Aichi Medical University, a peer teaching support system was introduced in the 2018 academic year to assist students with low academic performance. While the initiative yielded some positive outcomes, variations in group motivation occasionally resulted in a lackadaisical attitude. Furthermore, limited faculty involvement restricted the scope of in-depth discussions. The onset of COVID-19 in 2020 further disrupted learning modalities, leading to an increase in the number of students repeating academic years. To address these challenges, several revisions were implemented in the learning support system starting in the 2022 academic year. These changes included confirming students’ willingness to participate in study sessions, increasing the number of faculty tutors, and enabling students to form study groups autonomously. This paper discusses the evolution of our learning support system and the experiences that led to these revisions.

Objective: To examine the clinical significance of elevated C-reactive protein (CRP) levels in cases of severe fever with thrombocytopenia syndrome (SFTS), with a particular focus on their role in predicting outcomes beyond that of previous reports.Patients and Methods: CRP values and SFTS case data retrieved from a PubMed search were extracted for analysis. For comparison, the subjects were divided into two groups based on their CRP levels: normal (CRP ≤0.3 mg/mL) and elevated (CRP >0.3 mg/dL).Results: Forty-four cases were identified: 25 with normal CRP levels and 19 with elevated CRP levels. In an univariate analysis, no significant differences were observed between the two groups with respect to age, sex, date of blood examination, white blood cell count, outcome, or lactate dehydrogenase, alanine transaminase, creatine, or ferritin levels. However, the normal group contained a higher proportion of women, and the incidence of other infectious diseases was relatively low.Conclusion: In cases of SFTS, a CRP level >0.3 mg/dL in the first collection indicates the potential for a mixed infection other than an SFTS-associated infection and male prevalence. Further prospective studies are necessary to confirm whether the findings of the present study are generalizable among patients with SFTS.

Purpose: To clarify the significance of attempts to improve palliative care unit (PCU) quality using self-assessment sharing programs formulated by the Hospice Palliative Care Japan. Method: We conducted self-assessments of 7 sections (detection and assessment of patient’s needs, care planning, care implementation, preparation, and support for patients’ discharge, management at the dying stage, care of bereaved family, hospice bed management and meeting community needs) including 47 items on a five-point scale, and determined targets for care improvement in 2018, 2021, and 2022. The change of mean scales of 7 sections and 47 items in each fiscal year and the relationship to the targets for care improvement were investigated. Results: From 2018 to 2022, mean scores increased for detection and assessment of patient’s needs, near-death care, and care for bereaved family members. Conclusion: The self-assessment sharing programs have potential to analyze the status of PCU, clarify improvement targets, and improve the care quality in PCU.

[Purpose] The purpose of this study is to elucidate the awareness of Generative AI among students. To this end, fundamental data was collected through an awareness survey.[Methods] The survey targeted 103 students enrolled in four Anma, Massage, and Acupuncture teacher training institutions nationwide. It was conducted anonymously using Google Forms from October to November 2023.[Results] Fifty-seven people responded (response rate: 55.3％). The main results are as follows：1. Thoughts (impressions) on Generative AI: A relatively large number of students (38.6％) had "expectations" for Generative AI, while those who felt "resistance" were in the minority (24.6％).2. Awareness of the reliability, safety, and efficiency of Generative AI: Opinions were divided on reliability, with 42.1％ saying "it's a little high" and 26.3％ saying "it's a little low." Safety was also rated low, with 43.9％ saying "it's a little low."3. Opinions on the use of Generative AI in the classroom: The most common response to the use of Generative AI was "somewhat in favor" at 47.4％, with 21.1％ of students actively in favor.4. Usefulness of Generative AI as a teaching material: Regarding the usefulness of Generative AI as a teaching material, 45.6％ said "it's somewhat useful," while 24.6％ said "I don't know."5. Impact on learning skills: While many students expressed concern that Generative AI would have a negative impact on their "writing ability" and "thinking ability," many expressed hopes that it would have a positive impact on their "reading ability" and "questioning ability."[Discussion and Conclusion] This survey revealed that while students have high expectations for generative AI, they also have anxiety and resistance. It was also shown that while many students expect it to improve work efficiency, they have concerns about its reliability and safety. Furthermore, while opinions about its use in the educational field are positive, careful consideration is required regarding its impact on learning skills.

