The Impact of Immunonutritional and Physical Status on Surgical Outcome After Pancreaticoduodenectomy in Elderly Patients

BACKGROUND/AIM

The aim of this study was to determine the significance of immunonutritional and physical index in the assessment of risk associated with pancreaticoduodenectomy (PD) in the elderly.

PATIENTS AND METHODS

This study enrolled 92 patients who underwent PD. They were divided into 2 groups: Group A included patients 79 years and younger (n=79) and Group B patients 80 years and older (n=13). Among 37 patients, physical function and body composition were also evaluated.

RESULTS

Significantly higher neutrophil-lymphocyte ratio, lower prognostic nutritional index (PNI), and controlling nutritional score were observed in Group B. Muscle strength and walking ability were significantly impaired in Group B, although there was no significant difference in body composition. Age was not correlated with the incidence of postoperative complications, overall survival or recurrence-free survival by univariate and multivariate analysis.

CONCLUSION

PD is justified for the elderly, with acceptable morbidity and prognosis. However, immunonutritional status and physical function are significantly impaired; thus, appropriate case selection and active nutritional support are required for the elderly.

Nd3+-activated CaF2 ceramic lasers

Nd,Y:CaF₂ and Nd,La:CaF₂ ceramics featuring good optical quality have been fabricated by reactive sintering and a hot isostatic pressing method. The transmission spectra, emission spectra, and fluorescence decay curves were measured. Lasing at 1064 and 1065 nm was observed in Nd,Y:CaF₂ and Nd,La:CaF₂, respectively, upon quasi-continuous-wave pumping by a diode laser emitting at 791 nm. To the best of our knowledge, this is the first demonstration of Nd³⁺-activated CaF₂ ceramic laser.

Effect of Systematic Conversion to Generic Mycophenolate Mofetil (MMF) in Kidney Transplantation: A Single-Center Clinical Experience from Japan

INTRODUCTION

Recently, more and more generic drugs have been used for immunosuppressive drugs in the field of organ transplantation. Some reports have indicated that blood concentration of most generic drugs is difficult to maintain stability, and it may cause the difference in graft survival of transplanted organs between original drugs and generic drugs. In this article, we report the cases could not maintain blood concentration of generic drugs of mycophenolate mofetil (MMF).

RESULTS

In 4 cases out of 5 cases that we had to change original MMF to generic MMF, there were cases that blood concentration level was not stabilized. There were possibility that the lowered blood concentration level of MMF caused a rejection, in two cases. Mean MMF trough level was decreased from 3.6 ± 1.9 μg/mL to 0.6 ± 0.4 μg/mL. Due to the early detection, it did not become severe or failure of graft function, however, we cannot deny the possibilities that side effects were increased and rejection rose. In these cases, we discontinued to use the generic drugs thereafter due to unstable plasma concentration of MMF.

DISCUSSION

Some reports have indicated that failure to maintain plasma concentration of MMF leads to rejection. Therefore, maintenance of effective plasma concentration and prevention of rejection are essential to long-term graft survival in kidney transplant.

CONCLUSION

Generic drug formulations may exhibit differences in effects and absorption compared to the brand-name drug. If the generic drug should be used, patients should be closely monitored.

Compact, highly efficient, 2.1-W continuous-wave mid-infrared Fe:ZnSe coherent source, pumped by an Er:ZBLAN fiber laser

In this Letter, we report a compact and robust coherent source, operating in mid-infrared (IR) and based on the Fe:ZnSe chalcogenide gain medium, optically pumped by an Er:ZBLAN fiber laser. The output power of 2.1 W with a 59% slope efficiency with respect to the absorbed pump power at liquid nitrogen cooling is achieved. We show that strong re-absorption at a high pump power and iron ion doping concentrations leads to a continuous tuning of central wavelength from 4012 to 4198 nm. The robustness of a high-power Er:ZBLAN fiber laser combined with prominent spectroscopic properties of Fe:ZnSe media pave the way for the development of a reliable tunable continuous-wave mid-IR sources for scientific and industrial purposes.

Safety of Elderly Living Kidney Donors: 2 Cases of Donors Older Than 80 Years: A Case Report

Much controversy exists over the performance of elderly living donor kidney transplantation. We report the safety of 2 cases of elderly living kidney donations in our hospital. CASE 1: An 82-year-old man was a living kidney donor for his 56-year-old son. The donor suffered from hypertension, but has successfully managed his blood pressure with only one medication. His serum creatinine was 0.7 mg/dL and inulin clearance was 122.5 mL/min, which met the usual criteria for living kidney donors. This was his son's secondary kidney transplantation, and no other donors existed. CASE 2: An 80-year-old woman was a living kidney donor for her 45-year-old son. Her serum creatinine was 0.61 mg/dL and inulin clearance was 71.7 mL/min, which met the marginal kidney donor criteria. In both cases, we determined that the donor kidney function was acceptable. Though we explained the risks of the transplantation thoroughly, the patients' strong will to offer a kidney to their family member did not change. We decided to carry out the transplantation. At the time of publication, nearly 2 years have passed since the transplantation, but both donors and recipients are doing well. In the future, it seems more likely that the number of elderly living donor kidney transplantation will rise. On one hand, there is no absolute contraindication for elderly donors, while on the other hand, the criteria for a living kidney donor must be strictly examined. Furthermore, careful observation of both donors and recipients after transplantation is required.

