Satou Hospital

Abstract Objective This departmental audit’s main goal was to assess the clinical case notes’ quality in the internal medicine wards of District Headquarters Hospital, Nankana Sahib, in compliance with pertinent local standards and the General Medical Council’s (GMC) UK “Good Medical Practice” guidelines. Methods There were two stages to this audit. Twenty inpatient case notes were reviewed for the initial evaluation in October 2023, and they were evaluated using a set of nine documentation criteria that were established from local and GMC recommendations. Targeted solutions, such as staff education and strengthened documentation standards, were put into place when inadequacies were identified. In December 2023, a re-audit was carried out to gauge progress. This is a clinical audit conducted through a formal audit cycle, including criteria setting, standards, targeted staff intervention, and re-audit to assess improvements Results Just 45% of the case notes satisfied the documentation requirements, according to the first assessment. Incomplete patient demographic information on continuation sheets (25%), poor readability (50%), and missing physician names (45% of instances) were among the main flaws. Significant progress was seen after the intervention. In the re-audit, 90% of case notes included complete demographic information, 90% were readable, and 95% had the name of the treating doctor. In all cycles, every other documentation requirement, including the inclusion of diagnosis, management plans, and patient communication records, was routinely fulfilled. Conclusion The re-audit underscored the significance of frequent audit cycles and ongoing professional growth by showing a notable increase in adherence to clinical documentation requirements. Maintaining high-quality case notes promotes safer and more efficient patient care by improving communication among medical staff.

ABSTRACTIntroductionAndrogen receptor signaling inhibitors (ARSIs) improve survival in prostate cancer; however, it may increase cardiovascular risks, especially in elderly patients with heart disease.Case PresentationA 94‐year‐old man with aortic valve stenosis, hypertension, and diabetes had a nodal metastatic progression of prostate cancer at 88 years of age, leading to the implementation of androgen deprivation therapy (ADT). After 5 years of therapy, prostate‐specific antigen (PSA) re‐elevated; however, ADT was maintained. At 94 years old, darolutamide was started due to worsening of urinary symptoms. Although these symptoms improved, the patient developed a heart failure with elevated B‐type natriuretic peptide (BNP). Darolutamide was discontinued, leading to reduced BNP levels but increased PSA levels. A reduced dose (300 mg/day) resulted in stable PSA levels without BNP elevation.ConclusionCareful cardiovascular monitoring is crucial when ARSIs are used in older patients with heart disease. Dose adjustments may help balance oncological benefits and cardiac safety.

The poor prognosis of glioblastoma (GBM) patients is attributed mainly to abundant neovascularization and presence of glioblastoma stem cells (GSCs). GSCs are preferentially localized to the perivascular niche to maintain stemness. However, the effect of abnormal communication between endothelial cells (ECs) and GSCs on GBM progression remains unknown. Here, we reveal that ECs-derived SEMA3G, which is aberrantly expressed in GBM patients, impairs GSCs by inducing c-Myc degradation. SEMA3G activates NRP2/PLXNA1 in a paracrine manner, subsequently inducing the inactivation of Cdc42 and dissociation of Cdc42 and WWP2 in GSCs. Once released, WWP2 interacts with c-Myc and mediates c-Myc degradation via ubiquitination. Genetic deletion of Sema3G in ECs accelerates GBM growth, whereas SEMA3G overexpression or recombinant SEMA3G protein prolongs the survival of GBM bearing mice. These findings illustrate that ECs play an intrinsic inhibitory role in GSCs stemness via the SMEA3G-c-Myc distal regulation paradigm. Targeting SEMA3G signaling may have promising therapeutic benefits for GBM patients.

