A Case of Advanced Recurrent Rectal Cancer With Posterior Reversible Encephalopathy Syndrome During S-1 + Irinotecan + Bevacizumab Therapy / 日本農村医学会雑誌

The patient was a 75-year-old man with advanced rectal cancer underwent abdominoperineal resection and lymph node dissection as conversion surgery after chemotherapy. Intraoperatively, lateral lymph node metastasis was evident in internal iliac vasculature and was deemed unresectable, so chemotherapy was continued after the operation. Due to an elevation in tumor markers and the appearance of lung metastasis, S-1 + irinotecan + bevacizumab therapy was performed as third-line therapy. On day 22 of the third course, he was transported to our hospital with abdominal pain and nausea. Contrast-enhanced computed tomography revealed adhesive bowel obstruction, and chemotherapy was discontinued. Restlessness and diplopia appeared after admission, and magnetic resonance imaging showed a high-intensity area on T2-fluid attenuated inversion recovery images, mainly in the occipital lobe. Because neurological symptoms and imaging findings improved with symptomatic treatment, we diagnosed him with posterior reversible encephalopathy syndrome. Although this disease can develop in association with chemotherapy and, for example, eclampsia, sepsis, renal failure, and autoimmune disease, it is rare and we report this case together with a review of the literature.

A case of splenectomy for spontaneous splenic rupture / 日本農村医学会雑誌

Splenic rupture can be divided into traumatic and atraumatic forms. Causes of atraumatic splenic rupture include hematologic disease, malignancy, and infection, all of which are extremely rare. An 80-year-old man complaining of left upper abdominal pain was referred to our hospital for further examination and treatment. On arrival, his vital signs were stable, but contrastenhanced computed tomography showed a discontinuity of the splenic membrane and fluid accumulation in the perisplenic area and pelvic floor, suggestive of a hematoma. There was no history of trauma, and suspecting atraumatic splenic rupture, we performed an emergency splenectomy. The patient had a good postoperative course and was discharged on postoperative day 11. He had no previous hematologic disease, and there were no clinical findings suspicious of viral infection. Pathological diagnosis was also negative for malignancy, and idiopathic splenic rupture was diagnosed. We describe here this case of splenectomy for spontaneous splenic rupture.

A Case of Hiatal Hernia with Incarcerated Necrotic Transverse Colon / 日本農村医学会雑誌

An 85-year-old woman was transported to our hospital because of nausea and abdominal pain. Contrast-enhanced computed tomography revealed type IV hiatal hernia with incarcerated necrotic transverse colon. Emergency laparotomy was performed. When the incarcerated stomach and transverse colon were returned to the abdominal cavity, the transverse colon was resected and anastomosed due to necrosis. After the hiatal defect was closed, the Toupet method was also performed. No regurgitation or obstruction was observed after the operation, and the patient was discharged 63 days postoperatively. Here we report this rare case of intestinal necrosis due to type IV hiatal hernia and review the literature.

Self-regulated Learning Strategies and Support for Nurses via Distance Learning / 医学教育

Information pertaining to self-regulated learning strategies for nurses in distance learning is scarce, There is also insufficient information regarding suitable learning support. We conducted a survey, exploring the demographic data and self-regulated learning strategies of 183 nurses who used distance learning; 159 nurses responded. In this study, nurses tended to use “asking peers” as their primary learning support. Additionally, “developing learning plans,” “devising learning methods,” and “reflecting on learning methods” showed a positive correlation. “Developing learning plans,” “devising learning methods,” and “rewarding oneself” also showed a positive correlation. Finally, a positive correlation was found between “asking peers” and “rewarding oneself.” A bulletin board for exchanging opinions among learners and the implementation of a pre-course were suggested as ways to support distance learning for nurses.

Attempted Cleaning of a Closed Cycle Type Cell Culture Incubator / 日本農村医学会雑誌

Since fiscal year 2015, our hospital has conducted regular hospital inspections by a medical engineer (ME). About 1 year after the start of this inspection, fungi and common bacteria were detected, so we searched for the cause and report here successful cleanup of the incubator. When the incubator was cleaned during a periodic inspection, the ME discovered that dirt mainly adhered to the fan and the bed rest. Also, fungi were detected from the fans, so the ME cleaned and disinfected all the fans and then switched to a process of washing the central supply room. Following this process, bacteria were no longer detected from inside the incubator, but they have been consistently detected from the fans. We have no reported cases of patient infection, and we believe this is because the ME is responsible for periodic cleaning against bacteria and for conducting inspections. This demonstrates that successful cleaning of the incubator led to control of the spread of infectious diseases.

A Survey of Administering and Management of Medications by Caregivers and the Usefulness of Medicated Patches / 医薬品情報学

<b>Objective: </b>The care of patients with Alzheimer’s disease (AD) has a significant impact on the life of caregivers.  Some of the major daily tasks for caregivers are the administering and management of patients’ medications.  The aims of the present study were to evaluate the current state of administering and management of medications by caregivers, and the usefulness of medicated patches for improving compliance.<br><b>Methods: </b>We sent questionnaires to 62 caregivers of AD patients, and 60 responses were analyzed (response rate: 96.8%).<br><b>Results: </b>We found that approximately half of caregivers had some difficulties with administering and managing medications.  A total of 80% of caregivers took less than 3 min to administer and manage medications.  Approximately half of caregivers responded that patches were useful, but 15% stated that current medications were not the cause of difficulties.  These respondents were concerned that patches may result in adverse skin reactions.<br><b>Conclusions: </b>The results of this survey indicate that caregivers do not have difficulties with administering and managing medications, and further concern is needed about the usefulness of medicated patches.

