Cultural prescribing is an emerging approach that connects people with arts, cultural activities, heritage, and culturally meaningful places to support health and well-being. It is usually situated within social prescribing and overlaps with Arts on Prescription, museum-based programmes, creative health, community arts, and participatory arts. However, inconsistent terminology and intervention models make its scope difficult to define. This critical narrative review clarifies the concept of cultural prescribing, summarizes its proposed mechanisms and current evidence, examines implementation and ethical challenges, and considers the contribution of socially engaged art. Existing reviews indicate that referral-based arts programmes can improve psychosocial well-being and may reduce anxiety, depression, loneliness, and social isolation, but the evidence remains limited by observational designs, heterogeneous interventions, selective participation, and insufficient long-term and economic evaluation. Cultural engagement may operate through emotional regulation, aesthetic absorption, meaning-making, identity development, learning, embodiment, social connection, place attachment, and collective agency. Implementation depends on trusted relationships, accessible and sustainable cultural infrastructure, adequate support for artists and community organizations, and attention to inequalities in participation. Socially engaged art is not synonymous with cultural prescribing, because it does not necessarily begin with a clinical referral or seek health outcomes. Nevertheless, its emphasis on dialogue, collaboration, shared authorship, and social transformation can extend cultural prescribing beyond the referral of individuals to pre-existing activities. Cultural prescribing can therefore be understood as a continuum from referral to participation, co-creation, and collective transformation. A relational and community-oriented model may be particularly relevant in Japan, where libraries, local festivals, traditional practices, and informal community spaces can function as cultural health assets. Future research should evaluate not only individual symptoms but also relationships, cultural inclusion, community capacity, and structural conditions.
With the advances in molecular biology, molecular testing has been incorporated into pathogen testing for infectious diseases. There are two main objectives for the molecular diagnosis of infectious diseases- first, to detect pathogen genes by using highly sensitive nucleic acid amplification tests, such as polymerase chain reaction and isothermal amplification, and second, to characterize the properties of the pathogen using next-generation sequencing. Polymerase chain reaction plays a key role in molecular testing. The extensive development of polymerase chain reaction methods is underway, focusing on the acceleration of reaction time (microfluidic polymerase chain reaction), quantification (real-time polymerase chain reaction, digital polymerase chain reaction), full automation, and point-of-care testing. Isothermal amplification is a method for amplifying nucleic acids at a constant temperature. Loop-mediated isothermal amplification, recombinase polymerase amplification, and nucleic acid sequence-based amplification have been developed for isothermal amplification. Isothermal amplification does not require a thermal cycler or simplified temperature control; therefore, it is suitable for point of care testing. CRISPR-based diagnostics are a new method for detecting amplified nucleic acids. CRISPR-Cas reaction proceeds at a constant temperature, it is often combined with isothermal amplification. Next-generation sequencing has a high sequence throughput to rapidly obtain large amounts of genomic information and can be used to detect novel pathogens and diagnose complex infectious diseases. It can also be used to track the sources and transmission routes of outbreaks and monitor pathogen evolution. Furthermore, next generation sequencing has enabled the analysis of microbiomes that can serve as biomarkers for diseases or disease susceptibility. In the future, the molecular diagnosis of infectious diseases will advance by overcoming these shortcomings and integrating various technologies as hybrid platforms. This review describes the developments in molecular diagnostics for the treatment of infectious diseases.
