Publications by authors named "Jun Kataoka"

45 Publications

Granular cell tumor coexisting with adenocarcinoma in the stomach: Report of a rare case.

Ann Med Surg (Lond) 2021 May 26;65:102271. Epub 2021 Apr 26.

Division of Surgery Gastroentelogical Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Introduction: and importance: Granular cell tumor (GCT) is a benign, mesenchymal tumor that originates from Schwann cells.

Case Presentation: A 75-year-old Japanese woman was referred to our hospital due to epigastric discomfort. Upper gastrointestinal endoscopy revealed an ulcerated cancer lesion, approximately 1.2 cm in diameter, at the angle of the stomach in the posterior gastric wall and a yellowish submucosal tumor, 5 mm in diameter, near an anal ulcerated lesion. Based on these findings, the patient was scheduled for laparoscopic distal gastrectomy and lymph node dissection. The pathological diagnosis was a moderately differentiated tubular adenocarcinoma invading mucosal stroma without lymph node metastasis and GCT in the stomach. Tumor cells were positive for S-100 and were consistent with the characteristics of GCT.

Clinical Discussion: To the best of our knowledge, this is an extremely rare case with reports of only 6 cases of such a combination, including our case.

Conclusions: We believe that the coexistence of a GCT and gastric cancer in our patient was accidental and that there was no relation between them.
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http://dx.doi.org/10.1016/j.amsu.2021.102271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100089PMC
May 2021

Collision Tumor Comprising Primary Malignant Lymphoma and Adenocarcinoma in the Ascending Colon.

Case Rep Gastroenterol 2021 Jan-Apr;15(1):379-388. Epub 2021 Mar 18.

Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, Osaka, Japan.

We describe the case of a 78-year-old man with collision tumor from the primary malignant lymphoma and adenocarcinoma in the ascending colon. He suffered anemia from sigmoid colon cancer, and colonoscopy revealed early-stage colorectal cancer with a diameter of 20 mm in the cecum, the biopsy specimen showed moderately differentiated adenocarcinoma. Contrast-enhanced computed tomography (CT) revealed bowel wall thickening with contrast enhancement at the cecum; however, no lymph node and organ metastases were found. As above, we performed laparoscopic ileocecal resection with D3 lymph node dissection. The postoperative course was uneventful, and he was discharged from the hospital on postoperative day 11. Histopathological findings were moderately differentiated adenocarcinoma which invaded the muscularis propria and serosa from the submucosa, while the adjacent serosa showed a highly diffuse proliferation of atypical cells with an irregular nuclear-to-cytoplasmic ratio. Besides, immunohistochemical staining findings were diffuse large B-cell lymphoma, and diffuse large B-cell lymphoma was coexistent with moderately differentiated adenocarcinoma. We treated the patient with cyclophosphamide, doxorubicin, vincristine, and prednisolone in combination with rituximab (R-CHOP therapy) during 3 months postoperatively. When the 8 courses had been completed, postoperative positron emission tomography-CT (PET-CT) confirmed complete response, and the disease control has been doing well. Malignant lymphoma of the colorectal region is relative rare, and the occurrence of synchronous lymphoma and adenocarcinoma of the colon is also rare. Furthermore, collision tumor by these different entities is very unusual. We presented here such a case. The accurate clinical determination of the dominant tumor and a close follow-up is required for proper treatment in these cases.
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http://dx.doi.org/10.1159/000513972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077522PMC
March 2021

Total pancreatectomy for pancreatic remnant carcinoma five years after pancreaticoduodenectomy: Report a case.

Int J Surg Case Rep 2021 Apr 20;81:105795. Epub 2021 Mar 20.

Department of Gastroenterological Center Surgery, Shunjukai Shiroyama Hospital, Osaka, Japan.

Introduction And Importance: The prognosis of non-invasive intraductal papillary mucinous neoplasma (IPMN) is better than that of pancreatic cancer. However, if the first surgical finding revealed an invasive IPMC, the risk of recurrence was found to be 7-21%.

Case Presentation: A 76-year-old Japanese man had undergone subtotal stomach-preserving pancreaticoduodenectomy for intraductal papillary mucinous carcinoma non-invasive type at our hospital. No signs of adenocarcinoma at the resection margin were found by pathological examination of frozen sections. Five years later, a blood analysis showed increased serum CA19-9 level. A contrast-enhanced computed tomography scan of the abdomen revealed a mass adjacent to the pancreaticogastrostomy anastomosis. The patient underwent a total pancreatectomy. The tumor was identified as a recurrent IPMC with subserosal invasion, but without nodal involvement. The resection margins were negative. The patient's postoperative course was uneventful, and he was discharged after 12 days. He is being followed up without adjuvant chemotherapy.

Discussion: The prognosis of IPMN is better than that of pancreatic cancer. However the risk of recurrence in invasive IPMC was found to be 7-21%. Therefore, IPMC must be surveilled every three months using tumor markers and imaging. Local recurrence in remnant pancreas is usually treated with systemic therapy. The median long-term survival after total pancreatectomy (range 7-24 months) was shown to be better than when chemotherapy alone was used (range 10-13 months).

Conclusion: We chose secondary surgery in term of survival time although there are quality of life drawbacks that currently make total pancreatectomy more inappropriate in patients than chemotherapy.
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http://dx.doi.org/10.1016/j.ijscr.2021.105795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024913PMC
April 2021

Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study.

Crit Care 2021 02 16;25(1):69. Epub 2021 Feb 16.

Department of Emergency Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo Prefecture, Amagasaki, 660-8550, Japan.

Background: Many studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls. Many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2, but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 subscales and interpreted the patients' subjective significance of impairment.

Methods: A prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 hospitals in Japan. Adult ICU patients expected to receive mechanical ventilation for > 48 h were enrolled, and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, indicated by the change in SF-36 physical component score (PCS) ≥ 10 points; mental status, indicated by the change in SF-36 mental component score (MCS) ≥ 10 points; and cognitive function, indicated by the worsening of Short-Memory Questionnaire (SMQ) score and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients' subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating to evaluate minimal clinically important difference (MCID).

