ORIGINAL PAPERS
Ketamine reduces the dose of remifentanil required during
prolonged head and neck surgery: a propensity-matched
analysis
Tasuku Fujii and Kimitoshi Nishiwaki
pg(s) 1 - 6
<Abstract> - < PDF >
High-dose opioids induce hyperalgesia and tolerance, which negatively affects postoperative recovery.
Prolonged surgery inevitably requires higher opioid doses. Ketamine reduces perioperative opioid consumption and prevents opioid-induced tolerance. However, its effects in cases of prolonged surgery remain
unknown. This study aimed to evaluate the dose of intraoperative remifentanil, an ultrashort-acting μ-opioid
agonist, administered after an intravenous ketamine bolus during prolonged head and neck surgery. This
single-center, retrospective, observational study included 251 patients who underwent head and neck
surgery (operation time ≥8 h) between January 2015 and December 2019. The participants were stratified
into two groups: those who received an intravenous bolus of ketamine and those who did not (ketamine
group and non-ketamine group, respectively). Propensity score-matching was used to match patients in a
1:1 ratio between the two groups, based on their covariates. The difference in intraoperative remifentanil
dose administered between the two groups was assessed. After 1:1 propensity score-matching, 89 matched
patients were selected from each group. The mean ± standard deviation dose of remifentanil administered
was significantly lower in the ketamine group than in the non-ketamine group before (0.15±0.05 vs
0.17±0.05 μg/kg/min; P=0.01) and after matching (0.15±0.06 vs 0.17±0.05 μg/kg/min; P=0.03). In conclusion, intravenous ketamine administration may reduce the intraoperative dose of remifentanil required
during prolonged head and neck surgery. However, further studies are required to evaluate the effect of
this finding on enhanced recovery after surgery.
Reliability and validity of lower limb joint range of motion
measurements using a smartphone
Yousuke Miyachi, Morihiro Ito, Kunihiro Furuta, Rua Ban,
Shuntaro Hanamura and Mitsuhiro Kamiya
pg(s) 7 - 18
<Abstract> - < PDF >
This study aimed to examine the reliability and validity of using a smartphone to measure the multi-joint
range of motion of the lower limbs. We measured the straight leg raise angle, ankle dorsiflexion angle,
and hip internal rotation angle in each of the 40 lower extremities of 20 healthy adults. Measurements
were compared between a conventional method using a goniometer and a smartphone application method.
The intraclass correlation coefficient (ICC) was used to evaluate the reliability of each smartphone
measurement, and Bland–Altman analysis was used to examine measurement errors. The criterion-related
validity of the two methods was also examined. Intra-rater reliability (ICC 0.668–0.939) was substantial
to almost perfect, with no systematic errors found for all items, and the standard errors of measurement
were acceptable. Inter-rater reliability (ICC 0.701–0.936) was also substantial to almost perfect, but the
straight leg raise angle and hip internal rotation angle showed fixation errors. For these two measurements,
with more than one examiner, the limit of agreement of error needs to be considered. No systematic
errors were found in the ankle dorsiflexion angle, and the standard error of measurement was within the
acceptable range. A moderate to strong correlation (r = 0.626–0.915) was found between the conventional
and smartphone methods, demonstrating good criterion-related validity. However, in the ankle dorsiflexion
angle measurements, the reliability and validity were shown to be lower than the other two items. This
suggested the necessity of changing the measurement conditions in order to use the ankle dorsiflexion
angle in clinical practice.
