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Introduction Advances in diagnostic technologies have resulted in an increase in patients with synchronous cancers. We report robotic hemicolectomy and robotic partial nephrectomy via a posterior approach. Case presentation A 72‐year‐old woman presented with synchronous ascending colon and right kidney cancers. We performed simultaneous robotic right hemicolectomy and robotic right partial nephrectomy. The renal tumor was located in a posterior and mid‐lower pole of the kidney, we positioned the ports similar to the retroperitoneal approach and to gain a confronting approach to the tumor. Conclusion Considering preoperative evaluations and intraoperative conditions comprehensively, it is essential to flexibly adapt to the appropriate surgical position and port arrangement to perform the surgery with consideration for oncological principles.

Abstract Background Venous air trap chamber designs vary considerably to suit specific continuous renal replacement therapy circuits, with key variables including inflow design and filter presence. Nevertheless, intrachamber flow irregularities do occur and can promote blood coagulation. Therefore, this study employed computational fluid dynamics (CFD) simulations to better understand how venous air trap chamber designs affect flow. Methods The flow within a venous air trap chamber was analyzed through numerical calculations based on CFD, utilizing large eddy simulation. The working fluid was a 33% glycerin solution, and the flow rate was set at 150 ml/min. A model of a venous air trap chamber with a volume of 15 ml served as the computational domain. Calculations were performed for four conditions: horizontal inflow with and without a filter, and vertical inflow with and without a filter. Streamline plots and velocity contour plots were generated to visualize the flow. Results In the horizontal inflow chamber, irrespective of filter presence, ultimately the working fluid exhibited a downstream vortex flow along the chamber walls, dissipating as it progressed, and being faster near the walls than in the chamber center. In the presence of a filter, the working fluid flowed uniformly toward the outlet, while in the absence of a filter the flow became turbulent before reaching the outlet. These observations indicate a streamlining effect of the filter. In the vertical inflow chamber, irrespective of filter presence, the working fluid flowed vertically from the inlet into the main flow direction. Part of the working fluid bounced back at the chamber bottom, underwent upward and downward movements, and eventually flowed out through the outlet. Stagnation was observed at the top of the chamber. Without a filter, more working fluid bounced back from the bottom of the chamber. Conclusions CFD analysis estimated that the flow in a venous air trap chamber is affected by inflow method and filter presence. The “horizontal inflow chamber with filter” was identified as the design creating a smooth and uninterrupted flow throughout the chamber.

Abstract Background POCUS training courses are effective at improving knowledge and skills, but few studies have followed learners longitudinally post-course to understand facilitators, barriers, and changes in POCUS use in clinical practice. We conducted a prospective observational study of physicians who attended 11 standardized POCUS training courses between 2017 and 2019 in Japan. Physicians who attended a standardized POCUS course were surveyed about their current frequency of POCUS use of the heart, lung, abdomen, and lower extremity veins, and perceived barriers and facilitators to POCUS use in clinical practice. Results Data were analyzed from 112 completed surveys (response rate = 20%). A majority of responding physicians were faculty (77%) in internal medicine (69%) affiliated with community hospitals (55%). The mean delay between course attendance and survey response was 50.3 months. A significant increase in POCUS use from 4 years after attending a POCUS training course. In addition to improving access to ultrasound machines and training opportunities, a supportive local clinical environment, including colleagues to share experiences in learning POCUS and local experts to supervise scanning, is important to foster ongoing POCUS practice and implementation into clinical practice.

Abstract The aims of this study were to determine the prevalence and predictors of nocturnal polyuria (NP) in Japanese patients. This multicentral, observational study enrolled patients with the chief complaint of nocturia at 17 Japanese institutions between January 2018 and December 2022. The frequency of daily voiding and volume of urination were evaluated using bladder diaries. NP was diagnosed in patients with an NP index of > 33%. The primary endpoint was NP prevalence in patients with nocturia. The secondary endpoints were the prevalence of NP according to sex and age and the identification of factors predicting NP. This study analyzed 875 eligible patients. NP was present in 590 (67.4%) patients, with prevalence rates of 66.6% and 70.0% in men and women, respectively. Age ≥ 78 years, body mass index (BMI)

