Multiple chemical sensitivity (MCS), an acquired disorder with multiple recurrent symptoms, has been studied for its association with diverse environmental factors. The present study investigated the factors associated with the self-reported prevalence of MCS in public facility workers and the general population in Korea. The Quick Environmental Exposure Sensitivity Inventory (QEESI) questionnaire was obtained from public facility workers (N=530) and the general population (N=500) to determine the prevalence of MCS and the degree of its risk. Information about demographic characteristics, subjective perceptions of sick building syndrome or sick house syndrome or allergy (SBS/SHS/Allergy), and certain home- or workplace-related events were also obtained. There was not a statistical difference between the public facility workers and the general population in the QEESI scores. The overall prevalence of MCS was 14.4% and there was no statistical difference between the two groups. Regarding the overall degree of risk of MCS, 21.8% of the study subjects were categorized as “very suggestive”, and there was no significant difference between the two groups. Gender and the subjective perception of SBS/SHS/Allergy significantly affected the prevalence of MCS and the MCS risk criteria. Considering the absence of diagnostic criteria and/or treatment methods for MCS in Korea, these results can be utilized in establishing future strategies to manage MCS.

Registered nurses and licensed practical nurses have received professional education, but to enhance their work motivation it is necessary to create work environments in which they can concentrate on their jobs as specialists. One of the methods to develop such work environments is to use nursing assistants effectively. We investigated professional nurses’ feelings toward nursing assistants and then examined the associations between those feelings and their work motivation. The analyzed subjects were 2,170 female nurses working in 25 hospitals with from 55 to 458 beds. The average age of the respondents was 38.0 (standard deviation, 10.6 years). Factor analyses extracted four factors of professional nurses’ feelings toward nursing assistants: 1. knowledge related to healthcare, 2. nursing assistants’ attitudes toward work, 3. human relations, and 4. distinguishing between professional nurses’ work and nursing assistants’ work. Using multiple linear regression analysis, our results revealed that scores of maintaining a high motivation to work thanks to nursing assistants became lower as the ages of the respondents increased. Scores of maintaining a high motivation to work thanks to nursing assistants became higher as professional nurses gained satisfaction from: knowledge related to healthcare, nursing assistants’ attitudes toward work, and human relations. Hospital managers should consider these findings to improve working environments in which professional nurses can feel motivated to work.

Case reports of hyperammonemia due to urease-producing bacteria are found occasionally, but most of them are associated with urinary tract infections. We experienced a case of infectious enterocolitis with hyperammonemia in which the causative bacteria was speculated to be urease-producing bacteria. A Japanese woman in her 70s had been diagnosed with microscopic polyangiitis in a nearby hospital and was transferred to our hospital. Although the microscopic polyangiitis was relatively under control after treatment with steroids and rituximab, frequent diarrhea with hyperammonemia (324 µg/dl) appeared and she became comatose. Her blood ammonia decreased to 47 µg/dl and her consciousness recovered to a normal state after antibiotic treatment for infectious enterocolitis and ammonia detoxification therapy. Liver dysfunction, portosystemic shunt, excessive protein intake and constipation were not observed, and she took no medications that would cause hyperammonemia. Although culture results could not identify urease-producing bacteria, considering the clinical course, acute hyperammonemia was suspected to be due to urease-producing bacteria infection. It is necessary to consider the influence of urease-producing bacteria as a cause of acute hyperammonemia not only in urinary tract infections but also in infective enterocolitis.

According to questionnaire surveys in 2011 and 2013 about the health effects of radiation after the Fukushima Daiichi Nuclear Power Plant Accident, the guardians of child patients were more anxious than doctors and medical students. Also, according to the thyroid examinations in a Fukushima health survey, 190 cases of thyroid cancer were reported, and anxiety about radiation effects remained. This study is based on a survey about the guardians of child patients anxiety about radiation effects six years after the nuclear power plant accident, and includes a questionnaire survey about radiation effects and thyroid examinations in a Fukushima health survey. Anonymous question sheets with 20 questions were sent to pediatric medical facilities in Fukushima, and the parents of children who consulted the pediatric and medical staff answered the questionnaire. Thirty percent of the guardians of child patients had never been educated about radiation and 67% had never been educated about the effects of radiation on humans. The guardians of child patients were more anxious than the medical staff about thyroid cancer, health effects on children and genetic effects. Our results indicate that the guardians of child patients think that the increase in the incidence of thyroid cancer is due to radiation effects after the nuclear power plant accident and they desire continued thyroid examinations.

