Yonago acta medica最新文献

Driveline infection in patients with implantable left ventricular assist devices (LVAD) remains common and crucial. Once a driveline exit-site infection reaches the LVAD component, radical treatment such as LVAD exchange may become necessary, although the clinical results are unsatisfactory. The Jarvik 2000 device, which utilizes a postauricular cable, allows the driveline to exit the body behind the ear (postauricular) instead of through an abdominal site. Here, we report the case of a patient who had awaited heart transplantation for more than 6 years and had a critical driveline infection that almost reached the LVAD pump. The patient underwent a pump exchange using the Jarvik 2000 with a postauricular cable, with excellent results. It is a useful replacement option for patients with abdominal driveline infections, owing to its small pump pocket and the availability of an alternative pathway for the driveline.

Psoriasis is a common chronical inflammatory skin disease with a prevalence of 2%-4% worldwide. In contrast, porocarcinoma is a relatively rare cutaneous neoplasm and an associated localization of both lesions is rare. Here, we describe the first case of porocarcinoma in a patient with psoriasis. A 71-year-old Japanese man was referred to our clinic for evaluation of nodule within a keratotic plaque of 20-years history on his leg. Histopathological examination showed that the plaque revealed acanthosis with regular elongation of rete ridges, agranulosis and the presence of Munro microabscesses. In contrast, massive proliferation of atypical poroid cells and a few cuticular cells in the dermis were seen in the nodule. We speculated that it is likely the porocarcinoma was caused by the elevated risk of skin cancer due to chronic inflammatory process of psoriasis itself in our patient.

Papillary glioneuronal tumor (PGNT) is a low-grade biphasic tumor that is composed of glial fibrillary acidic protein (GFAP)-positive glial cells and synaptophysin-positive neurons. We report a case of PGNT occurring in the right occipital lobe of a 48-year-old woman who presented with acute headache and left homonymous hemianopsia, the latter of which was difficult to distinguish from malignant brain tumors because of peritumoral brain edema, intratumoral hemorrhage, and intraoperative fluorescence staining. PGNT should be included as one of the differential diagnoses in cases where the tumor shows hemorrhagic change despite decreased perfusion in arterial spin labeling MRI.

Background: Transcatheter aortic valve implantation (TAVI) has recently become more common as a treatment for severe, symptomatic aortic stenosis (AS). Cognitive impairment (CI) is strongly associated with the prognosis of TAVI patients. However, some cognitive assessments currently in use are difficult to perform routinely in the clinical setting. To easier CI evaluation, we investigated whether CI using the clock-drawing test (CDT), one part of the Mini-Cog, affects the postoperative prognosis of TAVI patients with AS.

Methods: The present study enrolled 52 patients (median age, 85 years; 28.8% male) who underwent TAVI and were discharged between 2019 and 2021. The outcome was readmission for all causes within one year of discharge and patients were grouped according to whether they were readmitted or not. Cognitive function was assessed using the Mini-Cog which combines verbal playback and CDT.

Results: Of the 52, 11 patients (21.2%) comprised readmission group, including 4 (36.4%) each for fracture and infection, and 1 (9.1%) each for heart failure, subdural hematoma, and pneumothorax. Median Mini-Cog score was lower in the readmission group than in the non-readmission group (4 vs. 5; P < 0.05). The frequency of Mini-Cog score < 3 (indicative of CI) and CDT failure were significantly higher in the readmission group than in the non-readmission group, respectively (46% vs. 7%, P < 0.01) (46% vs. 12%, P < 0.05). Both of Mini-Cog score < 3 and CDT failure were independently associated with readmission. The areas under the curve showed CDT was an indicator of readmission with similar accuracy to the Mini-Cog score < 3. Kaplan-Meier curves showed significant differences in readmission after 1 year between the 2 Mini-Cog groups with scores of < 3 or ≥ 3 points and CDT failure and success.

Conclusion: The CDT may be a very easy and simple screening assessment of preoperative CI with readmission within one year after TAVI.

A 71-year-old woman was referred to our clinic with a 2-month history of pain and exudate from her right first toe. Physical examination revealed a subungual nodule that elevated the nail plate and produced distal onycholysis. We performed onychectomy and removed the nodule. A histopathological specimen from the nodule showed hyperkeratosis and acanthosis in the epidermis, papillomatosis and dilated vessels in the superficial dermis, and aggregation of eccrine glands in the mid-dermis. Based on these findings, a diagnosis of eccrine angiomatous hamartoma (EAH) was made. EAH is a rare cutaneous hamartoma that is histologically characterized by proliferation of eccrine glands and vascular components. To our knowledge, EAH occurring in the subungual region has not been reported. The pathogenesis of acquired EAH has not been completely elucidated, but several cases have been reported to be caused by external stimuli. Although the subungual area generally has no sweat glands, our case suggests that a traumatic stimulus can induce EAH anywhere including regions where sweat glands are normally not found.

