Notes

Activated pluripotent stem tissues while ideal sensors with regard to fibromyalgia along with myalgic encephalomyelitis/chronic tiredness affliction.
Hepatitis C virus (HCV) infection is a major cause of hepatocellular carcinoma (HCC) in Japan. However, the cause and prognosis of HCC may be dramatically changed by direct acting antiviral agents (DAAs). selleck inhibitor Although the 2015 nationwide survey used a large cohort, its findings may be outdated. The present study therefore aimed to show the latest outcomes by patients' hepatitis virus infection status.

We included 552 patients who underwent hepatectomy for primary HCC between 2002 and 2018 and compared clinical factors between those treated before 2014 (n=380) and after 2014 (n=172), when DAAs became available.

Distribution of hepatitis virus infection status between the two groups differed significantly (
<0.001). In the earlier group, 46% of the patients had HCC with HCV infection (C-HCC), whereas the rate of C-HCC decreased (31%) and 54% of the patients had HCC with no hepatitis virus infection (NBNC-HCC) in the latter group. The proportion of HCC with hepatitis B virus infection (B-HCC) and the prognosis of B-HCC did not significantly change between the two groups. Among patients with C-HCC, the latter patients had significantly longer relapse-free survival (RFS) than the earlier patients (
=0.033). link2 However, RFS did not significantly differ between the earlier and latter patients with NBNC-HCC.

Postoperative prognosis has changed according to patients' hepatitis virus infection status. The proportion of patients with NBNC-HCC has increased, but their prognosis has not been improved. Treatment strategies for NBNC-HCC should be established.
Postoperative prognosis has changed according to patients' hepatitis virus infection status. The proportion of patients with NBNC-HCC has increased, but their prognosis has not been improved. Treatment strategies for NBNC-HCC should be established.
Prognostic factors after treatment for intrahepatic recurrent hepatocellular carcinoma (RHCC) after hepatic resection (Hx) are controversial. The current study aimed to examine the impact of treatment modality on the prognosis of intrahepatic RHCC following Hx.

For control of variables, the subjects were 56 patients who underwent treatment for intrahepatic RHCC, three or fewer tumors, each measuring ≤3cm in diameter without macroscopic vascular invasion (MVI), between 2000 and 2011. Retreatment consisted of repeat Hx (n=23), local ablation therapy (n=11) and transarterial chemoembolization or transcatheter arterial infusion (TACE/TAI) (n=22). We retrospectively investigated the relation between type of treatment for RHCC and overall survival (OS) as well as disease-free survival (DFS).

In multivariate (MV) analysis, the poor prognostic factors in DFS after retreatment consisted of disease-free interval (DFI) (≤1.5y) (
= .011), type of retreatment (TACE/TAI) (
= .002), age (<65y old) (
= .0022), perioperative RBC transfusion (
= .025), while those in OS after retreatment were DFI (≤1.5y) (
< .0001). In evaluation of stratification for type of retreatment, DFS in the repeat Hx group was significantly better than those in the local ablation therapy group or the TACE/TAI group (
= .023 or
< .0001, respectively).

DFI (≤1.5y) was an independent poor prognostic factor in both DFS and OS, and repeat Hx for intrahepatic RHCC, few in number and size without MVI, seems to achieve the most reliable local control.
DFI (≤1.5 y) was an independent poor prognostic factor in both DFS and OS, and repeat Hx for intrahepatic RHCC, few in number and size without MVI, seems to achieve the most reliable local control.
Antimesenteric cutback end-to-end isoperistaltic anastomosis (Sasaki-Watanabe anastomosis; Sasaki-W anastomosis), which was developed in our department, is a novel hand-sewn anastomotic technique for Crohn's disease intended to prevent anastomotic stenosis and preserve the peripheral circulation.

The aim of the present study is to present the surgical technique of Sasaki-W anastomosis and to assess the safety and the early results of the surgical anastomotic recurrence of Sasaki-W anastomosis.

The present study was a single-center retrospective cohort study. As an early-period group, 13 patients with Crohn's disease, who were mainly selected from cases considered to be at high risk of recurrence, underwent 15 Sasaki-W anastomoses from August 2009 to January 2012. As a late-period group, 36 patients with Crohn's disease, who were selected regardless of risk factors, underwent 37 Sasaki-W anastomoses from September 2016 to March 2020. The medical data including patient characteristics, surgical records, postoperative details, and surgical recurrences were assessed.

There were no intraoperative complications. With a median follow-up of 107mo, surgical recurrence occurred in one patient at 106mo after surgery in the early-period group. The cumulative surgical recurrence-free rate in the early-period group was 100% at 5y and 86% at 10y after surgery. No patients required reoperation in the late-period group.

Sasaki-W anastomosis is safe and feasible. Although long-term study is needed, this anastomotic technique can be a reasonable operative option for Crohn's disease.
Sasaki-W anastomosis is safe and feasible. Although long-term study is needed, this anastomotic technique can be a reasonable operative option for Crohn's disease.
The outcomes of gastrectomy for gastric cancer in patients at each severity of chronic kidney disease (CKD) remain unknown.

We retrospectively analyzed the outcomes of 560 patients who underwent distal or total gastrectomy for gastric cancer between 2009 and 2018. We classified the patients into four groups based on estimated glomerular filtration rate stage 1/2 (normal to mild, n=375), stage 3a (mild to moderate, n=122), stage 3b (moderate to severe, n=43), and stage 4/5 (severe to end-stage, n=20) CKD. The relationship between CKD stage and the incidence of postoperative morbidity was analyzed.

