Effectiveness of active learning-based transfer movement training for caregivers working in a residential care home.

[Purpose] This study examined the effectiveness of active learning-based transfer movement training provided to caregivers by physical therapists. [Participants and Methods] This study enrolled 29 participants (age: 47.0 ± 10.1 years, 22 female participants) working at a residential care home. The participants were shown a video in which caregivers experienced difficulty in transferring a patient; this was followed by group discussions. To verify the effectiveness of this educational intervention, a questionnaire including six items related to reducing the burden on caregivers, daily living care, and rehabilitation was administered to the participants at three time points (before training, three days after training, and one month after training). Multiple comparisons were performed, and the effect size (r) was calculated. [Results] Significant differences were observed between the responses obtained before training and three days after training and between the responses obtained before training and one month after training for all six items. The effect sizes (r) after three days and one month of training were above 0.6 for all six items. [Conclusion] The training improved the assessment skills of caregivers, and its effects persisted after one month, suggesting the effectiveness of active learning-based transfer movement training.

Probing local structure of glass with orientation-dependent luminescence.

The local ordering of particles is considered an important process in glass transition. Ordering is usually observed in simulation and micrometer-sized colloid. However, clear information on local ordering at the molecular level is difficult to obtain experimentally. In this study, we prepared an easily glass-forming fluorophore with a color change owing to the intermolecular arrangement in the liquid, glass, and crystal states. The bathochromic shifts of the photoluminescence spectra indicated a change in the intermolecular orientation upon immediate cooling of the melt. The recovery of the spectra by successive heating indicated that rotation contributed to the change in the intermolecular orientation. The orientation in the glass was distinct from that during crystal growth, which was observed as a slow bathochromic shift by maintaining the temperature between the melting points of the blue- and green-luminescent crystals obtained from dichloromethane/ethanol and dichloromethane/hexane, respectively. Our results demonstrate that the anisotropic interaction between glass-forming luminophores is useful for uncovering molecular-level events in the glassy state.

Development of 12 sets of chromosome segment substitution lines that enhance allele mining in Asian cultivated rice.

Many agronomic traits that are important in rice breeding are controlled by multiple genes. The extensive time and effort devoted so far to identifying and selecting such genes are still not enough to target multiple agronomic traits in practical breeding in Japan because of a lack of suitable plant materials in which to efficiently detect and validate beneficial alleles from diverse genetic resources. To facilitate the comprehensive analysis of genetic variation in agronomic traits among Asian cultivated rice, we developed 12 sets of chromosome segment substitution lines (CSSLs) with the japonica background, 11 of them in the same genetic background, using donors representing the genetic diversity of Asian cultivated rice. Using these materials, we overviewed the chromosomal locations of 1079 putative QTLs for seven agronomic traits and their allelic distribution in Asian cultivated rice through multiple linear regression analysis. The CSSLs will allow the effects of putative QTLs in the highly homogeneous japonica background to be validated.

Necrotizing fasciitis of the extremities in high and low Charlson Comorbidity Index: A multi-center retrospective cohort study.

BACKGROUND: Necrotizing fasciitis (NF) is a life-threatening and acute progressive soft tissue infection and needs early surgical intervention, that is, debridement or amputation. Surgical strategy or prognosis is influenced by the speed of progression and patients' general condition, which can be calculated by the Charlson Comorbidity Index (CCI). The purpose of this study was to investigate the association between the CCI scores and prognosis of patients with NF of the upper/lower extremities. METHODS: In the retrospective cohort study, we analyzed patients with NF of the upper/lower extremities who were determined to undergo surgery by orthopedic surgeons at four tertiary hospitals between August 2003 and April 2016. We divided the patients into two groups, Group L (low CCI scores of 0-2) and Group H (high CCI scores of ≥3). The primary event of this study was defined as death or amputation. Mortality cases were included when amputation was informed with documented certification but patients died while waiting for surgery. We compared the patients' background, laboratory data on admission, the laboratory risk indicator for necrotizing fasciitis (LRINEC) score, and primary outcome between the two groups. RESULTS: Of the 56 patients, 28 patients were classified into Group L and the other 28 patients into Group H. The data in this study showed that patients in Group H had lower white blood cell counts and hemoglobin and higher creatinine than Group L, but there was no difference in LRINEC scores between the two groups. Streptococcus pyogenes was the most common infectious agent in Group L (54%) but not in Group H (11%). Poorer outcome was observed in Group H compared with Group L (4 mortality and 16 amputation vs. no mortality and 9 amputation, P = 0.007). CONCLUSIONS: Laboratory data and causative microorganisms were different between high CCI and low CCI patients with NF. High CCI scores were associated with limb amputation or death caused by NF of the upper/lower extremities; whereas, low CCI scores were more likely associated with S. pyogenes monoinfection.