Progression of liver fibrosis and associated factors among
chronic hepatitis B patients at a general hospital
in Northern Vietnam
Ngoc Minh Luu, Thi Kim Thuy Nguyen, Thu Trang Vu,
Thai Son Dinh, Ngoc Hoat Luu, Thi Thanh Toan Do, Van Son Nguyen,
Thi Bich Van Ha, Dinh Chuc Nguyen, Thi Huong Tran,
Thi Thuy Hang Phung, Xuan Phuong Duong, Quynh Long Khuong,
Thi Thu Trang Nguyen, Yu Mon Saw, Thi Ngoc Anh Hoang
and Thi Nhan Nguyen
pg(s) 19 - 28
<Abstract> - < PDF >
Evaluation of liver fibrosis is necessary to make the therapeutic decision and assess the prognosis
of CHB patients. The current study aimed to describe the progression and identify some influencing
factors in patients with chronic hepatitis B at a General Hospital in Northern Vietnam. The longitudinal
study included 55 eligible subjects diagnosed Hepatitis-B-virus. Dependent variable was the aspartate
aminotransferase/platelet ratio index and we collected some demographic variables and disease related
and behaviour variables. Bayesian Model Averaging was used to select variables into model. Mixed-effect
linear models were used to evaluate the change of the aspartate aminotransferase/platelet ratio index over
time and identify related factors. the aspartate aminotransferase/platelet ratio index differences between
examinations, age of participants, working status were statistically significant. This pattern indicated that
the average the aspartate aminotransferase/platelet ratio index of the population decreased by 0.005 (95%
CI=-0.009; –0.001) after each patient’s visit, and increased by 0.013 if the patient’s age increased by 1
year (95% CI=0.005; 0.0219). For non-working patients, the aspartate aminotransferase/platelet ratio index
was lower, coefficient was –0.054 (95% CI=-0.108; 0.001). Other variables such as gender, education level,
time for disease detection, drinking tea, alcohol consumption, forgetting to take medicine and the aspartate
aminotransferase/platelet ratio index were not significantly different. The study showed that the majority
of study subjects had average the aspartate aminotransferase/platelet ratio index, and were relatively well
controlled and treated during the study. Age and working status are factors that influence the the aspartate
aminotransferase/platelet ratio index.
Editors' Choice
Evaluation of system-related magnetic resonance imaging
geometric distortion in radiation therapy treatment planning:
two approaches and effectiveness of three-dimensional
distortion correction
Yutaka Kato, Kuniyasu Okudaira, Takeshi Kamomae, Motoki Kumagai,
Youta Nagai, Toshiaki Taoka, Yoshiyuki Itoh and Shinji Naganawa
pg(s) 29 - 41
<Abstract> - < PDF >
We propose two methods to evaluate system-related distortion in magnetic resonance imaging (MRI)
in radiation therapy treatment planning (RTP) and demonstrate the importance of three-dimensional (3D)
distortion correction (DC) by quantitatively measuring the distortion magnitude. First, a small pin phantom
was scanned at multiple positions using an external laser guide for accurate phantom placement and
combined into one image encompassing a large area. Direct plane images were used for evaluating in-plane
distortion and multiplanar reconstruction images for through-plane distortion with no DC, two-dimensional
(2D) DC, and 3D DC. Second, a large grid sheet was scanned as the direct plane of the phantom placement.
The distortion magnitude was determined by measuring the displacement between the MRI and reference
coordinates. The measured distortions were compared between in- and through-plane when applying DC
and between the two methods. The small pin phantom method can be used to evaluate a wide range of
distortions, whereas data from the entire plane can be obtained with a single scan using the grid sheet
without a laser guide. The mean distortion magnitudes differed between the methods. Furthermore, the 3D
DC reduced in- and through-plane distortions. In conclusion, the small pin phantom method can be used
to evaluate a wide range of distortions by creating a combined image, whereas the grid sheet method
is simpler, accurate, repeatable, and does not require a special-order phantom or laser guide. As 3D DC
reduces both in- and through-plane distortions, it can be used to improve RTP quality.
Editors' Choice
Developing online lectures using text mining reduces health
workers’ anxiety in non-epicenter areas of COVID-19
Masahiko Ogasawara, Haruhiro Uematsu, Kuniyoshi Hayashi
and Yasuhiro Osugi
pg(s) 42 – 59
<Abstract> - < PDF >
COVID-19 is indirectly associated with various mental disorders such as anxiety, insomnia, and depression, and healthcare professionals who treat COVID-19 patients are particularly prone to severe anxiety.
However, neither the anxiety of healthcare workers in non-epicenter areas nor the effects of knowledge
support have been examined thus far. Participants were 458 staff working at the Toyota Regional Medical
Center who completed a preliminary questionnaire of their knowledge and anxiety regarding COVID-19.
Based on text mining of the questionnaire responses, participants were offered an online lecture. The effect
of the lecture was analyzed using a pre- and post-lecture rating of anxiety and knowledge confidence, and
quantitative text mining. The response rates were 45.6% pre- and 62.9% post-lecture. Open-ended responses
regarding anxiety and knowledge were classified into seven clusters using a co-occurrence network. Before
the lecture, 28.2%, 27.2%, and 20.3% of participants were interested in and anxious about “infection
prevention and our hospital’s response,” “infection and impact on myself, family, and neighbors,” and
“general knowledge of COVID-19,” respectively. As a result of the lecture, Likert-scale ratings for anxiety
of COVID-19 decreased significantly and knowledge confidence increased significantly. These changes were
confirmed by analyses of open-ended responses about anxiety, lifestyle changes, and knowledge. Positive
changes were strongly linked to the topics focused on in the lecture, especially infection prevention. The
anxieties about COVID-19 of healthcare workers in non-epicenter areas can be effectively reduced through
questionnaire surveys and online lectures using text mining.
