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Background Previous studies have suggested that postoperative non-steroidal anti-inflammatory drug (NSAID) use may increase the risk of anastomotic leakage after colorectal surgery. However, the association between NSAIDs and anastomotic leakage after oesophagectomy is unclear. The aim of this retrospective study was to assess the effect of early postoperative NSAID use on anastomotic leakage after oesophagectomy. Methods The Data of patients who underwent oesophagectomy for cancer between July 2010 and March 2019 were extracted from a Japanese nationwide inpatient database. Stabilized inverse probability of treatment weighting (IPTW), propensity score matching, and instrumental variable analyses were performed to investigate the association between NSAID use in the early postoperative period (defined as the day of and the day after surgery) and short-term outcomes, adjusting for potential confounders. The primary outcome was anastomotic leakage. The secondary outcomes were acute kidney injury, gastrointestinal bleeding, and mortality. Results Among 39 418 eligible patients, early postoperative NSAIDs were used by 16 211 individuals (41 per cent). Anastomotic leakage occurred in 5729 patients (15 per cent). In stabilized IPTW analyses, NSAIDs were not associated with anastomotic leakage (odds ratio 1.04, 95 per cent c.i. 0.97 to 1.10). The proportions of acute kidney injury and gastrointestinal bleeding, as well as 30-day mortality and in-hospital mortality, did not differ according to NSAID use. Propensity score matching and instrumental variable analyses demonstrated similar results. Conclusion Early postoperative NSAID use was not associated with anastomotic leakage or other complications in patients who underwent oesophagectomy.

Vanillin is one of the platform chemicals in industry, which is used not only as a traditional fragrance but also as a raw material for medicines and polymer materials. Industrial vanillin production by alkaline aerobic oxidation of lignin is carried out with degradation of lignosulfonate at temperatures around 170°C under pressurized air in the presence of Cu2+ as a catalyst. However, this method has problems such as low vanillin yields and by production of sulfur-containing wastewater, and various studies have been conducted to solve them. Research on the mechanism of the vanillin formation reaction by aerobic oxidation of lignin and the search for a method to control this reaction has also been conducted. In this chapter, we review relevant studies from the above perspective, mainly those conducted by the authors’ research group.

Studies have shown that epidural analgesia (EDA) is associated with a decreased risk of pneumonia and anastomotic leakage after esophagectomy, and several guidelines strongly recommend EDA use after esophagectomy. However, the benefit of EDA use in minimally invasive esophagectomy (MIE) remains unclear.The aim of this retrospective study was to compare the short-term outcomes between patients with and without EDA undergoing MIE for esophageal cancer.Data of patients who underwent oncologic MIE (April 2014-March 2019) were extracted from a Japanese nationwide inpatient database. Stabilized inverse probability of treatment weighting (IPTW), propensity score matching, and instrumental variable analyses were performed to investigate the associations between EDA use and short-term outcomes, adjusting for potential confounders.Among 12,688 eligible patients, EDA was used in 9954 (78.5%) patients. In-hospital mortality, respiratory complications, and anastomotic leakage occurred in 230 (1.8%), 2139 (16.9%), and 1557 (12.3%) patients, respectively. In stabilized IPTW, EDA use was significantly associated with decreased in-hospital mortality (odds ratio [OR] 0.46 [95% confidence interval 0.34-0.61]), respiratory complications (OR 0.74 [0.66-0.84]), and anastomotic leakage (OR 0.77 [0.67-0.88]). EDA use was also associated with decreased prolonged mechanical ventilation, unplanned intubation, nonsteroidal anti-inflammatory drug use, acetaminophen use, postoperative length of stay, and total hospitalization costs and increased vasopressor use. One-to-three propensity score matching and instrumental variable analyses demonstrated equivalent results.EDA use in oncologic MIE was associated with low in-hospital mortality as well as decreased respiratory complications, and anastomotic leakage, suggesting the potential advantage of EDA use in MIE.

We have proposed plausible reaction pathways involved in the chemical conversion of softwood lignin to vanillin through alkaline aerobic oxidation.