[Thoracoscopic Surgery for Lung Cancer Invading the Superior Chest Wall].

We herein report a case of a 73-year-old man with lung cancer who underwent thoracoscopic right upper lobectomy with combined resection of the superior chest wall. His tumor was 48 mm in diameter and located in the posterior right lung apex involving the chest wall between ribs 1 and 3. The anterior aspects of the ribs 2 and 3 were separated using forceps under thoracoscopic vision. The first rib could be released from the tumor by peeling off the parietal pleura. An 8 cm incision was made posteriorly between the scapula and vertebrae to obtain the posterior aspect of the ribs 2 and 3. After separating the pulmonary vessels and bronchus, en bloc resection of the superior sulcus tumor was completed. Thoracoscopic chest wall resection of the superior sulcus tumor can be an alternative to the Paulson posterolateral-paravertebral thoracotomy approach, which can cause severe postoperative pain and limited range of motion of the shoulder joint.

[Surgical Case of the Primary Pulmonary Leiomyosarcoma:Report of a Case].

A 70-year-old man was referred for an abnormal chest shadow. Enhanced computed tomography (CT) revealed a well-circumscribed lung tumor of 53 mm in diameter in the left upper lobe with slight enhancement. Positron emission tomography-CT showed a high maximum standardized uptake value for the tumor but no metastasis in the lymph nodes or other organs. Although a definitive diagnosis could not be made by transbronchial biopsy, the tumor was highly suspected to be malignant based on the radiological findings, and a left upper lobectomy with mediastinal lymph nodes dissection was performed for definitive diagnosis and treatment. A pathological examination showed the tumor to be composed of mitotic spindle-shaped cells, which were positive for α-smooth muscle actin, desmin, and caldesmon. The MIB-1 labelling index was 60~70%. According to these pathologic findings, the tumor was identified as a leiomyosarcoma. Metastases to the skin of chest and hilar lymph nodes were noted six months after the surgery for which radiotherapy was performed.

[The Outcome of Second Anatomical Pulmonary Resection for Ipsilateral Metachronous Lung Cancer].

INTRODUCTIONS: When the first intervention for lung cancer is anatomical resection, the ipsilateral repeat anatomical resection for metachronous second lung cancer becomes technically challenging. Herein, we report the outcomes of second anatomical pulmonary resection for ipsilateral metachronous lung cancer at our institution. SUBJECTS: Sixteen consecutive patients[ 10 men and 6 women, average age 70( range 59~81) years] were reviewed in this retrospective study. These patients underwent ipsilateral repeat anatomical resection for metachronous second lung cancer between 2009 and 2020. RESULTS: All case required right-sided lung resections. The previous interventions of patients included upper lobectomy, lower lobectomy, middle lobectomy, S2 segmentectomy, and S6 and S10a segmentectomy in 9, 4, 1, 1, and 1 case, respectively. The second surgical interventions were middle lobectomy, S6 segmentectomy, upper lobectomy, lower lobectomy, S1 segmentectomy, and S2 segmentectomy, in 6, 4, 2, 2, 1, and 1 case, respectively. Postoperative complications occurred in three patients. The median follow-up period was 53.5 months. Three patients died during the follow-up period. Of the 13 patients still alive, 6 had recurrence. The five-year overall survival rate was 80%. CONCLUSIONS: Although only a few cases were assessed, the prognosis after second anatomical pulmonary resection for ipsilateral metachronous lung cancer at our institution was satisfactory.

[Completion Pneumonectomy for the Recurrence of Lung Cancer].

INTRODUCTIONS: The morbidity and mortality after completion pneumonectomy (CP) are reportedly high. We, herein, report the outcomes of CP at our institution. SUBJECTS: Nine consecutive patients [7 men and 2 women, average age of 72 years(range 44~84 years)] who underwent CP for recurrence of lung cancer during 2012~2018 were retrospectively reviewed. RESULTS: Right-sided sleeve CP was performed in two cases and left-sided CP in seven cases. The indications for surgery were lymph node metastasis of the cancer, pulmonary metastasis, and bronchial stump recurrence in 4, 3, and 2 cases, respectively. Postoperative complications occurred in six patients. One of the patients who underwent right sleeve pneumonectomy developed bronchopleural fistula and died 68 days after the surgery. The mean follow-up period was 33 months, and four patients died during follow-up. Of the 5 patients still alive, 4 had no recurrence and 1 had recurrence in the stump of the main bronchus. The five-year overall survival rate was 78%. CONCLUSIONS: Although only few cases were assessed, the prognosis after CP at our institution was relatively good.

