Globally, the elderly population is growing rapidly. The number of elderly people requiring nursing care is expected to increase along with the elderly population. However, the high turnover rate of care workers has caused a labor shortage, which in turn has encouraged further turnover, creating a vicious cycle. Preventing turnover is an important issue not only for the physical and mental health of care workers but also for the quality of nursing care. In particular, Japan has emerged as the world’s first super-aged society, experiencing an increase in the number of elderly people requiring nursing care and a shortage of care workers. This review summarizes the research on factors influencing care worker turnover and intent to leave the profession in Japan. Additionally, workplace interpersonal problems have been shown to be consistently associated with care worker turnover or intention to leave in previous studies that were reviewed.

Invasive pancreatic ductal carcinoma is a representative refractory malignant tumor, and even with the development of early diagnosis and treatment techniques, the treatment outcome has been remarkably poor. Surgical resection is the curative treatment for resectable pancreatic cancer and borderline resectable pancreatic cancer. However, the survival rate in patients with pancreatic cancer treated by resection alone is low because of the high postoperative recurrence rate. In this review article, we report recent studies on perioperative treatment for pancreatic cancer. Perioperative therapy is the addition of chemotherapy or radiation therapy before or after surgery to improve resectability and curative effects. Because it is difficult to cure redsecttable pancreatic cancer by surgery alone, multidisciplinary treatment combined with perioperative adjuvant chemotherapy is the current standard of care. Although perioperative chemotherapy and chemoradiotherapy have been investigated for borderline resectable pancreatic cancer, the effectiveness of preoperative treatment has not been sufficiently proven. Potentially curative pancreatic cancer is treated by surgery plus perioperative therapy; treatment cannot be either alone. We regard the successful completion of surgery and perioperative care as the key to improving treatment outcomes. Therefore, ongoing randomized controlled trials for the treatment of BR-pancreatic cancer are expected to induce further improvements survival outcomes of patients with BR-pancreatic cancer.

Background Chemotherapy-induced nausea and vomiting (CINV) are the most common and distressing adverse events in patients receiving anticancer therapy. Radiotherapy also induces nausea and vomiting, so concurrent chemoradiotherapy-induced nausea and vomiting (CRINV) are significant problems for patients undergoing chemoradiotherapy. Conventionally, three-drug combination therapy with dexamethasone, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, and neurokinin-1 (NK1) receptor antagonist has been used to prevent CRINV induced by concurrent chemoradiotherapy with cisplatin for patients with head and neck cancer (HNC). Nonetheless, CRINV still remains a problem. The effectiveness of adding olanzapine to prevent CINV has been reported, suggesting the efficacy of four-drug combination therapy for CRINV. However, its effectiveness has hardly been reported in patient receiving chemoradiotherapy for HNC.

Methods A total of 109 patients with HNC who received concurrent chemoradiotherapy with cisplatin from April 2014 to March 2021 were included and divided into the following two groups according to antiemetic treatment regimen: the conventional group (Con group; n = 78) who received three-drug combination therapy and the olanzapine group (Olz group; Olz group, n = 31) who received four-drug combination therapy with olanzapine. Acute (0 to 24 h from cisplatin) and delayed (25 to 120 h from cisplatin) CRINV were then compared using the Common Terminology Criteria for Adverse Events.

Results No significant difference in acute CRINV were observed between both groups (P = 0.5761, Fisher’s exact test). However, the Olz group had a significantly lower incidence rate of delayed CRINV over Grade 3 compared to the Con group (P = 0.0318, Fisher’s exact test).

Conclusion Four-drug combination therapy with olanzapine was effective in suppressing delayed CRINV due to chemoradiotherapy with cisplatin for HNC.

Background Delirium is a clinical symptom that can have serious side effects in patients, and it develops acutely and shows reversibility. Postoperative delirium is an important neuropsychological complication after surgery that directly or indirectly affects patients.