Results: Among 192 patients, 48 (25%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥ 1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 17 (17.8%) patients. Physical, mental, and cognitive impairments occurred in 32.3%, 14.6% and 37.5% patients, respectively. Population with only mandatory education was associated with PICS occurrence (odds ratio: 4.0, 95% CI 1.1-18.8, P = 0.029). The MCID of PCS and MCS scores was 6.5 and 8.0, respectively.

Conclusions: Among the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS was associated with population with only mandatory education. Future studies elucidating the MCID of SF-36 scores among ICU patients and standardizing the PICS definition are required. Trial registration UMIN000034072.
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http://dx.doi.org/10.1186/s13054-021-03501-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888178PMC
February 2021

Combined Intraoperative Identification and Monitoring of Recurrent Laryngeal Nerve Paresis during Minimally Invasive Esophagectomy: Surgical Technique Using Nerve Integrity Monitoring for Esophageal Carcinoma.

Case Rep Gastroenterol 2020 Sep-Dec;14(3):644-651. Epub 2020 Nov 30.

Division of Surgery Gastroenterology, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Recurrent laryngeal palsy occurs after No. 106 rec RL lymphadenectomy procedure, which is assumed to cause postoperative respiratory complications. A 71-year-old Japanese man with T1b N0 M0 stage 1 esophageal cancer was scheduled for thoracoscopic esophagectomy with two-field lymph node dissection using nerve integrity monitoring (NIM). The patient demonstrated an uneventful postoperative course with 56 days remission. Under general anesthesia conditions, a single-lumen intubation tube was inserted for NIM. The automatic periodic stimulation electrode was placed on the bilateral vagus nerves on the left and right, respectively. The NIM had set and enabled the identification of the nerve accurately and continuous intraoperative nerve monitoring using impulses from the stimulation probe. The postoperative outcomes and comparison of the potential amplitudes of electromyography were observed while no postoperative vocal cord paresis was present. Combined intraoperative identification and monitoring of recurrent laryngeal nerve significantly changes the quality of the lymphadenectomy procedure and is a promising optical imaging technique. It has gained recognition for being able to reduce or prevent recurrent laryngeal nerve paralysis. It was considered a reasonable method, but it has been superseded by NIM, which is a novel technology.
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http://dx.doi.org/10.1159/000510209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772838PMC
November 2020

Performance demonstration of a hybrid Compton camera with an active pinhole for wide-band X-ray and gamma-ray imaging.

Sci Rep 2020 08 20;10(1):14064. Epub 2020 Aug 20.

Graduate School of Medicine, Osaka University, Osaka, Japan.

X-ray and gamma-ray imaging are technologies with several applications in nuclear medicine, homeland security, and high-energy astrophysics. However, it is generally difficult to realize simultaneous wide-band imaging ranging from a few tens of keV to MeV because different interactions between photons and the detector material occur, depending on the photon energies. For instance, photoabsorption occurs below 100 keV, whereas Compton scattering dominates above a few hundreds of keV. Moreover, radioactive sources generally emit both X-ray and gamma-ray photons. In this study, we develop a "hybrid" Compton camera that can simultaneously achieve X-ray and gamma-ray imaging by combining features of "Compton" and "pinhole" cameras in a single detector system. Similar to conventional Compton cameras, the detector consists of two layers of scintillator arrays with the forward layer acting as a scatterer for high-energy photons (> 200 keV) and an active pinhole for low-energy photons (< 200 keV). The experimental results on the performance of the hybrid camera were consistent with those from the Geant4 simulation. We simultaneously imaged [Formula: see text]Am (60 keV) and [Formula: see text]Cs (662 keV) in the same field of view, achieving an angular resolution of 10[Formula: see text] (FWHM) for both sources. In addition, imaging of [Formula: see text]At was conducted for the application in future nuclear medicine, particularly radionuclide therapy. The initial demonstrative images of the [Formula: see text]At phantom were reconstructed using the pinhole mode (using 79 keV) and Compton mode (using 570 keV), exhibiting significant similarities in source-position localization. We also verified that a mouse injected with 1 MBq of [Formula: see text]At can be imaged via pinhole-mode measurement in an hour.
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http://dx.doi.org/10.1038/s41598-020-71019-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441182PMC
August 2020

Adverse events associated with prophylactic corticosteroid use before extubation: a cohort study.

Ann Transl Med 2020 Jul;8(14):853

Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.

Background: Systemic corticosteroid use is recommended before extubation in mechanically ventilated patients to prevent postextubation airway complications and reintubation. However, the adverse events associated with such use remain unclear. This study aimed to describe the incidence of adverse events associated with prophylactic corticosteroid use before extubation in mechanically ventilated adult patients.

Methods: This is a retrospective cohort study of 251 mechanically ventilated adults who received prophylactic corticosteroids in the intensive care units of four tertiary-care hospitals. The patients received 20 mg methylprednisolone at 12, 8, 4, and 0 hours before extubation (total dose, 80 mg) and were followed for 72 hours after extubation. The primary outcome was a clinically significant increase in blood glucose levels of ≥100 mg/dL within 24 and 72 hours after prophylactic corticosteroid administration.

Results: Fifty-seven (23.1%) out of 247 patients and 73 (30.3%) out of 241 patients showed a clinically significant increase in blood glucose levels within 24 and 72 hours after receiving prophylactic corticosteroids, respectively. The clinically significant increase in blood glucose levels was significantly associated with underlying diabetes mellitus and was not significantly associated with hyperglycemia within 3 days before the initiation of prophylactic corticosteroids or with patient age. New-onset infections and delirium were also common, with incidences of 7.6% and 7.7%, respectively.

Conclusions: Prophylactic corticosteroid use before extubation was associated with adverse events, the most common of which was increased blood glucose levels. Lower doses of prophylactic corticosteroids may need to be considered in patients with diabetes mellitus or hyperglycemia.
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http://dx.doi.org/10.21037/atm-20-1790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396740PMC
July 2020

Laparoscopic cholecystectomy for cholecystitis using direct gallbladder indocyanine green injection fluorescence cholangiography: A case report.

Ann Med Surg (Lond) 2020 Sep 4;57:218-222. Epub 2020 Aug 4.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

: Laparoscopic cholecystectomy is the treatment of choice for almost all biliary diseases. We present a novel technique using near-infrared fluorescence imaging for laparoscopic cholecystectomy.

