To determine pre‑school speech outcomes after palatoplasty in the Oral and Maxillofacial Surgery Department of Yamaguchi University Hospital, we performed speech evaluation and nasometry examination.

As subjects, 8 boys and 11 girls with cleft palate who visited our department from August 2006 to November 2017 and underwent palatoplasty were included. Nasometry was performed with assessment of the presence or absence of hypernasality and nasal emission, and the presence or absence and type of abnormal articulation.

Four patients（21.1%） showed hypernasality, and among abnormal articulations, glottal stop and nasopharyngeal snort were observed in 2（ 10.5% ） and 6（ 31.6% ） patients, respectively. Six patients （ 31.6% ） had nasal emission. Mean nasalance scores were 54.3% and 20.9% for patients with and w ithout hypernasality, 40.2% and 22.2% for patients with and without nasal emission, and 42.4% and 17.4% for patients with and without abnormal articulations. Among the patients with abnormal articulations, mean nasalance scores were 54.5% for patients with glottal stop and 38.3% for patients w ith nasopharyngeal snort.

Thus, nasometry can be considered as a useful examination to reflect nasopharyngeal closure function and articulatory function in patients with cleft palate after palatoplasty.

Medical record keeping is an important basic medical skill in clinical clerkship. To support and continuously evaluate this learning, we devised a peer review education program for medical records. During clinical clerkship, after the medical records written by the medical students were checked regarding each evaluation item and the outline, the students were provided guidance for improvement. The evaluations were conducted twice, and a questionnaire survey was administered to the students at the end of the clinical clerkship. The results showed an increase in scores in all evaluation items, in particular, "clinical reasoning and diagnostic process" and "plan". In the questionnaire, this peer review education was generally well received. It was suggested that current clinical practice does not provide sufficient opportunities to learn clinical inferences, assessments, and plans, but the multiple sessions of peer review education could improve these skills. Our peer review education system was useful for the practice of medical record keeping skills.

This study aimed to examine the association betw een ward nurses' psychological safety perceptions for their teams and gender, age, years of experience, and clinical department of the ward. 31 JPSN（ Japanese version of Team Psychological Safety for Nursing Professionals： JPSN） is used to measure psychological safety perceptions for the team and consists of seven items on a seven point Likert scale. We conducted a secondary analysis of data collected from a nationwide web based survey of nurses in the ward nursing teams in December 2020. The differences in means were analyzed by t‑test for gender. Age, years of experience, and ward department were each divided into several groups. One‑way ANOVA was then conducted. The results suggest that ward nurses' psychological safety perception for the team tends to be lower than that of nurses in other countries and general workers. There were no significant differences in the scores of psychological safety perception for the team among the variables of age, gender, years of experience, and ward department. Ward nurses' psychological safety perception for the team is an important factor in promoting effective nurse‑team interaction. Therefore, it is necessary to examine the relationship with other factors to establish psychological safety perceptions of the team in Japan.

A 60‑year‑old man was noted to have pancytopenia w ith hemolysis. The presence of paroxysmal nocturnal hemoglobinuria（ PNH）‑type erythrocytes, dysplasia of blood cells in the bone marrow, and cytogenetic abnormalities of del（ 13q） led to the diagnosis of PNH with myelodysplastic syndrome. We initiated eculizumab 2 years after the diagnosis of PNH and switched to ravulizumab. Although good inhibition of hemolysis was obtained for some time, extravascular hemolysis worsened and transfusion dependence increased. Seven years after the diagnosis of PNH, a splenic infarction occurred and the patient was treated with unfractionated heparin（ UFH）， followed by apixaban. One month later, he was retreated with UFH because the splenic infarction had worsened. Two days after the initiation of UFH, acute myocardial infarction and renal infarction occurred sequentially. Considering heparin‑induced thrombocytopenia（ HIT）， we changed UFH to argatroban； however, further cerebral infarction occurred and the patient died. Since the platelet count decreased during the initial administration of UFH, thrombosis occurred after the re administration of UFH, and the HIT antibody was positive, it was possible that HIT was the cause of multiple thromboses. UFH is often used as anticoagulant therapy for thrombosis in PNH patients； however, HIT should be considered as a complication if thrombocytopenia or thrombosis occurs during the clinical course.