Cardiac surgery increases the risk of delirium due to the complexity of surgical procedures, use of intraoperative and postoperative anesthetics and other pharmacologic agents, and possible postoperative complications. This study aims to determine the relationship between the development of delirium and its causative factors after cardiac surgery and its associated postoperative complications, and identify the high-relevance risk factors of postoperative delirium.

Methods The participants comprised 730 patients who were admitted to the intensive care unit and underwent cardiac surgery. The collected data included 19 risk factors based on the patients’ medical information records. As a delirium diagnostic tool, we used the Intensive Care Delirium Screening Checklist, with four or more points indicating delirium. For statistical analysis, the dependent variables were determined based on the presence or absence of delirium, while the independent variables were determined based on the risk factors of delirium. A t-test, χ² test, and logistic regression analysis were performed on risk factors between the two groups—the delirium group and no delirium group.

Results Postoperative delirium was observed in 126 (17.3%) of 730 patients after cardiac surgery. Postoperative complications were more common in the delirium group. Independent risk factors associated with postoperative delirium were identified in 7 of the 12 factors.

Conclusion As cardiac surgery is invasive and affects the development and severity of delirium, efforts and intervention methods are necessary to predict the risk factors for the development of delirium before surgery, and to prevent its occurrence after surgery. In the future, it is necessary to further investigate factors associated with delirium that can be directly intervened.

Background Rapid antigen tests are widely used to diagnose influenza. However, despite their simplicity and short turnover time, the sensitivity of these tests is relatively low, and molecular tests with greater sensitivity are being sought. In this study, we developed and clinically evaluated a protocol for the rapid multiplex testing of influenza A and B, using a rapid real-time PCR system, GeneSoC^®, that is based on microfluidic thermal cycling technology.

Methods The specificity of the developed assay was validated using cultured viral strains of influenza A/B, human metapneumovirus, and respiratory syncytial virus. Analytical sensitivity was evaluated using serially diluted RNA synthesized via in vitro transcription and nasopharyngeal swab samples collected from consecutive patients seeking medical attention for a combination of upper respiratory and general symptoms. Cross-validation of GeneSoC^® based on comparisons with conventional real-time RT-PCR and rapid antigen tests was performed by parallel testing of influenza-positive clinical specimens.

Results The GeneSoC^® assay detected the target sequences of influenza A and B at minimum concentrations of 38 and 65 copies/µL in reaction, respectively. For the analysis of clinical specimens, the positive, negative, and overall agreement between GeneSoC^® RT-PCR and a conventional real-time RT-PCR was in all cases 100%, whereas for the comparison between GeneSoC^® RT-PCR and the rapid antigen test, the agreements for positive, negative, and overall findings were 100%, 90.9%, and 95.7%, respectively. The mean time for completing GeneSoC^® RT-PCR was 16 min 29 s (95% confidence interval, 16 min 18 s to 16 min 39 s).

Conclusion The microfluidic real-time PCR system, GeneSoC^®, has an analytical performance comparable to that of conventional real-time RT-PCR with rapid turnover time, and represents a promising alternative to rapid antigen tests for diagnosing influenza A and B.

Background This study aimed to evaluate the effect of aggressive embolization of side branches arising from the aneurysmal sac before endovascular aneurysm repair.

Methods This retrospective study included 95 patients who underwent endovascular infrarenal abdominal aortic aneurysm repair at Tottori University Hospital between October 2016 and January 2021. Of these, 54 underwent standard endovascular aneurysm repair (conventional group), and 41 underwent coiling of the inferior mesenteric and lumbar arteries before undergoing endovascular aneurysm repair (embolization group). The occurrence of type II endoleak, change in aneurysmal sac diameter, and reintervention rate due to type II endoleak during follow-up were evaluated.

Results Compared to the conventional group, the embolization group had a significantly lower incidence of type II endoleak, more frequent aneurysmal sac shrinkage, and lower aneurysmal sac growth related to type II endoleak.

Conclusion Our results demonstrated the effectiveness of aggressive aneurysmal sac embolization before endovascular aneurysm repair to prevent type II endoleak and the consequent long-term aneurysmal sac enlargement.