: A 78-year-old woman diagnosed with acute cholecystitis (Grade II) was scheduled for emergency laparoscopy according to Tokyo Guidelines 2018. We performed a direct percutaneous drainage of the gallbladder to grasp the gallbladder itself. Subsequently, indocyanine green was administered into the gallbladder through the same tube, and the cystic and common bile ducts could be easily detected. The postoperative course was good, and the patient was discharged in remission nine days after the surgery.

: Real-time fluorescence cholangiography with indocyanine green is reliable for biliary anatomy visualization before the dissection of the Calot's triangle. Our method of indocyanine green injection into the same drainage catheter does not require pre-preparation and can be simultaneously performed with drainage intraoperatively. This surgical technique is simple, straightforward, and effective and can be useful in intraoperative decision-making, especially during laparoscopic cholecystectomy.
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http://dx.doi.org/10.1016/j.amsu.2020.07.057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415627PMC
September 2020

Ultimate Stomaless Technique of Two-Stage Operation for Lower Rectal Cancer Performed on a Patient with a High Body Mass Index: The Reborn Operation (Novel Pull-Through Method).

Case Rep Gastroenterol 2020 Jan-Apr;14(1):248-254. Epub 2020 Apr 29.

Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

A 58-year-old Japanese man, with a body mass index of 41.7 kg/m2 (height: 179.8 cm; weight: 133.8 kg), underwent a laparoscopic pull-through procedure with delayed coloanal anastomosis performed in two surgical stages for lower rectal cancer. This method was selected because the volume of the abdominal wall was fairly thick and it would have been impossible to perform diverting ileostomy and colostomy, which are routinely conducted. First, a colonic pull-through segment of about 10 cm was left outside the anal canal without any tension and was fixed by sutures under indocyanine green fluorescence imaging (ICG FI). The second surgical stage was performed 10 days after the first operation under general anesthesia. Final coloanal anastomosis was performed with near-infrared light without diverting the stoma under ICG FI. The patient demonstrated a good postoperative course and was discharged from our hospital in remission 15 days after the latest operation. We could inspect the coloanal flow of the anastomosis under ICG FI before the reconstruction. This procedure was considered to be a standard method, but it was overtaken by new technology, ICG FI. This procedure is an ultimate stomaless surgery for ultralow rectal cancer that can be performed in selected cases, such as in patients with a high body mass index and with hope for stomaless operation.
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http://dx.doi.org/10.1159/000507076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252201PMC
April 2020

Successful multi-stage treatment of stoma limb perforation following Hartmann's operation report a case.

Surg Case Rep 2020 May 14;6(1):102. Epub 2020 May 14.

Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino, Habikino city, Osaka, 583-0872, Japan.

Background: Stoma-related complications are not rare, whereas the spontaneous perforation of the stoma limb is relatively rare. Herein, we report a case of stoma limb perforation which occurred after Hartmann's operation.

Case Presentation: A 50-year-old Japanese man presented to our Hospital with acute and severe abdominal pain. Abdominal computed tomography (CT) scan revealed that an abscess with free air was formed around the sigmoid colon. We performed Hartmann's operation, whereas he experienced redness, purulent discharge, and swelling around the colostomy at 10 days postoperatively. The contrast-enhanced CT scan of the abdomen revealed an abscess formation with air around the colostomy. He was diagnosed with an abdominal wall abscess due to perforation of the stoma limb. After the drainage, his symptoms were ameliorated by oral analgesics, anti-inflammatory drugs, and prophylactic antibiotic. Four months after the first operation, we performed a closedown of the sigmoid colostomy and fistula resection. The patient's postoperative course was uneventful, and he was discharged 14 days later.

Conclusions: This case depicts rare complications of Hartmann's operation. Operation is usually performed in patients with stoma limb perforation. However, if they are stable and the abscess is located in their abdominal wall, they may be treated successfully using a multi-stage approach of local drainage toward the stoma wall followed by stoma closure.
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http://dx.doi.org/10.1186/s40792-020-00827-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225223PMC
May 2020

Usefulness of repair using Hem-o-lok™ for peritoneal tear as a complication of totally extraperitoneal repair: Case series.

Ann Med Surg (Lond) 2020 Jan 23;49:5-8. Epub 2019 Nov 23.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Introduction: Peritoneal tear (PT) is a frequent intraoperative event during totally extraperitoneal repair (TEP). We aimed to introduce our surgical technique for PT during TEP to avoid the more difficult TEP procedure.MethodsOne surgeon with 10 years of experience performed our TEP method in 147 TEP cases from January 2012 to June 2019. We investigated the repair time of each repair technique using endoscopic suturing (suturing group, SG) and endoscopic Hem-o-lok stapling (CG).

Results: Twenty-three (15.6%) PT cases occurred as TEP complication. The mean repair times (with standard deviation) of the PT were 16.2 ± 13 and 7.6 ± 7.0 min in the SG and CG, respectively, indicating a significant difference (P = 0.043). The repair time of the PT using Hem-o-lok (Teleflex, Wayne, PA, USA) stapling was shorter than that using endoscopic suturing, which was significantly different despite the length of the PT.

Conclusion: Hem-o-lok stapling is feasible in case of PT during TEP.
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http://dx.doi.org/10.1016/j.amsu.2019.11.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911983PMC
January 2020

Development and performance verification of a 3-D position-sensitive Compton camera for imaging MeV gamma rays.

Sci Rep 2019 Dec 6;9(1):18551. Epub 2019 Dec 6.

Osaka University, Research Center for Nuclear Physics, Osaka, Japan.

