Nagoya Journal of Medical Science最新文献

The quality of care in care facilities for older adults varies according to the employees' satisfaction level. This study aimed to clarify the relationship between the level of support from supervisors and colleagues and job satisfaction among nurses working in care facilities for older persons. Using a cross-sectional design, we analyzed the responses of 295 nurses in long-term care facilities in Japan to a questionnaire survey. The surveyed items included the nurses' satisfaction with their current job (the dependent variable), and the degree of support from supervisors and colleagues. Of the 295 nurses, 166 (56.3%) were satisfied with their nursing jobs. Additionally, 125 (42.4%) nurses had low support from both supervisors and colleagues, 110 (37.3%) had high support from either supervisors or colleagues, and 60 (20.3%) had high support from both. There was a positive association between support from supervisors and nurses' satisfaction. Furthermore, based on the criterion of low support from supervisors and colleagues, high support from either or both was significantly associated with nurses' satisfaction (an odds ratio of 2.04 in the case of support from either and 4.02 in the case of support from both). These results suggest that there should be strategic hiring and training of managers who can support staff, as well as the strengthening of teamwork.

Neuroendocrine tumors (NETs) are a heterogenous group of neoplasms originating from neuroendocrine cells, most frequently found in the gastrointestinal tract and pancreas. A defining feature of NETs is the overexpression of somatostatin receptors (SSTRs), particularly subtype 2 (SSTR2), which is the primary target for both diagnostic imaging and therapeutic interventions. Peptide receptor radionuclide therapy (PRRT) using ¹⁷⁷Lu-DOTATATE, a radiolabeled somatostatin analog, has emerged as a transformative alternative for patients with advanced or progressive well-differentiated NETs. Considering that SSTR expression is also present in various other tumors-including pheochromocytomas, paragangliomas, meningiomas, and medullary thyroid carcinomas-there is increasing interest in expanding the use of PRRT to other SSTR-positive malignancies. This review aimed to present evidence, explore ongoing clinical research, and highlight emerging directions for ¹⁷⁷Lu-DOTATATE therapy beyond gastroenteropancreatic NETs.

Distraction osteogenesis can induce substantial skeletal tissue regeneration; however, the treatment duration is long, making the procedure suboptimal for clinical care. Rho-associated coiled-coil-containing protein kinase inhibitors might promote bone generation in distraction osteogenesis and shorten treatment durations. However, the relationship between Rho-associated coiled-coil-containing protein kinase inhibitors and distraction osteogenesis levels has not been described. In this study, we focused on osteoblasts and osteoclasts, which are essential for bone remodeling and regeneration. Proliferation assay, boyden chamber, and wound healing assay were performed on MC3T3-E1 and RAW264 cells. Osteogenic differentiation assay was performed on MC3T3-E1 cells, and osteoclast differentiation assay was performed on RAW264 cells. Samples collected from distraction osteogenesis model mice were subjected to micro-computed tomography analysis and tissue staining. We found that Y-27632, a Rho-associated coiled-coil-containing protein kinase inhibitor, promoted cell motility and affected cell differentiation and bone differentiation in MC3T3-E1 preosteoblast cells. We also found that Y-27632 promoted cell motility and osteoclast differentiation in the osteoclast precursor RAW264 cells. In vivo experiments showed that the local administration of Y-27632 in a mouse distraction osteogenesis model promoted bone formation and increased the number of osteoblasts and osteoclasts in the distraction osteogenesis gap. These findings demonstrate that Y-27632 promotes bone formation in a mouse distraction osteogenesis model. Collectively, the study findings suggest that Y-27632 can be used as a therapeutic agent to promote distraction osteogenesis healing.