Reversibility of Rocuronium-Induced Deep Neuromuscular Block with Sugammadex in Infants and Children-A Randomized Study.

Sugammadex 4 mg·kg-1 is recommended for reversal from rocuronium-induced deep neuromuscular block. However, there is limited data regarding the dose-response of sugammadex required for reversal from deep neuromuscular block in pediatric patients. The aim of this study was to determine the reversibility of rocuronium-induced deep neuromuscular block with sugammadex in infants and children. Seventy-five children (48 infants and 27 children, mean standard deviation (S.D.), age: 11.6 (6.7) months) were enrolled in this study. After induction of anesthesia and administration of 0.6 mg·kg-1 rocuronium, neuromuscular block was acceleromyographically evaluated by observing contractions of the adductor pollicis muscle to ulnar nerve train-of-four (TOF) stimulation. Subsequently, the intensity of rocuronium-induced block was determined every 6 min using post-tetanic count (PTC) stimulation during sevoflurane and remifentanil anesthesia. When the first response to the PTC stimulus was detected, either 1, 2 or 4 mg·kg-1 sugammadex was administered and the time required for facilitated recovery to a TOF ratio of 0.9 following each dose was compared. The time [mean (S.D.)] from the administration of 1 mg·kg-1 sugammadex until recovery to a TOF ratio of 0.9 was significantly longer [129.1 (83.5) s, p < 0.001] than that with 2 and 4 mg·kg-1 sugammadex [70.3 (26.7) s and 68.2 (34.5) s, respectively]. Incomplete reversal was seen in 3 patients in the 1 mg·kg-1 group. The results suggested that a 4 mg·kg-1 sugammadex dose is recommended for reversal from rocuronium-induced deep neuromuscular block even in infants and children.

[A Case of Advanced Cardia Gastric Cancer with Pernicious Anemia].

A 70s male was referred to our hospital with anemia that was detected during a medical checkup. Upper gastrointestinal endoscopy showed advanced cardia gastric cancer. A diagnosis of pernicious anemia was made due to the macrocytic hyperchromic anemia and detection of intrinsic factor antibody. A CT scan showed fundic wall thickening and regional lymph node metastasis. After anemia improved following vitamin B12 injection, total gastrectomy with lymphadenectomy was performed. The histopathological findings showed adenocarcinoma(tub1>tub2), Type2 , pT3(SS), pN1(2/24), Stage ⅡB, INF b, ly1, v2, PM0, DM0, EW(+), pR1. He was administered systematic chemotherapy using S-1 for one year after surgery and has been followed up without recurrence for 5 years.

[Consideration of Surgical Treatment for Ileus Symptoms Associated with Progressing Cancer in Our Hospital].

INTRODUCTION: Many cases of terminal cancer develop ileus symptoms such as vomiting and abdominal distension. The causes of ileus symptoms include peritoneal dissemination, localized recurrence, etc. The treatments include octreotide acetate, decompression measures such as ileus tube, and surgical treatment. We evaluated the results of cases that underwent surgical methods to reduce ileus symptoms. METHODS: The subjects were 31 patients comprising 38 cases with ileus symptoms between January 2013 and January 2018. The surgical procedures included bypass(17 cases), tumor extirpation(7 cases), stoma(11 cases), and other(3 cases). RESULTS: Dietary intake information was available for 27 of the 38 cases; in cases that underwent tumor excision, all meals were able to be ingested and there were many cases of long-term survival. DISCUSSION: Surgical procedures can allow patients to eat food and should be considered as dietary intake after treatment is associated with survival duration.

[A Case of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus Successfully Treated by Three-Dimensional Conformal Radiotherapy].