Treatment options for patients with resectable thoracic esophageal squamous cell cancer (ESCC) and synchronous head and neck cancer (HNC) are unclear. Little has been reported about the effects of chemotherapy on early HNC. The aim of this study was to investigate the treatment outcomes of resectable thoracic ESCC with synchronous early HNC. We retrospectively reviewed 37 patients undergoing esophagectomy for thoracic ESCC with synchronous early HNC from January 2008 to December 2018. Among 37 patients who had synchronous early HNC, 27 patients received preoperative therapy for ESCC before HNC treatment, and 16 of 27 patients achieved a complete response for HNC by preoperative chemotherapy. Fifteen of 16 patients did not receive additional treatment, and regional recurrence of HNC was not observed. In one other case, an oral excision was performed, but no cancer cell remnants were found pathologically. No significant difference in overall survival and disease-free survival was observed between 15 patients with follow-up and 22 patients with surgery or radiation. Our results indicate that early HNC with comorbid ESCC could be followed up without additional treatment if preoperative chemotherapy is successful.

To examine the association of BMI with mortality and related outcomes after oncologic esophagectomy.Previous studies showed that high BMI was a risk factor for anastomotic leakage and low BMI was a risk factor for respiratory complications after esophagectomy. However, the association between BMI and in-hospital mortality after oncologic esophagectomy remains unclear.Data for patients who underwent esophagectomy for esophageal cancer between July 2010 and March 2019 were extracted from a Japanese nationwide inpatient database. Multivariate regression analyses and restricted cubic spline analyses were used to investigate the associations between BMI and short-term outcomes, adjusting for potential confounders.Among 39,406 eligible patients, in-hospital mortality, major complications, and multiple complications (≥2 major complications) occurred in 1069 (2.7%), 14,824 (37.6%), and 3621 (9.2%), respectively. Compared with normal weight (18.5-22.9 kg/m2), severe underweight (16.0 kg/m2), mild/moderate underweight (16.0-18.4 kg/m2), and obese (≥27.5 kg/m2) were significantly associated with higher in-hospital mortality [odds ratio 2.20 (95% confidence interval 1.65-2.94), 1.25 (1.01-1.49), and 1.48 (1.05-2.09), respectively]. BMI showed U-shaped dose-response associations with mortality, major complications, and multiple complications. BMI also showed a reverse J-shaped association with failure to rescue (death after major complications).Both high BMI and low BMI were associated with mortality, major complications, and multiple complications after esophagectomy for esophageal cancer. Patients with low BMI were more likely to die once a major complication occurred. The present results can assist with risk stratification in patients undergoing oncologic esophagectomy.

Esophageal squamous cell carcinoma (ESCC) and head and neck (H&N) cancer coincide in high frequency and early detection of synchronous cancer is inevitable for these patients. The aim of this study is to analyze the effect of routine endoscopic screening for synchronous esophageal cancer in patients with H&N cancer. From April 2020 to March 2022, 35 patients with newly-diagnosed H&N cancer had routine screening endoscopy for synchronous esophageal cancer. All patients with H&N cancer were referred to our department prior to the treatment for H&N cancer. The locations of H&N cancers were oral/oropharyngeal/hypopharyngeal/laryngeal/other H&N cancer; 9/6/9/9/2 respectively. Image-enhanced endoscopy using BLI (blue laser imaging) was performed in all patients. Lugol staining was used in 20 patients and multiple Lugol voiding lesions were detected in 9 patients. Among all patients, abnormal endoscopic findings in esophagus were detected in 15 patients (43%), and biopsy was performed in 11 patients (31%). Biopsy revealed SCC in 5 patients and atypical epithelium in 2 patients. Esophageal lesions were all found in early stage within indication of endoscopic treatment. 3 patients underwent endoscopic treatment after treatment of H&N cancer. Routine endoscopic screening for patients with H&N cancer is effective in early detection of synchronous esophageal cancer with minimally invasive treatment for esophageal neoplasm. The treatment of chemotherapy for H&N cancer may be effective for esophageal lesions, therefore, careful surveillance is required during the treatment of H&N cancer. Routine endoscopy should be continued further for these patients for screening of metachronous cancer.

With the advent of a new program for postgraduate medical students in 2004, the number of applicants choosing surgical careers in Japan has been declining. We conducted this study to evaluate the impact of preclinical clerkship and how it affects students' attitudes toward a surgical career.The subjects of our study were fifth-year medical students who participated in a clinical clerkship in general surgery in our department between April 2021 and March 2022. We conducted pre- and post-preclinical clerkship surveys to assess the perceived image of surgeons and the impact of clerkship on surgical career interest.Among 132 medical students (77 men and 55 women) who rotated through preclinical clerkship in our department, 125 participated in the survey and 66% expressed interest in a surgical career. In the post-clerkship survey, an increased interest in a surgical career was expressed by 79% of the students; notably, including those who initially expressed interest. Approximately 77% of students were satisfied with the practical skill training they received.Engaging medical students early in surgical experience through a preclinical clerkship for general surgery appears to promote their interest in a surgical career.