Background We compared short-term clinical outcomes between robotic-assisted minimally invasive esophagectomy (RAMIE) and video-assisted thoracic esophagectomy (VATS-E) using propensity score-matched analysis.

Methods We enrolled 114 patients with esophageal cancer who underwent esophagectomy at our institution from January 2013 to January 2022. Propensity score matching was performed to minimize selection bias between the RAMIE and VATS-E groups.

Results After propensity score matching, 72 patients (RAMIE group, n = 36; VATS-E group, n = 36) were selected for analysis. No significant differences in clinical variables were observed between the two groups. The RAMIE group had a significantly longer thoracic operation time (313 ± 40 vs. 295 ± 35 min, P = 0.048), a higher number of right recurrent laryngeal nerve lymph nodes (4.2 ± 2.7 vs. 2.9 ± 1.9, P = 0.039), and a shorter postoperative hospital stay (23.2 ± 12.8 vs. 30.4 ± 18.6 days, P = 0.018) than the VATS-E group. The RAMIE group tended to have a lower rate of anastomotic leakage (13.9% vs. 30.6%) than the VATS-E group, although the difference was not statistically significant (P = 0.089). No significant differences were found in recurrent laryngeal nerve paralysis (11.1% vs. 13.9%, P = 0.722) or pneumonia (13.9% vs. 13.9%, P = 1.000) between the RAMIE group and the VATS-E group.

Conclusion Although RAMIE for esophageal cancer requires a longer thoracic surgery time, it might be a feasible and safe alternative to VATS-E for treating esophageal cancer. Further analysis is needed to clarify the advantages of RAMIE over VATS-E, especially in terms of long-term surgical outcomes.

Background Japanese spotted fever (JSF) is a tick-borne bacterial febrile disease caused by Rickettsia japonica characterized by fever, rash, and occasional death. The number of patients in Japan and the Tottori Prefecture has been increasing over the past 20 years. Most cases were found in Eastern Tottori; however, the distribution of patients has expanded to the Central and Western regions. Ticks carried by wild animals may be the cause, but the prevalence of R. japonica in ticks has not yet been analyzed.

Methods Ticks were collected by flagging-dragging from 16 sites in Tottori, Japan. The ticks were morphologically classified and DNA was extracted. The 17-kDa antigen gene was amplified using nested PCR. PCR amplicons from ticks and JSF patients were sequenced and phylogenetically compared.

Results In total, 177 ticks were collected and identified as Haemahysalis, Ixodes, Amblyomma, and Dermcentor. The Spotted Fever Group Rickettsia (SFGR) was detected in Haemahysalis and Amblyomma spp. using PCR, with positivity rates of 36.8% and 33.3%, respectively. DNA sequencing and phylogenetic analysis revealed that positive ticks harbored R. japonica, P. raoultii, and other Rickettsiae species; however, the patient’s samples were restricted to R. japonica. Similar to the incidence of JSF, the rate of R. japonica-positive ticks was higher in the Eastern region; however, R. japonica-positive ticks were also detected in the Western region.

Conclusion R. japonica sequences had been found in ticks collected in Tottori Prefecture. Ticks harboring R. japonica were found in the Eastern and Western parts of Tottori Prefecture and the sequences were identical to the human cases. Only the R. japonica sequence has been detected in patients with spotted fever symptoms, even though ticks were harboring various SFGRs.

Background Allergic bronchopulmonary mycosis (ABPM) occurs with fungi, other than Aspergillus fumigatus. However, the clinical characteristics of ABPM caused by non-Aspergillus species are unspecified.

Methods We retrospectively reviewed all patients with ABPM who visited to our hospital between April 2005 and December 2020. The causative fungi and clinical characteristics were analyzed. Patients were divided into the Aspergillus group and the non-Aspergillus group.

Results Fourteen patients and five patients were included in the Aspergillus group and the non-Aspergillus group, respectively. Compared to the Aspergillus group, the non-Aspergillus group had a significantly low serum immunoglobulin E level and low forced vital capacity. In addition, the non-Aspergillus group had a lower rate of the requirement for oral corticosteroid treatment and a low frequency of recurrence.

