Effect of the Japanese Herbal Kampo Medicine Dai-Kenchu-To on Postoperative Adhesive Small Bowel Obstruction Requiring Long-Tube Decompression: A Propensity Score Analysis

Adhesive small bowel obstruction (ASBO) is an adverse consequence of abdominal surgery. Although the Kampo medicine Dai-kenchu-to is widely used in Japan for treatment of postoperative ASBO, rigorous clinical studies for its use have not been performed. In the present retrospective observational study using the Japanese diagnosis procedure combination inpatient database, we selected 288 propensity-score-matched patients with early postoperative ASBO following colorectal cancer surgery, who received long-tube decompression (LTD) with or without Dai-kenchu-to administration. The success rates of LTD were not significantly different between Dai-kenchu-to users and nonusers (84.7% versus 78.5%; P = .224), while Dai-kenchu-to users showed a shorter duration of LTD (8 versus 10 days; P = .012), shorter duration between long-tube insertion and discharge (23 versus 25 days; P = .018), and lower hospital charges ($23,086 versus$26,950; P = .018) compared with Dai-kenchu-to nonusers. In conclusion, the present study suggests that Dai-kenchu-to is effective for reducing the duration of LTD and saving costs

Observation of moisture tendencies related to shallow convection

Tropospheric moisture is a key factor controlling the global climate and its variability. For instance, moistening of the lower troposphere is necessary to trigger the convective phase of a Madden-Julian oscillation (MJO). However, the relative importance of the processes controlling this moistening has yet to be quantified. Among these processes, the importance of the moistening by shallow convection is still debated. The authors use high-frequency observations of humidity and convection from the Research Vessel (R/V) Mirai that was located in the Indian Ocean ITCZ during the Cooperative Indian Ocean Experiment on Intraseasonal Variability/Dynamics of the MJO (CINDY/DYNAMO) campaign. This study is an initial attempt to directly link shallow convection to moisture variations within the lowest 4 km of the atmosphere from the convective scale to the mesoscale. Within a few tens of minutes and near shallow convection occurrences, moisture anomalies of 0.25-0.5 g kg-1 that correspond to tendencies on the order of 10-20 g kg-1 day-1 between 1 and 4 km are observed and are attributed to shallow convective clouds. On the scale of a few hours, shallow convection is associated with anomalies of 0.5-1 g kg-1 that correspond to tendencies on the order of 1-4 g kg-1 day-1 according to two independent datasets: lidar and soundings. This can be interpreted as the resultant mesoscale effect of the population of shallow convective clouds. Large-scale advective tendencies can be stronger than the moistening by shallow convection; however, the latter is a steady moisture supply whose importance can increase with the time scale. This evaluation of the moistening tendency related to shallow convection is ultimately important to develop and constrain numerical models

Differences between Faster versus Slower Components of Convectively Coupled Equatorial Waves

Abstract This paper describes an analysis of multiyear satellite datasets that subdivide two halves (faster and slower) of the space–time spectral signal peaks corresponding to convectively coupled equatorial waves such as Kelvin and inertia–gravity waves [n = 0 eastward inertia–gravity wave (EIGn0 wave), and n = 1 and n = 2 westward inertia–gravity waves (WIGn1 and WIGn2 waves, respectively)]. The faster (slower) component of an equatorial wave is defined as that which has a spectral signal peak in the regions with deeper (shallower) equivalent depths. The data obtained from the Tropical Rainfall Measuring Mission (TRMM) precipitation radar (TRMM-PR) are composited around space–time-filtered equatorial-belt data from the TRMM-3B42 rainfall product to separately estimate the convective and stratiform rainfall modulations. Results indicate that the faster components of WIGn1 and WIGn2 waves modulate convective rain relatively more (and stratiform rain relatively less) than their slower counterparts. For Kelvin and EIGn0 waves, however, there is no significant difference in the rainfall modulation between their faster and slower components. A space–time cospectral analysis of the satellite-retrieved rainfall and moisture shows that in the spectral regions corresponding to WIGn1 and WIGn2 waves, precipitation is significantly correlated with low-level moisture but not with midlevel moisture. In contrast, significant coherence between rainfall and moisture at these levels is found in the spectral regions corresponding to the Kelvin and EIGn0 waves. These results may bear on different convection–wave coupling mechanisms for these “divergent” waves (stratiform instability versus moisture–stratiform instability)

Differences between More Divergent and More Rotational Types of Convectively Coupled Equatorial Waves. Part II: Composite Analysis based on Space–Time Filtering

Abstract This paper describes an analysis of multiyear satellite datasets to characterize the modulations of convective versus stratiform rain, rain system size, and column water vapor by convectively coupled equatorial waves. Composites are built around space–time filtered equatorial-belt data from the Tropical Rainfall Measuring Mission (TRMM) 3B42 rainfall product, while TRMM Precipitation Radar (PR) and passive microwave data are the composited variables. The results are consistent with the more reanalysis-dependent findings in Part I, indicating that higher-frequency (or more divergent) waves, such as Kelvin and inertia–gravity families, modulate mesoscale convective systems and stratiform rain relatively more, whereas slower (or more rotational) types such as Rossby, mixed Rossby–gravity, and tropical depression (TD) or “easterly” waves primarily modulate convective rain and smaller-sized precipitation systems. Column water vapor composites indicate that the more rotational wave types modulate the moisture field more pronouncedly than do the divergent waves, leading the authors to speculate that the slow/rotational versus fast/wavelike distinction in precipitation characteristics may correspond to the different balances of two main convective coupling mechanisms: moisture control of cumulus cells versus convective inhibition control (via low-level density waves) of mesoscale convective systems. The Madden–Julian oscillation (MJO) is unique in that it exhibits prominent modulation of both stratiform precipitation (like the fast divergent waves) and small-sized precipitation features, convective rainfall, and moisture (like the other low-frequency, rotational waves). A composite of other waves’ amplitudes as a function of MJO amplitude and phase shows that divergent waves are more active in the developing phase and rotational waves are more active in the decaying rather than developing phase of the MJO

Differences between More Divergent and More Rotational Types of Convectively Coupled Equatorial Waves. Part I: Space–Time Spectral Analyses

Abstract Precipitation-related differences in different types of convectively coupled equatorial waves are examined here and in a companion paper. Here the authors show spectra and cross-spectra among tropical-belt time sections of satellite-derived surface rain, infrared brightness temperature Tb, precipitable water (PW), and Japan Meteorological Agency reanalysis of divergence and PW. Cross-spectra between rain and divergence at 1000- and 200-hPa levels show significant coherence peaks oriented along the dispersion curves of Kelvin, n = 1 equatorial Rossby (ERn1), mixed Rossby–gravity (MRG), n = 0 eastward inertial gravity (EIGn0), and n = 1 and n = 2 westward inertial gravity (WIG) waves, as well as the spectral signatures of the Madden–Julian oscillation (MJO) and tropical depression (TD)-type disturbances. Middle-troposphere divergence (indicative of stratiform rain and half-depth convection involvement in the coupling) is coherent with rain for the higher-frequency and more divergent wave types (Kelvin, EIGn0, WIG) but shows little coherence with rain for more rotational disturbance types (ERn1, MRG, TD). These two broad families also exhibit different rain–PW phase lags, a result supportive of the notion that stratiform rain (which occurs in dry conditions after peak PW and rain) is more involved in the more divergent wave types