Background Many studies have addressed chronic dysphagia resulting from chemoradiotherapy for head and neck cancer (HNC) because of its severity, but changes in the swallowing function during chemoradiotherapy has been rarely reported. This study aimed to elucidate the changes in the swallowing function during chemoradiotherapy for HNC.
Methods From April 2018 to July 2020, 20 patients who underwent definitive or postoperative chemoradiotherapy at our hospital for head and neck squamous cell carcinoma were evaluated by flexible endoscopy with the Hyodo scoring system for swallowing, the Penetration–Aspiration Scale (PAS), and the Functional Outcomes Swallowing Scale (FOSS).
Results Assessments at the start of treatment, at 40 Gy, and at the end of treatment yielded these mean values: Hyodo score—0.39, 1.22, and 2.56; PAS—1.00, 1.05, and 1.5; FOSS—0.2, 0.55, and 1.1, respectively. The Dunn multiple comparison test was used for analysis to determine significance (P < 0.05). The Hyodo score and FOSS were significantly increased at the end of treatment versus initial evaluation; however, score was maintained at a tolerable level for oral intake. PAS did not show a significant increase.
Conclusion In conclusion, changes in the swallowing function during chemoradiotherapy for HNC were mild, and swallowing function was maintained at a tolerable level for oral intake.
Background Robotic surgery for rectal cancer is used worldwide, with an increasing incidence of robotic surgeons. Therefore, the most appropriate educational system for next-generation robotic surgeons should be urgently established.
Methods We analyzed 39 patients who underwent robotic rectal surgery performed by a next-generation surgeon with limited experienced in laparoscopic rectal cancer surgery. The dual console system was used in the initial 15 cases, and we assessed short-term outcomes and the learning curve on operative time using the cumulative sum method.
Results The patients were divided into two groups: 15 cases in the early phase, and 24 cases in the late phase. The operative time and surgeon console time were significantly shorter in the late phase than the early phase (P < 0.001). Postoperative complications were more frequently observed in the early phase (P = 0.049); however, the estimated blood loss and length of hospital stay were not significantly different. In the initial 15 cases that using the dual console, the average operative time changing to the expert surgeon was 82 minutes in the first 5 cases, 19 minutes on average in the next 5 cases, and no change occurred in the last 5 cases. The learning curve peaked after 14 cases, plateaued from case number 15 to 23, and decreased in a linear fashion until the final case.
Conclusion Education of a next generation surgeon using a dual console system for robotic rectal cancer surgery was performed safely.
Background The standard treatment for resectable advanced esophageal squamous cell carcinoma in Japan is surgery followed by neoadjuvant chemotherapy, and it is important to predict the effect of neoadjuvant chemotherapy before treatment. Therefore, this study aims to extract conventional blood examination data, such as tumor markers and/or inflammatory/nutritional index levels, that can predict the pathological response of patients with esophageal squamous cell carcinoma to neoadjuvant chemotherapy.
Methods We retrospectively analyzed the medical records of 66 patients with thoracic esophageal squamous cell carcinoma who received neoadjuvant chemotherapy, followed by curative esophagectomy at Tottori University Hospital between June 2009 and December 2019.
Results We demonstrated that the product of the platelet-to-lymphocyte ratio (PLR) multiplied by the cytokeratin-19 fragment (CYFRA) level, which was termed “PLR-CYFRA,” is the most accurate indicator that predicts the pathological response to neoadjuvant chemotherapy, with the highest area under the curve [0.795 (95% confidence interval: 0.665–0.925), P < 0.001] in receiver operating characteristic analyses. Therefore, we divided patients into the PLR-CYFRALow (< 237.6, n = 21) and PLR-CYFRAHigh (≥ 237.6, n = 45) groups and found that the percentage of PLR-CYFRALow was significantly higher in patients with a better pathological response (P < 0.001). Furthermore, patients with good pathological response had significantly better prognoses in terms of disease-specific survival (P = 0.014), recurrence-free survival (P = 0.014), and overall survival (P = 0.032). In the multivariate analysis, PLR-CYFRA was an independent predictor of the pathological response of patients with esophageal squamous cell carcinoma to neoadjuvant chemotherapy (P = 0.002).
Conclusion Pretreatment PLR-CYFRA might be a useful and simple tool that predicts the pathological effect of neoadjuvant chemotherapy in esophageal squamous cell carcinoma.
