Influence of caregiver understanding of their capability to perform activities of daily living, disease comprehension, and attitudes on occupational low back pain: a cross-sectional study.

[Purpose] The aim in this study was to evaluate the impact of caregiver understanding of their ability to perform activities of daily living (ADLs), movement abilities, diseases, and attitudes on the prevalence of occupational low back pain. [Participants and Methods] A cross-sectional survey was conducted of caregivers of older adults living in residential care facilities. Of the 150 questionnaires distributed, 71 were valid. The survey collected data on demographics, low back pain status using a numerical rating scale, and familiarity with ten ADLs and five diseases (stroke, rheumatoid arthritis, fractures, Parkinson's disease, and dementia). [Results] In this study, 52% of the participants reported lower back pain. Significant factors included an understanding of repositioning in ADLs, familiarity with stroke and rheumatoid arthritis, and attitudes toward using patients' residual functions. Participants with limited knowledge of repositioning and stroke, a better understanding of rheumatoid arthritis, and those who did not consider residual function were more prone to lower back pain. [Conclusion] Our findings highlight the importance of enhancing caregiver education on ADL movements and disease specifics, particularly stroke and rheumatoid arthritis, and promoting the use of patients' residual capabilities. Improved training and information sharing among caregivers may reduce the risk of occupational low back pain.

Analysis of fall risk factors and environmental hazards for older adults in Japan: assessing fall situations and locations.

[Purpose] This study aimed to examine falls among older adults in Japanese households and determine the risk associated with each fall location. [Participants and Methods] This study included 99 participants (249 fall events) who received daycare rehabilitation at a nursing care facility. Data on fall circumstances were collected from the medical records and accident reports. The analyzed variables included age, medical status, level of care required, fall history, location, and mode of transportation during the falls. [Results] Falls occurred most commonly in bedrooms. Falls at an entrance were associated with no assistive device (OR: 1.76, 95% CI: 1.06-1.80) and 1 history of falls (OR: 1.22, 95% CI: 1.03-3.10). Risk factors for falls in bedrooms included Parkinson's disease (OR: 1.83, 95% CI: 1.11-1.87), orthopedic disease (OR: 1.11, 95% CI: 1.15-3.43), and cane walking (OR: 1.08, 95% CI: 1.33-4.13). Falls in a hallway were associated with no assistive device (OR: 1.75, 95% CI: 1.15-1.91). [Conclusion] Bedrooms and hallways in Japanese households were identified as locations with a high risk of falls. The unique architectural and cultural features of Japanese homes may contribute to this risk. Rehabilitation programs should consider individual fall histories, medical conditions, and differences in mobility.

The Association Between Surgical Site Infection and Prognosis of T4 Colorectal Cancer.

OBJECTIVES: Patients with T4 colorectal cancer have poor prognosis, wherein no prognostic factors have been established. Surgical site infection (SSI) has been reported to be one of the risk factors for colorectal cancer recurrence. In this study, we evaluated the relationship between SSI occurrence and prognosis of T4 colorectal cancer and the prognostic impact of the site of SSI occurrence. METHODS: We examined 100 patients with T4 colorectal cancer who underwent radical surgery between April 2002 and December 2017, in a retrospective case-control study, excluding stage IV cases, and classified them into two groups: without SSI (non-SSI) and with SSI (SSI). The five-year relapse-free survival (RFS) and overall survival (OS) were calculated and compared between the two groups. The relationship between prognosis and the SSI site was also assessed according to the SSI site in the incisional/deep and organ/space SSI groups.  Results: The without SSI and with SSI groups included 73 and 27 patients, respectively. The five-year RFS was 55.1% and 22.2% in the without SSI and with SSI groups, respectively (hazard ratio (HR), 2.224; 95% confidence interval (CI), 1.269-3.898; P=0.005). The five-year OS was 67.0% and 38.4% in the without SSI and with SSI groups, respectively (HR, 2.366; 95% CI, 1.223-4.575; P=0.010). The patients in the with SSI group had a significantly poorer prognosis compared with the without SSI group. By SSI site, the prognosis was significantly worse in patients with SSI in the incisional/deep SSI group. CONCLUSIONS: In T4 colorectal cancer, SSI occurrence was a high-risk factor for recurrence and may be a prognostic factor. This result suggested that patients with SSI occurrence may require close postoperative follow-up and appropriate adjuvant chemotherapy.

