We report a case of persistent pain in a 21-year-old male patient, which responded well to yokukansan and keishikaryukotsuboreito, after biopsy surgery performed 5 years ago. Chronic postsurgical pain (CPSP) is a condition in which pain persists even after the surgical wound has healed, significantly affecting the patient’s daily life and mental state. Our patient was diagnosed with fibrous osteodysplasia based on a biopsy of the sacral region, but his postoperative pain persisted and became chronic. The patient’s activities of daily living (ADL) significantly declined, and he was unable to maintain a normal school life. Simultaneous treatment with shigyakusan, keishibukuryogankayokuinin, tramadol hydrochloride, and acetaminophen was started, and the medication was repeatedly changed. His quality of life notably improved with yokukansan and keishikaryukotsuboreito. In recent years, there have been many reports of the use of yokukansan for chronic pain, and the results of our case suggest that the addition of the anxiolytic and analgesic effects of keishikaryukotsuboreito is effective for intractable chronic pain.

Recently, with the increase of laparoscopic surgery, there has also been an increase in the number of surgeries that require the head-down position for a long duration and left-right rotation. We have encountered 3 cases of brachial plexus neuropathy that was thought to be caused by such surgical positions in our institute. Currently, we have improved the fixation method and fixtures and created a neuropathy checklist, and we are conducting standardized observation and decompression programs within the team. We examined whether our current programs are effective using a body pressure measuring device for 20 patients undergoing headdown lithotripsy surgery under general anesthesia. The correlation between the mean body pressure on the right shoulder after 30 min and body tilt angle was studied. We also observed changes in body pressure before and after manual decompression every 30 min while the patient was in the head-down position. Before that study, we conducted an experience questionnaire survey of 10 operating room nurses. The results indicated that there was no increase in body pressure in proportion to the body tilt angle (15-20 deg). The body pressure after decompression decreased significantly at 30, 60, and 120 min after placing the patient in the head-down lithotripsy position. There was no significant correlation between body pressure and the headdown positioning time. There was a significant correlation between body mass index (BMI) and body pressure at 30 min (r=0.474, p=0.035). Complaints of trunk displacement, shoulder pain and pressure, and head and neck traction were often noted in the nurse questionnaire. These complaints were more frequently seen in cases with a larger right-down rotation angle and higher BMI. From these results, it was concluded that decompression of the body with the current fixtures and our regular observation and decompression program using the neuropathy checklist is effective for preventing brachial plexus injury in patients undergoing lithotripsy laparoscopic surgery in the head-down position and with left-right rotation.

Purpose: The purpose of this study is to clarify the factors related to the content of consultation in the cancer nursing outpatient department of Gunma University Hospital. Method: A retrospective survey was conducted with 1084 cases, excluding the unknown cases, from 1308 consultations in FY2019. Survey items included age, gender, consulter, number of uses, treatment status, consultation content, etc. We conducted χ2 tests, and binomial logistic regression analysis between the content of the consultation and the attributes of the user. Results: The treatment-related content was associated with the following factors: 70s or older, family/relatives only, presence of recurrence/metastasis, first use, pre-treatment, urinary organs, uterine/ovary, and unknown primary. The body-related content was associated with the following factors: under treatment, post-treatment, no recurrence/metastasis, and digestive organs. The mental health-related content was associated with 30s or younger, 40s–60s, patient only, and second time or more. The social aspects-related content was associated with the following factors: patient only, family/relatives only, no recurrence/metastasis, and breast. Conclusion: The results reveal that associated factors differ by consultation content. These findings can be used to prepare for consultation based on the relevant associated factors.

　　We have been working to improve nursing care for patients who are receiving chemotherapy by understanding the feelings of nurses who work in the chemotherapy outpatient unit. Previous efforts to understand the feeling of nurses involved with cancer chemotherapy revealed that they felt anxious about whether their care of chemotherapy patients was sufficient. To clarify their level of anxiety and difficulties faced, structured group interview analysis was conducted in the present study. Based on our findings, a number of nurses reported anxiety and psychological burden, which were classified into four categories: “Unclear how to interact with patients and their families”, “Mental burden of nurses”, “Anxiety handling anti-cancer agents”, and “Problems with human relations”. In particular, nurses were psychologically burdened by feeling unable to provide individual nursing care to patients and their families. The findings suggest that nurses should acquire professional expertise related not only to chemotherapy nursing itself but also to palliative care. A multipronged approach based on interprofessional collaboration is also needed to satisfy the individual requirements of patients who are receiving chemotherapy and their families.