Fluoride-fiber-based side-pump coupler for high-power fiber lasers at 2.8 μm

A side-pump coupler made of fluoride fibers was fabricated and tested. The tested device had a coupling efficiency of 83% and was driven with an incident pump power of up to 83.5 W, demonstrating high-power operation. Stable laser output of 15 W at a wavelength of around 2.8 μm was achieved over 1 h when using an erbium-doped double-clad fiber as the active medium. To the best of our knowledge, this is the first time a fluoride-glass-fiber-based side-pump coupler has been developed. A test with two devices demonstrated further power scalability.

Robustness of adult female survival maintains a high-density sika deer (Cervus nippon) population following the initial irruption

Context Irruption of large herbivore populations is characterised by three distinct phases: (1) an exponential increase in population to a peak abundance; (2) a population crash; and (3) a second increase to another population peak, typically lower than the first peak of abundance. However, there has been little study of age- and sex-specific factors that affect the post-initial irruption interactions with food sources. Aims We aimed to investigate annual survival rates of sika deer (Cervus nippon Temminck, 1838) in the sequent irruption of a population on Nakanoshima Island, Lake Toya, Japan, with a chronically high density during the period 2002–12. Methods Survival monitoring data were obtained for 219 individuals (93 males and 126 females) using radio-collars. Annual survival was quantified, and related factors, i.e. deer abundance and winter severity, were determined by model selection using Akaike information criterion values. Key Results The results showed that annual survival rates across sexes and age classes (fawn, yearling, prime-aged, old) decreased with increasing population density, snow depth and winter precipitation. Winter severity had a greater effect on adult survival than density regulation. Nevertheless, female adult survival was maintained at a high level, with a mean of 0.84 (95% CI: 0.80–0.88). Key conclusions Robust survival rates for adult females might contribute to the maintenance of a high-density sika deer population in the post-initial irruption. Implications We suggest that in the absence of predation and hunting, sika deer population is not able to self-regulate to the density level that avoids an irreversible impact on plants.

Efficacy and safety of paclitaxel/ramucirumab as the second-line chemotherapy in Japanese patients with advanced gastric cancer

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Background: Second-line chemotherapy can now be considered as a proven treatment option for metastatic or locally advanced gastric cancer (AGC). Two global randomized phase III trials (REGARD and RAINBOW) showed that survival benefit was significantly observed in patients treated with ramucirumab (RAM) alone and in combination with weekly doses of PTX, compared with placebo, respectively. The purpose of the study is to evaluate the efficacy and safety of weekly dose of PTX combined with RAM practically as the second-line treatment in Japanese patients with AGC refractory to an S-1-containing chemotherapy regimen. Methods: We conducted a retrospective review of the data of 18 patients with AGC who received more than 2 cycles of PTX/RAM combined chemotherapy as the second-line regimen following S-1-based treatment. The objective response rate (ORR), adverse events, progression-free survival (PFS) and overall survival (OS) were analyzed and compared with PTX monotherapy group. Results: Median number of courses were 5 for the PTX/RAM group and the discontinuation of treatment except for disease progression was found in 2 cases (33.3%). The rates of hematological toxicities of higher than grade 3 were 33.3% in the PTX/RAM group, which were higher than those found in the PTX groups. The tumor responses of the PTX/RAM group were 22% for the ORR and 78% for the DCR, compared with 21% and 48% in the PTX group, respectively. The dose intensities of PTX were 72.4% in the former group. The survival data showed that the MST after second-line exposure was 290 days and the median PFS was 131 days in the PTX/RAM group, compared with 159 days and 90 days in the PTX group, which were not significantly different. Conclusions: PTX/RAM might be one of the best regimens for Japanese patients with AGC as the second-line treatment following S-1-containing chemotherapy.

A facile, selective, high recovery system for precious metals based on complexation between melamine and cyanuric acid

We developed a facile, selective, high recovery system for precious metals based on complexation between melamine and cyanuric acid (denoted as MC) through hydrogen bonding.

Comparison of open, laparoscopic, and hand-assisted laparoscopic devascularization of the upper stomach and splenectomy for treatment of esophageal and gastric varices: a single-center experience

INTRODUCTION

Laparoscopic devascularization of the upper stomach and splenectomy (Dev+Sp), is technically difficult in patients with portal hypertension because of enlarged collateral vessels and spleen. This report presents the efficacy and safety of hand-assisted laparoscopic (HALS) Dev+Sp.

METHODS

Ten patients underwent HALS Dev+Sp as a treatment for esophagogastric varices between 2005 and 2012 (HALS group). A vessel-sealing system was used for devascularization of vessels. An autosuture device was applied to dissect the splenic hilum and the left gastric and enlarged short gastric vessels. The operative and postoperative data were compared between patients who previously underwent laparoscopic Dev+Sp (LAP group, n = 9) and conventional Dev+Sp (OP group, n = 10) between 2001 and 2008.

