Yonago acta medica最新文献

Background: Perioperative hypothermia, a common occurrence in patients undergoing general anesthesia, is defined as a core body temperature below 36°C. The relationship between patient body composition and the incidence of hypothermia remains underreported. This study aims to elucidate the association between body composition and perioperative hypothermia in patients undergoing open gastrectomy.

Methods: Patients undergoing open gastrectomy were enrolled in the study. Patients whose bladder temperature was lower than 36°C were allocated to the hypothermia group, and the other patients were allocated to the control group. The patient's body composition was evaluated by bioelectrical impedance analysis.

Results: A total of sixty-eight patients participated in this study. Among them, 34 experienced perioperative hypothermia (bladder temperature below 36°C) and were classified into the hypothermia group, while the remaining 34 were placed in the control group. The hypothermia group had a significantly higher body surface area per body weight. Additionally, the hypothermia group exhibited significantly lower total fat mass, skeletal muscle mass index, and basal metabolic rate (P < 0.05). However, body fat percentage and visceral fat mass did not differ significantly between the groups. Multivariate analysis identified total fat mass below 11.2 kg (HR 4.51, 95% CI: 1.35-15.03, P = 0.014) and skeletal muscle mass index below 10.06 kg/m² (HR 5.61, 95% CI: 1.86-16.93, P = 0.002) as independent risk factors for perioperative hypothermia.

Conclusions: Low total fat mass and a low skeletal muscle mass index are significant risk factors for perioperative hypothermia in patients undergoing open gastrectomy. These risk factors could improve the accuracy of identifying high-risk patients for perioperative hypothermia.

Background: Parent training (PT) is an effective program for improving the parenting skills and mental health of parents of children with developmental disabilities (DD) and for improving children's behavioral problems. However, studies must substantiate the effectiveness of PT for the parents of adolescents with DD in improving parental mental health and children's problem behaviors with ample scientific evidence. This study is a retrospective observational study and has two objectives. The first is to examine the effectiveness of online adolescent PT (ON-APT), in which lectures on counseling skills are incorporated for the parents of adolescents with DD. The second aim is to examine the effects of different delivery conditions on community- and clinical-based ON-APT.

Methods: Data from seven parents and children who participated in community-based ON-APT and 14 parents and 12 children who participated in clinical-based ON-APT were included in the analysis. Prior to the intervention (pre-test) and after the intervention (post-test), paired t-tests were conducted using the CBCL, BDI-II, and PATS scores to demonstrate the effectiveness of the ON-APT program. Second, a two-way repeated measures analysis of variance with aligned rank transform was conducted to assess the impact of varying ON-APT delivery conditions (clinical- versus community-based ON-APT) and time (pre- and post-tests) on the outcome variables.

Results: ON-APT resulted in significant improvements in some children's problem behaviors (withdrawal). Community-based ON-APT resulted in improvements in some children's problem behaviors (total score, withdrawal, and social problems scales) compared with clinical-based ON-APT.

Conclusion: This study shows the potential effectiveness of ON-APT, in which lectures on counseling skills are incorporated for parents of adolescents with DD. Further, a comparison between clinical-based and community-based ON-APT showed that integrating face-to-face consultations into ON-APT may improve children's problem behaviors. However, this study provides preliminary evidence for its potential efficacy, and future studies should demonstrate this efficacy through a validation design.

Background: The efficacy of parent training for neurodevelopmental disorders has been demonstrated in numerous studies. This study conducted a needs assessment of Japanese parents regarding parent training for neurodevelopmental disorders.

Methods: Responses from 806 parents of children with neurodevelopmental disorders, as well as those with suspected but undiagnosed neurodevelopmental disorders, who had not yet received parent training were analyzed. The survey examined overall trends in the conditions for implementing parent training, methods of grouping, fees, methods of follow-up, facilitator expertise, and effects of parent training. Additionally, differences based on neurodevelopmental diagnosis, parental employment status, household income, parental educational background, and child age were also analyzed.

Results: The results showed that parents preferred the program to be offered "once per week," "five sessions per program," "lasting 60 minutes each," "on weekends" and "in the morning," and "at a location within 30 minutes of travel to the venue." However, parents' expectations for parent training varied according to parental employment, household income, parental education, and child age. The only difference in diagnostic status was the preferred institution of attendance.

Conclusion: To expand the parent training programs within communities and increase the number of participants, it is necessary to analyze the expectations of prospective participants. The results of this survey suggest that PT providers should consider the conditions for implementing parent training, cost, and facilitator expertise to meet the participants expectations.

Background: The inflammatory response plays a crucial role in tumor development. Inflammatory markers are recognized prognostic factors in many types of cancer, including gastric cancer. However, the correlation between inflammatory markers and prognosis in remnant gastric cancer (RGC) remains unclear. The aim of this study was to evaluate the importance of inflammatory markers as a prognostic factor in patients who underwent gastrectomy for RGC.

