Caring Partnership within Newman's Theory of Health as Expanding Consciousness: Aiming for Patients to Find Meaning in Their Treatment Experiences.

Despite the continuous advances in cancer treatment, many patients undergoing cancer treatment still suffer because of inability to find meaning in their treatment experiences. Nurses involved also suffer because they prioritize the implementation of treatment protocols rather than providing holistic care. Therefore, special care is needed in clinical settings. This report aimed to demonstrate helpfulness and possibility of "caring partnership" with patients in the treatment phase on the basis of Margaret Newman's theory of health as expanding consciousness. Caring partnership is a nursing intervention in a unitary and relational perspective that helps patients and nurses make a difference. For this intervention, patients need to recognize their own pattern in the relationship to exert their own strengths in finding meaning to their cancer treatment experience and so their lives, while nurses are encouraged to partner with them, trusting patients' own power and becoming a rich environment for them. Hence, dialog is necessary to facilitate patients' pattern recognition in process of the patient-nurse partnership. Three cases are presented for each treatment phase (perioperative, chemotherapy treatment, and prolonged postoperative self-care management). Through caring partnership with an oncology certified nurse, the patients found meaning in their treatment experiences and exerted their own inner strength to establish a new way of life, and the nurses reconfirmed what nursing was. From the theoretical viewpoint, caring partnership was helpful for patients in distress and was possible in clinical settings even with partial involvement during a treatment phase.

Evaluation of Facial Soft Tissue in Patients With Cleft Lip and Palate Corrected Using Maxillary Protraction Appliances.

ABSTRACT: Noncontact optical surface scanners have been used to evaluate facial soft tissues. Appropriate evaluation of patients with cleft lip and palate requires comprehensible assessment of the changes in their pre- and post-orthodontic soft tissue and facial growth during chairside assistance. The authors developed a new scanning system that required a shorter measurement time than conventional modalities. The system was implemented on a mannequin and a 6-year-old patient. Seven midfacial landmarks were identified on their faces. The authors measured these landmarks 5 times daily. An experienced orthodontist evaluated and recorded the scores. The scores obtained from the mannequin had a variation of within 0.2 mm, while those obtained from the patient varied within 0.8 mm, except that of the inferior limit of the lips. The study findings suggest that the new laser scanning system can accurately measure facial soft tissue. Further studies should fix patients' head at a definite position for more accurate measurements. An appropriately angled laser sensor would eliminate distortions, thereby increasing the measurement validity.

Comparative analysis of the prognostic utility of preoperative nutritional parameters in patients with resectable esophageal carcinoma.

OBJECTIVE: Although surgical resection is a mainstay in the management of esophageal carcinoma (EC), its postoperative outcomes remain unsatisfactory. To optimize surgical strategies for EC, a simple method of stratifying patients according to risk factors is desired. Controlling nutritional status (CONUT), the prognostic nutritional index (PNI), transthyretin and transferrin are nutritional parameters used to predict the long-term outcomes of EC patients. We aimed to comparatively evaluate the prognostic significance of these four markers, measured preoperatively, in patients with operable EC. METHODS: In total, 224 patients undergoing surgical resection for EC were retrospectively reviewed. Overall/cancer-specific survivals (OS/CSS) were estimated applying the Cox proportional hazard model to univariate and multivariate analyses. PNI, transthyretin and transferrin levels were treated as continuous variables in these analyses. RESULTS: Preoperative CONUT had significant associations with tumor location, depth and preoperative irradiation. The other three markers all showed significant relationships with age and tumor depth. On univariate Cox regression analysis, preoperative CONUT, PNI, transthyretin and transferrin all correlated significantly with OS and CSS. On multivariate Cox regression analysis, the preoperative transthyretin level was identified as an independent predictor of OS (HR 0.51 per 10 mg/dL increase, 95% CI 0.29-0.88, p = 0.017) and CSS (HR 0.50, 95% CI 0.27-0.91, p = 0.027) as well as tumor depth, nodal metastasis and preoperative irradiation, while the other three parameters were not. CONCLUSIONS: Preoperative transthyretin, as a continuous variable, independently predicted both OS and CSS in resectable EC patients, appearing to be the best prognosticator among conventional nutrition-related parameters.

Late recurrence of gastric carcinoma 15 years after surgery.

A 70-year-old man who had undergone total gastrectomy 15 years ago for mucinous gastric carcinoma on the lesser curvature of the cardia, visited our hospital complaining of cough. Chest X-ray showed a right hilar shadow and an infiltrative shadow in the left middle lung field, which was not seen in the previous year. Whole-body positron emission tomography-computed tomography (CT) revealed abnormal uptake in the irregular consolidation of the left lung, enlarged right hilar lymph nodes, and a mass lesion on the right adrenal gland. Advanced primary lung adenocarcinoma with multi-organ metastasis was suspected and a CT-guided percutaneous lung biopsy was performed. Histopathological examination showed immunostaining patterns in complete accordance with those of the resected specimen of stomach, and the diagnosis of late recurrence of gastric carcinoma was confirmed. Pulmonary metastasis might have occurred as a direct hematogenous metastasis rather than through the liver. He achieved 31 months survival after the diagnosis receiving some sequences of chemotherapy. Late recurrence over 10 years after gastrectomy is extremely rare and significant predictive factors of late recurrence are not known. We hope that this case will help in detecting significant factors predictive of late recurrence after gastrectomy for gastric carcinoma.

Laparoscopic distal gastrectomy in a patient with gastric cancer complicated by eventration of the diaphragm: A case report.

