This study aimed to explore, identify, and classify the strengths of elderly individuals living in rural areas from their own perspectives, using an asset-based approach. A qualitative analysis was conducted through group interviews. The study included two groups of four elderly individuals who resided in District D of Area C, City B, Prefecture A, and three groups of five to six elderly individuals from District E in the same city. As a result, 133 key items related to the strengths of elderly individuals were identified. These items were further classified into 39 subcategories, which were grouped into three major categories: individuals (personal strengths), associations (organizations/groups), and institutions (environments/resources that support strengths). Specifically, 18 subcategories were classified into the individuals category, 11 into the associations category, and 10 into the institutions category. These findings revealed that elderly individuals in rural areas actively take on various roles within their communities, utilizing their rural environment both as individuals and as part of a group. The rural setting itself was found to significantly influence their engagement, while intergenerational support and assistance from public institutions also played a crucial role. In the future, we aim to utilize these “strengths of elderly individuals” to develop strategies that empower community residents to lead vibrant, active, and secure lives in their familiar environments.

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　Our hospital is the only medical institution in Ibaraki Prefecture designated as a Type I infectious disease center and a regional perinatal maternal and child health care center, and we have been actively accepting COVID-19-positive pregnant women. In this report, we describe the perinatal outcomes of 58 pregnant women who were polymerase chain reaction/antigen positive for COVID-19 and were managed at our hospital between July 2020 and September 2022. The severity of illness was mild in 49 patients (84.5%), moderate I in 5 (8.6%), moderate II in 2 (3.4%), and false positive in 2 (3.4%). Obstetric complications included 5 cases of impending preterm delivery, 3 cases of gestational diabetes mellitus, and 1 case of impending miscarriage. Among 22 of the women who gave birth while positive for COVID-19, the mode of delivery was vaginal delivery in 18 cases, cesarean section in 3 cases, and emergency cesarean section in 1 case after transfer to another hospital. Four cases were delivered on day 4 of illness, 3 on day 5, and 1 each on days 1, 3, 7, 8, 14, 16, 21, 25, and 29; 4 cases were asymptomatic at delivery but had tested positive on admission or screening at the time of family positive identification. The mean gestational age was 38 weeks 4 days (range, 34 weeks 2 days to 40 weeks 6 days; standard deviation [SD], 10.164 days), mean birth weight was 3042 g (range, 2000-3680 g; SD, 401.268 g), mean Apgar scores at 1 and 5 min were respectively 7.90 (range, 6-9; SD, 0.514) and 8.86 (8-9, SD, 0.343), and umbilical arterial pressure (UVC) was 7.90 mmHg (range, XX-XX; SD, X.343), and umbilical artery blood gas pH was 7.304 (range, 7.120-7.360; SD, 0.058). In the 44 COVID-19-positive pregnant women managed from the sixth wave onward, 43 (97.7%) had mild disease and 1 (2.3%) was a false positive. Since COVID-19-positive pregnant women are considered to be at high risk during the perinatal period and require careful management, many medical institutions initially performed elective Cesarean sections. However, the perinatal outcomes were good in the 18 patients who delivered vaginally at our hospital, and it is not essential to choose cesarean section because of COVID-19 positivity alone, unless the patient is severely ill. The reason for the significant decrease in the disease severity from the sixth wave onward may be the influence of widespread vaccination or changes in the disease caused by mutant strains. While continuing to recommend vaccination of pregnant women, it is necessary to flexibly change the response according to the disease status of COVID-19 in the future.

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　Postoperative delirium is a neuropsychiatric disorder characterized by abnormal behaviors following surgery, including disorientation, delusions, and hallucinations. This study preoperatively assessed predisposing factors for delirium and examined its postoperative symptoms and treatments. A total of 71 patients who underwent general anesthesia were included. Delirium assessment sheets from the DELirium Team Approach (DELTA) program were used for delirium evaluation. Postoperative delirium was observed in 17 cases. Patients were divided into two groups: those with postoperative delirium symptoms (delirium group) and those without (non-delirium), and their predisposing factors were compared. The delirium group had a significantly higher proportion of patients aged 70 years or older, as well as patients with organic brain disorders and coexisting dementia. The mean age was significantly higher in the delirium group (78.5 years) compared to the non-delirium group (69.4 years). No significant differences were observed between the two groups in operative time, duration of anesthesia, blood loss, or transfusion volume. Delirium symptoms in the delirium group included inattention in 15 cases, disorganized thinking in 8 cases, and altered levels of consciousness in 6 cases. Treatments included physical restraints in 15 cases, administration of antipsychotic medications in 10 cases, and use of sedative-hypnotics in 4 cases. Particular attention should be given to the risk of postoperative delirium, especially in surgical patients aged 70 or older and those with organic brain disorders.

