ジュウショウ カンジャ ノ コウクウ カンリ : ICU ニオケル センモンテキ コウクウ ケア ノ トリクミ

In-depth oral care toward severe human cases is crucial for the management of their general condition. As a matter of fact, maintenance of a good oral hygiene condition can reduce the risk for developing respiratory diseases such as aspiration pneumonia and ventilator-associated pneumonia. In September ２００７, we initiated at Tokushima University Hospital Intensive Care Unit （ICU）a collaboration between nurses and medical doctors to provide professional oral care to patients. The aim of this activity was to establish a standardized protocol of oral care in order to reduce the risk for infectious disease complications for inpatients undergoing respiratory care. At the initial oral examination, the majority of patients in ICU had dry lips, and showed tongue coating and the presence of oral debris on tooth and oral mucosa surfaces. In addition, we sometimes observed ulcer formation on oral mucosa or tooth mobility, which are conditions that ICU members should pay an attention when fixing the endotracheal tube. Our professional oral care protocol reduced oral debris, dry mouth, and oral malodor to some extent in the majority of patients at ICU. An intensive collaboration between dental professionals with nurses and medical doctors, was favored through this activity. Our long-term objective is to contribute to the maintenance of general condition continuously as a member of multi-professional team

Clinical characteristics of tuberculosis patients in a tertiary hospital

　We retrospectively assessed the clinical characteristics of tuberculosis patients in a tertiary hospital. The subjects consisted of 80 patients who Mycobacterium tuberculosis was isolated from clinical specimens and who received a definite diagnosis of tuberculosis in our tertiary hospital without isolated bedrooms between January 2010 and June 2018. The average age of the 80 patients was 68.3 years old, consisting of 43 males and 37 females (6 non-Japanese). Sixty-eight patients had underlying diseases, and malignant diseases were most frequently recognized. Seven patients were diagnosed as outpatients and the remaining patients were diagnosed after admission. The final diagnose consisted of 56 patients with pulmonary tuberculosis and 35 patients with extrapulmonary tuberculosis (tuberculous lymphadenitis, tuberculous pleurisy, miliary tuberculosis, etc.). Concerning the results of interferon-γ release assays (IGRAs), while the positive response rate of QFT was 75%, that of T-SPOT was 81%. The clinical specimens used to diagnose tuberculosis were as follows: expectorated sputum, 26 patients; bronchoscopic specimens, 32; biopsy tissue, 17; and others, 5. The interval from the first consultation to diagnosis was three months at the maximum and within one month in most patients. Regarding radiological findings, pulmonary lesions including miliary tuberculosis showed various atypical findings: 39 of 66 patients with bilateral lesions; 50 with no cavity lesion; and 13 with the extent of the lesion exceeding the unilateral lung field. 　Tuberculosis patients in our tertiary hospital had many underlying diseases such as malignant or autoimmune diseases and were receiving immunosuppressive treatment. Therefore, because IGRAs do not always show a positive response and radiological findings also do not show typical findings, it is important to investigate acid-fast bacilli for various clinical specimens and actively perform diagnostic methods including bronchoscopy in order to prevent nosocomial infection

Fluorescence-guided bone resection by using Visually Enhanced Lesion Scope in diffuse chronic sclerosingosteomyelitis of the mandible: clinical and pathological evaluation

Diffuse chronic sclerosingosteomyelitis (DCSO) is a refractory disease, becausethe etiology and pathogenesis remain poorly understood and to determine the border betweenunhealthy boneandhealthybone is difficult. However, progressive inflammation, clinical symptoms and a high recurrence rate of DCSO were the reasons for surgical treatment. We report a case of a 66-year old woman with DCSO of the right side of mandible who was treated with hemimandibulectomy and simultaneous reconstruction by vascularized free fibula flap. After preoperative administration of minocycline for 1 month, the bone fluorescence was successfully monitored by using a Visually Enhanced Lesion Scope (VELscope®). Intraoperatively, we could determine the resection boundaries. We investigated the clinical and histopathological findings. The fluorescence findings were well correlated with histopathological findings. Using a VELscope®was handy and useful to determine the border between DCSO lesion andhealthybone. The free fibula flap under the minocycline-derived bone fluorescence by using a VELscope®offered a good quality of mandibular bone and the successful management of an advanced and refractory DCSO

Alterations in 18F-FDG accumulation into neck-related muscles after neck dissection for patients with oral cancers

Background: 18 F-fluoro-2-deoxy-D-glucose ( 18 F-FDG) accumulations are commonly seen in the neck-related muscles of the surgical and non-surgical sides after surgery with neck dissection (ND) for oral cancers, which leads to radiologists having difficulty in diagnosing the lesions. To examine the alterations in 18 F-FDG accumulation in neck-related muscles of patients after ND for oral cancer. Material and Methods: 18 F-FDG accumulations on positron emission tomography (PET)-computed tomography (CT) in neck-related muscles were retrospectively analyzed after surgical dissection of cervical lymph nodes in oral cancers. Results: According to the extent of ND of cervical lymph nodes, the rate of patients with 18 F-FDG-PET-positive areas increased in the trapezius, sternocleidomastoid, and posterior neck muscles of the surgical and/or non-surgical sides. In addition, SUVmax of 18 F-FDG-PET-positive areas in the trapezius and sternocleidomastoid muscles were increased according to the extent of the ND. Conclusions: In evaluating 18 F-FDG accumulations after ND for oral cancers, we should pay attention to the 18 F-FDG distributions in neck-related muscles including the non-surgical side as false-positive finding

