Central venous catheterization (CVC) is an essential procedure in various clinical procedures. However, the method of training trainees differs according to each supervising doctor. A medical safety committee for the safe insertion of CVC was established in order to create an original protocol for CVC insertion at Showa University Northern Yokohama Hospital. The committee established a registration system for CVC-certified doctors, and also created an educational program. Under this system, the CVC committee requires all CVC-certified doctors to submit a CVC safety report to the medical risk management office in order to evaluate major or minor complications and the number of punctures. Currently, 155 doctors are registered in this system of the 218 doctors and residents who are participating in the training sessions. Our educational system for non-experts provides an excellent training opportunity. However, the system of safety reports and registration is not perfect, and therefore such efforts will ultimately lead to improved patient safety.

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We compared the effects of different preoperative beverages on children undergoing elective laparoscopic percutaneous extraperitoneal closure for inguinal hernia repair. In this study, 120 low-risk patients (aged 1-10 years) scheduled for surgery were randomly assigned to an oral rehydration liquid (OSB, n = 24) group, oral rehydration jelly (OSJ, n = 24) group, carbohydrate-rich drink (ArgW, n = 24) group, tap water (TW, n = 24) group, or a fasting (NPO, n = 24) group. The patients in the NPO group fasted from midnight the night before surgery. Approximately 2 to 3 hours before entering the operating room, patients in the OSB, OSJ, ArgW, and TW groups consumed ≤ 100ml (<15kg in weight) or ≤ 200ml (≥ 15kg in weight) of OS-1, OS-1 Jelly, Arginaid^® Water, and tap water, respectively. Patients in the NPO group continued fasting until surgery. Anesthesia was induced by inhalation of sevoflurane and oxygen. When venous access was obtained, we collected blood samples to measure free fatty acid (FFA) levels. After intubation, we measured the volume of gastric contents (VGC) using a gastric tube, and the cross-sectional area of the pyloric region of the stomach (CSA) using ultrasonography. The groups were compared using analysis of variance and Scheffé's post hoc test. A p value of < 0.05 was considered statistically significant. The volume of the stomach content was notably large for the ArgW group. In the ArgW group, 10 patients had VGC of ≥ 25ml. CSA did not significantly differ between the groups. FFA during induction of anesthesia was significantly lower in the ArgW group. In children, carbohydrate loading with ArgW may prevent preoperative starvation. However, it may remain in the stomach for more than two hours.

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Vascular calcification is a highly regulated process. Tumor necrosis factor-α (TNF-α) has been shown to accelerate the highly regulated osteogenic process in vascular smooth muscle cells (VSMCs). Vitamin D receptor activators have been associated with beneficial cardiovascular outcomes in patients with chronic kidney disease. Vitamin D deficiency, especially low circulating concentrations of 25-hydroxyvitamin D₃ [25(OH)D₃] are associated with increased risks for cardiovascular disease and death. We examined whether 25(OH)D₃ exhibits a suppressive effect on VSMC mineralization induced by phosphate and TNF-α. Human VSMCs were treated with either vehicle or 25(OH)D₃ (10^-8 to 10^-6 M) in 2.5mM of a high phosphate media with TNF-α (1ng/ml) for 6 days. VSMC mineralization was determined and the expression of genes associated with the osteogenic process and vitamin D metabolism was examined by real-time reverse transcription polymerase chain reaction. Vehicle-treated VSMCs exhibited massive mineralization, which was inhibited by 25(OH)D₃. While the vehicle-treated VSMCs exhibited the increase in mRNA expressions associated with the osteogenic process (Cbfa1/Runx2 and osteocalcin) compared with VSMCs with a normal phosphate media, 25(OH)D₃ suppressed the increase in these mRNA expressions. Furthermore, the vehicle-treated VSMCs exhibited the decrease in vitamin D receptor and 25-hydroxyvitamin D-1α-hydroxylase mRNA expressions which were marginally rescued by 25(OH)D₃. 25(OH)D₃ abrogated the acceleration of the osteogenic process induced by phosphate and TNF-α in VSMCs, which was linked to the inhibition of VSMC mineralization.

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To report the current state of the video library system of laparoscopic surgery in our institute. We obtained informed consent from all of the patients using a consent form written about the management of the operation's digital videography of laparoscopic surgery before the operation. The dedicated PC was placed in a secure room, and a dedicated staff entered the videography and data file into the PC. The privacy of the patients was strictly protected. The total number of operation digital videographies stored and managed in three years was 1381. The total storage volume in the hard disc was 4.037TB. The mean storage volume per one operation was 2.9GB. From stored videography it is easy to extract high-quality, still images useful for teaching, presentations and publications. Our video library system has a low operating cost, and digital videography and still photography can easily be recorded via this video library system producing high-quality video recording.

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