Purpose Advances in mitral valve repair and adoption have been partly attributed to improvements in echocardiographic imaging technology. To further educate and guide repair surgery, we have developed a methodology to quickly produce physical models of the valve using novel 3D echocardiographic imaging software in combination with stereolithographic printing. Description Quantitative virtual mitral valve shape models were developed from 3D transesophageal echocardiographic images using software based on semi-automated image segmentation and continuous medial representation (cm-rep) algorithms. These quantitative virtual shape models were then used as input to a commercially available stereolithographic printer to generate a physical model of the each valve at end systole and end diastole. Evaluation Physical models of normal and diseased valves (ischemic mitral regurgitation and myxomatous degeneration) were constructed. There was good correspondence between the virtual shape models and physical models. Conclusions It was feasible to create a physical model of mitral valve geometry under normal, ischemic and myxomatous valve conditions using 3D printing of 3D echocardiographic data. Printed valves have the potential to guide surgical therapy for mitral valve disease.

Objectives：To develop a " MITORI"Care Scale that evaluates nursing care for patients with end-stage cancer and their families and to examine its reliability and validity.M ethods：The original" M ITORI"Care Scale was developed based on a descriptive study and a comprehensive review of the literature. A revised 49 -item version was developed based an examination of the content validity of the original scale. Subsequently, the revised questionnaire was distributed to 5 6 2registered nurses employed at 4general hospitals in Japan.Results：Exploratory factor analysis by principal factor analysis with promax rotation was conducted. The following five factors comprised of 22 items were finally extracted：" Care facilitating death without regret,"" Spiritual care,"" Assurance of palliative care,"" Supporting decision making with appropriate information,"and " Arrangement of available care."A confirmatory factor analysis was conducted by analyzing covariance structures and the hypothesized statistical model was found to fit the actual data. The reliability of the scale was confirmed by a Cronbachʼ s alpha internal consistency reliability coefficient of 0.9 1( 0.6 7-0. 83 for subscales) and a test-retest reliability coefficient of 0.7 4. The criterion-related validity was confirmed by interventions using Family Support and Dying Care, the Scale of the Professional Autonomy in Nursing, and the Satisfaction Scale of Hospice Nurses in Providing End-of-Life Care. Furthermore, the construct validity was confirmed by the known-group technique.Conclusion：The above findings indicate that the " M ITORI"Care Scale is sufficiently valid to improve the quality of nursing care for patients with end-stage cancer and their families.

Background: Although fatigue is a common and distressing symptom in cancer survivors, the mechanism of fatigue is not fully understood. Therefore, this study aims to investigate the relation between the fatigue and mindfulness of breast cancer survivors using anxiety, depression, pain, loneliness, and sleep disturbance as mediators.Methods: Path analysis was performed to examine direct and indirect associations between mindfulness and fatigue. Participants were breast cancer survivors who visited a breast surgery department at a university hospital in Japan for hormonal therapy or regular check-ups after treatment. The questionnaire measured cancer-relatedfatigue, mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance. Demographic and clinical characteristics were collected from medical records.Results: Two-hundred and seventy-nine breast cancer survivors were registered, of which 259 answered the questionnaire. Ten respondents with incomplete questionnaire data were excluded, resulting in 249 participants for the analyses. Our final model fit the data well (goodness of fit index = .993; adjusted goodness of fit index = .966; comparative fit index = .999; root mean square error of approximation = .016). Mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance were related to fatigue, and mindfulness had the most influence on fatigue (β = − .52). Mindfulness affected fatigue not only directly but also indirectly through anxiety, depression, pain, loneliness, and sleep disturbance.Conclusions: The study model helps to explain the process by which mindfulness affects fatigue. Our results suggest that mindfulness has both direct and indirect effects on the fatigue of breast cancer survivors and that mindfulness can be used to more effectively reduce their fatigue. It also suggests that health care professionals should be aware of factors such as anxiety, depression, pain, loneliness, and sleep disturbance in their care for fatigue of breast cancer survivors.

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