Postoperative mortality analysis on nationwide data from diagnosis procedure combination database in Japan

[Introduction] The present study aimed to investigate the postoperative mortality due to all surgeries at the prefectural level using a nationwide diagnosis procedure combination (DPC) database in Japan and to evaluate the data according to temporal changes and regional differences. [Methods] Data were provided in accordance with the guidelines indicated on the Ministry of Health, Labor and Welfare, Japan. The number of cases and in-hospital mortality were calculated for each representative surgery for each hospitalization according to fiscal year of discharge from 2011 to 2018 and according to prefecture. Values of ≥10 in each aggregated data cell were presented. [Results and discussion] The aggregated result data contain 474, 154 records, with about 2, 000 different surgical codes. More than 10 mortalities were recorded in only 16, 890 data cells, which can be used in the mortality analysis. In the analyses of artificial head insertion, cerebral aneurysm neck clipping, coronary artery and aortic bypass grafting, and tracheotomy, regional differences and a declining trend were observed in some categories. [Conclusion] In addition to considering categories that can be used in the analysis, careful consideration must be given to the inclusion of background context such as the quality of care

An iteration method for calculating the relative capacity

An iteration method is given for computing the relative capacity of a discrete memoryless channel, i.e., the maximum of the information transmission rate per cost. The algorithm is simpler and more tractable than that of B. Meister and W. Oettli (1967,Inform. Contr. 11, 341–351). Also it contains Arimoto and Blahut's method for computing the capacity as a special case. The convergence of the iteration method is monotone nondecreasing and a bound on the speed of the convergence is given

Immunological Function of Sphingosine 1-Phosphate in the Intestine

It has been shown that dietary materials are involved in immune regulation in the intestine. Lipids mediate immune regulation through a complex metabolic network that produces many kinds of lipid mediators. Sphingosine-1-phosphate (S1P) is a lipid mediator that controls cell trafficking and activation. In this review, we focus on the immunological functions of S1P in the regulation of intestinal immune responses such as immunoglobulin A production and unique T cell trafficking, and its role in the development of intestinal immune diseases such as food allergies and intestinal inflammation, and also discuss the relationship between dietary materials and S1P metabolism

Metabolism of Dietary and Microbial Vitamin B Family in the Regulation of Host Immunity

Vitamins are micronutrients that have physiological effects on various biological responses, including host immunity. Therefore, vitamin deficiency leads to increased risk of developing infectious, allergic, and inflammatory diseases. Since B vitamins are synthesized by plants, yeasts, and bacteria, but not by mammals, mammals must acquire B vitamins from dietary or microbial sources, such as the intestinal microbiota. Similarly, some intestinal bacteria are unable to synthesize B vitamins and must acquire them from the host diet or from other intestinal bacteria for their growth and survival. This suggests that the composition and function of the intestinal microbiota may affect host B vitamin usage and, by extension, host immunity. Here, we review the immunological functions of B vitamins and their metabolism by intestinal bacteria with respect to the control of host immunity

Host- and Microbe-Dependent Dietary Lipid Metabolism in the Control of Allergy, Inflammation, and Immunity

The intestine is the largest immune organ in the body, provides the first line of defense against pathogens, and prevents excessive immune reactions to harmless or beneficial non-self-materials, such as food and intestinal bacteria. Allergic and inflammatory diseases in the intestine occur as a result of dysregulation of immunological homeostasis mediated by intestinal immunity. Several lines of evidence suggest that gut environmental factors, including nutrition and intestinal bacteria, play important roles in controlling host immune responses and maintaining homeostasis. Among nutritional factors, ω3 and ω6 essential polyunsaturated fatty acids (PUFAs) profoundly influence the host immune system. Recent advances in lipidomics technology have led to the identification of lipid mediators derived from ω3- and ω6-PUFAs. In particular, lipid metabolites from ω3-PUFAs (e.g., eicosapentaenoic acid and docosahexaenoic acid) have recently been shown to exert anti-allergic and anti-inflammatory responses; these metabolites include resolvins, protectins, and maresins. Furthermore, a new class of anti-allergic and anti-inflammatory lipid metabolites of 17,18-epoxyeicosatetraenoic acid has recently been identified in the control of allergic and inflammatory diseases in the gut and skin. Although these lipid metabolites were found to be endogenously generated in the host, accumulating evidence indicates that intestinal bacteria also participate in lipid metabolism and thus generate bioactive unique lipid mediators. In this review, we discuss the production machinery of lipid metabolites in the host and intestinal bacteria and the roles of these metabolites in the regulation of host immunity