The ability of human deciduous tooth dental pulp cells (HDDPCs) to differentiate into odontoblasts that generate mineralized tissue holds immense potential for therapeutic use in the field of tooth regenerative medicine. Realization of this potential depends on efficient and optimized protocols for the genetic manipulation of HDDPCs. In this study, we demonstrate the use of a PiggyBac (PB)-based gene transfer system as a method for introducing nonviral transposon DNA into HDDPCs and HDDPC-derived inducible pluripotent stem cells. The transfection efficiency of the PB-based system was significantly greater than previously reported for electroporation-based transfection of plasmid DNA. Using the neomycin resistance gene as a selection marker, HDDPCs were stably transfected at a rate nearly 40-fold higher than that achieved using conventional methods. Using this system, it was also possible to introduce two constructs simultaneously into a single cell. The resulting stable transfectants, expressing tdTomato and enhanced green fluorescent protein, exhibited both red and green fluorescence. The established cell line did not lose the acquired phenotype over three months of culture. Based on our results, we concluded that PB is superior to currently available methods for introducing plasmid DNA into HDDPCs. There may be significant challenges in the direct clinical application of this method for human dental tissue engineering due to safety risks and ethical concerns. However, the high level of transfection achieved with PB may have significant advantages in basic scientific research for dental tissue engineering applications, such as functional studies of genes and proteins. Furthermore, it is a useful tool for the isolation of genetically engineered HDDPC-derived stem cells for studies in tooth regenerative medicine.
Cells, Cultured ; DNA Transposable Elements ; Dental Pulp ; cytology ; Humans ; Induced Pluripotent Stem Cells ; cytology ; Nerve Tissue Proteins ; genetics ; Tooth, Deciduous ; cytology ; Transfection

The ability of human deciduous tooth dental pulp cells (HDDPCs) to differentiate into odontoblasts that generate mineralized tissue holds immense potential for therapeutic use in the field of tooth regenerative medicine. Realization of this potential depends on efficient and optimized protocols for the genetic manipulation of HDDPCs. In this study, we demonstrate the use of a PiggyBac (PB)-based gene transfer system as a method for introducing nonviral transposon DNA into HDDPCs and HDDPC-derived inducible pluripotent stem cells. The transfection efficiency of the PB-based system was significantly greater than previously reported for electroporation-based transfection of plasmid DNA. Using the neomycin resistance gene as a selection marker, HDDPCs were stably transfected at a rate nearly 40-fold higher than that achieved using conventional methods. Using this system, it was also possible to introduce two constructs simultaneously into a single cell. The resulting stable transfectants, expressing tdTomato and enhanced green fluorescent protein, exhibited both red and green fluorescence. The established cell line did not lose the acquired phenotype over three months of culture. Based on our results, we concluded that PB is superior to currently available methods for introducing plasmid DNA into HDDPCs. There may be significant challenges in the direct clinical application of this method for human dental tissue engineering due to safety risks and ethical concerns. However, the high level of transfection achieved with PB may have significant advantages in basic scientific research for dental tissue engineering applications, such as functional studies of genes and proteins. Furthermore, it is a useful tool for the isolation of genetically engineered HDDPC-derived stem cells for studies in tooth regenerative medicine.

A 31-year-old healthy mother of twins developed Guillain-Barré syndrome in her fourth gestational week of pregnancy. Impaired motor coordination, sensation, and joint position sense were observed. Immunoglobulin therapy was not performed given the early stage of pregnancy. She received rehabilitation to accommodate changes in her body shape and movements necessary for pregnancy, childbirth, and childcare. The patient delivered a healthy baby by cesarean section. By 42 weeks postpartum, she was capable of almost all housework activities and childcare. Family support was important in this case. Patient-oriented intervention, which included periodic confirmation and establishment of goals in each phase and continuity of intervention, was also essential.

Aim:Shakuyakukanzoto is a Japanese herbal medicine that is known to be useful for the treatment of urinary stone pain. In this study, we investigated the effects of shakuyakukanzoto for acute renal colic.Methods:Twenty-five patients were enrolled in this study. Eleven patients took 5.0 g of shakuyakukanzoto powder, and 14 control patients took non-steroidal anti-inflammatory drugs (NSAIDs) for their acute renal colic. The effects were evaluated before and 15, 30, and 60 minutes after treatment with a numerical rating scale (NRS). We defined scale point zero as not having pain, and scale point ten as having the strongest pain.Results:Mean NRS scores improved from 6.7 ± 2.3 to 3.4 ± 3.5 after 15 minutes (shakuyakukanzoto group), and from 8.3 ± 1.8 to 7.0 ± 1.9 after 15 minutes (control group). NRS scores were improved immediately and significantly in both groups. The NRS score of shakuyakukanzoto group was significantly lower than that of control group at the any time after treatment. No side effects were observed in this study.Conclusion : Shakuyakukanzoto has an immediate effect, and it is more effective than NSAIDs. Shakuyakukanzoto was a useful treatment for acute renal colic.

Aim : Hochuekkito is a Japanese herbal medicine that is known to be useful for the treatment of uterine prolapse and urinary incontinence. In this study, we investigated the effects of hochuekkito prescriptions in female patients with stress urinary incontinence (SUI).
Methods : 13 women were enrolled in this study. They each took 7.5 g of hochuekkito powder prior to a meal three times a day, for 4 weeks. The effects were evaluated before and after treatment with a visual analogue scale (VAS), a incontinence-quality-of-life index (IQOL), and voiding diaries. Moreover, pad tests and uroflowmetry measures were done before and after treatment.
Results : VAS and IQOL scores were not improved significantly. Although the mean number of SUI episodes per one day, and the number of pads used decreased after treatment as compared to before, these were not significantly different. Micturition frequency and uroflowmetry parameters did not change after treatment. However, in patients whose Body Mass Index (BMI) was < 25, subjective symptoms significantly improved after treatment. No side effects were observed in this study.
Conclusion : Hochuekkito was a useful treatment for slender female patients with SUI.