Epidural versus patient-controlled intravenous analgesia on pain relief and recovery after laparoscopic gastrectomy for gastric cancer: randomized clinical trial

Background: Epidural analgesia (EDA) is a main modality for postoperative pain relief in major open abdominal surgery within the Enhanced Recovery After Surgery protocol. However, it remains unclear whether EDA is an imperative modality in laparoscopic gastrectomy (LG). This study examined non-inferiority of patient-controlled intravenous analgesia (PCIA) to EDA in terms of postoperative pain and recovery in patients who underwent LG. Methods: In this open-label, non-inferiority, parallel, individually randomized clinical trial, patients who underwent elective LG for gastric cancer were randomized 1:1 to receive either EDA or PCIA after surgery. The primary endpoint was pain score using the Numerical Rating Scale at rest 24 h after surgery, analysed both according to the intention-to-treat (ITT) principle and per protocol. The non-inferiority margin for pain score was set at 1. Secondary outcomes were postoperative parameters related to recovery and adverse events related to analgesia. Results: Between 3 July 2017 and 29 September 2020, 132 patients were randomized to receive either EDA (n = 66) or PCIA (n = 66). After exclusions, 64 patients were included in the EDA group and 65 patients in the PCIA group for the ITT analysis. Pain score at rest 24 h after surgery was 1.94 (s.d. 2.07) in the EDA group and 2.63 (s.d. 1.76) in the PCIA group (P = 0.043). PCIA was not non-inferior to EDA for the primary endpoint (difference 0.69, one side 95% c.i. 1.25, P = 0.184) in ITT analysis. Postoperative parameters related to recovery were similar between groups. More EDA patients (21 (32.8%) versus 1 (1.5%), P Conclusions: PCIA was not non-inferior to EDA in terms of early-phase pain relief after LG. Registration number: UMIN000027643 (https://www.umin.ac.jp/ctr/index-j.htm). Conclusions: PCIA was not non-inferior to EDA in terms of early-phase pain relief after LG.Registration number: UMIN000027643 (https://www.umin.ac.jp/ctr/index-j.htm)

Reconciling biodiversity conservation and flood risk reduction : The new strategy for freshwater protected areas

Aim: Natural disaster risk reduction (DRR) is becoming a more important function of protected area (PAs) for current and future global warming. However, biodiversity conservation and DRR have been handled separately and their interrelationship has not been explicitly addressed. This is mainly because, due of prevailing strategies and criteria for PA placement, a large proportion of PAs are currently located far from human-occupied areas, and habitats in human-occupied areas have been largely ignored as potential sites for conservation despite their high biodiversity. If intensely developed lowland areas with high flooding risk overlap with important sites for biodiversity conservation, it would be reasonable to try to harmonize biodiversity conservation and human development in human-inhabited lowland areas. Here, we examined whether extant PAs can conserve macroinvertebrate and freshwater fish biodiversity and whether human-inhabited lowland flood risk management sites might be suitable to designate as freshwater protected areas (FPAs). Location: Across Japan. Methods: We examined whether extant PAs can conserve macroinvertebrate and freshwater fish biodiversity and analysed the relationship between candidate sites for new FPAs and flood disaster risk and land use intensity at a national scale across Japan based on distribution data for 131 freshwater fish species and 1395 macroinvertebrate species. Results: We found that extant PAs overlapped with approximately 30% of conservation-priority grid cells (1 km2) for both taxa. Particularly for red-listed species, only one species of freshwater fish and three species of macroinvertebrate achieved the representation target within extant PAs. Moreover, more than 40% of candidate conservation-priority grid cells were located in flood risk and human-occupied areas for both taxa. Main conclusions: Floodplain conservation provides suitable habitat for many freshwater organisms and helps control floodwaters, so establishing new FPAs in areas with high flood risk could be a win-win strategy for conserving freshwater biodiversity and enhancing ecosystem-based DRR (eco-DRR)

ノウソン チイキ ニ オケル チュウコウレイ カンリュウシャ ノ チイキ シャカイ カツドウ ニ カンスル ケンキュウ : ソノ2 チュウコウレイ カンリュウシャ ノ セイカツ ジッタイ

