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Introduction: In this multicenter clinical study, we aimed to investigate the efficacy and safety of the transhepatic arterial administration of granulocyte-colony stimulating factor (G–CSF)–mobilized autologous peripheral blood (PB)-CD34+ cells compared with standard therapy in patients with decompensated cirrhosis type C. Methods: Patients were randomly assigned (2:1) to the CD34+ cell transplant (CD34+ cell) or standard-of-care (SOC) group and followed up for 52 weeks. The primary endpoints were the non-progression rate of Child-Pugh (CP) scores at 24 weeks post-enrollment and the safety of the protocol treatment. Results: Fourteen patients (CD34+ cell group: 10; SOC group: 4) were enrolled. CP scores at 24 weeks had a non-progression rate of 90% in the CD34+ cell group and 100% in the SOC group, with no significant difference between groups. Importantly, 4 out of 10 patients in the CD34+ cell group exhibited an improvement from decompensated to compensated cirrhosis, whereas all patients in the SOC group remained in decompensated cirrhosis. With regard to secondary endpoints, a trend toward increased serum albumin levels in the CD34+ cell group was noted. Serious adverse events (SAEs) occurred in three patients in the CD34+ cell group and in one patient in the SOC group. No causal relationship was observed between all SAEs and G-CSF, leukapheresis, or cell transplantation in the CD34+ cell group. No patients died and no hepatocellular carcinoma occurred within the study period. Conclusions: PB-CD34+ cell infusion therapy may have the potential to circumvent the decompensated stage of cirrhosis, thus avoiding the need for liver transplantation.

Abstract Introduction Given the increase in the primary care nursing workforce and the need to further grow nursing roles in the community understanding how this is included in undergraduate education is important. This study aimed to explore the inclusion of primary care in the undergraduate nursing education curriculum of four countries. Method A mixed‐method design was employed to obtain a broader context of primary care nursing in nursing education and teaching approaches relating to primary care nursing. Subsequently, Australia, Canada, Spain, and Ireland were selected for this study because primary healthcare systems are established as a part of their healthcare system. Results In total, 136 nursing faculties (40 in Australia, 35 in Canada, 46 in Spain, and 15 in Ireland) were invited to participate in this study. Of these, 27 responses were obtained (19.8% response rate). Following the survey phase, in‐depth interviews were conducted with 13 participants. The results indicated that the highest number was coded within the theme of “Understanding of PHC in the curriculum” (n = 108). The second highest number (n = 87) was within the theme of “Interpretation differences of PHC in curriculum,” and the third highest (n = 31) was coded within “Policy impact on health by national government and others.” Conclusion The results emphasized the ambiguity of primary care within the undergraduate nursing curriculum and that interpretation and implementation into the curriculum largely depended on the school's intentions.

Introduction: The COVID-19 pandemic is a considerable challenge for infected patients who require more attention for recovery. Therefore, this study aimed to explore the lived experience of patients with COVID-19. Methods: This qualitative, hermeneutic phenomenological study was conducted in the southeast of Iran from March to May 2020. The data were purposefully collected from 16 patients with COVID-19. Data were collected using in-depth semi-structured telephone interviews and analyzed using the Van Manen method. Results: The lived experiences of patients were categorized into five themes, including incredible clinical symptoms of COVID-19, horror and stigma, bad memories of hospitalization, trust in God and hope as recovery agents from COVID-19, and reborn after recovery from COVID-19. Conclusion: Patients with COVID-19 have experienced variety of physical and psychosocial challenges. Health care providers have to supply appropriate strategies to fulfill the infected patients needs in such a crisis.

Background: The beliefs and perceptions of parenteral nutrition and hydration (PNH) by advanced cancer patients have not been elucidated. Objectives: To clarify their beliefs and perceptions and to explore the relationships between their beliefs and perceptions and cachexia stages. Design/setting/subjects: A questionnaire survey of advanced cancer patients receiving palliative care across Japan. Measurements: We asked patients to answer 15 items regarding their beliefs and perceptions of PNH. Frequencies were calculated for the patient characteristics and survey parameters. Comparisons were performed using the Mann?Whitney U test. We conducted a factor analysis and a multiple logistic regression analysis to identify the independent factors affecting cancer cachexia stages. Results: Among 495 patients, 378 responded. Due to missing data, 357 remained in the frequency distribution analysis, and 344 were classified into the noncachexia group (n?=?174) and cachexia group (n?=?170). Approximately 60% thought that PNH were beneficial. Approximately 70% considered PNH a standard medical practice. Approximately 70% did not feel that they received a sufficient explanation. There were no significant differences in any items between the two groups. We extracted four conceptual groups. The concept of ?Belief that PNH are harmful? was identified as an independent factor [odds ratio 2.57 (95% confidence intervals 1.10?6.01), p?=?0.030]. Conclusion: More than half of the patients thought that PNH were beneficial and standard medical practices with or without cancer cachexia. The negative perception of PNH decreased in patients with cancer cachexia.

