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Purpose The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for surgical staffs to minimize exposure to COVID-19 or save medical resources without harmful patient outcomes, in accordance with the statement of each surgical society. No research has empirically validated declines in surgical volume in Japan, based on the usage of surgical triage. We aimed to identify whether the announcement of surgical priorities by each Japanese surgical society may have affected the surgical volume decline during the 1st wave of this pandemic. Methods We extracted 490,719 available cases of patients aged > 15 years who underwent elective major surgeries between July 1, 2018, and June 30, 2020. After the categorization of surgical specialities, we calculated descriptive statistics to compare the year-over-year trend and conducted an interrupted time series analysis to validate the decline of each surgical procedure. Results Monthly surgical cases of eight surgical specialities, especially ophthalmology and ear/nose/throat surgeries, decreased from April 2020 and reached a minimum in May 2020. An interrupted time series analysis showed no significant trends in oncological and critical surgeries. Conclusion Non-critical surgeries showed obvious and statistically significant declines in case volume during the 1st wave of the COVID-19 pandemic according to the statement of each surgical society in Japan. Supplementary Information The online version contains supplementary material available at 10.1007/s00595-021-02286-6.

BackgroundMaintaining critical care for non-Coronavirus-disease-2019 (non-COVID-19) patients is a key pillar of tackling the impact of the COVID-19 pandemic. This study aimed to reveal the medium-term impacts of the COVID-19 epidemic on case volumes and quality of intensive care for critically ill non-COVID-19 patients.MethodsAdministrative data were used to investigate the trends in case volumes of admissions to intensive care units (ICUs) compared with the previous years. Standardized mortality ratios (SMRs) of non-COVID-19 ICU patients were calculated in each wave of the COVID-19 epidemic in Japan.ResultsThe ratios of new ICU admissions of non-COVID-19 patients to those in the corresponding months before the epidemic: 21% in May 2020, 8% in August 2020, 9% in February 2021, and 14% in May 2021, approximately concurrent with the peaks in COVID-19 infections. The decrease was greatest for new ICU admissions of non-COVID patients receiving mechanical ventilation (MV) on the first day of ICU admission: 26%, 15%, 19%, and 19% in the first, second, third, and fourth waves, respectively. No statistically significant change in SMR was observed in any wave of the epidemic; SMRs were 0.990 (95% confidence interval (CI), 0.962-1.019), 0.979 (95% CI, 0.953-1.006), 0.996 (95% CI, 0.980-1.013), and 0.989 (95% CI, 0.964-1.014), in the first, second, third, and fourth waves of the epidemic, respectively.ConclusionsCompared to the previous years, the number of non-COVID-19 ICU patients continuously decreased over the medium term during the COVID-19 epidemic. The decrease in case volumes was larger in non-COVID-19 ICU patients initially receiving MV than those undergoing other initial treatments. The standardized in-hospital mortality of non-COVID-19 ICU patients did not change in any waves of the epidemic.EYWORDSIntensive care unit, COVID-19, mechanical ventilation, in-hospital mortality

Background: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for medical staff worldwide, especially for those working in hospitals in which COVID-19-positive or -suspected patients are being treated. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, that could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals.Methods: In this retrospective cohort study, we extracted the data of elderly patients (age >65 years) who received dementia care in acute care hospitals to which COVID-19-positive or -suspected patients were admitted between July 1, 2018 and June 30, 2020. We calculated descriptive statistics to compare the year-on-year trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint.Results: The year-on-year trend in the number of patients who were physically restrained per 1,000 hospital admissions increased after the government’s announcement of COVID-19 restrictions, with a maximum incidence of 111.4% between the 47th and 48th week after the announcement. Additionally, a significant increase in the use of physical restraints in elderly dementia patients was noted (p=.002).Conclusions: Elderly dementia patients who required personal care experienced an obvious and significant increase in the use of physical restraints during the COVID-19 pandemic. Understanding the causes and mechanisms underlying an increased use of physical restraints in dementia patients can help design more effective care protocols for similar future situations.

