or acetaminophen suppositories were used as analgesics during intracavitary brachytherapy for cervical cancer. Although the current pain management protocol is clinically acceptable, inadequate analgesia is indicated in approximately 30% of patients.

Body talk and body dissatisfaction in Japanese university students: Longitudinal study using the Japanese Body Talk Scale.

This study evaluated the reliability and validity of the Japanese version of the Body Talk Scale (BTS), designed to measure negative fat talk, negative muscle talk, and positive body talk. The study also explored the longitudinal associations between each body talk category and body dissatisfaction. We conducted two separate studies among university students in Japan. Separate confirmatory factor analyses for female and male data indicated that the initially proposed three-factor model demonstrated an acceptable fit, whereas the bi-factor model provided a better fit. The Japanese BTS showed good construct validity, acceptable to adequate internal consistency, and test-retest reliability within 2 weeks. A four-week longitudinal study involving 386 women and 216 men (mean age = 19.22 and 19.62, respectively) revealed that negative fat talk predicted an increase in the discrepancy between the thin ideal body image and the actual body image among women. In contrast, positive body talk was linked to reduced body dissatisfaction and body image discrepancy in women. There were no such significant associations in men. These findings support the use of the Japanese BTS as a valuable instrument for future research on the intrapersonal and interpersonal effects of various types of body talk.

Investigation of the possibility of using an augmented reality-based endotracheal aspiration simulation tool for nursing education.

AIM: We developed an augmented reality technology-based endotracheal aspiration simulation tool (the AR tool) consisting of three modes: a mode for nursing students to learn endotracheal aspiration by themselves (learning mode); a mode for repeated practice (practice mode); and a mode for confirmation testing (test mode). This study aimed to compare the learning outcomes of the AR tool with traditional training mannequins and identify potential uses and improvements of the AR tool. METHODS: We invited students, and faculty members from the three universities who agreed to cooperate in conducting this study. Fifty-four students and nine faculty members agreed to participate in this study. The students were divided into two groups. One group was to study with the AR tool and the other group was to study with the traditional half-body training mannequin for suction. The students in both groups were asked to demonstrate endotracheal aspiration on another full-body type training mannequin which could be used as a patient with a tracheostomy (Skill test). Group interviews with faculty members focused on the topic of the AR tool's potential use in nursing education and improvement needed. RESULTS: There was little significant difference in the skill test results of endotracheal aspiration of students in both groups. The students and faculty members both expressed an interest in the AR tool. They said it was suitable for self-study of endotracheal aspiration. CONCLUSIONS: This AR tool is an effective teaching tool for learning the sequence of endotracheal suctioning, although there are some areas that need improvement.

Venoarterial-extra corporeal membrane oxygenation-assisted parathyroidectomy for hypercalcemic crisis due to parathyroid carcinoma complicated by severe circulatory and respiratory failure: a case report.

BACKGROUND: Hypercalcemia crisis is a rare but severe form of hypercalcemia complicated by multiple organ failure. Hypercalcemia crisis due to hyperparathyroidism is commonly caused by a parathyroid tumor, which often requires surgical resection. However, there are no clear recommendations on when the surgery should be performed. CASE PRESENTATION: A 64-year-old female patient developed hyperparathyroidism due to a parathyroid tumor and hypercalcemic crisis, which was complicated by severe circulatory and respiratory failure refractory to medical therapy, and an emergent surgery was planned to resect the parathyroid tumor. To prevent intraoperative circulatory and respiratory collapse, venoarterial-extra corporeal membrane oxygenation (VA-ECMO) was introduced, resulting in a safe operation and anesthetic management. CONCLUSIONS: In patients with hypercalcemic crisis complicated by severe circulatory and respiratory failure, induction of prophylactic VA-ECMO was useful for safe anesthetic management. Surgical resection should be performed as soon as the diagnosis is made before VA-ECMO is required.

