膵癌術後予防肝動注におけるリザーバー留置術の検討 : 従来法とcoaxialシステムの比較

PURPOSE: Previous reports have shown the effectiveness of adjuvant hepatic arterial infusion chemotherapy (HAIC) in pancreatic cancer. However, percutaneous catheter placement is technically difficult after pancreatic surgery. The purpose of this study was to evaluate the feasibility and outcome of HAIC using a coaxial technique compared with conventional technique for postoperative pancreatic cancer. MATERIALS AND METHODS: 93 consecutive patients who received percutaneous catheter-port system placement after pancreatectomy were enrolled. In 58 patients from March 2006 to August 2010 (Group A), a conventional technique with a 5-Fr indwelling catheter was used and in 35 patients from September 2010 to September 2012 (Group B), a coaxial technique with a 2.7-Fr coaxial catheter was used. RESULTS: The overall technical success rates were 97.1 % in Group B and 86.2 % in Group A. In cases with arterial tortuousness and stenosis, the success rate was significantly higher in Group B (91.7 vs. 53.8 %; P = 0.046). Fluoroscopic and total procedure times were significantly shorter in Group B: 14.7 versus 26.7 min (P = 0.001) and 64.8 versus 80.7 min (P = 0.0051), respectively. No differences were seen in the complication rate. The 1 year liver metastasis rates were 9.9 % using the conventional system and 9.1 % using the coaxial system (P = 0.678). The overall median survival time was 44 months. There was no difference in the survival period between two systems (P = 0.312). CONCLUSIONS: The coaxial technique is useful for catheter placement after pancreatectomy, achieving a high success rate and reducing fluoroscopic and procedure times, while maintaining the safety and efficacy for adjuvant HAIC in pancreatic cancer.博士（医学）・乙第1380号・平成28年7月8日© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016The final publication is available at Springer via http://dx.doi.org/10.1007/s00270-016-1292-

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Changes in activity and transcript level of liver and gill metabolic enzymes during smoltification in wild and hatchery-reared masu salmon (Oncorhynchus masou)

It is important for success of the masu salmon, Oncorhynchus masou, stock enhancement program in Hokkaido (northern Japan) to demonstrate physiological problems in hatchery-reared (hatchery) smolt for artificial release. The present study examined changes in liver and gill metabolic parameters in wild and hatchery masu salmon during smoltification and elucidated differences in hepatic and gill metabolism between wild and hatchery fish. As reference to freshwater-adapted wild and hatchery smolt in this study, metabolic parameters of coastal smolt were studied. Yearling wild and hatchery smolting fish were collected from the Ken-ichi River and the Donan Research Branch, which used Ken-ichi river water for fish culture, at the same time every month from March through May, 2008. Coastal smolts were caught from Nemuro Bay of Hokkaido in June. Decreased hepatic glycogen content during smoltification, which was observed in wild fish and revealed activation of glycogenolysis, was not found in hatchery fish. Hatchery fish demonstrated a positive change in hepatic ATP content during smoltification, while wild fish showed negative change in the content, which reflected activated consumption of hepatic ATP stores during smoltification. Increases in gill pyruvate kinase activity during smoltification, which were found in wild fish and indicated activation of glycolysis, were not detected in hatchery fish. There was a difference in increased timing of hepatic citrate synthase activity during smoltification between hatchery and wild fish. Increased gill citrate synthase activity during smoltification, which was observed in wild fish and reflected enhancement of the citric acid cycle, was not found in hatchery fish. Hatchery smolt revealed lower liver cytochrome c oxidase activity and transcript levels of some respiratory chain enzymes compared to wild smolt in May, which suggested lower respiratory chain capacity in hatchery fish at mid-smolt stage. On the other hand, there were no remarkable differences in hepatic and gill 3-hydroxyacyl-coenzyme A dehydrogenase related to lipolysis and creatine kinase activities, which operate in resolution of creatine phosphate, during smoltification between hatchery and wild fish. These results suggested hatchery masu salmon had some metabolic problems with carbohydrate metabolism, the citric acid cycle, and the respiratory chain. Our study will give valuable information to improve physiological quality of hatchery smolt for artificial release