In gamma-ray astronomy, the 1-10 MeV range is one of the most challenging energy bands to observe owing to low photon signals and a considerable amount of background contamination. This energy band, however, comprises a substantial number of nuclear gamma-ray lines that may hold the key to understanding the nucleosynthesis at the core of stars, spatial distribution of cosmic rays, and interstellar medium. Although several studies have attempted to improve observation of this energy window, development of a detector for astronomy has not progressed since NASA launched the Compton Gamma Ray Observatory (CGRO) in 1991. In this work, we first developed a prototype 3-D position-sensitive Compton camera (3D-PSCC), and then conducted a performance verification at NewSUBARU, Hyogo in Japan. To mimic the situation of astronomical observation, we used a MeV gamma-ray beam produced by laser inverse Compton scattering. As a result, we obtained sharp peak images of incident gamma rays irradiating from incident angles of 0° and 20°. The angular resolution of the prototype 3D-PSCC was measured by the Angular Resolution Measure and estimated to be 3.4° ± 0.1° (full width at half maximum (FWHM)) at 1.7 MeV and 4.0° ± 0.5° (FWHM) at 3.9 MeV. Subsequently, we conceived a new geometry of the 3D-PSCC optimized for future astronomical observations, assuming a 50-kg class small satellite mission. The SΩ of the 3D-PSCC is 11 cmsr, anticipated at 1 MeV, which is small but provides an interesting possibility to observe bright gamma-ray sources owing to the high intrinsic efficiency and large field of view (FoV).
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http://dx.doi.org/10.1038/s41598-019-54862-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898691PMC
December 2019

Beta-ray imaging system with γ-ray coincidence for multiple-tracer imaging.

Med Phys 2020 Feb 25;47(2):587-596. Epub 2019 Dec 25.

RIKEN Center for Biosystems Dynamics Research, Kobe, 650-0047, Japan.

Purpose: Beta-ray imaging systems are widely used for various biological objects to obtain a two-dimensional (2D) distribution of β-ray emitting radioisotopes. However, a conventional β-ray imaging system is unsuitable for multiple-tracer imaging, because the continuous energy distribution of β-rays complicates distinguishing among different tracers by energy information. Therefore, we developed a new type of β-ray imaging system, which is useful for multiple tracers by detecting coincidence γ-rays with β-rays, and evaluated its imaging performance.

Methods: Our system is composed of position-sensitive β-ray and γ-ray detectors. The former is a 35 × 35 × 1-mm Ce-Doped((La, Gd) Si O ) (La-GPS) scintillation detector, which has a 300-µm pitch of pixels. The latter is a 43 × 43 × 16-mm bismuth germanium oxide (BGO) scintillation detector. Both detectors are mounted on a flexible frame and placed in a user-selectable position. We experimentally evaluated the performance of the β-ray detector and the γ-ray efficiencies of the γ-ray detector with different energies, positions, and distances. We also conducted point sources and phantom measurements with dual isotopes to evaluate the system performance of multiple-tracer imaging.

Results: For the β-ray detector, the β-ray detection efficiencies for Ca (245-keV maximum energy) and Sr/ Y (545 and 2280-keV maximum energy) were 14.3% and 21.9%, respectively. The total γ-ray detection efficiency of the γ-ray detector for all γ-rays from Na (511-keV annihilation γ-rays and a 1275-keV γ-ray) in the center position with a detector distance of 20 mm was 17.5%. From a point-source measurement using Na and Sr/ Y, we successfully extracted the position of a positron-γ emitter Na. Furthermore, for a phantom experiment using Ca and F or F and Na, we successfully extracted the distribution of the second tracer using the annihilation γ-ray or de-excitation γ-ray coincidence. In all the imaging experiments, the event counts of the extracted images were consistent with the counts estimated by the measured γ-ray efficiencies.

Conclusions: We successfully demonstrated the feasibility of our β-ray autoradiography system for imaging multiple isotopes. Since our system can identify not only a β-γ emitter but also a positron emitter using the coincidence detection of annihilation γ-rays, it is useful for PET tracers and various new applications that are otherwise impractical.
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http://dx.doi.org/10.1002/mp.13947DOI Listing
February 2020

[Malignant gastrointestinal lymphoma with cicatricial stenosis after complete response to chemotherapy].

Nihon Shokakibyo Gakkai Zasshi 2019 ;116(10):826-832

Second Department of Internal Medicine, Osaka Medical College.

A 75-year-old woman presented complaining of anorexia. A malignant gastrointestinal lymphoma was diagnosed, and chemotherapy was initiated. After 2 months, she developed vomiting. Computed tomography (CT) revealed thickening of the jejunal wall and dilatation of the intestine proximal to that area. Positron emission tomography-CT showed no uptake. Small bowel stenosis due to cicatricial stenosis after chemotherapy was suspected. Laparoscopic partial resection of the stenotic small bowel segment was performed. Histopathologically, only granulation tissue was seen with no evidence of tumor. Occasionally, cicatricial stenosis can develop after chemotherapy for malignant gastrointestinal lymphoma. Therefore, this condition must be considered an important complication of treatment for this disease.
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http://dx.doi.org/10.11405/nisshoshi.116.826DOI Listing
October 2019

Novel technique with the IRIS U kit to prevent urethral injury in patients undergoing transanal total mesorectal excision.

Ann Med Surg (Lond) 2019 Oct 13;46:1-3. Epub 2019 Aug 13.

Department of Colorectal Surgery Osaka Medical College, Osaka, Japan.

Background: Low anterior resection of the rectum with total mesorectal excision (TME) has been the gold standard for the surgical treatment of rectal cancer as it has the lowest recurrence rates. The key issue while performing transanal TME (TaTME) is avoiding iatrogenic urethral injury. We introduce our surgical technique for TaTME.

Surgical Technique: Intraurethral indocyanine green injection using the IRIS U kit with subsequent visualization under NIR was safely utilized during the TaTME. We were able to easily detect and visualize the IRIS urethral kit. The prostatic segment of the urethra can be identified in real-time using the infrared illumination system urethral kit (IRIS U kit).

Benefits: The prostatic segment of the urethra was easily and quickly identified by the green fluorescence during TaTME.

Conclusion: Our TaTME technique is an easy and feasible approach that provides real-time urethral images.
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http://dx.doi.org/10.1016/j.amsu.2019.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706455PMC
October 2019

ML-EM algorithm for dose estimation using PET in proton therapy.

Phys Med Biol 2019 09 4;64(17):175011. Epub 2019 Sep 4.

Department of Medical Physics, Graduate School of Medicine, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan. Author to whom any correspondence should be addressed.

