[in Japanese]

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[in Japanese]

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Delirium exacerbates the prognosis of ICU patients but is likely to be overlooked without an appropriate screening being performed. In Japan, however, there exists no verified ICU delirium evaluation method available to the medical staff other than psychiatrists. Therefore, we verified the validity and reliability of the Japanese version of the CAM-ICU Flowsheet at two ICU facilities in Japan. Using the evaluation of the DMS-IV-TR in the psychiatrists group as the standard criteria for delirium diagnosis, we compared the evaluation of the Japanese version of the CAM-ICU Flowsheet between the research nurses group and the staff nurses group. We performed a comparative analysis with 82 patients and found that the prevalence of delirium was 22.0% and the RASS level was ranging from -0.33 to -0.28. As a result, the Japanese version of the CAM-ICU Flowsheet showed the sensitivities of 78% and 78% and the specificities of 95% and 97% to the DSM-IV-TR, respectively. The degree of coincidence between the Japanese versions of the CAM-ICU Flowsheet turned out to be：κ=0.81. Thus, the Japanese version of the CAM-ICU Flowsheet was proven to be available as a tool for the ICU delirium evaluation with validity and inter-rater reliability for surgical ICU patients.

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Although delirium exacerbates the prognosis of ICU（Intensive Care Unit）patients, there exists no verified ICU delirium evaluation method in Japan. Therefore, we conducted verification of the validity and reliability of the Japanese version of ICDSC（Intensive Care Delirium Screening Checklist）at two ICU facilities in Japan. Using the evaluation of the DMS-IV-TR（Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision）in the psychiatrists’group as the standard criteria for delirium diagnosis, we comparatively evaluated the Japanese version of ICDSC between the research nurses’group and the staff nurses’group. Eighty-two patients were examined and the prevalence of delirium turned out to be 22.0%. We examined the cutoff values of ICDSC and selected three points as the cutoff value for a clinical reason to secure high specificity. In this case, the Japanese version of ICDSC had the sensitivities of 66.7% and 72.2% and the specificities of 78.1% and 71.9% for the DSM-IV-TR, while the inter-rater reliability was estimated by a k-value of 0.55. Thus, the Japanese version of ICDSC proved to be a valid and reliable delirium evaluation tool based on DSM-IV-TR as well as a tool available for the retrospective evaluation of delirium.

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To examine the progress from suspected hearing loss to rehabilitation, we conducted a survey involving 50 patients at the Department of Otolaryngology, Yamaguchi University Hospital, who underwent a hearing test or consultation for rehabilitation and whose progress concerning hearing loss we were able to observe. With regard to the 14 patients who had received hearing screening for infants, their rehabilitation had started at less than 1 year old regardless of the degree of hearing loss. Concerning the 26 patients who had not received hearing screening, those with severe of excessively severe hearing loss had started their rehabilitation at an average age of 21 months old, while patients with slight or moderate hearing loss had stated their rehabilitation at an average age of 4 years and 9 months old.Next, we assessed the speech recognition and language development of the 19 patients we were able to observe over a long period. With regard to the 19 patients who were assessed using the Wechsler Intelligence Scale for Children-Fourth Edition（WISC-Ⅳ），we observed a correlation between their composite score for the Verbal Comprehension Index（VCI）and that for the Perceptual Reasoning Index（VCI）．

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Objective：Rho-kinase（ROK）-mediated vascular smooth muscle（VSM）contraction plays a pivotal role in cerebral vasospasm（CV）．Previous studies showed that hypercholesterolemia increased sphingosylphosphorylcholine-ROK-mediated VSM contraction. Lipid rafts and caveolae are cholesterol-enriched membrane microdomains that influence signal transduction. In this study, we showed the effect of cholesterol, lipid raft, and caveolae on CV.Methods：Sprague-Dawley rats received a control diet, a cholesterol-diet, or a cholesterol-diet+β-cyclodextrin, which depletes VSM cholesterol, for 8 weeks, and were subjected to SAH model surgery. We used double-hemorrhage SAH model, and CV of basilar artery（BA）at Day5 were measured using cranial window preparations. Total cholesterol levels in the internal carotid artery（ICA）were measured using gas chromatography. The expression of Flotilli-1, a planar raft marker, and Caveolin-1, a caveolae marker, in the ICA were analyzed by western blotting.Results：SAH-induced CV was markedly reversed by intracisternal infusion with Y27632（10μM），a ROK-inhibitor. Whereas the cholesterol-diet increased VSM cholesterol and CV, depletion of VSM cholesterol inhibited CV. The cholesterol-diet also increased Flotillin-1 and Caveolin-1 expression in the VSM. Depletion of VSM cholesterol also inhibited the increasing of Flotillin-1 and Caveolin-1 expression.Conclusions：These results indicate that cholesterol potentiates CV and are compatible with a role for lipid rafts and caveolae in this process.