Methods: This multicenter retrospective study involved 107 patients with RGC who underwent curative gastrectomy at 10 institutions in Japan between January 2000 and December 2016. Both overall survival (OS) and relapse-free survival (RFS) were analyzed.

Results: Receiver operating characteristic analyses indicated that the lymphocyte/monocyte ratio (LMR) had a higher area under the curve compared with other potential prognostic factors. Patients were categorized into high- and low LMR groups by the optimal LMR cutoff value. Preoperative LMR was significantly correlated with reconstruction way after the primary surgery (p=0.032) and lymphatic invasion (p=0.046). OS and RFS were significantly worse in the low- vs high LMR groups. Low LMR, T3 or deeper tumor invasion, and low body mass index were independent prognostic factors for OS and RFS.

Conclusion: Preoperative low LMR is associated with poor OS and RFS in patients who undergo gastrectomy for RGC.

Background: Selective mutism (SM) is an anxiety disorder in which children struggle to speak in specific social situations, and parents often have trouble coping with their child's symptoms. We analyzed parents' issues and support needs regarding SM through their responses to two open-ended questions, examining how these needs varied with diagnosis and comorbid conditions.

Methods: Quantitative content analysis was conducted on responses obtained from 70 parents of children with SM (ages 29-63 years) recruited through SM information exchange group and social networking service. The participants responded to two open-ended questions regarding the issues they faced and the support they needed for their children's SM symptoms.

Results: The results showed that issues faced by parents of children with SM could be divided into five groups: (A) Regret over Delayed Initial Response, (B) School Non-attendance in Children with SM, (C) Inadequate Support from Teachers, (D) Inconsiderate Communication Lacking Empathy from Others, and (E) Communication Barriers Leading to Bullying and Social Isolation. The support needs of parents were categorized into four groups: (a) Places for Consultation and Obtaining Information, (b) Growth in the Number of Supporters Who Understand SM, (c) Opportunities to Improve Knowledge about SM, and (d) Specific Methods for SM Improvement. Furthermore, although comorbid conditions did not significantly affect parental issues and support needs, slight differences were observed based on the presence of a diagnosis.

Conclusion: This study highlights that parents of children with SM are troubled by professionals' lack of knowledge and their children's symptoms, driving them to seek better understanding and more resources. The results also suggest that the support needs of these parents vary depending on whether their child is diagnosed with SM. Future research should globally identify parental issues and support needs, determine the core elements, and establish a more comprehensive support system.

Adjusting the dosage of renal excretory drugs according to the patient's renal function is essential. Vancomycin necessitates such adjustments due to its potential to cause nephrotoxicity when administered in excess. Creatinine-based equations for assessing the glomerular filtration rate, such as the Cockcroft-Gault and Modification of Diet in Renal Disease equations, are often used for dosage adjustments. However, vancomycin-induced nephrotoxicity sometimes occurs in critically ill patients, even in those with a normal estimated glomerular filtration rate. This case involved a 64-year-old male with cholangitis who developed vancomycin-induced nephrotoxicity. The patient was sarcopenic and had multiple risk factors that predisposed him to drug-induced nephrotoxicity. Moreover, creatinine-based equations may lead to the overestimation of glomerular filtration rate and subsequent vancomycin overdose. This case underscores the need for careful interpretation of creatinine-based assessments. We propose strategies to optimize medication dosing, particularly in patients with sarcopenia, to mitigate such risks.

Background: Recently developed rapid real-time reverse transcription PCR (RT-PCR) systems adopting microfluidic thermal cycling technology are ideal for point-of-care (POC) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Because the RNA extraction step before real-time RT-PCR is rate-limiting, a direct RNA extraction method (direct method) that adopts chemical viral lysis and eliminates RNA purification steps is preferable for rapid real-time RT-PCR. In the direct method, selecting the transport medium is essential because it may be introduced into subsequent real-time RT-PCR steps, but might inhibit PCR. However, the influence of transport medium on the combination of the direct method and rapid real-time RT-PCR has been yet unstudied. In the present study, we examined the influence of various transport mediums when combining the direct method and rapid real-time RT-PCR of GeneSoC^® (GeneSoC^® RT-PCR), the recently developed compact PCR system that adapts novel microfluidic thermal cycling technology.

Methods: To explore the influence of the transport medium on the GeneSoC^® RT-PCR, the concordance of the RNA extraction and direct method was evaluated in the clinical samples collected in viral transport medium (VTM) or eSwab^®. The sensitivity of GeneSoC^® RT-PCR combined with the direct method was assessed using spiked samples in generic (H₂O and PBS) or commercially available transport media (VTM and eSwab^®). Analytical sensitivity was examined using clinical specimens collected from the VTM and eSwab^®. The inhibitory effect of PCR inhibitors on clinical specimens was assessed using clinical samples diluted 1,000 times.

