タンノウ テキシュツジュツ デ チュウイ スベキ タンカン ソウコウ イジョウ Cystohepatic duct ノ 1レイ

　A 74-year-old man presented with epigastralgia and was diagnosed as having cholelithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) initially visualized the cystic duct with the Heister valve from the common bile duct, and then two intra-hepatic biliary ducts of segment 5 (B5) were visualized from the neck of the gallbladder. There was a contrast medium filling defect in B5, which was considered to be due to an incarcerated stone. Magnetic resonance cholangiopancreatography (MRCP) and three-dimensional computed tomography (CT) cholangiography showed similar findings, suggesting that the patient had a biliary anomaly of the cystohepatic duct in which two intrahepatic bile ducts (B5) flowed into the neck of the gallbladder and a stone incarcerated in the neck of the gallbladder.　At surgery, during mobilization of the gallbladder, there was a thick string between the liver and the gallbladder, and this was considered to be the junction of B5 with the gallbladder. Therefore, the neck of the gallbladder was cut, and an incarcerated stone 10 mm in diameter was removed. Intraoperative cholangiography revealed that the cystohepatic ducts were preserved. The postoperative course was uneventful and there was no bile leakage or liver dysfunction.　Although cystohepatic duct is a rare biliary anomaly, the surgeon should be alert for its possible presence during cholecystectomy. When cholecystectomy is scheduled, more than one preoperative examination by three-dimensional CT cholangiography, MRCP or ERCP should be performed, and the surgeon should be careful not to overlook any biliary anomaly.　Keywords: cystohepatic duct, biliary duct anomaly, cholecystectomy, three-dimensional computed tomography, gallston

Evaluation of patients who underwent percutaneous transhepatic portal vein embolisation by Tc-99m GSA scintigraphy

Purpose: To analyse the correlation between the fold change in residual liver volume (RLV) and residual liver uptake at 15 (RLU15) before and after percutaneous transhepatic portal vein embolisation (PTPE). Material and methods: Between August 2010 and December 2016, 20 patients who underwent PTPE were retrospectively selected. Before and three weeks after PTPE, contrast-enhanced computed tomography (CECT) and Tc-99m GSA scintigraphy were performed to analyse the fold changes in RLV and RLU15, respectively, as well as their correlation. Results: After PTPE, a significant increase was observed in the RLV (before: 464 ± 99 ml; after: 573 ± 118 ml, p = 0.004) and the RLU15 (before: 11.0 ± 2.9%; after: 17.7 ± 3.8%, p = 5 × 10-7). The fold increase of RLV and RLU15 in all patients was 1.25 ± 0.15 and 1.66 ± 0.33, respectively. No significant correlation was observed in the fold increase in both RLV and RLU15 (r = 0.14, p = 0.66). In patients no. 3 and 9, who were outliers, the increase in RLV was minimal and RLU15 increased greatly, and these 2 patients underwent radical hepatectomy after PTPE. Conclusions: No correlation was observed between the fold increase in RLV and RLU15 before and after PTPE. In order to accurately evaluate the residual liver function, it should be considered necessary to evaluate not only by morphological CECT volumetry, but also by functional outcome of Tc-99m GSA scintigraphy. Residual liver volume may not necessarily reflect RLF. It may be possible to improve the radical resection rate by detecting the potential increase of RLF with RLU15 of Tc-99m GSA scintigraphy

Reproduction of Secondary School Social Studies Lessons in Cambodia

This study used a field survey to clarify the current state and characteristics of secondary school social studies lessons in Cambodia and explore the reasons that these lessons were being reproduced. The current state of the Cambodian social studies education system was observed through five classes broadly exploring different areas and subjects in January and February 2018. Four common characteristics were observed: (1) course objectives to understand normative and factual knowledge; (2) knowledge-based content; (3) activities to ask questions about the lesson contents; and (4) evaluations to ascertain whether the students can repeat the given knowledge. However, we presume that external situations influence the teachers’ choice of lesson structure in reproducing these common lessons. In addition, issues with teachers’ internal beliefs about the meta-cognition deficiencies in the lesson constructions and themselves must be addressed. Appropriate support is necessary based on these real-world teaching situations and school teacher culture

