Oral health adversely affects quality of life, mastication, and socialization. Periodontal disease is a risk factor for infectious and chronic diseases and is a medical and public health problem. The removal of dental plaque by tooth brushing is effective for its prevention, and sonic toothbrushes have become common. In this study, we investigated subjective changes in plaque deposition and periodontal disease symptoms before and after the short-term use of a sonic toothbrush in 25 Japanese undergraduate nursing students. Subjective changes in periodontal disease symptoms were assessed clinically by completing a self-administered questionnaire, and plaque status was assessed clinically by staining 12 teeth that could be measured by nurses. Overall, the use of the sonic toothbrush significantly reduced plaque accumulation (p = 0.001). The addition of an interdental brush and floss to the sonic toothbrush further reduced plaque buildup. The use of a sonic toothbrush was found to improve dental hygiene compared with the use of a hand toothbrush. In the future, it may become a tool for nurses to provide guidance on tool selection and methods of plaque removal as a method of oral health intervention.

View full abstract

Purpose: This study examined factors related to the overall satisfaction level of older people residing in remote island with at-home medical and long-term care services. Methods: The survey targeted older people reporting services at a day rehabilitation center in remote island of Nagasaki Prefecture and investigated individuals' backgrounds, including age, sex, long-term care level, living environment, and anxiety about life and health. The abbreviated Japanese version of the Lubben Social Network Scale (LSNS-6) was used to measure their social networks, and the Japanese 8-item version of the Client Satisfaction Questionnaire (CSQ-8J) was used to measure their level of satisfaction with medical and long-term care services. Results: Data were analyzed for 220 participants, including 82 men (37.3%) and 138 women (62.7%). The mean age was 81.9 ± 7.9 (mean ± standard deviation) years, the mean LSNS-6 score was 12.8 ± 7.0 points, and the mean CSQ-8J score was 24.0 ± 4.0 points. The results of the multiple regression analysis (backward stepwise method) showed that only the item ″Information on medical care intentions is shared among medical personnel and long-term care workers″ was significantly associated with CSQ-8J scores (p=0.009). The results suggest the need to obtain more detailed information regarding illness and treatment and to share it with concerned parties.

View full abstract

Background: The aim of this study was to clarify how clinical clerkship students' impressions of robotic surgery changed after completing practical training in the simulator. Methods: Forty-two final-year students who were selected to our department for a clinical clerkship in 2022 were given an overview of robotic surgery using a simulator. We created an original online questionnaire survey comprising seven multiplechoice questions and e-mailed it to each student after they completed the clinical clerkship. Results: The questionnaire response rate was 100%. Most students had heard about robotic surgery before their practical training (60%), and 80% were aware that our institution had simulators. However, only 36% of students had opportunities to touch the simulators before the clinical clerkship. The simulator was very useful in increasing the students’ interest in and familiarity with robotic surgery. However, simulation training alone did not lead to the medical students picturing themselves being involved in robotic surgery in the future. Conclusion: This questionnaire survey revealed both positive and negative aspects of the current situation of robotic surgery education for medical students. It was thought that not only education using simulators but also education about medical effects such as improvement of treatment effects by using robots would contribute to understanding of the significance of robotic surgery.

View full abstract

Background: Inclusion body myositis (IBM), an inflammatory muscle disease, sometimes leads to swallowing impairment. The anesthetic management of patients with IBM should be carefully performed to prevent the development of postoperative pulmonary complications (PPCs). Prompt recovery of consciousness from general anesthesia may contribute to the prevention of PPCs. Remimazolam, a newly developed general anesthetic, can provide early and reliable awakening; however, its use in patients with IBM has not been reported. Case presentation: A 76-year-old man with IBM experienced swallowing impairment, for which laparoscopy-assisted gastrostomy was planned. Total intravenous anesthesia was performed with remimazolam, remifentanil, and rocuronium. Upon awakening from anesthesia following flumazenil administration, he completely recovered consciousness. After extubation, he was able to protrude his tongue, cough, and breathe comfortably. There were no PPCs, and the patient’s postoperative course was uneventful. Conclusions: PPCs should be prevented in patients with IBM, and anesthetic management with remimazolam may help with this.

View full abstract

The optimal treatment strategy of multiple station N2 stage ⅢA non-small-cell lung cancer remains controversial. A 66-yearold man was diagnosed with lung adenocarcinoma, pathological multiple station N2 stage ⅢA. After three lines of chemotherapy were administered, partial response was obtained. Since 18F-fluorodeoxyglucose (18F-FDG) positron emission tomographycomputed tomography (PET-CT) showed reduced uptake in every lesion, salvage surgery was performed. In the resected lung, adenocarcinoma was detected, but no lymph node metastasis was seen. The down-staging by PET-CT well reflected the pathological findings and effectively worked in this case. More than eleven years after surgery, no recurrence has been confirmed. A combination of chemotherapy, PET-CT, and salvage surgery is one of the strategies that could bring patients with multiple station N2 stage ⅢA non-small cell lung cancer a long-term survival.

View full abstract

Abdominal paragangliomas are rare tumors that arise near the root of the inferior mesenteric artery, termed the organ of Zuckerkandl. The laparoscopic approach is technically demanding for abdominal paragangliomas and tumor handling is difficult. A 26-year-old woman presented with abdominal pain. Pelvic CT and MRI showed a round, well defined, 53 × 51-mm mass attached to the sacrum. The preoperative diagnosis was schwannoma arising from the retroperitoneum and laparoscopic tumor resection was performed. Intraoperatively, the tumor appearance was of a round, whitish mass in the retroperitoneum, with involvement of the inferior mesenteric artery, which was ligated and dissected. We used indocyanine green fluorescence imaging to assess colonic perfusion. The histological findings were consistent with paraganglioma. We performed complete resection of a paraganglioma arising from the organ of Zuckerkandl combined with resection of the inferior mesenteric artery. Indocyanine green fluorescence imaging helped confirm adequate blood flow and avoided resection of the colon.

View full abstract