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　Botulinum toxin has been successfully used to treat limb spasticity, but the optimal timing for initiating treatment remains unclear. Beneficial effects of early treatment have been suggested in previous studies. However, in Japan early treatment is difficult because of the drug’s cost. Here we report a case of severe limb spasticity that was treated in the subacute phase using botulinum toxin. The patient was a 50-year-old woman who had shoulder pain and equinus due to spasticity 3 months after stroke onset. Following botulinum toxin treatment of the pectoralis major and gastrocnemius muscles, her symptoms improved and she could walk with an orthosis and perform activities of daily living under supervision. In conclusion, botulinum toxin treatment can be considered when appropriate candidates have severe limb spasticity even in the subacute phase.

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　Smooth muscle tumor of uncertain malignant potential (STUMP) is a type of uterine tumor that does not meet criteria for benign or malignant disease and can recur even after hysterectomy. Recently, loss of the ATRX gene, which encodes a chromatin remodeling protein, has been reported as a factor in recurrence. In this case, the patient underwent a simple abdominal hysterectomy and bilateral adnexectomy for a pelvic mass at the age of 59 years with a diagnosis of STUMP. At age 62 years, multiple masses were found in the thoracic cavity and the patient was diagnosed with recurrent uterine STUMP. Comprehensive genomic profiling revealed mutations in the ATRX gene. No treatment was effective, and the patient died 6 months after recurrence. Additional immunostaining of the surgical specimen was performed retrospectively and ATRX(-) status was confirmed. This case suggests that ATRX expression on immunostaining can be a prognostic factor.

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　Leiomyosarcoma of the spermatic cord is a rare disease. We encountered a case in a 74-yearold man. A biopsy revealed the definitive diagnosis, and right high orchiectomy was performed. No adjuvant therapy was given. The patient relapsed 2 months later and died 4 months after surgery.

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　Malignant pleural effusion is characterized by fluid buildup between the lung and the chest wall due to cancer cells in the pleura. Most cases are caused by lung cancer, breast cancer, ovarian cancer, or malignant lymphoma. Urothelial carcinoma is a rare cause of malignant pleural effusions and is difficult to diagnose by cytological examination. We report a case of malignant pleural effusion due to urothelial carcinoma. An 80-year-old man presented with right back pain. After close examination, he was diagnosed with ureteral cancer. During the course of treatment, a unilateral pleural effusion was found, and cytological and histological examinations were performed on suspicion of malignant pleural effusion. Cytological examination revealed numerous round-to-ovoid cells with irregularly enlarged nuclei. Immunohistological studies were performed on cell block specimens, and urothelial carcinoma was diagnosed. Cytological examination of malignant pleural effusions may require estimation of the primary site. It is important to take a multifaceted approach that considers not only the cytological findings but also the clinical findings and medical history.

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　This study aimed to examine the nursing management behaviors of nurse managers at Hospital A and to identify challenges in developing nurse managers capable of implementing nursing management behaviors based on the competency model. Individual interviews were conducted twice with nine nurse managers. Newly appointed nurse managers demonstrated competencies related to supporting others, such as “self-improvement and learning ability”. The competencies requiring further development included “interpersonal influence”, which also relates to supporting others. Among nurse managers with more than 4 years of experience, both the competencies they exhibited and those requiring further improvement included “commitment to the organization”, with references to contributing to the overall benefit of the hospital. Newly appointed nurse managers need support in reflecting on their nursing management behaviors by observing and learning from others. Meanwhile, nurse managers with over 4 years of experience require assistance in collaborating with other departments to contribute to the hospital as a whole.

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