Effects of Preoperative Use of an Immune-Enhancing Diet on Postoperative Complications and Long-Term Outcome: A Randomized Clinical Trial in Colorectal Cancer Surgery in Japanese Patients

Background: Despite recent advances in surgical techniques and perioperative management, postoperative infectious complications remain a problem in surgical patients. We performed a prospective randomized clinical trial to examine the effects of preoperative Immune Enhancing Diets (IEDs) on postoperative complications in Japanese patients who underwent curative colorectal cancer surgery. This study was also designed to evaluate the optimal dose of preoperative IEDs for the patients without malnutrition. Finally, we analyzed recurrence free survival (RFS) and disease-specific survival (DSS) after surgery in patients who did and did not receive IEDspreoperatively.Material and Methods: This was a prospective, randomized clinical trial conducted at the Department of Surgery, National Defense Medical College, from October 2002 to October 2005. The 88 patients undergoing colorectal surgery were enrolled and were randomly divided into 3 groups. The high- (High, N=26) and low- (Low, N=31) dose groups received normal food and, respectively, 750ml/day or 250ml/ day of IEDs for 5 days before the operation. The primary endpoint was the rates of surgical site infection (SSI) and non- infectious complications. We also evaluated the RFS and DSS rate, respectively. Results: The patients were followed for 77±10 months (9-133 months) after surgery. Incisional SSI rates in the IEDs (High and Low) groups were significantly lower than in the Control group. (0%*, 0%* and 17%) (*P<0.01 vs. Control) The incidences of the infections not involving the surgical site (non-SSI) and the lengths of hospital stay were similar among the three groups. No significant differences were observed in RFS or DSS.Conclusion: In Japanese patients undergoing colorectal cancer surgery, preoperative IEDs significantly reduced the rate of incisional SSI as compared with the control group. Very interestingly, in Japanese patients, preoperative 250ml/day IED intake may be adequate for colorectal cancer patients without malnutrition. However, with regard to the long term outcome, beneficial effects of preoperative IEDs are not evident

Entecavir Reduces Hepatocarcinogenesis in Chronic Hepatitis B Patients

Chronic hepatitis B (CHB) leads to cirrhosis and hepatocellular carcinoma (HCC). With a cohort of 1,206 CHB patients who visited Okayama University Hospital and related hospitals in 2011 and 2012, we compared the incidence rates of HCC among the patients grouped by age, hepatitis B virus (HBV) DNA, hepatitis B e antigen (HBeAg), and treatment. HCCs were observed in 115 patients with the median observation period of 1,687 days. Among the HCC patients aged &#8805; 35 years, HBV DNA &#8805; 4 log copies/mL and positive HBeAg at diagnosis (n=184), the HCC incidence rate was 8.4% at 5 years in the entecavir (ETV)-treated patients, 21.8% in the lamivudine (LVD)-treated patients, and 26.4% among the patients not treated with drugs. The cumulative HCC incidence was significantly reduced in the ETV-treated patients compared to those treated with LVD or not treated (p=0.013). Among the patients aged &#8805; 35 years with HBV DNA &#8805; 4 log copies/mL and negative HBeAg (n=237), the cumulative HCC incidence was 14.6% in 5 years in ETV group and 13.9% among those not treated with a drug (p>0.05). Only small numbers of HCCs occurred in other patients. In CHB patients aged&#8805;35 years with HBV DNA &#8805;4 log copies/mL and positive HBeAg, ETV treatment is recommended for the suppression of HCC development

Mixed HCV Infection of Genotype 1B and Other Genotypes Influences Non-response during Daclatasvir + Asunaprevir Combination Therapy

