Global warming and the Summer Olympic and Paralympic games: a perspective from the Tokyo 2020 Games

The Tokyo 2020 Olympic and Paralympic Games provided a significant opportunity to consider global warming as an issue to be seriously addressed to run the safe and fair games in the era of climate change. As the global temperature continuously rises and extreme hot-weather events increase in frequency and intensity, the future summer Olympic and Paralympic games will need to deal with the heat by applying thorough and appropriate countermeasures. In the recent decades, many mitigation measures to protect athletes from heat have been rapidly discussed by the sports community, including countermeasures to hold games at times and places with moderate temperature and climatic risk assessments with Wet Bulb Globe Temperature (WBGT) during the games. However, the excessive heat conditions in the Tokyo 2020 Games affected not only athletes, but also all people concerned the events. While deliberate considerations by organizers had been given to mitigate extraordinary heat, the evaluations of these measures and epidemiological analyses of risk factors of patients must be further enhanced to develop efficient measures for the future. Therefore, we discussed the underlying climate-related problems of the summer Olympic and Paralympic Games in view of what we had experienced in the Tokyo 2020 Games. Facing with emerging global warming, future intervention against heat in the summer Olympic and Paralympic games will need to integrate systematic disease surveillance and evaluation of intervention with an effective combination with the approaches previously conducted. The Tokyo 2020 Games is a wake-up call to accelerate the public health measures towards the creeping global warming.

Indications for and Technical Aspects of Colorectal Endoscopic Submucosal Dissection

Due to the widespread acceptance of gastric and esophageal endoscopic submucosal dissections (ESDs), the number of medical facilities that perform colorectal ESDs has grown and the effectiveness of colorectal ESD has been increasingly reported in recent years. The clinical indications for colorectal ESD at the National Cancer Center Hospital, Tokyo, Japan include laterally spreading tumor (LST) nongranular type lesions >20 mm and LST granular type lesions >30 mm. In addition, 0-IIc lesions >20 mm, intramucosal tumors with nonlifting signs and large sessile lesions, all of which are difficult to resect en bloc by conventional endoscopic mucosal resection (EMR), represent potential candidates for colorectal ESD. Rectal carcinoid tumors less than 1 cm in diameter can be treated simply, safely, and effectively by endoscopic submucosal resection using a ligation device and are therefore not indications for ESD. The en bloc resection rate was 90%, and the curative resection rate was 87% for 806 ESDs. The median procedure time was 60 minutes, and the mean size for resected specimens was 40 mm (range, 15 to 150 mm). Perforations occurred in 23 (2.8%) cases, and postoperative bleeding occurred in 15 (1.9%) cases, but only two perforation cases required emergency surgery (0.25%). ESD was an effective procedure for treating colorectal tumors that are difficult to resect en bloc by conventional EMR. ESD resulted in a higher en bloc resection rate as well as decreased invasiveness in comparison to surgery. Based on the excellent clinical results of colorectal ESDs in Japan, the Japanese healthcare insurance system has approved colorectal ESD for coverage.

The Effects of Pharmacologic Pupil Dilatation on Ocular, Corneal, and Internal Aberrations

PURPOSE: The present study investigates the effects of pharmacologic pupil dilatation on ocular, corneal and internal aberrations. METHODS: Sixty-two right eyes of 62 healthy participants were included in the present study. Ocular, corneal and internal aberrations were measured with a KR-1W wavefront aberrometer (Topcon Corp., Tokyo, Japan) before mydriasis in mesopic conditions. After pupil dilatation with a mydriatic drug (phenylephrine chloride 0.5% + tropicamide 0.5%) (Mydrin-P, Santen, Osaka, Japan), the measurements were repeated. The wavefront data of 4-mm and 6-mm diameter zones were analyzed. The changes of aberrations before and after mydriasis were evaluated by paired t-test. RESULTS: The values of ocular, corneal and internal spherical aberrations before and after mydriasis on the 4-mm diameter pupil zone were not statistically significantly different. On the 6-mm diameter zone, the ocular and internal spherical aberrations were statistically significantly different (p = 0.025, p = 0.002, respectively, paired t-test). However, the corneal aberrations did not show significant changes. The internal aberrations average before mydriasis was -0.043 (+/-0.21) microm and was shifted in a negative direction to -0.093 (+/-0.17) microm after mydriasis. The ocular aberrations average also changed toward negative after mydriasis. The high-order aberrations and astigmatism did not change significantly. CONCLUSIONS: The ocular and internal spherical aberrations changed toward negative with mydriasis in the participants' eyes suggesting the change of the ocular spherical aberration to be attributed to internal changes.

