Clinical study of single-incision laparoscopic cholecystectomy

We experienced 63 patients with non-inflammatory disease who underwent single-incision laparoscopic cholecystectomy (TANKO-LC). Herein we report the procedure of operation and the short-term results. We compared 63 cases of TANKO-LC with 109 cases of non-inflammatory conventional laparoscopic cholecystectomy (S-LC) within the same period. At first, our standard procedure was to insert multiple trocars in the abdominal cavity through a single wound ; now, we insert only a single trocar all cases. In the 63 cases investigation, 3 cases required trocar addition and one case converted to open surgery. Intra and postoperative complications were recognized in 2 cases (port-site infection). No significant complications were recognized. In comparing the TANKO-LC group and the S-LC group, the operation time was intentionally longer in the TANKO-LC group (TANKO-LC group : 118 min, S-LC group : 90 min), but there were no differences in the blood loss, the rates of intra and postoperative complications and the conversion rate. Laparoscopic cholecystectomy is a standard operation for gallbladder removal, but single-incision laparoscopic cholecystectomy is considered a useful operation with the same low operative complication rate yet more satisfactory cosmetic results

Clinical study of the prognostic factors in colorectal cancer patients with synchronous liver metastasis

This study was aimed to clarify the prognostic factors in colorectal cancer patients with synchronous liver metastasis. Fifty-four patients were assessed to evaluate prognoses according to various clinico-pathological factors and therapeutic procedures. The patients' survival was significantly related to extrahepatic distant metastasis and therapeutic procedures. Regarding therapeutic procedures, the liver resection group showed significantly improved survival compared with the chemotherapy group, especially in liver metastasis Grade B. For colorectal liver metastases, it is clear that liver resection is the most effective treatment at present. Further improvement of patient prognoses is expected to be achieved by future research on combination chemotherapy

A case of transverse colon cancer with remarkable extramural invasion to stomach and jejunum

A 77-year-old woman was admitted to our hospital due to abdominal pain and body weight loss. A palpable mass the size of an infant's head was tender on palpation and identified as an epigastric lesion. Colonoscopic examination revealed stenosis of the transverse colon, although no intraluminal growth of the tumor was found. The histologic findings of the biopsy material were poorly differentiated and/or undifferentiated cells. Abdominal CT scan showed an irregular-shaped tumor with a diameter of 10cm invading the stomach and jejunum. We performed an operation under a diagnosis of extramurally growing cancer or malignant lymphoma of the colon. Partial resection of the transverse colon was done by distal gastrectomy and partial resection of the jejunum. Histologic examination of the operative specimens revealed moderately differentiated adenocarcinoma of the transverse colon, prominently proliferating into the surrounding tissues. The finding of a long stenotic lesion and extramural compression by colonography are characteristic of this tumor, based on a review of 43 literature reports in Japan

Improving the Research Environment of High Performance Computing for Non-Cluster Experts Based on Knoppix Instant Computing Technology

Abstract. We have designed and implemented a new portable system that can rapidly construct a computer environment where highthroughput research applications can be performed instantly. One challenge in the instant computing area is constructing a cluster system instantly, and then readily restoring it to its former state. This paper presents an approach for instant computing using Knoppix technology that can allow even a non-computer specialist to easily construct and operate a Beowulf cluster . In the present bio-research field, there is now an urgent need to address the nagging problem posed by having highperformance computers. Therefore, we were assigned the task of proposing a way to build an environment where a cluster computer system can be instantly set up. Through such research, we believe that the technology can be expected to accelerate scientific research. However, when employing this technology in bio-research, a capacity barrier exists when selecting a clustered Knoppix system for a data-driven bioinformatics application. We have approached ways to overcome said barrier by using a virtual integrated RAM-DISK to adapt to a parallel file system. To show an actual example using a reference application, we have chosen InterProScan, which is an integrated application prepared by the European Bioinformatics Institute (EBI) that utilizes many database and scan methods. InterProScan is capable of scaling workload with local computational resources, though biology researchers and even bioinformatics researchers find such extensions difficult to set up. We have achieved the purpose of allowing even researchers who are non-cluster experts to easily build a system of "Knoppix for the InterProScan4.1 High Throughput Computing Edition." The system we developed is capable of not only constructing a cluster computer environment composed of 32 computers in about ten minutes (as opposed to six hours when done manually), but also restoring the original environment by rebooting the pre-existing operating system. The goal of our instant cluster computing is to provide an environment in which any target application can be built instantly from anywhere