Purpose: A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods: We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared. Results: The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Purpose: This study was conducted to identify the typical sites and patterns of peri-implant bone defects on conebeam computed tomography (CBCT) images, as well as to evaluate the detectability of the identified bone defects on panoramic images. Materials and Methods: The study population included 114 patients with a total of 367 implant fixtures. CBCT images were used to assess the presence or absence of bone defects around each implant fixture at the mesial, distal, buccal, and lingual sites. Based on the number of defect sites, the presentations of the peri-implant bone defects were categorized into 3 patterns: 1 site, 2 or 3 sites, and circumferential bone defects. Two observers independently evaluated the presence or absence of bone defects on panoramic images. The bone defect detection rate on these images was evaluated using receiver operating characteristic analysis. Results: Of the 367 implants studied, 167 (45.5%) had at least 1 site with a confirmed bone defect. The most common type of defect was circumferential, affecting 107 of the 167 implants (64.1%). Implants were most frequently placed in the mandibular molar region. The prevalence of bone defects was greatest in the maxillary premolar and mandibular molar regions. The highest kappa value was associated with the mandibular premolar region. Conclusion The typical bone defect pattern observed was a circumferential defect surrounding the implant. The detection rate was generally higher in the molar region than in the anterior region. However, the capacity to detect partial bone defects using panoramic imaging was determined to be poor.

Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]). Conclusions RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

Introduction  NPO Japan Heart opened a children’s medical center in Cambodia in 2018 to treat pediatric cancer. In many public hospitals in Cambodia, patients’ meals must be prepared by their families with little knowledge about hygiene and nutrition, so patients may not always receive sufficient nutrition for their treatment. We considered a hygienic and nutritious diet essential for effective pediatric cancer treatment.  Therefore, the “Japan Heart Children’s Medical Center Meal Project” was launched. The objectives of this study were as follows; (1) to describe that patients receive hygienic and nutritious meals during their hospitalization and after discharge, (2) to measure the effects of providing hospital meals and nutrition education by Cambodian staff who are not qualified dietitians, and to clarify the changes in the nutritional status of pediatric cancer patients as a result of these activities.Methods  The target group was pediatric cancer patients and their families.  Japanese dietitians and chefs conducted study sessions, created menu standards based on the Minimum Dietary Diversity (MDD) , and trained local staff to provide meals and nutrition education.   To provide hospital meals, local staff conducted hygiene management, prepared menus based on standards, and measured eating rates. They also provided nutrition education to the patients and their families, and connected survey before and after education. Nutrition assessment was conducted based on WHO Growth Chart BMI for age by measuring height and weight.Results  The MDD achievement rate for the menu increased from 72% to 100% (after intervention 1week-2 week (January, 2020)), and the eating rate increased from 45.9% to a maximum of 80.5% (April, 2020-January, 2022). Surveys before and after nutrition education showed that 89.1% of patient families improved their knowledge and awareness. Height and weight were assessed by BMI, and the percentage of patients with ≤−2SD decreased from 28.1% at admission to 15.9% at discharge.  Conclusions  In Cambodia where there is no dietitian system, it is important to do activities with contents that is feasible for local staff who have never studied nutrition.  In order to further support treatment from the nutritional aspect, it is desirable to develop nutritional human resources in Cambodia.

Infected thoracic aortic aneurysms are rare. Standard treatment methods have not yet been established for medical treatment, timing of surgery, or surgical techniques. In this study, we report a case in which an ascending aortic reconstruction using an autologous superficial femoral artery was successfully performed for an infected pseudoaneurysm of the thoracic aorta without the use of artificial materials. The patient was a 78-year-old man with bacteremia caused by Staphylococcus aureus and an infected pseudoaneurysm of the thoracic aorta. The patient underwent replacement of the ascending aorta and coronary artery bypass grafting. The patient was discharged from the hospital with no recurrence of infection and no abnormality of the reconstructed aorta.

Objective: This study aimed to clarify the details of inpatient cancer rehabilitation interventions provided by designated cancer hospitals in Japan. Methods: This questionnaire-based survey asked specialists regarding the outline of their facilities’ inpatient cancer rehabilitation, Dietz classification, disease, and intervention details. Results: Restorative interventions were the most common, and the most common cancer was lung cancer followed by colorectal cancer; hematologic malignancy; gastric cancer; and liver, gallbladder, and pancreatic cancer. Intervention proportions for colorectal and gastric cancer were significantly higher in general hospitals than in university hospitals and cancer centers; in contrast, those for hematological malignancy were significantly higher in university hospitals than in general hospitals. For bone and soft tissue sarcomas, intervention proportions in cancer centers were significantly higher than those in university and general hospitals; and for oral, pharyngeal, and laryngeal cancers, they were significantly higher in university hospitals and cancer centers than in general hospitals. The most common intervention was walking training, followed by resistance training, basic motor training, activities of daily living training, and respiratory rehabilitation. Respiratory rehabilitation was performed significantly more frequently in university and general hospitals than in cancer centers.Conclusion: The diseases had differed according to the characteristics of the facilities, and the interventions were considered accordingly. In future, it will be necessary to verify the effectiveness of inpatient cancer rehabilitation according to facility characteristics and to disseminate information on inpatient cancer rehabilitation.