Predicting the occurrence of in-season groin pain in male high school soccer players: a cohort study.

[Purpose] This study investigated whether pre-season HAGOS (Japanese Copenhagen Hip and Groin Outcome Scores) and eccentric muscle strength of the hip muscles predict in-season groin pain incidences in high school soccer players. [Participants and Methods] This study had a cohort design. The participants were male high school players under 18 years playing in the Japan Soccer League, which is an elite-level soccer league of that age category in Japan. The HAGOS and the strength of hip abductor and adductor muscles in eccentric contraction were measured before the season, and hip and groin pain incidences were recorded during the season. Multiple logistic regression analysis was performed to investigate the factors derived from the pre-season HAGOS and hip muscle strength tests, presumably pertaining to the development of in-season groin pain. [Results] The eccentric adductor muscle strength of the dominant leg and the HAGOS were selected as factors associated with groin pain during the season. [Conclusion] Low pre-season HAGOS and weak dominant-leg eccentric adductor muscle strength were suggested as factors to predict in-season groin pain occurrence in male high school soccer players.

Quantification of microbial community assembly processes during degradation on diverse plastispheres based on physicochemical characters and phylogenetic bin-based null model analysis.

To understand the differences in degradation processes depending on the chemical properties of polymers, it is necessary to both quantify the microbiome composition and evaluate the process of microbial turnover (i.e., community assembly processes) in a variety of polymer materials. In this study, using a phylogenetic bin-based null model analysis (i.e., iCAMP), we evaluated community assembly processes from original estuary water to 37 types of polymers, which provide overwhelmingly diverse niches for microbes, in 14-day incubation experiments. First, we evaluated the polymer properties related to degradation rates. Polymers with higher adipic acid (AdA) monomer exhibited higher motility, hydrophilicity, and degradation rates, whereas those with higher aromatic monomer exhibited the opposite trends. Second, microbiome composition analysis was performed, and the microbiomes were significantly changed by the AdA or aromatic content. This was consistent with the polymer properties, suggesting that polymer motility and hydrophilicity attributable to the first-order structure modify the accessibility of the enzyme to the reaction site and hence the degradation rate, resulting in differences in microbiome community composition. Finally, we determined community assembly processes from estuary water to plastics using a phylogenetic bin-based null model analysis. The importance of heterogeneous selection was higher in mobile, hydrophilic, and fast-degrading polymers, while that of homogeneous selection was lower. This suggests that the environmental difference between before and after incubation becomes significant under rapid degradation, which select microbes adapted to biofilm environments. In addition, the more stochastic turnover prevailed, the more variation in the communities (i.e., ß-diversity) increased. This suggests that turnover processes not dictated by the environment lead to instability in community compositions.

Exploration capacity versus specific enzymatic activity of ectomycorrhizas in response to primary productivity and soil phosphorus availability in Bornean tropical rainforests.

Ectomycorrhizal (ECM) fungi are functionally important in biogeochemical cycles in tropical ecosystems. Extracellular enzymatic activity of ECM on a ground-area basis is the product of two attributes; exploration capacity (ECM surface-area) and specific enzymatic activity. Here, we elucidated which attribute better explained the ECM enzymatic activity in response to different levels of soil phosphorus (P) and Nitrogen (N) availability in five Bornean tropical rainforests. We determined the surface area of ECM root tips as well as the enzymatic activities per ECM surface area for carbon (C), N and P degrading enzymes in each site. We evaluated the relationship of ECM enzyme activities with the resource availabilities of C (Above-ground net primary production; ANPP), N, and P of ECM by a generalized linear mixed model. The ECM enzymatic activities on a ground-area basis were more significantly determined by specific enzymatic activity than by the exploration capacity. Specific enzymatic activities were generally negatively affected by C (ANPP) and soil P availability. ECM fungi enhance the specific enzyme activity rather than the exploration capacity to maintain the capacity of nutrient acquisition. The less dependence of ECM fungi on the exploration capacity in these forests may be related to the limitation of C supply from host trees. We highlighted the adaptive mechanisms of ECM fungi on nutrient acquisition in tropical ecosystems through the response of enzymatic activity to nutrient availability across the elements.