Abstract Background An increased focus on quality and patient safety has led to the evolution of hospitalists. The number of hospitalists covering ward and outpatient care is on the rise in Japan. However, it is unclear what roles hospital workers themselves consider important in their practice. Therefore, this study investigated what hospitalists and non-hospitalist generalists in Japan consider important for the practice of their specialty. Methods This was an observational study that included Japanese hospitalists (1) currently working in a general medicine (GM) or general internal medicine department and (2) working at a hospital. Using originally developed questionnaire items, we surveyed the items important to hospitalists and non-hospitalist generalists. Results There were 971 participants (733 hospitalists, 238 non-hospitalist) in the study. The response rate was 26.1%. Both hospitalists and non-hospitalists ranked evidence-based medicine as the most important for their practice. In addition, hospitalists ranked diagnostic reasoning and inpatient medical management as the second and third most important roles for their practice, while non-hospitalists ranked inpatient medical management and elderly care as second and third. Conclusions This is the first study investigating the roles Japanese hospitalists consider important and comparing those to that of non-hospitalist generalists. Many of the items that hospitalists considered important were those that hospitalists in Japan are working on within and outside academic societies. We found that diagnostic medicine and quality and safety are areas that are likely to see further evolution as hospitalists specifically emphasized on them. In the future, we expect to see suggestions and research for further enhancing the items that hospital workers value and emphasise upon.

Abstract Background In Japan, the nurse practitioner (NP) system has only been in place for a short time, and there is no ultrasound (US) simulation course for NPs. Therefore, NPs may have to attend US simulation courses for physicians. We evaluated whether US simulation course for physicians lead to improved image acquisition and interpretation amongst NPs and, if so, if these changes would be maintained over time. Methods A 2-day point-of-care ultrasound (POCUS) course designed for physicians in cardiac US, lung US, lower extremity deep vein thrombosis (DVT) US, and abdominal US was held for Japanese nurse practitioners (JNP) and JNP trainees in 2018 and 2019. Participants kept a record of the number of US examinations they performed for 3 months before and 3 months after the course. The number of US exams performed was grouped into six categories. All participants underwent pre-course, immediate post-course, and 4-month post-course testing to assess image interpretation skills, image acquisition skills, and confidence. Results Thirty-three participants from 21 facilities completed the program. Before and immediately after the course, test scores of the image interpretation test, image acquisition test, and confidence increased significantly (37.1, 72.6: P

Purpose: Point-of-care ultrasound (POCUS) allows bedside clinicians to acquire, interpret, and integrate ultrasound images into patient care. Although the availability of POCUS training courses has increased, the educational effectiveness of these courses is unclear. Methods: From 2017 to 2019, we investigated the educational effectiveness of a standardized 2-day hands-on POCUS training course and changes in pre- and post-course exam scores in relationship to participants’ (n = 571) clinical rank, years of POCUS experience, and frequency of POCUS use in clinical practice. Results: The mean pre- and post-course examination scores were 67.2 (standard deviation [SD] 12.3) and 79.7 (SD 9.7), respectively. Higher pre-course examination scores were associated with higher clinical rank, more years of POCUS experience, and more frequent POCUS use (p < 0.05). All participants showed significant changes in pre- to post-course exam scores. Though pre-course scores differed by clinical rank, POCUS experience, and frequency of POCUS use, differences in post-course scores according to participant baseline differences were non-significant. Conclusion: A standardized hands-on POCUS training course is effective for improving POCUS knowledge regardless of baseline differences in clinical rank, POCUS experience, or frequency of POCUS use. Future studies shall evaluate changes in POCUS use in clinical practice after POCUS training.