Daclatasvir (DCV) + asunaprevir (ASV) combination therapy has become available for patients with hepatitis C virus (HCV) serogroup 1 infection. We studied the efficacy of this therapy by focusing on the factors associated with sustained virological responses (SVR) including resistance-associated variants (RAVs) and mixed infection of different HCV genotypes. We enrolled 951 HCV serogroup 1-positive patients who received this combination therapy at our hospital or affiliated hospitals. The presence of RAVs in non-structural (NS) regions 3 and 5A was analyzed by direct sequencing. HCV genotypes were determined by PCR with genotype-specific primers targeting HCV core and NS5B regions. SVR was achieved in 91.1% of patients. Female sex, age > 70 years, and RAVs were significantly associated with non-SVR (p<0.01 for all). Propensity score-matching results among the patients without RAVs regarding sex, age, and fibrosis revealed that mixed HCV infection determined by HCV NS5B genotyping showed significantly lower SVR rates than 1B-mono infection (p=0.02). Female sex and RAVs were significant factors associated with treatment failure of this combination therapy for patients with HCV serogroup 1 infection. Mixed HCV infection other than 1B-mono infection would be useful for predicting treatment failure

The electron-capture origin of supernova 2018zd

In the transitional mass range ($\sim$ 8-10 solar masses) between white dwarf formation and iron core-collapse supernovae, stars are expected to produce an electron-capture supernova. Theoretically, these progenitors are thought to be super-asymptotic giant branch stars with a degenerate O+Ne+Mg core, and electron capture onto Ne and Mg nuclei should initiate core collapse. However, no supernovae have unequivocally been identified from an electron-capture origin, partly because of uncertainty in theoretical predictions. Here we present six indicators of electron-capture supernovae and show that supernova 2018zd is the only known supernova having strong evidence for or consistent with all six: progenitor identification, circumstellar material, chemical composition, explosion energy, light curve, and nucleosynthesis. For supernova 2018zd, we infer a super-asymptotic giant branch progenitor based on the faint candidate in the pre-explosion images and the chemically-enriched circumstellar material revealed by the early ultraviolet colours and flash spectroscopy. The light-curve morphology and nebular emission lines can be explained with the low explosion energy and neutron-rich nucleosynthesis produced in an electron-capture supernova. This identification provides insights into the complex stellar evolution, supernova physics, cosmic nucleosynthesis, and remnant populations in the transitional mass range.Comment: Author version of the published letter in Nature Astronomy, 28 June 202

The electron-capture origin of supernova 2018zd

In the transitional mass range (~8–10 solar masses) between white dwarf formation and iron core-collapse supernovae, stars are expected to produce an electron-capture supernova. Theoretically, these progenitors are thought to be super-asymptotic giant branch stars with a degenerate O + Ne + Mg core, and electron capture onto Ne and Mg nuclei should initiate core collapse1–4. However, no supernovae have unequivocally been identified from an electron-capture origin, partly because of uncertainty in theoretical predictions. Here we present six indicators of electron-capture supernovae and show that supernova 2018zd is the only known supernova with strong evidence for or consistent with all six: progenitor identification, circumstellar material, chemical composition5–7, explosion energy, light curve and nucleosynthesis8–12. For supernova 2018zd, we infer a super-asymptotic giant branch progenitor based on the faint candidate in the pre-explosion images and the chemically enriched circumstellar material revealed by the early ultraviolet colours and flash spectroscopy. The light-curve morphology and nebular emission lines can be explained by the low explosion energy and neutron-rich nucleosynthesis produced in an electron-capture supernova. This identification provides insights into the complex stellar evolution, supernova physics, cosmic nucleosynthesis and remnant populations in the transitional mass range. Electron-capture supernovae are thought to come from progenitors with a narrow range of masses, and thus they are rare. Here the authors present six indicators of an electron-capture supernova origin, and find that supernova 2018zd fulfils all six criteria.Instituto de Astrofísica de La PlataFacultad de Ciencias Astronómicas y Geofísica