During almost 20 years between May 1998 when I was appointed to a professorship at Gunma University, and April 2018, I had been endeavoring to contribute the improvements of research, as well as clinical work and education of surgical field. In this manuscript, I would like to demonstrate the research work which I performed under the concept of “Contemplation of Surgical Science”, with great help and efforts of numerous numbers of colleagues.

Background & Aims: To obtain a better guide for the nursing care of patients with Parkinson's disease undergoing long-term care by describing the improvement of unconvincing results after deep brain stimulation (DBS).

Methods: Using a modified grounded theory approach, semi-structured interviews were performed with 11 patients (aged 50-80 years) who had undergone 5-14 years of DBS before this study.

Results: The improvement process of unconvincing outcomes in patients with Parkinson's disease following DBS starts with the patients' attempts to share the unconvincing outcomes, followed by repeating the cycle of ambiguity in unconvincing outcomes and becoming saddled with them under maintainable support, and ends in achieving realization of the improvement plan.

Conclusions: Patients could hide their unconvincing outcomes from the other patients while struggling for a long time, and they stated that they tried to cope with unconvincing outcomes by reconsidering the meaning of DBS. Its course differs for each person. These findings may be helpful in improving long-term care, enhancing patient satisfaction and quality of life, and in educating patients considering post-DBS care.

Objectives: We evaluated the usefulness of a cooling system installed in the sliding microtome for paraffin-embedded tissue and digital image analysis (DIA) for thickness evaluation.

Methods: We prepared formalin-fixed paraffin-embedded fish sausage sample blocks and sliced the block using a microtome with (continuous cooling) or without (refrigerant cooling) a cooling system. DIA was used to evaluate the percentage of eosin-stained area (positive rate) on the specimen.

Results: The plotted mean positive rate of 2–8-μm thick specimens showed a logarithmic curve and showed a high correlation coefficient (R²>0.93). Hence, we utilized this plot as a standard curve to estimate specimen thickness. Under both cooling conditions, three individuals prepared 20 specimens that were 3-μm thick. The mean estimated thickness in the continuous and refrigerant cooling was <4μm and> 6μm², respectively.

Conclusions: DIA is a useful technique in estimating specimen thickness. Our data showed that specimens prepared with conventional cooling (such as refrigerant cooling) were twice as thick as the setting value of the microtome.

Objectives: In the present study, we retrospectively investigated how C-reactive protein, albumin, and hemoglobin changed in breast cancer patients in the 12 months before death.

Methods: We targeted 22 women (median age, 62) out of 1,411 patients who underwent breast cancer treatment from December 2005 to April 2014. Twelve of the patients (55%) were ER positive, and 6 (27%) were HER2 positive. C-reactive protein, albumin, and hemoglobin were measured 10–12 months, 7–9 months, 4–6 months, 2–3 months, and 1 month before death. In order to compare the average values in each period, pairwise multiple comparisons were performed.

Results: C-reactive protein was found to increase significantly between 12 months before death and 1 month before death (p<0.0001). Albumin declined significantly between 3 months before death and 1 month before death (p<0.0001). There was a statistically significant decrease in hemoglobin between 12 months before death and 1 month before death (p=0.001).

Conclusion: Breast cancer patients at the end-of-life showed obvious changes in C-reactive protein, albumin, and hemoglobin in the three months before death.

Objectives: The purpose of this research was to clarify the evaluation on nursing in an outpatient setting of the use of “a nursing algorithm to promote treatments more attuned to the social roles of each cancer survivor,” developed by the researchers.

Methods: Nursing support using the algorithm was performed by the nurses at the outpatient departments who were engaged in cancer treatment in A prefecture. Thereafter, interviews were conducted by the institution, and the results were analyzed in a qualitative and inductive manner.

Results: The survey included 28 nurses, 70％ of whom had at least 10-years' nursing experience. The evaluation on nursing in an outpatient setting were consolidated from 49 codes to 10 sub-categories, yielding the following: “use of the algorithm enabled the nurses to support cancer survivors living in a society with an integrated approach,”“enabled them to share directions of support across different job categories,” and “enhanced the nurses' feeling of self-satisfaction as a nurse in an outpatient setting.”

Discussion: Use of the algorithm threw light on the social background of each cancer survivor, enabling the nurses to provide individualized support. Such support contributed to promoting a relationship of trust with the survivors, as well as to enforcing the nurses' feeling of satisfaction.

Objective: [¹²³I] N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-[¹²³I]iodophenyl) nortropane (¹²³I-FP-CIT) or dopamine transporter (DAT) SPECT scan quantitatively depicts striatum dopamine transporter density. The specific binding ratio (SBR) is important for Parkinson's disease (PD) diagnosis. Correction techniques may improve ¹²³I-FP-CIT image quality, but they are currently not standardized. We aim to determine attenuation correction (AC) and scatter correction (SC) influence on ¹²³I-FP-CIT quantitative analysis.

Methods: We preformed SPECT imaging on a striatal phantom representing striatum-to-background ratios ranging from 10:1 to 1:1. We used the Chang method for AC and triple energy window for SC. Commercially available software semi-automatically calculated SBR. We performed correlation analysis between SBR and the actual concentration ratio in four groups: no correction (NC), SC, AC, and combined correction (CC), paying particular attention to SBR values below the clinical cut-off (4.5). We applied the same imaging conditions, reconstruction, and corrections on 49 human ¹²³I-FP-CIT SPECT studies. Asymmetric index values (AI) were also analyzed. Receiver operating characteristic (ROC) analysis provided AI diagnostic cut-off values in PD patients. PD patient population whose AI values were above these cut-off value were subject to a correlation study to confirm the association between their clinical symptoms and ¹²³I-FP-CIT SPECT.

