橈骨遠位端骨折の外科的治療に対する、腕神経叢ブロック（腋窩アプローチ）と全身麻酔との間の患者満足度の比較

Background: Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). Whether anesthesia type affects patient outcomes is unclear. This study retrospectively compared patient satisfaction between GA and NB after surgery. Methods: This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively. Results: After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p = 0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: -1.27 and -0.77, p = 0.00074 and p = 0.0388, respectively), as was surgery duration (effect size: -0.84, p = 0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p = 0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively. Conclusions: Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.博士（医学）・乙第1511号・令和3年6月25日Copyright © 2020 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0

キツエン ボウシ キョウイク ゼンゴ ニオケル コウコウセイ ノ キツエン ニ タイスル タイド ト イシキ ノ ヘンカ

In order to prevent the smoking habit, it is important to start a smoking prevention education （SPE）earlier. Implementing educational intervention with appropriate timing and content is necessary during and after the high school years when a smoking habit is easily formed. The purpose of this research was to clarify high school students’ attitudes and beliefs towards smoking before and after SPE and to examine how to provide optimal SPE in the future. The subjects were ６８０ high school students in the A prefecture. The SPE was implemented, their attitudes and beliefs towards smoking habit were measured using a scale of“belief and attitude towards smoking habits”, and its changes were assessed before and after the education and eight months later. The scores showed significant change in negative attitude toward smoking habit immediately after the SPE. However, the survey after eight months showed the SPE effects were not maintained except one item. Gender and the presence or absence of smokers in their family was involved in the continuation of the effects of SPE. It was suggested that it is necessary to have an appropriate intervention method to the subjects’ characteristics and the optimal intervention timing should be discussed and an approach to reinforce the continuance of effects of SPE are required for the SPE in the future

コウコウセイ オ タイショウ トシタ キツエン ボウシ キョウイク ノ コウカ オヨビ カゾク エノ ハキュウ コウカ

The aim of this survey was to clarify the effects of smoking prevention education to the highschool students, and its ripple effects to their families. Participants were same group of６３０students. Questionnaire surveys were conducted, self-reporting and anonymous, immediately before and after the lecture meeting, and after８month in２０１１‐２０１２fiscal year. As a result, significant favorable changes were observed in female students regarding the images of smoking and the prediction of behavior associated with smoking in the future. However, favorable outcome was not observed among both male and female students after eight months. As useful educational contents, to help stop smoking behavior in the future, the causes of vulnerability to cancer and strong dependence on nicotine were pointed out. Significantly high rates were observed : male students selected the“economical reasons”“, social responsibility”and“transition of smoking rate”; female students selected the“effect on appearance”and“effect on babies”. Also, the smoking rate of the parents of targeted students was lower than the national average, which revealed that their parents were grappling with the problem of smoking abstinence, caused by the chance of having conversations about smoking with their family members. We conclude that it is necessary to construct the educational contents appropriate for the characteristics of each targeted group including family background in order to make smoking abstinence a success. Future studies are also necessary to develop effective educational continuous and periodical approaches of the lecture meeting, which will trigger the cessation of smoking and promote conversation within the family unit

Biceps-Related Physical Findings Are Useful to Prevent Misdiagnosis of Cervical Spondylotic Amyotrophy as a Rotator Cuff Tear

Study DesignCase–control study.PurposeThe aim of the present study was to identify physical findings useful for differentiating between cervical spondylotic amyotrophy (CSA) and rotator cuff tears to prevent the misdiagnosis of CSA as a rotator cuff tear.Overview of LiteratureCSA and rotator cuff tears are often confused among patients presenting with difficulty in shoulder elevation.MethodsTwenty-five patients with CSA and 27 with rotator cuff tears were enrolled. We included five physical findings specific to CSA that were observed in both CSA and rotator cuff tear patients. The findings were as follows: (1) weakness of the deltoid muscle, (2) weakness of the biceps muscle, (3) atrophy of the deltoid muscle, (4) atrophy of the biceps muscle, and (5) swallow-tail sign (assessment of the posterior fibers of the deltoid).ResultsAmong 25 CSA patients, 10 (40.0%) were misdiagnosed with a rotator cuff tear on initial diagnosis. The sensitivity and specificity of each physical finding were as follows: (1) deltoid weakness (sensitivity, 92.0%; specificity, 55.6%), (2) biceps weakness (sensitivity, 80.0%; specificity, 100%), (3) deltoid atrophy (sensitivity, 96.0%; specificity, 77.8%), (4) biceps atrophy (sensitivity, 88.8%; specificity, 92.6%), and (5) swallow-tail sign (sensitivity, 56.0%; specificity, 74.1%). There were statistically significant differences in each physical finding.ConclusionsCSA is likely to be misdiagnosed as a rotator cuff tear; however, weakness and atrophy of the biceps are useful findings for differentiating between CSA and rotator cuff tears to prevent misdiagnosis

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

General anesthetic management of a patient with multiple chemical sensitivity for oral surgery: a case report

Abstract Background Multiple chemical sensitivity (MCS) was first described in 1987. It is said that MCS is caused by neurological and immunological mechanisms in addition to psychosomatic mechanisms. When performing general anesthesia in patients with MCS, careful perioperative management is necessary. Case presentation The patient was a 32-year-old man. Wisdom teeth extraction under general anesthesia was scheduled under the diagnosis of pericoronitis. In 2015, he was diagnosed with MCS. Since then, he experienced sweating and urticaria when exposed to artificial fragrances. We prepared the surgical surroundings by letting the patient touch every possible equipment. In selecting the anesthetic drugs, a completely intravenous route was selected because of the possibility that artificial fragrance of inhalation anesthesia could induce symptoms. There was no allergic reaction during the preoperative period. Conclusions It is important to reduce psychological burden of patient and to eliminate all possible reactive substances to prevent symptom onset