Bu araştırmada okul öncesi öğretmenlerinin dijital okuryazarlık düzeyleri ile dijital vatandaşlık düzeyleri arasındaki ilişki düzeyi araştırılmıştır. İlişkisel tarama modelinde yapılan bu araştırmada kolay ulaşılabilir örneklem seçimiyle 2023-2024 eğitim yılında Denizli il merkezinde bağlı resmi okullarda okul öncesi öğretmeni olarak çalışan 282 öğretmene ulaşılarak veri toplanmıştır. Araştırmada okul öncesi öğretmenlerinin dijital okuryazarlık düzeyleri hem maddeler hem de alt boyutlarda genel olarak yüksek düzeyde iken alt boyutlarda profesyonel üretim boyutunda orta düzeyde olarak tespit edilmiştir. Okul öncesi öğretmenlerinin dijital vatandaşlık düzeylerinin maddelere göre katılımın farklılık gösterdiği görülürken alt boyutlarda internette politik aktivizm ve ağ etkenliği boyutlarında orta düzeyde, yerel/küresel farkındalık ve eleştirel bakış açısı boyutlarıyla genel dijital vatandaşlık düzeyinin yüksek ve teknik beceriler boyutunda çok yüksek düzeyde olduğu saptanmıştır. Okul öncesi öğretmenlerinin dijital okuryazarlık düzeyleri eğitim düzeyi ve medeni duruma göre anlamlı farklılık göstermez iken cinsiyet, yaş, kıdem, sınıfındaki öğrenci sayısı, dijital okuryazarlık düzeyi, dijital vatandaşlık düzeyi, dijital platformları takip durumu ve web 2.0 araçlarını kullanma durumuna göre ise anlamlı farklılık göstermiştir. Okul öncesi öğretmenlerinin dijital vatandaşlık düzeylerinin ise cinsiyet, yaş, kıdem, sınıfındaki öğrenci sayısı, eğitim düzeyi, medeni durum, dijital platformları takip durumu ve web 2.0 araçlarını kullanma durumuna göre anlamlı farklılık gösterdiği tespit edilmiştir. Bununla birlikte okul öncesi öğretmenlerinin dijital okuryazarlık düzeyleri ile dijital vatandaşlık düzeyleri arasındaki ilişkinin anlamlı, orta düzeyli ve pozitif yönlü olduğu tespit edilmiştir. Elde edilen bulgular ışığında okul öncesi öğretmenlerinin dijital okuryazarlık düzeyleri artıkça dijital vatandaşlık düzeylerinin de arttığı ya da okul öncesi öğretmenlerinin dijital okuryazarlık düzeyleri düştükçe dijital vatandaşlık düzeylerinin de düştüğü söylenebilmektedir. Araştırma sonucunda konu ile ilgili olabilecek yeni araştırmalara yönelik önerilerde bulunulmuştur.

Depression is a common mood disorder in systemic lupus erythematosus (SLE) patients, affecting quality of life and medication adherence. Sleep-disordered breathing (SDB) is a known contributor to depression in the general population, but its prevalence and impact on depression in SLE remain unclear. This study aimed to investigate the prevalence of SDB and its association with depression. A cross-sectional study was conducted among 414 Japanese adults with SLE from five university hospitals. The main exposure was high-risk SDB, assessed with the Berlin Questionnaire. The main outcome was moderate to severe depression evaluated using the Patient Health Questionnaire-9. Poisson regression models with robust error variance estimated adjusted prevalence ratios (aPRs). The mean age and body mass index were 47.5years and 22.1kg/m2, respectively. The prevalence of high-risk SDB and moderate to severe depression were 15.2% (95% confidence interval: 11.9-19.0%) and 19.1% (95% CI: 15.4-23.2%). High-risk SDB was associated with moderate to severe depression (aPR 2.63, 95% CI 1.62-4.27), with a dose-dependent relationship according to the number of positive risk categories. SDB is common in SLE and is associated with depression. SLE patients with SDB symptoms should undergo concurrent depression screening.

