Dominant dystrophic epidermolysis bullosa (DDEB) is a rare inherited skin disorder characterized by extreme fragility of the skin and mucosa that poses significant challenges for anesthetic management. Herein, we report a case of a 65-year-old woman with DDEB who underwent a 13-hour surgery for mandibular cancer under general anesthesia. To prevent skin and mucosal injuries, meticulous perioperative strategies were implemented, including the use of barrier films and pressure-relieving pads and avoiding adhesive devices. High-flow nasal cannula oxygenation enabled awake fiberoptic intubation without the need for mask ventilation, minimizing the risk of blister formation and airway trauma. Despite the prolonged duration, no pressure ulcers or new skin injuries developed, other than minor epidermal peeling of the lips. This case demonstrates that comprehensive preoperative planning and intraoperative protection can ensure safe anesthesia in patients with DDEB undergoing long surgical procedures.

Objective: This study aimed to investigate the amount of physical activity, including daily movement, and the factors related to the amount of physical activity undertaken by patients with type 2 diabetes mellitus at an outpatient clinic.Patients and Methods: A self-administered questionnaire was distributed to 111 patients, aged 20 years or older, with type 2 diabetes mellitus, who visited a diabetes outpatient clinic. The amount of physical activity was investigated using the International Physical Activity Questionnaire-Long Version. Influencing factors were divided into individual attributes (age, sex, and employment status), disease-related factors (body mass index, treatment period, medication usage, insulin usage, symptoms of fatigue, and lethargy), and emotion-related factors (depression and optimism). These were tested using stepwise regression analysis.Results: Daily physical activity was 288 metabolic equivalents of task/minute. The sub-scores by the time of day showed “physical activity within the household” and “physical activity during leisure time” as the highest, with 51 metabolic equivalent of tasks/minute. Employment status, medication usage, and depression status were found to have a significant influence and explained 17.9% of the distribution of the entire model.Conclusion: The results suggest that the amount of daily physical activity among non-working patients should increase. Moreover, we highlight the need to provide diabetes education from the early treatment stages and the importance of early detection and care of patients’ psychological needs.

The system of the Japanese Board of Cardiovascular Surgery is changing. Since the last time, we have deliberated on the medical specialty board for U-40 column articles about the problems faced by young cardiovascular surgeons. This time, we conducted the second survey to U-40 members about the realities of becoming a board-certified cardiovascular surgeon. The results showed the circumstances and details on how to acquire the board certification. Moreover, we discussed about the current problems and future perspectives for the young cardiovascular surgeons.

BACKGROUND: Achieving a desirable death is an urgent aging-related problem in Japan. However, measures of the quality of death and dying in Japan are lacking. This study aimed to identify components of a desirable death in the residents of Kagawa prefecture, Japan, through focus group interviews. METHODS: A group interview was conducted with 30 residents aged 20-80 (M = 50.9, SD = 22.1 years; 43.3% ≥ 65 years; 40.0% unemployed) who had experienced the death of a closely associated person. Participants were grouped into four generations with diverse characteristics (e.g., age, sex, occupation). The interview lasted 1-2 h and involved one interviewer, one observer, and one recorder. The interview theme was "What is a desirable death?" Participants were asked "What do you want to achieve before you die?" or "What would a close friend want to experience when death is near?" We then extracted important items related to "desirable death" using serialization and observation records, while also consulting three analysts. The analysis results of the four generations were ultimately integrated into final categories. RESULTS: The most common experience of a familiar death was that of parents, followed by grandparents. Half of participants had witnessed the death. Through category analysis, eight important categories related to desirable death were ultimately extracted. Nine items were identified as common to all generations. While the elderly generation had wide-ranging opinions, the younger generations' opinions tended to concentrate on satisfaction with life and family relations. CONCLUSION Eight concepts were extracted as important factors of a desirable death from the residents of Kagawa prefecture, Japan.