Importance of absorbable surgical sutures for the prevention of stitch abscess after surgery in patients with oral squamous cell carcinoma

To elucidate the significance of absorbable surgical sutures in the occurrence of stitch abscess after surgery in patients with oral squamous cell carcinoma (SCC). The subjects were 251 patients who underwent excision and/or reconstruction and/or neck dissection for oral SCC using absorbable surgical sutures. Detection rates and characteristics of patients with stitch abscess were retrospectively evaluated by comparing between our present and previous data. There was only one stitch abscess among the 251 patients. A significant difference in the incidence of stitch abscess was found between the present data and our previous data. Of course, no significant correlations were found between the occurrence of stitch abscess using absorbable surgical sutures and the various factors seen in our previous analysis. A complete switch of surgical sutures from silk to absorbable surgical sutures is needed for surgery in patients with oral SCC

Community Clinical Psychological Support of an Evening High School (X)

ある定時制高校への大学院生による地域臨床的な支援活動は今年で10年目となった。今年度も「改訂版支援モデル（循環型）」に基づいて、校内巡回、教室内支援、グループワークの実施、先生方との情報共有、広報活動を行った。今年度は支援員の人数が例年と比較して少なかったことから、相談室の開室を後期のみに限定し、前期は校内巡回や広報活動における支援の浸透化を図った。また、情報共有シート（気になるメモ）や話し合いを通して先生と情報共有することや、支援員内における情報共有をこまめに行ったことでより質の高い支援を心掛けた。広報活動、グループワーク、相談室についての改善点もいくつか考えられた。そこで、次年度を視野に入れた縦の連携に関する新たな視点を有することが重要であると考えられ、今後の課題となることが示唆された。This year marks the 10th year of graduate students\u27 involvment in community clinical psychological support at a night high school. Based on the \u27Revised Edition Support Model (Circulation Type)\u27, graduate school students engaged in making rounds on campus, support within classrooms, conducting groups, sharing infomation with teachers, and public relations activities. This year the number of support staff was smaller than in recent years, hence, the consultation room was opened only during the later semester while in the first semester, increased support were allocated to making rounds, and on public relations activities. Moreover, refined levels of support were obtained using \u27information sharing sheets\u27 (\u27concerns memo\u27) and through discussions. Severals points of possible improvements in public relations activities, group work and the consulting room was considered. Through such engagements, passing information to next year\u27s staff evolved as an issue to be considered as continuity was regarded as an important issue

食生活の多様性とうつ病および自殺の有病率との関連 ―26年間の国際比較研究―

Purpose: This study aimed to determine the associations of dietary diversity with depression and suicide rates by an ecological analysis using 26-years worldwide statistics.Methods: Average food supply and energy supply by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database (FAOSTAT). Dietary diversity scores were calculated from food group classifications. Age-standardized depression prevalence and suicide rates per 100,000 people by country were obtained from the Global Burden of Disease (GBD) 2017 database. The association between food diversity scores and depression prevalence and suicide rates was analyzed by a mixed effects model controlling for covariates in 137 countries with populations of 1 million or greater.Results: A significant negative association was found in the analysis of the relationship between dietary diversity and the prevalence of major depression in the model controlled for all covariates [β (se) = –225.6 (61.9), p < 0.001]. In addition, a significant negative association between dietary diversity and the suicide rate was also found in the model controlled for all covariates [β (se) = –3.08 (1.50), p < 0.05].Conclusion: Dietary diversity was significantly negatively associated with the rates of major depression and suicide. Diets rich in foods may reduce the prevalence of depression and suicide rate.【目的】本研究は、26年間の世界的な統計を用いた生態学的分析により、食生活の多様性とうつ病や自殺率との関連を明らかにすることを目的とした。【方法】生産と家庭間の喪失を除く国別平均食料供給量とエネルギー供給量を国連食糧農業機関統計局データベース（FAOSTAT）から入手した。食物群分類から食事多様性スコアを算出した。年齢標準化された国別の人口10万人当たりのうつ病有病率と自殺率は、Global Burden of Disease（GBD）2017データベースから取得した。人口100万人以上の137カ国を対象に、食品多様性スコアとうつ病有病率および自殺率との関連を、共変量を制御した混合効果モデルで解析した。【結果】食生活の多様性とうつ病の有病率との関係を分析したところ、すべての共変量を調整したモデルにおいて、有意な負の関連が認められた［β（se）＝－225.6（61.9）、p < 0.001］。さらに、食生活の多様性と自殺率との間の有意な負の関連も、すべての共変量を調整したモデルで認められた［β（se）= －3.08（1.50）、p < 0.05］。【結論】食生活の多様性は、うつ病および自殺の発生率と有意に負の関連があった。食物を豊富に含む食事は、うつ病や自殺を減少させる可能性がある