Discussion of 2011 Tokyo Declaration on Japanese Acupuncture and Moxibustion / 中国针灸

The contents of 2011 Tokyo Declaration on Japanese Acupuncture and Moxibustion (Declaration for short) and its effect on development situation, current status, features, opportunities and challenges of Japanese acupuncture and moxibustion are introduced, some proposals brought up in the Declaration are analyzed as well. The Declaration summarizes six characteristics of Japanese acupuncture and moxibustion, including paying great attention to palpation techniques such as pulse and abdominal diagnosis, always selecting response point in the meridian during acupuncture treatment, etc. Also six proposals have been brought up to promote the development of Japanese acupuncture and moxibustion, such as being devoted to spread the latest knowledge of acupuncture and moxibustion to medical professionals and the public in order to get correct understanding and proper evaluation, etc. What's more, the Declaration makes a prospection of improving international academic exchange and promoting the globalization of acupuncture and moxibustion and so on. The Declaration is served as a link between past and future in the history and developing process of Japanese acupuncture and moxibustion, which has a great meaning to the development of Japanese acupuncture and moxibustion. We should have a clear understanding of weakness and strength in the development of acupuncture and moxibustion, seize the opportunity and develop science of acupuncture and moxibustion with our own characteristics, which makes more contribution to development of international acupuncture and moxibustion.

Estimation of Corneal Spherical Aberration from Topography

PURPOSE: To formulate an equation to estimate corneal spherical aberration using Orbscan (Bausch & Lomb Surgical, Rochester, NY, USA) parameters. METHODS: The study was carried out retrospectively. The participants were 76 eyes of 76 senile cataract patients with the mean age of 57.37 +/- 17.63 years. Both Orbscan and KR-1W (Topcon Corp, Tokyo, Japan) were taken as preoperative examinations. Correlation analysis between various parameters from Orbscan and corneal spherical aberrations for a 6 mm pupil by KR-1W was performed. And multivariable linear regression was performed with the significantly correlated Orbscan parameters from the correlation analysis. RESULTS: The mean corneal spherical aberration from KR-1W system was 0.25 +/- 0.08 microm. As a result of the multivariable linear regression, we could generate following equations. If the Q-value was available, estimated corneal spherical aberration = 0.389 x Q-value + (0.022 x Axial power 3 mm) - 0.633 (R2 = 0.436). If the Q-value was not available, estimated corneal spherical aberration = 0.184 x (Mean power 5 mm - Mean power 3 mm) + (0.02 x Axial power 3 mm) - 0.563 (R2 = 0.429). By using the equations, 93.4-94.7% of subjects were in the error range of 0.10 microm. CONCLUSIONS: Even when equipped with Orbscan only, an appropriate aspheric intraocular lens can be selected using the estimated corneal apherical aberration by the equations.

The Changes of Corneal and Ocular High-Order Aberrations before and after Playing Computer Games

PURPOSE: To evaluate changes in corneal and ocular high-order aberration, ocular fatigue, and tear break-up time (TBUT) before and after playing computer games and the correlations among the variables. METHODS: Thirty-nine normal healthy subjects played computer games for 1 hour. Ocular fatigue was evaluated with a questionnaire, TBUT was measured with slit-lamp biomicroscopy, and high-order aberrations were measured with a KR-1W aberrometer (Topcon Medical System, Inc., Tokyo, Japan) in each subject before and after playing computer games. The right eye was used for statistical analyses. RESULTS: Subjective ocular fatigue (expressed as the interview score) increased from 4.23 +/- 5.35 to 12.05 +/- 8.68 after playing games (p < 0.001) and TBUT decreased from 8.03 +/- 6.43 sec to 4.90 +/- 3.31 sec (p < 0.001). Ocular high-order aberrations in the 4 mm and 6 mm zones were not significantly changed before and after playing games (p = 0.150, p = 0.202, respectively). However, corneal high-order aberrations in the 4 mm and 6 mm zones were significantly increased after playing computer games (p = 0.002, p = 0.002, respectively). Changes in TBUT, interview score, and corneal high-order aberration were not correlated with each other. CONCLUSIONS: Playing computer games increased corneal high-order aberrations as well as subjective ocular fatigue and TBUT.