Intracranial complications of acute rhinosinusitis have become rare in the antibiotic era, but delayed diagnosis and treatment can lead to severe or even fatal outcomes. Therefore, clinicians should always be aware of the potential for intracranial involvement when treating patients with paranasal sinus infections. We experience a case of an 11-year-old boy who developed a subdural abscess secondary to acute rhinosinusitis. The patient initially presented with frontal headache and vomiting on day 0, and computed tomography (CT) revealed left frontal, ethmoidal, and maxillary sinusitis. Despite intravenous antibiotic therapy with ceftriaxone, right lower limb paresis developed on day 5, and magnetic resonance imaging (MRI) demonstrated a left subdural abscess. Endoscopic sinus surgery (ESS) was performed at another hospital, but the abscess enlarged, leading to transfer to our institution. On admission, he exhibited impaired consciousness, right leg paresis, and diplopia. Emergency simultaneous ESS and burr-hole drainage were performed in collaboration between otorhinolaryngology and neurosurgery teams. Pus was drained from both the frontal sinus and subdural space, and a subdural drain was placed. Cultures of the pus were negative, and broad-spectrum antibiotics were continued. The patient's neurological symptoms gradually improved, and follow-up MRI on day 54 showed complete resolution of the abscess. He was discharged on day 55 without neurological sequelae. This case emphasizes the importance of accurate diagnosis and the rapid, simultaneous performance of paranasal sinus drainage and intracranial abscess drainage through multidisciplinary collaboration. We report such a pediatric case of acute rhinosinusitis complicated by a subdural abscess, together with a brief review of the relevant literature.
Plasma high-density lipoprotein (HDL) plays a key role in transporting accumulated excess cholesterol from the peripheral tissues to the liver, and has other multiple cardioprotective functions, including antioxidant, anti-inflammatory, and antithrombotic effects. However, HDL-cholesterol (HDL-C) levels, which are commonly measured in a clinical testing, may not necessarily reflect the beneficial aspects of HDLs. In fact, recent studies have shown that increasing HDL-C with medication does not reliably prevent cardiovascular disease. Furthermore, recent advances in proteomic technology have revealed hundreds of proteins associated with HDLs, which contribute to their structural heterogeneity and functional diversity. Accordingly, identifying specific HDL family members is useful in assessing cardiovascular disease risk, rather than evaluating HDL as a single family. Certain HDLs contain apolipoprotein E (apoE), which plays an important role in cholesterol transport. However, our understanding of apoE-containing HDL (apoE-HDL) has become complex as apoE-HDL is a heterogeneous population that differs in particle compositions and sizes, as well as biological functions. This review focuses on apoE-HDL and summarizes its characteristics and functions as well as the clinical significance of its measurement, discussing its potential as a novel biomarker for cardiovascular disease risk assessment.
Background Clarifying the psychosocial factors associated with help-seeking intention among residents in rural areas is essential for developing community-based support systems and preventing social isolation. This study examined psychosocial factors associated with help-seeking intention among adults in a rural region of Japan. Methods A total of 448 adults living in Tottori Prefecture, Japan, participated in an online survey. Measures included help-seeking intention, perceived social climate, intrapersonal factors, social and interpersonal resources, and attitudes and skills related to help-seeking. Hierarchical logistic regression was conducted, with age and gender in Step 1 and 23 psychosocial variables in Step 2 using forward likelihood-ratio selection. Multicollinearity was assessed, and sensitivity analyses examined robustness. Results Individuals who believed that "it is unavoidable to burden others as long as one is alive" had higher help-seeking intention (OR = 2.69). Those endorsing that "it is better to be useful to others" also showed higher intention (OR = 4.94). Participants who had consulted someone during childhood worries were more likely to have help-seeking intention (OR = 6.48). Having a place to connect with others outside home, school, or work was associated with higher intention (OR = 1.90). Believing that "being listened to is meaningful" was associated with higher intention (OR = 2.59), and willingness to "consult another person if the first consultation did not go well" was also positive (OR = 3.88). In contrast, individuals who felt isolated (OR = 0.43) and those who did not know how to seek support (OR = 0.30) were less likely to have help-seeking intention. Conclusion Help-seeking intention in rural adults was associated with diverse psychosocial factors, including tolerance toward burdening others, value of being useful, childhood help-seeking experience, third places, perceived value of being listened to, persistence in help-seeking, subjective isolation, and uncertainty about how to seek help.
