Adult onset IgAV

Immunoglobulin A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, primarily occurs during childhood between the ages of 3 and 15 years and is the most common form of systemic vasculitis in children ; its occurrence in adults has been rarely reported. Such low incidence could be attributable to either under-diagnosis or misdiagnosis. Thus, not only pediatricians but also physicians should be able to diagnose IgAV accurately to manage the patients appropriately and avoid its associated complications. In addition, treatment of adult onset IgAV with renal involvement has not been fully established yet. We describe here a case of adult onset IgAV complicated by proteinuria and pharyngitis, which was cured by no specific treatment

Usefulness of Palliative Prognostic Index, Objective Prognostic Score, and Neutrophil–Lymphocyte Ratio/Albumin Ratio As Prognostic Indicators for Patients Without Cancer Receiving Home-Visit Palliative Care : A Pilot Study at a Community General Hospital

Background: Although the palliative prognostic index (PPI), objective prognostic score (OPS), and neutrophil–lymphocyte ratio/albumin ratio (NLR/Alb) are well-known prognostic indicators for cancer patients, they do not provide clarity when it comes to predicting prognosis in patients without cancer who receive home-visit palliative care. Objective: The aim of this study was to determine whether PPI, OPS, and NLR/Alb can predict prognosis for patients without cancer who received home-visit palliative care. Design: This is a retrospective study. Setting/Subjects: We recruited 58 patients without cancer who received home-visit palliative care from Tokushima Prefectural Kaifu Hospital, Japan, and died at home or at the hospital within seven days of admission between January 2009 and March 2023. Measurements: The PPI, OPS, and NLR/Alb of the study patients were evaluated at regular intervals, and statistical analysis was performed on the relationship between these indices and the time to death. Results: Simple regression analysis showed that PPI, OPS, and NLR/Alb were negatively correlated with the period until death (p < 0.001). The survival curves of the groups classified according to PPI, OPS, and NLR/Alb were significantly stratified. The predictive capacities of PPI, OPS, and NLR/Alb for death within 21 days were as follows: PPI (area under the curve [AUC]: 0.71; sensitivity: 59%; specificity: 68%), OPS (AUC: 0.73; sensitivity: 88%; specificity: 47%), and NLR/Alb (AUC: 0.72; sensitivity: 72%; specificity: 73%). Conclusions: PPI, OPS, and NLR/Alb were useful in predicting the survival period and short-term prognosis within 21 days for patients without cancer who received home-visit palliative care

医療格差是正と医師働き方改革のための遠隔医療

For local government hospitals in sparsely populated areas, access to emergency and specialized medical care is essential for the wellbeing of local residents. However, Tokushima Prefectural Kaifu Hospital has grappled with numerous crises in the past, stemming from a chronic shortage of doctors. Due to the inherent challenges and constraints associated with traditional face-to-face medical treatment, where doctors directly provide medical care, it becomes challenging to ensure the sustainability of emergency and specialized medical care with limited staffing. To address this issue, we are opting for a paradigm shift in medical care driven by digital technology, often referred to as Digital Transformation（DX）. At our hospital, we introduced a remote emergency medical treatment system for emergency medical care in 2013 and for remote outpatient treatment in 2018 as part of medical DX. The former is a system that transmits medical images taken at a hospital to a smartphone or tablet to support on-call doctors and foster collaboration between hospitals. Under remote outpatient treatment, specialists from remote medical institutions deliver medical care to patients visiting our hospital; this service has been harnessing 5G connectivity in recent years. By embracing medical DX, we not only ensured the quality of medical care but also reduced the mental and physical strain on doctors and patients. This enabled medical institutions in depopulated areas to provide sustainable emergency and specialized medical care. If implemented, these measures may contribute toward rectifying the medical disparities between urban and depopulated areas

Fundamental Study for the Relationship between Melt Flow and Spatter in High-Power Laser Welding of Pure Titanium

The objectives of this study is to clarify the rerationship between melt flow and spatters ejected from a molten pool during 10 kW laser welding of a pure titanium plate. Three-dimensional X-ray transmission in-situobservation of the weld molten pool with tungsten carbide tracers revealed that the melt flowed mainly along the bottom of the molten pool from the keyhole tip to the rear part and then from the rear to the front near the surface of the molten pool, while the melt in front of a keyhole flowed upwards along the keyhole wall at a velocity of less than 0.6m/s and then was accelerated to 2.1m/s at the height of about 2 mm above the keyhole inlet. One-way upward melt flows were continuously piled up at the tip of the elongated melt, resulting in spattering as droplets from the molten pool. Moreover, about 80% of spatters were generated from 50-100mm/s to 300 mm/s, the ratio and the size of spatters occurring from the rear part of a keyhole increased from 20% to 80% and became smaller than 1 mm