Background: In the daily routine of acute care wards, where priority is given to patients with severe illnesses and those who require urgent care, working with and supporting the decision making of terminally ill patients can be challenging.

Methods: This study aimed to clarify the perceived difficulties of and learning needs among acute care ward nurses providing end-of-life care during the COVID-19 pandemic. In order to perform analyses by years of clinical experience, we conducted semi-structured interviews with both novice and experienced nurses. Participants were nurses working in the acute care ward of hospitals in the Kansai area.

Results: We interviewed 31 nurses who agreed to cooperate, including 18 novice/advanced beginner nurses and 13 proficient/expert nurses. Perceived difficulties were categorized into four main groups for novice/advanced beginner nurses: , , , and . Perceived difficulties were categorized into four main groups for proficient/expert nurses: , , , and . Perceived learning needs were categorized into three main groups for novice/advanced beginner nurses: , , and . Perceived learning needs were categorized into three main groups for proficient/expert nurses: , , and .

Conclusion: Novice/advanced beginner nurses felt anxiety and confusion, and were overwhelmed with how to care for terminal patients. Proficient/expert nurses were able to think about how to make patients and their families feel better, and were able to think specifically about post-mortem care. Many proficient/expert nurses were thinking not only about patient care but also about patients' room environment and how to spend time with their families. They sought learning opportunities regarding angel care, including methods of teaching it and basic techniques for performing it, and realized that information sharing within wards, chain of command within the hospital, information exchange with other hospitals, and inter-hospital collaboration were all important during COVID-19 pandemic.

Background: Achieving gender equality is an important goal in Japan. Consequently, this study aimed to examine gender differences in a series of associations between job demands or resources and job performance mediated by work engagement (WE) in the motivational process of the job demands-resources model.

Methods: This study recruited 671 non-manual workers (260 men and 411 women) through an online survey. The measured variables were demographic information, job demands or resources, WE, and job performance. Multiple-group structural equation modeling was used to analyze the data.

Results: Regarding the level of job demands or resources and WE, no significant difference was observed between men and women. Whereas, job performance was significantly higher in women than in men. Additionally, multiple-group structural equation modeling indicated that the model that imposed on all path coefficients for equality constraints had a better fit, and consequently, no gender differences.

Conclusion: Although the motivational process indicated no gender differences, job performance was higher in women than in men due to the management of a gender-equal and friendly work environment. Further comprehensive examinations, that use other variables not included in the present study, are required to understand women's high job performance.

Background: Voriconazole therapy for fungal infections usually continues for several years and is often administered on an outpatient basis. Maintaining the voriconazole plasma concentration in the therapeutic range is highly important for effective therapy; however, it is difficult to obtain sufficient information to assess the voriconazole concentration in outpatients. Therefore, we developed a method to simultaneously measure the plasma concentrations of voriconazole and its major metabolite, voriconazole N-oxide, to obtain rapid results after outpatient blood collection and before medical consultation and to attain a better understanding of adherence and the drug-drug interactions of voriconazole.

Methods: Fifty microliters of patient plasma was deproteinized with methanol, injected into the liquid chromatography-tandem mass spectrometry system, and purified using an online column. Separation was achieved on an InertSustain C18 column (2.1 mm id × 50 mm, 2 μm) with a mobile phase of 30:70 (0.1% formic acid in water:methanol) at a flow rate of 0.2 mL/min. Detection was performed using electrospray ionization in positive ion multiple reaction monitoring mode.

Results: The analysis time was 4 min. The calibration curve was linear, in the range of 0.1 μg/mL to 20 μg/mL for voriconazole and 0.05 μg/mL to 10 μg/mL for voriconazole N-oxide, with a coefficient of determination at R² > 0.999.

Conclusion: There is no need to dilute the patient's plasma even if the concentration of voriconazole is near the upper limit of measurement. Furthermore, the short measurement-time could immediately inform physicians of the patient's voriconazole concentration during ambulatory medical care. Simultaneous measurement of voriconazole and voriconazole N-oxide may also be useful for the immediate adjustment of voriconazole dosage in outpatients and would help us to understand adherence or drug-drug interactions in plasma voriconazole concentrations.

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.

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.