Objective: We conducted an action research to investigate whether an ethics conference organized by nurse administrators during clinical practice promoted the ethical sensitivity of the nursing staff and their practice of ethical nursing care.Methods: Based on the research plan, we asked nurse administrators to hold an ethics conference in their nursing areas, and summarize their assessment and unresolved issues after the conference. In addition, we asked them to participate in focus group interviews that were held after the conference. The interview narratives were audio-taped and transcribed verbatim, but information from which an individual could be identified was excluded. Ethical considerations: This study was approved by the institutional review board of Tenri Hospital (approval no. 925). All participants voluntarily joined in the study and their personal information was protected.Results: Nine nurse administrators from four nursing areas participated in the study. Generic categories in conducting an ethics conference for the first time included: the administrators who participated in the study; Selected conference members and limited their number at planning and they; Scheduled not to exceed the time frame, while at the second or later conferences, they; Arranged interprofessional conference and they; Held the conference in response to the requirement of the nursing staff. The participants acknowledged that the nursing staff; Enhanced their ethical sensitivity, they; Changed their attitude toward patients and family, and they; Committed themselves on familiarizing the ethics conference. Over the course of the study, the participants acknowledged their role in; Leading the future direction of nursing care and in; Creating suitable circumstances for the conference to become prevailing. Furthermore, they; Prepared the conference in advance, they; Gave advice to grasp ethical issues, and finally they; Become confident in holding the conference regularly.Conclusion: Ethics conferences organized by nurse administrators promote the ethical sensitivity of the nursing staff and their practice of ethical nursing care. The conference is expected to be held regularly.

Purpose: Percutaneous ablation techniques, including microwave ablation (MWA) and radiofrequency ablation (RFA), are important minimally invasive treatment options for liver tumors. MWA is expected to provide a larger ablation zone than RFA in a shorter time. The aim of this study was to investigate the duration of ablation, the number of punctures, and technique efficacy of RFA versus MWA for hepatocellular carcinoma (HCC) and liver metastasis. Methods: Between January 2014 and December 2018, 208 sessions with 274 tumors (263 HCCs and 11 liver metastases) treated by RFA and 32 sessions with 34 tumors (26 HCCs and 8 liver metastases) treated by MWA were enrolled in this retrospective study. We investigated age, sex, Child-Pugh classification, number, and size of tumors. Technical success (TS), local tumor progression (LTP), size and shape of the ablation zone, number of punctures, and duration of ablation were compared. Postoperative follow-up was performed with imaging studies performed between January 2014 and March 2019. Results: The TS rate was 88.2% for MWA and 92.3% for RFA. The LTP rate after 3 months was 6.7% for MWA and 5.4% for RFA. The LTP rate after 6 months was 15.0% for MWA and 10.7% for RFA. There was no significant difference between MWA and RFA. The number of punctures per tumor was 1.42 ± 0.56 for MWA and 2.76 ± 1.27 for RFA. The duration of ablation per tumor was 10.40 ± 4.26 minutes for MWA and 23.20 ± 10.54 minutes for RFA. Compared with RFA, MWA caused spherical ablation in a shorter time with fewer punctures (P < 0.05). Conclusion: MWA had similar short-term outcomes with fewer punctures and duration of ablation than RFA. MWA has potential as a less invasive treatment for liver tumors.

Subtotal thyroidectomy for Graves' hyperthyroidism is a surgical procedure that leaves a small remnant of the thyroid gland to maintain thyroid function and to avoid lifelong thyroid hormone replacement therapy. In this retrospective study, we evaluated thyroid function after subtotal thyroidectomy for Graves’ hyperthyroidism and the correlation between remnant weight and postoperative thyroid function. Between January 1997 and December 2019, 128 patients who underwent subtotal thyroidectomy for Graves’ hyperthyroidism in Tenri Hospital were enrolled. Fifty-one patients underwent bilateral subtotal thyroidectomy, and 77 patients underwent the Hartley-Dunhilloperation. Operative time and blood loss were significantly lower with the Hartley-Dunhilloperation than with bilateral subtotal thyroidectomy. The median postoperative follow-up time was 59 months (range 6–280 months), and the mean weight of the preserved thyroid remnant was 5.1 g. Persistent or recurrent hyperthyroidism was observed in 17 (13.3%) patients, with a mean duration of recurrence of 53 months (range 2–160 months). Three patients with recurrent hyperthyroidism underwent successful reoperations and persistent postoperative complications were not observed. Hypothyroidism occurred in 84 (65.6%) patients, while a euthyroid state was achieved in 27 (21.1%) patients. Postoperative thyroid function did not differ significantly with the weight of the remnant.