Results: Phantom study. AC or CC increased SBR ¹²³I-FP-CIT SPECT, making them very close to the standard ratios (AC: y=1.19x - 0.7; R²=0.98; CC: y=1.4x - 1.2; R²=0.98), while NC and SC underestimated SBR at lower values (1 to 4). Clinical study. There was no difference in SBR between NC and SC, while AC and CC produced significantly higher SBR than NC (p<0.0001). Only SC affected AI values (p<0.05). The association between clinical symptoms and ¹²³I-FP-CIT imaging results were maintained only when either NC (n=12, p<0.05) or CC (n=14, p<0.05) was applied.

Conclusions: AC increased SBR more than other corrections, while SC increased AI value more than other corrections. The association between clinical symptom and SPECT findings were maintained when either NC or CC was applied. These correction methods should be carefully selected for ¹²³I-FP-CIT SPECT brain imaging.

Background: Social bonds between spouses (pair bond) positively affect health conditions. Recently, we reported that the administration of serotonin-selective reuptake inhibitors to monogamous prairie voles ameliorated the impairment of pair bonding caused by traumatic stresses, suggesting the involvement of the serotonergic system in the formation of pair bonds in this model animal. Before investigating this possibility, we investigated the cohabitation condition which leads to a pair bond using our colony of prairie voles.

Methods: Male prairie voles were cohabited with females for 96h in a control experiment. Otherwise, subject males were cohabited with an estradiol-primed females for 6 h or 24h. Subsequently, partner preferences by subject male prairie voles were assessed for 3 h.

Results: All subjects in the 96 h cohabitation group preferred to huddle with their partner than stranger females. Twenty-four hour cohabitation induced partner preference; however a 6-h cohabitation did not, despite accompanying mating bouts.

Conclusions: The formation of pair bonds by prairie voles requires 24 h of cohabitation. Mating bouts in a 6-h cohabitation appear to be insufficient for the formation of a pair bond. Such factors need to be considered when performing experiments using pharmacological methods that enhance or inhibit pair bonds.

We report a case of an unruptured cerebral aneurysm associated with internal carotid artery (ICA) hypoplasia and an aberrant right subclavian artery successfully treated with coil embolization. A 56-year-old female was referred to our hospital for a left unruptured ICA aneurysm with a bleb. She had no signs of neurological deficit. Computed tomography angiography and digital subtraction angiography revealed the presence of a right ICA hypoplasia and an aberrant right subclavian artery. The size of the aneurysm was 7.5×5.8 mm, and its neck was 3.6 mm. We treated the aneurysm with balloon-assisted coil embolization. Temporary endovascular balloon occlusion of the ICA was needed several times to finish the embolization. The aneurysm was completely obliterated, with no signs of neurological deficit after surgery. In the case of an ICA hypoplasia, the incidence of a cerebral aneurysm is suggested to be higher than in the general population due to the increase in the hemodynamic stress on the normally developed side. The coexistence of ICA hypoplasia and an aberrant right subclavian artery is rare. Accessibility limitations and ischemic tolerance must be considered when treating patients with congenital vascular anomalies via endovascular surgery.

A 70 year-old male underwent laparoscopic abdominoperineal excision of the rectum and bilateral lateral lymph nodes dissection for rectal cancer. The patient was extubated and returned to the general ward. Immediately after his return, he went into respiratory arrest and required re-intubation and mechanical ventilation. Multiple factors such as decreased cerebral metabolism and prolonged effects of anesthesia and muscle relaxants were considered as causes of respiratory arrest.

An 85 year-old female patient presented to our hospital emergency department for pneumonia and heart failure. She was transferred to a long-term care facility, but the day after transfer, her abdominal pain increased and she returned to our hospital. She was diagnosed with bilateral strangulated obturator hernia, and underwent ultrasound guided reduction of the incarceration. Ten days after her readmission, she underwent an elective laparoscopic hernia repair. The postoperative course was good, and she was transferred to a long-term care facility on postoperative day 7.

Obturator hernia is common in elderly people, and many of these patients have preexisting disease, increasing their risk of perioperative complication. We report a case in which we avoided emergency surgery by performing ultrasound guided reduction, and performing reliable treatment by elective laparoscopic surgery.

An 81-year-old female was brought to our hospital by ambulance because of nausea and vomiting lasting for two days. We diagnosed a right strangulated femoral hernia, and performed a manual reduction. Semi-emergency laparoscopic hernia repair was performed the day after admission. Intraoperatively, we observed a right femoral hernia and small intestine discolored over 6cm to dark red. Laparoscopic hernia repair and partial enterectomy were performed. Her postoperative course was good and she was discharged on postoperative day 12. One year and three months after surgery, she has yet to experience hernia recurrence or mesh infection.

By choosing laparoscopic surgery, we could perform appropriate treatment with adequate observation in the peritoneal cavity, as well as reliable repair with a low recurrence rate similar to that of usual inguinal hernia.

Duodenal diverticulum generally remains asymptomatic, and seldom perforates. We experienced three cases of perforated duodenal diverticulum. All cases presented complaining of abdominal pain and CT findings consistent with perforated duodenal diverticulum. We performed diverticulectomy and duodenal decompression with gastric catheter by the Witzel maneuver to the first with second cases. The third case was managed conservatively, combining antibiotics and decompression of the duodenum. Since the perforation site was the a periampullary diverticulum, we decided surgical treatment would be excessive.

Although treatment strategies of perforated duodenal diverticulum are controversial, surgical treatment is more common. Currently, some cases have suggested that definite CT diagnosis and prompt treatment enable conservative treatment in some cases. We report three cases of perforated duodenal diverticulum, along with a review of the literature.