OC-005 ENDOSCOPIC SURGICAL SKILL QUALIFICATION SYSTEM IN JAPAN: PROVEN PERFORMANCE IN HERNIA SURGERY

Endoscopic Surgical Skill Qualification System by Japan Society for Endoscopic Surgery is implemented from 2004.

Laparoscopic inguinal hernia repair (TAPP, TEP) is positioned as a low difficulty level operation under general surgery field in this system.

An application qualification to the system demands the list of a specified operative cases, to participate in education seminars, and training of endoscopic surgery over 2 years after the Board Certified.

A specified case quantity is the operative experience of above 5 examples of a high-difficulty level and 45 examples of a low difficulty level operation.

Candidates submit 3 no edited videos of the endoscopic surgery performed for indirect hernia with the orifice above 1.5 cm in a male-sex. Which to examine among 3 videos is decided randomly by the society.

Two hernia-specified referees examine one candidate. When both results don't agree, an extra referee will examine newly and fixes the result.

An evaluation is estimated within 60 points of common standards and 40 points by an hernia. Equal to or more than 70 points in amount become a pass. Acceptance rate in hernia was 16% in 2021.

The Nationwide Survey of Endoscopic Surgery reported recurrence rates of after laparoscopic hernia surgery as 5% in TEP in and 4% in TAPP in 2012–2013, 2.0% and 1.3% in 2018∼2019, what is improved beyond the period.

It's no exaggeration to say that the Qualification System has played a big part.

The Qualification System like no other in the world is to be introduced.

Using indocyanine green angiography to achieve complete engraftment of pectoralis major myocutaneous flaps

Although the pectoralis major myocutaneous (PMMC) flap is among the useful reconstructive materials following oral cancer ablation, this flap has an unstable blood circulation that could result in partial necrosis of the skin paddle. This report describes the usefulness of indocyanine green angiography (ICGA) to achieve complete engraftment of the PMMC flap. Five patients with oral cancer underwent reconstruction with a PMMC flap after cancer ablation. During the skin paddle design and flap elevation, the blood supply to the flap was assessed by ICGA. Areas of the skin paddle that showed no ICG fluorescence were excised. Consequently, prior to transfer to the recipient site, the blood supply to all flaps was confirmed with indocyanine green visible at the edge of the skin paddle, and complete engraftment was achieved without partial necrosis. Based on the results observed, ICGA would make a useful contribution to complete engraftment of the PMMC flap.

Effects of a power plant closure on home ranges of green turtles in an urban foraging area

A natural experiment was conducted to determine effects of a fossil-fueled power plant on home ranges of east Pacific green turtles Chelonia mydas in an urban foraging ground. The power plant, located in south San Diego Bay, California, USA, co-existed with a resident foraging aggregation of ~60 green turtles for ~50 yr. It was decommissioned during a long-term green turtle monitoring study, thus providing a rare opportunity to evaluate how the cessation of warm-water effluent affected turtle movements and habitat use in the area. During pre- and post-decommissioning of the power plant, 7 and 23 green turtles, respectively, were equipped with GPS-enabled satellite transmitters. Useful data were obtained from 17 turtles (4 for pre- and 13 for post-decommissioning). Core use areas (50% utilization distribution [UD]) increased from 0.71 to 1.37 km2 after the power plant decommissioning. Increase in post-power plant 50% UD was greater during nighttime (0.52 to 1.44 km2) than daytime (1.32 to 1.43 km2). Furthermore, UDs moved from the effluent channel to an area closer to seagrass pastures, a presumed foraging habitat of the turtles. The observed expansion of green turtle home ranges may increase turtle-human interactions, such as boat strikes, within the foraging ground; this underscores how seemingly innocuous human actions contribute to inadvertent consequences to wildlife. Possible management and conservation actions include increasing awareness of the public regarding turtle presence in the area through signage and education as well as legislating for a reduction in boat speeds in select areas of the bay.

The assessment of surgical and non-surgical treatment of stage II medication-related osteonecrosis of the jaw

Background

Non-surgical treatment has generally been recommended for stage II medication-related osteonecrosis of the jaw (MRONJ) in preference to surgery. However, non-surgical treatment is not empirically effective. The aim of this study was to evaluate whether surgical or non-surgical treatment leads to better outcomes for stage II MRONJ.