Results: While only 1 copy/reaction of RNA was detected in H₂O and eSwab^® of the spiked samples, a minimum of 5 copies/reaction was detected in PBS (-) and VTM. Among the clinical specimens tested using the direct method, the detection of viral RNA was unstable in the samples containing less than 100 copies/reaction viral RNA in VTM, whereas less than 10 copies/reaction viral RNA were detected in eSwab^®. The positive, negative, and overall concordance between the RNA extraction and the direct method was 84%, 100%, and 85%, respectively, in eSwab^® samples, whereas the values were 35%, 100%, and 38%, respectively, in VTM samples. When the clinical samples were diluted 1,000 times, GeneSoC^® RT-PCR could detect as low as 1.15 copies/reaction RNA using direct method, and the sensitivity was comparable to that of RNA extraction.

Conclusion: The combination of the direct method and microfluidic rapid PCR machine GeneSoC^® has a high sensitivity for detecting SARS-CoV-2 RNA in clinical samples with eSwab^® transport medium.

Background: Pseudomonas aeruginosa is an important causative agent of bacterial keratitis. This study investigates the antibacterial effect of photodynamic antimicrobial chemotherapy (PACT) with the chlorin derivative TONS504 (TONS504-PACT) and a blue light-emitting diode (LED) on P. aeruginosa in vitro. It also explores the synergistic effects of combining TONS504-PACT with EDTA, and compares the antibacterial effects of TONS504-PACT using blue light with those of previously reported red light.

Methods: To evaluate the antibacterial effects of TONS504-PACT using blue light on P. aeruginosa, PACT with TONS504 (0-100 mg/L) was applied using a 405 nm LED at 0-30 J/cm² to P. aeruginosa (10^7-8 CFU/mL). The antibacterial effects were assessed by calculating the survival fraction. Subsequently, to compare the effects of TONS504-PACT using blue light with those of using red light, PACT with TONS504 (10 or 100 mg/L) was conducted using a 405 or 660 nm LED at 30 J/cm² and evaluated in the same manner. Finally, to investigate the synergistic antibacterial effects of TONS504-PACT with EDTA, PACT with TONS504 (0-100 mg/L) was applied using a 405 nm LED at 5 J/cm², both with and without EDTA (0.015 M), and its antibacterial effects were similarly assessed.

Results: TONS504-PACT using blue light decreased the survival of P. aeruginosa, depending on the light intensity. The greatest antibacterial effect was observed at 10 mg/L and 30 J/cm², showing a survival fraction of 3.5 × 10^-5. TONS504-PACT demonstrated a significantly greater antibacterial effect using blue light than that demonstrated using red light at 10 mg/L, though not at 100 mg/L. The combination of TONS504-PACT using blue light with EDTA significantly enhanced antibacterial effects at all concentrations.

Conclusion: These findings confirm the effectiveness of TONS504-PACT using blue light against P. aeruginosa and suggest its potential as a treatment for bacterial keratitis.

Numerous vascular anomalies of the hepatic artery have been reported. Protection of the hepatic arterial supply is important during gastrectomy. We herein report a case in which an anatomical variant of the hepatic artery was discovered in a patient undergoing laparoscopic distal gastrectomy with D1+ lymph node dissection for early gastric cancer. A 50-year-old man was referred to our hospital because of epigastric pain and hematemesis, and he was diagnosed with early gastric cancer after hemostasis of a bleeding ulcer. Computed tomography showed an anatomical variation of the right hepatic artery, which branched from the gastroduodenal artery. Moreover, the right gastric artery branched from the right hepatic artery. Our preoperative understanding of this unusual branch of the hepatic artery enabled safe laparoscopic surgery with adequate lymph node dissection. No postoperative complications occurred. This vascular anomaly has not been previously reported in patients undergoing gastrectomy.

This study aimed to determine whether more stable electroretinography parameters could be obtained in younger children using skin electrodes placed at the inner canthus and ears compared to using contact lens electrodes. The study included three Japanese patients (two girls and one boy) who presented with epileptic spasms before the age of 3 years. We compared the electroretinography parameters obtained with skin electrodes and contact lens electrodes. We could record reproducible results using skin ERG with a montage of electrodes placed at the inner canthus and the ear in children. Moreover, standard data for younger children were created, enabling the evaluation of electroretinography parameters recorded with skin electrodes in individual pediatric patients. The skin electroretinography using the new montage may be stable parameters for evaluating retinal function in younger children.