The Current Status of BCG Vaccination in Young Children in South Korea / 결핵및호흡기질환

BACKGROUND: Delivery of Bacille Calmette-Gurein (BCG) Tokyo vaccine, with the multipuncture device, has been much preferred over BCG Pasteur, with the intradermal method, possibly due to the easier manner of administration, a desire to avoid any trouble with scars, as well as side effects and higher profits to providers in South Korea. METHODS: To determine BCG scar status in 0~6 year old children vaccinated with two BCG vaccines (Pasteur BCG vaccine with intradermal method and BCG Tokyo vaccine with percutaneous method), the data from the national BCG scar survey in 2006 was analyzed. RESULTS: Based on the national survey, the high proportion that were vaccinated with BCG Tokyo vaccines with the multipuncture method (64.5%) was noted in 0~6 year old Korean children. From inspection of scar formation, as an indicator of vaccination, the median number of the visible pin scars from the percutaneous method was 16 (interquartile range, 12~18) in the Korean children, and pin scars decreased as the age of the children increased (p<0.001). CONCLUSION: The findings in this survey clearly showed a growing preference of parents for the BCG Tokyo vaccines by the multipuncture method in South Korea.

The Relationship among Refractive Power, Axial Length and Choroidal Thickness Measured by SD-OCT in Myopia

PURPOSE: To measure choroidal thickness in healthy myopic eyes and to evaluate the relationship among choroidal thickness and refractive power and axial length. METHODS: Eighty healthy myopic eyes were evaluated in the present study. The refractive power was measured using an automatic refractor and the axial length using A-scan. The subjects were divided into two groups based on refractive power (> or =-6.0 D and or =25 mm and <25 mm). The choroidal thickness was measured using spectral domain (SD) optical coherence tomography (3-dimensional [3D] OCT-2000, Software Version 6.01; Topcon Corp., Tokyo, Japan), and the statistical relationship between the two groups was analyzed. RESULTS: A statistically significant difference was found in choroidal thickness according to refractive power and axial length between the two groups (p < 0.001 and p < 0.05, respectively). CONCLUSIONS: Refractive power and axial length had a significant relation to choroidal thickness measured by OCT. When excluding eyes with pathologic myopia, high myopia in healthy eyes may cause choroidal thinning.

Evaluation of RF300 for Leukoreduction of Red Blood Cells / 대한수혈학회지

BACKGROUND: Use of universal leukoreduction for prevention of leukocyte associated transfusion reactions is common practice in many countries. This study was conducted in order to evaluate the performance of a newly developed leukoreduction filter for red blood cells (RBCs), the RF300 (Kolon Industries, Inc, Gumi, Korea). METHODS: Filtration time, RBC recovery, residual leukocyte count, and leukocyte removal rate were evaluated. To assess the quality of RBCs after filtration, percent hemolysis was monitored for a period of 21 days. Performance of the RF300 (N=78) was compared with that of the Bio-R O2 plus (Fresenius, Hamburg, Germany), the Pall Purecell RC (Pall Co., Washington, USA), and the Sepacell R-500N (Asahi, Tokyo, Japan). RESULTS: The shortest filtration time was observed using the RF300 (P<0.05). Using the RF300, recovery of RBC was 96.5%, which was higher than that of two filters (P<0.05). Mean residual leukocyte count was 0.26x10(6)/unit, with a leukocyte removal rate of 3 log. Using the RF300, mean percent hemolysis was 0.32% at day 21, which was comparable with that of two filters, but lower than that of one filter (P<0.05). CONCLUSION: The RF300 meets all established quality requirements for conduct of safe and effective leukoreduction of RBCs.

Cystoid Macular Edema Detected by Scanning Laser Ophthalmoscopy in Retro-Mode

PURPOSE: To investigate the visualization of cystoid macular edema (CME) using noninvasive retromode imaging by a new scanning laser ophthalmoscope (SLO) and compare to previous imaging modalities. METHODS: The authors of the present study retrospectively reviewed the medical records of 21 eyes of 20 patients with CME due to various etiologies. All eyes were examined with fundus camera, fluorescein angiography (TRC-50EX, Topcon, Tokyo, Japan), SLO (F-10, Nidek, Gamagori, Japan), and spectral-domain optical coherence tomography (OCT) (3D OCT-1000, Topcon, Tokyo, Japan). In the present study the SLO was used in the retro-mode with an infrared laser. RESULTS: Previous fundus photography could not detect CME adequately although SLO retro-mode could show numerous oval or polygonal cystoid spaces more readily. Furthermore, each individual small cystoid space could be detected and the area of each cystoid space could be measured. The area of the largest cystoid space showed a correlation with its height, as measured with OCT (R = 0.606, p = 0.004). The area of the whole foveal cystoid space showed a correlation with central macular thickness, as measured with OCT (R = 0.493, p = 0.023). CONCLUSIONS: A new commercially available SLO (F-10) in the retro-mode can allow us to detect each cystoid space non-invasively and to measure the extent of CME.

