Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study

男女の消化器外科医による手術成績は同等 --女性消化器外科医のさらなる活躍に向けて--. 京都大学プレスリリース. 2022-09-29.Study finds no differences in performance between male and female surgeons. 京都大学プレスリリース. 2022-10-04.[Objective] To compare short term surgical outcomes between male and female gastrointestinal surgeons in Japan. [Design] Retrospective cohort study. [Setting] Data from the Japanese National Clinical Database (includes data on >95% of surgeries performed in Japan) (2013-17) and the Japanese Society of Gastroenterological Surgery. [Participants] Male and female surgeons who performed distal gastrectomy, total gastrectomy, and low anterior resection. [Main outcome measures] Surgical mortality, surgical mortality combined with postoperative complications, pancreatic fistula (distal gastrectomy/total gastrectomy only), and anastomotic leakage (low anterior resection only). The association of surgeons’ gender with surgery related mortality and surgical complications was examined using multivariable logistic regression models adjusted for patient, surgeon, and hospital characteristics. [Results] A total of 149 193 distal gastrectomy surgeries (male surgeons: 140 971 (94.5%); female surgeons: 8222 (5.5%)); 63 417 gastrectomy surgeries (male surgeons: 59 915 (94.5%); female surgeons: 3502 (5.5%)); and 81 593 low anterior resection procedures (male surgeons: 77 864 (95.4%);female surgeons: 3729 (4.6%)) were done. On average, female surgeons had fewer post-registration years, operated on patients at higher risk, and did fewer laparoscopic surgeries than male surgeons. No significant difference was found between male and female surgeons in the adjusted risk for surgical mortality (adjusted odds ratio 0.98 (95% confidence interval 0.74 to 1.29) for distal gastrectomy; 0.83 (0.57 to 1.19) for total gastrectomy; 0.56 (0.30 to 1.05) for low anterior resection), surgical mortality combined with Clavien-Dindo grade ≥3 complications (adjusted odds ratio 1.03 (0.93 to 1.14) for distal gastrectomy; 0.92 (0.81 to 1.05) for total gastrectomy; 1.02 (0.91 to 1.15) for low anterior resection), pancreatic fistula (adjusted odds ratio 1.16 (0.97 to 1.38) for distal gastrectomy; 1.02 (0.84 to 1.23) for total gastrectomy), and anastomotic leakage (adjusted odds ratio 1.04 (0.92 to 1.18) for low anterior resection). [Conclusion] This study found no significant adjusted risk difference in the outcomes of surgeries performed by male versus female gastrointestinal surgeons. Despite disadvantages, female surgeons take on patients at high risk. Greater access to surgical training for female physicians is warranted in Japan

The effects of perioperative oral management on perioperative serum albumin levels in patients treated surgically under general anesthesia : A multicenter retrospective analysis in Japan

The purpose of the present study was to investigate the efficacy of perioperative oral managements (POMs) on perioperative nutritional conditions in patients undergoing surgery with general anesthesia. Medical records were retrospectively reviewed and the effects of POMs were investigated based on a large number of cases using a multicenter analysis. The profile of serum albumin levels was assessed and compared between patients with and without POMs using the multivariate analysis. Seventeen Eleven thousand and one hundred sixty patients (4,873 males and 6,287 females) were reviewed. Of these, 2710 patients (24.3%) had undergone POMs. The results of a multivariate analysis revealed the significant positive effect of POMs on perioperative serum albumin level (change between at admission and discharge, (Estimate: 0.022, standard error: 0.012, P < .0001). Patient gender, age, surgical site, performance status, the American Society of Anesthesiologists (ASA) physical status classification, operation time, amount of blood loss, and serum albumin level at admission were also significant predictors. Adjusted multivariate analysis of the effects of POMs on perioperative change of serum albumin level in all subjects reveled the significance of POMs intervention (estimate: 0.022, standard error: 0.012, P < .0001). These results suggest that POMs exerts significant positive effects on perioperative serum albumin levels in patients underwent surgery under general anesthesia

