[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

Background and aims：Feeding catheter jejunostomy is useful as an access route for early enteral nutrition during esophageal cancer surgery；however, it may be a cause of the postoperative bowel obstruction associated with feeding jejunostomy（BOFJ）. To avoid BOFJ, we have introduced the feeding catheter duodenostomy through the round ligament since 2018. The aim of this study was to compare the incidence of BOFJ and postoperative body weight change between feeding catheter jejunostomy and duodenostomy.
Patients and Methods：A total of 109 patients who underwent thoracoscopic esophagectomy and gastric tube reconstruction for esophageal cancer between March 2013 and November 2020 were included. Patient backgrounds（age, sex, preoperative weight, BMI, cancer stage, preoperative treatment）, surgical outcomes （operative time, blood loss）, postoperative complications（wound infection, pneumonia, anastomotic leakage, BOFJ）, and body weight change at 1, 3, 6, and 12 months after surgery were compared, and categorized into jejunostomy（J）and duodenostomy（D）groups.
Results：The D group consisted of 35 patients. Age, sex, weight, BMI, cancer stage, operative time, postoperative complications and duration of tube placement were not significantly different between the two groups. The D group had significantly less preoperative chemotherapy（45.7％ vs. 78.4％；P＝0.001）and lower operative blood loss volume（150mL vs. 120mL；P＝0.046）. There were 12 cases of BOFJ, all of which occurred in the J group. Postoperatively, the D group had a significantly lower weight loss ratio than the J group at 1 month after surgery（93.9％ vs. 91.8％；P＝0.039）.
Conclusion：In thoracoscopic esophagectomy, feeding duodenostomy may prevent bowel obstruction and reduce the weight loss at the early postoperative period without prolonging the operative time compared with feeding catheter jejunostomy.

View full abstract

Background: The association between preoperative Prognostic Nutrition Index/Controlling Nutritional Status （PNI/CONUT） score and postoperative complications for cholecystitis is unclear. We evaluated the association among preoperative clinical status, including Charlson Comorbidity Index, American Society of Anesthesiologists‐physical status classification system （ASA‐PS）, Tokyo Guidelines 2018 （TG2018） severity grade, PNI, and CONUT, and postoperative complications for patients undergoing surgical treatment for cholecystitis.
Results: Sixty‐seven patients undergoing surgery for cholecystitis diagnosed by TG2018 were enrolled in this study. Sixty patients underwent laparoscopic cholecystectomy （42 were completed by laparoscopic and 18 were converted to open surgery）, and seven patients underwent initially open cholecystectomy. Nine patients had postoperative complications （Clavien‐Dindo Grade Ⅲ or more）. There was a significant association between postoperative complications and being in the preoperative low‐PNI （＜40） group compared with the high‐PNI （≥40） group （78％ vs. 22％, p＝0.038）, and being in the preoperative high‐CONUT group （score ≥5, moderate and severe） compared with being in the low‐CONUT group （score ≤4, normal and light） （67％ vs. 33％, p＝0.043）. There was no significant association between postoperative mortality （n＝2） and preoperative factors；however, the patients had low PNI （＜40）. Preoperative body mass index, albumin, total lymphocytes, and total cholesterol were not significantly associated with postoperative complications or mortality.
Conclusion: Evaluation of preoperative PNI and CONUT may be predictive factors for postoperative complications undergoing surgery for cholecystitis.

View full abstract

About 20％ of sepsis survivors suffer from psychological disorders more than a year after being discharged from the hospital. Post‐sepsis syndrome is a serious sequela observed in patients with sepsis, which includes psychological, neurocognitive, and functional impairments. Although it has a substantial impact on the quality of life in septic patients, the underlying mechanisms are still unknown. Sepsis‐associated encephalopathy （SAE） occurs in approximately 70％ of patients with sepsis and contributes to mortality, and psychological and neurocognitive disorders. Thus, preventing or attenuating SAE is essential for improving the quality of life of survivors of sepsis. The major pathogenesis of SAE is neuroinflammation with blood‐brain barrier dysfunction and aberrant activation of immune cells and glial cells such as microglia in the brain. As most previous studies focused on microglia, there has been limited research on the role of T cells in SAE and post‐sepsis syndrome. Our study suggests that the γδ T and regulatory T cells contribute to the exacerbation of and recovery from SAE and resultant psychological disorders, respectively. Targeting T cells could provide researchers and physicians with a new perspective on establishing a therapeutic strategy for dealing with SAE and psychological disorders following sepsis.

View full abstract