We aimed to identify prognostic predictive factors of patients with penile squamous cell carcinoma (PSCC). This retrospective study reviewed the clinical and pathological data of patients with PSCC at 10 institutions in Japan between January 2008 and December 2019. The primary endpoint was cancer-specific survival (CSS). We also identified useful predictive factors for CSS in patients with PSCC. In total, 64 patients with PSCC were enrolled. At the end of the follow-up period, 15 patients (23.4%) died owing to PSCC and six (9.4%) died owing to other causes. The 2- and 3-year CSS rates were 78.9% and 76.6%, respectively. Using the Kaplan–Meier method, the Eastern Cooperative Oncology Group performance status 0, serum albumin levels ≥4.2 g/dL, hemoglobin levels ≥13.2 g/dL, C-reactive protein levels

We present the study on the relationship between supermassive black holes (SMBHs) and their host galaxies using our variability-selected active galactic nuclei (AGNs) sample ( i _AB ≤ 25.9 and z ≤ 4.5) constructed from the Hyper Suprime-Cam Subaru Strategic Program Ultradeep survey in the COSMOS field. We estimated the black hole (BH) mass ( M _BH = 10 ^5.5−10 M _⊙ ) based on the single-epoch virial method and the total stellar mass ( M _star = 10 ^10−12 M _⊙ ) by separating the AGN component with spectral energy distribution fitting. We found that the redshift evolution of the BH–stellar mass ratio ( M _BH / M _star ) depends on the M _BH , which is caused by no significant correlation between M _BH and M _star . Variable AGNs with massive SMBHs ( M _BH > 10 ^9 M _⊙ ) at 1.5 < z < 3 show considerably higher BH–stellar mass ratios (> ∼1%) than the BH–bulge ratios ( M _BH / M _bulge ) observed in the local Universe for the same BH range. This implies that there is a typical growth path of massive SMBHs, which is faster than the formation of the bulge component as final products seen in the present day. For the low-mass SMBHs ( M _BH < 10 ^8 M _⊙ ) at 0.5 < z < 3, on the other hand, variable AGNs show similar BH–stellar mass ratios with the local objects (∼0.1%), but smaller than those observed at z > 4. We interpret that host galaxies harboring less massive SMBHs at intermediate redshift have already acquired sufficient stellar mass, although high- z galaxies are still in the early stage of galaxy formation relative to those at the intermediate/local Universe.

Recently, cytoreductive prostatectomy for metastatic prostate cancer (mPCa) has been associated with improved oncological outcomes. This study was aimed at evaluating whether robot-assisted radical prostatectomy (RARP) as a form of cytoreductive prostatectomy can improve oncological outcomes in patients with mPCa. We conducted a retrospective study of twelve patients with mPCa who had undergone neoadjuvant therapy followed by RARP. The endpoints were biochemical recurrence-free survival, treatment-free survival, and de novo metastasis-free survival. At the end of the follow-up period, none of the enrolled patients had died from PCa. The 1- and 2-year biochemical recurrence-free survival rates were 83.3% and 66.7%, respectively, and treatment-free survival rates were 75.0% and 56.3%, respectively. One patient developed de novo bone metastases 6.4 months postoperatively, and castration-resistant prostate cancer 8.9 months postoperatively. After RARP, the median duration of recovery of urinary continence was 5.2 months. One patient had severe incontinence (>2 pads/day) 24 months postoperatively. RARP may be a treatment option in patients with mPCa who have achieved a serum prostate-specific antigen level < 0.2 ng/mL, and present without new lesions on imaging.

Abstract The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

The drag-reducing effects of two nonionic-type surfactants, oleyl-N, N-dimethylamine N-oxide (ODMAO) and octadecyl-N, N-bis(2-hydroxyethyl)amine N-oxide (C18BAO), in ethylene glycol (EG) aqueous solution were comprehensively investigated at various surfactant concentrations of up to 2000 ppm by weight at various solution temperatures ranging from −5 to 80 °C in turbulent pipe flows. In EG aqueous solution (30% by weight), the mixture of ODMAO with salicylic acid with a molar ratio of 0.2 could effectively reduce the turbulent drag in the low-temperature range (up to 40 °C), whereas the effect of C18BAO was more notable at a temperature higher than 40 °C. Furthermore, the mixture of ODMAO and C18BAO in EG aqueous solution exhibited a high drag reduction ratio of more than 60% in a considerably wider range of solution temperatures (from 20 to 60 °C), while the drag reduction performance deteriorated below 0 °C and beyond 60 °C.