Conclusion Patients with non-Aspergillus ABPM had lower type 2 inflammation than did patients with allergic bronchopulmonary aspergillosis.

Background In Japan, the number of suicides has increased since the coronavirus disease (COVID-19) epidemic. However, only a few studies have examined the trends among individuals who attempted suicide. In this study, we examined the background characteristics and motives of individuals who attempted suicide and visited the emergency room because of suicide-related behavior before and after the spread of COVID-19.

Methods This single-center retrospective observational study collected information from electronic medical records. We included patients who presented to the emergency department of Tottori University Hospital with suicide-related behaviors between May 1, 2017, to August 31, 2022. The period from May 1, 2017, through December 31, 2019, was designated as ‘the period before COVID-19” (before-period), and that from January 1, 2020, through August 31, 2022, was designated as “the period after COVID-19” (after-period). We compared the total number of cases, their background, and motives for suicide-related behaviors between the before- and after-periods.

Results The total number of suicide events was 304. Of these, 182 and 122 occurred during the before-period and after-period, respectively. The incidence of the F3 category of the International Classification of Diseases, 10^th Revision, increased, while that of the F4 and F6 categories decreased during the after-period. The proportion of suicide attempts due to health problems decreased and that of work problems increased during the after-period.

Conclusion The total number of suicide-related behaviors decreased after the COVID-19 pandemic. This may be because patients with psychiatric disorders other than depression and schizophrenia often engage in suicidal behavior through non-fatal methods, such as drug overdose and wrist-cutting, which may have led them to refrain from seeing a doctor. The proportion of suicidal motivation due to work-related fatigue has increased, perhaps because the quality and quantity of work changed significantly due to COVID-19.

Background Pre-discharge home assessment visits for elderly hospitalized patients are conducted by the hospital staff to ensure a smooth transition to home care and are effective in preventing falls and reducing the rehospitalization rates. However, the effect of an application that enables the viewing of videos of the patient’s home activities during the pre-discharge visit on the multidisciplinary professionals who provide services to the patient has not yet been fully clarified.

Methods Multidisciplinary professionals at 23 facilities located in western Tottori Prefecture who used a video-sharing application (Patto-Mie Net) were invited to be interview participants. Those who agreed were interviewed about the usefulness of the application in their work and its effect on multidisciplinary collaboration. A verbatim transcript was made, and thematic analysis was conducted using the qualitative analysis software NVivo.

Results Twenty-eight people participated in the interviews, including nurses, care managers, rehabilitation specialists, care workers, and other social care professions. Fourteen themes and five categories were generated from the analysis: comprehensive information visualization and transferability, identification of changes over time and prognostic prediction, promoting multidisciplinary collaboration, patient and family reality, and disadvantages and concerns.

Conclusion The use of an application that allows video-sharing of a patient’s home movement status during a pre-discharge visit has revealed a variety of benefits for multiple professionals in hospitals and other facilities. In particular, the results were characterized by the psychological closeness between multiple professionals, promotion of interprofessional communication, and sharing of reality, including the psychosocial background of the patient and family.

Background A drain is often placed in the abdominal cavity for postoperative monitoring and early detection of complications such as rebleeding and pancreatic or bile leaks. Since determining the color of the drainage fluid is subjective, an objective method of judging color is needed.

Methods The hemoglobin concentration of the drainage fluid after gastrointestinal surgery was measured using the Hemato Check Module, a newly developed instrument capable of absorbance analysis with an optical sensor. The correlation between the results and those measured by an existing blood count measuring device (XN3000) was investigated.

Results A total of 215 specimens were analyzed in 43 patients. For the correlation analysis, there was a strong positive correlation with a correlation coefficient of 0.884 (P < 0.001). The Hemato Check Module showed a clear proportional error compared to the XN3000.

Conclusion The Hemato Check Module was a convenient and accurate instrument for measuring hemoglobin concentration in waste fluid to determine the presence of blood.