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This study aimed to clarify and delineate how“the best care for the person”was created using the Pathways to Excellent Nursing Practice（PENP）model that was developed by the author in a previous study. The experience of a nurse in the actual daily child care for her child was analyzed by interpretive phenomenology using the PENP model. The following results were obtained：The mother understood the child from the child’s viewpoint, and developed empathy with the child by linking the child’s expression, the problem/ contradiction in the child’s mind world, and the child’s experience world. Then, the mother set a goal for solving the problem/contradiction in the child’s mind world, and took measures based on the factors in the child’s experience world that produced the problem/contradiction in the child’s mind world. Finally, the mother put the measures into practice with the aim of achieving the goal. The findings of this study can be refined, and should contribute to the development of an education system for creating and offering“the best care for the person”．

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We developed a logbook for bedside teaching two years ago and encouraged students to utilize it in bedside teaching. We wanted students to use the logbooks to record their growth, and to reflect on their past logbooks. We believe it is first necessary to develop in students the motivation for independent learning, so that a busy teacher can efficiently train students despite time constraints. As two years have passed since the introduction of the logbook, we administered a questionnaire survey about the current situation of the logbook to a bedside teaching student and a teacher. For the further improvement of bedside teaching, it is necessary for us to actively refine the logbook and improve it for the sake of both students and teachers.

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Regardless of a doctor’s choice of specialized domain in the future, it is necessary for us to train them in primary care and community medicine to keep their understanding and ability in this regard constant. Therefore, in the previous trial, we introduced community medicine bedside training led by the relevant clinical department’s medical office belonging to the same school, targeting the neighborhood around Yamaguchi University. Subsequently, we reported the training outline and some results gleaned from the student questionnaire. In this new trial, we included the problems regarding training instructions or the university, encountered by the students based on their specialization. While we have managed to address these problems, it was thought that there was a need to establish an even better community medicine training system.

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Abdominal ultrasound revealed a liver tumor in a 46-year-old male during a medical screening, and a hemangioma on contrast-enhanced tomography （CT）and, a pancreatic mass were also found. The patient was then referred to our department for further evaluation and treatment. A 2cm tumor with massive central calcification was observed in the pancreatic tail. Although the contrast enhancement was poor in the arterial phase, the contrast enhancement was equal to that of the surrounding pancreatic tissue in the equilibrium phase. A low signal was displayed on T1-weighted magnetic resonance imaging （MRI），whereas a mildly elevated signal was displayed on T2-weighted MRI. During endoscopic ultrasonography（EUS），the tumor was visualized as a well-defined hypoechoic lesion with central calcification. Considering the above imaging findings, the differential diagnoses of solid pseudopapillary neoplasm（SPN）and neuroendocrine tumor were proposed. We performed endoscopic ultrasound-guided fine-needle aspiration（EUS-FNA）to obtain a definitive diagnosis. Hyperplasia of the tumor cells with small oval nuclei was observed upon histopathological examination. Immunostaining revealed that the tumor was positive for vimentin, CD 10 and β-catenin and negative for chromogranin A. SPN was suspected based on this immunostaining pattern. We performed laparoscopic spleen-preserving resection of the pancreatic body and tail. SPN was ultimately diagnosed during the histopathological examination of the resected specimen.

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A 58-year-old female reported to Yamaguchi University Medical Hospital with a complaint of fatigability. After a detailed examination, she was diagnosed as having myasthenia gravis with thymoma accompanying Graves’disease. She underwent extended thymectomy via bilateral thoracoscopic approach after she had achieved euthyroid status through medication. Soon after the surgery, temporary sinus tachycardia was identified, which was not due to thyrotoxic storm. She had no postoperative respiratory muscle paralysis or crisis due to progression of myasthenia gravis. It has been found that myasthenia gravis is often associated with　autoimmune disease, especially Graves’disease. However, controversy surrounds the best therapeutic strategy in patients with myasthenia gravis and Graves’disease. Our case suggests that medical control of the hyperthyroidism followed by an extended thymectomy via a minimally invasive approach is a treatment option for patients with combined myasthenia gravis and hyperthyroidism.

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In late years, the adaptation of ESD for the early gastric cancer tends to be spread in Japan. According to Japanese gastric cancer treatment guidelines 2010, the early gastric cancer having a negligible risk of lymph node metastasis except absolute indication is decided as the lesion satisfying the expanded criteria. The Doctors performing ESD for the cancer satisfying the expanded criteria positively are not rare. However, we experienced the case that had lymph node metastasis although satisfying the expanded criteria for ESD. The case is female in 40s. Endoscopic examination revealed a type 0Ⅱc tumor of the 10×5mm size in the antrum of stomach, and diagnosed Group5（sig）．It was estimated to be satisfying the expanded criteria for ESD, but the patient hoped to be performed surgery as certain treatment. After surgery, pathological analysis revealed that the gastric cancer had #4d lymph node metastasis although it was 10mm size, UL（-），M, ly0, v0 and satisfied the expanded criteria for ESD. So it is very important thing that we report to patient of the metastasis risk of the cancer satisfying the expanded criteria.

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