Background: Recent researches reported the impact of the coronavirus disease 2019 (COVID - 19) pandemic on the clinical practice of specific type cancers. The aim of this study was to reveal the impact of the COVID-19 outbreak on the clinical practice of various cancers. Methods: We included hospitalized patients aged 18 years or older diagnosed between July 2018 and June 2020 with one of the top 12 most common cancers in Japan (colon/rectum, lung, gastric, breast, bladder & urinary tract, pancreas, non-Hodgkin lymphoma, liver, prostate, esophagus, uterus, and gallbladder & biliary tract) using Diagnostic Procedure Combination data, an administrative database in Japan. The intervention was defined April 2020 based on a declaration of emergency from Japanese government. The change volume of number of monthly admissions with each cancer was tested by interrupted time series (ITS) analysis, and monthly cases with radical surgery or chemotherapy for each cancer were descripted. Results: 403,344 cases were included during the study period. The most common cancer was colon/rectum (20.5%), followed by lung (17.5%). In almost cancer cases, the number of admissions decreased in May 2020. In particular, colorectal, lung, gastric, breast, uterine, or esophageal cancer cases decreased by over 10%. The number of admissions with surgery or chemotherapy decreased in colorectal, lung, gastric, breast, uterine, or esophageal cancer. ITS analysis indicated that cases with gastric or esophageal cancer were affected more than other type of cancer. Conclusions: The COVID-19 outbreak has a negative impact on the number of admission cases with cancer; the magnitude of impact varied by cancer diagnosis.

Silicalite-1 membranes with high pervaporation (PV) performance were prepared on a seeded tubular silica support using modified steam-assisted conversion (SAC) under gel-free conditions, called the gel-free SAC method, for the first time. The seeded support was first dipped in a TPAOH aqueous solution and dried. Subsequently, the TPAOH-coated silicalite-1 seed layer was converted into a silicalite-1 membrane layer, followed by heating in an autoclave with a small amount of water at the bottom of the autoclave. In this method, silica support was not only used as the support but also as the silica source to grow the zeolite seed layer into a continuous and dense zeolite membrane layer. In other words, no additional supply of silica source such as synthesis gel to grow the seed layer was required. The silicalite-1 membrane prepared in this study had a separation layer with a thickness of approximately 7 µm and exhibited high PV performance with a separation factor of 66 and high flux of 4.47 kg m −2 h −1 for 10 wt% ethanol/water mixtures at 323 K. This membrane preparation method is quite simple and uses minimum necessary reagents. Therefore, it is economical and suitable for the preparation of membranes on an industrial scale.

Production of bioethanol, a renewable energy source, is limited by the costly, energy-consuming concentration processes involved. Membrane separation techniques have emerged as promising alternatives to overcome these limitations. In this study, silicalite-1 zeolite membranes with high pervaporation (PV) performance were prepared on porous tubular silica supports by a secondary growth method. The effects of the deposited seed amount on the support and synthesis parameters, namely, the tetra- n -propylammonium concentration (TPA + /Si), alkalinity (OH − /Si), and crystallization time, were investigated. A dense zeolite layer was formed between the typical columnar crystal layer of silicalite-1 membranes and the silica support. The PV performance was mainly dependent on the thickness of the dense layer: as the thickness increased, the separation factor increased. The silicalite-1 membrane prepared using a synthesis solution with a molar composition of 1SiO 2 :0.05TPABr:0.08NaOH:75H 2 O at 433 K for 8 h exhibited the highest separation performance with a separation factor of 92 and a flux of 3.00 kg m −2 h −1 for 10 wt% ethanol/water mixtures at 323 K, which is the best result reported to date for tubular supports. Thus, silica supports proved to be suitable for the preparation of high-performance silicalite-1 membranes for ethanol/water mixture separation.

