Introduction: Sedative-analgesic agents are reported to reduce the pain and discomfort of esophagogastroduodenoscopy (EGD), but the specific effects of these agents on examination of the esophagogastric junction (EGJ) are unknown. We conducted a prospective, randomized, double-blind clinical trial in which we compared the effects of midazolam and pethidine hydrochloride on EGJ examination during EGD. Methods: The 32 patients included in the study were chosen from among 80 patients scheduled to undergo EGD at our hospital between February 2016 and May 2018. Patients were randomly allocated to intravenous administration of midazolam (n=16) or pethidine (n=16). The midazolam was administered to patients at the same dose as during the previous examination, whereas the pethidine was administered at a dose of 35 mg. Perfect observation was defined as examination of the full circumferential extent of the EGJ. The primary study endpoint was the percentage of patients in whom perfect observation was achieved. Results: Perfect observation was achieved in six patients (37.5%) in the midazolam group and nine patients (56.3%) in the pethidine group (between-group difference: 18.8%, 95% confidence interval [CI]: -59.0% to 21.5%; P=0.29). The mean extent of EGJ examination was 65.0±38.3% in the midazolam group and 78.6±27.3% in the pethidine group (intergroup difference: -13.6%, 95% CI: -37.8% to 10.3%; P=0.25). The mean visual analog scale score for pain and discomfort during endoscopy was 0.75±2.02 in the midazolam group and 2.25±1.77 in the pethidine group, indicating significantly higher levels of discomfort in the pethidine group (intergroup difference: -1.50, 95% CI: -2.87 to -1.30; P=0.033). There was no between-group difference in the number of procedural accidents or degree of the endoscopists' satisfaction. Conclusion: Midazolam was superior to pethidine in relieving discomfort during EGD, but pethidine tended to be better than midazolam for observing the EGJ.

Objective: We conducted a prospective investigation of the effects of changes in surgical position on central venous pressure (CVP) and stroke volume variation (SVV) and the correlation between CVP and SVV.

Methods: Subjects were patients who underwent elective hepatectomy at the St. Marianna University School of Medicine Hospital from November 25, 2020 to December 31, 2022. The relevant measurements were taken after induction of anesthesia and prior to the surgery. After induction, measurements of blood pressure, pulse, SVV, and CVP were taken while the operating table was placed in a reverse Trendelenburg position at angles of 0°, 5°, and 10°. A Flo Trac^TM sensor (Edwards Lifesciences, Irvine, CA, USA) was used to measure SVV.

Results: When the patient was placed in a reverse Trendelenburg position at 10°, the CVP decreased by a mean of -1.6 (±0.7) mmHg, whereas the SVV increased by a mean of 2.9 (±1.6) %. A negative correlation was observed between the width of variation of CVP and SVV (r=-0.31, R² value=0.10) and between the CVP and SVV values (r=-0.30, R² value=0.09). We also noted that the mean CVP decreased by 5 mmHg at 10° among patients in whom the CVP was less than 7.5 mmHg and the SVV was greater than 10% when the patients were placed at 0°.

Conclusion: We determined that both CVP and SVV values changed when patients were moved into the reverse Trendelenburg position. Our findings also showed that the CVP and width of variation of CVP and SVV due to patient placement into the reverse Trendelenburg position were both affected by physique. These results suggest that among patients in whom the CVP was ＜7.5 mmHg at 0°, an adequately low CVP value can be maintained using only the reverse Trendelenburg position, thus allowing hepatectomy to be performed safely.

Background: In an aging population, hepatectomy, a highly invasive surgical procedure, is increasingly being performed on individuals aged 80 and above in Japan. However, there is a need to evaluate the effectiveness of the eligibility criteria used for patient selection and assess the surgical outcomes and risks associated with the procedure.

Methods: This retrospective cohort study included 104 patients aged 80 years or older who met the lesion localization criteria for hepatectomy. The patients were divided into the hepatectomy group and the non-surgical group. Survival rates and postoperative complications were evaluated using Kaplan-Meier analysis and multivariate regression models.

Results: The eligibility criteria effectively identified patients who were not suitable for hepatectomy, as evidenced by the survival outcomes of the non-surgery group. The hepatectomy group had a median overall survival of 59.3 months. Postoperative complications were observed in 21.4% of hepatectomy cases, with a mortality rate of 1.19%. Factors such as prealbumin and indocyanine green retention rate at 15 min were found to influence postoperative prognosis. Intraoperative bleeding volume was identified as a significant predictor of complications. Female patients had a lower rate of postoperative complications.