RESULTS

The mean operative time was 328, 336, and 245 min (P < 0.05) and the mean blood loss was 1786, 981, and 250 mL (P < 0.05) in the OP, LAP, and HALS groups, respectively. Laparoscopic surgery was converted to HALS in one patient and to open surgery in three patients. There were no conversions in the HALS group. There was no significant difference in the cumulative recurrence rate and bleeding rate in the groups.

CONCLUSION

HALS Dev+Sp is a feasible and effective surgery in patients with portal hypertension.

Portal vein thrombosis in liver cirrhosis

Portal vein thrombosis (PVT) is considered to be a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions, such as gastroesophageal bleeding and acute intestinal ischemia. Moreover, no consensus regarding PVT in cirrhosis exists. Suggested causes of PVT in cirrhosis include reduced portal blood flow velocity, multiple congenital or acquired thrombophilic factors, inherited or acquired conditions, and derangement of liver architecture. However, the understanding of PVT in cirrhosis is incomplete. In addition, information on the management of PVT in cirrhosis is inadequate. The aims of this review are to: (1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis; (2) describe the principal factors most frequently involved in PVT development; and (3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.

Hepatic vein waveform and splenomegaly predict improvement of prothrombin time after splenectomy in hepatitis C virus-related cirrhotic patients

AIM

Whether hepatic function can recover in cirrhotic patients after splenectomy remains controversial.

METHODS

All consecutive Japanese patients with hepatic cirrhosis due to hepatitis C who had undergone elective splenectomy in Kyushu University Hospital between January 2008 and December 2009 were included in this retrospective study. Prothrombin time, serum albumin and total bilirubin concentrations were reviewed before and after splenectomy and analyzed to clarify whether splenectomy improves hepatic function in patients with cirrhosis and to determine the factors predictive of improvement in hepatic function.

RESULTS

Prothrombin time and total serum bilirubin concentration improved after splenectomy; however, serum albumin concentrations did not increase significantly. Twelve months after splenectomy, total serum bilirubin had decreased by over 0.3 mg/dL in 52.3% of patients and prothrombin time had improved by over 10% in 52.3% of patients. Multiple linear regression analysis identified hepatic vein waveform (HVWF) type I (P = 0.0174) and spleen weight (P = 0.0394) as independent predictors of improvement in prothrombin time and preoperative total serum bilirubin (P = 0.0002) as the only independent predictor of decrease in total bilirubin. Total bilirubin and prothrombin time were significantly improved after splenectomy in patients with HVWF type I, however, they were not improved in patients with HVWF type II.

CONCLUSION

Prothrombin time and total bilirubin improve in approximately half of cirrhotic patients within a year after splenectomy. HVWF type I and splenomegaly may be predictive factors for improvement in prothrombin time after splenectomy in patients with cirrhosis due to hepatitis C.

Deformation Behavior, Processability and Physical Properties for Biaxially Oriented Film of LLDPE

The bubble deformation behavior of double bubble tubular film (DBTF) of linear low density polyethylene (LLDPE) is experimentally analyzed. Also investigated is how the bubble deformation behavior of the stretched films are changed by stretching conditions, especially stretching temperature, and how the properties of stretched films are influenced by stretching conditions.

From the results, the optimum conditions required to obtain a stable bubble and good properties for the DBTF of LLDPE are indicated. The relationship between the DBTF and laboratory tenter stretched film (LTSF) is investigated in order to predict the processability and the properties of the DBTF by using the laboratory tenter biaxial stretcher. This method is not only more time efficient, but also reduces overall costs of developing the DBTF.

Stretchability and Properties of LLDPE Blends for Biaxially Oriented Film

In order to improve the stretchability of linear low density polyethylene (LLDPE) for double bubble tubular film (DBTF), the blending of LLDPEs have been investigated. Three LLDPEs of varying densities were blended, and several films having different densities, molecular-weight distributions and composition distributions were produced. The stretchability and properties of these films were investigated and the relationship between the stretchability and the material properties were also discussed. The material properties of LLDPE which showed better stretchability were reported. Furthermore, the stretchability of LLDPE by using the laboratory tenter stretched film (LTSF) and the DBTF were compared. The prediction of the stretchability for the DBTF by using the LTSF was reported.

Stretchability and Properties of Various LLDPE for Biaxially Oriented Film

Stretchability and properties of linear low density polyethylene (LLDPE) blends for biaxially oriented film was investigated in the previous report [1]. That report focused on changing the film density by blending three different densities of LLDPE. The relationship among stretchability, film density and the composition distribution was explored. In this report, several different densities and melt flow indices (MFI) of LLDPE were examined. A film with a density of about 0.915 g/cm3 displayed the best stretchability, while films not less than 2 g/10 min MFI had poor stretchability. The most suitable composition distribution for stretching was reported. The properties of biaxially oriented films were also evaluated. Furthermore, the relationship between the laboratory tenter stretched film (LTSF) and the double bubble tubular film (DBTF) was investigated. There was a correlation between the density in film over 0.910 g/cm3 and the stretchability of the DBTF and LTSF.