DNA methylation is associated with muscle loss in
community-dwelling older men -the Yakumo study- :
a preliminary experimental study
Daisaku Kato, Yasuhiko Takegami, Taisuke Seki, Hiroaki Nakashima,
Yusuke Osawa, Koji Suzuki, Hiroya Yamada, Yukiharu Hasegawa
and Shiro Imagama
pg(s) 60 – 68
<Abstract> - < PDF >
Frailty is a state of reduced muscle strength and activity in older people. DNA methylation is associated
with osteoporosis and muscle loss in murine and other animal studies, but there are no epidemiological
studies in humans. This study aimed to assess the association of osteoporosis and muscle loss with DNA
methylation in community-dwelling older people. This cross-sectional study was performed in a rural part
of Japan. We analyzed 204 subjects (98 men and 106 women). In univariate analysis, the two groups were
compared according to the presence or absence of osteoporosis and of muscle loss. Logistic regression
analysis was performed to determine predictors of frailty in the muscle loss group. We used age, sex,
body mass index, smoking history, drinking history, serum albumin and C-reactive protein levels, diabetes,
hypertension, hyperlipidemia, heart disease history, and LINE-1 DNA methylation as the factors. Probability
values < 0.05 were considered to be statistically significant. The levels of LINE-1 DNA methylation in
leukocytes were associated with muscle loss in men over the age of 60. LINE-1 DNA methylation levels
were not associated with bone mineral density in either the men or women over the age of 60. LINE-1
DNA methylation levels in leukocytes correlated significantly with the risk of frailty in men over the
age of 60. Promoting an understanding of DNA methylation may lead to a better understanding of the
pathophysiology of muscle loss.
Age and sex differences in factors associated with
hypertension among an urban poor population
in Bangladesh
Abubakr Ahmed Abdullah Al-Shoaibi, Chifa Chiang,
Md. Khalequzzaman, Sohel Reza Choudhury, Yoshihisa Hirakawa,
Syed Shariful Islam, Atsuko Aoyama and Hiroshi Yatsuya
pg(s) 69 - 79
<Abstract> - < PDF >
This study explores the differences in factors associated with hypertension between younger and
older subjects in an urban slum community in Bangladesh. We analyzed the data of 1,008 men and
1,001 women obtained from a cross-sectional survey conducted between October 2015 and April 2016.
Multivariable logistic regression models were stratified by age (18 to 44 and 45 to 64 years) in men
and women separately. The multivariable model included age (continuous) and the following categorical
variables simultaneously: education duration, marital status, tobacco smoking, smokeless tobacco use, total
physical activity, body mass index (BMI), waist circumference, and the blood levels of glycated hemoglobin
(HbA1c), triglycerides, high- and low-density lipoprotein (HDL and LDL) cholesterol. Hypertension was
defined as the presence of either blood pressure ≥140/90 mmHg or the use of antihypertensive medication.
The prevalence of hypertension was 13.0% (younger men), 14.6% (younger women), 35.6% (older men),
and 38.7% (older women). In younger men, higher waist circumference and increased LDL cholesterol
levels were significantly associated with hypertension. In older men, physical activity was the only significant factor that was inversely associated with hypertension. In younger women, higher BMI, increased
HbA1c, triglycerides, and LDL cholesterol levels were associated with hypertension. In older women, a
higher HbA1c was the only factor significantly associated with hypertension. These findings suggest that
public health interventions to prevent hypertension may require different approaches according to sex and
age groups within the poor urban population in Bangladesh.
Alternating bortezomib-dexamethasone and lenalidomide-dexamethasone in patients with newly diagnosed multiple
myeloma aged over 75 years
Akihiro Yokoyama, Akiko Kada, Toshiya Kagoo, Michihiro Hidaka,
Hiroatsu Iida, Yasuhiko Miyata, Akiko M. Saito, Morio Sawamura,
Takuya Komeno, Kazutaka Sunami, Naoki Takezako
and Hirokazu Nagai
pg(s) 80 - 90
<Abstract> - < PDF >
More than 40% of Japanese patients with multiple myeloma (MM) are over 75 years of age at diagnosis.