長期間の多職種連携による離床

Early mobilization is an effective way to improve the physical function of critically ill patients, but there are numerous barriers to mobilization. One such is an early ward transfer. Mobilization is often insufficient in a ward, and the patient cannot be liberated from mechanical ventilation. We experienced a case of a successfully liberated patient from prolonged mechanical ventilation in long-term mobilization as orchestrated by a multidisciplinary team in the ICU. A ４５-year-old female was admitted to the ICU and placed on mechanical ventilation for acute respiratory distress syndrome（ARDS）. We deployed a mobilization protocol, which was mostly restricted to passive exercise in the first ２ weeks after admission. On day ３０, the patient recovered from unstable respiration, but could not be liberated from mechanical ventilation because of muscle weakness, diagnosed as ICU-acquired weakness. The patient was gradually mobilized and transferred to a chair on day ３５, and she was able to stand on day ５６. On day ６５, she was completely liberated from mechanical ventilation and discharged from the ICU ７０ days after her initial admission. Long-term mobilization is important for liberation of a patient from prolonged mechanical ventilation as well as early mobilization in the ICU

Immunological profile in a family with nephrogenic diabetes insipidus with a novel 11 kb deletion in AVPR2 and ARHGAP4 genes

<p>Abstract</p> <p>Background</p> <p>Congenital nephrogenic diabetes insipidus (NDI) is characterised by an inability to concentrate urine despite normal or elevated plasma levels of the antidiuretic hormone arginine vasopressin. We report a Japanese extended family with NDI caused by an 11.2-kb deletion that includes the entire <it>AVPR2 </it>locus and approximately half of the <it>Rho GTPase-activating protein 4 </it>(<it>ARHGAP4</it>) locus. ARHGAP4 belongs to the RhoGAP family, Rho GTPases are critical regulators of many cellular activities, such as motility and proliferation which enhances intrinsic GTPase activity.</p> <p>ARHGAP4 is expressed at high levels in hematopoietic cells, and it has been reported that an NDI patient lacking <it>AVPR2 </it>and all of <it>ARHGAP4 </it>showed immunodeficiency characterised by a marked reduction in the number of circulating CD3+ cells and almost complete absence of CD8+ cells.</p> <p>Methods</p> <p>PCR and sequencing were performed to identify the deleted region in the Japanese NDI patients. Immunological profiles of the NDI patients were analysed by flow cytometry. We also investigated the gene expression profiles of peripheral blood mononuclear cells (PBMC) from NDI patients and healthy controls in microarray technique.</p> <p>Results</p> <p>We evaluated subjects (one child and two adults) with 11.2-kb deletion that includes the entire <it>AVPR2 </it>locus and approximately half of the <it>ARHGAP4</it>. Hematologic tests showed a reduction of CD4+ cells in one adult patient, a reduction in CD8+ cells in the paediatric patient, and a slight reduction in the serum IgG levels in the adult patients, but none of them showed susceptibility to infection. Gene expression profiling of PBMC lacking <it>ARHGAP4 </it>revealed that expression of RhoGAP family genes was not influenced greatly by the lack of <it>ARHGAP4</it>.</p> <p>Conclusion</p> <p>These results suggest that loss of <it>ARHGAP4 </it>expression is not compensated for by other family members. ARHGAP4 may play some role in lymphocyte differentiation but partial loss of <it>ARHGAP4 </it>does not result in clinical immunodeficiency.</p

A pathogenic C terminus-truncated polycystin-2 mutant enhances receptor-activated Ca2+ entry via association with TRPC3 and TRPC7.

Mutations in PKD2 gene result in autosomal dominant polycystic kidney disease (ADPKD). PKD2 encodes polycystin-2 (TRPP2), which is a homologue of transient receptor potential (TRP) cation channel proteins. Here we identify a novel PKD2 mutation that generates a C-terminal tail-truncated TRPP2 mutant 697fsX with a frameshift resulting in an aberrant 17-amino acid addition after glutamic acid residue 697 from a family showing mild ADPKD symptoms. When recombinantly expressed in HEK293 cells, wild-type (WT) TRPP2 localized at the endoplasmic reticulum (ER) membrane significantly enhanced Ca2+ release from the ER upon muscarinic acetylcholine receptor (mAChR) stimulation. In contrast, 697fsX, which showed a predominant plasma membrane localization characteristic of TRPP2 mutants with C terminus deletion, prominently increased mAChR-activated influx in cells expressing TRPC3 or TRPC7. Coimmunoprecipitation, pulldown assay, and cross-linking experiments revealed a physical association between 697fsX and TRPC3 or TRPC7. 697fsX but not WT TRPP2 elicited a depolarizing shift of reversal potentials and an enhancement of single-channel conductance indicative of altered ion-permeating pore properties of mAChR-activated currents. Importantly, in kidney epithelial LLC-PK1 cells the recombinant 679fsX construct was codistributed with native TRPC3 proteins at the apical membrane area, but the WT construct was distributed in the basolateral membrane and adjacent intracellular areas. Our results suggest that heteromeric cation channels comprised of the TRPP2 mutant and the TRPC3 or TRPC7 protein induce enhanced receptor-activated Ca2+ influx that may lead to dysregulated cell growth in ADPKD. © 2009 by The American Society for Biochemistry and Molecular Biology, Inc.Publisher\u27s version/PDF may be used after 12 months embarg

