Niigata College of Nursing

Prenatal genetic testing in Japan has undergone major changes over the past 2 decades. Maternal serum screening (MSS), amniocentesis (AC), and chorionic villus sampling (CVS) have been the principal tools used to identify fetal chromosomal abnormalities. Recently, non-invasive prenatal testing (NIPT) has reshaped clinical decision-making. However, updated national-level data capturing trends in conventional prenatal testing methods are limited. We aimed to assess the current landscape of prenatal genetic testing in Japan. To update the national data, we compiled test volumes from five major high-volume laboratories that analysed prenatal genetic tests and conducted a supplemental nationwide questionnaire-based survey on ultrasound (US)-only screening between 2020 and 2023. Over this period, MSS declined from 34,887 cases in 2018 to 25,553 in 2023, AC from 16,454 in 2014 to 5620 in 2023, and CVS from 2149 in 2015 to 1167 in 2023, whereas US-only screening increased slightly to >10,000 cases annually. The chromosomal abnormality detection rate among AC cases increased from 8% during 2006-2014 to 20.0% in 2023, with trisomy 21 comprising 43.6% of the cases. During the same period, the proportion of mothers aged ≥35 years increased from 14.0% in 2003 to 30.4% in 2023, whereas the proportion of national live births decreased by 35.3%. Thus, declining test volumes cannot be attributed solely to demographic changes but also reflect the influence of NIPT uptake, improved pretest risk stratification, and changing reproductive decision-making supported by expanding genetic counselling. This study provides foundational data for future prenatal genetic testing practices and policies in Japan.

On February 1, 2025, the bones of a sperm whale (Physeter macrocephalus) were beached on Kakizaki Beach in Joetsu City.This was followed by the discovery of a decomposed carcass of a male sperm whale on February 27 on Yoneyama Beach in Kashiwazaki City (both in Niigata Prefecture).The bones and carcass were considered to belong to the same individual.The beached bones included those of the cranium, left maxilla, right mandible, sternum, left first rib, and a piece of bone of unknown origin.Five caudal vertebrae were removed from the carcass at Yoneyama Beach.Based on the lengths of these bones, the whale was estimated to be 15.6-16.7 m long.Few instances of sperm whales stranding ashore or being sighted in the Sea of Japan have been reported.Records dating back to 1901 show only two cases of stranded carcasses (including this one) and four sightings of swimming whales.The whale in this case was assumed to have died from unknown causes with the body decomposing adrift.Subsequently, the bones may have been separated by high waves, stranding some on shore.The bones (excluding the maxilla) were stored at the Joetsu Science Museum.The remaining carcasses were buried at each site.

目 的：治療中の若年層乳がん患者が折り合いをつけながら生活を送るプロセスについて明らかにする．

The spread of the coronavirus disease (COVID-19) has significantly affected medical education. In particular, conducting practical training in a face-to-face format has become difficult. To address this problem, online physiology practice combined with team-based learning (TBL) for deep learning of renal physiology was conducted among second-year medical students. The experiment was performed by a group of students, while other students watched online. After the experiment, all students were grouped using breakout rooms. Following a discussion of the data, a clinical case study related to the experiment was conducted using TBL. To examine the effect of online practice in a case study under TBL, the participants completed an anonymous, open-ended, web-based questionnaire after the program, enabling us to compare their expectations and satisfaction. The questionnaire consisted of questions examining students' opinions on the appropriateness of online practice, degree of understanding, ease of asking questions, time efficiency, and the usefulness of case studies using TBL. There was no change in the number of students who participated in the online practice before and after class. After class, more students considered the level of understanding easier and displayed better on-time efficiency than with regular face-to-face training. However, these questions are difficult to answer. Online-based physiology practice combined with clinical case studies under TBL helped maintain students' expectations and satisfaction with the training.

In nurse scheduling, whereby work schedules for nurses are created, it is very difficult to create a work schedule that satisfies all the various requirements.Hence, various studies have been conducted on the nurse scheduling problem.However, for practical use, adjustments including various constraints and evaluation values are required, as the created shift schedule is often not practical as it is.Therefore, we have proposed a work revision method using reinforcement learning on a constructive nurse scheduling system.In this paper, we extend the proposed method to dynamic nurse scheduling, in which the work schedule is revised or rescheduled when an absence occurs.Furthermore, we confirm whether or not the extended method can be used to create a work schedule that is feasible in various sudden absences of a nurse.

目 的：Mobile Deviceを活用し，総合周産期母子医療センターの夜勤帯シフトにおいて実際に行われている看護行為と看護行為数を明らかにする．方 法：総合周産期母子医療センター産科病棟および母体・胎児集中治療室（以下 MFICU）において，夜勤帯スタッフ延べ56名が実施した看護行為の種類・その回数の測定を行った．看護行為分類は日本看護協会看護業務区分表Aを一部改変した20項目で構成され，データはスタッフの役割別，経験レベル層別でそれぞれクロス分析を行った．結 果：スタッフが実施した上位の看護行為項目は「安全」「申し送り・連絡・報告」「看護計画・記録」で，いずれも患者の安全のために必要となる看護行為項目であった．経験レベル別の各看護行為数の傾向として，新人レベルでは状況判断能力が求められる看護行為項目の割合が少なかった．結 論：ハイリスク妊産褥婦・新生児の多い施設では経験レベルを考慮した夜勤帯人員配置が，助産管理上より重要であることが再確認された．

To investigate the combined effects of blood pressure (BP) and glycemic status on the risk of heart failure. Examined was a Japanese claims database from 2008 to 2019 on 589 621 individuals. Cox proportional hazards model identified the incidence of heart failure among five levels of SBP/DBP according to glucose status. Mean follow-up period was 5.6 years. The incidence of heart failure per 1000 person-years in the normoglycemia, borderline glycemia, and diabetes groups were 0.10, 0.18, and 0.80, respectively. In normoglycemia, a linear trend was observed between both SBP and DBP categories and hazard ratios for heart failure ( P for linearity <0.001). In borderline glycemia, J-shaped association was observed between DBP categories and hazard ratios, although the liner trend was significant ( P < 0.001). In diabetes, the linear trend for the relationship between DBP categories and hazard ratios was not significant ( P = 0.09) and the J-shaped association in relation to the hazard ratios was observed between SBP categories and heart failure risk. In the lowest SBP category (i.e. SBP < 120 mmHg), patients with diabetes had more than five-fold heart failure risk [hazard ratio (95% confidence interval), 5.10 (3.19-8.15)], compared with those with normoglycemia and SBP less than 120 mmHg. The association between SBP/DBP and heart failure risk weakened with worsening of glucose metabolism, suggesting strict BP control accompanied by excessively lowered DBP should be cautious in prevent heart failure in abnormal glycemic status. Particularly in diabetes, comprehensive management of risk factors other than BP may be essential to prevent heart failure. Further trials are needed to support these suggestions and apply them to clinical practice.