Clinical study of keratocystic odontogenic tumors

The odontogenic keratocyst (OKC) was originally classified as a developmental cyst, and OKCs were histologically divided into orthokeratotic (O-OKCs) and parakeratotic (P-OKCs) types. Clinical features differ between O-OKCs and P-OKCs with P-OKCs having a tendency to recur after surgical treatment. According to the revised histopathological classification of odontogenic tumors by the World Health Organization (2005) , the term keratocystic odontogenic tumor (KCOT) has been adopted to describe P-OKCs. In this retrospective study, we examined 186 KCOTs treated at the Maxillofacial Surgery Department of the Tokyo Medical and Dental University Hospital from 1981 through 2005. The patients ranged in age from 7 to 85 years (mean, 32.7) and consisted of 93 males and 93 females. The most frequently treated areas were the mandibular molar region and ramus. The majority of KCOTs in the maxillary region were treated by enucleation and primary closure. The majority of KCOTs in the mandibular region were enucleated, and the wound was left open. Marginal resection was performed in the 4 patients with large lesions arising in the mandible. In patients who were followed for more than a year, recurrences were observed in 19 of 120 lesions (15.8%) . The recurrences were found at the margins of the primary lesion in contact with the roots of the teeth or at the upper margins of the mandibular ramus. Clinicians should consider aggressive treatment for KCOTs because the recurrence rate of P-OKCs is higher than that of other cyst types such as O-OKCs, dentigerous cysts, primordial cysts that were non-keratinized, and slightly keratinized stratified squamous epithelium. Although more aggressive treatment is needed for KCOTs as compared to other cystic lesions, it is difficult to make a precise diagnosis preoperatively on the basis of clinical features and X-ray imaging. Therefore, preoperative biopsy is necessary for selecting the appropriate treatment for patients with cystic lesions.

Analysis of copy number abnormality (CNA) and loss of heterozygosity (LOH) in the whole genome using single nucleotide polymorphism (SNP) genotyping arrays in tongue squamous cell carcinoma

Chromosomal loss of heterozygosity (LOH) is a common mechanism for the inactivation of tumor suppressor genes in human epithelial cancers. LOH patterns can be generated through allelotyping using polymorphic microsatellite markers; however, owing to the limited number of available microsatellite markers and the requirement for large amounts of DNA, only a modest number of microsatellite markers can be screened. Hybridization to single nucleotide polymorphism (SNP) arrays using Affymetarix GeneChip Mapping 10 K 2.0 Array is an efficient method to detect genome-wide cancer LOH. We determined the presence of LOH in oral SCCs using these arrays. DNA was extracted from tissue samples obtained from 10 patients with tongue SCCs who presented at the Hospital of Tokyo Dental College. We examined the presence of LOH in 3 of the 10 patients using these arrays. At the locus that had LOH, we examined the presence of LOH using microsatellite markers. LOH analysis using Affymetarix GeneChip Mapping 10K Array showed LOH in all patients at the 1q31.1. The LOH regions were detected and demarcated by the copy number 1 with the series of three SNP probes. LOH analysis of 1q31.1 using microsatellite markers (D1S1189, D1S2151, D1S2595) showed LOH in all 10 patients (100). Our data may suggest that a putative tumor suppressor gene is located at the 1q31.1 region. Inactivation of such a gene may play a role in tongue tumorigenesis.

Short-term Mechanical Circulatory Support with a Centrifugal Pump: Results of Peripheral Extracorporeal Membrane Oxygenator According to Clinical Situation

BACKGROUND: A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO. MATERIAL AND METHODS: Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age 54.4+/-15.1 years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of DLP(R) (Medtronic Inc, Minneapolis, MN) or RMI(R) (Edwards Lifesciences LLC, Irvine, CA) was used together with a 17~21 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system (EBS(R); Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of 2.4~3.0 L/min/m2 and an activated clotting time (ACT) of around 180 seconds. RESULTS: Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation. CONCLUSION: Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.

