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The Development of the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS^©)

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Open Journal of Psychiatry 2016年第1期6卷 20-33页

作者： hirokazu Ito Misao Miyagawa Kazuhiro Ozawa Tetsuya Tanioka Yuko Yasuhara Mutsuko Kataoka Beth King Masahito Tomotake Rozzano C. Locsin Department of Nursing Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan Department of Nursing Faculty of Health and Welfare Tokushima Bunri University Tokushima Japan Nursing Collaboration Center Gifu College of Nursing Gifu Japan Mifune Hospital Kagawa Japan Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton Florida USA

The purpose of this study was to develop the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©. This study used the on-line survey method from February to April 2015. There were 644 respondents comprised of professional nurses with minimum qualification of 3 years’ experience being in a psychiatric unit of a stand-alone 200-bed or more Psychiatric Hospital in Japan. Assessment items were derived from 211 specific items selected from nursing textbooks, excluding the North-American-Nursing-Diagnosis-Association (NANDA). The questionnaire contained Cover Letter, Demographic Data Sheet, and the PsyNACS© questionnaire. There were 644 questionnaires accessed but only 435 were completed and valid. Item levels of importance were evaluated: 1) Unnecessary, 2) Not very important, 3) Important and 4) Very important. Data analysis used descriptive and multivariate statistics. Factor analysis (principal factor analysis, varimax rotation), the Kaiser-Meyer-Olkin (KMO) and the Bartlett’s test of Sphericity assessed the adaptive validity of the factor analysis. Factor loadings were set at 0.4 or more for the configuration of items. Internal consistency and reliability were established using Cronbach’s alpha coefficient. Mean factor points were calculated, including standard deviation, range, and confidence interval at 95%. Statistical significance was at 0.05 level. Nine Patient Assessment Data (PAD) with 2 to 5 Cluster Assessment Data (CAD) each were categorized. Thirty one CADs comprised the Patient Assessment Data: (PAD1) Psychological symptom and stress, (PAD2) Information about treatment, (PAD3) Function of eating and balance of water, (PAD4) Life and value, (PAD5) Vital signs and health assessment, (PAD6) Self-care, (PAD7) Social support, (PAD8) Activity, sleeping and mobility capability, and (PAD9) Sexual function and sexual behavior. The PsyNACS© is a classificati

关键词： PsyNACS Psychiatric Nursing Patient Assessment Data Psychiatric Hospital

X-ray diagnosis with a bloating agent for foreign object ingestion

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World Journal of Clinical Cases 2014年第5期2卷 157-159页

作者： hirokazu Tomishige Zenichi Morise Tatsuya Suzuki Fujio Hara Masahito Hibi Takazumi Kato Takashi Hashimoto Department of Surgery Fujita Health University School of MedicineBanbuntane Houtokukai HospitalNagoyaAichi 454-8509Japan Department of Pediatric Surgery Fujita Health University School of MedicineToyoakeAichi 470-1192Japan

The location of an ingested foreign object is often difficult to determine by X-ray if gastric air bubbles are not clear in the *** that provide negative contrast can facilitate precise object localization,which is important for object retrieval and treatment of the *** case report describes a male child,2 years and 2 mo of age,who accidentally swallowed a lithium battery while playing at home.A plain X-ray showed that the battery was in the abdomen,but it was unclear whether the object was still inside the stomach.A second X-ray examination performed after oral administration of a bloating agent to produce expansion of the stomach and provide negative contrast confirmed that the ingested battery was still in the *** battery was then carefully removed using magnetic and balloon catheters under fluoroscopic *** case report describes the successful use of an orally administered bloating agent without pain to the child in orderto determine the precise location of a foreign object in the abdomen.

