In our investigation of the development of nursing personnel, we encountered the issue of specialized outpatient nursing units involving collaboration between faculty at nursing education institutions and nursing personnel who engage in clinical nursing. Although these units operate in cooperation with the medical model, they are run independently by nurses and thus differ from the medical model Moreover; these units provide services that utilize expertise in various nursing fields to patients, families, and users.
These units provide a setting for nursing practice, education, and research, and as a pioneering approach, we have promoted their awareness within and outside our university. Specialized outpatient nursing units established by nursing personnel are becoming more common nationwide. Nursing expertise will become increasingly essential given the changes in social environment surrounding medicine today. We provide an overview of the educational and research activities conducted thus far through specialized outpatient nursing units from the perspective of the development of nursing personnel in regard to nursing education, the issue of practice settings, and nursing settings that meet the needs of society.

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Background and Aim: The aim of the present study was to elucidate the pathogenesis of anemia associated with pegylated interferon (PegIFN) -based regimens using in-air micro particle-induced X-ray emission (PIXE).
Methods: Four chronic hepatitis C (CHC) patients, three CHC patients receiving PegIFN monotherapy, five CHC patients receiving PegIFN+ribavirin (dual therapy), five CHC patients receiving PegIFN+ribavirin+telaprevir (triple therapy), and four healthy controls were enrolled in this study. Elemental distribution in erythrocytes was analyzed using in-air microPIXE.
Results and Conclusions: Erythrocyte shrinkage was observed in CHC patients receiving triple therapy. Cl, S, and K dots spread patchily in the erythrocytes of CHC patients receiving monotherapy, and this was more prominent in CHC patients receiving triple therapy. Ca dots formed small dense granules in CHC patients receiving dual and triple therapies. Zn and Cu levels were higher in CHC patients receiving dual and triple therapies. The number of Mn dots was higher in CHC patients receiving triple therapy.
In conclusion, PegIFN, ribavirin, and telaprevir may alter the membrane structure of erythrocytes, thereby contributing to anemia associated with PegIFN-based regimens. Furthermore, derangements in the distribution of Ca may play roles in ribavirin-induced anemia.

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Background: The WISH-type S-form brace, a type of hip brace, has been shown to improve hip function, functional mobility and gait biomechanics in patients with osteoarthritis of the hip.
Aims: The effects of the brace on postural control were evaluated.
Methods: The Cross test using a force plate was performed.
Results: The hip brace showed a direct beneficial effect of improving the maximum excursions of the center of pressure in both the medial-lateral and anterior-posterior directions. The performance in the Cross test of patients using the brace improved in the later phase, indicating an indirect effect of the brace. Interestingly, the brace also exerted a direct effect on the muscle strength of the braced leg in both hip flexion and adduction.
Conclusions: Augmentation of the power output of the adductor and flexor muscles by the brace may support the moment required for resistance against the upper body mass leaning on the braced side and backward, which may allow the excursions to be augmented.

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Background & Aims: The correlation between low serum dehydroepiandrosterone sulfate (DHEA-S) levels and coronary artery disease (CAD) is yet unclear. Therefore, we investigated the correlation between DHEA-S levels and the presence or severity of CAD in middle-aged and elderly men.
Methods: Fifty-six consecutive middle-aged and elderly men who underwent selective coronary angiography were divided into the CAD group (n= 41) and control group (without CAD; n= 15). CAD was defined as≥75% occlusion in≥1 major coronary arteries. Serum DHEA-S, lipid, and plasma glucose levels were determined after a 12-h fast. Coronary artery stenosis severity was estimated using the Gensini score.
Results: DHEA-S levels were significantly lower in the CAD group than in the control group; however, other clinical parameters showed no difference between the groups. An age-adjusted multiple regression analysis revealed that DHEA-S-dependent determinants were significantly correlated with the Gensini score (β=-0.291, p<0.05), but not with other clinical parameters.
Conclusions: Middle-aged and elderly men with CAD may have lower serum DHEA-S levels than age-matched men without CAD, and serum DHEA-S levels may negatively correlate with coronary artery stenosis severity in all men, suggesting a cardioprotective effect of DHEA-S.