Key Clinical Message Embolization with IMPEDE embolization plug cannot be confirmed on site. Therefore, we propose that the diameter of the device selected be up to 50% larger than the vein diameter to prevent embolization failure and recanalization. Abstract Balloon‐occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration (PTO) are performed for treating sporadic gastric varices. IMPEDE embolization plug has been recently developed for these procedures; however, no studies have reported its use. This is the first report on its use in PTO of gastric varices.

Abstract Most patients with hepatitis E virus (HEV) infection are asymptomatic and improve naturally without any treatment, but even non‐immunocompromised individuals may develop persistent HEV infections and should be monitored regularly for the onset.

Abstract Hepatic arteriovenous malformation occurs hyperpulsatile heart failure, hepatic encephalopathy, and ascites as clinical symptoms. Oral medication are effective, but hepatic angioembolization or heart surgery in case of its symptoms worsen.

Objective: The prevalence of obstructive sleep apnea (OSA) in Japan is 9% among males and 3% among females. Up to 2.5 million patients are estimated to suffer from the disease, but limited number of facilities are capable of carrying out polysomnography (PSG), leaving more than 80% of these individuals are undiagnosed. In recent years, the development of new portable sleep monitoring (PMs) devices has been remarkable. We evaluate the correlation between the results of the LS-140 PMs device (Fukuda Denshi Tech Co. Ltd.), released in 2017, and those of PSG. Methods: We obtained contemporaneous data from the same patients by equipping 58 patients with PMs (LS-140) devices while they underwent PSG. Our primary outcome was Case 2 of the intraclass correlation coefficient (ICC), i.e., the ICC (2.1). And we used a Bland-Altman analysis to compare the apnea-hypopnea index (AHI) given by PSG and the respiratory event index (REI) given by LS-140 and examined the sensitivity and specificity of the REI relative to the AHI in the diagnosis of OSA. We also carried out the same comparison but in terms of the presence or absence of periodic limb movements (PLMs). Results: The ICC (2.1) between The REI and the AHI was 0.944, a rather high value (p

We reported here four cases presenting with disturbance of consciousness over long periods of time and hyperammonemia. Two patients were on maintenance hemodialysis. Contrast-enhanced computed tomography (CT) of abdomen and balloon-occluded retrograde contrast venography revealed existence of a non-cirrhotic portosystemic shunt. Conservative treatment such as intravenous branched-chain amino acid administration and oral lactulose administration had only a modest effect in all patients. Improvements in symptoms were observed following the occlusion of the shunt path in three patients. Measurements of ammonia values would be the most important test for screening, but changes in Fischer’s ratio or indocyanine green (ICG) test values were also correlated with clinical symptoms. Neurologists should keep in mind the possibility of non-cirrhotic portosystemic shunts when they encounter patients with disturbance of consciousness. They should also remember that occlusion of the shunt pathway is an effective treatment.

Objectives: Patients with disseminated intravascular coagulation (DIC) due to sepsis often develop cerebral infarction; but the frequency, mechanism of onset and prognosis have not been fully elucidated. We reported courses and characteristics of septic DIC cases hospitalized in our hospital in the present study. Methods: Patients with septic DIC who underwent brain imaging were selected. Vital signs, disorders of consciousness and blood test results at the time of onset were compared between cases that developed cerebral infarction (cerebral infarction group) and those that did not (non-infarction group).In cases of cerebral infarction, the site and the size of the infarct lesion were also described. Results: In 27 septic DIC patients who underwent brain imaging, eight patients had cerebral infarction. Although the percentage of patients who survived in the cerebral infarction group (2/8, 25%) was lower than that in the non-infarction group (7/17, 37%), , no significant difference was observed as both group showed poor prognoses. Those two patients who survived in the cerebral infarction group had severe consciousness disturbance and poor functional prognosis. Although the body temperature was significantly lower and the blood pressure was higher in the cerebral infarction group, no significant difference was found in general blood tests, so we thought it would be necessary to look for other markers that could be indicators for the risk of cerebral infarction. In the cerebral infarction group, two cases had a single lesion, and six cases had multiple lesions. Of the latter, two cases had massive lesions with a diameter of 1.5 cm or greater, four cases had only small lesions with a diameter of less than 1.5 cm, and two cases had a mixture of both. Most of the patients had lesions in the vertebrobasilar artery, which suggested that the pathogenesis involves not only embolism due to microthrombi, but also vasculitis and intravascular inflammation. Conclusions: Cerebral infarction was observed highly frequently; eight out of 27 cases (29.6%) when brain imaging was undergone in septic DIC patients. The prognosis of patients with cerebral infarction was poor, but no difference from the non-infarction group was observed. In addition to embolism, the presence of inflammation is considered to be important for the onset. In order to predict the prognosis and determine a suitable treatment, it would be recommended to undergo brain imaging when patients with septic DIC have consciousness disturbance or elevated blood pressure, and do not have fever.

Abstract Combined therapy with adrenal arterial embolization and RF ablation may represent a useful therapeutic option with curative properties in select patients with pheochromocytoma.