多職種連携と患者特性に配慮したケアを行った高度肥満症の一例

A ４８-year-old man who weighed ２１６ kg was significantly overweight with a body mass index （BMI）of ７５．６kg/m２, and was unable to walk due to disuse syndrome. Because of the psychological and social problems in the background, a psychological examination was performed and the staff took time to build a trusting relationship with the patient, taking into account his characteristics. With diet and rehabilitation, he was able to lose weight to １２４kg and BMI ４３．９kg/m２ over ６００ days, and was able to walk with assistive devices and defecate by himself. The patient was discharged from our hospital after a series of multidisciplinary meetings with medical, nursing, welfare, and governmental agencies to create an environment for home recuperation. The reasons for the improvement to enable him to be discharged from the hospital were due to the multi-disciplinary meetings among the staff inside and outside the hospital, information sharing and advanced coordination, and smooth communication with the patient by taking into account his characteristics from a psychological standpoint

Insulinoma with symptoms of suspected transient ischemic attack : A case report

We report the case of a６７-year-old woman who had symptoms suggestive of a transient ischemic attack（TIA）, such as lightheadedness and transient visual changes before meals for ４ months. She experienced altered consciousness before lunch and was taken to the emergency room２weeks ago. She had repeated hypoglycemia with a blood glucose level of ３１ mg/dL. Insulin secretion was not suppressed, with an immunoreactive insulin level of １４．０ μU/mL and connecting peptide immunoreactivity of １．８３ ng/mL for occasional blood glucose levels of ４９ mg/dL. Dynamic CT revealed a １７‐mm mass enhanced during the arterial phase in the pancreatic uncinate process, suggestive of a pancreatic neuroendocrine tumor. A selective arterial secretagogue（calcium）injection test revealed the localization of insulinoma in the head of the pancreas. Therefore, pancreatoduodenectomy was performed. Hyperglycemia occurred after the surgery, and it was judged that the insulinoma was resected. This case showed TIA-like symptoms without signs of sympathetic overdrive associated with hypoglycemia. Thus, the diagnosis was delayed. Insulinoma may present with symptoms of neuroglycopenia but not autonomic activity due to hypoglycemia. Insulinoma should be distinguished in patients with unknown neurological symptoms since neuroglycopenia caused by insulinoma is diverse

A Cluster of Respiratory Syncytial Virus Infections in a Hospital Ward for Adult Immunocompromised Patients

Four male patients admitted to the same ward in the first half of September 201Y were identified to have respiratory syncytial virus（RSV）infection. Their ages ranged from 49 to 85 years（median 72.5）. One patient was infected with human immunodeficiency virus and three patients had hematological malignancies. Following immuno-chromatological testing with a nasal cavity swab, RSV infection was diagnosed. Although blood and sputum cultures were performed in three patients, no significant bacteria were detected. Two cases responded to supportive therapy. However, one patient died secondary to multiple myeloma, and another patient developed pneumonia and died with an exacerbation of leukemia. RSV infections in immunocompromised hosts are associated with a poor prognosis. Early diagnosis will facilitate isolation of infected individuals to prevent hospital outbreaks