Diaphragmatic eventration refers to an abnormal elevation of the diaphragm. Here, we report the case of a patient with gastric cancer who underwent successful laparoscopic distal gastrectomy despite the presence of diaphragmatic eventration. The patient was a 72-year-old man diagnosed with early gastric cancer in the antrum, as detected by upper gastrointestinal endoscopy. Preoperative imaging revealed an elevation of the left side of the diaphragm, which was diagnosed as diaphragmatic eventration. Laparoscopic surgery is beneficial for obtaining an optimal field of view. However, there are critical points that must be considered when laparoscopic distal gastrectomy is performed in patients with gastric cancer complicated by diaphragmatic eventration. There were difficulties that affected manipulation because the elevated diaphragm drew the intraperitoneal organs into the thoracic cavity, causing displacement of the normal anatomical position. We found it beneficial to secure the lesser curvature of the stomach given the possible effects of gastric deformation.

Deletion of Prdm8 impairs development of upper-layer neocortical neurons.

Upper-layer (UL) neocortical neurons are the most prominent distinguishing features of the mammalian neocortex compared with those of the avian dorsal cortex and are vastly expanded in primates. However, little is known about the identities of the genes that control the specification of UL neurons. Here, we found that Prdm8, a member of the PR (PRDI-BF1 and RIZ homology) domain protein family, was specifically expressed in the postnatal UL neocortex, particular those in late-born RORß-positive layer IV neurons. We generated homozygous Prdm8 knockout (Prdm8 KO) mice and found that the deletion of Prdm8 causes growth retardation and a reduced brain weight, although the brain weight-to-body weight ratio is unchanged at postnatal day 8 (P8). Immunohistochemistry showed that the relative UL thickness, but not the thickness of the deep layer (DL), was significantly reduced in Prdm8 KO mice compared with wild-type (WT) mice. In addition, we found that a number of late-born Brn2-positive UL neurons were significantly decreased in Prdm8 KO mice. To identify genes regulated by Prdm8 during neocortical development, we compared expression profiling analysis in Prdm8 KO and WT mice, and identified some candidate genes. These results suggest that the proper expression of Prdm8 is required for the normal development and construction of UL neurons in the mammalian neocortex.

Prdm8 regulates the morphological transition at multipolar phase during neocortical development.

Here, we found that the PR domain protein Prdm8 serves as a key regulator of the length of the multipolar phase by controlling the timing of morphological transition. We used a mouse line with expression of Prdm8-mVenus reporter and found that Prdm8 is predominantly expressed in the middle and upper intermediate zone during both the late and terminal multipolar phases. Prdm8 expression was almost coincident with Unc5D expression, a marker for the late multipolar phase, although the expression of Unc5D was found to be gradually down-regulated to the point at which mVenus expression was gradually up-regulated. This expression pattern suggests the possible involvement of Prdm8 in the control of the late and terminal multipolar phases, which controls the timing for morphological transition. To test this hypothesis, we performed gain- and loss-of-function analysis of neocortical development by using in utero electroporation. We found that the knockdown of Prdm8 results in premature change from multipolar to bipolar morphology, whereas the overexpression of Prdm8 maintained the multipolar morphology. Additionally, the postnatal analysis showed that the Prdm8 knockdown stimulated the number of early born neurons, and differentiated neurons located more deeply in the neocortex, however, majority of those cells could not acquire molecular features consistent with laminar location. Furthermore, we found the candidate genes that were predominantly utilized in both the late and terminal multipolar phases, and these candidate genes included those encoding for guidance molecules. In addition, we also found that the expression level of these guidance molecules was inhibited by the introduction of the Prdm8 expression vector. These results indicate that the Prdm8-mediated regulation of morphological changes that normally occur during the late and terminal multipolar phases plays an important role in neocortical development.

Long-term maxillomandibular changes after maxillary distraction osteogenesis in growing children with cleft lip with or without palate.

Objective : To evaluate the long-term maxillomandibular changes after maxillary distraction osteogenesis in growing children having cleft lip with or without cleft palate. Patients : Eight Japanese patients with cleft lip with or without cleft palate aged 9.3 to 13.1 years. Measures : The maxillary and mandibular positions before (T0), immediately after (T1), and 1, 3, and 5 years after distraction osteogenesis (T2, T3, and T4, respectively) measured on cephalograms superimposed at the sella turcica with the Frankfort horizontal plane as the horizontal reference. The anterior nasal spine (x, y), pogonion (x), and menton (y) were used for linear measurements, and sella turcica-nasion-point A, sella turcica-nasion-point B, and point A-nasion-point B angles were used for angular measurements. Results : The mean horizontal maxillary advancement (anterior nasal spine [x]) was 12.3 mm during T0 to T1, but -2.7, -1.1, and -0.1 mm of the posttreatment changes were observed during T1 to T2, T2 to T3, and T3 to T4, respectively. Anterior nasal spine (y) shifted 2.3 mm downward during T0 to T1, and further downward changes were observed during T1 to T2 and T2 to T3 (P < .05). Pogonion (x) did not show distinct changes due to individual variance, but menton (y) shifted downward from T1 to T4. Sella turcica-nasion-point A significantly decreased during T1 to T2 and T2 to T3 but not during T3-T4. Point A-nasion-point B significantly decreased only during T2 to T3, and sella turcica-nasion-point B did not show any distinct change. Conclusions : There was no further maxillary advancement after distraction osteogenesis in the growing children with cleft lip with or without cleft palate. Therefore, long-term observation and management of occlusion in case of the mandibular growth pattern are important.