Diabetes is known to be associated with anastomotic leakage (AL) after esophagectomy. However, it is unknown whether well-controlled diabetes is also associated with AL.We conducted a two-center retrospective cohort database study of patients who underwent oncological esophagectomy (2011-2019). Patients were divided into four groups: normoglycemia, pre-diabetes, well-controlled diabetes (hemoglobin A1c [HbA1c] 7.0%), and poorly controlled diabetes (HbA1c ≥ 7.0%). The occurrence of AL and length of stay were compared between groups using multivariable analyses. The relationship between categorical HbA1c levels and AL was also investigated in patients stratified by diabetes medication before admission.Among 1901 patients, 1114 (58.6%) had normoglycemia, 480 (25.2%) had pre-diabetes, 180 (9.5%) had well-controlled diabetes, and 127 (6.7%) had poorly controlled diabetes. AL occurred in 279 (14.7%) patients. Compared with normoglycemia, AL was significantly associated with both well-controlled diabetes (odds ratio 1.83, 95% confidence interval [CI] 1.22-2.74) and poorly controlled diabetes (odds ratio 1.95, 95% CI 1.23-3.09), but not with pre-diabetes. Preoperative HbA1c levels showed a J-shaped association with AL in patients without diabetes medication, but no association in patients with diabetes medication. Compared with normoglycemia, only poorly controlled diabetes was significantly associated with longer hospital stay after surgery, especially in patients with operative morbidity (unstandardized coefficient 14.9 days, 95% CI 5.6-24.1).Diabetes was associated with AL after esophagectomy even in well-controlled patients, but pre-diabetes was not associated with AL. Operative morbidity, including AL, in poorly controlled diabetes resulted in prolonged hospital stays compared with normoglycemia.

Bovine pneumonia is a disease that causes significant economic losses in livestock industries and is vital for animal welfare. The whole-genome sequence of Pasteurella multocida strain Pm1, isolated from a calf suffering from pneumonia in Japan, is reported here.

Vasa is an ATP-dependent RNA helicase of the DEAD (Asp-Glu-Ala-Asp) box family and a representative component of the germ plasm. In this study, we cloned the full-length vasa homolog in the bivalve Atrina pectinata (psvasa), and performed phylogenetic analysis, mRNA expression analysis for tissue-specific distributions, and immunostaining analysis to reveal its histological localization. The sequence of psvasa was 3587 bp in length and contained a 5' untranslated region of 150 bp, an open reading frame of 2214 bp, and a 3' untranslated region of 1223 bp. The deduced amino acid sequence of psvasa was 737 amino acids long and contained evolutionarily conserved sequences reported in other animals. The mRNA expression analysis showed the highest expression levels in the gonads. Expression was especially high in the ovaries, followed by the testes. The immunostaining analysis showed Vasa-positive cells in the developing gonads, suggesting the presence of putative germ stem cells contributing to the supply of germ cells. Furthermore, characteristic Vasa signals were observed in the basophilic nuclei of the oocytes, suggesting that psvasa plays an important role in the progression of meiosis in oocytes.

Gonadotropin-releasing hormone (GnRH) plays an important role in reproduction in both vertebrates and invertebrates; however, little is known about GnRH during gonadal development in bivalves. We developed a time-resolved fluoroimmunoassay (TR-FIA) for Manila clam Ruditapes philippinarum GnRH (rpGnRH) and measured the amount of rpGnRH in the cerebral ganglion (CG) and sex steroid hormones in the hemolymph during gonadal development. The cross-reactivity of the anti-rpGnRH antibody against other forms of GnRH was0.15%, and the displacement curve obtained for serially diluted CG extracts was parallel to the rpGnRH standard curve, confirming the suitability of the TR-FIA system. Based on histological observation, gonadal development of the clams was classified into early developing (stage 1), late developing (stage 2), ripe (stage 3), and partially spent (stage 4). In female clams, rpGnRH levels in the CG peaked at stage 1, and 17β-estradiol (E2) levels in the hemolymph peaked at stage 2. The rpGnRH levels in males and hemolymph testosterone levels in both sexes did not differ significantly across stages. Hemolymph E2 levels in males were below the detection limit for the TR-FIA. These results suggest that rpGnRH and E2 secretion in females can activate ovarian development of the Manila clam at the early and late developing stages, respectively.