Antioxidant effects of photodegradation product of nifedipine.

Recently, increasing evidence suggests that the antihypertensive drug nifedipine acts as a protective agent for endothelial cells, and that the activity is unrelated to its calcium channel blocking. Nifedipine is unstable under light and reportedly decomposes to a stable nitrosonifedipine (NO-NIF). NO-NIF has no antihypertensive effect, and it has been recognized as a contaminant of nifedipine. The present study for the first time demonstrated that NO-NIF changed to a NO-NIF radical in a time-dependent manner when it interacted with human umbilical vein endothelial cells (HUVECs). The electron paramagnetic resonance (EPR) signal of NO-NIF radicals in HUVECs showed an asymmetric pattern suggesting that the radicals were located in the membrane. The NO-NIF radicals had radical scavenging activity for 1,1-diphenyl-2-picrylhydrazyl, whereas neither NO-NIF nor nifedipine did. In addition, the NO-NIF radical more effectively quenched lipid peroxides than NO-NIF or nifedipine. Furthermore, NO-NIF attenuated the superoxide-derived free radicals in HUVECs stimulated with LY83583, and suppressed iron-nitrilotriacetic acid (Fe-NTA)-induced cytotoxicity in rat pheochromocytoma (PC12) cells. Our findings suggest that NO-NIF is a candidate for a new class of antioxidative drugs that protect cells against oxidative stress.

[Influence of job-hunting anxiety on job-hunting: from the viewpoint of coping].

The present study developed a job-hunting anxiety scale and investigated the influence of job-hunting anxiety on coping, number of job-hunting applications, and satisfaction with job-hunting. Questionnaires were completed by 306 college students who had started job-hunting. Explorative factor analysis extracted five factors such as "appeal anxiety", "support anxiety", "activity persistence anxiety", "test anxiety", and "a lack of readiness anxiety". Analysis of covariance structures indicated that (a) job-hunting anxiety was negatively related to problem-focused coping, the number of job-hunting applications, and the satisfaction with job-hunting, and (b) problem-focused coping was positively related to the number of job-hunting applications and the satisfaction with job-hunting. These results suggest that reduction of job-hunting anxiety and the use of problem-focused coping facilitated job-hunting.

The Difference Between Set and Delivered Tidal Volume: A Lung Simulation Study.

BACKGROUND: Precise control of tidal volume is one of the keys in limiting ventilator-induced lung injury and ensuring adequate ventilation in mechanically ventilated neonates. The aim of the study was to compare the tidal volume (mVT) measured from the expiratory limb of the ventilator with the actual tidal volume (aVT) that would be delivered to the patient using a lung model to simulate a neonate. METHODS: This study was conducted using the ASL5000 lung simulator. Three combinations of parameters were set: resistance (cmH2O/L/sec) and compliance (mL/cmH2O) of 50 and 2 (Group 1), 100 and 1 (Group 2), and 150 and 0.5 (Group 3), respectively. The ASL5000 was connected to each of the ventilators including one anesthesia machine ventilator (Drager Fabius GS) and two ICU ventilators (Servo-i Universal and Evita Infinity V500). Each ventilator was evaluated with a set tidal volume of 30 mL (sVT) and a respiratory rate of 25 breathes/minute in both the volume-controlled ventilation (VCV) and dual-controlled ventilation (DCV) modes. RESULTS: The discrepancies between sVT, mVT and aVT were highest with the Fabius anesthesia machine ventilator and increased in the simulated lung injury groups. When comparing the ICU ventilators, the difference was greater the Servo-i and increased when using the DCV mode and with simulated lung injury. CONCLUSION: Accurate tidal volumes were achieved only with the Infinity ICU ventilator. This was true regardless of mode of ventilation and even during simulated lung injury.

Rapid detection of Lactobacillus crispatus and Lactobacillus iners in vaginal specimens by loop-mediated isothermal amplification.

