アドバンス助産師が認識する現在と次世代の中間看護管理者に求められるマネジメントスキルの比較

Advanced midwives are expected to be candidates for middle managers in the next generation. Higher levels of management skills than the current levels may be required for middle managers in the future due to the progress of perinatal medicine. The aim of this study was to compare levels of management skills that are currently required for middle managers and levels of management skills that will be important in the next 10-20 years in advanced midwives. A self-administered questionnaire survey was conducted for 1652 advanced midwives in hospitals that have more than 300 beds in Japan. The scores for all management skills that will be required in the next generation were significantly higher than those for currently required management skills. Currently required management skills that were given high scores, including communication ability, ability to perform safety management and problem-solving ability, were also given high scores for middle managers in the next generation. Advanced midwives believed that management skills including the ability to participate in social activity, ability to use information and communication technology, and ability to participate in management in which these scores are low at present are needed for middle managers in the next generation. Advanced midwives consider that management skills for middle managers will change in the future. By acquisition of high levels of management skills, middle managers will be able to perform management of perinatal medicine and nursing

Changes in Sequential Organ Failure Assessment sub-scores as predictors of mortality in patients with septic acute kidney injury requiring continuous renal replacement therapy

Patients with septic acute kidney injury （AKI） often require continuous renal replacement therapy （CRRT）, but factors that predict their prognosis have been insufficiently established. Thus, this study aimed to evaluate the associations of the Sequential Organ Failure Assessment （SOFA） score, SOFA-sub scores, and SOFA sub-score components with mortality in patients with AKI on CRRT. A total of 231 patients with AKI who required CRRT were enrolled in this retrospective, cohort study. Associations between the SOFA-sub scores on days 1 or 4 of CRRT and all-cause death within 30 days were assessed. The respiratory SOFA sub-score in patients with sepsis on day 1 was associated with mortality. However, this association disappeared on day 4, and coagulation and renal SOFA-sub scores were significantly associated with mortality in patients with sepsis. These findings differed from patients without septic AKI. The baseline respiratory SOFA sub-score was significantly associated with mortality in patients with septic AKI, whereas the coagulation SOFA sub-score became a prognostic factor on day 4. The evaluation of SOFA-sub scores and changes in the factors after CRRT initiation may be useful for predicting prognosis in patients with septic AKI

Repair of double-chambered right ventricle using right ventricular outflow chamber ventriculotomy via left intercostal thoracotomy under beating heart in two dogs

Double-chambered right ventricle was diagnosed in two dogs, one of them a pup and the other full grown. Both dogs underwent surgery using the novel approach of right ventricular outflow chamber ventriculotomy via left intercostal thoracotomy with moderate hypothermia and moderate pump flow cardiopulmonary bypass under beating heart. No major complication occurred during and after the operation. On continuous wave Doppler echocardiography, the pressure gradient across the stenosis in the right ventricle decreased from 130 mmHg pre-operatively to 40 mmHg post-operatively at 1 year 5 months in the adult dog, and from 209 mmHg pre-operatively to 47 mmHg post-operatively at 1 year in the pup. Both dogs are active without clinical signs

Polyclonal Immunoglobulin Recovery after Autologous Stem Cell Transplantation Is an Independent Prognostic Factor for Survival Outcome in Patients with Multiple Myeloma