Abstract Aim This study aimed to translate the TeamSTEPPS® Teamwork Perceptions Questionnaire (T‐TPQ) into Japanese and assess its validity and reliability. Design Translation of the T‐TPQ and a cross‐sectional survey. Methods Following a forward and back translation of the questionnaire, content validity was assessed by an expert panel using item‐level content validity index. Construct validity was assessed by a confirmatory factor analysis. Further, intraclass correlation coefficient was estimated by test–retest methods. Results A total of 587 healthcare professionals responded to the translated T‐TPQ. The item‐level content validity index ranged between 0.8 and 1.0, indicating an acceptable content validity. The multiple fit indices showed an acceptable fitting model. Fifty‐one healthcare professionals participated in the test–retest method. Intraclass correlation coefficients for all dimensions ranged from 0.838 to 0.957, indicating acceptable test–retest reliability. Our findings suggest that the Japanese version of the T‐TPQ has acceptable validity and reliability.

Most cases of anisakiasis occur in the stomach. Colonic anisakiasis, especially when asymptomatic, is extremely rare. We report a case of asymptomatic colonic anisakiasis and present a literature review of cases of colonic anisakiasis. A 52-year-old man underwent colonoscopy for colorectal cancer screening. Although no colorectal neoplasm was found, an Anisakis larva was detected in the transverse colon and the larva was removed by grasping forceps. Our review of PubMed revealed that 40% of cases of colonic anisakiasis are asymptomatic. We conclude that asymptomatic colonic anisakiasis may not be as rare as conventionally assumed.

Abstract Background Frailty results in a high risk for disability, hospitalization, and mortality. This study aimed to investigate perioperative details of frail patients who underwent pancreatectomy and whether frailty can be a predictive factor of postoperative complications, especially of clinically relevant postoperative pancreatic fistula (CR-POPF). Methods This retrospective study included patients who underwent pancreatectomy in our hospital between August 2016 and March 2019. The patients were divided into frail and pre-/non-frail groups. The diagnostic criteria were based on the Japanese version of the Cardiovascular Health Study. Results Of 93 patients, 11 (11.8%) and 82 (88.2%) were frail and pre-/non-frail patients, with median ages of 82 and 72 years, respectively (p = 0.041). Postoperative complications (Clavien-Dindo ≧ IIIa) were found in 8 and 32 patients (p = 0.034), CR-POPF in 3 and 13 patients (p = 0.346), and postoperative hospital stays were 21 and 17 days (p = 0.041), respectively. On multivariate analysis, frailty was an independent predictive factor (odds ratio [OR] 5.604, 95.0% confidence interval [CI] 1.002-30.734; p = 0.047) of postoperative complications (Clavien-Dindo ≧ IIIa) after pancreaticoduodenectomy. On multivariate analysis, a soft pancreas (OR 5.696, 95.0% CI 1.142-28.149; p = 0.034) was an independent and significant predictive factor of CR-POPF after pancreaticoduodenectomy. Conclusions Frailty may be a useful predictive factor of postoperative complications in patients undergoing pancreaticoduodenectomy.

We conducted a deep spectroscopic survey, named SSA22-HIT, in the SSA22 field with the DEep Imaging MultiObject Spectrograph (DEIMOS) on the Keck telescope, designed to tomographically map high- z H i gas through analysis of Ly α absorption in background galaxies’ spectra. In total, 198 galaxies were spectroscopically confirmed at 2.5 < z < 6 with a few low- z exceptions in the 26 × 15 arcmin ^2 area, of which 148 were newly determined in this study. Our redshift measurements were merged with previously confirmed redshifts available in the 34 × 27 arcmin ^2 area of the SSA22 field. This compiled catalog containing 730 galaxies of various types at z > 2 is useful for various applications, and it is made publicly available. Our SSA22-HIT survey has increased by approximately twice the number of spectroscopic redshifts of sources at z > 3.2 in the observed field. From a comparison with publicly available redshift catalogs, we show that our compiled redshift catalog in the SSA22 field is comparable to those among major extragalactic survey fields in terms of a combination of wide area and high surface number density of objects at z > 2. About 40% of the spectroscopically confirmed objects in SSA22-HIT show reasonable quality of spectra in the wavelengths shorter than Ly α when a sufficient amount of smoothing is adopted. Our data set enables us to make the H i tomographic map at z ≳ 3, which we present in a parallel study.