Background In recent years, the effectiveness of magnetic resonance imaging (MRI)-ultrasound fusion targeted biopsy (MRF-TB) has been widely reported. In this study, we assessed the effect of reduction of the number of systematic biopsy (SB) cores on the cancer detection rate (CDR).
Methods Patients with a high prostate-specific antigen (PSA) level underwent prostate MRI. The Prostate Imaging-Reporting and Data System version 2 (PI-RADS) was then used to rate the lesions. The inclusion criteria were as follows: (1) PSA level between 4.0 and 30.0 ng/mL and (2) patients with one or more lesions on MRI and a PI-RADS score of 3 or more. All enrolled patients were SB naïve or had a history of one or more prior negative SBs. A total of 104 Japanese met this selection criterion. We have traditionally performed 14-core SB following the MRF-TB. In this study, the CDRs of 10-core SB methods, excluding biopsy results at the center of the base and mid-level on both sides, were compared with those of the conventional biopsy method.
Results We compared CDRs of the 14-core and 10-core SBs used in combination. The overall CDR was 55.8% for the former and 55.8% for the latter, thereby indicating that there was no significant difference (P = 1.00) between the two. In addition, the CDRs of csPCa were 51.9% for the former and 51.1% for the latter, which indicated that there was no significant difference (P = 0.317).
Conclusion There was no significant difference in the CDR when the number of SB cores to be used in combination was 14 and 10.
Background This study aimed to examine the effects of nurses’ work–life balance (WLB), job demands and resources, and organizational attachment on their work engagement (WE). The second aim was to shed light on whether the relationships among WLB, job demands, resources, and WE are modulated by organizational attachment.
Methods In total, 425 nurses working in a university hospital responded to the questionnaire. The primary statistical analysis method was hierarchical multiple regression with WE as the dependent variable.
Results In the model in which all variables were applied, affective commitment (AC) (β = 0.41), family-to-work positive spillover (β = 0.25), and number of children (β = 0.13) were found to have a significant association with WE. Family-to-work negative spillover (FWNS) and AC had significant interaction effects. The result suggests that when AC was low, WE tended to decline further due to FWNS; however, when AC was high, WE did not change due to the effect of FWNS.
Conclusion These results confirmed that to improve nurses’ WE, hospital organizations should implement initiatives to facilitate WLB that considers nurses’ household roles. Furthermore, high organizational attachment buffered the home’s negative influence on work, thereby helping nurses work energetically.
Background Postoperative inflammation is associated with cancer progression in several cancers. However, the prognostic significance of postoperative fever remains unclear in gastric cancer patients.
Methods We enrolled 442 patients with a histopathological diagnosis of gastric adenocarcinoma who underwent curative surgery.
Results The mean duration of postoperative fever ≥ 37°C was 8.7 days (range: 0–186 days) and significantly longer in patients with advanced gastric cancer, venous invasion, and open or total gastrectomy vs. patients with early gastric cancer (P = 0.0072), no venous invasion (P = 0.025), laparoscopic gastrectomy (P = 0.027), and either proximal or distal partial gastrectomy (P = 0.0015). Five-year overall survival rates were 69.5% vs. 83.6% in the prolonged postoperative fever group (≥ 6 days of ≥ 37°C) vs. the nonprolonged group (< 6 days of ≥ 37°C), respectively (P = 0.0008). In patients without Clavien-Dindo classification postoperative infectious complications grade ≥ 2, 5-year overall survival was 69.7% vs. 84.0% in patients with prolonged postoperative fever vs. those without, respectively (P = 0.0067). Five-year disease-specific survival was 85.9% vs. 93.1% in patients with prolonged fever vs. those without, respectively (P = 0.041). Multivariate analysis indicated that postoperative fever was an independent prognostic indicator.
Conclusion Postoperative fever ≥ 37°C duration may be useful in predicting prognosis in gastric cancer patients.
Background Drought has been a considerable problem for many years in northern Bangladesh. However, the health impacts of drought in this region are not well understood.
Methods This study analyzed the impact of drought duration and severity on select causes of mortality in northern Bangladesh. Rainfall data from three meteorological stations (Rangpur, Dinajpur and Nilphamari) in northern Bangladesh were used to assess drought and non-drought periods, and the Standardized Precipitation Index was used to categorize mild, moderate, severe, and extreme drought. Mortality data from 2007 to 2017 for the three areas were collected from the Sample Vital Registration System, which is a survey of 1 million people. The generalized linear model with Poisson regression link was used to identify associations between mortality and the drought severity and 1-month preceding SPI.