Conclusion: The eligibility criteria for hepatectomy developed in this study were effective in identifying suitable candidates among super elderly patients aged 80 and above. Analysis of survival outcomes and factors affecting postoperative prognosis and complications provided valuable insights into surgical management in this specific patient population. Meticulous surgical technique and effective bleeding control strategies are crucial in minimizing the risk of complications. Further research and interventions focused on optimizing management of intraoperative bleeding may contribute to improved outcomes in hepatectomy patients. It is important to consider the limitations of this single-center study and conduct larger multi-center studies for generalizability.

Introduction: Helium is known to reduce airway resistance and improve ventilatory physiology. Helium also has a high CO₂ diffusion coefficient. Thus, CO₂ diffusion occurs faster in a helium gas mixture than in air or oxygen. Helium-oxygen mixture has been used with mechanical ventilator settings such as conventional mechanical ventilation (CMV) or high-frequency oscillatory ventilation (HFOV). Although helium-oxygen mixture was shown to promote CO₂ excretion in combination with either CMV or HFOV, it has not been examined which ventilatory mode is more effective in promoting CO₂ excretion when used with helium-oxygen mixture. This study aimed to compare the changes of arterial partial pressure of CO₂ (PaCO₂) by using helium-oxygen mixture between CMV and HFOV.

Methods: Six Japanese white rabbits were used, and following tracheostomy, they were connected to the ventilator. A control PaCO₂ between 40 and 70 mmHg was maintained before administration of helium-oxygen mixture, and blood gas analysis was performed during and after administration of helium-oxygen mixture. The 2-way type repeated measures analysis of variance was used for comparison of PaCO₂, and it was followed by post hoc tests. Simple pairwise comparisons were performed for oxygenation at each time points between under CMV and HFOV.

Results: There was a statistical significance for the differences of time points (P-value＜0.000001) as well as for the interaction term (P-value＜0.001). According to the post hoc tests, under HFOV, PaCO₂ during administration of helium-oxygen mixture was significantly lower compared to both before and after administration. In intergroup comparison, PaCO₂ during helium-oxygen inhalation under HFOV was significantly lower than that under CMV. Arterial partial pressure of oxygen/fraction of inspiratory oxygen ratio during administration under HFOV was significantly higher than that under CMV.

Conclusions: This study demonstrated that ventilatory management of healthy lung rabbits with helium-oxygen mixture results in more efficient ventilation and better oxygenation with piston-driven HFOV than with CMV.

CXCL13 is a chemokine involved in the pathophysiology of connective tissue diseases by contributing to ectopic lymphoid follicle formation. 59 patients with new-onset dermatomyositis (DM) (n = 42) / polymyositis (PM) (n = 17) were evaluated from October 2018 to March 2023 for clinical and pathophysiological significance of CXCL13 in DM and PM at our university hospital. Plasma CXCL13 levels were measured by ELISA, and their correlation with clinical characteristics and treatment was analyzed. Plasma CXCL13 levels were higher in patients with DM than in those with PM (P = 0.016), and these subsets could be differentiated using a cut-off value of 81.1 U/L (area under curve = 0.8). In patients positive for anti-aminoacyl-tRNA synthetase antibodies, those with DM had significantly higher plasma CXCL13 levels than those with PM (P = 0.001). Plasma CXCL13 levels correlated with serum levels of creatine kinase (P = 0.007), but not with KL-6 (P = 0.288) in patients with DM. Following treatment, plasma CXCL13 levels significantly decreased in patients with DM (P = 0.008). In conclusion, plasma CXCL13 levels were high, especially in patients with DM. CXCL13 can be an important chemokine implicated in the pathophysiology of DM, which serves as a novel immunological marker of disease activity in patients with DM.

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is an extremely rare and deadly cancer with a poor prognosis. Unfortunately, the causes that lead to the development of SCCOHT are unknown. In this study, we present a case in which SCCOHT and low-grade serous carcinoma (LGSC) occurred in the same ovary. The patient, a woman in her 30s, visited the obstetrics and gynecology department for weight loss and abdominal distension. Imaging examinations indicated an ovarian malignancy. Therefore, simple total hysterectomy, bilateral adnexectomy, and omentectomy were performed. The left ovary was enlarged with proliferation of SCCOHT and LGSC. The tumor had metastasized to the right ovary and multiple metastatic dissemination sites were found in the abdominal cavity. This case of combined SCCOHT and LGSC suggests that SCCOHT arises from the dedifferentiation of LGSC.