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an acquired demyelinating syndrome of the central nervous system mediated by MOG antibodies. Clinical phenotypes include optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis. MOG antibody-associated meningitis (MOGAM) is a form of aseptic meningitis characterized by the presence of serum MOG antibodies. Parenchymal lesions are typically absent in MOGAM; however, some cases may progress to MOGAD. Leptomeningeal lesions are rarely detected on contrast-enhanced T1-weighted magnetic resonance imaging (MRI) but may be conspicuous on contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging. We report a case of a 5-year-old boy who initially presented with a prolonged headache and fever. Contrast-enhanced FLAIR imaging revealed localized leptomeningeal enhancement (LME), and the patient was treated for suspected aseptic meningitis. Subsequently, additional parenchymal lesions developed, and serum MOG antibodies were detected, leading to a diagnosis of MOGAD. He achieved remission with corticosteroid therapy but experienced a relapse a year later, with LME localized to the same site on MRI. At recurrence, the contrast-enhanced T1-weighted image showed faint leptomeningeal enhancement, whereas contrast-enhanced FLAIR imaging clearly depicted LME. Intravenous methylprednisolone pulse therapy was promptly initiated, which resulted in resolution without progression to MOGAD. This is the first pediatric report of recurrent MOGAM with LME recurring at the identical site. Contrast-enhanced FLAIR imaging enabled early detection of LME at recurrence and facilitated timely corticosteroid therapy, which may have prevented progression to MOGAD.
Progressive myoclonus epilepsy (PME) is a severe developmental and epileptic encephalopathy characterized by drug-resistant seizures and progressive neurological regression. In the late stage, patients often develop myoclonic status epilepticus (MSE), for which an optimal treatment has not been established. Neuronal ceroid lipofuscinosis type 8 (NCL8), caused by pathogenic variants in the CLN8 gene, is a rare lysosomal disorder that can present with PME. However, published clinical experience is limited. We report the case of a boy with PME due to NCL8 who developed recurrent MSE with respiratory compromise and showed clinical improvement following the introduction of oral topiramate. He had developmental delays from late infancy, onset of epilepsy at three years of age, and multiple seizure types, including myoclonic seizures, generalized tonic-clonic seizures, and atypical absence seizures. Neurological regression progressed, and the patient became bedridden by 6 years of age. NCL8 was diagnosed based on the presence of a known pathogenic CLN8 variant and autofluorescent storage material in lysosomes identified on skin biopsy. At nine years of age, frequent and prolonged myoclonic seizures, confirmed by long-term video electroencephalography (EEG), occurred repeatedly with oxygen desaturation, requiring intensive care with continuous midazolam infusion. Despite escalation of antiseizure medication therapy, MSE persisted. After the initiation and titration of oral topiramate, the duration and frequency of myoclonic events decreased, allowing successful withdrawal of the continuous midazolam infusion. No further MSE occurred during an 8-month follow-up period, although occasional isolated myoclonic events persisted. Therefore, topiramate may be a useful therapeutic option for MSE in children with PME due to NCL8.
Background:Persistent right venous valve (PRVV), a remnant of the fetal right valve of the sinus venosus, may facilitate right-to-left atrial shunting through the patent foramen ovale (PFO). Although PRVV has been reported to cause severe neonatal cyanosis requiring surgical intervention, its clinical significance in otherwise healthy term neonates remains poorly defined. Methods:We retrospectively analyzed consecutive term neonates (≥ 37 weeks' gestation) with stable general conditions who exhibited periodic breathing-like oxygen saturation (SpO2) fluctuations and were found to have PRVV-associated right-to-left atrial shunting on transthoracic echocardiography. Clinical characteristics and SpO2 values recorded during routine monitoring were reviewed, and the minimum, median, and maximum SpO2 values during hospitalization were assessed. Results:Ten term neonates were included. Minimum SpO2 values ranged from 81% to 94% (median, 87%), whereas median SpO2 values remained high (95-100%) in all cases. These desaturation episodes occurred predominantly during sleep and were frequently synchronized with inspiration, suggesting a circulatory rather than respiratory mechanism. Although some neonates experienced transient desaturation reaching as low as 80%, none developed sustained hypoxemia, required prolonged oxygen supplementation, or underwent additional respiratory investigations or therapeutic interventions. All neonates remained clinically stable throughout hospitalization. Conclusion:In otherwise healthy term neonates, PRVV with PFO-related right-to-left atrial shunting may cause transient oxygen desaturation, occasionally reaching as low as 80%; however, it is generally self-limiting and clinically benign. Recognition of this hemodynamic mechanism may help clinicians appropriately interpret transient SpO2 decreases and avoid unnecessary respiratory evaluations in selected neonates.