Objectives: Evaluations of subjective effectiveness, quality of life (QOL), and mental status of patients receiving treatment with botulinum toxin (BTX) for hemifacial spasm (FS), blepharospasm (BS), and cervical dystonia (CD) were conducted using a self-administered questionnaire. Methods: Eighty-eight patients who received BTX treatment in the stable stage were analyzed. A numerical rating scale was used to assess treatment effectiveness, home QOL, and social QOL. Anxiety and depression were examined using the hospital anxiety and depression scale. Results: In men, the treatment effectiveness was 2.1±1.0 for FS patients, 2.8±0.5 for BS patients, and 4.0±2.0 for CD patients, which indicates that FS was more effectively treated than CD. QOL scores were higher and anxiety and depression scores were lower in FS patients than BS and CD patients. Overall, social QOL scores were lower than home QOL. A high prevalence ratio of depression was found in BS and CD patients. Conclusions: CD responded less effectively to BTX compared with FS and BS. Additionally, FS and BS patients exhibited similar treatment effects. All of these disorders affect the patient’s appearance, which can reduce self-esteem and social QOL and potentially cause anxiety and depression. BS and CD patients exhibited a higher prevalence of depression than FS patients, which indicates a relationship with the underlying mechanisms of dystonia. Asking patients about subjective effectiveness, QOL, and psychiatric status can help staff respond to patient issues.

Abstract Thyroglossal duct on the dorsum of the tongue in the pediatric patient can cause a difficult airway due to the large mass and risk of airway obstruction associated with a swollen tongue after surgery.

Mycolicibacterium mageritense (M. mageritense) is a rare species among rapidly growing mycobacteria, and M. mageritense pleurisy is very rare. Here, we report for the first time, an immunocompetent patient with pleurisy caused by M. mageritense. The patient had no history of immunodeficiency and no recurrence of lung cancer after surgery. However, 8 months after surgery, he developed a new lung shadow and pleurisy. Although whole-genome analysis of the colony cultured from the patient's pleural fluid revealed M. mageritense, we could not identify it in time, resulting in a poor outcome. M. mageritense pleurisy in this case might have occurred via a bulla rupture of the lung lesion because computed tomography of the patient's chest showed pneumothorax and a lung lesion in contact with thoracic cavity. This case emphasized that nontuberculous mycobacterial pleurisy should be considered in the differential diagnoses of pleural effusion even in immunocompetent patients. Advancement of comprehensive and rapid analyses of genomic data from clinical specimens will lead to better treatment strategies.

Abstract In the anesthetic management in this case was how to manage the patient without causing respiratory depression and respiratory muscle fatigue.

Kazuhiro Hayashi,1–3 Masato Kako,3 Kentaro Suzuki,3 Yui Takagi,3 Chiaki Terai,3 Shotaro Yasuda,3 Izumi Kadono,3 Taisuke Seki,4 Hideki Hiraiwa,4 Takahiro Ushida,1 Yoshihiro Nishida3,4 1Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan; 2Department of Rehabilitation, Aichi Medical University Hospital, Nagakute, Japan; 3Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan; 4Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan Purpose: Patients who undergo total knee arthroplasty (TKA) or total hip arthroplasty (THA) often develop postoperative pain. Exercise approaches are recommended postoperatively; however, the impact of excessive variation in physical activity is unclear. The purpose of the present preliminary study was to investigate the impact of excessive variation in physical activity using the accelerometer in the early period after TKA or THA. Patients and methods: Seventy-two patients were enrolled in the study. Forty patients underwent initial TKA, and 32 initial THA. Physical activity was measured for 8 days from postoperative day 3 to 10. Patients with substantial correlation between physical activity and postoperative day were classified as the “good-pacing” group. Patients with no correlation between them were classified as the “poor-pacing” group. They were also evaluated using a pain visual analog scale (VAS), pain catastrophizing scale, and hospital anxiety and depression scale. Results: The average age was 68 years, and 59 patients (82%) were women. The average maximum number of steps per day was 2,181. There were 45 patients with good pacing and 27 with poor pacing. The poor-pacing group showed significantly lower maximum number of steps per day, higher postoperative average VAS score, higher postoperative worst VAS score, and longer duration of postoperative hospital stay than the good-pacing group. Conclusion: Patients with excessive variation in physical activity showed severe postoperative pain and prolonged postoperative hospital stay. The postoperative variation in physical activity could be an outcome for improvement in patients after lower-limb arthroplasty. Keywords: total joint arthroplasty, postoperative pain, rehabilitation, pacing, accelerometer

Purpose: Nurses played a critical role in performing triage during the Iran-Iraq War. However, their experiences in triage have not been discussed. Therefore, the current study aimed to investigate the triage experiences of civilian nurses during the Iran-Iraq War. Methods: Oral history method and in-depth interviews were used to collect data to gain the nurses' experiences in triage. Results: Four themes were extracted from the data, which were the development of triage, challenging environment to perform triage, development of mobile triage teams, and challenges of triage chemical victims for nurses. Conclusion: Triage is an important skill for nurses to manage critical situations such as disasters and wars. Nurses have to be competent in performing triage. Involvement in critical situations helps the nurses learn and gain more experience on how to manage unexpected events. Keywords: Military nursing, Nurses, Triage, Iran-Iraq war