A man in his 50s was referred to our hospital with a liver tumor detected by ultrasonography during a medical checkup. Enhanced CT scan and MRI showed hepatocellular carcinoma(HCC)in S8 of the liver. Laparoscopic partial hepatectomy was performed. The histopathological findings showed well differentiated HCC. Two years later, his serum PIVKA-Ⅱ levels were slightly elevated. A new lesion was detected by US, CT, and MRI at S5 of the liver. A second laparoscopic partial hepatectomy was performed. The histopathological findings showed moderately differentiated HCC. After 1 year, MRI detected 2 new HCCs(S4, S8). The tumor at S8 had invaded the right branch of the portal vein. There was no indication for right hepatectomy because of liver dysfunction. Lipiodol-TACE followed by DEB-TACE was not effective on the tumor. The HCC at S8 had enlarged and formed a portal vein tumor thrombus. PIVKA- / Ⅱ levels increased to 3,596 mAU/mL. The patient was adminis- tered Three-dimensional conformal radiotherapy(45 Gy/15 Fr)and his PIVKA-Ⅱ levels decreased to the normal range. He has been followed-up without recurrences for 2 years and 9 months.

[Endoscopic Topical Therapy Using Mesh for Refractory Suture Failure after Rectal Cancer Surgery].

We reported a case that could be cured with endoscopic topical therapyusing mesh for refractorysuture failure after rectal cancer surgery. The patient was a 73-year-old man. He was diagnosed as lower rectal cancer, and underwent laparoscopic super law anterior rectum resection. On the 13th postoperative day, abdominal pain appeared, suspected ileal necrosis, emergencylaparoscopic examination laparotomywas performed. Upper gastrointestinal perforation was suspected from pus and food on the whole intraperitoneal cavity, and we moved laparotomy. But any perforations were not found, we resected ileum and inserted a drain tube to Douglas fossa. After second surgerydischarge of the juice from the drain was confirmed, diagnosis was made of suture failure of the anastomosis of the rectal cancer. He rejected artificial stomy, we chose conservative therapy. On 114th day after second surgerywe put a mesh for inguinal hernia in the puncture under the endoscope. On the next dayafter the treatment discharge of the juice from the drain was stopped. And finallyhe was discharged. This endoscopic treatment is considered to be useful for refractorysuture failure.

[Jejunal Interposition after Totally Laparoscopic Proximal Gastrectomy Using Overlap Method].

There are several reconstruction methods in laparoscopic proximal gastrectomy(LPG)for earlygastric cancer at the upper part of the stomach. To prevent the esophageal reflux after gastrectomy, we chose jejunal interposition(JI)via the retrocolic route for LPG. We performed totallyLPG with JI using overlap method. METHODS: Five ports were placed. After the lymph nodes dissection bythe standard procedure, the esophagus and the proximal side of the stomach were transected byliner staplers. The jejunum was moved to the upper abdomen through the small hole of the mesocolon. The interposing jejunum was made, and the esophagojejunostomyand jejunogastrostomywere done byusing overlap method. At the end, the jujunum was pulled under the mosocolon escluding the interposing jejunum. The JI reconstruction via a retrocolic route after LPG was completed. DISCUSSION: Following LPG, the JI reconstruction is not so popular because the surgical procedure is complicated. In our technique, the JI reconstruction accomplished easier byoverlap method. CONCLUSION: Our procedure is a considerable operation of reconstruction following LPG.

[Two Cases of Stage IV Pancreatic Cancer Has Gained Relatively Long Free Survival in Multimodality Therapy].

We experienced 2 cases in which Stage IV pancreatic cancer(General rules for the study of pancreatic cancer, The 6th edition, Japanese Pancreas Society)underwent chemotherapy and radiotherapy after surgical operation and had relatively long term relapse-free survival. Local control by adding radiation therapy to surgical resection and suppressing the distant metastases in adjuvant chemotherapy may improve the prognosis.

[A Case of Long-Term Survival of Breast Cancer with Lymph Node and Liver Metastases Treated with Sequential Anti-HER2 Drugs, Chemotherapy, and Endocrine Therapy].

A 50s-year-old woman underwent left partial mastectomy with axillary lymphadenectomy for breast cancer. Histological examination indicated invasive ductal carcinoma, pT1c, pN0, Stage I , ly(+), ER(+), PgR(+). She received adjuvant therapy with tamoxifen and 50 Gy of irradiation to the residual breast. Four years after mastectomy, she was found to have left Rotter lymph node metastasis; then, anastrozole was administered instead of tamoxifen. Nine months later, she was found to have liver metastasis. Immunohistostaining revealed that the breast cancer was HER2-positive; she received AC followed by paclitaxel(PTX)with trastuzumab(T), and achieved complete response(CR). Subsequently, abdominal, cervical lymph node, and liver metastases appeared. Letrozole followed by lapatinib with capecitabine, FEC100, PTX with T, eribulin, S-1, docetaxel with pertuzumab and T, everolimus with exemestane, bevacizumab, and PTX were then administered, resulting in long-term disease control. Sixteen years after mastectomy, she receives outpatient chemotherapy in performance status 1 state.

