Preoperative Prediction of Communication Difficulties during Awake Craniotomy in Glioma Patients: A Retrospective Evaluation of 136 Cases at a Single Institution

Awake craniotomy has been widely performed in patients with glioma in eloquent areas to minimize postoperative brain dysfunction. However, neurological examination in awake craniotomy is sometimes problematic due to communication difficulties during the intraoperative awake period. We evaluated preoperative predictors of these difficulties in awake craniotomy for patients with glioma. In all, 136 patients with glioma who underwent awake craniotomy at our institution between January 2012 and January 2020 were retrospectively evaluated. Patients were divided into two groups (appropriately awake group and inappropriately awake group) depending on their state during the intraoperative awake period, and the relationship between communication difficulties in awake craniotomy and both clinical and radiological characteristics were assessed. The appropriately awake group included 110 patients, and the inappropriately awake group included 26 patients. Reasons for inclusion in the inappropriately awake group were insufficient wakefulness in 15 patients, restless state in 6, and intraoperative seizures in 5. In multivariate analysis, the likelihood of being inappropriately awake was inversely correlated with preoperative seizures (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.06–0.89; p = 0.033) and positively correlated with left-sided lesions (OR, 7.31; 95% CI, 1.54–34.62; p = 0.012). Both lack of preoperative seizures and left-sided lesions were identified as risk factors for intraoperative difficulties in awake craniotomy for patients with glioma. Understanding these risk factors may lead to more appropriate determination of eligibility for awake craniotomy.     

Impact of COVID-19 on the Volume of Acute Stroke Admissions: A Nationwide Survey in Japan

This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.     

Work-Setting Factors and Reasons for Drinking in Japanese Male Workers: A Questionnaire Survey

We conducted a questionnaire survey at a major company in 1989 to explore the relationship between male employees' work-setting features and reasons for drinking. A factor analysis of 20 work-setting items resulted in four main work-setting factors: quality of work, relationships with superiors, work quantity/environment and relationship with colleagues. A multiple regression analysis was carried out to test the relationships between these four work-setting factors and reasons for drinking. The respondents who drank socially in business situations were more satisfied with their relationships with their superiors and colleagues, but this drinking behaviour did not significantly correlate with the quality of work and work quantity/environment factors. Social drinking in business situations appears to promote a friendly relationship with colleagues and superiors in Japanese companies. Those who drank to reduce frustration were less satisfied with all the four work-setting factors. It appears that drinking is more likely to occur to reduce the strain associated with work overload. © 1997 John Wiley & Sons, Ltd.     

Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: A rapid practice guideline

This rapid practice guideline provides evidence-based recommendations for the use of awake proning in adult patients with acute hypoxemic respiratory failure due to COVID-19. The panel included 20 experts from 12 countries, including one patient representative, and used a strict conflict of interest policy for potential financial and intellectual conflicts of interest. Methodological support was provided by the guidelines in intensive care, development, and evaluation (GUIDE) group. Based on an updated systematic review, and the grading of recommendations, assessment, development, and evaluation (GRADE) method we evaluated the certainty of evidence and developed recommendations using the Evidence-to-Decision framework. We conducted an electronic vote, requiring >80% agreement amongst the panel for a recommendation to be adopted. The panel made a strong recommendation for a trial of awake proning in adult patients with COVID-19 related hypoxemic acute respiratory failure who are not invasively ventilated. Awake proning appears to reduce the risk of tracheal intubation, although it may not reduce mortality. The panel judged that most patients would want a trial of awake proning, although this may not be feasible in some patients and some patients may not tolerate it. However, given the high risk of clinical deterioration amongst these patients, awake proning should be conducted in an area where patients can be monitored by staff experienced in rapidly detecting and managing clinical deterioration. This RPG panel recommends a trial of awake prone positioning in patients with acute hypoxemic respiratory failure due to COVID-19.     

A chronicle of organ transplant progress in Japan

This study records the progress of organ transplantation in Japan by reviewing significant developments in five areas: actual transplant legislation; landmark cases notably affecting public impressions of organ transplants; efforts to establish brain death criteria; action on the part of the Japan Medical Association; and current attempts to legislate on brain death. The account demonstrates how the notions of both brain death and heart transplantation have met with strong resistance. The first and only heart transplant occurred in 1968. Through its historical emphasis, this report reveals that, although opposition has not impeded transplant research, the determination of death and the idea of heart transplants remain highly controversial due to specific religious, philosophical, and cultural factors.     

Brain Death in Pediatric Patients in Japan: Diagnosis and Unresolved Issues

Brain death (BD) is a physiological state defined as complete and irreversible loss of brain function. Organ transplantation from a patient with BD is controversial in Japan because there are two classifications of BD: legal BD in which the organs can be donated and general BD in which the organs cannot be donated. The significance of BD in the terminal phase remains in the realm of scientific debate. As indicated by the increasing number of organ transplants from brain-dead donors, certain clinical diagnosis for determining BD in adults is becoming established. However, regardless of whether or not organ transplantation is involved, there are many unresolved issues regarding BD in children. Here, we will discuss the historical background of BD determination in children, pediatric emergencies and BD, and unresolved issues related to pediatric BD.     