Regardless of the treatment benefits, complications and relapses obstruct long-term survival. We conducted
a phase II, open-label, single-arm, multicenter clinical trial to assess the efficacy and safety of alternating
bortezomib-dexamethasone (Bd) and lenalidomide-dexamethasone (Ld) (Bd/Ld) treatment in MM patients
aged over 75 years (MARBLE trial). Patients received Bd therapy from days 1 to 35 and Ld therapy from
days 36 to 63. For Bd therapy, patients were administered bortezomib 1.3 mg/m2 and oral dexamethasone
20 mg on days 1, 8, 15, and 22. For Ld therapy, they were administered lenalidomide 15 mg from days
36 to 56 and dexamethasone 10 mg on days 36, 43, 50, and 57. They underwent six treatment cycles in
total, each consisting of a 63-day regimen. In total, 10 patients were enrolled, with a median age of 81
years. Efficacy was not evaluated because the patients were fewer than planned. The overall response rate
was 80.0% and complete response rate 40.0%. Seventy percent of patients completed the study treatment.
Progression-free survival and overall survival at 2 years were 40.0% and 80.0%, respectively. Adverse
events of grade 3 or higher, including anemia, decreased lymphocyte count, neutropenia, and hypokalemia,
were observed in eight patients. Alternating chemotherapy with Bd/Ld might be feasible, but its efficacy
should be verified further.
Sedentary behavior is associated with arteriosclerosis
in frail older adults
Nariaki Shiraishi, Yusuke Suzuki, Isao Kuromatsu, Hitoshi Komiya
and Masafumi Kuzuya
pg(s) 91 - 100
<Abstract> - < PDF >
This prospective, cross-sectional, cohort observational study was conducted to evaluate the associations
between sedentary behavior and arteriosclerosis-related vascular issues in community-dwelling frail older
adults. We included 116 Japanese community-dwelling older adults (92 females and 24 males) who availed
daycare at two long-term care insurance facilities in the cities of Yokkaichi and Handa between 2017 and
2019. An unpaired t-test and the chi-square test were used for intergroup comparisons. Logistic regression
analysis was conducted with cardio–ankle vascular index as the dependent variable, sedentary behavior
as the explanatory variable, and the other evaluated factors as covariates. Long-time sedentary behavior
(based on the median value for all participants) was associated with high cardio–ankle vascular index after
adjusting for age, sex, body mass index, ankle–brachial index, and walking MET-minutes in 1 week (odds
ratio 3.086, 95% confidence interval 1.275–7.467, p=0.012). After adjusting for other variables (care needs
certificate, skeletal muscle mass index, body fat percentage, grip strength, 4-m walking duration, etc), there
was a significant association between long-time sedentary behavior and high cardio–ankle vascular index
values (odds ratio 4.977, 95% confidence interval 1.497–16.554, p=0.009). The results study confirmed an
association between long-time sedentary behavior in frail older adults and the degree of arterial stiffness
assessed by the cardio–ankle vascular index. Interventions in older adults that focus on daily sedentary time
to prevent the onset and exacerbation of geriatric syndromes secondary to the progression of arteriosclerosis
warrant further investigation.
Evaluation of frailty and neutrophil-to-lymphocyte and
platelet-to-lymphocyte ratios relationship
in elderly people
Zeynep Aşık and Mehmet Özen
pg(s) 101 - 110
<Abstract> - < PDF >
It was aimed to evaluate the relationship between frailty and inflammation in people receiving home
health care. It was a cross-sectional study. Edmonton Frail Scale was used to determine the level of frailty
and, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were used to determine inflammation.
Of 332 people included in the study, 54.82% were females and 45.18% were males. Participants’ ages
were between 65 and 106. When we examined the frailty of the participants according to the Edmonton
Frail Scale, the mean score was 9.403 ± 2.032. The mean neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of the participants were 4,397±5,038 and 169,363±101,461 respectively. Accordingly,
neutrophil-to-lymphocyte ratio was high in men, frail elderly, 75–84 age range, hypertension patients,
malnutrition patients; and neutrophil-to-lymphocyte ratio was low in diabetes mellitus, dementia, cerebrovascular accident and hemiplegia. Platelet-to-lymphocyte ratio, another inflammatory marker, was high in
men, non-frail elderly, 75–84 age range, hypertension patients and cerebrovascular accident patients; it
was low in hemiplegia, malnutrition, dementia, diabetes mellitus. In the study, no statistically significant
difference was found between Edmonton Frail Scale and inflammatory markers. More studies are needed
on this subject. In addition, we think that examining NLR and PLR values will be useful for monitoring
inflammation in frail elderly.