Positron emission tomography (PET) has been extensively studied and clinically investigated for dose verification in proton therapy. However, the production distributions of positron emitters are not proportional to the dose distribution. Thus, direct dose evaluation is limited when using the conventional PET-based approach. We propose a method for estimating the dose distribution from the positron emitter distributions using the maximum likelihood (ML) expectation maximization (EM) algorithm combined with filtering. In experiments to verify the effectiveness of the proposed method, mono-energetic and spread-out Bragg-peak proton beams were delivered by a synchrotron, and a water target was irradiated at clinical dose levels. Planar PET measurements were performed during beam pauses and after irradiation over a total period of 200 s. In addition, we conducted a Monte Carlo simulation to obtain the required filter functions and analyze the influence of the number of algorithm iterations on estimation. We successfully estimated the 2D dose distributions even under statistical noise in the PET images. The accuracy of the 2D dose estimation was about 10% for both beams at the 1-[Formula: see text] values of relative error. This value is comparable to the deviations in the measured PET activity distributions. For the laterally integrated profile along the beam direction, a low error within 5% was obtained per irradiation value. Moreover, the difference of estimated proton ranges was within 1 mm, and 2D estimation from the PET images was completed in 21 ms. Hence, the proposed algorithm may be applied to real-time dose monitoring. Although this is the first attempt to use the ML-EM algorithm for dose estimation, the proposed method showed high accuracy and speed in the estimation of proton dose distribution from PET data. The proposed method is thus a step forward to exploit the full potential of PET for in vivo dose verification.
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http://dx.doi.org/10.1088/1361-6560/ab3276DOI Listing
September 2019

Ultrasonographic Assessment of Passive Cephalic Excursion of Diaphragm During Cough Expiration Predicts Cough Peak Flow in Healthy Adults.

Respir Care 2019 Nov 21;64(11):1371-1376. Epub 2019 May 21.

Department of Emergency and Critical Care Medicine, St Marianna University Hospital, Kawasaki, Kanagawa, Japan.

Background: Evaluation of cough strength is clinically important, especially for patients with neuromuscular disorders and before extubation of mechanically ventilated patients. The pressure gradient between the airway and thoracoabdominal cavities during the cough expiratory phase generates cough flow and passive cephalic movement of the diaphragm. We hypothesized that passive diaphragmatic cephalic excursion, peak velocity, or both during cough expiration might predict cough peak flow (CPF). This physiologic study investigated associations of CPF with simultaneously measured ultrasonographic indices in healthy adults during the cough expiratory phase.

Methods: 56 healthy adults participated in this study. Right hemidiaphragm excursion and peak velocity were measured with ultrasonography during voluntary cough expiration with maximum effort. CPF was simultaneously measured for all coughs along with the ultrasonographic measurements. A linear regression model was used to determine whether ultrasonographic indices predicted CPF.

Results: Simple regression analysis showed significant associations between excursion and CPF in men and women ( < .001, beta coefficient 37.8, 95% CI 10.9-64.7, adjusted R = 0.195 for men; < .001, beta coefficient 46.1, 95% CI 22.3-69.9, adjusted R = 0.386 for women). A multiple regression model adjusted for age, height, and sex showed a significant association between CPF and excursion ( < .001, adjusted beta coefficient 38.32, 95% CI 21.20-55.44, adjusted R = 0.643). Simple regression analysis showed a significant association between diaphragmatic peak velocity and CPF only in women ( = .004, beta coefficient 5.07, 95% CI 1.81-8.33, adjusted R = 0.280 for women).

Conclusions: Passive cephalic excursion of the diaphragm during the cough expiratory phase significantly predicted CPF with maximum cough effort in healthy adults. Future studies should investigate the relationship between CPF and excursion in persons with respiratory and neuromuscular disorders.
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http://dx.doi.org/10.4187/respcare.06780DOI Listing
November 2019

Laparoscopic omentectomy in primary torsion of the greater omentum: report of a case.

Surg Case Rep 2019 May 9;5(1):76. Epub 2019 May 9.

Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino Habikino-city, Osaka, 583-0872, Japan.

Background: Torsion of the greater omentum is a rare cause of acute abdominal pain in adults and children. It is very difficult to make a correct diagnosis of torsion clinically because it mimics other acute pathologies; however, the preoperative diagnosis can be easily confirmed with the use of computed tomography (CT). Herein, we report a case of laparoscopic omentectomy for primary torsion of the omentum, which was not improved by conservative treatment.

Case Presentation: A 50-year-old Japanese man presented to our hospital with acute right lower quadrant abdominal pain of a few hours' duration. Routine blood tests showed a white blood cell count of 8900/mm, and the C-reactive protein (CRP) level was 8.13 mg/dl. Contrast-enhanced CT scan of the abdomen revealed twisting of the omentum with a local mass of fat density and fluid distributed in a whirling oval-shaped mass pattern at the right flank and iliac fossa. Therefore, the patient was admitted to our hospital based on a diagnosis of omental torsion. The patient was treated with conservative treatment with analgesics, anti-inflammatories, and antibiotics. Although his symptoms were ameliorated, his laboratory and radiological findings worsened. We performed laparoscopic omentectomy 6 days after admission. The resected omentum was 24 cm × 22 cm in size and was twisted and dark red in color, suggesting infarction. Histological analysis revealed that the specimen was ischemic and hemorrhagic omentum, accompanied by inflammatory infiltration. The patient's postoperative course was uneventful, and he was discharged 9 days later.

Conclusion: This is a rare case of primary torsion of the greater omentum that was treated successfully with laparoscopic omentectomy. Considering the increase in surgical difficulty due to inflammation from prolonged torsion and the limited efficacy of conservative treatment, we conclude that surgical intervention is warranted as early as possible when torsion of the greater omentum is suspected.
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http://dx.doi.org/10.1186/s40792-019-0618-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509293PMC
May 2019

Laparoscopic Total Devascularization of the Upper Stomach and Splenectomy (Hassab's Procedure) Under Indocyanine Green Fluorescence Imaging: Initial Experience.

Surg Innov 2019 Aug 8;26(4):432-435. Epub 2019 Feb 8.