Demographics,management and treatment outcomes of benign and malignant retroperitoneal tumors in Japan

Objectives

To show the demographics, type of treatment and clinical outcomes of patients with retroperitoneal tumors in Japan.

Methods

We carried out a retrospective analysis of patients with retroperitoneal tumors treated between 2000 and 2012 at 12 university hospitals in Japan. Histology was re‐evaluated using the 2013 World Health Organization classification.

Results

A total of 167 patients were included in the analysis. The number of diagnosed patients increased over the 12‐year study period. Liposarcoma and schwannoma were the most common histological types among intermediate/malignant and benign tumors, respectively. The intermediate/malignant tumors were larger and were more frequently found in older people. Surgical resection was the primary treatment for 151 patients. The median survival duration for patients with malignant tumors was 91 months, and was significantly shorter than that for patients with benign and intermediate tumors (P < 0.01). R2 resection was associated with significantly shorter survival than R0/R1 resection for malignant tumors (P < 0.01), but not for intermediate. Grossly complete resection of the recurrent tumors improved survival.

Conclusion

The number of patients diagnosed with retroperitoneal tumors increased over time. R2 resection of primary tumors was found to be associated with poor prognosis in malignant tumors, but not in intermediate tumors. Complete surgical resection of recurrent tumors was associated with a better oncological outcome.     

Current State of Gastric Stump Carcinoma in Japan: Based on the Results of a Nationwide Survey

Background  

Carcinoma of the gastric remnant after partial gastrectomy for benign disease or cancer is unusual but an important cancer model. The Japanese Society for the Study of Postoperative Morbidity after Gastrectomy (JSSPMG) performed a nationwide questionnaire survey to understand the current state of gastric stump carcinoma in Japan.     

SARS-CoV-2 Vaccine Acceptability in Patients on Hemodialysis: A Nationwide Survey

Open in a separate window     

Nationwide survey on complications of spine surgery in Japan

The Japan Spine Research Society carried out a nationwide survey on complications of the spine, enrolling a total of 16157 patients who had undergone spine surgery in 196 institutes in the 1-year period from January to December 2001. Diseases, surgical procedures, and complications were surveyed in detail. Forty-nine percent of patients were aged 60 years or older, which was remarkably increased in comparison with the percentage reported by the 1994 survey (37.3%). The number of cases with degenerative spinal diseases comprised 78.2% of the total number of spine surgery cases. The percentage of patients with stenosis was the greatest (38.5%), reflecting the increase in the elderly population undergoing spine surgery. Spinal instrumentation was used with 5497 patients (34.0%). The frequency of its use was much greater than that reported in 1994 (27.0%). The pedicle screw was the most frequently used instrument (54.6%). The use of spinal instrumentation greatly increased for spinal deformity, trauma, and tumors. Posterior lumbar interbody fusion has been increasingly used in cases of lumbar degenerative disease. Complications of spinal surgery were reported in 1383 patients (8.6%). The incidence of complications associated with instrumentation surgery was 12.1%, being twice as much as that associated with noninstrumentation surgery (6.8%).     

Epidemiologic Study of Primary Brain Tumors in Miyazaki Prefecture: A Regional 10-year Survey in Southern Japan

The increased use of neuroimaging and the aging of society have changed the incidence and proportion of histological types of intracranial tumors in Japan. A population-based epidemiological survey has been reported only from Kumamoto Prefecture. We performed a 10-year survey in Miyazaki Prefecture to compare our findings with the incidence rate (IR) of primary intracranial tumors (PIT) reported in the Kumamoto survey. Our study included 1915 new cases of PIT diagnosed in Miyazaki Prefecture between 2007 and 2016. The crude IR was 16.97/100000/year. The most common tumor was meningioma (46.3%), followed by glioma (17.1%), pituitary adenoma (13.1%), schwannoma (8.2%), and malignant lymphoma (3.8%). The age-specific IR of all PITs and of meningiomas, gliomas, pituitary adenomas, schwannomas, lymphomas, and germ cell tumors was similar in both prefectures. To directly compare with the age-adjusted IRs reported in the Kumamoto survey, we calculated the IR for the two prefectures. The age-adjusted IR of primary brain tumors in Miyazaki Prefecture was 14.65/100000/year, which was slightly higher than in the Kumamoto survey (14.09/100000/year between 1989 and 2008). The age-adjusted IR of glioma, schwannoma, and malignant lymphoma showed only a small difference between Miyazaki and Kumamoto. However, the age-adjusted IR of meningiomas was higher in Miyazaki than Kumamoto (6.15- vs. 4.97/100000/year), but the IR of pituitary adenoma was higher in Kumamoto than Miyazaki (2.66- vs. 2.13/100000/year). Although there were some differences between the two surveys, the IR of PIT showed a similar pattern in Kumamoto and Miyazaki, which are neighboring districts on Kyushu Island.     