Correlations between intraplan and postplan parameters
in I-125 permanent prostate brachytherapy using loose seeds
or linked seeds
Fumitaka Ito, Hidetoshi Kobayashi, Masayuki Ito, Ryoichi Shiroki
and Shinya Hayashi
pg(s) 111 - 119
<Abstract> - < PDF >
The purpose of this study was to determine the most appropriate seed arrangement by comparing two
different methods (linked seeds and loose seeds). A total of sixty-one patients (28 linked seed brachytherapy
cases and 33 loose seed brachytherapy cases) with clinically localized prostate cancer were treated with
I-125 permanent prostate brachytherapy. Modified peripheral loading was the method used for seed placement. The parameters evaluated were as follows: prostate D90, V100, and V150; urethral D90, D10, and
D5; and rectal V100 (RV100) and D2 (RD2). Coefficient parameters (r and r2) were assessed by regression
analysis. Prostate V150, urethral D90, urethral D10, urethral D5, and RD2 showed significant correlations
between both methods in all patients. Urethral D90, urethral D10, urethral D5, and RD2 showed significant
correlations in patients who received linked seed brachytherapy. Prostate V150, urethral D90, urethral
D10, urethral D5, RV100, and RD2 showed significant correlations in patients who received loose seed
brachytherapy. Urethral D90, urethral D10, urethral D5, and RD2 showed significant correlations in the
linked seed and loose seed brachytherapy analyses. In contrast, prostate D90 and prostate V100 showed no
correlation. Parameters of normal organ damage showed good correlations between intraplan and postplan
parameters. These parameters may be useful to determine normal organ damage during guided brachytherapy
with two different methods (linked seeds and loose seeds).
A use-case analysis of Clinical Data Interchange Standards
Consortium/Study Data Tabulation Model in academia
in an investigator-initiated clinical trial
Shizuko Takahara, Toshiki I. Saito, Yasuhito Imai, Takahiro Kawakami
and Toshinori Murayama
pg(s) 120 - 132
<Abstract> - < PDF >
Submitting data compliant with the Clinical Data Interchange Standards Consortium (CDISC) standards
is mandatory for new drug applications (NDAs). The standards set by CDISC are widely adopted in the
pharmaceutical business world. Introduction of CDISC standards in academia can be necessary to reduce
labor, resolve the shortage of data managers in academia, and gain new knowledge through standardized
data accumulation. However, the introduction of CDISC standards has not progressed in communities
within the academia that do not apply for NDAs. Therefore, herein, we created study data tabulation
model (SDTM)-compliant datasets within the academia, without outsourcing, to reduce costs associated
with investigator-initiated clinical trials. First, we input data from paper case report forms (CRFs) into an
electronic data capture system with minimal function for paper CRFs, “Ptosh,” which is compatible with
SDTM. Then, we developed a generic program to convert data exported from Ptosh into fully SDTM-compliant datasets. The consistency was then verified with an SDTM validator, Pinnacle21 Community
V3.0.1 (P21C). This resulted in generation of SDTM datasets, resolving all “Rejects” in P21C, thereby
achieving the required quality level. Although Ptosh directly exports data in SDTM format, manual mapping
of items on CRFs to SDTM variables prepared in Ptosh is necessary. SDTM mapping requires extensive
knowledge and skills, and it was assumed that mapping is challenging for the staff without in-depth
knowledge of CDISC standards and datasets. Therefore, for CDISC dissemination in academia, it is crucial
to secure the staff, time, and funding to acquire the knowledge.
