This study investigated whether the presence of Mycoplasma fermentans (M. fermentans) in the temporomandibular joint (TMJ) could be associated with the pathology of temporomandibular joint disorders (TMD). One hundred fifteen synovial fluid (SF) samples from patients with TMD were evaluated for the presence of DNA of M. fermentans by polymerase chain reaction (PCR) assay. Specific antibody against M. fermentans was also detected in the SF as well as sera by Western blot analysis. M. fermentans DNA was identified in 37.4% of the SF samples from the TMD patients. There was no difference between PCR-positive and -negative rate regarding sex and disease categories, e.g., internal derangement (ID) and osteoarthritis (OA). However, the prevalence of M. fermentans DNA in ID patients was higher in elderly patients (73.3%) than in younger patients (31.8%). Anti-M. fermentans immunoreactivities (IgG) specific for lipoproteins with various molecular sizes, 56 kilo-Dalton (kDa), 48 kDa, 38 kDa, and 29 kDa, were also identified in the SF. The immunoreactivity was also detected in the patients'sera. The reactivity patterns of the anti-M. fermentans antibodies were, however, different between the SF and the sera; reactivities to 48 kDa and 29 kDa lipoproteins were prominent in the former, while the reactivities to those of 56 kDa, 48 kDa, and 29 kDa were evidently increased in the latter. The presence of specific DNA and antibody for M. fermentans in the TMJ implies that M. fermentans could possibly induce joint specific immunoreaction, thus perpetuating the inflammatory reaction in the diseased TMJ.

We encountered a terminally ill patient, who had resigned as hospital nurse soon after she had fallen ill. As a former health professional, she was acting the good patient and performing her part as a member of the family. The patient was suffering social pain, so much so that she seemed to be unable to express what was really on her mind. One day, the ex-nurse gave us her precious nurse pin. It was when it occurred to us that what the patient had said and behaved was an expression of spiritual pain. Then, we started exploring the meaning of what she had said and done and tried to get at the structure of her spiritual pain referring to Murata's three structures of the spiritual pain of terminally ill patients: “time existence,” “relational existence” and “autogenic existence.” Eventually, we found that her behavior to respond to the wish of her family and to keep a good relationship with her physicians, which she herself regarded as social pain, was to sweep away uneasiness about and fear of being left alone, that is, the spiritual pain associated with “relational existence.” We also found that the spiritual pain associated with “time existence” intermingled with her wish to continue to be a nurse as expressed in the handing over of her nurse's pin.
Pain ; Patients ; Nurses ; seconds ; SOCIAL

Background: Hand hygiene is recognized as the leading factor to prevent Healthcare-Associated Infection. This report describes an investigation of education in hand hygiene for nurses to visualize hand contamination.
Method: Twenty-nine nurses underwent education using adenosine triphosphate (ATP) measurements and fluorescent cream and black light, and a survey was conducted.
Results: A significantly higher number of nurses recognized the importance of hand hygiene after receiving education. Approximately 80% of nurses were able to: ″reflect on their methods for washing their hands″ , ″understand the necessity of keeping their hands clean after removing their gloves″ , and ″check for areas of the hands that had not been cleaned″ .
Discussion: This report suggested that education in hand hygiene using adenosine triphosphate (ATP) measurements and fluorescent cream and black light for nurses improves their perception of the importance of hand hygiene.

OBJECTIVE: The Japan Society of Gynecologic Oncology (JSGO) initiated a nation-wide training system for the education and certification for gynecologic oncologists in 2005. To assess the impact of the quality of the JSGO-accredited institutions, JSGO undertook an analysis of the Uterine Cervical Cancer Registry of the Japan Society of Obstetrics and Gynecology (JSOG) to determine the effectiveness of the JSGO-accredited institutions on the treatment and survival of women with cervical cancer. METHODS: The effectiveness of 119 JSGO-accredited institutions and 125 non-JSGO-accredited institutions on the treatment and survival of women with cervical cancer were compared by analyzing the tumor characteristics, treatment patterns, and survival outcomes of women with stage T1B–T4 cervical cancer utilizing the data in the JSOG nation-wide registry for cervical cancer (2006–2009). RESULTS: A total of 14,185 eligible women were identified: 10,920 (77.0%) cases for 119 JSGO-accredited institutions and 3,265 (23.0%) cases for 125 non-accredited institutions. A multivariate analysis showed that age, stage, histology type, and treatment pattern were independently associated with mortality. Moreover, women who received treatment at the JSGO-accredited institutions had a significantly decreased mortality risk compared to non-accredited institutions (adjusted hazard ratio [aHR]=0.843; 95% confidence interval [CI]=0.784–0.905). Similar findings on multivariate analysis were seen among subset of women who received surgery alone (aHR=0.552; 95% CI=0.393–0.775) and among women who received radiotherapy (aHR=0.845; 95% CI=0.766–0.931). CONCLUSION: Successful implementation of gynecologic oncology accrediting institution was associated with improved survival outcome of women with cervical cancer in Japan.
Accreditation* ; Certification ; Education ; Female ; Gynecology ; Humans ; Japan* ; Mortality ; Multivariate Analysis ; Obstetrics ; Radiotherapy ; Surgical Procedures, Operative ; Uterine Cervical Neoplasms*