Purpose: To report the successful treatment of rhegmatogenous retinal detachment associated with Harada's disease by surgical resection of subretinal fibrous strands blocking retinal reattachment.Case report: A 63-year-old man presented to another hospital with binocular hyperemia. As binocular vitreous bodies, predominantly in the right eye, were opacified, he was diagnosed with uveitis, and systemic medical evaluation revealed that Harada’s disease underlay the ocular condition. After a sub-Tenon injection of triamcinolone to the right eye, intraocular visibility improved and rhegmatogenous retinal detachment was found. Seven days after vitreous surgery, retinal detachment recurred. As additional surgery was unsuccessful due to wrinkles of the retina, the patient was referred to our hospital. On fundoscopic examination, the original retinal tear was found to be closed, suggesting that subretinal strands had formed that inhibited retinal reattachment. We therefore performed another vitreous surgery to resect the subretinal proliferative tissue, resulting in successful retinal reattachment.Discussion: Association of Harada’s disease with rhegmatogenous retinal detachment has rarely been described. The reason for the rare occurrence of the condition is that as the inflammatory process is limited to the choroid and retinal pigment epithelium in Harada’s disease, vitreous degeneration is unlikely to occur. However, in cases where subretinal strands prevent retinal reattachment despite closure of the original tear, surgical resection of the strands is required. This case represents a rare association of the inflammatory process of Harada’s disease with rhegmatogenous retinal detachment, leading to the formation of subretinal strands that blocked retinal reattachment. Conclusion: Rhegmatogenous retinal detachment associated with Harada’s disease may cause proliferative vitreoretinopathy with subretinal strands despite closure of the original tears, and resection of the subretinal strands may achieve retinal reattachment.

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma, which is included in the low-grade B-cell lymphoma category, comprises 40% of lymphomas that develop in the stomach. Patients may present with non-specific gastrointestinal symptoms, such as epigastric discomfort or nausea, or the disease may be incidentally detected by an upper gastrointestinal series performed as a part of a preventative medical examination. Under endoscopy, the appearance of gastric MALT lymphoma varies, including multiple erosions or ulcers, cobblestone-like mucosa, IIc-type early gastric cancer, or protruding tumor. Lymphoma cells are small to medium in size with centrocyte-like morphology, and infiltrate into and proliferate in the lamina propria of gastric mucosa. The cells are positive for CD20, CD79a, and BCL2, and negative for CD5, CD10, CD23, BCL6, and cyclin D1. Six to 26% of patients have t(11;18)(q21;q21)/API2-MALT1 translocation, which is detected by fluorescence in situ hybridization using biopsy specimens. Around 80% of patients have early-stage disease categorized as stage I or II₁ by the Lugano staging scheme. The prevalence of Helicobacter pylori infection in Japanese patients is 90%. The infection is detected either by endoscopy-based or non-invasive tests. H. pylori eradication therapy is the treatment of choice for patients with H. pylori-positive early-stage disease. H. pylori infection is eliminated at a rate between 67.5 and 92.6% by first-line eradication therapy, and between 83.9 and 98.0% by second-line therapy. The overall response rate of gastric MALT lymphoma ranges between 50 and 80% based on Wotherspoon or GELA histopathological criteria. Many clinical studies revealed t(11;18)/API2-MALT1 to be a biomarker predicting treatment resistance. For eradication treatment-refractory and H. pylori-negative patients, low- to medium-dose radiotherapy is performed. Patients with advance-stage disease, i.e., Lugano stage II₂ or higher or Ann Arbor stage III or higher, receive single-agent rituximab or rituximab plus cytotoxic drugs. However, the watchful waiting policy may be feasible for patients with asymptomatic disease or those with a low tumor burden.