The Key Ripper: a specialized fixed suture-cutting device to facilitate drain removal.

The removal of post-surgical drains requires suture cutting. We developed a novel and specialized device that can safely remove the threads fixing the drains, making drain removal safer and easier than the current removal approach using scissors or a scalpel.

From "content" to "competence": A cross-cultural analysis of pedagogical praxis in a Chinese science lesson.

This research is based on an approach that looks at cross-cultural research design as a "lens" for a deeper understanding of what goes on in the classroom. The research question is how a cross-cultural study like this one can lead to identifying the cultural script of teaching and help educators reflect on their practice. In this context, Chinese lessons could be described as a case-based study of pedagogical reasoning that drives a shift from focusing on "content" to "competence". This article draws on qualitative data collected by the researchers and a cross-cultural analysis of a science lesson in an elementary school in Beijing, China. Using the Japanese educators' critiques and Chinese reviews, the article determines the cultural script of teaching science (the first research question) and the way Chinese teachers reflect on their practice through the Japanese lens (the second research question). This study exposes the importance of teachers' understanding and reflecting on their practice, technically, practically, and critically. The analysis results show how teachers learn to change their lenses, to reflect on their teaching and reconstruct their understanding about teacher professionalism through at least four basic elements: didactics, praxis, pedagogy, and theory.

Impact of clinical characteristics of colonic diverticular bleeding in extremely elderly patients treated with direct oral anti-coagulant drugs: a retrospective multi-center study.

Since there were no available data about colonic diverticular bleeding in extremely elderly patients (>80 years old) treated with direct oral anticoagulants (DOACs), we tried to determine clinical characteristics in those with colonic diverticular bleeding taking DOACs and to compare clinical outcomes of those in DOAC-treated to those in warfarin-treated . We enrolled DOAC-treated (n = 20) and warfarin-treated (n = 23) extremely elderly patients with diverticular bleeding diagnosed by colonoscopy. We performed a retrospective review of patients' medical charts and endoscopic findings. We classified colonic diverticular bleeding based on endoscopic features due to modified previous study following three groups, type A (active bleeding), type B (non-active bleeding) and type C (bleeding suspected). Clinical outcomes such as number of recurrent bleeding, thrombotic events and mortality were estimated. There were no differences in endoscopical features and clinical characteristics between patients treated with DOAC and warfarin therapy. However, the number of recurrent bleeding, frequency of required blood transfusions and units of blood transfusion in warfarin-treated patients were significantly higher (p<0.05) compared to those in DOAC-treated groups. In addition, mortality and thrombotic events did not differ between DOAC- and warfarin-treated patients. Clinical outcomes suggest that DOACs can be recommended for extremely elderly patients with colonic diverticular disease.

Azacitidine-associated haemorrhagic enteritis in a case of myelodysplastic syndrome: A case report.

WHAT IS KNOWN AND OBJECTIVE: 5-Azacitidine (AZA) is an agent widely used to treat myelodysplastic syndrome (MDS). CASE DESCRIPTION: We herein report an 83-year-old woman diagnosed with MDS who was treated with AZA. She tolerated the first cycle of AZA; however, severe adverse events involving haemorrhagic enteritis with multiple intestinal ulcers developed after the second and third cycles. Additionally, the interval between the administration of AZA and the development of haematochezia shortened with each cycle of AZA. WHAT IS NEW AND CONCLUSION: We herein report as-yet-undescribed potential side effects, AZA-associated haemorrhagic enteritis that should be kept in mind.

Biliary tract bleeding with obstructive jaundice after endoscopic ultrasound-guided fine-needle aspiration of a pancreatic head tumor.

BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe procedure and extraintestinal bleeding after EUS-FNA is rare. Two cases of biliary tract bleeding after EUS-FNA was reported, but no case of biliary hemorrhage with obstructive jaundice after EUS-FNA of pancreatic head tumor has been reported. We discuss one such case, the pitfalls encountered during EUS-FNA and how they were overcome. CASE PRESENTATION: A 78-year-old man suspected of pancreatic head cancer was introduced to our hospital for pathological examination by EUS-FNA. Because he took antithrombotic drugs, we performed EUS-FNA after withdrawal of the drugs and replacement by heparin. The next day after EUS-FNA, obstructive jaundice was suspected by hematologic examination. Endoscopic retrograde cholangio-pancreatography was carried out and biliary tract bleeding was observed. We diagnosed obstructive jaundice due to hemobilia and inserted an endonasal biliary drainage tube. During the following period, the bleeding stopped and total bilirubin decreased. On the 15th hospital day, he was transferred to another hospital for pre-operative examination. CONCLUSION: Biliary tract bleeding after EUS-FNA is quite rare but endosonographers must appreciate and deal appropriately with this adverse event.

A novel case of functional gastric neuroendocrine carcinoma occurred after endoscopic submucosal dissection.

In Japan, endoscopic submucosal dissection (ESD) is becoming a standard treatment for intramucosal differentiated gastric cancer. Although ESD is associated with a high cure rate for patients with early gastric cancer, tumors may recur, albeit rarely. We performed ESD on an 80-year-old man with a small depressed type of gastric cancer of the posterior wall of the cardia, found to be locally invasive on histology. Thirty months later, local recurrence and multiple liver metastases were detected, accompanied by frequent severe hypoglycemia. Despite chemotherapy, the patient died 6 months after relapse. On autopsy, the recurrent gastric lesion and liver metastases were examined immunohistochemically. Several characteristic tumor cells were positive for chromogranin A, cluster of differentiation (CD) 56, Ki-67, and insulin-like growth factor (IGF)-II. Western blot analysis of the patient's serum obtained during a hypoglycemic attack showed the high molecular weight form of IGF-II or "big" IGF-II. The patient was diagnosed with non-islet cell tumor hypoglycemia (NICTH), with "big" IGF-II being produced by the gastric neuroendocrine carcinoma. This is the novel case of a functional gastric neuroendocrine carcinoma that occurred after ESD and induced a hypoglycemic attack associated with NICTH.

Mean corpuscular volume (MCV) and the risk of colorectal adenoma in menopausal women.

BACKGROUND/AIMS: It has been reported that alcohol intake and folate deficiency are associated with an increased risk of colorectal adenomas and carcinomas. Mean corpuscular volume is increased under these conditions. We have reported that the mean corpuscular volume was higher in patients with adenoma than without adenoma in middle-aged men. The aim of this study was to assess the association between mean corpuscular volume and risk of colorectal adenoma in menopausal women. METHODOLOGY: The subjects were 415 menopausal women who underwent both barium enema examination and total colonoscopy, and their blood samples were analyzed. The subjects were divided into two groups with or without adenoma, and were divided into four groups according to the mean corpuscular volume value. Various variables were compared among the groups, and the odds ratios of adenoma were calculated. RESULTS: The mean corpuscular volume was higher in patients with adenoma than without adenoma (P = 0.002). As for the mean corpuscular volume value, the odds ratio (95% CI) of patients with adenoma was 1.00 (referent); (mean corpuscular volume (fl) < 90), 1.50 (0.93-2.07); (> or = 90 but < 92.5), 1.52 (0.97-2.07); (> or = 92.5 but < 95) and 2.87 (2.25-3.45); (> or = 95). CONCLUSIONS: Mean corpuscular volume > or = 95 may be used as an index of the risk for colorectal adenomas in menopausal women.