Miyanomori Memorial Hospital

Urinary incontinence (UI) in the first 3 months after robot-assisted radical prostatectomy (RARP) frequently impairs work performance, yet its quantitative impact on presenteeism remains unclear. This prospective cohort study longitudinally evaluated how early postoperative UI influences presenteeism among employed Japanese men undergoing RARP. We consecutively enrolled 92 employed male patients scheduled for RARP and assessed them preoperatively, at discharge, and at 1- (PS-1) and 3-month (PS-3) post-surgery. Outcomes were the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), WHO Health and Work Performance Questionnaire (HPQ)-Presenteeism Scale, King's Health Questionnaire (KHQ), and Kessler Psychological Distress Scale (K6). Of the 92 eligible participants, 85 (92.4%) completed the PS-1 and 80 (87.0%) completed the PS-3 assessment. Median ICIQ-SF total scores increased from 0 (IQR 0-2) preoperatively to 9 (6-12) at PS-1, remaining elevated at 7 (4-10) at PS-3 (p < 0.001). Mean HPQ-presenteeism declined from 81.4% ± 13.9% preoperatively to 64.9% ± 18.8% at PS-1, partially recovering to 75.3% ± 16.1% at PS-3 (p < 0.001). At PS-1, UI impact on daily life (ρ = -0.45) and ICIQ-SF total (ρ = -0.43) were moderately associated with lower presenteeism; at PS-3, correlations persisted and extended to multiple KHQ subscales (ρ = -0.41 to -0.53). Early postoperative UI after RARP produces a clinically meaningful reduction in work productivity, greatest at PS-1 and still evident at PS-3. Targeted continence care and occupational support during this window may mitigate productivity loss and facilitate sustainable return to work.

Background & AimsPerioperative nutritional status is critical during the postoperative recovery process in patients undergoing cardiac surgery. Several studies on patients undergoing cardiac surgery have reported low energy intake in early postoperative food intake via oral nutrition; however, no study has shown an association of low energy intake with postoperative hospital length of stay (LOS). This study aimed to determine whether early postoperative low food intake was associated with prolonged postoperative hospital LOS in patients undergoing cardiac surgery. MethodsThis was a retrospective, observational, single-center study conducted in patients aged ≥18 years undergoing elective cardiac surgery from January 1, 2020, to May 31, 2023. Patients were categorized by food intake as food intake < 50% (low food intake group) and ≥ 50% (adequate food intake group) at lunch on postoperative day (POD) 3. The primary outcome of this study was the postoperative hospital LOS. A generalized linear model was used to examine the association between food intake and postoperative hospital LOS using the following explanatory variables: age, European System for Cardiac Operative Risk Evaluation (EuroSCORE) II value, preoperative risk of malnutrition, activities of daily living status, Sequential Organ Failure Assessment score, and C-reactive protein level. ResultsOf the 315 patients, 104 (33.0%) had a food intake of <50% on POD3. There were no significant differences in age, sex, EuroSCORE II value, and comorbidities between the two groups. Patients in the low-food intake group had a significantly lower Barthel Index (6.7% vs. 1.4%, p = 0.017) and a higher malnutrition risk according to the Mini Nutritional Assessment Short Form score (40.4% vs. 28.2%, p = 0.043). Food intake of <50% on POD3 was associated with prolonged postoperative hospital LOS (β = 1.135 [95% confidence interval: 1.004–1.262], p = 0.018). ConclusionsLow food intake on POD3 is associated with prolonged postoperative hospital LOS in patients undergoing elective cardiac surgery. Early postoperative food intake should be closely monitored in patients after elective cardiac surgery.

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 occasionally becomes severe and requires endotracheal intubation. Endotracheal intubation is usually performed using a laryngoscope; however, the operator needs to be in close proximity to the patient’s face during the procedure, which increases the risk of droplet exposure. Therefore, we simulated fiberoptic endotracheal intubation on a mannequin representing the patient, using an ultrathin flexible gastrointestinal endoscope as an alternative to the bronchoscope, in order to maintain distance from the patient during the procedure. We performed this procedure 10 times and measured the time required; the median procedure time was 6.4 s (interquartile range, 5.7-8.1 s). The advantage of this method is the short procedure time and distance maintained from the patients. The flexible tip-steerable control and length of the gastrointestinal endoscope contributed to shortening the procedure time and maintaining distance from the patients. In addition, this method can handle difficult airways without risk of misplacement of the endotracheal tube. However, it is necessary to consider the risk of aerosol generation associated with this procedure. In the pandemic setting of coronavirus disease 2019, this approach may be useful when a gastrointestinal endoscopist is in charge of endotracheal intubation of patients with coronavirus disease 2019.

札幌市市街域の北海道大学構内で，1981年の掘削で得られた150 mコアの第四系層序を明らかにするために，14C年代測定，堆積相解析，火山灰分析，花粉分析，珪藻分析，放散虫分析を行った．孔内地質はHU-1層～HU-9層に区分され,分析結果に基づく野幌丘陵との地層対比では，HU-1層～HU-3層（深度150～75 m）は前・中期更新世の下野幌層，HU-4層～HU-5層（深度75～35 m）は後期更新世のもみじ台層，HU-6層（深度35～34 m）は後期更新世の小野幌層，HU-7層～HU-8層（深度34～7.8 m）は後期更新世の札幌扇状地堆積物，HU-9層（深度7.8～0 m）は完新統に相当することが明らかになった．最終間氷期堆積物であるHU-4層～HU-5層からは，寒冷期や温暖期が確認され，今後の石狩低地帯南部の第四系との詳細な対比の可能性が生じた．既存井との地層対比では，150 mコアの深度130 m（標高－119 m）付近に挟在する下野幌層相当層中の泥炭は，隣接する2本の井戸の標高－110 m付近に認められる亜炭質層と連続し，更には石狩海岸平野下の下野幌層相当層の標高－102～－126 mに挟在する泥炭に対比される．

放射線治療における皮膚障害発現の予防に対して桂枝加竜骨牡蛎湯の効果を検討した。対象は肺癌の診断で60Coによる放射線療法を行った10例のうち, 完遂できた9例 (平均50.3Gy) である。放射線療法の間, 3例に桂枝加竜骨牡蛎湯を内服させた。高度な放射線皮膚障害 (皮膚剥離) は非内服群でのみ認めた (6例中4例)。内服群3例は, 全て皮膚剥離を示さず, 放射線治療を終了した。放射線治療中における皮膚障害の進行抑制において桂枝加竜骨牡蛎湯の効果が示唆された。

In 51 eases with cerebral vascular disease (CVD), dynamic study of radioisotope was done as screening using r-scintilation camera connecting minicomputor. Intraveneous bolus injection was performed 10〜15 mCi of ^<99m>TcO_4^-. CVD can be diagnosed early and easily from the following data. 1) demonstration of space occuping lesion. 2) difference between right and left area in clearance curve. 3) arm-to-head circulation time, mean transit time. 4) pattern of clearannce curve.