Trajectories of end-of-life medical and long-term care expenditures for older adults in Japan: retrospective longitudinal study using a large-scale linked database of medical and long-term care claims

We analyzed trajectories of medical and long-term care expenditures during the 60 months before the date of death. We identified six distinct spending trajectories for the total care expenditures. Factors associated with the high-persistent trajectory were chronic illnesses, various organ failures, neurodegenerative diseases, fractures, and tube feeding. This finding has implications for improving the quality of end-of-life care and its financial foundation

Regurgitant leak from the area between the stent post and the sewing ring of a stented bovine pericardial valve implanted in the aortic valve position

Biologic valves can sometimes have a small closure or leakage backflow jet originating from the central coaptation point. This is physiologic regurgitation that usually only requires monitoring, and not treatment

Intra-operative autologous blood donation for cardiovascular surgeries in Japan: A retrospective cohort study

心臓外科手術における効果的な輸血戦略を検証 --コロナ禍の献血不足対策として--. 京都大学プレスリリース. 2021-03-16.Intra-operative autologous blood donation is a blood conservation technique with limited evidence. We evaluated the association between intra-operative autologous blood donation and decrease in peri-operative transfusion in cardiovascular surgery based on evidence from a Japanese administrative database. We extracted the data of patients who had undergone cardiovascular surgery from the Diagnosis Procedure Combination database in Japan (2016–2019). Based on the surgery type, we examined the association of intra-operative autologous blood donation with the transfusion rate and amount of blood used in cardiac and aortic surgeries using multilevel propensity score matching. We enrolled 32, 433 and 4, 267 patients who underwent cardiac and aortic surgeries and received 5.0% and 6.7% intra-operative autologous blood donation with mean volumes of 557.68 mL and 616.96 mL, respectively. The red blood cell transfusion rates of the control and intra-operative autologous blood donation groups were 60.6% and 38.4%, respectively, in the cardiac surgery cohort (p < .001) and 91.4%, and 83.8%, respectively, in the aortic surgery cohort (p = .037). The transfusion amounts for the control and intra-operative autologous blood donation groups were 5.9 and 3.5 units of red blood cells, respectively, for cardiac surgery patients (p < .001) and 11.9 and 7.9 units, respectively, for aortic surgery patients (p < .001). Intra-operative autologous blood donation could reduce the transfusion rate or amount of red blood cells and fresh frozen plasma for patients undergoing index cardiovascular surgery and could be an effective blood transfusion strategy in cardiovascular surgery for Japanese patients

Pore form and size dependence on plastic joining characteristics of resin/metallic foam by friction stir incremental forming

The version of record of this article, first published in International Journal of Advanced Manufacturing Technology, is available online at Publisher’s website: https://doi.org/10.1007/s00170-024-13405-1.A metallic foam specimen was plastically joined with a resin (polymethyl methacrylate, PMMA) sheet by applying friction stir incremental forming (FSIF) process. In FSIF process, a rotating flat-ended (no probe) rod tool was pushed vertically and fed horizontally against the resin sheet which was placed on the foam. The tool operation heated frictionally the resin and deformed incrementally to the resin, while the tool operation did not deform plastically to the cellular matrix of the foam. Due to the plastic flow of the heated resin, the bottom of the resin was interlocked mechanically to the pores near the top surface of the foam. In this study, the relationship between the pore morphology (form and size) and the joining characteristics (joinability, flow thickness of the resin, and joining strength) was investigated using commercial open-cell nickel and closed-cell aluminum foams. According to the experimental investigations, the foam with small size and low depression angle of the surface pore showed better results in relation with the joining strength and the (flow thickness of the resin)/(depth of the surface pore)