A Diagnostic Algorithm for Eosinophilic Granulomatosis with Polyangiitis Initially Diagnosed as Lumbar Disc Hernia or Lumbar Spinal Stenosis: Personal Experience and Review of the Literature.

Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) is a rare systemic vasculitis and is difficult to diagnose. EGPA has a number of symptoms including peripheral dysesthesia caused by mononeuropathy multiplex, which is similar to radiculopathy due to lumbar disc hernia or lumbar spinal stenosis. Therefore, EGPA patients with mononeuropathy multiplex often visit orthopedic clinics, but orthopedic doctors and spine neurosurgeons have limited experience in diagnosing EGPA because of its rarity. We report a consecutive series of patients who were initially diagnosed as having lumbar disc hernia or lumbar spinal stenosis by at least 2 medical institutions from March 2006 to April 2013 but whose final diagnosis was EGPA. All patients had past histories of asthma or eosinophilic pneumonia, and four out of five had peripheral edema. Laboratory data showed abnormally increased eosinophil counts, and nerve conduction studies of all patients revealed axonal damage patterns. All patients recovered from paralysis to a functional level after high-dose steroid treatment. We shortened the duration of diagnosis from 49 days to one day by adopting a diagnostic algorithm after experiencing the first case.

[Two Cases of Emergency Extracorporeal Membrane Oxygenation Support in Children Suffering from Tracheo-innominate Artery Fistula].

Tracheoinnominate artery fistula (TIF) is a relatively rare life-threating complication of long-term tracheostomy. Two patients with TIF were successfully resuscitated by extracorporeal membrane oxygenation (ECMO) support along with advanced cardiovascular life support. The first patient was a 16-year-old boy undergoing long-term tracheostomy because of cerebral palsy, and the other patient was a previously healthy 11-year-old girl who had undergone primary tracheal tumor resection. In both cases, the onset of TIF was sudden, and the patients were immediately transferred to the operating room for emergency thoracotomy under ongoing cardiopulmonary resuscitation. Innominate artery division was performed under ECMO support. Adequate fluid replacement and hemorrhage control are primary treatment options for resuscitating a patient with TIF. However, hemorrhagic shock in patients with TIF is different from that in other patients, because bleeding into the trachea causes severe respiratory failure and poor oxygenation, which may worsen the resuscitation rate. Thus, ECMO can be used as an option for maintaining oxygenation during cardiopulmonary resuscitation in TIF. Anesthesiologists should pay attention to the increased risk of bleeding due to anticoagulation during ECMO initiation. In conclusion, the results of these cases demonstrate the effectiveness of extracorporeal cardiopulmonary resuscitation in TIF patients.

[A Case of Recurrent Inflammatory Breast Cancer Treated Using Multidisciplinary Therapy].

The patient was a 65-year-old woman who underwent segmental mastectomy for left breast cancer 5 years ago. The pathological diagnosis ofthe tumor was noninvasive ductal carcinoma, TisN0M0 and Stage 0. Postoperative radiation therapy was performed, but chemotherapy and hormone therapy were not administered. The patient presented with redness of the residual left breast. Skin biopsy showed lymphatic invasion of adenocarcinoma, and the patient was diagnosed with inflammatory carcinoma ofthe breast. After 4 cycles ofAC followed by 4 cycles ofdocetaxel, the mass was diminished and the redness disappeared. Total mastectomy with wide skin resection and axillary lymph node dissection was performed. The pathological diagnosis revealed scirrhous carcinoma ofthe left residual breast(T3N0, Stage II B, s, f, g, margin[-], ly0, v0, ER[+], PgR[+], HER2[1+]). She received treatment with an aromatase inhibitor, and 2 years after the operation is alive with no recurrence.

[A Case of Small Intestinal Gastrointestinal Stromal Tumor(GIST)with Synchronous Colonic Cancer and Gastric Cancer at a Different Time].

The patient was a 70-year-old woman with a gastrointestinalstromaltumor (GIST)of the small intestine and synchronous colonic cancer, who underwent laparoscopic right colectomy and resection of the small intestine. We started imatinib therapy because GIST belongs to a high-risk group, according to the modified Fletcher classification. Gastric cancer was diagnosed 2 years after the start of imatinib therapy. Only 4 of the 12 GIST cases seen at our institution over the last 5 years were complicated by another cancer. This is the first case of GIST in which 2 other cancers occurred at both the same and different times. We suggest that imatinib might be a factor in the development of gastric cancer.