The aging rate in Japan has increased to 28％, with 73％ of hospitalized patients in Japan being above 65 years of age. The ill effects of age and sickness result in a greater likelihood of declining physical and cognitive functions in hospitalized older adults, rendering them unable to comply with the treatment protocol, including prescribed rest. Subsequently, catheter self-extraction and falls are common occurrences, leading to nurses initiating behavioral restraints upon admission to ensure the patient’s safety. Nursing care should ideally involve minimal physical restraints; however, behavioral inhibition has not yet been reduced which may be attributed to the difficult and complex judgments made when dealing with such patients. To date, only a few studies have explored the reasons for initiating behavioral restraint on the day of admission, assuming the decision is related to nurses’ thoughts. This study aimed to elucidate the reasoning and beliefs of nurses initiating behavioral restraints on the day of admission. We used semistructured interviews （prepared using an interview guide） to survey 14 general ward nurses who initiated behavioral restraints on the day of admission. The interview transcripts were produced （verbatim, code, and category） to review the reasons （and thoughts） behind adopting behavioral restraints. The responses given by nurses yielded seven categories of reasons for initiating behavioral restraints, the most prominent being “there is a history of self-extraction and there is a possibility that it will be expunged again” and “cognitive function has deteriorated.” Likewise, eight categories of “thoughts” were identified, including “if there is a record of dangerous behavior, I feel the need to control it” and “if an incident occurs, I have to take responsibility,” leading to initiating behavioral restraints. A patient-centered analysis allowed us to determine the reasons for nurses’ actions, particularly when they did not have sufficient information about a patient’s level of cognition, were unable to predict their actions, or when they did not understand a patient because of a lack of information. Most nurses also rely on the opinions of senior nurses; hence, sympathy and mutual respect among nurses influence their decision to initiate behavioral restraints. When a medical accident occurs, nurses tend to feel responsible for how the patients behave, and creating a culture of safety that is addressed as a ward-wide issue is important to prevent the same incident from recurring. Nevertheless, nurses must strive to protect and respect the dignity of patients in all aspects of nursing, presently and in the future. Nurses feel responsible for upholding the safety of patients; however, administrative efforts are warranted to prevent the recurrence of troublesome incidents and continuously implement safety measures that protect and respect the dignity of patients. This approach may help reduce behavioral inhibition strategies adopted by nurses.

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About 10％ of all full-term infants require resuscitation; in some cases, the transition of respiratory and cardiovascular dynamics does not progress, leading to neonatal asphyxia, with severe cases presenting with hypoxic-ischemic encephalopathy. Hypothermic therapy is the standard treatment widely used for moderate to severe encephalopathy. We retrospectively analyzed the electronic medical records of 11 cases of severe neonatal asphyxia admitted to our neonatal intensive care unit between January 2018 and December 2022 who were treated with hypothermic therapy. Overall, there was no sex bias, and most births were cesarean sections or first births. The Apgar scores of the neonates tended to fluctuate over time, and significant differences were observed in response to resuscitation. Almost all patients were intubated; however, chest compressions and adrenaline administration were performed in only three cases. The cases were compared based on the presence or absence of abnormal findings on magnetic resonance imaging （MRI） of the head, revealing a significantly higher rate of clinical seizures in cases with abnormal MRI findings. Neurodevelopmental disorders were observed in five cases, all of which had abnormal findings on head MRI, indicating a direct correlation between head MRI findings and neurodevelopmental disorders. Furthermore, the appearance of symptoms such as clinical seizures presumably arising from brain damage affects the neurological prognosis. Therefore, outpatient follow-up is highly recommended for patients receiving hypothermia therapy, especially in cases involving clinical convulsions.

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Bear attacks are frequently extensive and deep but do not often involve tissue loss. We report a case of a successfully reconstructed full-thickness defect of more than two-thirds of the upper lip caused by a bear bite. Reconstructing upper-lip defects using the lip tissue itself is desirable, but it is often difficult when the defect is large. This case report indicated that by diagnosing the extent of the injury and using multiple local flaps, extensive tissue defects can be successfully reconstructed.

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Although dermoid cysts can develop anywhere in the body, they are rarely present on the floor of the oral cavity. Herein, we have reported the case of a 21-year-old woman who presented with a mandibular swelling. Computed tomography, magnetic resonance imaging, and ultrasonography revealed a tumor that was approximately 50mm in diameter and extended from the floor of the oral cavity to the submandibular region. The tumor was excised via an intraoral incision, and histopathological examination revealed that the tumor was a dermoid cyst. No recurrence was observed at the 8-month follow-up.

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The RECELL® autologous cell harvesting system （covered by insurance in Japan since September 1, 2022） is used for the treatment of burns. It creates an autologous cell mixture by immersing small fragments of the patient’s skin in an enzyme solution, passing them through a buffer solution, and separating the cells with a scalpel. The mixture is then directly sprayed onto burn wounds to promote early epithelialization. Several case reports about the use of RECELL have been published from Japan describing the efficacy of the system in achieving similar outcomes with a smaller harvested skin area compared with split-thickness skin grafts alone. Additionally, this technique can reduce the epithelialization time at the donor site. However, as an upcoming treatment methodology, there are concerns about RECELL® regarding the optimal timing of treatment, the most appropriate burn sites and depths, the choice of postoperative wound dressings, and the timing of dressing changes. Herein, we present two cases of extensive burns treated with RECELL® elaborating on our treatment approach and the patient’s postoperative course, and discuss potential future developments of this technique.

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