A rapid detection method for Lactobacillus crispatus and Lactobacillus iners, which are important for maintaining a healthy vaginal environment, was developed using loop-mediated isothermal amplification (LAMP). The LAMP assay had a lower limit of detection of 10 fg DNA and could detect both species within 45 min.

Simulation of pressure support for spontaneous breathing trials in neonates.

BACKGROUND: Endotracheal tubes used for neonates are not as resistant to breathing as originally anticipated; therefore, spontaneous breathing trials (SBTs) with continuous positive airway pressure (CPAP), without pressure support (PS), are recommended. However, PS extubation criteria have predetermined pressure values for each endotracheal tube diameter (PS 10 cmH2O with 3.0- and 3.5-mm tubes or PS 8 cmH2O with 4.0-mm tubes). This study aimed to assess the validity of these SBT criteria for neonates, using an artificial lung simulator, ASL 5000™ lung simulator, and a SERVO-i Universal™ ventilator (minute volume, 240-360 mL/kg/min; tidal volume, 30 mL; respiratory rate, 24-36/min; lung compliance, 0.5 mL/cmH2O/kg; resistance, 40 cmH2O/L/s) in an intensive care unit. We simulated a spontaneous breathing test in a 3-kg neonate after cardiac surgery with 3.0-3.5-mm endotracheal tubes. We measured the work of breathing (WOB), trigger work, and parameters of pressure support ventilation (PSV), T-piece breathing, or ASL 5000™ alone. RESULTS: WOB displayed respiratory rate dependency under intubation. PS compensating tube resistance fluctuated with respiratory rate. At a respiratory rate of 24/min, the endotracheal tube did not greatly influence WOB under PSV and the regression line of WOB converged with the WOB of ASL 5000™ alone under PS 1 cmH2O; however, at 36/min, endotracheal tube was resistant to breathing under PSV because trigger work increased exponentially with PS ≤ 9 cmH2O. The regression line of WOB under PSV converged with the WOB of T-piece breathing under PS 1 cmH2O. Furthermore, PS compensating endotracheal tube resistance was 6 cmH2O. The WOB of ASL 5000™ alone approached that of respiratory distress syndrome (RDS); however, the pressure of patient effort was normal physiological range at PS 10 cmH2O. PS equalizing WOB under PSV with that after extubation depended on the respiratory rate and upper airway resistance. If WOB after extubation equaled that of T-piece breathing, the PS was 0 cmH2O regardless of the respiratory rates. If WOB after extubation approximated  to that of ASL 5000™ alone, the PS depended on the respiratory rate. CONCLUSION: SBT strategies should be selected per neonatal respiratory rates and upper airway resistance.

How do Rumination and Social Problem Solving Intensify Depression? A Longitudinal Study.

In order to examine how rumination and social problem solving intensify depression, the present study investigated longitudinal associations among each dimension of rumination and social problem solving and evaluated aspects of these constructs that predicted subsequent depression. A three-wave longitudinal study, with an interval of 4 weeks between waves, was conducted. Japanese university students completed the Beck Depression Inventory-Second Edition, Ruminative Responses Scale, Social Problem-Solving Inventory-Revised Short Version, and Interpersonal Stress Event Scale on three occasions 4 weeks apart (n = 284 at Time 1, 198 at Time 2, 165 at Time 3). Linear mixed models were analyzed to test whether each variable predicted subsequent depression, rumination, and each dimension of social problem solving. Rumination and negative problem orientation demonstrated a mutually enhancing relationship. Because these two variables were not associated with interpersonal conflict during the subsequent 4 weeks, rumination and negative problem orientation appear to strengthen each other without environmental change. Rumination and impulsivity/carelessness style were associated with subsequent depressive symptoms, after controlling for the effect of initial depression. Because rumination and impulsivity/carelessness style were not concurrently and longitudinally associated with each other, rumination and impulsive/careless problem solving style appear to be independent processes that serve to intensify depression.