Patients with differentiated thyroid cancer usually have good prognosis, while those with advanced disease often develop local recurrences or distant metastases, resulting in poor clinical outcomes. The main treatment options for unresectable differentiated thyroid cancer are radioactive iodine (¹³¹I) therapy and tyrosine kinase inhibitors. However, many advanced patients become refractory to radioactive iodine and tyrosine kinase inhibitors have a high incidence of treatment-related adverse events. We investigated the synergistic effects of the combination with the molecular targeted agent lenvatinib and external beam radiation using differentiated thyroid cancer cells and its xenograft mouse model. The combination with lenvatinib and external beam radiation markedly inhibited cell proliferation in vitro and tumor growth in nude mice, suggesting a synergistic treatment effect. Immunofluorescence analysis and immunohistochemistry with a cell proliferation marker Ki-67 showed that the expressions of Ki-67 were decreased in the combination therapy group. The combination therapy also induced apoptosis, G2/M phase cell cycle arrest and increased intracellular uptake of lenvatinib, which may contribute to the synergistic antitumor effect. Combination therapy with lenvatinib and radiation including external beam radiation and ¹³¹I, suggests a powerful and tolerable new therapeutic strategy for advanced thyroid cancer.

The gut microbiota resides in the human gastrointestinal tract, maintaining a certain homeostatic balance. Recent advancements in next-generation sequencing have accelerated our understanding of the human gut microbiota and its role in human health. The imbalance of the gut microbiota (dysbiosis) in childhood elevates the risk of various diseases. Therefore, preventing and correcting dysbiosis is related to maintaining and promoting lifetime health. Among various factors that affect the establishment of gut microbiota, the impact of antibiotics is large. Therefore, we conducted a study on patients with febrile urinary tract infections to reveal the long-term effect of low-dose antibiotic use on childhood gut microbiota. Among the participants, the initial treatment dose of antibiotics significantly decreased the microbial diversity, and the order Lactobacillales became dominant. However, after the initial treatment, diversity recovered within 1 to 2 months and was maintained even during the use of low-dose trimethoprim-sulphamethoxazole, which revealed that the impact of low-dose antibiotics on childhood gut microbiota is insignificant. Furthermore, the order Enterobacteriales, which includes the main causative bacteria of febrile urinary tract infections, was suppressed in patients under prophylaxis, indicating that prophylaxis using trimethoprim-sulphamethoxazole is an effective and safe treatment to prevent febrile urinary tract infections.

Type 1 autoimmune pancreatitis (AIP) is an intractable disease involving immune disorders. AIP has Th2-type immune response abnormalities, but the pathophysiology has not yet been elucidated. It has been reported that the pathophysiology of AIP involves abnormalities in regulatory T cells (Tregs) and changes in the proportions of naïve Tregs (nTregs) and activated effector Tregs (eTregs). Interleukin 35 (IL-35) is a newly discovered inhibitory cytokine, which is mainly produced by Tregs. We analyzed the association of Tregs and IL-35 in AIP. As a result, plasma IL-35 was high in AIP. The ratios of nTregs/CD4 positive cells and eTregs/CD4 positive cells in the peripheral blood of AIP patients were low and high, respectively. However, the gene expression of EBi3 and IL-12p35 in nTregs and eTregs did not increase. In pancreatic tissues, AIP had a large number of EBi3 or IL-12p35 positive cells, and also a large number of EBI3 and IL-12p35 double-positive cells. These findings suggest that IL-35 contributes to the immune-pathological conditions of AIP through the suppression of Th2 responses and promotion of the differentiation of Tregs.

The acquisition of toileting skills is an important developmental task for toddlers and preschoolers. Sometimes, health problems related to elimination, such as functional constipation and voiding dysfunction, occurs when children learn to toilet. Furthermore, some parents feel that it is too burdensome to toilet-train their children. This study aimed to focus on child toilet learning to develop nursing intervention program, preventing, finding early and intervening in the health problems related to toileting of children and the parental difficulty of approaching children for toilet learning.

This is a collective case study informed by the transition theory. The longitudinal semi-structured interviews were conducted. The transition process in each case was identified based on the description of each case. After within-case analysis, an across-case analysis was undertaken to identify commonalities and differences in the toilet learning process and the parental perceptions and engagement in the child toilet learning process. The nursing intervention based on role supplementation was performed for some children and parents who had problem in this learning process. Effectiveness was evaluated for each case.

A total of 22 children and their mothers participated in this study. The children were aged 20–60 months. The data revealed the transition of the child toilet learning process and maternal care for it. The three phase of child learning facilitated the child’s transition: perceiving their body by sharing their sensuous experience, getting the knacks for using their body through trial and error, capturing the trimming to go to the toilet in daily life. The nursing intervention was conducted in eight of 22 cases. The cases were categorized into groups. Four cases needed nursing intervention to adjust the mother’s interpretation gap regarding their child and how the mother captured the child. Additionally 4 cases had problems with child bowel habits. Through nursing intervention, some mothers were aware that their child was not what they wanted to be. Some children noticed their sensation related to defecation, which led to work on elimination as their own.

The child transition of toilet learning consisted of three phases: to sensate their body, to use their body, and to be aware of the social expectations. With supplemental nursing intervention for children and parents, the environment of child learning was established by their significant others. This study provides some opportunities to gain perspectives about some of the resources on which toddlers and preschoolers acquire life skills through their bodies and how parents can take responsibility for child developmental transition.

The coronavirus disease 2019 (COVID-19) pandemic, including the fourth wave that severely affected Osaka from March 2021 onward, continues to affect human beings worldwide. Our institution accepts patients with COVID-19, mainly those with severe respiratory dysfunction. In this paper, we summarize our activities to ensure patient safety based on the reports of COVID-19–related medical incidences and deaths searched by our reporting system and discuss the important features. Until May 2021, 149 COVID-19–related incident reports were generated. The major classes of the reports were treatment and surgery (33%), tube trouble (14%), and injection and infusion (10%). The major factors identified in the reports were insufficient observation (32%), noncompliance of rules (21%), and insufficient confirmation (14%). The characteristics of COVID-19–related medical incidences were divided into two types: disease–related incidences and incidences with infectious disease control measures. During the study period, 78 cases were deaths caused by COVID-19, and the majority of deaths occurred in patients aged over 80 years.