Silicalite-1 membranes with high pervaporation performance were prepared successfully on a silica-particle-coated tubular silica support using a gel-free steam-assisted conversion (SAC) method. The effects of the silica-particle layer formed on the top surface of the silica support and the physical properties of the silica particles themselves on the membrane-formation process were investigated. The silica particles coated served as the additional silica source for growing the silicalite-1 seed crystal layer into the silicalite-1 membrane. As a result, it was possible to form a dense and continuous membrane even under gel-free conditions. Furthermore, it was found that the properties of the silica particles, such as their primary particle diameter, had a determining effect on their solubility during the steam treatment, that is, on the supply rate of the silica source. The silicalite-1 membrane obtained using the spherical-silica-particle-coated support had an approximately 9-&mu, m-thick separation layer and showed very high pervaporation performance, exhibiting a separation factor of 105 and a flux of 3.72 kg m&minus, 2 h&minus, 1 for a 10 wt % ethanol/water mixture at 323 K. Thus, the gel-free SAC method can be used with a silica support coated with silica particles to readily prepare high-performance membranes without producing any chemical waste.

Intra-operative autologous blood donation is a blood conservation technique with limited evidence. We evaluated the association between intra-operative autologous blood donation and decrease in peri-operative transfusion in cardiovascular surgery based on evidence from a Japanese administrative database. We extracted the data of patients who had undergone cardiovascular surgery from the Diagnosis Procedure Combination database in Japan (2016–2019). Based on the surgery type, we examined the association of intra-operative autologous blood donation with the transfusion rate and amount of blood used in cardiac and aortic surgeries using multilevel propensity score matching. We enrolled 32, 433 and 4, 267 patients who underwent cardiac and aortic surgeries and received 5.0% and 6.7% intra-operative autologous blood donation with mean volumes of 557.68 mL and 616.96 mL, respectively. The red blood cell transfusion rates of the control and intra-operative autologous blood donation groups were 60.6% and 38.4%, respectively, in the cardiac surgery cohort (p < .001) and 91.4%, and 83.8%, respectively, in the aortic surgery cohort (p = .037). The transfusion amounts for the control and intra-operative autologous blood donation groups were 5.9 and 3.5 units of red blood cells, respectively, for cardiac surgery patients (p < .001) and 11.9 and 7.9 units, respectively, for aortic surgery patients (p < .001). Intra-operative autologous blood donation could reduce the transfusion rate or amount of red blood cells and fresh frozen plasma for patients undergoing index cardiovascular surgery and could be an effective blood transfusion strategy in cardiovascular surgery for Japanese patients., 心臓外科手術における効果的な輸血戦略を検証 --コロナ禍の献血不足対策として--. 京都大学プレスリリース. 2021-03-16.

A MFI zeolite membrane was synthesized on a porous silica substrate. The defect-free MFI zeolite membrane was synthesized via a secondary growth method using seed crystals (Si/Al = 20) on a silica substrate in a parent gel of Si/Al = 100. The silica substrate prevented the dissolution of the seed crystals during the synthesis to promote the MFI zeolite membrane synthesis. The MFI zeolite membranes were employed for a contactor-type reactor for methanol-to-olefins (MTO) reactions to produce olefins, such as propylene. The methanol conversion was 99.9% with the selectivity of ethylene - pentene at 91.5% for the permeate side of the membrane contactor. The propylene selectivity was high at 48.5% with the C3H6/C3H8 ratio at 236.

Background In response to the coronavirus diseases 2019 (COVID-19) pandemic, the Japanese government declared a state of emergency on April 7, 2020. Six days earlier, the Japan Surgical Society had recommended postponing elective surgical procedures. Along with the growing public fear of COVID-19, hospital visits in Japan decreased. Methods Using claims data from the Quality Indicator/Improvement Project (QIP) database, this study aimed to clarify the impact of the first wave of the pandemic, considered to be from March to May 2020, on case volume and claimed hospital charges in acute care hospitals during this period. To make year-over-year comparisons, we considered cases from July 2018 to June 2020. Results A total of 2,739,878 inpatient and 53,479,658 outpatient cases from 195 hospitals were included. In the year-over-year comparisons, total claimed hospital charges decreased in April, May, June 2020 by 7%, 14%, and 5%, respectively, compared to the same months in 2019. Our results also showed that per-case hospital charges increased during this period, possibly to compensate for the reduced case volumes. Regression results indicated that the hospital charges in April and May 2020 decreased by 6.3% for hospitals without COVID-19 patients. For hospitals with COVID-19 patients, there was an additional decrease in proportion with the length of hospital stay of COVID-19 patients including suspected cases. The mean additional decrease per COVID-19 patient was estimated to 5.5 million JPY. Conclusion It is suggested that the hospitals treating COVID-19 patients were negatively incentivized.