Material and Methods

In this retrospective study, surgery was performed in a total of 28 patients while 24 patients underwent non-surgical treatment. The outcomes of both treatment approaches after 6 months were evaluated and statistically compared. In addition, risk factors for surgical and non-surgical treatments were assessed for each.

Results

Surgical treatment in 25 patients (89.3%) resulted in success, with failure in 3 patients (10.7%). Non-surgical treatment was successful for 8 patients (33.3%) and failed in 16 patients (66.7%). There was therefore a significant difference between surgical and non-surgical treatment outcomes (P<0.01). Regarding risk factors, in non-surgical treatment primary diseases, medications, and drug holiday had a significant effect on outcomes (P<0.01). Risk factors for surgical treatment could not be clarified.

Conclusions

Surgical treatment is more effective than non-surgical treatment for stage II MRONJ, and drug holiday, primary disease, and medication constitute risk factors in non-surgical treatment.

Key words:Bisphosphonate, bisphosphonate-related osteonecrosis of the jaw, denosumab, management, medication-related osteonecrosis of the jaw.

A case of trichilemmal carcinoma with distant metastases in a kidney transplantation patient

Transplant recipients receiving immunosuppressants are at a high risk of cancer, especially skin cancer. Trichilemmal carcinoma is comparatively rare compared with other skin cancers. We report here a first case of trichilemmal carcinoma arising in a kidney transplant recipient. A 63-year-old man who had undergone a living donor renal transplantation at the age of 50 years presented with a 15 × 10 mm lesion on his forehead. The pathological diagnosis after resection was trichilemmal carcinoma. Distant metastases involving the lymph nodes, lung, and liver occurred, and the patient died. Given that trichilemmal carcinoma generally has an indolent clinical course and a low metastatic potential, the present case of trichilemmal carcinoma with an aggressive course resulting in distant metastases is rare.

Soft x-ray intensity profile measurements of electron cyclotron heated plasmas using semiconductor detector arrays in GAMMA 10 tandem mirror

Temporally and spatially resolved soft x-ray analyses of electron cyclotron heated plasmas are carried out by using semiconductor detector arrays in the GAMMA 10 tandem mirror. The detector array has 16-channel for the measurements of plasma x-ray profiles so as to make x-ray tomographic reconstructions. The characteristics of the detector array make it possible to obtain spatially resolved plasma electron temperatures down to a few tens eV and investigate various magnetohydrodynamic activities. High power electron cyclotron heating experiment for the central-cell region in GAMMA 10 has been started in order to reduce the electron drag by increasing the electron temperature.

Evaluation of lower-starch diets for lactating Holstein dairy cows

The objective of this experiment was to measure ruminal and lactational responses of Holstein dairy cows fed diets containing 3 different starch levels: 17.7 (low; LS), 21.0 (medium; MS), or 24.6% (high; HS). Twelve multiparous cows (118 ± 5 d in milk) were assigned randomly to dietary treatment sequence in a replicated 3 × 3 Latin square design with 3-wk periods. All diets were fed as total mixed rations and contained approximately 30.2% corn silage, 18.5% grass silage, and 5.0% chopped alfalfa hay. Dietary starch content was manipulated by increasing dry ground corn inclusion (% of dry matter) from 3.4 (LS) to 10.1 (MS) and 16.9 (HS) and decreasing inclusion of beet pulp and wheat middlings from 6.7 and 13.4 (LS) to 3.4 and 10.1 (MS) or 0 and 6.8 (HS). In vitro 6-h starch digestibility of the diet increased as nonforage sources of fiber replaced corn grain (% of dry matter; 73.6, HS; 77.3, MS; 82.5, LS) resulting in rumen-fermentable starch content by 14.6, 16.2, and 18.1% for the LS, MS, and HS diets, respectively. Diets had similar neutral detergent fiber from forage and particle size distributions. Dry matter intake, solids-corrected milk yield, and efficiency of solids-corrected milk production were unaffected by diet, averaging 26.5 ± 0.8, 40.8 ± 1.6, and 1.54 ± 0.05 kg/d, respectively. Reducing dietary starch did not affect chewing time (815 ± 23 min/d), mean ruminal pH over 24h (6.06 ± 0.12), acetate-to-propionate ratio (2.4 ± 0.3), or microbial N synthesized in the rumen (585 ± 24 g/d). Total tract organic matter digestibility was higher for HS compared with MS and LS diets (69.2, 67.3, and 67.0%, respectively), but crude protein, neutral detergent fiber, and starch digestibilities were unaffected. As dietary starch content decreased, in vitro ruminal starch fermentability increased and, consequently, the range between HS and LS in rumen-fermentable starch (3.5 percentage units) was less than the range in starch content (6.9 percentage units). Under these conditions, dietary starch content had no measurable effect on ruminal fermentation or short-term lactational performance of high-producing Holstein dairy cows.