Cesarean section can lead to residual myometrial thickness thinning and cesarean scar syndrome. We report a novel trimming technique for residual myometrial thickness recovery in women with cesarean scar syndrome. Case 1: A 33-year-old woman who developed cesarean scar syndrome (CSS) and abnormal uterine bleeding post-cesarean scar became pregnant following hysteroscopic treatment. The myometrium at previous scar was dehiscent; therefore, a transverse incision was made above the scar. Post-operative uterine recovery failed owing to lochia retention, and developed cesarean scar syndrome again. Case 2: A 29-year-old woman who developed cesarean scar syndrome post-cesarean section became pregnant spontaneously. The myometrium at the previous scar was dehiscent like case 1. Scar repair was performed using a trimming technique during cesarean section; there were no subsequent complications and she conceived again spontaneously. Performing this novel surgical procedure during cesarean section may contribute to residual myometrial thickness recovery in women with cesarean scar syndrome.

Garré’s osteomyelitis, first described by Carl Garré in 1893, is a type of chronic osteomyelitis accompanied by hyperplastic periostitis. This condition affects relatively young patients and occurs in the fibula, femur, and other long bones as chronic non-purulent sclerosing osteomyelitis. Further, reactive periosteal bone formation develops due to chronic irritation or infection. In the maxillofacial region, it often occurs in the first molar region of the mandible due to caries and other similar causes, and it is rarely associated with impacted teeth. Herein, we present a 12-year-old female patient who primarily complained of swelling on the right side of the mandible. Despite taking antibiotics prescribed at local otolaryngologist, the swelling did not completely resolve. Thus, the patient was referred to the Department of Otorhinolaryngology at our hospital, where a dental-related disease was suspected. On a computed tomography scan, radiolucent findings were observed around the germ of the impacted wisdom tooth as well as hyperostosis in the lower jaw. Thus, Garré’s osteomyelitis was suspected. The patient received oral anti-inflammatory treatment by the incision prior to surgery. Thereafter, the tooth germ was enucleated and newly-formed bone, which was laterally located to the cortical bone of the mandible, was removed under the effect of general anesthesia. On computed tomography scan 9 months after the surgery, hyperostosis in the angle of the mandible disappeared. Thereafter, pain and swelling did not recur, and the patient was doing well.

Posterior reversible encephalopathy syndrome (PRES) is characterized by transient vasogenic edema predominantly in supratentorial areas within the posterior circulation regions. Although PRES with only brainstem involvement is quite rare, accurate diagnosis is important because prompt antihypertensive therapy contributes to a favorable outcome. Herein, we report a case with isolated brainstem PRES showing dramatical improvement in an apparent diffusion coefficient (ADC) value of the lesion in magnetic resonance imaging (MRI) after clinical remission. The present case suggests the association between favorable clinical course and complete amelioration on MRI.

Atypical anti-glomerular basement membrane (GBM) nephritis is a slowly progressive characterized by linear deposition of immunoglobulin (Ig) G in the GBM without circulating anti-GBM antibodies or lung involvement. There is no established therapy for this disease, and efficacy of the immunosuppressive treatment is questionable. A few cases of atypical anti-GBM nephritis have been reported after administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine. Classic anti-GBM disease has also been reported after the administration of the second dose of the SARS-CoV-2 vaccine. Herein, we present the case of a SARS-CoV-2 vaccine-induced atypical anti-GBM nephritis that developed after the first dose and was unresponsive to immunosuppressive therapy. A 57-year-old Japanese woman developed edema 11 days after the first dose of the SARS-CoV-2 mRNA vaccine. She developed nephrotic-range proteinuria and microscopic hematuria. Renal biopsy revealed endocapillary proliferative glomerulonephritis with linear IgG deposition. However, electron-dense deposits were not detected on electron microscopy. The patient tested negative for circulating anti-GBM antibodies and was diagnosed with atypical anti-GBM nephritis. Although steroids and mizoribine were administered, the patient’s renal function deteriorated. In conclusion, atypical anti-GBM nephritis may have earlier onset than the classic anti-GBM disease. Given its uncertainty of effectiveness, immunosuppressive agents should be carefully used for SARS-CoV-2 mRNA vaccine-induced atypical anti-GBM nephritis.