Fatigue among Medical Students in a Trial of Computer-based Testing for Common Achievement Tests / 医学教育

We investigated the degree of fatigue among medical students during the second trial of the Common Achievement Tests, which use a computer-based testing (CBT) method. A revised questionnaire for subjective fatigue symptoms proposed by the Industrial Fatigue Research meeting of the Japan Society for Occupational Health was used to examine the degree of fatigue. The CBT examinee group (n=41) sat for the examination for 6 hours using video display terminals. Significant changes were seen in 19 of the 25 items for subjective symptoms. At the end of the test period, significant differences between the CBT examinee group and the lecture participant group (n=50) were found for 15 of the items for subjective symptoms. Subjective symptoms were classified into 5 categories: sleepiness, instability, displeasure, feeling languid, and blurred vision. In the CBT examinee group, rates of symptoms increased significantly in all 5 categories. The increase in the rate of “blurred vision” was especially marked.

Adaptations of myoglobin in rat skeletal muscles to endurance running training. Effects of intensity, duration and period of training / 体力科学

A study was conducted to clarify the effects of running intensity and duration of endurance training on myoglobin concentration ( [Mb] ) in rat skeletal muscles, and to clarify its temporal changes during the training. One hundred five male Wistar rats were divided into a training group and an untrained group. The training was carried out at 5 times a week for 12 weeks when the animals were 4 to 16 weeks of age. The training intensities were set at 20, 30 and 40 m/min with a duration of 60 min. The training duration was varied to 30, 60, 90 and 120 min when the rats were trained at 30 m/min. The temporal changes in the [Mb] were examined after the first, third and ninth week of training, during which the rats were trained at 40 m/min for 60 min per session. Three muscles (soleus: Sol, plantaris: P1, gastrocnemius-surface/deep: Gas-S, Gas-D) were analyzed for the [Mb] and citrate synthase activity (CS activity) . With regard to the intensity of training, the [Mb] increased with exercise intensity in Sol, Gas-D and P1, but not in Gas-S. P1 showed a greater increase of the [Mb] than Sol or Gas-D. On the other hand, CS activity in red muscle (Sol and Gas-D) increased even at low intensity, whereas white muscle (fast-twitch muscle: Pl and Gas-S) showed a significant increase in CS activity at an intensity of 40m/min. As to the duration of training, the [Mb] increased with the duration of running at 30 m/min of intensity, and showed the maximal adaptation with 90-min duration in all muscles except for Gas-S. Changes in CS activity according to the duration of running were similar to those for the [Mb] in all muscles. Finally, the [Mb] increased significantly with prolongation of the training period (after the 1 st, 3 rd and 9 th weeks training) in all muscles except Gas-S. However, the adaptive response of Mb tended to be delayed as compared with CS activity. These results suggest that <I>1) </I>the response of Mb to training stimuli can depend on the muscle specificity (fiber type composition or the initial [Mb] ), and level of motor unit recruitment in usual, <I>2) </I> Mb synthesis can be enhanced by an increase of training intensity, <I>3) </I> a training duration of 90 min can bring out the Mb adaptation maximally and <I>4) </I> the adaptive response of Mb would need more time as compared with CS activity.

Time Course of Rat Soleus Muscle Fiber Composition and Motoneurons During Three Weeks Hindlimb Suspension / 体力科学

We examined the time course of soleus muscle fiber type composition. Soma area and succinate dehydrogenase (SDH) activity of soleus motoneurons during three weeks of hindlimb suspension (HS) in rats. Adult female Wistar rats (n=34, 252-288g BW) were divided into four groups: control (n=8), hindlimb suspended for one week (HS 1 wk, n=8), two weeks (HS 2 wk, n=9), and three weeks (HS 3 wk, n=9) . Soleus muscle fiber composition was calculated from transverse sections stained for myosin ATPase (preincubation pH 10.3, 4.3) . The fiber type composition did not change in the HS 1 wk, but in the HS 2 wk and HS 3 wk, the proportion of type I fibers decreased and that of type IIc and ha fibers increased. Using a fluorescent neuronal tracer nuclear yellow, motoneurons innervating the soleus muscle were identified, and the soma area and SDH activity were measured. The soma area did not change for up to two weeks of HS, but decreased in the HS 3 wk. Compared with control, SDH activity of soleus motoneurons decreased in the HS 1 wk. However, in the HS 2 wk, the activity increased to the level of control. In the HS 3 wk, the activity tended to increase further. Generally, muscle fibers and their motoneurons have unitary characteristics. However, these results suggest that change in soleus muscle fiber composition are not accompanied by changes in soma area and SDH activity in soleus motoneurons during three weeks of HS.