The association between surgical site infection and postoperative colorectal cancer recurrence and the effect of laparoscopic surgery on prognosis.

PURPOSE: Studies have shown that surgical site infection (SSI) incidence is lower in patients undergoing laparoscopic surgery. Therefore, we reported the SSI countermeasures adopted by our institution and aimed to evaluate the association between SSI occurrence and postoperative colorectal cancer recurrence and the usefulness of laparoscopic surgery for prognosis. METHODS: Among the patients with colorectal cancer who underwent radical surgery at our hospital between January 2015 and December 2017, 197 with stage I-III cancer without distant metastases were included. We retrospectively analyzed patients' electronic medical records and classified them into the non-SSI (without SSI, n = 159) and SSI (with SSI, n = 38) groups. We calculated and compared the 5-year relapse-free survival (RFS) and overall survival (OS) rates. Additionally, we assessed the relationship between prognosis in the non-SSI, incisional SSI, and organ/space SSI groups and the usefulness of laparoscopic surgery. RESULTS: The 5-year RFS and OS were 80.5% versus 63.2% (P = 0.024; hazard ratio [HR], 2.065; 95% confidence interval [CI], 1.099-3.883) and 88.7% versus 84.2% (P = 0.443; HR, 1.436; 95% CI, 0.570-3.617), respectively. The SSI group had a significantly worse 5-year RFS prognosis. Regarding the relationship with laparoscopic surgery, the SSI incidence was 45.0% (9/20 cases) and 16.4% (29/177 cases) with laparotomy and laparoscopic surgery, respectively, indicating a significantly reduced SSI occurrence with laparoscopic surgery (P = 0.005). CONCLUSION: Patients with SSI were at high risk for colorectal cancer recurrence, and laparoscopic surgery may be useful for reducing SSI.

Large-scale omics dataset of polymer degradation provides robust interpretation for microbial niche and succession on different plastisphere.

While biodegradable polymers have received increased attention due to the recent marine plastic problem, few studies have compared microbiomes and their degradation processes among biodegradable polymers. In this study, we set up prompt evaluation systems for polymer degradation, allowing us to collect 418 microbiome and 125 metabolome samples to clarify the microbiome and metabolome differences according to degradation progress and polymer material (polycaprolactone [PCL], polybutylene succinate-co-adipate [PBSA], polybutylene succinate [PBS], polybutylene adipate-co-terephthalate [PBAT], and poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) [PHBH]). The microbial community compositions were converged to each polymer material, and the largest differences were observed between PHBH and other polymers. Such gaps were probably formed primarily by the presence of specific hydrolase genes (i.e., 3HB depolymerase, lipase, and cutinase) in the microorganisms. Time-series sampling suggested several steps for microbial succession: (1) initial microbes decrease abruptly after incubation starts; (2) microbes, including polymer degraders, increase soon after the start of incubation and show an intermediate peak; (3) microbes, including biofilm constructers, increase their abundance gradually. Metagenome prediction showed functional changes, where free-swimming microbes with flagella adhered stochastically onto the polymer, and certain microbes started to construct a biofilm. Our large-dataset-based results provide robust interpretations for biodegradable polymer degradation.

Bayesian network highlights the contributing factors for efficient arsenic phytoextraction by Pteris vittata in a contaminated field.