Resorption of labial bone in maxillary anterior implant

PURPOSE: The purpose of this study was to evaluate the amount of resorption and thickness of labial bone in anterior maxillary implant using cone beam computed tomography with Hitachi CB Mercuray (Hitachi, Medico, Tokyo, Japan). MATERIALS AND METHODS: Twenty-one patients with 26 implants were followed-up and checked with CBCT. 21 OSSEOTITE NT(R) (3i/implant Innovations, Florida, USA) and 5 OSSEOTITE(R) implants (3i/implant Innovations, Florida, USA) were placed at anterior region and they were positioned vertically at the same level of bony scallop of adjacent teeth. Whenever there was no lesion or labial bone was intact, immediate placement was tried as possible as it could be. Generated bone regeneration was done in the patients with the deficiency of hard tissue using Bio-Oss(R) (Geistlich, Wolhusen, Switzerland) and Bio-Gide(R) (Geistlich, Wolhusen, Switzerland). Second surgery was done in 6 months after implant placement and provisionalization was done for 3 months. Definite abutment was made of titanium abutment with porcelain, gold and zirconia, and was attached after provisionalization. Two-dimensional slices were created to produce sagittal, coronal, axial and 3D by using OnDemand3D (Cybermed, Seoul, Korea). RESULTS: The mean value of bone resorption (distance from top of implant to labial bone) was 1.32 +/- 0.86 mm and the mean thickness of labial bone was 1.91 +/- 0.45 mm. CONCLUSION: It is suggested that the thickness more than 1.91 mm could reduce the amount and incidence of resorption of labial bone in maxillary anterior implant.

In vitro antimicrobial effect of the tissue conditioner containing silver nanoparticles

PURPOSE: The aim of this study was to identify in vitro antimicrobial activity of the tissue conditioner containing silver nanoparticles on microbial strains, Staphylococcus aureus, Streptococcus mutans and Candida albicans. MATERIALS AND METHODS: Experimental disc samples (20.0x3.0 mm) of tissue conditioner (GC Soft-Liner, GC cooperation, Tokyo, Japan) containing 0.1 - 3.0% silver nanoparticles (0%: control) were fabricated. Samples were placed on separate culture plate dish and microbial suspensions (100 microL) of tested strains were inoculated then incubated at 37degrees C. Microbial growth was verified at 24 hrs and 72 hrs and the antimicrobial effects of samples were evaluated as a percentage of viable cells in withdrawn suspension (100 microL). Data were recorded as the mean of three colony forming unit (CFU) numerations and the borderline of the antimicrobial effect was determined at 0.1% viable cells. RESULTS: A 0.1% silver nanoparticles combined to tissue conditioner displayed minimal bactericidal effect against Staphylococcus aureus and Streptococcus mutans strains, a 0.5% for fungal strain. Control group did not show any microbial inhibitory effect and there were no statistical difference between 24 hrs and extended 72 hrs incubation time (P > .05). CONCLUSION: Within the limitation of this in vitro study, the results suggest that the tissue conditioner containing silver nanoparticles could be an antimicrobial dental material in denture plaque control. Further mechanical stability and toxicity studies are still required.

Leveraging Devices, Data and Discovery for Smarter Healthcare in Japan / 대한의료정보학회지

OBJECTIVES: Over the past decade, hospitals and clinics have gradually adopted hospital information systems, including provider order entries and electronic health records. Although these systems have helped to improve patient safety and efficiency of healthcare providers, not all healthcare providers and patients are satisfied with the current situation. Healthcare should be smarter. Thus, there is a need for state-of-the-art medical and healthcare devices that can handle massive amounts of data with the help of sophisticated information processing and discovery technologies. METHODS: This article compares hospital information systems with the information systems of other social infrastructures. It also explores the possibilities of smarter healthcare, including personal health devices and personal health records with interoperability. RESULTS: The main traits of the iEHR at Teikyo University Hospital in Tokyo include IT governance, unification, and workflow efficiency. CONCLUSIONS: Smarter healthcare can be achieved by leveraging the full capabilities of devices, data, and sophisticated algorithms.

