Preliminary Experience of Laparoscopic Cholecystectomy with Gallbladder Bed Dissection for Suspected Gallbladder Cancer

Selecting the appropriate operation for gallbladder cancer depends on the depth of cancer invasion, which remains difficult to determine preoperatively, especially with respect to the subserosal layer (pT2). We devised a laparoscopic cholecystectomy with gallbladder bed dissection (LC with GBD) as a new total biopsy method for suspected gallbladder cancer. We retrospectively reviewed the medical records of 19 patients who underwent LC with GBD to assess the usefulness of this procedure and the pathological findings. No severe morbidity or recurrence was encountered. LC with GBD could be performed easily and safely, and the patients’ postoperative course was almost equal to that of patients treated by conventional LC. Histologically, gallbladder cancer was diagnosed in five cases (pT1a, 3; pT2, 2). We believe that LC with GBD could play an important role in the potential treatment strategy for pT2 gallbladder cancer

Isolated gestational proteinuria preceding the diagnosis of preeclampsia : an observational study

Introduction. Some pregnant women develop significant proteinuria in the absence of hypertension. However, clinical significance of isolated gestational proteinuria (IGP) is not well understood. This study aimed to determine the prevalence of IGP in singleton pregnancies and the proportion of women with IGP who subsequently developed preeclampsia (IGP-PE) among all PE cases. Material and methods. This was an observational study of 6819 women with singleton pregnancies at 12 centers, including 938 women with at least once determination of protein-to-creatinine ratio (P/Cr). Significant proteinuria in pregnancy (SPIP) was defined as P/Cr (mg/mg) level >0.27. IGP was defined as SPIP in the absence of hypertension. Gestational hypertension (GH) preceding preeclampsia (GH-PE) was defined as preeclampsia (PE) in which GH preceded SPIP. Simultaneous PE (S-PE) was defined as PE in which both SPIP and hypertension occurred simultaneously. Results. IGP and PE were diagnosed in 130 (1.9%) and 158 (2.3%) of 6819 women, respectively. Of 130 women with IGP, 32 (25%) progressed to PE and accounted for 20% of all women with PE. Hence, women with IGP had a relative risk of 13.1 (95% CI; 9.2-18.5) for developing PE compared with those without IGP [25% (32/130) vs. 1.9% (126/6689)]. At diagnosis of SPIP, P/Cr levels already exceeded 1.0 more often in women with S-PE than in those with IGP-PE [67% (33/49) vs. 44% (14/32), respectively, p = 0.031]. Conclusions. IGP is a risk factor for PE, and IGP-PE accounts for a considerable proportion (20%) of all PE

Exoplanets around Low-mass Stars Unveiled by K2

We present the detection and follow-up observations of planetary candidates around low-mass stars observed by the K2 mission. Based on light-curve analysis, adaptive-optics imaging, and optical spectroscopy at low and high resolution (including radial velocity measurements), we validate 16 planets around 12 low-mass stars observed during K2 campaigns 5-10. Among the 16 planets, 12 are newly validated, with orbital periods ranging from 0.96-33 days. For one of the planets (K2-151b) we present ground-based transit photometry, allowing us to refine the ephemerides. Combining our K2 M-dwarf planets together with the validated or confirmed planets found previously, we investigate the dependence of planet radius $R_p$ on stellar insolation and metallicity [Fe/H]. We confirm that for periods $P\lesssim 2$ days, planets with a radius $R_p\gtrsim 2\,R_\oplus$ are less common than planets with a radius between 1-2$\,R_\oplus$. We also see a hint of the "radius valley" between 1.5 and 2$\,R_\oplus$ that has been seen for close-in planets around FGK stars. These features in the radius/period distribution could be attributed to photoevaporation of planetary envelopes by high-energy photons from the host star, as they have for FGK stars. For the M dwarfs, though, the features are not as well defined, and we cannot rule out other explanations such as atmospheric loss from internal planetary heat sources, or truncation of the protoplanetary disk. There also appears to be a relation between planet size and metallicity: those few planets larger than about 3 $R_\oplus$ are found around the most metal-rich M dwarfs.Comment: 29 pages, 21 figures, 6 tables, Accepted in Astronomical Journa