The effect of cholecalciferol supplementation on allograft function in incident kidney transplant recipients: A randomized controlled study

It is unknown whether cholecalciferol supplementation improves allograft outcomes in kidney transplant recipients (KTRs). We conducted a single-center randomized, double-blind, placebo-controlled trial of daily 4000 IU cholecalciferol supplementation in KTRs at 1-month posttransplant. The primary endpoint was the change in eGFR from baseline to 12-month posttransplant. Secondary endpoints included severity of interstitial fibrosis and tubular atrophy (IFTA) at 12-month posttransplant and changes in urinary biomarkers. Of 193 randomized patients, 180 participants completed the study. Changes in eGFR were 1.2 mL/min/1.73 m2 (95% CI; −0.7 to 3.1) in the cholecalciferol group and 1.8 mL/min/1.73 m2 (95% CI, −0.02 to 3.7) in the placebo group, with no significant between-group difference (−0.7 mL/min/1.73 m2 [95% CI; −3.3 to 2.0], p = 0.63). Subgroup analyses showed detrimental effects of cholecalciferol in patients with eGFR <45 mL/min/1.73 m2 (Pinteraction <0.05, between-group difference; −4.3 mL/min/1.73 m2 [95% CI; −7.3 to −1.3]). The degree of IFTA, changes in urine albumin-to-creatinine ratio, or adverse events including hypercalcemia and infections requiring hospitalization did not differ between groups. In conclusion, cholecalciferol supplementation did not affect eGFR change compared to placebo among incident KTRs. These findings do not support cholecalciferol supplementation for improving allograft function in incident KTRs. Clinical trial registry: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) as UMIN000020597 (please refer to the links below). UMIN-CTR: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023776.Doi Y., Tsujita M., Hamano T., et al. The effect of cholecalciferol supplementation on allograft function in incident kidney transplant recipients: A randomized controlled study. American Journal of Transplantation 21, 3043 (2021); https://doi.org/10.1111/ajt.16530

Analysis of Surgical Outcomes of Diverticular Disease of the Colon

We analyzed retrospectively the surgical outcomes of diverticular diseases of the colon at the surgical division of Fukuyama Medical Center. Data were collected from 39 patients who underwent surgery for diverticular disease at Fukuyama Medical Center. Thirty-nine patients were admitted between 2005 and 2010. The mean age of the 39 patients was 63.6 years. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into 2 groups, Elective vs. Emergent group, right vs. left colon group and laparotomy vs. laparoscopic approach. Multivariate analysis of the logistic model of morbidity revealed a significantly higher rate in the left colon and the Cox proportional hazards model clearly showed fewer postoperative hospital days with the laparoscopic approach. Surgical procedures should be decided in reference to the particular clinical and pathological features of diverticular disease to gain an acceptable morbidity and mortality rates

Cholecalciferol Supplementation Attenuates Bone Loss in Incident Kidney Transplant Recipients: A Prespecified Secondary Endpoint Analysis of a Randomized Controlled Trial