Phytoextraction is a low-cost and eco-friendly method for removing pollutants, such as arsenic (As), from contaminated soil. One of the most studied As hyperaccumulators for soil remediation include Pteris vittata. Although phytoextraction using plant-assisted microbes has been considered a promising soil remediation method, microbial harnessing has not been achieved due to the complex and difficult to understand interactions between microbes and plants. This problem can possibly be addressed with a multi-omics approach using a Bayesian network. However, limited studies have used Bayesian networks to analyze plant-microbe interactions. Therefore, to understand this complex interaction and to facilitate efficient As phytoextraction using microbial inoculants, we conducted field cultivation experiments at two sites with different total As contents (62 and 8.9 mg/kg). Metabolome and microbiome data were obtained from rhizosphere soil samples using nuclear magnetic resonance and high-throughput sequencing, respectively, and a Bayesian network was applied to the obtained multi-omics data. In a highly As-contaminated site, inoculation with Pseudomonas sp. strain m307, which is an arsenite-oxidizing microbe having multiple copies of the arsenite oxidase gene, increased As concentration in the shoots of P. vittata to 157.5 mg/kg under this treatment; this was 1.5-fold higher than that of the other treatments. Bayesian network demonstrated that strain m307 contributed to As accumulation in P. vittata. Furthermore, the network showed that microbes belonging to the MND1 order positively contributed to As accumulation in P. vittata. Based on the ecological characteristics of MND1, it was suggested that the rhizosphere of P. vittata inoculated with strain m307 was under low-nitrogen conditions. Strain m307 may have induced low-nitrogen conditions via arsenite oxidation accompanied by nitrate reduction, potentially resulting in microbial iron reduction or the prevention of microbial iron oxidation. These conditions may have enhanced the bioavailability of arsenate, leading to increased As accumulation in P. vittata.

A single-center retrospective analysis of the efficacy and safety of a modified regimen of irinotecan plus S-1 (IRIS) with molecular targeting agents as second-line chemotherapy in Japanese patients with recurrent or nonresectable colorectal cancer.

Background: As the second-line chemotherapy for stage IV recurrent or nonresectable colorectal cancer, our hospital started a modified treatment regimen comprising of irinotecan plus S-1 (IRIS) [tegafur/gimeracil/oteracil (S-1)] plus molecular targeting agents (MTAs), i.e., an epidermal growth factor receptor (EGFR) inhibitor such as panitumumab (P-mab) or cetuximab (C-mab) or vascular endothelial growth factor (VEGF) inhibitor such as bevacizumab (B-mab) since October 2012. The purpose of this study is to evaluate the efficacy and safety of this modified regimen. Methods: This retrospective study included 41 patients with advanced recurrent colorectal cancer at our hospital whom at least 3 courses of chemotherapy were conducted from January 2015 to December 2021. Based on the location of the primary tumor, patients were classified into two group (right-sided group, proximal to the splenic curve, and left-sided, distal to the splenic curve). We assessed archived data on RAS and BRAF status and UGT1A1 polymorphisms and use of the VEGF inhibitor bevacizumab (B-mab) and the EGFR inhibitors panitumumab (P-mab) and cetuximab (C-mab). In addition, progression-free survival rate (36M-PFS) and the overall survival rate (36M-OS) were calculated. Furthermore, the respective median survival time (MST), the median number of treatment courses; the objective response rate (ORR) and clinical benefit rate (CBR) and the incidence of adverse events (AEs) were assessed as well. Results: There were 11 patients (26.8%) in the right-sided group, and 30 patients (73.2%) in the left-sided group. There were 19 patients with RAS wild type (46.3%) (1 in the right sided group and 18 in the left sided group). P-mab was used for 16 of these patients (84.2%), C-mab for 2 (10.5%), and B-mab for 1 (5.3%); the remaining 22 patients (53.7%). Ten patients in the right group and 12 patients in the left group were a mutated type and received B-mab. BRAF testing was performed in 17 patients (41.5%); as more than 50% of patients (58.5%) were included before the assay's introduction. Five patients in the right-sided group and 12 patients in the left-sided group had wild type. There was no mutated type. UGT1A1 polymorphism was tested in 16/41 patients: Eight were wild type (8/41 patients, 19.5%) and 8, mutated type. Regarding the *6/*28 double heterozygous type, there was only 1 patient in the right-sided group and the remaining 7 patients were in the left-sided group. The total number of chemotherapy courses was 299, and the median number, 6.0 (range, 3-20). PFS, OS, and MST were as follows: 36M-PFS (total/Rt/Lt), 6.2%/0.0%/8.5% (MST; 7.6/6.3/8.9 months); and 36M-OS (total/Rt/Lt), 32.1%/0.0%/44.0% (MST; 22.1/18.8/28.6 months). The ORR and CBR were 24.4% and 75.6%, respectively. The majority of AEs were grades 1 or 2 and were improved with conservative treatment. Grade 3 leukopenia was observed in 2 cases (4.9%), neutropenia in 4 cases (9.8%), and malaise/nausea/diarrhea/perforation in 1 case each (2.4%). Grade 3 leukopenia (2 patients) and neutropenia (3 patients) were more commonly observed in the left-sided group. Diarrhea and perforation were also common in the left-sided group. Conclusions: This second-line modified IRIS regimen with MTAs is safe and effective and results in good PFS and OS.