This is to follow the previous article in which we showed that the number of returnees will increase in the near future and that they can play an important role in revitalizing local communities. The present paper is concerned with the analysis of their characteristics, and their contributions to farming and social activities in local communities. A mail survey was conducted in Oita andIwate prefectures concerning two types of aged members (50 and above) of farm families; (1) those who had always lived there and quit their off-farm employment about ten years before, (2) those who had been away and return to their native places about ten years before. This article focuses on the former group becausethere are few in the latter category. Aged returnees tend to have a high level of education and special skills, and a high proportion of them are alone or part of a nuclear family. It is shown that aged returnees are apt to hold many types of office, introducing unconventional forms of office holding and community power structure. The main reason for their readiness to hold office is perceived obligation to do community had been freed from them until they became returnees. They are expected to perform roles by the established residents.Our result indicate that within the context of the present trend of an aging agricultural labor force and rural population it is time to look into ways to tap the talents and abilities of aged returnees for the maintenance and development of local communities

ノウソン チイキ ニ オケル チュウコウレイ カンリュウシャ ノ チイキ シャカイ カツドウ ニ カンスル ケンキュウ : ソノ1 チュウコウレイ カンリュウ ノ ドウコウ ニ ツイテ

This is the first of three articles on aged returnees. Aged returnees are defined as those who are farmhouseholders or their spouses and re-establish their position in the community after they leave their previous work outside farming. They have received much attention these days as many of them take up farming, causing the ageing of the local agricultural labour force, and also as they may be able to perform important roles in the everyday activities of local communities. The present paper is mainly concerned with the analysis of the recent trend of aged returning and its backgrounds. It was found from a preliminary study that the aged returning is a phenomenon promoted by the increase in part-time farming and also by the ageing of farming populations and the fanning labour force. This leads the authors to estimate that: (1) the number of aged returnees will rise in future; (2) their distribution will accompany local differentials as it has so far. To follow this, forty-seven prefectures were classified into five typologies based on the recent trend, and Oita and Iwate prefectures were chosen for further investigation: the former having a longestablished experience in aged returning, and the latter showing signs of an increase. The results show that: (1) most aged returnees leave their outside-work at the age of retirement and a high proportion of those who settle in the community engage in fanning This indicates that they present high potential for playing important roles in community activities; (2) the availability of employment opportunities outside farming affects the numbers of aged returning, which is the cause for local differentials in its distribution

ノウカ フジン ノ パートタイム シュウロウ ノ ジッタイ ト ソノ ルイケイ : ノウカ フジン ノ パートタイム シュウロウ ニ カンスル ケンキュウ ソノ2

This study is concerned with the part—time employment of farmhouse woman. Part—time employment, looked on one of the employment style shifting from agriculture to another, cause influences not only on household management but also on agricultural management, rural community, and so on. This paper (the second article) deals mainly with actual conditions of various farmhouse woman\u27s part—time employments and those classification in order to verify the characteristics of part—time employment in rural areas. Two study areas for investigation are both in the same way as the first article. Using the questionnaire and hearing, information was collected concerning farmhouse woman\u27s enployment. The characteristics of part—time employment in rural areas can be summarized as follows. 1) Occupational classifications show variety mainly in manufacturing industry. 2/3 of part—timers are absent from work for farming during bussie2s)t season. 3) Part—timers are employed enterprises nearby their residence. 4) 1/3 of part—timers are the same on-duty hours as "full-timer" 5) Most of part—timers are under inferior conditions (e. g. annual income, paid holidays, social insurance) to regular, full-time employee. From a viewpoint of on-duty hours in a day and absent days for farming in a year, part—time employments are classified into five types, such as the whole year Sr full-time, the absence for farming & full-time, the whole year & part—time, the absence for farming & part—time, and the seasonal employment. Through analysis on characte-rist ics of these types, part—time employment of farmhouse woman have intention being compatible with non-farming employment and household affairs, nursing of infants, agricultural management