Modification of the Dialysate Port of Plasma Separators for Safe Blood Purification in Japan.

A fatal mix-up of a hemofilter with a plasma separator occurred in 2011. The close resemblance between the two blood purification columns commonly used in Japan posed a fundamental risk for such mix-ups. Both the in-hospital case investigation committee and the relevant academic societies have independently proposed the modifications of the dialysate port (D port) of the plasma separator to avoid this type of misuse. To make these devices foolproof, medical professionals, including physicians and clinical engineers, and members of the Medical Technology Association of Japan discussed measures to prevent this type of recurrence. Since new standards were soon to be issued by the International Organization for Standardization (ISO), the modifications were temporarily postponed. In September 2016, the ISO released new standards for small-bore connectors. The shape changes of the D port from the current slip-in type (ISO8637) to the Luer lock type (ISO80369-7) had been already approved by the Ministry of Health, Labor and Welfare of Japan by the end of November 2018, including a temporal use of a converter to connect the current type of D port to the new type of blood circuit. We must address the next issue that the new standard and the older standard coexist in the clinical setting, which may create a new risk.

Effect of sterilization on solute transport performances of super high-flux dialyzers.

The effect of sterilization was quantitatively evaluated for modern super high-flux dialyzers in terms of solute transport performances for autoclave sterilization (AC), gamma ray sterilization (G-ray), combination of these two and no sterilization (NS) as reference. A commercial polysulfone dialyzer (Kawasumi Laboratory Co., Tokyo, Japan) was chosen for investigation with six different sterilization processes, i.e., sterilization with AC one time and two times, that with G-ray using either no additives or an additive, that with AC one time followed by G-ray using no additive and that with NS. In vitro dialysis and ultrafiltration experiments were performed with aqueous test solution as pseudo blood, varying Q(B) , Q(D) , and Q(F) . Creatinine (MW113), vitamin B(12) (MW1355), and α-chymotrypsin (MW25000) were chosen as test solutes for dialysis experiments. Clearances (C(L) ) calculated from dialysis experiments and the sieving coefficient for albumin (MW66000) from ultrafiltration experiments were compared among six models. A dialyzer with NS showed much lower clearances for all three solutes than those with sterile. Therefore, the sterilization increases the solute transfer performances. Although no significant changes in clearances for creatinine and vitamin B(12) were found among five sterile models, much higher clearances for α-chymotrypsin were found in AC sterile models. Then, the effect of sterilization may become greater with the increase of molecular weight of solutes. According to the results of the sieving coefficient for albumin, AC may have enlarged the pore size of the membrane that could increase clearances for large solutes without changing those for relatively small solutes. The sterilization increases the solute clearance even in so-called super high-flux dialyzers and the effect of sterilization may be greater in larger solutes.

Single-port versus multiport laparoscopic cholecystectomy: a prospective randomized clinical trial.

PURPOSE: We report the outcomes of a randomized clinical trial of single-port laparoscopic cholecystectomy (SPLC) and multiport laparoscopic cholecystectomy (MPLC). METHODS: Fifty-four patients (27 in each group) were randomized. A visual analog scale was used with a 10-point scale for an objective assessment of incisional pain and incisional cosmesis on postoperative days 1, 3, and 14. RESULTS: The mean operating time was significantly longer in the SPLC. The mean cosmesis scores on postoperative days 3 (9.7 vs. 8.9, P = 0.01) and 14 (9.9 vs. 9.2, P<0.01) were significantly greater in the SPLC group than in the MPLC group. The group's mean visual analog scale scores for incisional pain, and their requirements for analgesics, did not differ significantly. CONCLUSIONS: Although SPLC takes longer than MPLC, experienced laparoscopic surgeons can perform SPLC safely with results comparable with those for MPLC. SPLC is superior to MPLC in terms of short-term cosmetic outcomes.

[A case of advanced adenocarcinoma of esophagogastric junction with severe esophageal invasion effectively treated by chemoradiotherapy using paclitaxel and cisplatin, and S-1 after chemoradiotherapy].

The patient was a 66-year-old male with adenocarcinoma of the esophagogastric junction and severe esophageal invasion, which was diagnosed as cType 3, cT4a (SE) cN3cM1 (LYM), cStage IV(histopathology: por 1). We tried concurrent chemoradiotherapy consisting of PTX 60 mg/m(2) and CDDP 25 mg/m(2), respectively (once a week), and a total of 45 Gy of radiotherapy treatment. Then, for effective continuation, chemotherapy using S-1 was performed as second-line therapy. A complete response was achieved and continued for more than 2 years after initial chemoradiotherapy; his complaints abated and his quality of life improved. Although gastro-intestinal symptoms and bone marrow suppression were observed as adverse effects, they were within a tolerable range and did not interfere with the concurrent chemoradiotherapy. This regimen appears to be feasible and effective for advanced gastric carcinoma refractory to other regimens.