1 Medico Shunju Shiroyama Hospital, Osaka, Japan.

The use of surgical treatment for refractory isolated gastric varices has decreased owing to the development of endoscopic and radiologic procedures, although surgeries are sometimes required as the final method. A 75-year-old Japanese woman was diagnosed with solitary gastric varices. Initially, intraoperative splenic artery embolization was performed using the balloon transcatheter technique under general anesthesia. Laparoscopic splenectomy was performed safely owing to preoperative splenic artery embolization. Intraoperative indocyanine green (ICG) fluorescence angiography was performed following the injection of 5 mL of ICG; the remnant stomach was observed using laparoscopic equipment with an ICG imaging system, and blood flow from the remnant gastric artery was confirmed. The blood did not pool or wash out immediately, which confirmed successful devascularization of the stomach. The total operative time was 269 minutes, and the intraoperative blood loss was 500 mL. The patient's postoperative course was good, and at 21 days after the last operation, she was discharged from our hospital in remission. Real-time fluorescence angiography with ICG is a reliable and objective technique of assessing blood flow of the stomach. Accurate, extensive devascularization in the lower esophagus and upper stomach was performed using Hassab's procedure in combination with ICG imaging.
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http://dx.doi.org/10.1177/1553350619828912DOI Listing
August 2019

Laparoscopic Excisional Cholecystectomy with Full-Thickness Frozen Biopsy in Suspected Gallbladder Carcinoma.

Case Rep Gastroenterol 2018 Sep-Dec;12(3):747-756. Epub 2018 Dec 13.

Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Owing to the advantages of a laparoscopic approach, laparoscopic cholecystectomy (LC) is thought to be the treatment of choice in gallbladder disease, even in cases of suspected malignancy. However, it is difficult to differentiate between cholecystitis and gallbladder carcinoma (GBC). We performed radical hepatectomy in patients with pT2 GBC diagnosed by full-thickness frozen biopsy. A 75-year-old Japanese man presented to our hospital with discomfort in the right upper quadrant of the abdomen. This patient was diagnosed with suspected GBC and was scheduled to undergo LC and intraoperative histological examination. Following the procedure, we made a diagnosis of GBC with negative invasion of the cystic duct stump. We converted the laparoscopic procedure to an open surgery involving wedge liver resection with lymphadenectomy. The patient was discharged from our hospital in remission 14 days following the radical hepatectomy. Histological examination showed that the GBC had invaded the liver (T3a), but there was no lymph node metastasis (N0): stage IIIA. Between April 2009 and September 2018, 580 patients underwent cholecystectomy for gallbladder disease at our hospital. Among these, 8 (1.4%) were suspected to have GBC preoperatively and underwent laparoscopic excisional cholecystectomy. We performed elective surgery in the early stage in two patients and second-look surgery in two patients recently. We were able to perform what we termed a laparoscopic excisional cholecystectomy, involving LC with a full-thickness frozen biopsy, even in situations where intraoperative histological examination was not available. Altogether, laparoscopic excisional cholecystectomy is an effective surgical treatment for suspected early GBC.
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http://dx.doi.org/10.1159/000495603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341341PMC
December 2018

The Prognostic Impact of Pretransplantation Inflammatory and Nutritional Status in Adult Patients after Myeloablative Single Cord Blood Transplantation.

Biol Blood Marrow Transplant 2019 05 11;25(5):981-988. Epub 2019 Jan 11.

Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.

Markers of inflammatory and nutritional status, such as the Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index, Glasgow Prognostic Score, and C-reactive protein-albumin ratio (CAR) has been demonstrated to be associated with poor prognosis in patients with various cancers. Although the relatively low cell dose of a single cord blood unit restricts the indication for cord blood transplantation (CBT) to pediatric and relatively smaller and lighter adult patients, the impact of malnutrition on outcomes after CBT is unclear. We retrospectively analyzed 165 adult patients who underwent myeloablative single-unit CBT in our institute. In multivariate analysis, a higher CONUT score, which is indicative of poor inflammatory and nutritional status, was significantly associated with poor outcomes, including low neutrophil engraftment and development of extensive chronic graft-versus-host disease. A higher CAR, which is also suggestive of poor inflammatory and nutritional status, was significantly associated with poor neutrophil engraftment and higher overall mortality. Body mass index (BMI) was not associated with transplantation outcomes. These data suggest that poor pretransplantation inflammatory and nutritional status might be a more practical parameter than lower BMI, for predicting transplantation outcomes after single CBT for adults.
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http://dx.doi.org/10.1016/j.bbmt.2019.01.006DOI Listing
May 2019

Combination of electrohydraulic lithotripsy and laparoscopy for gallbladder access in type III Mirizzi syndrome.

Asian J Endosc Surg 2019 Apr 13;12(2):227-231. Epub 2018 Dec 13.

Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Introduction: A 50-year-old Japanese man presented with obstructive jaundice. We performed endoscopic retrograde biliary drainage before biliary decompression. CT showed a thickened gallbladder wall with low-density areas and a 35-mm gallstone; the stone was impacted in the gallbladder neck and cystic duct. The patient was therefore diagnosed with Mirizzi syndrome (type II or III) and scheduled for laparoscopic treatment. We performed subtotal cholecystectomy and intraoperative choledochoscopy because we recognized a fistula between the gallbladder and common bile duct preoperatively.

Materials And Surgical Technique: We opened the ductus choledochus, and a choledochoscope was introduced under laparoscopic guidance. An electrohydraulic lithotripsy probe with irrigation was passed through the choledochoscope to extract the gallstone.

Discussion: This fragmentation technique is effective for impacted large stones observed in Mirizzi syndrome. Therefore, electrohydraulic lithotripsy with laparoscopy is effective in cases of difficult gallbladder access such as that that occurs in type II or III Mirizzi syndrome.
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http://dx.doi.org/10.1111/ases.12602DOI Listing
April 2019

Proportional modes versus pressure support ventilation: a systematic review and meta-analysis.

Ann Intensive Care 2018 Dec 10;8(1):123. Epub 2018 Dec 10.

Department of Emergency Medicine and Critical Care Medicine, St. Marianna University, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 2168511, Japan.

Background: Proportional modes (proportional assist ventilation, PAV, and neurally adjusted ventilatory assist, NAVA) could improve patient-ventilator interaction and consequently may be efficient as a weaning mode. The purpose of this systematic review is to examine whether proportional modes improved patient-ventilator interaction and whether they had an impact on the weaning success and length of mechanical ventilation, in comparison with PSV.

Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through May 13, 2018. We included both parallel-group and crossover randomized studies that examined the efficacy of proportional modes in comparison with PSV in mechanically ventilated adults. The primary outcomes were (1) asynchrony index (AI), (2) weaning failure, and (3) duration of mechanical ventilation.