Inferring microbial community assembly in an urban river basin through geo-multi-omics and phylogenetic bin-based null-model analysis of surface water.

Understanding the community assembly process is a central issue in microbial ecology. In this study, we analyzed the community assembly of particle-associated (PA) and free-living (FL) surface water microbiomes in 54 sites from the headstream to the river mouth of an urban river in Japan, the river basin of which has the highest human population density in the country. Analyses were conducted from two perspectives: (1) analysis of deterministic processes considering only environmental factors using a geo-multi-omics dataset and (2) analysis of deterministic and stochastic processes to estimate the contributions of heterogeneous selection (HeS), homogeneous selection (HoS), dispersal limitation (DL), homogenizing dispersal (HD), and drift (DR) as community assembly processes using a phylogenetic bin-based null model. The variation in microbiomes was successfully explained from a deterministic perspective by environmental factors, such as organic matter-related, nitrogen metabolism, and salinity-related parameters, using multivariate statistical analysis, network analysis, and habitat prediction. In addition, we demonstrated the dominance of stochastic processes (DL, HD, and DR) over deterministic processes (HeS and HoS) in community assembly from both deterministic and stochastic perspectives. Our analysis revealed that as the distance between two sites increased, the effect of HoS sharply decreased while the effect of HeS increased, particularly between upstream and estuary sites, indicating that the salinity gradient could potentially enhance the contribution of HeS to community assembly. Our study highlights the importance of both stochastic and deterministic processes in community assembly of PA and FL surface water microbiomes in urban riverine ecosystems.

Polymer composition optimization approach based on feature extraction of bound and free water using time-domain nuclear magnetic resonance.

As global environmental sustainability becomes increasingly emphasized, the development of eco-friendly materials, including solutions to the issue of marine plastics, is thriving. However, the material parameter space is vast, making efficient search a challenge. Time-domain nuclear magnetic resonance offers material property information through the complex T2 relaxation curves resulting from multiple mobilities. In this research, we used the Carr-Purcell-Meiboom-Gill (CPMG) pulse sequence to evaluate the binding state of water (water affinity) in polymers synthesized with various monomer compositions, which were immersed in seawater. We also assessed the T2 relaxation property of the polymers using the magic sandwich echo, double quantum filter, and magic-and-polarization echo filter techniques. We separated the T2 relaxation curves of CPMG into free and bound water for polymers by employing semisupervized nonnegative matrix factorization. By employing the features of separated bound water and polymer properties, a polymer composition optimization method offered crucial factors to monomers through random forests, predicted the components of the polymer using generative topography mapping regression, and determined expected values using Bayesian optimization for polymer composition candidates with the desired high water affinity and high rigidity.