Background We established persistently passable canine malignant mesothelioma (cMM) cell lines from tumor samples obtained from affected dogs, analyzed their characteristics, and investigated their sensitivity to anticancer drugs and photodynamic therapy (PDT) using 5-aminolevulinic acid hydrochloride (5-ALA). Methods Histopathological analyses were performed on SDK cells cultured under two-dimensional (2D) and three-dimensional (3D) conditions, as well as on tumor tissues derived from SDK cells. Cell proliferation in both culture systems and sensitivity to anticancer agents and PDT were assessed. Results In 2D culture, SDK cells appeared round to polygonal, with marked variability in size and the presence of pyknotic nuclei. In 3D culture, both large and small cells formed loose clusters with scattered cellular processes. Following subcutaneous transplantation into mice, tumor masses exhibited nodular lesions composed of tumor cells and fibroblasts. Cytokeratin expression was prominent in 3D-cultured cells and tumor tissues but weak in 2D-cultured cells. Vimentin and calretinin were expressed in all cells. SDK cells showed minimal sensitivity to carboplatin but were sensitive to doxorubicin. Notably, SDK cells were also sensitive to 5-ALA-mediated PDT. Conclusion SDK cells may serve as a novel cell line for elucidating the pathogenesis of cMM and for developing new therapeutic strategies.
Background The surgical management of benign prostatic hyperplasia (BPH) and upper urinary tract stones has remarkably evolved with technological advances. In this study, the trends in surgical techniques for these conditions in the San-in region of Japan were analyzed over a 10-year period. Methods A retrospective survey was conducted across 17 urological facilities in the San-in region (Tottori and Shimane prefectures) from 2014 to 2023. Data on the surgical procedures for BPH and upper urinary tract stones were collected, including the facility adoption rates and annual case volumes. Results For BPH treatment, HoLEP and bipolar TUR-P were the commonly performed procedures, with HoLEP accounting for approximately 50% of all cases. Minimally invasive surgical treatments, including water vapor energy (WAVE) and prostatic urethral lift (PUL), were introduced in 2022. For upper urinary tract stones, the utilization of TUL/URS equipped with holmium laser dramatically increased from 33.9% to 64.9% of all cases, whereas that of extracorporeal shock wave lithotripsy (ESWL) decreased from 59.9% to 32.1%. Conclusion This study shows the successful adoption of advanced urological techniques in rural Japan, with clear trends toward laser-based procedures for BPH and stone treatment. The observed decline in ESWL utilization is consistent with national and international trends, reflecting a global paradigm shift toward the endoscopic management of upper urinary tract stones.
Pleomorphic carcinoma of the mediastinal lymph nodes with an unknown primary site is extremely rare. A 68-year-old man was referred to our department after an enlarged lymph node in the right upper mediastinum was noted on computed tomography. An irregular nodule was also detected in the right upper lobe, showing no change compared with findings from 2 years earlier. FDG-PET (18F-fluorodeoxyglucose positron emission tomography) revealed strong uptake only in the mediastinal lymph nodes. EBUS-TBNA (Endobronchial ultrasound-guided transbronchial needle aspiration) of the lymph nodes revealed findings consistent with pleomorphic carcinoma. No other abnormalities were identified, and surgery was performed. As rapid pathology of the pulmonary nodule revealed no malignant findings, right upper mediastinal lymph node dissection was performed. The final pathological diagnosis was pleomorphic carcinoma. No malignant lesions were identified in the lungs. The patient has remained under strict observation, with no recurrence detected 1 year after surgery. Mediastinal lymph node carcinoma of unknown primary involving pleomorphic carcinoma, which carries a poor prognosis, needs strict follow-up owing to the risk of developing a future primary lung tumor.