Skin Perfusion Pressure Is a Prognostic Factor in Hemodialysis Patients

Peripheral arterial disease (PAD) is common in hemodialysis patients and predicts a poor prognosis. We conducted a prospective cohort study to identify risk factors for PAD including skin perfusion pressure (SPP) in hemodialysis patients. The cohort included 373 hemodialysis patients among 548 patients who received hemodialysis at Oyokyo Kidney Research Institute, Hirosaki, Japan from August 2008 to December 2010. The endpoints were lower limb survival (peripheral angioplasty or amputation events) and overall survival of 2 years. Our results showed that <70 mmHg SPP was a poor prognosis for the lower limb survival and overall survival. We also identified age, history of cardiovascular disease, presence of diabetes mellitus, smoking history, and SPP < 70 mmHg as independent risk factors for lower limb survival and overall survival. Then, we constructed risk criteria using the significantly independent risk factors. We can clearly stratify lower limb survival and overall survival of the hemodialysis patients into 3 groups. Although the observation period is short, we conclude that SPP value has the potential to be a risk factor that predicts both lower limb survival and the prognosis of hemodialysis patients

Management of Hepatocellular Carcinoma in Japan : JSH Consensus Statements and Recommendations 2021 Update

The Clinical Practice Manual for Hepatocellular Carcinoma was published based on evidence confirmed by the Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma along with consensus opinion among a Japan Society of Hepatology (JSH) expert panel on hepatocellular carcinoma (HCC). Since the JSH Clinical Practice Guidelines are based on original articles with extremely high levels of evidence, expert opinions on HCC management in clinical practice or consensus on newly developed treatments are not included. However, the practice manual incorporates the literature based on clinical data, expert opinion, and real-world clinical practice currently conducted in Japan to facilitate its use by clinicians. Alongside each revision of the JSH Guidelines, we issued an update to the manual, with the first edition of the manual published in 2007, the second edition in 2010, the third edition in 2015, and the fourth edition in 2020, which includes the 2017 edition of the JSH Guideline. This article is an excerpt from the fourth edition of the HCC Clinical Practice Manual focusing on pathology, diagnosis, and treatment of HCC. It is designed as a practical manual different from the latest version of the JSH Clinical Practice Guidelines. This practice manual was written by an expert panel from the JSH, with emphasis on the consensus statements and recommendations for the management of HCC proposed by the JSH expert panel. In this article, we included newly developed clinical practices that are relatively common among Japanese experts in this field, although all of their statements are not associated with a high level of evidence, but these practices are likely to be incorporated into guidelines in the future. To write this article, coauthors from different institutions drafted the content and then critically reviewed each other’s work. The revised content was then critically reviewed by the Board of Directors and the Planning and Public Relations Committee of JSH before publication to confirm the consensus statements and recommendations. The consensus statements and recommendations presented in this report represent measures actually being conducted at the highest-level HCC treatment centers in Japan. We hope this article provides insight into the actual situation of HCC practice in Japan, thereby affecting the global practice pattern in the management of HCC

Conceptual Design of Rapid Circular Particle Accelerator Using High-Gradient Resonant Cavities with Fixed Frequency

A new high-energy particle accelerator with static combined type of magnetic field and high-gradient resonant cavities is introduced for muon acceleration up to 300 MeV and proton acceleration up to 400 MeV. The accelerator concept is expected to realize Mpps-class rapid cycling high-energy particle acceleration in circular particle accelerators. Conceptual designs of the circular accelerator are discussed with an emphasis on short lifetime particles. The fundamental concept of particle acceleration and the related practical issues, which should be discussed when designing the accelerators, are described as well

子宮内膜症性腸閉塞に対する経肛門的イレウスチューブの有用性

One of the causative diseases of intestinal obstruction in young women is bowel endometriosis. During the course of ectopic endometriosis, it is estimated that about １０％ of patients develop bowel endometriosis. The first step in treatment is drug therapy. In cases of bowel endometriosis of the colon or rectum leading to intestinal obstruction, laparotomy is often required. A ４７-year-old woman with a history of endometriosis was undergoing drug therapy. She developed abdominal pain and nausea, and was diagnosed with septic shock and fecal ileus. A transanal drainage tube was inserted for decompression. The patient’s general condition improved, and a laparoscopic low anterior resection was performed on the ２３rd day. The patient was discharged on the １０th postoperative day without any postoperative problems. This case suggests that even in the case of septic shock caused by rectal stricture due to intestinal endometriosis, initial treatment with transanal decompression may stabilize the general condition, and may be superior in cosmetic change