关键词： Accidental ingestion Bloating agent X-ray Minimal invasion Foreign object

Multicentric occurrence of hepatocellular carcinoma with nonalcoholic steatohepatitis

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World Journal of Hepatology 2011年第1期3卷 15-23页

作者： hirokazu Kawai Minoru Nomoto Takeshi Suda Kenya Kamimura Atsunori Tsuchiya Yasushi Tamura Masahiko Yano Masaaki Takamura Masato Igarashi Toshifumi Wakai Satoshi Yamagiwa Yasunobu Matsuda Shogo Ohkoshi Isao Kurosaki Yoshio Shirai Masahiko Okada Yutaka Aoyagi Department of Clinical Laboratory Niigata University Medical and Dental Hospital Division of Gastroenterology and Hepatology Niigata University Graduate School of Medical and Dental Sciences Division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences Department of Medical Technology Niigata University Graduate School of Health Sciences Division of Preventive Medicine Niigata University Graduate School of Medical and Dental Sciences

AIM:To reveal the manner of hepatocellular carcinoma (HCC) development in patients with nonalcoholic steatohepatitis(NASH) focusing on multicentric occurrence (MO) of ***:We compared clinicopathological characteristics between patients with and without MO of HCC arising from NASH *** clinical features were implicated with reference to the literature ***:MO of HCC was identified with histological proof in 4 out of 12 patients with NASH-related HCC(2 males and 2 females).One patient had synchronous MO;an advanced HCC,two well-differentiated HCCs and a dysplastic nodule,followed by the development of metachronous MO of *** other three patients had multiple advanced HCCs accompanied by a well-differentiated HCC or a dysplastic *** these three patients,one had synchronous MO,one had metachronous MO and the other had both synchronous and metachronous *** were no obvious differences between the patients with or without MO in terms of liver function tests,tumor markers and anatomical extent of *** the other hand,all four patients with MO of HCC were older than 70 years old and had the comorbidities of obesity,type 2 diabetes mellitus(T2DM),hypertension and *** these conditions were not limited to MO of HCC,all the conditions were met in only one of eight patients without MO of ***,concurrence of these conditions may be a predisposing situation to synchronous MO of *** particular,old age,T2DM and cirrhosis were suggested to be prerequisite for MO because these factors were depicted in common among two other cases with MO of HCC under NASH in the ***:The putative predisposing factors and necessary preconditions for synchronous MO of HCC in NASH were suggested in this *** investigations are required to clarify the accurate prevalence and predictors of MO to establish better strategies for treatment and prevention leading to the prognostic improvement in NASH.

关键词： Nonalcoholic steatohepatitis Hepatocellular carcinoma Multicentric occurrence

Small undifferentiated intramucosal gastric cancer with lymph-node metastasis:Case report

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World Journal of Gastroenterology 2013年第20期19卷 3157-3160页

作者： Tomoyuki Odagaki Haruhisa Suzuki Ichiro Oda Shigetaka Yoshinaga Satoru Nonaka Hitoshi Katai hirokazu Taniguchi Ryoji Kushima Yutaka Saito Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan Gastric Surgery Division National Cancer Center HospitalTokyo 104-0045Japan Pathology Division National Cancer Center HospitalTokyo 104-0045Japan

It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) ***,the indications for endoscopic resection were expanded to include such undifferentiated EGC *** describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative *** surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative *** case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.

关键词： Early gastric cancer Endoscopic submucosal dissection Expanded indications Lymph-node metastasis Undifferentiated type

Regulatory T cells percentage in peripheral blood before and after eradication of <i>Helicobacter pylori</i>

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Health 2014年第4期6卷 236-242页

作者： Yuka Satoh Hatsue Ogawara Osamu Kawamura Yasuyuki Shimoyama Motoyasu Kusano Akihiko Yokohama Takayuki Saitoh Hiroshi Handa Norifumi Tsukamoto hirokazu Murakami Department of Blood Transfusion Service Gunma University Hospital Maebashi Japan Department of Endoscopy and Endoscopic Surgery Gunma University Hospital Maebashi Japan Department of Laboratory Sciences Course of Health Sciences Gunma Graduate School of Health Sciences Maebashi Japan Department of Medicine and Clinical Science Gunma Graduate School of Medicine Maebashi Japan Department of Medicine and Molecular Science Gunma University Graduate School of Medicine Maebashi Japan Faculty of Health Sciences Gunma Paz College Takasaki Japan Oncology Center Gunma University Hospital Maebashi Japan