Positive thinking is one of the psychological skills that mental training programs aim to help athletes cultivate in order to enhance performance. It has been noted, however, that some athletes do not find positive thinking effective for that purpose. This case report describes a fencing athlete who used positive thinking to cope with negative ruminations prior to a competition and then stopped using positive thinking and engaged in mindfulness. As a result of applying mindfulness, the patient developed the ability to take part in competitions without obsessing and without negative ruminations. These findings show the importance of assessing, in detail, how the psychological skills training used with athletes is affecting their cognition, behavior, and performance and of implementing appropriate interventions based on these assessments.

Congenital nephrogenic diabetes insipidus (CNDI) is a rare disease that results in polyuria due to decreased responsiveness to the antidiuretic hormone in the collecting ducts of the kidney. Without compensation by drinking large amounts of water, dehydration and hypernatremia can rapidly develop. We present a case of a patient originally diagnosed with CNDI who required surgery and a fasting period due to adhesive bowel obstruction. The patient was a 46-year-old man who was originally diagnosed with CNDI. He was prescribed trichlormethiazide but self-discontinued treatment in the process. His normal urine output was about 7,000–8,000 mL/day. He underwent robot-assisted radical cystectomy and uretero-cutaneostomy for bladder cancer. Two years later, he was hospitalized due to adhesive bowel obstruction. A 5% glucose solution was infused, and the dose was adjusted according to the urine volume and electrolytes. An adhesiotomy was performed due to recurrent bowel obstruction in a short period of time. A 5% glucose solution was used as the main infusion during the perioperative period. Once drinking water was resumed after surgery, urinary output and electrolytes were easily controlled. In conclusion, patients with CNDI should be given a 5% glucose solution as the primary infusion, and the infusion volume should be adjusted by monitoring daily urine output, electrolytes, and blood glucose levels. Infusion management is easier if oral intake is initiated as early as possible.

When resecting the internal jugular veins bilaterally in surgery for head and neck cancer, it is necessary to perform neck dissection in two stages or to reconstruct the internal jugular veins in one stage. Reconstruction of the internal jugular vein using grafting or direct anastomosis to the external jugular vein have both been reported. We report the case of a 53-year-old man with accidental injury to the left internal jugular vein after resection of the right internal jugular vein for supraglottic cancer. The left internal jugular vein was damaged near the inflow of the subclavian vein, making vein grafting difficult. Therefore, internal jugular venous return was reestablished by end-to-side anastomosis of the left internal jugular vein to the left external jugular vein system. In this surgical procedure, by incising the internal jugular vein obliquely, it was not necessary to match the calibers of the internal jugular vein and the external jugular vein system, and a smooth hemodynamic body was reconstructed. In addition, we were able to reconstruct the internal jugular vein while preserving blood flow in the external jugular vein system. End-to-side anastomosis of the internal jugular vein to the external jugular system is an option for internal jugular vein reconstruction.

Although rapid, the evaluation of bone marrow (BM) cellularity is semi-quantitative and largely dependent upon visual estimates. We aimed to construct an automatic quantification method using image analysis software. We used hematoxylin and eosin (HE)-stained specimens of BM biopsies and clots from patients who underwent BM examination at Tottori University Hospital from 2020 to 2022. We compared image analysis (Methods A, B, and C) with visual estimates in pathology reports of 91 HE specimens in 54 cases (29 males, 25 females), including 38 biopsy and 53 clot specimens. Cellularity was visually scored as hypocellular (n = 17), normocellular (n = 44), or hypercellular (n = 30). Compared with the visual estimates, intraclass correlation coefficients for Methods A, B, and C were 0.80, 0.85, and 0.88, respectively. The most appropriate values were obtained with Method C which detected both non-fatty and cell nuclear areas.