Steroid Rebound Phenomenon as a Cause of Delayed Cerebral Vasospasm in Post-Splenectomy Pneumococcal Meningitis: A Case Report.

Pneumococcal meningitis as an overwhelming post-splenectomy infection (OPSI) has a higher risk of neurological complications and is sometimes life-threatening. In acute pneumococcal meningitis, four days of dexamethasone is widely used for the prevention of neurological complications. Herein, we report a 68-year-old woman with the diagnosis of pneumococcal meningitis as OPSI. With adequate antibiotics and dexamethasone, her symptoms gradually improved. However, after dexamethasone withdrawal, her consciousness got worse and got into a coma. Brain magnetic resonance imaging revealed acute cerebral infarctions in the bilateral middle cerebral artery territory with multiple vascular stenoses and hydrocephalus. Vascular stenoses improved by follow-up, suggesting cerebral vasospasm. There were no suggestive findings of cerebral vasculitis. Follow-up cerebrospinal fluid analysis showed remained pleocytosis with no bacteria, which could not suggest meningitis recurrence. Since steroid therapy was rapidly withdrawn, we diagnosed that the cerebral vasospasm was due to the steroid rebound phenomenon. The steroid rebound phenomenon due to the excessive immune response to bacterial microstructures has been reported in pneumococcal meningitis. Especially, the present case was asplenia and the usual dexamethasone use would not adequately suppress the immune response to bacterial microstructures. Since pneumococcal meningitis as OPSI has a higher risk of neurological complications, clinicians should consider longer and more cautious steroid tapering.

Identification of salmoniformes aquaculture conditions to increase creatine and anserine levels using multiomics dataset and nonnumerical information.

Aquaculture is attracting attention as a sustainable protein source. Salmoniformes, which are generally called salmon, are consumed in large quantities worldwide and are popularly used for aquaculture. In this study, the relationship between muscle metabolites, intestinal microbiota, and nonnumerical information about the ecology of salmoniformes was investigated to improve the efficiency of aquaculture using nuclear magnetic resonance and next-generation sequencing with bioinformatics approach. It was revealed that salmoniformes are rich in anserine and creatine, which are useful for human health care, along with collagen and lipids. The important factors in increasing these useful substances and manage the environment of salmoniformes aquaculture should be noted.

Conversion surgery by hand-assisted laparoscopic surgery following chemotherapy for rectal cancer with H3 liver metastases: a case report.

Background: Recent advancements in molecularly targeted chemotherapy for stage IV colorectal cancer have enabled the possibility of complete resection in primary colorectal cancer, which often involves distant liver or lung metastases, by aggressive surgical resection followed by multi-combination chemotherapy. Case description: A 73-year-old man treated previously for hyperuricemia, hypertension, and a dissecting abdominal aortic aneurysm was referred to us after an incidental finding of multiple liver masses on abdominal ultrasound during follow-up for the aneurysm. A detailed examination by contrast-enhanced computed tomography revealed a ring-enhancing mass larger than 5 cm in diameter in segment 3 of the liver and more than 6 low-density areas with total diameter of 1 to 2 cm in both lobes. A barium enema examination revealed a Borrmann type 2 lesion covering two-thirds of the circumference of the colon, with a 5-cm major axis in the rectosigmoid colon. Biopsy revealed a well-differentiated adenocarcinoma. The patient was diagnosed with stage IV rectal cancer. Because there was no intestinal obstruction, we administered 9 cycles of bevacizumab with capecitabine and oxaliplatin as chemotherapy. Subsequent diagnostic imaging revealed the metastatic lesions in liver segment 3 had reduced to 2 low-density areas with a diameter of 8 mm, and the other hepatic metastases had disappeared; the main tumor had flattened and shrunk. Therefore, we used hand-assisted laparoscopic surgery (HALS) to perform anterior resection of the rectosigmoid colon and partial resection of liver segment 3 as conversion therapy. The patient was discharged 10 days after surgery. The rectal lesion was a well-differentiated adenocarcinoma with a depth of invasion of p-MP and a spread of L0, V0, and pN0. The partial hepatectomy did not indicate viable cancer cells; only necrotic, lysed tissue was observed. Postoperative chemotherapy involved 4 cycles of bevacizumab with capecitabine and oxaliplatin. At more than 42 months postoperatively, no metastasis or recurrence has been observed. Conclusions: This rare case demonstrates that conversion surgery can be a viable option following systemic chemotherapy in patients with advanced colon cancer and H3 liver metastases.