Metoidioplasty is a genital-masculinization surgery for transmen with gender dysphoria that creates a small penis from a hormonally enlarged clitoris, and while standing urination is currently facilitated by urethroplasty using buccal (Belgrade method) or labia-minora (Ring method) mucosal grafts combined with a vaginal flap, these techniques involve buccal wounds and are associated with high urethral-fistula rates. This study aims to describe our vaginal-mucosal graft metoidioplasty technique and report early outcomes from a case series of seven patients, based on the hypothesis that our approach may offer advantages over existing methods by avoiding buccal wounding seen in the Belgrade method and potentially reducing urinary complications compared to the Ring method. We performed vaginal-mucosal graft metoidioplasty on seven patients who expressed a desire to undergo metoidioplasty during preoperative counseling. At our institution, metoidioplasty is performed simultaneously with hysterectomy, oophorectomy, and vaginal closure, which allows us to harvest long vaginal flaps and vaginal-mucosal grafts of various sizes. We incorporate these grafts into urethroplasty to improve surgical outcomes. Primary outcome was the incidence of urinary complications, namely, urethral fistula and stricture. Median blood loss was 1610mL. Median operative time was 4:57h:min. Median postoperative follow-up period was 5 (range 2-11) months. One patient developed urethral fistula requiring closure surgery. Another had mild urethral stricture that is still under observation. The remaining patients had no noticeable complications. Vaginal-mucosal graft metoidioplasty does not involve buccal wounding and it had similar urethral-fistula rates in our small series as the Belgrade method (14% vs. 7%-15%). The technique permits urethral reconstruction with readily available vaginal mucosa. Blood loss was high because the vaginal flap is elevated with scissors and the vaginal-mucosal graft must be harvested in a circumferential manner. However, we believe blood loss will improve with experience. Our case series also only involved seven patients and follow-up of 2-11months, and patient satisfaction regarding cosmetic, urinary, and sexual outcomes was not routinely recorded. Longer follow-up, more cases, and the use of patient-recorded outcome measures are needed to determine long-term surgical, urinary, cosmetic, and sexual outcomes. Vaginal-mucosal graft metoidioplasty provides an accessible method for urethral reconstruction and may have acceptable urinary-complication rates, although further studies are required to confirm its safety and efficacy.

Abstract Noncontact acoustic inspection method using airborne sound waves and laser Doppler vibrometer (LDV) has been studied to detect internal defects in structures due to aging. To improve the inspection efficiency, fundamental experiments were conducted on movement measurement using a cart equipped with a sound source and LDV. The experimental results confirmed that the LDV resonated when the excitation sound pressure was increased to improve the signal-to-noise ratio. Therefore, an attempt was made to reduce the effects of LDV resonance by subtraction processing using vibration waveforms measured in the healthy part first. Next, a study was conducted on further improvements to defect detection performance by combining several noise reduction processes. As a result, it was revealed that even with movement measurements, defect with a diameter of 300 mm and a depth of 100 mm can be detected at average travel speed of 0.26 m s−1.

The activation of inflammasomes (NLRP3 and NLRP1) is central to the pathogenesis of inflammatory bowel disease (IBD). Here we examined the protective effects of a thioredoxin-mimetic peptide CB13 (TXM-CB13), known for its antioxidative stress and anti-inflammatory properties. We examined the effects of TXM-CB13 on dextran sulfate sodium (DSS)-induced colitis and lipopolysaccharide (LPS)-induced NLRP3 inflammasome activation in RAW264.7 macrophages. TXM-CB13 appeared to alleviate symptoms of DSS-induced colitis and to significantly suppress the protein and mRNA levels of NLRP3, Mlck, and IL-1β in colonic tissues. Additionally, TXM-CB13 treatment increased the levels of the intestinal barrier proteins Occludin, ZO-1, and NLRP1, as shown through immunohistochemistry and Western blot analysis. In vitro, TXM-CB13 inhibited LPS-induced TLR4 signaling, reducing MyD88 levels and consequently attenuating the activation of the NF-κB pathways, including p-IκB-α/IκB-α and p-NF-κB-p65/NF-κB-p65. This inhibition further reduced the activation of the NLRP3 inflammasome components, NLRP3, ASC, Caspase-1, GSDMD, and IL-1β. In addition, TXM-CB13 prevented the ROS-mediated dissociation of TXNIP from TRX, inhibiting NLRP3 activation. These findings suggest that TXM-CB13 is a potential therapeutic candidate for IBD through its modulation of the TLR4/MyD88/NF-κB/NLRP3 and ROS/TXNIP/TRX/NLRP3 pathways.