Background Alcohol consumption can lead to significant health issues, such as non-communicable diseases. In recent years, an increase in alcohol consumption among women has been reported. However, previous research on alcohol consumption has mostly focused on young adults, and little is known on the drinking habits of adult women in general. The present study aimed to qualitatively examine the background characteristics and social factors of women at increased alcohol consumption. Methods We conducted semi-structured interviews with 30 adult women who consumed 20g or more of ethanol per day regarding their reasons for drinking and related factors. Data were analyzed using open coding to extract key concepts. Results Three key domains were identified: the influences that initiate women's drinking habits, those that maintain and escalate drinking, and the social factors in which drinking takes place. In addition, the following were implicated as remarkable risk factors for alcohol-related non-communicable diseases in women: "family stress", which provides situations different in nature from what young people typically experience, can trigger the formation of drinking habits; "positive emotional experience" and "misunderstanding of effects and risks" can lead to high risk drinking without awareness; and casual drinking at home" leads to an increase in drinking opportunities and a rise in consumption due to the absence of women who typically play a moderating role in regulating drinking behavior. Conclusion Preventing alcohol-related health issues, including non-communicable diseases, requires implementing measures that take the underlying context into account.
Background Fetal echocardiography is essential for the prenatal diagnosis of congenital heart disease (CHD) and plays a key role in planning early postnatal management, delivery, and inter-facility transfer. However, prenatal diagnoses do not always correspond to postnatal diagnoses, and diagnostic discordance occurs at a certain frequency. This issue is particularly relevant in centers without neonatal cardiac surgery, where the clinical value of prenatal diagnosis must be evaluated primarily in the context of early neonatal management. Methods We retrospectively reviewed 43 cases in which fetal echocardiography was performed collaboratively by pediatric cardiologists and obstetricians specializing in fetal echocardiography at our institution between 2014 and 2021, with a prenatal diagnosis of CHD and a confirmed postnatal diagnosis. The concordance between prenatal and postnatal primary diagnoses was assessed. The primary endpoint was whether clinically significant changes in early postnatal management were required compared with prenatal expectations. Results Prenatal and postnatal primary diagnoses were discordant in seven cases (16%). In most discordant cases, the anticipated circulatory physiology and early management strategies remained appropriate after birth. Only two cases (5%) required clinically significant changes in early postnatal management. In one case, anticipated early postnatal hemodynamic instability due to an unrecognized systemic outflow obstruction prompted an urgent transfer to a specialized cardiac center after birth. In the other case, unanticipated duct-dependent systemic circulation required early postnatal medical management to support systemic circulation. Subsequent evaluation revealed multiple extracardiac anomalies, and genetic testing confirmed a severe chromosomal syndrome with a poor life prognosis. After extensive discussion with the family, cardiac surgery was not pursued. Conclusion The role of prenatal echocardiographic diagnosis of CHD lies not in achieving complete diagnostic concordance, but in accurately anticipating hemodynamic risks requiring early postnatal intervention. Even in centers without neonatal cardiac surgery, prenatal echocardiography supports appropriate early postnatal management and facilitates timely coordination with specialized cardiac centers.