Lymphedema is the swelling of tissues caused by lymphatic stasis. Intermittent pneumatic compression (IPC), a treatment device for lymphedema, improves lymphatic flow using multiple donut-shaped air chambers with graduated compression from the distal. However, the lymphatic pathway has complicated three-dimensional networks; thus, a simple donut-shaped air chamber cannot adapt to the anatomy. A new pneumatic lymphatic drainage (PLD) device consisting of multiple round air chambers located according to the lymphatic pathways was collaboratively developed with a company. The device's air chambers simulate a therapist's manual lymphatic drainage (MLD) movements; however, the efficacy of this novel PLD is unknown. This feasibility study evaluated the lymphatic flow change by lymphoscintigraphy under PLD in 18 lower limbs with lymphedema and showed that the PLD enhanced lymphatic flow, especially in limbs with mild lymphedema. Previous reports have shown that in patients with lymphedema, improving lymphatic flow requires IPC with a high pressure (~100 mmHg). Although the PLD in this study only utilized mild pressure (50 mmHg) for 10 min, the tracer injected into the distal leg moved stably to the inguinal region. MLD promotes flexible lymphatic flow in response to anatomical variations; however, technical heterogeneity, labor costs, and other problems exist. PLD that can imitate MLD would solve these problems derived from human power.

Recently, customer harassment has attracted considerable attention in various professional fields. Home visits are the basis of public health nurses' activities, but there are few reports on customer harassment during home visits. This study clarified the current situation and factors related to verbal abuse and physical violence experienced from residents during public health nurses' home visits. Data were collected from 80 individuals through a mailed survey of 154 public health nurses employed at 17 health centers in Gifu Prefecture. The survey utilized anonymous and self-administered questionnaires (response rate, 51.9%). The analysis showed that 80.0% of the participants had experienced the verbal abuse by residents during home visits, and 16.3% had experienced the physical violence. Result of logistic analysis, those who had experienced verbal abuse were approximately 10 times more likely to experience physical violence (adjusted odds ratio [AOR]=9.95; 95% confidence interval [CI]=2.49-39.79). Additionally, it was suggested that a factor associated with verbal abuse was "the number of months from starting work until visiting alone." In contrast, factors associated with physical violence included "total years of experience as a public health nurse," "highest level of education," "qualifications," "type of work," and "experience outside of public health center or health center."

This study evaluated the effects of a cycling intervention on glucose homeostasis, lipid profile, and body composition in individuals with insulin resistance and excess body weight. Seven women participants completed a 12-week supervised cycling program (20-30 min/day, 3 days/wk). Body composition assessments and biochemical analyses, including oral glucose tolerance tests, triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and non-high-density lipoproteins, were conducted pre- and post-intervention. Paired t-tests and Hedge's g assessed changes in body composition, lipid profile, and homeostatic model assessment for insulin resistance (HOMA-IR), while a 2×4 repeated-measures analyses of variance (ANOVA) analyzed exercise- and time-related effects on glucose and insulin. Post-intervention, significant moderate reductions were observed in body fat mass (p = 0.020, g = -0.52), body fat percentage (p = 0.006, g = -0.55), visceral fat area (p = 0.005, g = -0.64), and waist-to-hip ratio (p < 0.001, g = -0.87). A significant, small reduction in non-high-density lipoproteins was also noted (p = 0.016, g = -0.34). A 2×4 repeated-measures ANOVA revealed a significant effect of exercise on glucose concentration (p = 0.031; η² _p = 0.640, moderate), with lower post-exercise levels. Additionally, a significant time×exercise interaction was observed for insulin concentration (p = 0.009; η² _p = 0.30, moderate). Follow-up tests comparing pre to post-exercise changes revealed significant decreases in insulin levels at 30-min (p < 0.001), 60-min (p = 0.008), and 120-min (p = 0.011) postload. These findings suggest a 12-week cycling intervention improves glucose homeostasis, lipid profile, and body composition in overweight women with insulin resistance.

In medical education, psychological safety in teams and organizations facilitates problem solving in healthcare teams and learning opportunities for learners. Based on four types of organizational climate, this study examines the interventions needed for each type of team and organization to increase psychological safety and create an environment in which learners can learn independently and effectively. In considering interventions, the concept of three levels of personality organization, a framework for psychological assessment, seems to be valuable. Based on the overlap between the four types of organizational climate and the three levels of personality organization, the "Apathy Zone" requires educators and learners to reestablish autonomy rooted in reality. In the "Anxiety Zone," the challenge is for educators to recognize their own limitations and be willing to understand learners. In the "Comfort Zone," educators must respect learners' autonomy while observing norms. Both educators and learners must distinguish between the realms of self and others, focusing on essential goals. The "Learning Zone" requires educators and learners to move without overthinking to achieve essential goals. The psychological perspective provides guidance for understanding the formation of organizational climate and considering specific interventions.