NADPH Regeneration by Glucose Dehydrogenase fromGluconobacter scleroidesforl-Leucovorin Synthesis

A new process for (6S)-tetrahydrofolate production from dihydrofolate was designed that used dihydrofolate reductase and an NADPH regeneration system. Glucose dehydrogenase from Gluconobacter scleroides KY3613 was used for recycling of the cofactor. The reaction mixture contained 200 mM dihydrofolate, 220 mM glucose, 2 mM NADP, 14.4 U/ml dihydrofolate reductase, and 14.4 U/ml Glucose dehydrogenase, and the reaction was complete after incubation at pH 8.0, and 40 degrees C for 2.5 hr. With (6S)-tetrahydrofolate as the starting material, l-leucovorin was synthesized via a methenyl derivative. The purity of the l-leucovorin was 100%, and its diastereomeric purity was greater than 99.5% d.e. as the (6S)-form.

Synthesis and determination of configuration of natural 25-hydroxyvitamin D(3) 26,23-lactone

The four stereoisomers of 25-hydroxyvitamin D(3) 26,23-lactone were synthesized by a stereoselective lactonization method. Natural 25-hydroxyvitamin D(3) 26,23-lactone was produced from 25-hydroxy-[3alpha-(3)H]vitamin D(3) by in vitro incubation of kidney homogenate prepared from vitamin D-supplemented chickens or was isolated from the serum of rats given 1,25-dihydroxyvitamin D(3) and 25-hydroxy-[3alpha-(3)H]vitamin D(3). The four synthetic isomers and the naturally produced 25-hydroxyvitamin D(3) 26,23-lactone were subjected to high-performance liquid chromatography in a system capable of separating the four isomers. The natural lactone comigrated with synthetic (23S,25R)-25-hydroxyvitamin D(3) 26,23-lactone, establishing it as the natural vitamin D(3) metabolite.

Use of diffusion-weighted magnetic resonance imaging in empyema after cranioplasty

External decompression can be an effective treatment for acute intracranial hypertension, but the cranial defect must be repaired. The most serious complication of cranioplasty is late infection. Confusing an empyema that occurs after cranioplasty with a fluid collection (haematoma or liquor) can have catastrophic consequences, such as the development of cerebritis. The goal of this study was to assess the ability of diffusion-weighted (DW) magnetic resonance imaging (MRI) to diagnose empyema after cranioplasty. DW MRI and apparent diffusion coefficient (ADC) maps were studied in six patients with surgically verified empyema after cranioplasty. The findings were compared with those in five patients who had surgically verified haematoma or liquorrhoea. In the patients with empyema, the lesion was hyperintense, whereas the fluid collections (haematoma and liquorrhoea) were visualized as hypointense lesions. The ADC maps showed that empyema had a significantly lower intensity than the fluid collections (haematoma or liquorrhoea). DW MRI can be used to identify empyema after cranioplasty and can help to differentiate it from other fluid collections. Hence, this is a useful additional imaging modality for the diagnosis of empyema after cranioplasty.

Nanoscale lithography with frequency-modulation atomic force microscopy

A lithographic method to draw nanoscale structures by repetitive depositions of the tip material by field evaporation has been developed based on frequency-modulation atomic force microscopy (FM-AFM). Because of high stiffness of quartz tuning forks, a force sensor in the AFM, unwanted mechanical contact of the AFM tip with the substrate was prevented. Precise control of the tip-substrate gap distance with FM-AFM and a gold tip sharpened with focused ion beam enable us to deposit gold dots as small as approximately 20 nm in size and construct nanoscale patterns.