Results Only severe and extreme drought in the short-term drought periods affected mortality. Long-term drought was not associated with natural cause mortality in Rangpur and Nilphamari. In Dinajpur, mild and moderate drought was associated with circulatory- and respiratory-related mortality.
Conclusion The impact of drought on mortality varied by region. This study improves our understanding of how droughts affect specific causes of mortality and will help policy makers to take appropriate measures against drought impacts on selected cause of mortality. Future research will be critical to reduce drought-related risks of health.
Background Enhancement of reflective ability leads to improved nursing practice and individual growth. This study aimed to develop a reliable, validated scale that can effectively assess the reflective ability of clinical nurses.
Methods Study participants were 1,872 nurses. We developed an anonymous self-administered questionnaire consisting of 33 original scale items and used it to conduct a survey. The scale was developed based on a construct validity study using item analysis, exploratory factor analysis, and confirmatory factor analysis. Reliability was estimated with Cronbach’s α values. Criterion-related validity was assessed using Pearson’s correlation analysis.
Results There were 1,292 responses (response rate, 69.0%). Responses from 1,262 subjects with no missing data were analyzed (valid response rate, 97.7%). Based on the item analysis and exploratory factor analysis, we developed a trial scale model with 3 factors and 25 items. We named the first factor (Factor 1) “Recall Their Own Nursing Practice,” the second factor (Factor 2) “Reflect on Their Own Nursing Practice” and the third factor (Factor 3) “Expand Their Own Nursing Practice”. This model was modified based on modification indices from the confirmatory factor analysis. A model with 3 factors and 19 items was developed. It had acceptable fit indices (goodness of fit index = 0.914; adjusted goodness of fit index = 0.890; comparative fit index = 0.949; root mean square error of approximation = 0.070). Cronbach’s α coefficients were 0.962 for all scale items, 0.922 for Factor 1, 0.918 for Factor 2, and 0.885 for Factor 3. The correlation coefficient between the model and the Professional Identity Scale of Nurses was 0.506 (P < 0.01).
Conclusion We developed a reflective ability scale consisting of 3 factors and 19 items. We demonstrated its construct validity, reliability, and criterion-related validity. This scale can effectively assess the reflective ability of nurses.
Recent studies have shown that complete lymph node dissection (CLND) performed immediately did not improve the overall survival in patients with sentinel lymph node (LN)-positive melanoma. According to these results, nodal observation with ultrasonography becomes standard. However, it still has some limitations for detection of metastatic LNs. A 74-year-old woman was diagnosed with acral lentiginous melanoma of her left sole. The sentinel LN was positive for metastasis, but she refused CLND. Sixteen months after operation, ultrasonography showed an abnormal LN in the inguinal region. There was no other abnormal LNs around the LN. We resected the abnormal LN. The resected LN was black in color, and the adjacent LN that showed normal appearance in ultrasonography was also black. A recent study showed only 6.6% sensitivity in preoperative ultrasonographic detection of metastatic melanoma in a LN. We should keep in mind the limitation of ultrasonography for detection of a metastatic LN.
Gorham-Stout disease, a rare and intractable disease of unknown etiology, causes systemic bone lysis and replacement with lymphoid tissue. Here, we report a case of Gorham-Stout disease with cerebrospinal fluid leakage in a 16-year-old boy. The patient complained of nasal discharge, right ear obstruction, fever, and headache. A computed tomography scan of the head showed osteolysis around the right internal carotid artery, vestibule, and cochlea and osteolytic changes in the left parietal bone. It was suggested that the patient had bacterial meningitis owing to the leakage of cerebrospinal fluid from the fistula caused by the temporal bone osteolysis. He was treated with meropenem, and a transmeatal fistula closure and a bone biopsy of the left parietal bone were performed. Intraoperatively, osteolysis was observed on the promontory and around the internal carotid artery. The fistula was closed by dense filling and compression around the fistula, in the middle ear cavity, and in the external auditory canal. The symptoms disappeared after the surgery. Bone biopsy showed the presence of a lymphangioma, and Gorham-Stout disease was diagnosed. Prophylactic bisphosphonate therapy was initiated. A 4-year follow-up revealed no progression of the disease.