We retrospectively analyzed multiple myeloma (MM) patients who underwent autologous stem cell transplantation (ASCT) without maintenance therapy to assess the impact of recovery of normal immunoglobulin (Ig) on clinical outcomes. The recovery of polyclonal Ig was defined as normalization of all values of serum IgG, IgA, and IgM 1 year after ASCT. Among 50 patients, 26 patients showed polyclonal Ig recovery; 14 patients were in ≥complete response (CR) and 12 remained in non-CR after ASCT. The patients with Ig recovery exhibited a significantly better progression-free survival (PFS, median, 46.8 vs. 26.7 months, p = 0.0071) and overall survival (OS, median, not reached vs. 65.3 months, p < 0.00001) compared with those without Ig recovery. The survival benefits of Ig recovery were similarly observed in ≥CR patients (median OS, not reached vs. 80.5 months, p = 0.061) and non-CR patients (median OS, not reached vs. 53.2 months, p = 0.00016). Multivariate analysis revealed that non-CR and not all Ig recovery were independent prognostic factors for PFS (HR, 4.284, 95%CI (1.868–9.826), p = 0.00059; and HR, 2.804, 95%CI (1.334–5.896), p = 0.0065, respectively) and also for OS (HR, 8.245, 95%CI (1.528–44.47), p = 0.014; and HR, 36.55, 95%CI (3.942–338.8), p = 0.0015, respectively). Therefore, in addition to the depth of response, the recovery of polyclonal Ig after ASCT is a useful indicator especially for long-term outcome and might be considered to prevent overtreatment with maintenance therapy in transplanted patients with MM

Cryptosporidiosis in a transplant recipient with severe intractable diarrhea : Detection of Cryptosporidium oocysts by intestinal biopsies

Disseminated Cryptosporidium infection results in manifestations similar to those of graft‐versus‐host disease (GVHD), which hampers the detection of Cryptosporidium infection after allogeneic hematopoietic stem cell transplantation. Surveillance of oocysts on the surface of intestinal epithelial cells is needed for early and appropriate detection of Cryptosporidium infection in transplant recipients on immunosuppressants with severe intractable diarrhea. We present the first case of Cryptosporidium meleagridis infection in Japan after allogeneic cord blood transplantation

Multiple myeloma with high adenosine deaminase expression

A 50-year-old man with immunoglobulin A type multiple myeloma (MM) was referred to our hospital after bortezomib therapy. He had high alkaline phosphatase and lactate dehydrogenase levels. Computed tomography showed osteolytic and osteoblastic bone lesions. Response to salvage chemotherapy was temporary, and he developed a right pleural effusion with high adenosine deaminase (ADA) levels. He died from bleeding associated with a pelvic bone fracture 9 months later. ADA mRNA expression and ADA secretion of the MM cells from the patient were higher than those from myeloma cell lines tested. Clinical relevance of high ADA expression in MM cells is warranted

A case of pulmonary pleomorphic carcinoma with preexisting interstitial pneumonia successfully treated with pembrolizumab

Pulmonary pleomorphic carcinoma is often refractory to chemotherapy and follows an aggressive clinical course. Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced lung cancer, and a few cases with pleomorphic carcinoma have been reported to show tumor shrinkage after therapy with ICIs. When treating patients with ICIs, patient selection is essential, and monitoring and management of immune-related adverse events, including pneumonitis, are needed. We herein report a case of pulmonary pleomorphic carcinoma with preexisting interstitial pneumonia treated with pembrolizumab, antiprogrammed cell death 1 antibody. Our report highlights important considerations necessary when treating advanced pleomorphic carcinoma patients complicated with interstitial pneumonia. We also review the literature regarding the use of ICIs in such patients

Confirmation of the exotic status of Marphysa victori Lavesque, Daffe, Bonifácio &amp; Hutchings, 2017 (Annelida) in French waters and synonymy of Marphysa bulla Liu, Hutchings &amp; Kupriyanova, 2018

The bait worm Marphysa victori Lavesque, Daffe, Bonifácio & Hutchings, 2017 was originally described from Arcachon Bay, France. In the original description, the authors suggested that it may have been introduced, although definitive evidence was lacking at the time. In this paper, we confirm that M. victori is an exotic species originating from East Asia, probably a native of China or Japan. This species was most likely introduced into Arcachon Bay in the 1970s with non-native oysters Crassostrea gigas Thunberg, 1793. The Asiatic origin of this species is confirmed based on both morphological and molecular evidence. Comparison of the type specimens of M. victori with those of Marphysa bulla Liu, Hutchings & Kupriyanova, 2018 described from the Yellow Sea, China, showed no morphological or molecular differences and therefore the more recently named M. bulla is relegated to a junior synonym. This is the first example of a large-sized errant invertebrate species being introduced with oysters into Arcachon Bay.Initiative d'excellence de l'Université de Bordeau