A New Secured Technique for Suprahepatic Vena Caval Anastomosis in Porcine Liver Transplantation

It is well recognized that hemorrhage or kinking of the suprahepatic vena caval anastomosis is the most fatal complication apparent within 24 hr after orthotopic liver transplantation in the pig. A secured technique for suprahepatic vena caval anastomosis is described in detail herein. Our technique include (1) the use of a diaphragmatic cuff, (2) the closure of phrenic vein orifices using transfixation technique, and (3) the application of "stay-suture" in the orifice of right phrenic vein. This technique has added significantly to the strength of the suprahepatic vena caval anastomosis, and there has been no experiences of uncontrollable bleeding and kinking of suprahepatic vena caval anastomosis in 48 porcine orthotopic transplants of the liver. In conclusion, we believe that this technique described herein is a simplified and secured method to avoid the hemorrhage and kinking of suprahepatic anastomosis in porcine liver transplantation

Improved Techniques for Orthotopic Liver Transplantation in Pigs: A preliminary study

Orthotopic liver transplantations were performed on 12 pigs between November, 1986 and February, 1987. Survivals and causes of death were assessed according to the type of surgical procedure employed. Six operations were carried out according to the original procedure of Terblanche et al, whereas for other six animals, the transplantation was conducted by our modified procedure in which cannulation was made into the splenic vein without splenectomy at the veno-venous (v-v) bypass and a diaphragmatic cuff was used for the anastomosis of suprahepatic vena cava. 1/6 animals with original procedure and 5/6 with our modified procedure survived for more than 7 days. The total ischemic time was significantly short in the group subjected to the modified procedure. The major cause of death in the group on which the original procedure was conducted was gastric ulceration, accounting for 67% of the mortality, whereas in the modified procedure group, the mortality rate was reduced significantly to 17%. This operative technique has provided excellent survival rates in our transplanted animals

Use of Powered Prosthesis for Children with Upper Limb Deficiency at Hyogo Rehabilitation Center.

There has been no research investigating the use of powered prosthetic for children in Japan.To gain better insight into the state of powered prosthesis usage and identify a ratio of rejection among children.Subjects were 37 unilateral below elbow amputees between the ages of 0 and 16 at the time of their first experienced fitting with a powered prosthesis at our Center. The information was collected from medical records and through face-to-face interviews, and we examined rejection rate and the factors affecting the use of powered prosthesis.The rate of discontinuation was 21.6% as 8 of the 37 children stopped using powered prosthesis. All of them were fitted their prosthesis after 2 years of age, and they rejected prosthesis between 5 to 19 years. We found that the level of amputation had no influence on the use of a powered prosthesis.Children fitted before 2 years of age tend to accept their powered prosthesis than those fitted after 2 years. Multidisciprinary team approach, adequate rehabilitation, detailed follow-up and involvement of parents are quite important for introducing powered prosthesis for children

Characteristics of subjects fitted before and after 2 years old, and the situation for usage.

<p>Characteristics of subjects fitted before and after 2 years old, and the situation for usage.</p

Characteristics of subjects fitted before and after 2 years old, and the situation for usage.

<p>Characteristics of subjects fitted before and after 2 years old, and the situation for usage.</p

Charactristics of users and non-users and age when discontinuing the prosthesis.

<p>Charactristics of users and non-users and age when discontinuing the prosthesis.</p

Characteristics of subjects in this study.

<p>Characteristics of subjects in this study.</p

Impact of the coronavirus disease 2019 (COVID‐19) pandemic on the operational efficiency of emergency medical services and its association with out‐of‐hospital cardiac arrest survival rates: A population‐based cohort study in Kobe, Japan

Abstract Aim To identify whether the coronavirus disease 2019 (COVID‐19) pandemic affects the operational efficiency of emergency medical services (EMS) and the survival rate of out‐of‐hospital cardiac arrest (OHCA) in prehospital settings. Methods We conducted a population‐based cohort study in Kobe, Japan, between March 1, 2020, and September 31, 2022. In study 1, the operational efficiency of EMS, such as the total out‐of‐service time for ambulances, the daily occupancy rate of EMS, and response time, was compared between the pandemic and nonpandemic periods. In study 2, the impacts of the changes in EMS operational efficiency were investigated among patients with OHCA, with 1‐month survival as the primary outcome and return of spontaneous circulation, 24‐h survival, 1‐week survival, and favorable neurological outcomes as the secondary outcomes. Logistic regression analysis was conducted to identify the factors associated with survival among patients with OHCA. Results The total out‐of‐service time, occupancy rate, and response time significantly increased during the pandemic period (p < 0.001). The response time during the pandemic period increased significantly per pandemic wave. Regarding OHCA outcomes, 1‐month survival rates during the pandemic period significantly decreased compared with those during the nonpandemic period (pandemic 3.7% vs. nonpandemic 5.7%; p < 0.01). Similarly, 24‐h survival (9.9% vs. 12.8%), and favorable neurological outcomes significantly decreased during the pandemic period. In the logistic regression analysis, response time was associated with lower OHCA survival in all outcomes (p < 0.05). Conclusion The COVID‐19 pandemic has been associated with reduced operational efficiency of EMS and decreased OHCA survival rates. Further research is required to improve the efficiency of EMS and OHCA survival rates