Recent developments in cancer immunotherapy are remarkable. Many reports have described the clinical effects of immune checkpoint inhibitors (ICIs), supporting their utility as a promising therapy that will achieve prominent effects even in patients resistant to cytotoxic anticancer drugs or gene-targeting therapy. ICIs may also prolong overall survival. We analyzed 10 cases of advanced lung cancer targeted with nivolumab, which is one of ICIs in our hospital and reviewed the literature regarding ICIs. We retrospectively analyzed 10 cases that consisted of 6 males and 4 females, which comprised 7 adenocarcinomas, 2 squamous cell carcinomas and one pleomorphic carcinoma. Epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase mutations were negative in all the adenocarcinoma cases. The 10 analyzed cases included 9 inoperable cases and 1 postoperative recurrent case, 8 second-line cases, a third-line case, and a fourth-line case. The average frequency of administrations of nivolumab was 7.4 times. The survival rate was calculated by using the Kaplan-Meier method. The clinical responses to nivolumab were partial response in 2 cases, stable disease in 4 cases, and progressive disease in 4 cases. In the 10 cases, the response rate and disease control rate were 20% and 60%, respectively. The median progression-free survival time and median survival time were 115 days and 126 days, respectively. We observed 2 cases of dermatitis and one each of pyrexia, general fatigue and drug-induced pneumonia as adverse events (AEs). One of these AEs was severe (Stevens-Johnson syndrome grade 4) but could be treated by steroid pulse therapy, steroid ointment and instillation. Among the 10 examined cases of advanced lung cancer treated with ICIs at our hospital, ICIs proved effective in 2 cases. However, we also experienced a case with Stevens-Johnson syndrome grade 4 as a severe AE. These findings suggest that while ICIs may be effective in treating patients, candidates for ICIs must be carefully selected and cautiously observed.

This study sought to clarify the relationship between the educational role behavior of mid-career nurses toward new nurses, and their sense of self-efficacy. Educational role behaviors of mid-career nurses toward new nurses were set to 13 items related to career ladder and previous researches. To identify the relationship between the sense of self-efficacy in mid-career nurses and performing these 13 behaviors in their educational role toward new nurses, we had 310 mid-career nurses complete a questionnaire survey and analyzed the resulting data using Spearman’s rank correlation coefficient, Mann-Whitney U test, and Kruskal-Wallis test. We found that mid-career nurses who had served as preceptors (senior nurses who teach practical nursing skills to new nurses on a one-on-one basis) four or more times had a significantly higher sense of self-efficacy than those who had served as preceptors three times or less for four behaviors only (1. demonstrating specific methods when instructing new nurses on various support methods, 7. being receptive to new nurses, 11. striving for professional self-improvement in practical nursing as a mid-career nurse, and 12. co-ordinating interpersonal relationships in the organization). No relationships were observed between the total number of years of nursing experience and the number of years of working at the station concerned. For all 13 educational role behaviors, Spearman’s rank correlation coefficients of 0.5-0.7 indicated a significant relationship between implementation of the educational role behavior and a sense of self-efficacy. We believe that the high sense of self-efficacy that results from the performance of the 13 behaviors by mid-career nurses in their role of teaching new nurses leads them to demonstrate these behaviors in their everyday practice. It was also found that experience alone did not mean that mid-career nurses could adopt educational role behaviors with little burden, suggesting that support is universally necessary, regardless of experience.

A 45-year-old man had consciousness disorder due to fall trauma had received ventilation support and tracheostomy. Two months later, the tracheostomy tube was removed. One year later, he suffered from severe cicatricial tracheal stenosis. Under a diagnosis of post-intubation tracheal stenosis, he underwent circumferential resection and end-to-end anastomosis of the trachea. The central part of the resected trachea of 3 cartilage rings showed a stenosis like a pin hole. The post operative course was uneventful, and there was no stenosis or sutural insufficiency on examination by bronchoscopy. Tracheal resection and reconstruction is rare but effective for refractory tracheal stenosis.