Microbiome and Metabolome Analyses in Different Closed-Circulation Aquarium Systems and Their Network Visualization.

Understanding the causes of microbiome formation and its relationship to environmental conditions is important to properly maintain recirculating aquaculture systems (RASs). Although RAS has been applied to numerous fish types and environmental conditions (e.g., loading intensity), the effects of these environmental conditions (i.e., fish type and loading intensity) on microbiome composition are limitedly known. Therefore, we established three experimental aquarium tanks to explore the effects of fish type, loading intensity, filter pore size, and rearing day on microbiome compositions: (1) a tank for Acanthogobius flavimanus, (2) for Girella punctata, and (3) for G. punctata with higher loading intensity. Multivariate analysis showed that the microbial community composition differed among the tanks, indicating that the fish type and loading intensity significantly affected microbiome formation in rearing water. Some microbes, such as Sediminicola and Glaciecola, were detected at a higher loading intensity, indicating that these microbes might be an indicator of eutrophic conditions in the aquacultural systems. In addition, a partial correlation network revealed a connection between microbes and metabolites in the aquarium tanks. Such a microbe-metabolite network might be a clue to control the microbiome by adjusting the molecule abundance in the aquacultural environment.

A 73-Year-Old Woman Treated for Rheumatoid Arthritis with Lower Rectal Carcinoma Who Underwent Abdominoperineal Resection, Lateral Regional Lymph Node Resection, and Partial Hepatectomy by Hand-Assisted Laparoscopic Surgery (HALS): A Case Report.

BACKGROUND This report describes the case of a 73-year-old woman treated for rheumatoid arthritis with lower rectal carcinoma who underwent abdominoperineal resection, lateral regional lymph node resection, and partial hepatectomy by hand-assisted laparoscopic surgery (HALS). More recently, HALS has proven to be useful in multiple organ resections. CASE REPORT A 73-year-old woman who presented with hematochezia was diagnosed with lower rectal cancer and referred to our hospital. The patient had a history of rheumatoid arthritis and was taking oral nonsteroidal anti-inflammatory drugs. After further evaluation, the patient was diagnosed with stage IV rectal cancer with a metastatic liver lesion and a right lateral lymph node metastasis. All lesions were resected using HALS. A 50-mm longitudinal umbilical incision was created for use as a hand access site, and 3 ports with a diameter of 5 mm each were inserted into the lower abdomen to perform right lateral lymph node dissection and abdominoperineal resection. HALS was performed in the upper abdomen, where the liver was used to partially resect segment S6. The patient was discharged without complications 13 days after the operation. CONCLUSIONS In this complex case of advanced rectal carcinoma with liver metastases, use of the HALS surgical method was shown to be possible. Immunomodulatory treatment for rheumatoid arthritis may have influenced the outcome for this patient.

Efficacy of hand-assisted laparoscopic surgery (HALS) in older adult patients (≥80 years) with primary colorectal cancer.