Secondary male infertility: the importance of the urological
assessment for couples who desire children in later life
Hatsuki Hibi, Miho Sugie, Tadashi Ohori, Megumi Sonohara,
Noritaka Fukunaga and Yoshimasa Asada
pg(s) 133 - 138
<Abstract> - < PDF >
Amongst 942 out-patients who consulted our male infertility division between 2016 to 2020, 85 (9.0%)
patients suffered from secondary infertility. Of these, in 59 (69.4%) subjects, the first pregnancy was
achieved by natural conception. 81 subjects were evaluated for semen quality except for two subjects who
at the time were undergoing cancer treatment and another of two ejaculatory dysfunction (EjD). Semen
analysis revealed 16 subjects (19.8%) were azoospermic, whereas 9 (11.1%) were cryptozoospermic at
median three years of infertility. Left varicocelectomy had been undertaken in a total of 17 oligoasthenozoospermic and cryptozoospermic cases in order to improve semen quality. For achieving natural pregnancy,
microscopic vasoepididymostomy was performed in 3 subjects of obstructive azoospemia and patency was
achieved in two of three. 11 azoospermic subjects and two of the EjD underwent sperm retrieval surgery
for intracytoplasmic sperm injection (ICSI). Motile sperm recovery was obtained by microscopic epididymal
sperm aspiration (5/5=100%), microscopic testicular sperm extraction (micro-TESE, 2/6=33.3%), and
retrograde vasal sperm aspiration (2/2=100%). Natural pregnancy was obtained in two subjects following
varicocelectomy, and in one following vasoepididymostomy. Seven pregnancies were achieved by ICSI
using cryopreserved sperm and surgically retrieved sperm. Even if the first pregnancy occurred naturally,
30.9% subjects showed azoospermia or cryptozoospermia at median duration of three years. We would
like to emphasize that earlier urological assessment especially semen analysis is necessary if pregnancy
later in life is desired.
Issues concerning life-prolonging treatment in Japan, as
considered from attitudes among the legal and medical
professions
Yoshihiko Iijima
pg(s) 139 - 147
<Abstract> - < PDF >
In this paper, the author explores the clinical ethical issue of the withdrawal and withholding of
life-prolonging treatment, surveying 2,848 lawyers and 2,469 doctors as medical and legal professionals
in Japan on a variety of points for discussion. The main survey items are: (1) systems that should be
used in the withdrawal and withholding of life-prolonging treatment at the end of life; (2) problems in
determining treatment strategy at the end of life; (3) assessment of suspension of life support systems
(extubation); and (4) strategies for better end-of-life care. While 42.2% of lawyers cited legislature and
judiciary and 54.9% cited academic society guidelines as the system that should respond to the withdrawal
and withholding of life-prolonging treatment, 23.3% of doctors cited the legislature and the judiciary, and
65.4% academic society guidelines. In relation to current end-of-life care, 81.3% of lawyers and 69.3%
of doctors responded that there was room for improvement. Strategies for doing so included ensuring the
transparency of and publishing decision procedures, and notification to government. It is important for
medical institutions to normalize end-of-life care by making decisions with reference to guidelines and the
like, ensuring the transparency of decision-making procedures, and being managed by a public institution.
Safety and feasibility of primary radical surgery for
meconium peritonitis considering patients’ general
condition and perioperative findings
Yoichi Nakagawa, Hiroo Uchida, Hizuru Amano, Akinari Hinoki,
Chiyoe Shirota, Wataru Sumida, Kazuki Yokota, Satoshi Makita,
Masamune Okamoto, Aitaro Takimoto, Akihiro Yasui,
Shunya Takada and Takuya Maeda
pg(s) 148 - 154
<Abstract> - < PDF >
We reviewed the outcomes of meconium peritonitis and evaluated the safety and feasibility of primary
radical surgery for meconium peritonitis. A total of 21 cases of meconium peritonitis between 2006 and
2020 were retrospectively reviewed. The patients were classified into two groups based on the type of
surgery: group I (primary radical surgery, n = 16) and group II (multistage surgery; drainage only or
ileostomy, followed by elective surgery, n = 5). Patient backgrounds and surgical outcomes were compared
between the two groups. The term of prenatal diagnosis, preoperative white blood cell count, and preoperative catecholamine use were not significantly different between the two groups. Group I included more
mature neonates than group II (gestational age at birth, 35w1d vs 30w1d, p = 0.02; birth weight, 2.5 kg
vs 1.1 kg, p < 0.01). Preoperative C-reactive protein was significantly lower in group I (0.37 mg/dL vs
2.8 mg/dL, p < 0.05). Operation time, blood loss, time to enteral feeding, and complication rates were
not significantly different between the two groups. The surgical outcomes of primary radical surgery were
comparable to those of multistage surgery, although the patients’ backgrounds were different. Our strategy
of selecting one-stage or multiple-stage surgery for treatment of meconium peritonitis, depending on the
patient’s general condition and degree of intestinal ischemia, was reasonable.