Background:The soluble form of NKG2D (sNKG2D) ligands has been implicated in the severity of coronavirus disease-2019 (COVID-19). However, their longitudinal dynamics from the acute phase to hospital discharge and their relationships with clinical parameters are unclear. This study aimed to investigate the longitudinal dynamics of these ligands and determine their relationship with clinical parameters. Methods:This retrospective observational cohort study evaluated 64 patients with mild or moderate COVID-19. sULBP-2, soluble MIC-A (sMIC-A), and soluble MIC-B (sMIC-B) concentrations at admission, recovery, and discharge were analyzed. Associations with patient characteristics and laboratory parameters (white blood cell count and C-reactive protein, lactate dehydrogenase, Krebs von den Lungen-6, ferritin, and interleukin-6 levels), natural killer (NK) cell and T cell counts, and severe acute respiratory syndrome coronavirus 2 viral copy numbers were examined. Principal component analysis (PCA) was performed in the moderate group, and the relationship between sNKG2D ligands and clinical parameters using hierarchical cluster analysis. Results:Serum sULBP-2 concentrations were significantly higher in the moderate group at both admission and discharge. In contrast, sMIC-A and sMIC-B levels did not significantly differ. Higher sULBP-2 levels at admission persisted until discharge. PCA demonstrated that admission sULBP-2 levels were associated with inflammatory components; admission sMIC-A levels were associated with components related to NK cells and lung injury. Their discharge levels both converged into a shared principal component closely associated with NK cell. Clusters characterized by older age, elevated sULBP-2, and increased inflammatory responses and lung injury markers had worse disease severity. Conclusion:NKG2D ligand levels increase via distinct mechanisms during acute COVID-19 but converge toward a shared dynamics during recovery. sULBP-2 is the only sNKG2D ligand related with disease severity, and its elevation persists through discharge, suggesting prolonged impairment of NK cell function after clinical recovery. sULBP-2 may be an important biomarker of disease severity.
Vitamin E (VE) is a fat-soluble vitamin and well-known as an antioxidant. VE deficiency is associated with various oxidative stress- and aging-related pathologies and sufficient VE intake is thought to help prevent these conditions. However, it has been unclear how VE deficiency in the pre-aging stage affects the liver. In the present study, 11-month-old mice were fed a VE-restricted diet for 3 months, when age-related changes began to appear, to examine the effects of VE deficiency on the liver. Compared to the livers of mice fed a standard diet, those fed a VE-deficient diet showed metabolic dysfunction-associated steatohepatitis (MASH)-like findings including fibrosis. Mice fed the VE-deficient diet mixed with 2% rice bran (RB) showed milder fibrosis than those fed the VE-deficient diet alone. These results suggest that VE deficiency in the pre-aging stage may cause MASH-like changes in the liver, particularly fibrosis, and that RB is an effective means of supplying VE.
Background:Reconstructive plates used in mandibular reconstruction may lead to complications such as plate fracture or exposure, and their management is often difficult. In this study, we investigated complications associated with mandibular reconstruction plates in patients who underwent resection of oral squamous cell carcinoma in our department. Methods:Twenty-five patients who received mandibular reconstruction plates during oral squamous cell carcinoma resection at our department over approximately the past 10 years were reviewed. Parameters examined included age, sex, tumor location, stage, type and timing of complication, possible causes, and treatments. Results:Plate exposure occurred in 4 patients, and plate fracture occurred in 4 patients. All exposures were on the cutaneous side. Additional findings included screw fractures and bone resorption around screws. Plate fractures tended to occur more often in patients with strong occlusal support. Patients without reconstruction showed a significantly higher incidence of fracture. Plate fracture was also influenced by plate configuration and bending, while plate exposure was attributed mainly to insufficient soft tissue volume. Conclusion:Although plate reconstruction is useful, the relatively high frequency of complications requires careful consideration of multiple factors when determining its application.
Background:Severe short bowel syndrome (SBS) frequently leads to intestinal failure-associated liver disease (IFALD); nonetheless, the mechanisms underlying early hepatic changes remain unclear. Existing SBS rodent models involving ≥ 90% small bowel resection often exhibit high postoperative mortality, limiting the ability to evaluate subacute liver injury independent of parenteral nutrition. Methods:We established a severe SBS murine model by performing 90% small bowel resection (SBS90) in young C57BL/6 mice using a standardized Albert-Lembert anastomotic technique and optimized perioperative management, allowing survival to postoperative day (POD) 14 or longer without parenteral nutrition. Serum biochemistry and liver histology were compared between the Sham, SBS50 (SBS murine model by performing 50% small bowel resection), SBS75 (SBS murine model by performing 75% small bowel resection), and SBS90 groups. Results:SBS90 mice exhibited significantly higher serum ALT and T-bil levels than did controls. At POD14, the liver histology demonstrated macrovesicular steatosis with minimal inflammatory infiltration, whereas SBS90 mice evaluated on POD28 exhibited macrovesicular steatosis together with severe portal and periportal inflammatory cell infiltration. Conclusion:This reproducible severe SBS mouse model enabled early and time-dependent hepatic injury evaluation following massive intestinal resection, providing a platform for studying IFALD-contributing mechanisms.
