Risk factors for gallstone disease onset in Japan: Findings from the Shizuoka Study, a population-based cohort study.

In the research literature on factors associated with gallstones, large population-based cohort studies are rare. We carried out a study of this type to explore risk factors for the onset of gallstones. This study included Japanese participants aged 40-107 years who were followed prospectively from January 2012 to September 2020 using a dataset composed of two individually linked databases, one containing annual health checkup records and the other containing medical claims for beneficiaries of the National Health Insurance System and the Medical Care System for Elderly in the Latter Stage of Life in Shizuoka Prefecture, Japan. Among the 611,930 participants in the analysis set, 23,843 (3.9%) were diagnosed with gallstones during the observational period (median [max]: 5.68 [7.5] years). Multivariate analysis revealed that risk of gallstone disease was increased by male sex, cerebrovascular disease, any malignancy, dementia, rheumatic disease, chronic pulmonary disease, hypertension, and H. pylori-infected gastritis. These findings provide essential insights into the etiology of cholelithiasis and may contribute to efforts to reduce the incidence of the disease

Pregnancy, delivery, and breastfeeding after total gastrectomy for gastric cancer: a case report

Abstract Background The reports of pregnancy after total gastrectomy for gastric cancer are rare. Case presentation We report a case of a 35-year-old woman, gravida 0, para 0, who became pregnant and delivered a baby 2 years and 6 months after laparoscopic-assisted total gastrectomy for early gastric cancer. Postoperatively, she showed a good progress during the follow-up and was continuously taking oral iron supplement and administered with methylcobalamin intramuscular injection. Two years after gastrectomy, she became pregnant. During the pregnancy, she kept taking iron and vitamin B12 supplementation and had a good course of pregnancy and a normal delivery. However, 2 months after the delivery, liver dysfunction was detected via blood examination. The patient switched from exclusive breastfeeding to combined feeding with formula, and her laboratory results returned to normal. During 10 years of follow-up after the delivery, the patient was in good condition without any recurrence and nutritional deficiencies, and her child had thrived. Conclusions Careful monitoring and management of iron and vitamin deficiencies are essential during pregnancy and the lactation periods for patients who previously underwent total gastrectomy. During the lactation period, a combination of formula and breastfeeding provides maternal and fetal nutritional support

Appropriate treadmill exercise improves survival after gut ischemia reperfusion in mice

Summary: Background＆aims: It is unclear whether or not an appropriate prehabilitation protocol ameliorates surgical stress, ultimately improves survival after severe surgical insults. Methods: Male C57BL/6J mice received treadmill exercise according to the following protocols. Exp.1) Sixty-min treadmill running at 20 m/min. The exercise sessions were 5 days/week for 2 weeks, 3 days/week for 2 weeks or 3 days/week for 3 weeks (n = 29). Sedentary mice (n = 6) did not perform treadmill exercise. After finishing each protocol, the exercise completion rate was evaluated. All mice which had completed the protocol (n = 24) underwent 45 min superior mesenteric artery occlusion and reperfusion (Gut I/R) and survival after gut I/R was observed. Exp.2) According to the results of Exp.1, the exercise frequency and duration were set at 3 days/week for 3 weeks. To determine the appropriate running speed, mice (n = 94) ran on the treadmill for 60 min at 12, 15 or 18 m/min, while sedentary mice (n = 25) did not. The exercise completion rate and survival were observed. Results: Exp.1) The 3 days/week for 3 weeks exercise protocol showed the highest survival rate. However, the completion rate of each exercise group was only 50–60%. Exp.2) The completion rates at 15 m/min and 18 m/min were both approximately 90%. None of the 12 m/min group failed to complete the protocol. The 12 m/min and 15 m/min treadmill running groups showed equally improved survival as compared to the sedentary group (p < 0.05). Conclusions: An appropriate exercise protocol improves survival after gut I/R in mice. Prehabilitation strengthens resistance to severe surgical insults. Keywords: Prehabilitation, Gut ischemia reperfusio

Effects of short-term fasting on gut-associated lymphoid tissue and intestinal morphology in mice

Background & aims: Modern management guidelines for surgical patients recommend that the fasting period before surgery be as short as possible. This study aimed to examine the influences of 24-h fasting, with and without water, on intestinal morphology, mucosal IgA levels and gut-associated lymphoid tissue (GALT) cells as a center of systemic mucosal immunity in mice. Methods: Male Institute of Cancer Research mice (6-week-old, n = 24) were divided into three groups: ad libitum chow and water (Control), 24-h fasting without water (Fasted − water), and 24-h fasting with ad libitum water (Fasted + water). The Fasted + water group was used to examine possible influences of dehydration on the parameters measured. After a 24-h fasting, nasal and bronchoalveolar lavage were done under anesthesia. Then, the mice were killed by cardiac puncture. The whole small intestine was harvested and intestinal washing was obtained by lavage. Jejunal and ileal morphologies were evaluated by H&E staining. IgA levels in the intestinal, nasal, and bronchoalveolar washings were determined using ELISA. Lymphocytes were isolated from Peyer's patches (PPLs), the intraepithelial spaces (IELs), and lamina propria (LPLs) of the small intestine and GALT lymphocyte numbers were evaluated. Results: Villous height and crypt depth in the jejunum and ileum were both significantly lower in the Fasted − water and Fasted + water than in the Control group, with no significant difference between the Fasted − water and Fasted + water groups. There were no significant differences in mucosal IgA levels among the 3 groups. PPL numbers were similar in the three groups; however, significant decreases were observed in IEL and LPL numbers in the Fasted − water and Fasted + water groups as compared to the Control. Conclusions: Regardless of water supply, 24 h of fasting causes gut atrophy, with marked GALT lymphocyte losses in the IE space and LP