SHORT COMMUNICATIONS
Trends in the numbers of spine surgeries and spine
surgeons over the past 15 years
Kazuyoshi Kobayashi, Koji Sato, Fumihiko Kato, Tokumi Kanemura,
Hisatake Yoshihara, Yoshihito Sakai, Ryuichi Shinjo, Tetsuya Ohara,
Hideki Yagi, Yuji Matsubara, Kei Ando, Hiroaki Nakashima
and Shiro Imagama
pg(s) 155 - 162
<Abstract> - < PDF >
The purpose of this study is to examine trends in spine surgeries at ten facilities over 15 years, and
to analyze relationships with the number of spine surgeons at these facilities. The subjects were patients
who underwent spine surgery at the ten facilities from 2003 to 2017. Data were collected every year via
a questionnaire designed to obtain clinicopathological and surgical information. There were 37,601 spine
surgeries (60.2% male) recorded in the registry at 9 facilities in the Nagoya Spine Group (NSG) between
2003 and 2017, with an increase in the annual number of surgeries by 2.4 times over 15 years. On the
other hand, the number of spine surgeons has increased by just under 1.5 times. Instrumentation surgeries
increased from 959 in 2003 to 2,276 in 2017 (2.3 times). There was a particularly marked increase in
surgeries for spinal degenerative disease from 1,075 in 2003 to 2,821 in 2017 (2.6 times). The number of
surgeries performed per surgeon increased from 61.4 in 2003 to 102.8 in 2017, while the average number
of spine surgeons per hospital increased from 2.6 in 2003 to 3.7 in 2017. In conclusion, with heavier
burden on spine surgeons and the major changes in the spine surgery environment, training and increasing
surgeons with advanced expertise and skills will become increasingly important.
The equilibrated blood sevoflurane concentrations show
a rapid decrease after switching from ventilation for
the human lung to cardiopulmonary bypass
Takahiro Tamura, Atsushi Mori, Akira Ishii and Kimitoshi Nishiwaki
pg(s) 163 - 168
<Abstract> - < PDF >
Volatile anesthetics (VAs) protect myocardial cells during cardiovascular surgeries, including cardiopulmonary bypass (CPB). In CPB, blood is gradually transferred from the body to a CPB unit until the
target cardiac index is achieved, following which human lung (HL) ventilation is stopped. This pilot study
aimed to evaluate changes in the blood sevoflurane concentrations 5 min after the start of CPB when its
delivery to the oxygenator began after HL ventilation with sevoflurane was completed. Six patients were
recruited and participated in this study. For each patient, the equilibrated blood sample, collected 20 min
after starting the delivery of 1.7% sevoflurane (HL group), and another blood sample, collected 5 min after
starting the CPB, were analyzed using gas chromatography equipped with a flame ionization detector. The
mean (± standard deviation) sevoflurane concentrations in the HL and 5 min after starting CPB groups
were 58.6 ± 4.7 and 14.5 ± 5.0 μg/ml, respectively (P < 0.01). In conclusion, the equilibrated blood
sevoflurane concentrations showed a rapid decrease when switching from sevoflurane ventilation for the
HL to CPB unless it was introduced to the oxygenator until completion of the switch.
CASE REPORTS
Initial experience of tofacitinib for treating refractory
moderate-to-severe ulcerative colitis
Masanao Nakamura, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada,
Yasuyuki Mizutani, Eri Ishikawa, Takuya Ishikawa, Naomi Kakushima,
Kazuhiro Furukawa, Eizaburo Ohno, Hiroki Kawashima, Takashi Honda,
Masatoshi Ishigami and Mitsuhiro Fujishiro
pg(s) 169 - 179
<Abstract> - < PDF >
Ulcerative colitis (UC) is an incurable, chronic inflammatory disease of the large bowel whose etiology
and pathogenesis have not yet been comprehensively explained. Tofacitinib is a small molecule Janus kinase
inhibitor that was introduced for treating refractory UC. We aimed to examine the efficacy and safety of
tofacitinib for the treatment of 18 patients with UC. Continuous treatment rates were 50, 38, and 33% at
8, 24, and 52 weeks, respectively. Overall, 83.3% of these patients showed tumor necrosis factor (TNF)
antibody failure status. When the effective status was defined as a Lichtiger index (LI) that decreased by
3 points or more or was less than 4 points and remission status was defined as an LI less than 4 points,
the effective and remission rates (%) at 2, 8, and 16 weeks were 55.5 (10/18) and 22.2 (4/18), 38.8
(7/18) and 33.3 (6/18), and 38.8 (7/18) and 38.8 (7/18), respectively. Background characteristics of 2-week
responders and non-responders were compared. C-reactive protein level in responders was significantly
lower than that in non-responders, and the hemoglobin level in responders was significantly higher than
that in non-responders. This study provides preliminary results of the effectiveness of tofacitinib even for
TNF antibody and tacrolimus failure patients.