Fusion with a real-time virtual sonography system is an ultrasonography fusion technology with magnetic position navigation. We present a case of a left nephroblastoma successfully resected using real-time virtual sonography for tumor margin assessment and excision boundary determination. A 2-year-old girl presented with fever and abdominal distension. Contrast-enhanced computed tomography revealed a large heterogeneous mass (90 × 75 × 125 mm³) in the left kidney. Needle biopsy confirmed nephroblastoma. Chemotherapy with vincristine and actinomycin was initiated according to the International Society of Pediatric Oncology Wilms Tumor 2001 guidelines. Subsequent computed tomography revealed that the tumor size decreased to 45 × 25 × 63 mm³; however, margins with adjacent muscles remained unclear, indicating potential invasion beyond Gerota's fascia. Real-time virtual sonography evaluation revealed a single fat layer separating the tumor from the muscle groups, showing tumor regression to the medial side of Gerota's fascia, with visible respiratory movements on ultrasonography. Left nephrectomy, including Gerota's fascia, was performed, preserving the abdominal wall muscles. Pathology confirmed that the tumor had penetrated the renal capsule but was completely resected with clear margins. The postoperative diagnosis was high-risk stage II blastemal type nephroblastoma, prompting chemotherapy on postoperative day 12. During the 5-year follow-up, no recurrence was observed. Real-time virtual sonography is a valuable adjunct for detailed preoperative evaluation when computed tomography alone is inadequate, facilitating precise tumor margin assessment and successful surgical outcomes.

Small municipalities have few users with specific health guidance, which makes accurate evaluation difficult. This study verified the effectiveness of specific health guidance using data from specific health checkups and specific health guidance from a municipality in Gifu Prefecture over 7 years. The data were provided by Kokuho Database (KDB; National Health Insurance database) system and included 3,786 individuals who underwent a specific health checkup for the first time between 2008 and 2014, followed by another check the subsequent year. I calculated the differences in weight, body mass index (BMI), and waist circumference from the year of the health check to the weight, BMI, and waist circumference between the initial and the following year's checks based on health guidance usage status. I also evaluated whether there was a difference in the median and metabolic syndrome status in the following year. Weight, BMI, and waist circumference improvements were observed in the group that received health guidance at both incentive and active support groups. In the incentive support group, less than 40% of those who went from the preliminary group became the non-applicable group and more than 40% of those who went from applicable group also became the non-applicable group. In the active support group, less than 80% of those who moved from the preliminary group became the non-applicable group, while less than 30% of those who went from the applicable group also became the non-applicable group.

This study investigates the relationship between gratitude and presenteeism (working while unwell) among workers. Productivity loss due to health issues among workers is a critical problem. The largest portion of health-related costs comes from presenteeism, with mental disorders being the main contributors. Gratitude, as one of the positive psychological factors, might have a protective effect against presenteeism. This is because gratitude can reduce stress, increase support from others, improve the workplace atmosphere, and enhance self-efficacy. Therefore, we hypothesized that higher trait gratitude (individual differences in the tendency to feel gratitude) and higher frequency of gratitude expression would be associated with lower levels of presenteeism. In 2022, a cross-sectional study was conducted with workers in Tsukuba City. The outcome variable was the Single-item Presenteeism Question, which is an indicator of presenteeism. The explanatory variables included the Gratitude at Work Scale, a measure of trait gratitude in workplace, along with frequency of expressing gratitude. Multiple regression analysis was performed. The results showed that higher trait gratitude was associated with lower levels of presenteeism (standardized coefficient, -0.203; p < 0.001). Higher frequency of gratitude expression was associated with lower levels of presenteeism (standardized coefficient, -0.048; p = 0.016). The study confirmed that trait gratitude and frequency of gratitude expression were associated with presenteeism. However, it remains unclear whether gratitude directly reduces presenteeism, and further longitudinal studies are needed to explore this possibility.