Helicobacter pylori (H. pylori) induces gastroduodenal diseases and vigorous humural and cellular immune abnormalities. In order to clarify the immunological changes before and after eradication of H. pylori, the percentages and ratios of the following cells in the peripheral blood of 32 H. pylori-infected patients and 25 control subjects were analyzed: CD4+ T cells, CD8+ T cells, T helper 1 cells (Th1), T helper 2 cells (Th2), CD4+CD25+ T cells, Foxp3+ regulatory T cells (Treg), CD4/CD8 ratio, and Th1/Th2 ratio. CD4/CD8 ratio was significantly higher in H. pylori-infected patients before (mean ± SD, 2.9 ± 1.9) and after (mean ± SD, 2.8 ± 1.6) eradication of H. pylori than in control subjects (mean ± SD, 2.1 ± 0.9). The percentage of Th2 cells was significantly higher in H. pylori-infected patients (mean ± SD, 2.6 ± 1.1) than in control subjects (mean ± SD, 1.9 ± 1.1;p < 0.02). The percentage of Th2 cells after eradication of H. pylori (mean ± SD, 2.3 ± 1.4) was lower than that before eradication. There was no significant difference between control subjects (mean ± SD, 4.1% ± 1.5%) and patients before H. pylori eradication (mean ± SD, 4.5% ± 2.4%) in the percentage of Tregs, but the percentage was significantly higher in patients after H. pylori eradication (mean ± SD, 5.2% ±2.6%) than in control subjects. The function of peripheral induced Tregs was reported to suppress the excessive immune reaction in chronic inflammation. These data suggest that Tregs may proliferate and be activated to suppress the activation of humoral immunity in H. pylori-infected patients, and these changes continue after 3 months or later of successful eradication of H. pylori.

关键词： Helicobacter pylori Regulatory T Cell Th1 Cell Th2 Cell

Bone metastasis from early gastric cancer following non-curative endoscopic submucosal dissection

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World Journal of Gastroenterology 2013年第30期19卷 5016-5020页

作者： Hiroyuki Kawabata Ichiro Oda Haruhisa Suzuki Satoru Nonaka Shigetaka Yoshinaga Hitoshi Katai hirokazu Taniguchi Ryoji Kushima Yutaka Saito Endoscopy Division National Cancer Center Hospital Department of Internal Medicine Saiseikai Matsusaka General Hospital Gastric Surgery Division National Cancer Center Hospital Pathology Division National Cancer Center Hospital

A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in *** lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer *** the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused *** alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed *** patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical *** scintigraphy indicated increased *** examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract ***,the diagnosis of bone metastasis from EGC was *** reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very *** our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.

关键词： Endoscopic submucosal dissection Early gastric cancer Non-curative resection Bone metastasis Late recurrence

Granulomatous reaction in hepatic inflammatory angiomyolipoma after chemoembolization and spontaneous rupture

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World Journal of Gastroenterology 2015年第32期21卷 9675-9682页

作者： Keita Kai Atsushi Miyosh Shinichi Aishima Kota Wakiyama Shunya Nakashita Shinji Iwane Shinya Azama Hiroyuki Irie hirokazu Noshiro Department of Pathology Saga University Hospital Department of Surgery Saga University Faculty of Medicine Department of Pathology and Microbiology Saga University Faculty of Medicine Department of Internal Medicine Saga University Faculty of Medicine Department of Radiology Saga University Faculty of Medicine

A 77-year-old Japanese woman was transported to a nearby hospital due to sudden abdominal pain and transient loss of consciousness. Abdominal computed tomography(CT) suggested hemoperitoneum and hepatic nodule. She was conservatively treated. Contrast-enhanced CT two months later revealed an increased mass size, and the enhancement pattern suggested the possibility of hepatocellular carcinoma(HCC). Under a clinical diagnosis of HCC, transcatheter arterial chemoembolization(TACE) was performed. A subsequent imaging study revealed that most of the lipiodol used for the embolization was washed out. Therefore, surgical resection was performed. Histologically, the nodule contained numerous inflammatory cells including small lymphocytes, plasma cells and macrophages. Notably, epithelioid granulomatous features with multinucleated giant cells were observed in both the nodule and background liver. Some of the multinucleated giant cells contained oil lipid. Among the infiltrating inflammatory cells,spindle-shaped, histiocytoid or myoid tumor cells with eosinophilic cytoplasm were found. The tumor cells were positive for Melan A and HMB45. The nodule contained many Ig G4-positive plasma cells; these were counted and found to number 72.6 cells/HPF(range: 61-80). The calculated Ig G4:Ig G ratio was 33.2%. The nodule was finally diagnosed as previously ruptured inflammatory angiomyolipoma modified by granulomatous reaction after TACE.

