Impact of physiologically shaped pancreatic stent for chronic pancreatitis.

Endoscopic pancreatic stenting is used to prevent main pancreatic duct obstruction and relieve painful symptoms of chronic pancreatitis. However, the stent typically needs to be exchanged and the rate of adverse events is high. Few studies have evaluated the effect of stent shape on those outcomes. We evaluated the adverse events, stent patency, and total medical cost within 90 days of patients who received an 8.5 French (Fr) physiologically shaped pancreatic stent by comparing these features with those associated with a conventional straight-type stent for ≥ 90 days. The total stent-related adverse event rate was significantly lower for the physiologically shaped pancreatic stent (physiologically shaped, 6.7% [2/30]; straight-type, 50.6% [44/87]; P < 0.001). Stent occlusion was significantly less frequent (P < 0.001) and the total medical costs were significantly lower (P = 0.002) for the physiologically shaped stent. The stent-related adverse event rate was significantly higher for the 10 Fr straight type stent than for the 8.5 Fr physiologically shaped stent (10 Fr, straight-type vs. 8.5 Fr, physiologically shaped: 36.1% [13/36] vs. 6.7% [2/30]; P = 0.007). In conclusion, a physiologically shaped pancreatic stent was superior to a straight-type stent in terms of the patency rate and medical costs.

Predictive factors for the mortality of acute pancreatitis on admission.

BACKGROUND AND AIMS: The revised Atlanta classification is widely used for the evaluation of acute pancreatitis (AP) severity. However, this classification cannot be used within 48 hours of AP onset. The aim of this study was to investigate the predictive factors of mortality in patients with AP on admission. METHODS: We evaluated the association between AP mortality and clinical parameters at the time of admission in patients with AP from April 2013 to December 2017 at one university hospital and one tertiary care referral center. RESULTS: A total of 203 consecutive patients were enrolled. Nine patients (4.4%) died despite multidisciplinary treatment. In a multivariable analysis, hematocrit ≥ 40% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.13; P = 0.021), blood urea nitrogen (BUN) ≥ 40 mg/dL (OR, 1.26; 95% CI, 1.11-1.42; P < 0.001), base excess < -3.0 mmol/L (OR, 1.15; 95% CI, 1.04-1.26; P = 0.004), and inflammation extending to the rectovesical excavation (OR, 1.19; 95% CI, 1.10-1.30; P < 0.001) on admission were significantly associated with mortality. CONCLUSION: Among the imaging findings, inflammation extending to the rectovesical excavation was the only independent predictive factor for mortality in AP. This simple finding, obtained on computed tomography without contrast agent on admission, might be a promising prognostic factor for AP.

[Research on the method of stress assessment--from the research findings of 2010].

The Japanese Society for Occupational Mental Health has conducted research on assessment of the psychological load (i.e., stress) among workers. Investigations were conducted three times, and those were contract research projects assigned by the Ministry of Health, Labour and Welfare. In this project, the author was the primary researcher. In the latest research, a survey utilizing the Live Event Method was performed extensively nationwide; the survey covered 10,494 subjects (including 1,977 females) from all types of industry and occupation. The objective of this research was to reevaluate the Psychological Load Assessment Sheet used as an evaluation basis for the "Certification of workers' compensation related to mental disorders from psychological load." Two previous research investigations, conducted in 2002 and 2006, had suggested the need for such reevaluation. The outcomes revealed that, the longer the monthly overtime working hours, the higher the stress scores (in the range of 0 to 10), and the lower the appearance rate of stress. Subjects who performed 140 hours or more of overtime work per month, which fell under the category of "Extremely Excessive Overtime Work," showed 6.3 points, which was markedly high, and ranked fourth in the survey with 63 assessment items. The category, "Extremely Excessive Overtime Work," includes two working hour ranges, 120 hours or more and 160 hours or more; those working hour ranges were defined in the revision based on the latest research. Monthly overtime work of 120 hours or more, but less than 140 hours, was ranked ninth and scored 6.3 points. Monthly overtime work of 80 hours or more, but less than 100 hours, scored 5.3 points with a frequency of 14.2%. Based on the above results, new assessment items were added to the Psychological Load Assessment Sheet. This paper addresses and studies the issues explained above.