Background: Lumbar canal stenosis (LCS) is a degenerative spinal disorder predominantly affecting older adults, leading to low back pain, radicular symptoms, and neurogenic calculation. The condition significantly impacts functional ability and quality of life. This study aimed to evaluate the clinical spectrum and functional outcomes of patients with LCS in a tertiary care hospital setting. Methods: A hospital-based cross-sectional study was conducted from January to December 2023 in Satkhira District Hospital and Satkhira Medical College and Hospital including 38 patients aged ≥40 years with MRI-confirmed lumbar canal stenosis. Demographic, clinical, and symptom data were collected using a structured questionnaire. Patients underwent neurological and functional assessments, including gait, spinal motion, and neurogenic claudication evaluation. Radiological analysis documented the level and severity of stenosis. Functional outcomes were measured using the Oswestry Disability Index (ODI), and patients were categorized by disability grade. Treatment modalities, including conservative management and surgical decompression, were recorded, and post-treatment ODI scores were used to assess functional improvement. Results: The majority of patients were aged 60–69 years, with a slight male predominance. Low back pain (100%), radicular leg pain (84.2%), and neurogenic claudication (78.9%) were the most common symptoms. L4–L5 was the most frequently affected level, and central canal stenosis predominated. Functional assessment revealed moderate to severe disability at presentation. Conservative management was provided to 57.9% of patients, while 42.1% underwent surgical decompression. Both groups demonstrated significant improvement in ODI scores post-treatment; however, surgical patients achieved greater functional improvement compared to the conservative group (mean ODI reduction: 47.5% vs 30.6%). Conclusion: LCS predominantly affects older adults, presenting with characteristic clinical and radiological patterns and causing substantial functional impairment. Both conservative and surgical interventions improve functional outcomes, with surgical decompression providing superior improvement in selected patients. Early recognition, comprehensive evaluation, and individualized management are essential to optimize patient outcomes.

The effectiveness and safety of propofol-based sedation and midazolam sedation in pediatric bidirectional endoscopy were compared. We retrospectively analyzed the cases of pediatric patients (≤15 years old) who had undergone bidirectional endoscopy, esophagogastroduodenoscopy, and colonoscopy by pediatric gastroenterologists. Demographic data, indications, sedatives/dosages, clinical outcomes, endoscopic findings, adverse events, and total patient time requirements (total time in which patients stay in our hospital) were compared in the two sedation groups. Ninety-one children (51 boys, 40 girls, mean age 13 years, range 9-15) treated at our hospital were enrolled. Propofol alone or in combination with midazolam and/or pentazocine was administered to 51 patients (propofol-based sedation group). Midazolam alone or in combination with pentazocine was administered to the other 40 patients (midazolam sedation group). In the propofol group, the following mean doses were used: propofol, 96 mg (range 40-145 mg); midazolam, 4.9 mg (range 3-5 mg); and pentazocine, 7.5 mg. In the midazolam group, the mean doses of midazolam and pentazocine were 6.2 mg (range 4-10 mg) and 15 mg, respectively. All procedures were successfully completed by pediatric gastroenterologists. The total procedure times and endoscopic findings were similar in the two groups, but the median patient time requirement in the propofol group was significantly shorter versus the midazolam group (7.3 h vs. 8.4 h, p < 0.001). No adverse events occurred in either group. Propofol-based sedation in pediatric bidirectional endoscopy was safely and effectively performed by pediatric gastroenterologists, and its patient time requirement was shorter than that for midazolam sedation.