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Background and Aim: Oxidative stress is an imbalance between the production and the elimination of oxidant species. In cancer and infection, white blood cells overproduce reactive oxygen species, causing the oxidative stress. In the present study, we evaluated the oxidative stress in patients with cancer, and compared the relationship between the oxidative stress and the number of white blood cells (WBC).
Subjects and Methods: The subjects were head and neck carcinoma patients (HNC) who were treated by chemotherapy (n=10), and blood tests were achieved before and after treatment. Otitis media patients (OM) who had surgery were also applied (n=10). The diacron-reactive oxygen metabolite (dROM), which indicated the concentration of hydroperoxides in serum, was measured as an index of oxidative stress. The biological antioxidant potential (BAP), which indicated the concentration of deoxidized iron ion in serum, was also measured as an index of anti-oxidative status.
Results: The dROM was significantly high in HNC, although dROM in OM was normal. There was no difference in BAP between HNC and OM. In HNC, WBC decreased significantly after chemotherapy, but changes in dROM did not show a particular trend. There was no relationship between them. In OM, WBC tended to increase after surgery, but dROM did not change.
Conclusions: The dROM did not increase after OM surgery, meaning that general anesthesia and surgery did not change the balance of oxidative stress and antioxidant potential. In HNC, a strong oxidative stress was present, as dROM was very high even before treatment. The dROM stayed high, whereas WBC decreased after chemotherapy. Reactive oxygen species in HNC patients might not be produced by WBC.

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Background: Although sedation is required in critically ill patients receiving intensive care, prolonged and excessive sedation can increase delirium risk, potentially impacting the mechanical ventilation time and hospitalization length. Consequently, daily discontinuance of sedation to assess consciousness (Spontaneous Awakening Trial [SAT]) and assessment of readiness for extubation to spontaneous breathing (Spontaneous Breathing Trial [SBT]) are needed.
Objectives: To introduce of SAT/SBT protocol and execute it safely.
Methods: After protocol development and a study session, patients who received SAT/SBT during 6 months beginning in October 2013 were surveyed.
Results: Of the 27 patients who underwent SATs, 18 patients who passed their SATs received SBTs. No unplanned extubation occurred, 2 patients were reintubated within 72 hours, and 2 patients experienced delirium. The duration of intubation was 5 ± 3 days and re-intubation rate was 7.2%.
Conclusion: The implemented SATs/SBTs were performed successfully and safely.

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Purpose: Faced with serving the needs of a super-aging society, the Japanese government is actively seeking to establish a community-based integrated care system. The goal is to shift hospital-based medical and nursing care to home or community-based settings. Medical and nursing personnel need to be educated to meet this social change. The purpose of this study was to clarify the current nursing practice of hospital nurses regarding the process for patients who are discharged to home.
Method: A questionnaire survey was distributed to 720 nurses who worked in a university hospital; 533 responded (response rate 74.0%).
Results: The results showed that half of the respondents thought they were fairly capable at helping patients who were discharged. In order to assist these patients, nurses required knowledge of the patients' living conditions at home and ability to perform discharge coordination and guidance through the discharge process.
Conclusion: Collaboration with the discharge support center and seminars about utilization of social resources are especially needed to enhance the nurses' ability to smoothly assist patients as they are discharged from the hospital into community-based settings.

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Purpose: The purpose of this study was to evaluate a continuing education program for visiting nurses supporting self-care of diabetic patients and their families.
Method: The attendees evaluated the program through a questionnaire, and an expert meeting of 11 specialists (including four nurses certified in either diabetes nursing or home vising nursing) assessed the results. The questionnaire contained questions on usefulness of the content and learning areas including knowledge, emotion, and psychomotor issues, and also included a section for attendees to comment freely.
Results: Forty-one questionnaires were answered from 2 sessions. The free comments showed that nurses understood contents of program. Furthermore, nurses shared the same emotions and problems as good points off this program. We discussed the results of the questionnaire survey by the expert meeting. We concluded that the program was effective in educating home visiting nurses, who support the self-care of people with diabetes and their families by modifying four things about time and lecture content in this program.
Conclusion: The education program of diabetes nursing for home visiting nurses is a highly useful educational tool.