Background: From 2004 to 2014, 821 colorectal cancer primary resections were conducted at our institution. Of these, 102 patients (12.4%) were older adults over 80 years old. underwent either the conventional laparotomy group (72 patients) or the hand-assisted laparoscopic surgery (HALS) group (30 patients). Methods: Data were extracted for 102 patients over 80 years old who underwent primary resection for colorectal cancer and were divided into two groups: conventional laparotomy (CL) (n=72) and hand-assisted laparoscopy (n=30). Pre-operative characteristics and outcomes were compared. Results: Baseline characteristics were similar between groups, except for age: CL group median 83.5 years old (range, 80-92 years old) and hand-assisted laparoscopy (HALS) group median 81.5 years old (range, 80-88 years old) (P=0.027). Pre-operative cardiac and lung function risk, performance status, and pathological classification stage (pStage) were almost similar between groups (P=0.668, P=0.176, P>0.999, P=0.217). No significant differences were found for operation time. The HALS group resulted in less blood loss (median 204 mL in the CL group and median 68 mL in the HALS group, P=0.003), shorter postoperative hospital stay (median was 18 days in the CL group and median was 12 days in the HALS group, P<0.001), and fewer postoperative wound infections (18 cases in the CL group and 2 cases in the HALS group, P=0.034). Five-year relapse-free survival (5Y-RFS) was 48.1% in the CL group and 73.3% in the HALS group (P=0.028). Five-year overall survival (5Y-OS) was 48.2% in the CL group and 73.3% in the HALS group (P=0.027). Conclusions: Approximately 70% of surgical treatment for patients over 80 years old with colorectal carcinoma were performed by CL. However, HALS had significant advantages including less blood loss, fewer wound infections, and shorter hospital stays. Therefore, HALS could proactively be considered to older adult patients with colorectal cancer.

Chemometric Analysis of NMR Spectra and Machine Learning to Investigate Membrane Fouling.

Efficient membrane filtration requires the understanding of the membrane foulants and the functional properties of different membrane types in water purification. In this study, dead-end filtration of aquaculture system effluents was performed and the membrane foulants were investigated via nuclear magnetic resonance (NMR) spectroscopy. Several machine learning models (Random Forest; RF, Extreme Gradient Boosting; XGBoost, Support Vector Machine; SVM, and Neural Network; NN) were constructed, one to predict the maximum transmembrane pressure, for revealing the chemical compounds causing fouling, and the other to classify the membrane materials based on chemometric analysis of NMR spectra, for determining their effect on the properties of the different membrane types tested. Especially, RF models exhibited high accuracy; the important chemical shifts observed in both the regression and classification models suggested that the proportional patterns of sugars and proteins are key factors in the fouling progress and the classification of membrane types. Therefore, the proposed strategy of chemometric analysis of NMR spectra is suitable for membrane research, which aims at investigating comprehensively the fouling phenomenon and how the foulants and environmental conditions vary according to the filtration systems.

Investigation of Fluoroscopy Time and Radiation Dose by the Number of Cerebral Angiography Operator Experiences.

Objective: We investigated the fluoroscopy time (FT) and radiation dose by the number of cerebral angiography (CA) operator experiences to clarify the learning curve of CA. Methods: The subjects were cases for whom CA was performed at our hospital for 5 years between April 2015 and March 2020. Based on the number of CA operator experiences, they were classified into four groups: 1-50 cases (group A), 51-100 cases (group B), 101-200 cases (group C), and 201 cases and later (group D). The FT and radiation dose were retrospectively investigated. Results: Of the 865 consecutive CA cases, 293 cases for follow-up, i.e. after treatment, 54 for arteriovenous shunt diseases, 21 lacking data, and 1 case requiring intervention for thrombosis during CA were excluded. In total, 496 CA cases were investigated. There were 61 cases in group A, 56 cases in group B, 44 cases in group C, and 335 cases in group D, and there was no significant difference in patient background factors among the groups. The median FT and radiation dose (interquartile range) in each group were 20.2 min (14.6) and 374 mGy (185.3) in group A, 14.8 min (12.1) and 366 mGy (167.9) in group B, 10.8 min (6) and 320 mGy (151.7) in group C, and 9.4 min (6.4) and 336 mGy (171) in group D. The FT was significantly shorter in group C than in group A, and significantly shorter in group D than in groups A, B, and C. The radiation dose was significantly lower in groups C and D than in groups A and B. Conclusion: This study suggested that CA can be performed alone after experiencing approximately 100 cases as an operator.