CKD was a predictor of overall morbidity independent of age, gender, American Society of Anesthesiologists Performance Status, pulmonary comorbidity, extent of lymphadenectomy, and operation time in a multivariate analysis. The incidences of overall and severe morbidity were significantly increased with CKD progression (both
.001). Compared to stage 1/2 CKD, the odds of overall morbidity were significantly elevated in stage 3a (odds ratio [OR] 1.87
.007), stage 3b (OR 3.86
.001), and stage 4/5 (OR 8.60
.001). The risk of procedure-related morbidity was strikingly increased in stage 3b (OR 2.93
.004). The risk of procedure-unrelated morbidity elevated markedly in stage 3a (OR 2.77
.001). A significant graded association between CKD progression and overall morbidity was also revealed in elderly patients (
.001).

The severity of CKD predicts the likelihood and type of morbidity after gastrectomy and can guide surgical decision-making for patients with gastric cancer.
The severity of CKD predicts the likelihood and type of morbidity after gastrectomy and can guide surgical decision-making for patients with gastric cancer.
Preoperative sarcopenia is an important risk factor for postoperative complications in patients with gastric cancer. However, the relationship between muscle quality and postoperative complications in patients with gastric cancer is inadequately studied. Therefore, we investigated the impact of preoperative muscle quality on severe postoperative complications after radical gastrectomy.

A total of 840 patients who underwent radical gastrectomy for p-stages I-III primary gastric cancer between April 2008 and June 2018 with preoperative computed tomography (CT) scans and body composition analysis were included. We measured intramuscular adipose tissue content (IMAC) as an indicator of muscle quality. A higher IMAC signified a poorer quality. All statistical analyses were performed with EZR, and a
-value<0.05 was considered statistically significant.

The low-IMAC and high-IMAC groups had 422 (50.2%) and 418 (49.8%) patients, respectively. The latter were older (
<0.001), had higher body mass index (BMI) (
<0.001), and higher rates of chronic kidney disease (CKD) (
=0.002) and diabetes (
<0.001). They had lower skeletal muscle indexes (SMI) (
=0.011) and higher visceral fat areas (VFA) (
<0.001). They also experienced more intraoperative blood loss (
<0.001) and greater complications (
=0.016). Multivariate analysis showed that high-IMAC was an independent risk factor for severe complications (odds ratio 2.260, 95% confidence interval 1.220-4.190,
=0.010).

Poor preoperative muscle quality is an independent risk factor for severe postoperative complications after radical gastrectomy in patients with gastric cancer.
Poor preoperative muscle quality is an independent risk factor for severe postoperative complications after radical gastrectomy in patients with gastric cancer.
Laparoscopic surgical approaches, including total extraperitoneal repair (TEP), have been widely accepted for inguinal hernia repair in Japan. However, there are limited data regarding recurrence after TEP in Japan, given the limited versatility of this procedure. This study retrospectively evaluated the rates of hernia recurrence after TEP and open mesh repair at multiple Japanese centers.

This retrospective study evaluated 1917 patients who underwent inguinal hernia repair at 32 institutions in the Oita prefecture between January 2014 and December 2015. Eligible patients were grouped according to whether they underwent TEP (1011 patients) or open mesh repair (636 patients). Propensity score matching was performed 11 (total 1076 patients, 538 patients from each group). The outcomes of interest were recurrence, morbidity, and postoperative recovery.

The TEP and open mesh repair groups had similar baseline characteristics. After propensity score matching, there was no significant difference between the two groups in terms of recurrence rate (TEP 0.5% vs open mesh repair 1.0%, P=.375). However, the TEP group had significantly longer operating times (median 70.2min vs 65.0min, P<.001), significantly less blood loss (0-5.1mL vs 0-20.4mL, P<.001), and significantly shorter postoperative hospital stays (median 5.0days vs 6.4days, P<.001). The overall incidences of morbidity were 6.2% in the TEP group and 7.2% in the open mesh repair group (P=.535).

This multicenter retrospective study with propensity score matching revealed that the recurrence rates were similarly low for TEP and open mesh repair of inguinal hernia. Thus, a well-trained surgical team could use TEP as a standard procedure.
This multicenter retrospective study with propensity score matching revealed that the recurrence rates were similarly low for TEP and open mesh repair of inguinal hernia. Thus, a well-trained surgical team could use TEP as a standard procedure.In Japan, 437 pancreas transplantations (PTx) were carried out between 2000 and 2019. Clinical data for all PTx cases are registered in the Japan Pancreas Transplant Registry of the Japan Society for Pancreas and Islet Transplantation. Here we analyzed the registry data to describe the current status of PTx in Japan. link3 The 437 PTx included 410 from deceased donors (407 from brain-dead and 3 from non-heart-beating donors) and 27 from living donors. We investigated the clinical characteristics of the 410 PTx from deceased donors. The rate of marginal donors using expanded donor criteria was higher in Japan than in other countries. At 1/5/10 years post-PTx, the overall survival rates were 95.8%/94.2%/88.7%, and the graft survival rates were 85.9%/76.2%/67.4% for pancreas and 93.2%/90.8%/78.2% for kidney (non-censored for death). These rates were comparable to those in other countries. When stratified by PTx category, survival was significantly better following simultaneous pancreas-kidney transplantation (SPK) compared to pancreas-after-kidney transplantation (PAK) or PTx alone (PTA).
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