Key Clinical Message The chemotherapy guidelines for mixed adenoneuroendocrine carcinoma (MANEC) remain poorly defined, and prognosis remains dismal. In this case, we successfully performed resection after FOLFOX for unresectable metastatic MANEC of the liver. Thus, chemotherapy for adenocarcinoma may be effective for MANEC.

Abstract Background Few studies have compared the effectiveness of brief training courses on point-of-care ultrasound (POCUS) skill acquisition of novice attending physicians vs. trainees. The purpose of this study was to evaluate the change in POCUS image interpretation skills and confidence of novice attending physicians vs. trainees after a 1-day POCUS training course. Methods A 1-day POCUS training course was held in March 2017 in Japan. A standardized training curriculum was developed that included online education, live lectures, and hands-on training. The pre-course assessment tools included a written examination to evaluate baseline knowledge and image interpretation skills, and a physician survey to assess confidence in performing specific ultrasound applications. The same assessment tools were administered post-course, along with a course evaluation. All learners were novices and were categorized as trainees or attending physicians. Data were analyzed using two-way analysis of variance. Results In total, 60 learners attended the course, and 51 learners (85%) completed all tests and surveys. The 51 novice learners included 29 trainees (4 medical students, 9 PGY 1–2 residents, 16 PGY 3–5 residents) and 22 attending physicians (6 PGY 6–10 physicians, and 16 physicians PGY 11 and higher). The mean pre- and post-course test scores of novice trainees improved from 65.5 to 83.9% while novice attending physicians improved from 66.7 to 81.5% (p

Background/Aim: A genomic analysis based on next-generation sequencing is important for deciding cancer treatment strategies. Cancer tissue sometimes displays intratumor heterogeneity and a pathologic specimen may contain more than two tumor grades. Although tumor grades are very important for the cancer prognosis, the impact of higher tumor grade distribution in a specimen used for a genomic analysis is unknown. Patients and Methods: We retrospectively analyzed the data of 61 clear cell carcinoma and 46 prostate cancer patients that were diagnosed between December 2018 and August 2022 using the GeneRead Human Comprehensive Cancer Panel or SureSelect PrePool custom Tier2. Genome annotation and curation were performed using the GenomeJack software. Results: Tumor mutation burden (TMB) was increased in proportion to the higher tumor grade distribution in grade 2 clear cell renal cell carcinoma (ccRCC). In PC, Grade Group 3/4 specimens that included an increased distribution of Gleason pattern 4 had more frequent gene mutations. Conclusion: Our results suggest the importance of selecting the maximum distribution of higher tumor grade areas to obtain results on the precise gene alterations for genomics-focused treatments. [ABSTRACT FROM AUTHOR]

This study puts emphasis on reducing the temperature error of dissipative particle dynamics (DPD) fluid by directly applying a minimal-stage third-order partitioned Runge-Kutta (PRK3) method to the time integration, which does not include any of additional governing equations and change in the DPD thermostat formulation. The error is estimated based on the average values of both kinetic and configurational temperatures. The result shows that the errors in both temperatures errors are greatly reduced by using the PRK3 scheme as comparing them to those of previous studies. Additionally, the comparison among three different PRK3 schemes demonstrates our recent findings that the symplecticity conservation of the system is important to reduce the temperature error of DPD fluid especially for large time increments. The computational efficiencies are also estimated for the PRK3 scheme as well as the existing ones. It was found from the estimation that the simulation using the PRK3 scheme is more than twice as efficient as those using the existing ones. Finally, the roles of both kinetic and configurational temperatures as error indicators are discussed by comparing them to the velocity autocorrelation function and the radial distribution function. It was found that the errors of these temperatures involve different characteristics, and thus both temperatures should be taken into account to comprehensively evaluate the numerical error of DPD.