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Acquired hemophilia A (AHA) is a rare coagulation disorder caused by autoantibodies against coagulation factor VIII (FVIII). We report herein a case of AHA successfully treated by sequential treatment with rituximab and steroid. A 78-year-old man was hospitalized with severe anemia due to hemorrhagic gastric ulcer. He received repeated sessions of endoscopic hemostatic therapy, but the bleeding remained uncontrolled. On laboratory examination, APTT was prolonged. He was referred to our hospital for evaluation of his coagulation abnormality. FVIII activity was markedly decreased to 2.0% and FVIII inhibitor was positive (34.9 BU/ml), by which the diagnosis of AHA was made. Because of the actively hemorrhaging gastric ulcer, we opted for induction therapy with rituximab as opposed to high-dose steroid therapy. FVIII inhibitor titer was markedly reduced after four times of weekly rituximab administration, but remained positive. We added steroid therapy (prednisolone 0.5 mg/kg) after endoscopically confirming hemostasis of the gastric ulcer. He finally achieved complete remission of AHA with undetectable inhibitors at 85^th hospital day. We tapered prednisolone gradually without relapse of AHA. His gastric ulcer was also healed.

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Robotic surgery for total prostatectomy was introduced to our hospital in November 2011. We report the introduction of robotic surgery for colorectal cancer in our hospital. We visited three main hospitals in Japan to observe robotic surgery. Our group, which included a nurse and a medical engineer, then went to Shizuoka Cancer center to study robotic surgery and acquired certification. We obtained approval from our Ethical Review Board to perform colorectal cancer with robotic surgery. The patient was a 67 year-old male. On endoscopic submucosal dissection of a lesion in the sigmoid colon, there was SM invasion greater than 1,000 μm, with vertical margin involvement. We invited an experienced instructor to supervise the surgery. Six ports were inserted into the abdominal cavity. We performed D3 dissection with preservation of the left colic artery; the sigmoid colon was mobilized and rectum was dissected supported by robotic surgery. Operative time was 6 hours 54 minutes. Four hours 43 minutes was with robotic support. Blood loss was 10 ml. The patient was discharged on postoperative day 8 without complications.

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Although natural-orifice specimen extraction is increasingly performed, no report of total gastrectomy with transvaginal specimen extraction has yet been published. This is the first report to apply this procedure to treat gastric cancer. We applied this procedure to four postmenopausal female patients who previously underwent vaginal delivery. They underwent laparoscopic total gastrectomy and D1+ lymph node dissection for gastric cancer. After posterior colpotomy was performed, an Alexis bundle wound protector with a cap was placed to expand and protect the vaginal incision. The resected specimens were retrieved via the vaginal route. Reconstruction was performed using the intracorporeal Roux-en-Y method. Totally laparoscopic total gastrectomy with transvaginal specimen extraction was successfully accomplished in all patients. No patient developed complications associated with this procedure. We achieved good cosmetic outcomes and patients experienced little pain. Totally laparoscopic total gastrectomy with transvaginal specimen extraction may be safe and feasible in a selected group of patients with gastric cancer.

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A-50-year-old man with lower abdominal pain visited the hospital. Laboratory tests showed a slight inflammatory response. Contrast-enhanced computed tomography revealed intestinal dilatation and local narrowing of the intestine in the left lower quadrant. Conservative therapy using an ileus tube failed to relieve symptoms, necessitating laparotomy seven days after admission; an intramesosigmoid hernia was diagnosed. The strangulated ileum was preserved, and the hernia orifice sutured closed. The patient was discharged on the 16th day after surgery. Intramesosigmoid hernia is a rare condition, so we report our experience along with a literature review.

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