Robot-assisted endoscopic surgery experience

In Japan,１２ new operative robot-assisted endoscopic surgery methods were officially approved by the ２０１８ revision of the medical payment system, and robot-assisted endoscopic surgery is using in each field. We have used the pneumatically driven endoscope manipulator robot（EMAROⓇ）in three video-assisted thoracoscopic surgery（VATS）lobectomy cases : right upper lobe lung cancer in a ５３-year-old male, right lower lobe lung cancer in a ７０-year-old male, and right lower lobe lung cancer in an ８１-year-old female. The average operative time was ２０９ min. The average bleeding volume was ４６．７ml. The grades ware nearly equal to those obtained in a standard VATS lobectomy. The head sensor that monitors the movement of the operator is connected to the endoscope holder. The operator can thus move the endoscope smoothly from the operator’s point of view, and endoscope-user skill is not needed. A VATS lobectomy can be performed by only two operators （no scope user is needed）, and this is a major advantage of the new manipulator robot. We expect to see further advances in the use of robot assistance in surgeries

An experiment on making "Belongingness to Classroom Group Scale" in high school.

本研究では、現代の高校生における学級集団への帰属意識の要因を明確にし、その学級集団への帰属意識の要因の構造をもとに、高等学校における学級集団への帰属意識とスクールモラールや、学校生活適応感尺度との関連性について考察した。まず、145名の高校生から学級集団への帰属意識の規定要因についての項目を収集し、高校生の心的リアリティーに添った具体的場面での46の質問項目を選定した。学級集団への帰属意識尺度の得点について因子分析を行ったところ、「学級からの受容」、「学級のまとまり」、「帰属阻害感」の3因子が抽出された。各因子尺度の信頼性分析により、信頼性が確認された。また、全ての並行検査との間に有意な相関がみられることから構成概念妥当性が支持されたと考える。In this study, factors of "Belongingness to Classroom Group" among high school students of today were clarified and the correlations with "School Morale" and "Adaptation to School Life Scale" were also investigated under the structure of those factors. To begin with, items of factors of "Belongingness to Classroom Group" were collected from 145 students and 46 questionnaires were selected from concrete situations meeting their mental reality. After that, factor analysis was done on the scores and three factors "Acceptance from Class", "Class Unity" and "Obstacle to Belonging" were extracted. By doing the reliability analysis, it is understood that sufficient reliabilities have been confirmed on these three factors. Also, significant correlations were observed with all tests done in parallel and therefore we think that the construct validity has been supported

The effects made on "The General Health" and on "Acceptance to School Life" by constituent factors of "Belongingness to Classroom Group" of high school students

本研究では、「高等学校における学級集団帰属意識尺度」を用いて、高等学校における学級集団への帰属意識と精神的健康度、及び学校生活への適応感との関連について分析することを目的とした。まず、「高等学校における学級集団帰属意識」を構成する3因子の構造を「帰属疎外感」→「学級からの受容感」→「学級の魅力」とし、その最初の2因子「帰属疎外感」と「学級からの受容感」を取り上げ、それぞれの得点の平均値を基準に高群と低群に分け、4つのタイプに分類した。そして、それらと自尊感情、GHQ及び学校生活適応感尺度の各因子得点に対して一元配置の分散分析を行ったところ、「不安」や「不眠」、「身体的症状」といった精神的健康上の問題や、自尊感情や「友人関係」、「特別活動への参加態度」など社会的意味をもつものとの関連が示唆された。This study aimed at analyzing correlations between "Belongingness to Classroom Group", "The General Health" and "Adjustment to School Life", by using "Belongingness to Classroom Group Scale in high school" As a first step, causal analysi was used to determine temporary orders of three factors which constitute "Belongingness to Classroom Group in high school", and the earliest two factors of "Obstacle to Belongigness" and "Acceptance from Classroom" were taken up and, on the basis of an average of scores obtained, a high group and a low group were arranged to make them classified into 4 types. Then, one way analysis of variance was used for scores obtained by each factor of "Self-Esteem", "G.H.Q"., "Adjustment to School Life", and of above-mentioned 4 types. As a result, It was suggested that there were positive correlations with problems of the general health such as uneasiness, sleeplessness or physical symptoms, as well as with the matters having social significance like self-esteem, friendship, participation in special activity, and etc

A Case of Adult Respiratory Distress Syndrome Associated with Acute Pancreatitis

A 52-year-old man was admitted to our department for acute pancreatitis. He developed adult respiratory distress syndrome (ARDS) on the 2nd hospital day, and was treated with respiratory management using positive endexpiratory pressure (PEEP) in addition to pharmacologic therapy for pancreatitis. The treatment was very effective, and he was discharged on the 72nd hospital day

The association between temperature variability and cause-specific mortality: Evidence from 47 Japanese prefectures during 1972–2015