Results: We included 15 studies (four evaluated PAV, ten evaluated NAVA, and one evaluated both modes). Although the use of proportional modes was not associated with a reduction in AI (WMD - 1.43; 95% CI - 3.11 to 0.25; p = 0.096; PAV-one study, and NAVA-seven studies), the use of proportional modes was associated with a reduction in patients with AI > 10% (RR 0.15; 95% CI 0.04-0.58; p = 0.006; PAV-two studies, and NAVA-five studies), compared with PSV. There was a significant heterogeneity among studies for AI, especially with NAVA. Compared with PSV, use of proportional modes was associated with a reduction in weaning failure (RR 0.44; 95% CI 0.26-0.75; p = 0.003; PAV-three studies) and duration of mechanical ventilation (WMD - 1.78 days; 95% CI - 3.24 to - 0.32; p = 0.017; PAV-three studies, and NAVA-two studies). Reduced duration of mechanical ventilation was found with PAV but not with NAVA.

Conclusion: The use of proportional modes was associated with a reduction in the incidence with AI > 10%, weaning failure and duration of mechanical ventilation, compared with PSV. However, reduced weaning failure and duration of mechanical ventilation were found with only PAV. Due to a significant heterogeneity among studies and an insufficient number of studies, further investigation seems warranted to better understand the impact of proportional modes. Clinical trial registration PROSPERO registration number, CRD42017059791. Registered 20 March 2017.
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http://dx.doi.org/10.1186/s13613-018-0470-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288104PMC
December 2018

Surgical strategy for suspected early gallbladder carcinoma including incidental gallbladder carcinoma diagnosed during or after cholecystectomy.

Ann Med Surg (Lond) 2018 Sep 2;33:56-59. Epub 2018 Aug 2.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Purpose: This paper presents an overview of the surgical strategy for patients with suspected gallbladder carcinoma (GBC), including incidental GBC cases, preoperatively or intraoperatively, as well as their outcomes.

Methods: Between April 2009 and December 2017, 529 patients underwent cholecystectomy for gallbladder disease at our hospital. Both intraoperative and postoperative histological examinations of the excised gallbladder facilitated the diagnosis of GBC. Surgery-related variables and surgical approaches were evaluated according to the extent of tumor invasion.

Results: Of 529 patients, eight were diagnosed with GBC during/after cholecystectomy, including four women and four men. Mean age was 75.4 (range, 59-89) years. Five patients had gallbladder stones and three had cholecystitis. Three patients with stages T1b and T2 underwent additional liver bed wedge resections with or without prophylactic common bile duct excision. Five of the eight patients are still alive and two of the remaining three died from other diseases; one patient with pT3 died of recurrent GBC (peritonitis carcinomatosa).

Conclusion: Because of the ability to obtain full-thickness frozen biopsies during laparoscopic cholecystectomy, we could diagnose GBC intraoperatively, allowing for rapid diagnosis and tumor resection. We recommend developing a surgical treatment strategy for suspected early GBC in advance of cholecystectomy.
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http://dx.doi.org/10.1016/j.amsu.2018.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127871PMC
September 2018

Surgical technique of laparoscopic hybrid approach for recurrent inguinal hernia: Report a case.

Int J Surg Case Rep 2018 7;50:13-16. Epub 2018 Jul 7.

Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan.

Introduction: Currently, laparoscopic surgery (LS) is a widely accepted surgical treatment for inguinal hernias, and it has major advantages, especially for recurrent cases.

Presentation Of Case: We diagnosed the recurrent inguinal hernia after wound infection and performed the laparosocopic approach. We would like to introduce our method. We distinguished between the presence and absence of bilateral inguinal hernia with an intra-abdominal scope using the transabdominal preperitoneal inguinal hernia repair (TAPP) technique, which we call laparoscopic examination. Thus, we can distinguish between the types of inguinal hernias and whether they are bilateral or not. We dissected the Retzius space on the inside of an epigastric arteriovenous fistula as part of TEP part A, and dissection was performed without a balloon. We separated and dissected the Retzius space. We also performed lateral dissection of the preperitoneal space. We made an incision in the peritoneum at the inner groin ring (hernia sac). We isolated the cord structures (parietalization) using TAPP. We finally checked this operation from the abdominal space (TAPP filed) and determined whether the repair was satisfactorily completed or not.

Discussion: Our hybrid method is not special but the conventional laparoscopic approach adapted each merits both TAPP and TEP.

Conclusion: Our method is effective for difficult recurrent inguinal hernias.
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http://dx.doi.org/10.1016/j.ijscr.2018.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083376PMC
July 2018

Precision imaging of 4.4 MeV gamma rays using a 3-D position sensitive Compton camera.

Sci Rep 2018 05 25;8(1):8116. Epub 2018 May 25.

National Institute of Radiological Sciences, QST, Department of Accelerator and Medical Physics, Chiba, Japan.

Imaging of nuclear gamma-ray lines in the 1-10 MeV range is far from being established in both medical and physical applications. In proton therapy, 4.4 MeV gamma rays are emitted from the excited nucleus of either C* or B* and are considered good indicators of dose delivery and/or range verification. Further, in gamma-ray astronomy, 4.4 MeV gamma rays are produced by cosmic ray interactions in the interstellar medium, and can thus be used to probe nucleothynthesis in the universe. In this paper, we present a high-precision image of 4.4 MeV gamma rays taken by newly developed 3-D position sensitive Compton camera (3D-PSCC). To mimic the situation in proton therapy, we first irradiated water, PMMA and Ca(OH)2 with a 70 MeV proton beam, then we identified various nuclear lines with the HPGe detector. The 4.4 MeV gamma rays constitute a broad peak, including single and double escape peaks. Thus, by setting an energy window of 3D-PSCC from 3 to 5 MeV, we show that a gamma ray image sharply concentrates near the Bragg peak, as expected from the minimum energy threshold and sharp peak profile in the cross section of C(p,p)C*.
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http://dx.doi.org/10.1038/s41598-018-26591-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970135PMC
May 2018

Increase in intra-abdominal pressure during airway suctioning-induced cough after a successful spontaneous breathing trial is associated with extubation outcome.

Ann Intensive Care 2018 May 8;8(1):61. Epub 2018 May 8.

Department of Emergency and Critical Care Medicine, St. Marianna University Hospital, 2-16-1 Sugao, Kawasaki, Kanagawa, 2168511, Japan.

