Aim: To investigate the factors related to short-term and long-term post-operative weight loss from gastrectomy for gastric cancer.

Subjects and Methods: From September 2014 to June 2015, 104 patients who underwent elective gastrectomy or total gastrectomy for gastric cancer in our hospital were followed-up for 6 months to examine weight loss and then were investigated retrospectively. Univariate analysis using Fisher's exact test, t test, Mann-Whitney U test, and multivariate regression analysis were performed to correlate variables with weight loss. P < 0.05 was defined as being statistically significant.

Results: There was a statistically significant correlation between pre-operative chemotherapy and shortterm weight loss (P = 0.013) in multivariate analysis. With regard to long-term weight loss, there were statistically significant correlations between both the skeletal muscle mass index reduction rate (P = 0.020) and the short-term weight loss (P < 0.001) in multivariate analysis.

Conclusion: Pre-operative chemotherapy was associated with short-term weight loss. Short-term weight loss and the skeletal muscle mass index reduction rate also affected long-term weight loss.

The shape-changeable medical food is, in the reaction between polysaccharides and cations in the stomach, and changes into a semi-solid state. The present study verified the influence of solidification due to gastric pH and calcium lactate hydrate on the shape-changeable medical food.

HINE E-GEL^® (Otsuka Pharmaceutical Factory, Inc., Naruto City, Japan) or Mermed_® (TERUMO Co., Ltd, Tokyo, Japan) (300mL/h) and artificial gastric juices (AGJ) (80mL/h) were constantly added to AGJ pH1.2 or McIlvaine Buffer pH5.0 (40mL), to mimic the intragastric secretion. Calcium lactate hydrate 1g was mixed in AGJ or McIlvaine Buffer (40mL) by simple suspension method. The weight and viscosity of the solidified contents 60 minutes after were measured. ① pH1.2 ② pH1.2+Ca1g ③ pH5.0 ④ pH5.0+Ca1g test groups were assigned.

At pH5.0, the shape remained unchanged, but the addition of calcium lactate hydrate to pH 5.0 was shown shape-change similarly to that observed at pH1.2. (HINE E-GEL^®/Mermed_® ①288.1±12.5g, 9964.7±1401.2mPa・s/225.9±21.2g, 5199.0±1417.7mPa・s, ② 383.7±23.7g, 28560.7±5687.9mPa・ s/385.9±22.2g, 6798.3±888.3, mPa・s, ③2.9±0.5g/4.8±0.3g (viscosity measurement impossible), ④ 247.2±38.3g, 14630.3±3161.8 mPa・s,/220.3±63.5g, 2266.3±986.0mPa・s).

Gastric acid and changes in shape were inhibited by an acid reducer, but with calcium lactate hydrate administered internally, even at a high pH, the shape-changeable medical food showed shape-change. This in vitro study must be verified in vivo.

Background: An immune-enhancing diet has been used to alter eicosanoid synthesis, cytokine production, and immune function in an attempt to limit the undesired immune reactions following surgical injury. This prospective randomized study was designed to investigate the effect of preoperative immunonutrition on surgical complications, and the participation of prostaglandin E₂ (PGE₂) on T cell differentiation in patients undergoing a severely stressful surgery.

Methods: The enrolled patients who were scheduled to undergo pancreaticoduodenectomy were randomized into 2 groups. Patients in the immunonutrition group (n=25) received oral supplementation containing arginine, ω-3 fatty acids, and RNA for five days before surgery in addition to a 50% reduction in the amount of regular food. Patients in the control group (n=25) received no artificial nutrition and were allowed to consume regular food before surgery. All patients received early postoperative enteral infusion of a standard formula intended to provide 25 kcal/kg/day.

Results: Infectious complication rate and severity of complications (Clavien-Dindo classification) were significantly lower in the immunonutrition group than in the control group. mRNA expression levels of T-bet were significantly higher in the immunonutrition group than in the control group (P<0.05). Serum eicosapentaenoic acid (EPA) and EPA/arachidonic acid ratios were significantly higher in the immunonutrition group than in the control group (P<0.05). The levels of plasma PGE₂ were significantly lower in the immunonutrition group than in the control group (P<0.05).

Conclusions: Preoperative immunonutrition modulates PGE₂ production and T cell differentiation and may protect against the aggravation of surgical complications in patients undergoing pancreaticoduodenectomy.

OBJECTIVE: The peripherally inserted central venous catheter (PICC) is known as a catheter with less fatal complications, and its use has been gradually spreading in Japan. However, in our hospital, many catheters were accidentally removed due to complications. We considered the cause to be inadequate management after placement, and started PICC surveillance on 19 June 2014 to observe the PICC management and instruct nurses. After one year, we retrospectively evaluated the effect.

METHODS: We observed catheter fixation methods and infusion routes once a week, then pointed out and instructed inappropriate points. We also created our own manual and distributed it to all wards for daily management. We compared 125 PICCs (intervention group) that underwent PICC surveillance from June 2014 to June 2015 with 111 PICCs (control group) inserted from April 2010 to March 2012. The primary endpoint was the incidence of accidental PICC removals.

RESULTS: The incidence of accidental removals was significantly lower in the intervention group (32.4% in the control group and 16.8% in the intervention group) (odd ratio 0.421, p=0.005). The odds ratio after multivariable adjustment was 0.381 (p=0.004), and the risk reduction due to PICC surveillance was 61.9%.

CONCLUSION: Catheter management through PICC surveillance may contribute to the prevention of PICC complications.