关键词： Angiomyolipoma Inflammatory Rupture Lipiodol Liver

Preoperative chemoradiation and extended pelvic lymphadenectomy for rectal cancer:Two distinct principles

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World Journal of Gastrointestinal Surgery 2010年第4期2卷 95-100页

作者： Tsuyoshi Konishi Toshiaki Watanabe hirokazu Nagawa Masatoshi Oya Masashi Ueno Hiroya Kuroyanagi Yoshiya Fujimoto Takashi Akiyoshi Toshiharu Yamaguchi Tetsuichiro Muto Department of Gastroenterological Surgery Cancer Institute HospitalTokyo135-8550Japan Department of Surgical Oncology University of TokyoTokyo113-8655Japan Department of Surgery Teikyo University School of MedicineTokyo173-8605Japan

Extended pelvic lymphadenectomy(EPL) with total mesorectal excision(TME) has been reported to provide oncological benefit in lower rectal cancer in *** Western countries EPL is not widely accepted because of frequent morbidity but instead preoperative chemoradiation(CRT) followed by TME has been established as a standard treatment for decreasing local ***,several studies have focused on the comparison between these two distinct therapeutic approaches in Western countries and Japan.A study comparing Dutch trial data and Japanese data revealed that EPL and RT are almost equivalent in decreasing local recurrence in lower rectal cancer as compared with TME *** that almost 45 survival can be achieved by EPL even in the presence of metastatic lateral lymph nodes(LLNs),EPL performed by experienced surgeons definitely contributes to decrease local *** the other hand,a randomized controlled trial in Japan that compared EPL with conventional TME following preoperative RT revealed that EPL is associated with a higher frequency of sexual and urinary dysfunction without oncological benefits in the presence of preoperative *** this point,preoperative CRT followed by conventional TME without EPL would be a better therapeutic approach in patients without evident metastatic *** future treatment,it would be desirable to have a narrower indication for EPL using full advantage of recent improvement in image *** objective comparison of these two principles between Japan and the West is difficult due to differences in patient groups,further studies would lead to the next great step towards future improvement in treating lower rectal cancer.

关键词： Rectal cancer Extended lymphadenectomy Chemoradiation Pelvic lymph node Lateral lymph node

Clinicopathological Evaluation and Prognostic Analysis in Breast Cancer Patients with Brain Metastasis

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Journal of Cancer Therapy 2015年第8期6卷 727-734页

作者： Naoko Minatani hirokazu Tanino Yoshimasa Kosaka Mariko Kikuchi Hiroshi Nishimiya Mina Waraya Hiroshi Katoh Takumo Enomoto Norihiko Sengoku Masahiko Watanabe Department of Surgery Kitasato University School of Medicine Kanagawa Japan

Background: Brain metastases are diagnosed in 5% - 15% of patients with breast cancer. Clinical management of brain metastases appears to be crucial in improving the prognosis of patients with breast cancer that has metastasized to the brain. However, few studies have investigated whether treatment of metastatic brain tumors would lead to improved prognosis. Methods: A total of 41 breast cancer patients whose tumors metastasized to the brain and who were diagnosed and treated at our hospital were enrolled. This study was conducted to determine the characteristics of brain metastases and to identify the factors that may affect the treatment and prognosis of patients with brain metastases. Results: There were more patients with HER2 and triple negative subtypes than of the luminal subtype. The median time from the initiation of breast cancer treatment to the onset of brain metastasis was 31 months (range, 7 - 134 months). Significantly greater disease-specific survival (DSS) was observed in patients who had a performance status of 0 - 2 at the time of diagnosis of metastatic brain tumors than those with a performance status of 3 - 4 (p = 0.04). DSS was also significantly greater in patients who underwent surgery to remove brain metastases and in patients treated with systemic therapy (p = 0.0007 and 0.0001, respectively). Conclusions: It may be possible to improve the prognosis of patients with brain metastases if lesions are detected early enough when the patients’ performance status is still good. In order for these findings to be definitive, however, results of future prospective studies are eagerly awaited.

关键词： Brain Metastasis Breast Cancer Performance Status