A hydrophobic pure-silica *BEA-type zeolite membrane was prepared using the steam-assisted conversion (SAC) method on a seeded tubular silica support coated with dilute synthetic gel. This study systematically investigates the effects of the synthetic conditions on the membrane formation process and separation performance. Under the optimized conditions, when using a dilute synthetic gel with a H2O/SiO2 ratio of 500, a dense and continuous membrane layer was formed in 24 h. This was attributed to dissolution of the surface of the silica support during the steaming process, which functions as a silica source for the growth of a seed crystal layer. An increase in silica the concentration on the support surface locally enabled the formation of a membrane under the dilute synthetic gel composition. The obtained membrane exhibited selectivity toward n-butanol, in addition to a high flux with a separation factor of 132 and a flux of 1.00 kg m−2h−1 for a 1 wt% n-butanol/water mixture at 318 K. This novel simple membrane formation method combines a dilute synthesis gel with SAC, takes advantage of the dissolution of a silica support, and reduces the consumption and cost of chemical raw materials used for membrane synthesis.

Pheochromocytoma is complicated with catecholamine cardiomyopathy, and preoperative care becomes considerably more difficult We report anesthetic management for an 48-year-old man brought to our hospital by ambulance and immediately hospitalized due to pheochromocytoma crisis complicated with catechol- amine cardiomyopathy presenting inverted-takotsubo pattern asynergy. Before surgery, α and β blocking drugs were used to control hypertension and tachycardia, and continuous hemodiafiltration was initiated and the patient was intubated for severe pulmonary edema. Seven days later, he underwent laparoscopic adrenalectomy. Total intravenous anesthesia was achieved with propofol, remifentanil, fentanyl, and rocuronium. During the operation, continuous infusion of landiolol, phentolamine, and nitroglycerin, and addi- tional bolus injections of landiolol were given to control hypertension. After severing the right adrenal vein, noradrenaline (0.15 μg · kg⁻¹ · min⁻¹), and dopamine (4μg · kg⁻¹ · min⁻¹) were started and the patient was placed in the intensive care unit Inverted-takotsubo pattern asynergy is not very common, and treatment consists of supportive care, as in the usual takotsubo. Preoperative CHDF (continuous hemodiafiltration) may be useful when it is difficult to control hypertension or tachycardia with medications.

In this study, silicalite-1 membranes were prepared on seeded tubular silica supports using a gel-free steam-assisted conversion (SAC) method. The effects of seed crystal type on the growth and microstructure of the membranes were investigated. The morphologies of the membranes obtained by this preparation method reflected the orientation of the seed crystal layer covering the tubular support; when spherical seed crystals were used, the membrane surface was composed of randomly oriented crystals; whereas when coffin-type seed crystals were used, the membrane surface was composed of crystals arranged in a relatively b-axis orientation. This suggests that membrane layers can be grown with the same orientation as the seed crystals on the tubular support. That is, the gel-free SAC method is able to suppress changes in the orientation of zeolite crystals during membrane formation, which is a problem in conventional hydrothermal syntheses. This is a very interesting phenomenon that occurs only under gel-free SAC conditions, and accounts for the successful growth of the b-oriented silicalite-1 membrane layer on the tubular support. Our findings successfully demonstrate approaches for the formation of membrane layers that retain the orientation of zeolite seed crystals on tubular supports, and for the synthesis of oriented zeolite membranes with high permeability.