Clinical Usefulness of Point-of-care Test Chemistry Analyzer in Neonatal Intensive Care Unit

PURPOSE: Point-of-care tests (POCTs) have the potential to significantly influence management of neonates. The aim of this study was to assess the clinical usefulness of the POCT chemistry analyzer in a neonatal intensive care unit (NICU). METHODS: Blood samples of neonates admitted to the NICU were tested using a POCT chemistry analyzer (Piccolo Xpress Chemistry Analyzer, Abaxis, Union City, CA, USA) and a central laboratory chemical analyzer (Chemistry analyzer 7600-110, Hitachi Ltd., Tokyo, Japan) from March to September, 2010. Correlation of 15 analytes between the POCT and the central laboratory machine was evaluated. For consistency of the POCT, three consecutive samplings were performed. Differences among the three tests were recorded. The causes of performance errors were checked through log files. RESULTS: One hundred of 112 pairs of tests for accuracy performed in 54 neonates showed a high correlation between the two machines. Twelve performance errors occurred during the 112 tests. The most common error was insufficient sample error. Eighteen triplet tests performed in 18 patients for consistency revealed a difference range of 3-10%, which was considered to be acceptable. No error occurred during the 54 tests. CONCLUSION: The POCT is capable of analyzing multiple analytes with a minimal amount of whole blood in a short time. The few performance errors noted presently are likely preventable. This POCT is concluded to be suitable for use as a simple and rapid diagnostic method in the NICU with a minimal amount of blood collected in a less invasive manner.

Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis

BACKGROUNDS/AIMS: For patients with acute cholecystitis, conversion from laparoscopic cholecystectomy to open surgery is not uncommon due to possibilities of serious hemorrhage at the liver bed and bile duct injury. Recent studies reported successful laparoscopic subtotal cholecystectomy for acute cholecystitis. The purpose of this study was to determine the efficacy and feasibility of such an operation based on the experience of surgeons at our facility. METHODS: In this study, we enrolled 144 patients who had received either laparoscopic subtotal cholecystectomy (LSC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC) for acute cholecystitis from January 2004 to December 2009 at the Department of Surgery of our hospital. Their symptoms, signs, operative findings, pathologic results and postoperative results were compared and analyzed. RESULTS: There were 26 patients in the LSC group 80 in the LC group and 38 in the OC group. There were no differences in mean age, sex, and symptoms of acute cholecystitis. The LSC group showed higher CRP levels (p<0.001) and a higher grade according to the Tokyo criteria (p=0.001). The mean operative time was 115.6 minutes and mean blood loss was 158.9 ml without intra-operative or postoperative transfusion. There weren't any bile duct injuries during the operation. No group suffered bile leakage. Drains were removed 3.3 days after the operation in the LC group, the shortest time compared to the other groups (p<0.001). LC and LSC groups demonstrated shorter postoperative hospital days and time to diet resumption than the OC group (p<0.001). CONCLUSIONS: LSC appears to be a safe and effective treatment in cases of severe acute cholecystitis that require consideration of conversion to open surgery.

Results of Extracorporeal Membrane Oxygenation (ECMO) Support before Coronary Reperfusion in Cardiogenic Shock with Acute Myocardial Infarction

BACKGROUND: Despite aggressive treatment, the mortality rate of cardiogenic shock with acute myocardial infarction (AMI) is high. We performed extracorporeal membrane oxygenation (ECMO) prior to coronary reperfusion, and evaluated the early clinical results and risk factors. MATERIALS AND METHODS: From May 2006 to November 2009, we reviewed the medical records of 20 patients in cardiogenic shock with AMI (mean age 67.7+/-11.7 yrs, M : F 14 : 6). After initially performing ECMO using the CAPIOX emergency bypass system (EBS(R)Terumo, Tokyo, Japan), patients underwent coronary reperfusion (coronary artery bypass grafting, 13; percutaneous coronary intervention, 7). RESULTS: All patients were in a cardiogenic shock state, cardiopulmonary resuscitations (CPR) were performed for fourteen patients (mean CPR time 20.8+/-26.0 min). The mean time from vascular access to the initiation of ECMO was 17.2+/-9.4 min and mean support time was 3.8+/-4.0 days. Fourteen patients were able to be weaned from ECMO and ten patients were discharged (mean admission duration 50.1+/-31.6 days). Patients survived on average 476.6+/-374.6 days of follow-up. Longer CPR and support time, increased cardiac enzyme, lower ejection fraction, lower albumin, and major complications were the risk factors of mortality (p<0.05). CONCLUSION: The early application of ECMO prior to coronary reperfusion and control of risk factors allowed for good clinical results in cardiogenic shock with AMI.