Background: A patient's ability to clear secretions and protect the airway with an effective cough is an important part of the pre-extubation evaluation. An increase in intra-abdominal pressure (IAP) is important in generating the flow rate necessary for a cough. This study investigated whether an increase from baseline in IAP during a coughing episode induced by routine pre-extubation airway suctioning is associated with extubation outcome after a successful spontaneous breathing trial (SBT).

Methods: Three hundred thirty-five (335) mechanically ventilated patients who passed an SBT were enrolled. Baseline IAP and peak IAP during successive suctioning-induced coughs were measured with a fluid column connected to a Foley catheter.

Results: Extubation was unsuccessful in 24 patients (7.2%). Unsuccessful extubation was 3.40 times as likely for patients with a delta IAP (ΔIAP) of ≤ 30 cm HO than for those with a ΔIAP > 30 cm HO, after adjusting for APACHE II score (95% CI, 1.39-8.26; p = .007).

Conclusion: ΔIAP during a coughing episode induced by routine pre-extubation airway suctioning is significantly associated with extubation outcome in patients with a successful SBT. Trial registration UMIN-CTR Clinical Trial, UMIN000017762. Registered 1 June 2015.
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http://dx.doi.org/10.1186/s13613-018-0410-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940967PMC
May 2018

Hitomi X-ray studies of Giant Radio Pulses from the Crab pulsar.

Publ Astron Soc Jpn Nihon Tenmon Gakkai 2018 Apr;70(2)

Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge, CB3 0HA, UK.

To search for giant X-ray pulses correlated with the giant radio pulses (GRPs) from the Crab pulsar, we performed a simultaneous observation of the Crab pulsar with the X-ray satellite Hitomi in the 2 - 300 keV band and the Kashima NICT radio observatory in the 1.4 - 1.7 GHz band with a net exposure of about 2 ks on 25 March 2016, just before the loss of the Hitomi mission. The timing performance of the Hitomi instruments was confirmed to meet the timing requirement and about 1,000 and 100 GRPs were simultaneously observed at the main and inter-pulse phases, respectively, and we found no apparent correlation between the giant radio pulses and the X-ray emission in either the main or inter-pulse phases. All variations are within the 2 sigma fluctuations of the X-ray fluxes at the pulse peaks, and the 3 sigma upper limits of variations of main- or inter-pulse GRPs are 22% or 80% of the peak flux in a 0.20 phase width, respectively, in the 2 - 300 keV band. The values become 25% or 110% for main or inter-pulse GRPs, respectively, when the phase width is restricted into the 0.03 phase. Among the upper limits from the Hitomi satellite, those in the 4.5-10 keV and the 70-300 keV are obtained for the first time, and those in other bands are consistent with previous reports. Numerically, the upper limits of main- and inter-pulse GRPs in the 0.20 phase width are about (2.4 and 9.3) ×10 erg cm, respectively. No significant variability in pulse profiles implies that the GRPs originated from a local place within the magnetosphere and the number of photon-emitting particles temporally increases. However, the results do not statistically rule out variations correlated with the GRPs, because the possible X-ray enhancement may appear due to a > 0.02% brightening of the pulse-peak flux under such conditions.
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http://dx.doi.org/10.1093/pasj/psx083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999749PMC
April 2018

Longitudinal Study on Quality of Life and Psychosocial Conditions in Light of Responses to Illness-Related Information in Postoperative Cancer Patients.

Asia Pac J Oncol Nurs 2018 Apr-Jun;5(2):208-216

School of Nursing, Seirei Christopher University, Sizuoka Prefecture, Japan.

Objective: Illness-related information can be significant for cancer patients after gastrointestinal (GI) surgery in terms of their performing adaptive tasks. This study longitudinally investigated the health outcomes of Japanese patients who read a booklet about cancer patients' problems and adaption tasks and evaluated the association between the responses to the booklet and the patients' health outcomes.

Methods: A questionnaire survey about quality of life (QOL), fatigue, anxiety, cognitive plight, and resilience was administered to postoperative patients with GI cancer 1 week after their discharge from hospital and 6 months after surgery. The questionnaires were returned by email.

Results: The mean age of the 32 patients at 1 week was 60.9 years; nearly 68.8% of them were men. As a whole, only two variables, QOL and anxiety, were significantly improved at 6 months over those at 1 week. Three statements were taken to gauge the responses to the booklet. In the two-way ANOVA that took QOL and responses to the booklet as independent variables, the test found that QOL was significantly improved in patients who agreed with the statement "I vaguely understood the content" or "I will deal with my tasks as described in the scenarios" but not in patients who agreed with the statement "The scenarios reflect my situation." The anxiety in patients who agreed with the statement "The scenarios reflect my situation" was high at both survey points.

Conclusions: This study suggests that associations between the responses to the informational booklet and patients' health outcomes partially indicate the directional property of how to support their information usage.
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http://dx.doi.org/10.4103/apjon.apjon_59_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863431PMC
April 2018

Oxygen management in mechanically ventilated patients: A multicenter prospective observational study.

J Crit Care 2018 08 21;46:1-5. Epub 2018 Mar 21.

Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan.

Purpose: To observe arterial oxygen in relation to fraction of inspired oxygen (FO) during mechanical ventilation (MV).

Materials And Methods: In this multicenter prospective observational study, we included adult patients required MV for >48h during the period from March to May 2015. We obtained FO, PaO and SaO from commencement of MV until the 7th day of MV in the ICU.

Results: We included 454 patients from 28 ICUs in this study. The median APACHE II score was 22. Median values of FO, PaO and SaO were 0.40, 96mmHg and 98%. After day two, patients spent most of their time with a FO between 0.3 and 0.49 with median PaO of approximately 90mmHg and SaO of 97%. PaO was ≥100mmHg during 47.2% of the study period and was ≥130mmHg during 18.4% of the study period. FO was more likely decreased when PaO was ≥130mmHg or SaO was ≥99% with a FO of 0.5 or greater. When FO was <0.5, however, FO was less likely decreased regardless of the value of PaO and SaO.

Conclusions: In our multicenter prospective study, we found that hyperoxemia was common and that hyperoxemia was not corrected.
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http://dx.doi.org/10.1016/j.jcrc.2018.03.024DOI Listing
August 2018