Left hepatectomy accompanied by a resection of the whole caudate lobe using the dorsally fixed liver-hanging maneuver.

A resection of the caudate lobe often needs to be combined with a hemi-hepatectomy for hilar cholangiocarcinoma or a liver tumor in segment 1. To achieve complete resection of the whole caudate lobe, the cut line between the right edge of the paracaval portion and the right lateral sector should be precisely controlled. The liver-hanging maneuver (LHM) is a useful anterior approach that does not require mobilization of the remnant liver. However, the precise set-up of the cut line of the right edge has not been optimized in previous reports. We herein introduce a new modification of LHM that we named the "dorsally fixed liver-hanging maneuver" (DF-LHM) based on the results in five patients who underwent left hepatectomy combined with a total resection of segment 1. This technique provided adequate cut planes along the right edge of the caudate lobe, shortening the transection time and reducing intraoperative blood loss. The DF-LHM may represent a new key technique for this type of hepatectomy, and further applications for other anatomical resections can be modeled on the strategy

The factor associated with occurrence of mastitis caused by Staphylococcus aureus

[Purpose] Mastitis is a very important disease in dairy farming. In Ohotsuku, Japan, Staphylococcus aureus (SA) mastitis incidence increased after the introduction of anonymous post-dipping Iodine-based product A. The purpose of this study was to examine the association between the product A and the disease increase. [Materials and methods] The dairy cows monitoring data for 5 farms using product A and 4 farms using another anonymous Iodine-based product B in the dairy farms which belong to Ohotsuku Farmers’ Association and encountered with SA mastitis incidence were used for this analysis. Farming style (tie or free stall), pre-milking teat disinfectant (2 products) and post-dipping products were selected as explanatory variables. The incidence of SA mastitis on each teat between April 2005 and March 2007 was selected as a response variable. In univariate analysis, Generalized Linear Models (GLMs) with Poisson errors were used for the explanatory variables. In multivariable analysis, as the incidence of SA mastitis on each teat could be affected by the intra-class correlation at two levels: animal and farm levels, robust variance using Generalized Estimating Equations (GEE) was performed in statistical software R 2.13.1. The explanatory variables with the p-values less than 0.2 in the univariate analyses were selected for GEE and step-wise model simplification was performed. [Results] In univariate analysis, there was no significant difference in mean SA mastitis annual incidence per teat between tie (0.025) and free stall (0.028, p=0.53) or between two pre-dipping products (0.022 and 0.029, p=0.08). However, the mean annual incidence was significantly higher in teats which post-dipping product A was used (0.035) than those which product B was used (0.015, p<0.001). In multivariable analysis, only the use of post-dipping product A was significantly associated with the annual incidence (p<0.001). [Discussion] In the present study, only the post-dipping product was associated with the SA mastitis incidence among farming style, pre and post dipping products. Change of post-dipping product and economic evaluation after the intervention would be recommended to the farms with increased incidence

The factor preventing the farmers in Miyazaki Prefecture to restart farming after 2010 Miyazaki foot-and-mouth disease outbreaks

The purpose of this study is to reveal the factors by which they hesitate to restart farming activities suffering after Foot-and-mouth disease (FMD) outbreaks in Miyazaki 2010. Data were collected through interviews with 442 individuals in farming households in Miyazaki city and Shintomi and Kawaminami towns from August to November 2011 by Miyazaki Prefecture Mental Health and Welfare Center. In univariate analysis, associations between restarting of farming and agricultural, socio-economic, health and FMD related factors were examined. In multivariate analysis, generalized linear models were carried out. Response variable was selected as restarting of farming. As explanatory variables, the factors with p-value below 0.2 in the univariate analysis and the interaction terms with the correlation coefficients above 0.4 which might be logically associated with the factors were selected. Since there were several explanatory variables, two models: health associated and FMD associated models were developed. Health associated model was developed with factors related with health of farmers and their families for pig and cattle farms, respectively. FMD associated model was constructed with factors related with livestock and FMD control for vaccinated, infected and all farms, respectively. Stepwise model simplification was then employed. In the cattle farms, being elderly (OR 0.07, p=0.006) and K6 positive (OR 0.07, p=0.02) were preventive factors from restarting farming. On the contrary, being large scale farms (OR 1.01, p=0.009) and family-owned farms (OR 17.4, p=0.05) were encouraging factors. In pig farms, being large scale farms was an encouraging factor (OR 1.004, p=0.012). Among all farms, farmers who restarted were more dissatisfied with officially provided information on FMD (OR 0.6, p<0.001) while they were more satisfied with the current public support (OR1.3, p=0.03). Additionally, K6 positive was a preventive factor of restarting. Among farmers in infected farms, farmers which helped other farmers in culling tended to restart (OR 3.8, p=0.09). In conclusion, continuous mental health and psychosocial supports are warranted as the present study demonstrated that their suffering still persists. Furthermore, such psychosocial aspect should be a part of support in future animal infectious disease related disasters

The constitution of limonin

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Postoperative changes in protein-induced vitamin K absence or antagonist II levels after hepatectomy in patients with hepatocellular carcinoma: relationship to prognosis

Background. α-Fetoprotein (AFP) has been used as a marker for hepatocellular carcinoma (HCC). However, AFP levels are often high in patients with chronic hepatitis or cirrhosis. Protein-induced vitamin K absence or antagonist II (PIVKA-II) is more sensitive for the diagnosis of HCC and prediction of patient survival. Changes in these markers after treatment may reflect treatment curability and patient outcome. Methods. We conducted a retrospective analysis of prognosis of 63 HCC patients with high preoperative levels of AFP and PIVKA-II who underwent hepatectomy and examined the relationship between postoperative changes in both markers at 1 month and patient survival. Subjects were divided into three groups according to changes in these tumour markers after hepatectomy: normalization (N) group, decreased but still above the normal level (D) group and unchanged (U) group. Results. There were no significant differences in the numbers of patients who developed tumour recurrence between changes in AFP and PIVKA-II. Survival analysis showed no significant differences in tumour-free and overall survivals between groups with respect to AFP level. The PIVKA-II-N group showed significantly better tumour-free and overall survival compared with the D and U groups (p<0.01). Multivariate analysis that included other prognostic factors identified changes in PIVKA-II level as a significant and independent prognostic factor associated with overall survival. Discussion. Although changes in AFP did not correlate with patient prognosis, normalization of PIVKA-II was significantly associated with good patient survival after hepatectomy. Normalization of PIVKA-II after hepatectomy reflected the efficacy of treatment and is a suitable predictor of prognosis in HCC patients