Vitamin D deficiency, persistent hyperparathyroidism, and bone loss are common after kidney transplantation (KTx). However, limited evidence exists regarding the effects of cholecalciferol supplementation on parathyroid hormone (PTH) and bone loss after KTx. In this prespecified secondary endpoint analysis of a randomized controlled trial, we evaluated changes in PTH, bone metabolic markers, and bone mineral density (BMD). At 1 month post-transplant, we randomized 193 patients to an 11-month intervention with cholecalciferol (4000 IU/d) or placebo. The median baseline 25-hydroxyvitamin D (25[OH]D) level was 10 ng/mL and 44% of participants had osteopenia or osteoporosis. At the end of the study, the median 25(OH)D level was increased to 40 ng/mL in the cholecalciferol group and substantially unchanged in the placebo group. Compared with placebo, cholecalciferol significantly reduced whole PTH concentrations (between-group difference of −15%; 95% confidence interval [CI] −25 to −3), with greater treatment effects in subgroups with lower 25(OH)D, lower serum calcium, or higher estimated glomerular filtration rate (pint < 0.05). The percent change in lumbar spine (LS) BMD from before KTx to 12 months post-transplant was −0.2% (95% CI −1.4 to 0.9) in the cholecalciferol group and −1.9% (95% CI −3.0 to −0.8) in the placebo group, with a significant between-group difference (1.7%; 95% CI 0.1 to 3.3). The beneficial effect of cholecalciferol on LS BMD was prominent in patients with low bone mass pint < 0.05). Changes in serum calcium, phosphate, bone metabolic markers, and BMD at the distal radius were not different between groups. In mediation analyses, change in whole PTH levels explained 39% of treatment effects on BMD change. In conclusion, 4000 IU/d cholecalciferol significantly reduced PTH levels and attenuated LS BMD loss after KTx. This regimen has the potential to eliminate vitamin D deficiency and provides beneficial effects on bone health even under glucocorticoid treatment. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).Tsujita M., Doi Y., Obi Y., et al. Cholecalciferol Supplementation Attenuates Bone Loss in Incident Kidney Transplant Recipients: A Prespecified Secondary Endpoint Analysis of a Randomized Controlled Trial. Journal of Bone and Mineral Research 37, 303 (2022); https://doi.org/10.1002/jbmr.4469

Two cases of lymphoepithelial cyst of the pancreas

A 35-year-old man was found to have a cystic mass in the pancreatic body on a routine health examination ; high serum CA19-9 was also detected. The enucleated cyst was diagnosed as a lymphoepithelial cyst (LEC). A 74-year-old man found to have a cystic mass in the pancreatic head by computer tomography as well as high serum CA19-9 was suspected of a cystic neoplasm of the pancreas (IPMN), and pylorus-preserving pancreaticoduodenectomy (PPPD) was performed. Pathologically, the cyst was found to be LEC. It is often difficult to diagnose pancreatic cyst as LEC preoperatively. Care should be taken not to do over-surgery for benign disease LEC

A clinicopathological study of distal bile duct carcinoma at Fukuyama Medical Center

We experienced 20 patients with distal bile duct carcinoma from May, 1997 to December, 2007. The male/female ratio was 11/9 and the average age was 69.6 years. The operative procedures were as follows：pancreaticoduodenectomy (PD), 9；pyrolus preserving pancreaticoduodenectomy (PPPD), 8；subtotal stomach preserving pancreaticoduodenectomy (SSPPD), 2 and hepatico-jejunostomy without resection, 1. We performed a clinicopathological study on 16 patients with distal bile duct carcinoma, excluding 3 operation-related deaths and 1 unresectable case. The cumulative survival rate was 70% at 3 years and 11% at 5 years. The 3-year survival rates at fStageⅡ, fStageⅣa and fStageⅣb were 100%, 80% and 0%, respectively. Log-rank analysis revealed that pathological pancreatic and duodenal invasion and curative resectability may be prognostic factors, while lymph node metastasis and perineural and stump invasion did not affect prognosis. Six recurrences in the 11 curative resection cases (54.5%) were observed；therefore, postoperative systemic chemotherapy is warranted to curtail recurrence in advanced distal bile duct carcinoma

A retrospective study of the PROLENE hernia system comparedwith the mesh-plug technique

To compare the results of the PROLENE hernia system (PHS) and mesh-plug technique (MPT), a retrospective study of adult patients with inguinal hernia was performed. The total number of inguinal herniorrhaphies for the past 9 years was 376, and the numbers of operative treatments by PHS, MPT and the Bassini procedure were 79, 291 and 6, respectively. There were no significant differences either in the operating time or the hospitalization days. No postoperative complications were observed in the PHS group; however, 8 complications were found among the 291 cases (2.75 %) of the MPT group (hematoma, 3 ; seroma, 2 ; testitis, 1 ; mesh infection, 2). Out of the total 376 cases, the number of initial and recurrence cases was 355 and 21, respectively, and out of the 21 recurrence cases the number of initial surgeries by Bassini and MPT was 14 and 7, respectively. Among the 21 recurrence cases there were no recurrences after PHS