長崎国際大学生における食生活の現状と骨密度の関係

日本人はカルシウムの摂取量が慢性的に不足していることから、骨粗鬆症、骨軟化症、さらにくる病などの骨関連疾患が大きな問題となっている。一方で、その予防には食生活が重要性な要因であると認識されている。そこで今回、大学生の生活状況を調査するため、骨形成に関与する栄養素に注目し、長崎国際大学健康管理学部健康栄養学科で実施されている「健康栄養調査プロジェクト」の結果を解析した。男子学生のカルシウム（Ca）摂取量は、目標量（６５０mg/日）をほぼ満たす量（６４７±７９mg/日）であったが、女子学生の Ca 摂取量（４８０±１１mg/日）は目標量（６００mg/日）の８０％と不足していた。食品群別にみると、女子学生においてミネラル分が豊富な海藻類、小魚の摂取頻度が少なく、このことが女子学生でみられた Ca 摂取不足の主たる原因と考えられた。また、牛乳の摂取頻度が週７回以上の群は、７回未満の群に比べ骨密度の高い傾向がみられ、このことから若年期においても牛乳の摂取頻度が骨密度に影響している可能性が示唆された。Japanese people is chronically low level of calcium ingestion, therefore it is increased disorders related bone, osteoporosis, osteomalacia, rickets and other. On the other hand their prevention is closely related to dietary habit. In this study, to see about dietary habit on young people, we analyzed the result of "The Health and Nutritional Survey Project" conducted in Department of Health and Nutrition, Faculty of Health Management, Nagasaki International University about nutrient factor relative to bone formation. The calcium ingestion on male students (647±79mg/day) was close on tentative dietary goal for preventing life-style related diseases (DG) (650mg/day) by dietary reference intakes for Japanese [2005]. But calcium ingestion on female students (480±11mg/day) was lower, about 80% compared with DG (600mg). From the results of food group frequency, this low level of calcium ingestion on female students is likely to be caused by that frequency of sea vegetable and fingerling was few. And bone density evaluation was significantly high in group over 7 times/week compared with group below 7 times/week about frequency of milk. This result suggests that frequency of milk has an affect on bone density in early life

学生の健康及び食生活意識と血液検査値の関係に対する一考察 - 健康栄養調査ﾌﾟﾛｼﾞｪｸﾄ報告 第２報 -

長崎国際大学健康管理学部健康栄養学科に所属する学生を対象に平成１７年度に実施した「健康栄養プロジェクト」の結果のうち、学生（男子４３名、女子２８５名）の食生活意識、身体状況および血液生化学検査（総コレステロール、トリアシルグリセロール、ヘモグロビン A１c、血清鉄）の関係について検討を加えた。その結果、欠食頻度が高い者ほど疲労愁訴を有する割合が高くなる傾向があった。また、欠食回数及び食生活意識と血液生化学検査値との関係に男女差が見られた。男子学生では欠食がある場合は検査値が低くなる傾向がみられたが、女子学生では欠食が無いにもかかわらず低値を示す者が多かった。このことから、今後食生活指導を行う際には、食事内容を具体的に把握し、適正な食事量を認識させる重要性が示唆された。This study, "The Health and Nutrition Survey Project" for the undergraduates (43 males and 285 females) who belong to the department of health and nutrition in Nagasaki International University, was examined to grasp their life style, physical condition, eating-habits consciousness and blood biochemical levels. We focused on their physical condition, eating-habits, especially skipping-a-meal and some blood biochemical levels (total cholesterol, triacylglycerol, hemoglobin A1c and serum iron). First of all, the complaint of physical fatigue is more on much skipping-a-meal undergraduates. Moreover, the relation the times of skipping a meal and some blood biochemical levels was different between male and female. In male undergraduates, triacylglycerol and hemoglobin A1c levels were lower on skipping a meal. In female undergraduates, although no skipping a meal, much low total cholesterol, triacylglycerol, hemoglobin A1c and serum iron levels had shown on. It was suggested we have to instruct the proper amount of meals in them, grasping not only the habit of skipping-a-meal, but also concretely their meal contents