トクシマ ダイガク ビョウイン ニュウイン カンジャ ノ シカテキ ニーズ : コウクウ カンリ センター ニオケル ウケイレ ジョウキョウ カラ

Tokushima University Hospital Oral Health Management Center was created in April 2006 in order that medical inpatients could be easily referred to the dental section. From April 2007 to August 2009, among the 658 inpatients referred by the Oral Health Management Center, 210 requested professional oral healthcare. Requests for professional oral healthcare are currently increasing. Among 244 patients who asked for a bedside visit, 184 requested professional oral healthcare. Most inpatients were referred from the Division of Blood Internal Medicine; and the second Division referring numerous inpatients was that of Neurological Disorders. The increased tendency for professional oral healthcare requests might be related to the closer working relations among NST staff in the hospital, and/or better knowledge regarding the importance of oral health by medical doctors and nurses. The needs for dental services for inpatients varies. It is important for dental professionals to cooperate with medical care staff, and to be capable of dealing with various general conditions

Measurement of the total neutron scattering cross section ratios of noble gases of natural isotopic composition using a pulsed neutron beam

Precision measurements of slow neutron cross sections with atoms have several scientific applications. In particular the n-$^{4}$He s-wave scattering length is important to know both for helping to constrain the nuclear three-body interaction and for the proper interpretation of several ongoing slow neutron experiments searching for other types of neutron-atom interactions. We present new measurements of the ratios of the neutron differential scattering cross sections for natural isotopic-abundance mixtures of the noble gases He, Ar, Kr, and Xe to natural isotopic abundance Ne. These measurements were performed using a recently developed neutron scattering apparatus for gas samples located on a pulsed slow neutron beamline which was designed to search for possible exotic neutron-atom interactions and employs both neutron time of flight information and a position-sensitive neutron detector for scattering event reconstruction. We found agreement with the literature values of scattering cross sections inferred from Ar/Ne, Kr/Ne and Xe/Ne differential cross section ratios over the $q$ range of $1 - 7$ nm$^{-1}$. However for the case of He/Ne we find that the cross section inferred differs by 11.3% (7.6 $\sigma$) from previously-reported values inferred from neutron phase shift measurements, but is in reasonable agreement with values from other measurements. The very large discrepancy in the He/Ne ratio calls for a new precision measurement of the n-$^{4}$He scattering length using neutron interferometry

キャリア ケイセイ シエン キョウイク プログラム ノ カイハツ ト キョウイク コウカ ノ ヒョウカ : チーム イリョウ タイケン ガクシュウ ノ ジッセンテキ ケンキュウ オ トオシテ

我々は歯学部学生のキャリア形成支援のための教育プログラム「チーム医療体験学習」を開発し， 歯学部の2，3，4年次の学生を対象として実施した。本プログラムは，グループワークによる事前学 習とチーム医療の現場体験を2つの柱とし，学生の歯科医療職としてのキャリア意識を強化することを 目的とした。プログラム終了時のアンケートから，学生には歯科専門職としての将来の姿勢や目指す方 向性が具体化すると同時に幅広い知識を身につけたいといった学習に対する動機付が強化されるなど 明らかな教育成果が認められた。プログラム実施前後のアンケートの分析結果から， 「チーム医療体験 学習」が歯学部学生のキャリア形成支援教育の手法として有効なプログラムである可能性が示唆された。We prepared career advancement program “Experience learning in medical team treatment" towards the second，third and fouth year students of dental school. This program consits of prior learning concerned with 'Team treatment and Dental profession' and experience learning in medical team treatment at Tokushima University Hospital. The purpose of this program was to rouse career conciousness as a dental profession. This program provided students with career image which they want to be in the future. Besides，they were motivated to study more widely to approach their own image. In this paper，we evaluated the effects of the program“The experience learning in medical team treatment" on career advancement of dental school students. As a result，it is suggested that this program might be fruitful as career advancement on dental students

Gastrointestinal Stromal Tumor of the Stomach with Narrow Stalk-Like Based, Uneven Protruding Appearance Presenting with Severe Acute Anemia despite Small Size

We report the case of a 56-year-old woman who had a gastrointestinal stromal tumor (GIST) of the stomach. She was admitted to our hospital for epigastric pain, nausea, and severe acute anemia (hemoglobin level 4.3 g/dl). Esophagogastroduodenoscopy revealed a narrow stalk-like based, hemorrhagic and uneven protruding lesion in the lesser curvature of the gastric upper corpus. Although the tumor was less than 2 cm in diameter and was probably a benign GIST according to histology, laparoscopy-assisted local resection was needed because the patient had continuous severe anemia and epigastric pain. Histological assessment showed that the elongated spindle-like tumor cells originated from the intrinsic muscle layer, and was shown with growth to the mucosal side, cropping out to the surface in most areas of the protruding lesion. Only a small part of the tumor was within nontumoral gastric mucosa. Most of the tumor cells demonstrated immunoreactivity for KIT and CD34 in the cytoplasm but not for αSMA, S100, and desmin. Mitotic activity (0/50 high power field) and the labeling index for MIB-1 (about 1%) were low. The GIST of the stomach described in this report was a rare case with a narrow stalk-like based, uneven protruding mass presenting with severe acute anemia despite small size