Kimura disease is a chronic inflammatory disorder characterized by peripheral eosinophilia, elevated serum IgE levels, and a painless mass. Although it predominantly affects adult males, pediatric cases have also been reported. We report two pediatric cases of Kimura disease diagnosed after adverse events following vaccination, presenting with swollen lymph nodes of the neck and upper limbs. Since children are vaccinated more often than adults, a painless mass following vaccination may constitute an important clinical clue in the diagnosis of Kimura disease. Attention should be paid to the differentiation between Kimura disease and immunoglobulin G4-related disease (IgG4-RD) owing to its similarities. This report provides valuable insights into the link between vaccination and Kimura disease, and emphasizes the importance of early diagnosis, especially in children, to ensure timely treatment and appropriate management.
Background:Since 2011, the Department of Community Medicine at Tottori University has provided community-based clinical training for fourth-year medical students. However, conventional community-based training often remains observational and does not necessarily foster students' critical reflection or active questioning in clinical settings. To address this gap, ethnographic methods from medical anthropology were introduced in 2018, allowing students to engage in participant observation. After each weekly practicum session conducted at a community-based medical facility, students documented the questions that emerged and their reasoning in an electronic portfolio (ePF), receiving individual feedback from faculty. Methods:A qualitative descriptive study was conducted using text data from the 2019 ePF entries of 107 fourth-year medical students. Descriptions of participant observation were analyzed using the text-mining software KH Coder. Co-occurrence network diagrams and textual analysis were used to extract thematic categories. Results:Frequently used words included "observe," "think," "learn," and "feel." Cluster analysis revealed strong associations such as "question" with "have," "university" with "community," and "study" with "knowledge." Students commonly formulated action plans emphasizing active observation and critical questioning for future clinical training. Conclusion:Participant observation enabled students to reflect on differences between community and university-based clinical settings. The exercise promoted the development of critical thinking and multiple perspectives, suggesting the value of incorporating anthropological methods into pre-clinical medical education.
Background:Obturator hernias are a relatively rare condition that predominantly occurs in thin elderly women and are frequently associated with bowel incarceration. Therefore, early diagnosis and appropriate treatment are vital. This study aimed to identify risk factors for bowel resection in patients with incarcerated obturator hernias and evaluate the clinical benefits of laparoscopic transabdominal preperitoneal repair (TAPP). Methods:This retrospective study included 32 female patients diagnosed with incarcerated obturator hernias at our institution between January 2008 and June 2025. The patients were classified into bowel resection (n = 8) and non-resection (n = 24) groups. The clinical and radiological characteristics were compared. Furthermore, surgical outcomes were compared between the laparotomy (n = 18) and TAPP groups (n = 11). Results:The median age was 86 years and the median body mass index (BMI) was 17.1. The bowel resection group had a significantly longer symptom duration (P < 0.001), a higher incidence of ileus on computed tomography (P = 0.041), and a significantly smaller bowel diameter at the obturator canal (P = 0.031). Cutoff values predictive of resection were identified as 36 h and 10.0 mm for the duration of symptoms and bowel diameter at the obturator canal, respectively. Multivariate analysis demonstrated that both factors were independent predictors of bowel resection (P = 0.045 and 0.040, respectively). Compared to laparotomy, TAPP resulted in significantly lower blood loss (P < 0.001) and shorter postoperative hospital stay (P < 0.001). In the TAPP group, contralateral obturator hernias were identified and simultaneously repaired in six patients (54.5%). Conclusion:Symptom duration and bowel diameter at the obturator canal may serve as useful predictive factors for bowel resection in patients with incarcerated obturator hernias. TAPP is a minimally invasive and effective surgical strategy with favorable postoperative outcomes and the added advantage of bilateral hernia management.