A Nationwide Survey on Bariatric Surgery in France: Two Years Prospective Follow-up

Background Most studies on bariatric surgery outcomes have been performed in clinical trials (eg. the SOS) or reflect the clinical experience and practice of specific and experienced centers. Little is known about the current practice at a nationwide level. Methods This is a systematic nationwide study on the 2-year outcome of all consecutive 1,236 bariatric operations performed in France. Data on mortality, weight loss, complications, and patient satisfaction were collected independently from the medical and surgical team involved in the patients’ care. Results 87.3% of the patients underwent an adjustable gastric banding (ABG), 8.6% a vertical banded gastroplasty (VBG), 3.8% a Roux-en-Y gastric bypass (RYGBP) and 0.3% a biliopancreatic diversion (BPD). Loss of follow-up was 12% at year 1 and 18% at year 2. The rate of laparoscopic procedures was 98% for ABG and 73% for RYGBP. Mortality rate was 0.16% in the operative period and 0.27% during follow-up. Excess weight loss ranged from 43% (AGB) to 66% (RYGBP). Co-morbidities improved in more than 70% of patients. Conclusion Outcomes of bariatric surgery in routine practice (mortality, weight loss, course of co-morbidities, and quality of life) are similar to the results published in clinical trials.     

激光美容门诊就诊者对光老化认知的问卷调查

目的：对激光美容门诊的就诊者进行光老化认知的问卷调查,指导临床医师在激光美容门诊的健康教育工作。方法：以226例激光美容门诊的就诊者为研究对象,进行问卷调查,采用SPSS11．5软件进行分析。结果：30岁以上就诊者对光老化的知晓率更高,女性的知晓率高于男性,知识的准确性也明显高于男性,丈化程度高、来自于大城市的就诊者对光老化知识的准确性更高。结论：在美容门诊工作中应加强对青少年、男性、低文化、相对贫困地区的防晒健康教育。     

去大骨瓣开颅术的临床应用

目的探讨去大骨瓣开颅术治疗重型颅脑损伤的效果。方法对37例重型颅脑损伤合并脑疝患者采用去大骨瓣开颅术进行治疗,按格拉斯哥预后评分法观察手术疗效。结果恢复良好18例,中残4例,重残6例,植物样生存3例,死亡6例。结论去大骨瓣开颅术是治疗重型颅脑损伤的有效方法。     

四喃唑嗪治疗非细菌性前列腺炎和前列腺痛的疗效观察

非细菌性前列腺炎和前列腺痛很常见,然而,由于病因和病原体不明,治愈率很低,为了减轻最影响患者生活的症状,我们用四喃唑嗪治疗非细菌性前列腺炎和前列腺痛,23例有前列腺炎症状的患者依Meares-Stamey诊断标准检查,细菌培养阴性。依据前列腺液检查WBC>10HP为有炎症标准,进一步分为非细菌性前列腺痛,分别为15例,8例在开始和结束时我们用一个新的前列腺炎症状评分表对症状进行评分,以使对症状和治疗结果的评价更客观。经过14天的四喃唑嗪治疗,平均观察32.2天。症状评分治疗后平均下降了4.1(P<0.05)。与非细菌性前列腺炎相比,四喃唑嗪治疗前列腺痛效果更好。     

Trends and Outcomes in the Treatment of Gliomas Based on Data during 2001–2004 from the Brain Tumor Registry of Japan

The committee of Brain Tumor Registry of Japan (BTRJ) was founded in 1973 and conducts surveys and analyses of incidence, therapeutic methods, and treatment outcomes of primary and metastatic brain tumors with the cooperation of the Japan Neurosurgical Society members. Newly diagnosed 3,000–4,000 primary brain tumors and 600–1,000 brain metastases patients were enrolled in each year. This report describes the trends and treatment outcomes of gliomas from BTRJ volume 13, including 13,431 patients with primary brain tumors who newly started treatment from 2001 to 2004. Data from 382 diffuse astrocytomas (DAs), 121 oligodendrogliomas (OLs), 90 oligoastrocytomas (OAs), 513 anaplastic astrocytomas (AAs), 126 anaplastic oligodendrogliomas (AOs), 106 anaplastic oligoastrocytomas (AOAs), and 1,489 glioblastomas (GBMs) were analyzed for overall survival (OS) and progression free survival (PFS) depending on age, symptoms, Karnofsky performance status, location of the tumor, extent of resection (EOR), initial radiotherapy and chemotherapy. The 5-year PFS rates of the patients with DA, OL + OA, AA, AO + AOA, and GBM were 57.0%, 74.6%, 28.7%, 54.0%, and 9.2%, and the 5-year OS rates were 75.0%, 90.0%, 41.1%, 68.2%, and 10.1%, respectively. Higher EOR ≥ 75% in DA and OL + OA and that ≥ 50% in AA, AO + AOA, and GBM significantly prolonged OS. Complications and cause of death were also reported. BTRJ had been edited for all the patients, researchers, and especially for clinicians at bedside to give useful information about brain tumors and to contribute to the advances in brain tumor treatment. This report revealed various clinical problematic issues pertaining to the diagnosis and treatment of gliomas.