BackgroundIn the context of climate change, extreme temperature events are known to be associated with increased mortality risk. However, data about the mortality risk related to temperature variability (TV) accounting for both intra- and inter-day variations in temperature are limited.ObjectivesThe present study aims to quantify the associations between TV and cause-specific mortality in Japan, evaluate whether the effects of TV are modified by prefecture-level characteristics and examine the temporal trend in mortality risk of TV.MethodsData on daily all-cause and 11 cause-specific mortality and meteorological variables in 47 Japanese prefectures from 1972 to 2015 were collected. TV was defined as the standard deviation of daily minimum and maximum temperatures during exposure days. A quasi-Poisson regression model combined with a distributed lag non-linear model was firstly applied to assess the prefecture-specific mortality effects of TV, adjusting for potential confounders. The pooled effects of TV at the national level were then obtained via a meta-analysis through the restricted maximum-likelihood estimation. Potential effect modification by prefecture characteristics was firstly examined using a meta-regression analysis, and the joint modification of season and humidity was then evaluated after including product terms in two-stage analyses. Finally, the temporal trend in TV effects was evaluated by a random-effect meta regression model after obtaining the prefecture-year-specific effects.ResultsTV had significant adverse effects on all-cause and cause-specific mortality. The effects of TV were more detrimental to those with asthma and senility. In general, the estimates of mortality risk increased with longer exposure days. A 1 °C increase in TV at 0–7 days of exposure was associated with a 0.9% (95% confidence intervals: 0.82%–0.98%) increase in all-cause mortality. All-cause mortality risk of TV showed a decreasing trend during our study period. TV effects were larger in densely populated prefectures and on warm and humid days.ConclusionsTV-related death is a significant issue in Japan that requires effective interventions

The Echogenic Patterns of the Pancreatic Parenchyma in the Endoscopic Ultrasonography

Using the pancreas of the Japanese Macaque and human pancreas from autopsy cases, the echogenic patterns of the pancreatic parenchyma obtained by the ultrasonic endoscopy were compared with the histological findings. The parenchyma of the normal pancreas was observed as an echogenic pattern with homogeneous accumulation of small granular echoes. Such granular echoes are suggested to represent pancreatic acini on comparison with the tissue structure. This was confirmed by widening the pancreatic interstitium by infusing physiological saline into the main pancreatic duct. Such granular echoes became indistinct in the pancreas from autopsy cases due to autolysis. In the experimental pancreatic lesion produced by local injection of 1 % deoxycholic acid into the pancreas of Japanese Macaque, hemorrhage and fibrosis were noted 1 week later and fibrosis appears after 2 to 3 weeks. Hemorrhagic lesions were appeared as an area of high echogenicity, and fibrosis was appeared as an area of low echogenicity, with irregularity of the granular structure seen in the normal tissue

Inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>It has been reported that immunoglobulin G4-related systemic disease can spread to nearly every organ, and often presents as an inflammatory mass or masses at those sites. In the kidney, this disease is often diagnosed after a radical or partial nephrectomy following the discovery of an inflammatory mass which is often suspected to be a malignant tumor. Here, we present a rare case of inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease, which were diagnosed by computed tomography-guided biopsies.</p> <p>Case presentation</p> <p>A 54-year-old Japanese man was referred to our hospital with suspected bilateral renal cancer, multiple lung metastases and autoimmune pancreatitis. His serum immunoglobulin G4 level was high. We used computed tomography-guided biopsies and histopathological examinations of the biopsied specimens to diagnose the tumors as immunoglobulin G4-related bilateral renal and lung inflammatory pseudotumors. Our patient was treated with oral prednisolone, and after one month of treatment, contrast-enhanced computed tomography demonstrated a general improvement, as noted by a reduction in size of the masses.</p> <p>Conclusion</p> <p>Renal masses that are formed due to immunoglobulin G4-related disease require comprehensive diagnosis to prevent unnecessary surgical resections from being performed. Further consideration should be paid to immunoglobulin G4-related diseases in the future.</p

Clarithromycin expands CD11b+Gr-1+ MDSC-like cells

Macrolides are used to treat various inflammatory diseases owing to their immunomodulatory properties; however, little is known about their precise mechanism of action. In this study, we investigated the functional significance of the expansion of myeloid-derived suppressor cell (MDSC)-like CD11b+Gr-1+ cells in response to the macrolide antibiotic clarithromycin (CAM) in mouse models of shock and post-influenza pneumococcal pneumonia as well as in humans. Intraperitoneal administration of CAM markedly expanded splenic and lung CD11b+Gr-1+ cell populations in naïve mice. Notably, CAM pretreatment enhanced survival in a mouse model of lipopolysaccharide (LPS)-induced shock. In addition, adoptive transfer of CAM-treated CD11b+Gr-1+ cells protected mice against LPS-induced lethality via increased IL-10 expression. CAM also improved survival in post-influenza, CAM-resistant pneumococcal pneumonia, with improved lung pathology as well as decreased interferon (IFN)-γ and increased IL-10 levels. Adoptive transfer of CAM-treated CD11b+Gr-1+ cells protected mice from post-influenza pneumococcal pneumonia. Further analysis revealed that the CAM-induced CD11b+Gr-1+ cell expansion was dependent on STAT3-mediated Bv8 production and may be facilitated by the presence of gut commensal microbiota. Lastly, an analysis of peripheral blood obtained from healthy volunteers following oral CAM administration showed a trend toward the expansion of human MDSC-like cells (Lineage−HLA-DR−CD11b+CD33+) with increased arginase 1 mRNA expression. Thus, CAM promoted the expansion of a unique population of immunosuppressive CD11b+Gr-1+ cells essential for the immunomodulatory properties of macrolides