Lack of dose dependency for radiation pneumonitis after
chemoradiotherapy with the use of tomotherapy for lung
cancer
Yutaka Masuoka, Takuhito Tada, Masahiro Tokunaga, Noriko Takeshita,
Masaaki Terashima, Shinichi Tsutsumi, Kentaro Ishii and Keiko Shibuya
pg(s) 180 - 184
<Abstract> - < PDF >
A 71-year-old man with stage IIB (Union for International Cancer Control, 8th edition) non-small cell
lung cancer underwent intensity-modulated radiation therapy with a dose of 66 Gy administered in 33
fractions concomitant with carboplatin and paclitaxel therapy. On computed tomography after completion
of radiation therapy, ground-glass opacity, which was larger on the contralateral side, was observed, but
it was not observed in the high-dose area on the ipsilateral side. Although the adverse event theoretically
shows dose dependency, it was finally diagnosed as radiation pneumonitis. The presence of an atypical
distribution of radiation pneumonitis should be recognized to improve the diagnosis, and it is suggested
that the relative volume of the normal contralateral lung receiving a dose of ≥5 Gy is a possible risk
factor for radiation pneumonitis.
Good result for twelve years after bilateral hip and knee
arthroplasties for ankylosis with juvenile idiopathic
arthritis: a case report
Yoshiki Murotani, Hiroshi Fujita, Hiroaki Hara, Hideto Harada,
Masanao Kataoka and Yuki Okutani
pg(s) 185 - 199
<Abstract> - < PDF >
Juvenile idiopathic arthritis (JIA) can lead to joint deformity and bone destruction, which can cause gait
disturbances. To the best of our knowledge, there are no case reports with over 10 years of follow-up on
quadruple joint arthroplasties (QJA) for bilateral hip and knee ankylosis associated with JIA. We present the
case of a 29-year-old woman with JIA. The patient suffered from bilateral ankylosis of the hips and knees
and developed a swing gait requiring double crutches. We performed staged QJA with careful attention to
postoperative rehabilitation and her physical features, which included excessive pelvic anteversion, poor
bone quality, and short statue of bones. Twelve years after surgery, the patient was able to walk without
any support and showed good clinical functional scores. In addition, no radiological loosening following
QJA was observed. We hereby introduce a surgical strategy for total hip arthroplasty for excessive pelvic
anteversion, which involves two methods to calculate pelvic tilt on a pelvic anteroposterior radiograph.
These methods were able to approximately predict postoperative pelvic changes.
A long-term survivor of advanced retroperitoneal
dedifferentiated liposarcoma: a successful multimodal
approach with extended resection and chemotherapy
Koichi Nakahashi, Yukihiro Yokoyama, Masahide Fukaya,
Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Shunsuke Onoe,
Nobuyuki Watanabe and Tomoki Ebata
pg(s) 200 - 207
<Abstract> - < PDF >
Surgical resection is the mainstay of treatment for retroperitoneal liposarcoma (RPLS). Herein, we
describe a case of dedifferentiated RPLS successfully treated with an extended surgical approach with
adjuvant chemotherapy. A 61-year-old male was referred to our hospital with a chief complaint of chest
tightness. Abdominal computed tomography revealed a large retroperitoneal tumor, 11 cm in diameter,
extensively invading the surrounding organs: the celiac axis, the splenic artery, the pancreatic body and tail,
the lesser curvature of the stomach and the left adrenal gland. Endoscopic ultrasound-guided fine-needle
aspiration biopsy confirmed dedifferentiated liposarcoma, suggesting aggressive tumor biology. We performed
total gastrectomy combined with distal pancreatectomy with celiac axis and left adrenal gland resection with
a curative intent. The postoperative course was almost uneventful. As the pathological findings indicated a
positive margin with a well-differentiated liposarcoma component, we added adjuvant chemotherapy with
four cycles of doxorubicin and ifosfamide (AI). Five years after primary surgery, regular follow-up CT
demonstrated a pulmonary hilar lymph node enlargement and a tumor at paraesophageal locations. After
downsizing chemotherapy with eribulin followed by pazopanib, he underwent partial esophagectomy with
dissection of the paraesophageal tumor. The pathological findings indicated recurrence of dedifferentiated
liposarcoma with a tumor-free surgical margin. He is currently alive without any evidence of recurrence
almost 7 years after the first surgery and 15 months after the second surgery. The long-term survival
gained in this patient indicates that extended resections and adjuvant chemotherapy could prolong survival
in patients even with RPLS with dedifferentiated tumor histology.