Development of an artificial intelligence system to indicate intraoperative findings of scarring in laparoscopic cholecystectomy for cholecystitis.

Background: The surgical difficulty of laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) and the risk of bile duct injury (BDI) depend on the degree of fibrosis and scarring caused by inflammation; therefore, understanding these intraoperative findings is crucial to preventing BDI. Scarring makes it particularly difficult to perform safely and increases the BDI risk. This study aimed to develop an artificial intelligence (AI) system to indicate intraoperative findings of scarring in LC for AC.

Benefits of neoadjuvant chemotherapy with gemcitabine plus S-1 for resectable pancreatic ductal adenocarcinoma.

Currently, neoadjuvant chemotherapy (NAC) is usually performed even for resectable pancreatic ductal adenocarcinoma (rPDAC). The present study investigated the benefits of NAC with gemcitabine plus S-1 for rPDAC. The medical records of 170 patients diagnosed as having rPDAC based on preoperative imaging were reviewed retrospectively.

Compatibility of hypokalaemia caused by low-dose prednisolone plus abiraterone acetate therapy for metastatic castration-resistant prostate cancer.

Background: This study aimed to investigate the relationship between low-dose prednisolone (PSL) and the incidence of hypokalaemia at abiraterone acetate (abiraterone) plus PSL combination therapy targeting Japanese patients with metastatic castration-resistant prostate cancer (mCRPC).

Methods: This retrospective observational study included 153 Japanese patients treated with abiraterone and PSL for mCRPC at Kariya Toyota General Hospital and Gifu General Medical Center between September 2014 and October 2022. The incidence of grade ≥ 2 hypokalaemia as well as serum potassium level variations and the continuous combination therapy duration were compared between the low-dose (5 mg/day of PSL) and the standard-dose (10 mg/day of PSL) groups.

Prediction of intraoperative surgical difficulty during laparoscopic cholecystectomy using drip infusion cholangiography with computed tomography.

Background: Although findings from drip infusion cholangiography with computed tomography (DIC-CT) are useful in preoperative anatomic evaluation for laparoscopic cholecystectomy (LC), their relationship with intraoperative surgical difficulty based on the difficulty score (DS) proposed by Tokyo Guidelines 2018 is unclear. We examined this relationship.

Methods: Data were collected from 202 patients who underwent LC for benign gallbladder (GB) disease with preoperative DIC-CT in our department.

Prognostic significance of lymph node metastasis in pancreatic tail cancer: A multicenter retrospective study.

Background: Distal pancreatectomy (DP) with lymph node (LN) dissection is the standard procedure for pancreatic ductal adenocarcinoma of the tail (Pt-PDAC). However, the optimal surgery including extent of LN dissection is still being debated. The present study investigated the incidence and prognostic impact of LN metastasis on patients suffering from Pt-PDAC.

Influence of Previous Therapy for Neutropenia Caused by Combination Therapy of Ramucirumab and Docetaxel.

In the present study, the influence of previous immune checkpoint inhibitor (ICI) therapy with ramucirumab (RAM) + docetaxel (DTX) therapy on the occurrence of severe neutropenia in patients with non-small cell lung cancer (NSCLC) was evaluated, taking into account the influences of cytotoxic chemotherapy used in pretreatment. The study participants included patients who received a combination therapy of RAM and DTX as cancer chemotherapy for NSCLC. The influences of previous ICI treatment and pretreatment with cytotoxic anticancer agents on the development of grade ≥ 3 neutropenia were analysed.

Efficacy of pancreaticojejunostomy of the pancreatic stump during distal or central pancreatectomy.

Background: A stapler is usually used for transection and closure of the pancreas in distal pancreatectomy (DP) or central pancreatectomy (CP). When the pancreas is transected to the right of the portal vein, it is difficult to use a stapler and clinically relevant postoperative pancreatic fistula (CR-POPF) frequently occurs. We report on the efficacy of pancreaticojejunostomy (PJ) of the pancreatic stump for patients in whom stapler use is difficult.

Apoptosis-related factors are relevant to progression of pancreatic neuroendocrine tumors.

Background: Multidisciplinary therapy centered on antitumor drugs is indicated in patients with unresectable pancreatic neuroendocrine tumors (PanNET). However, the criteria for selection of optimal therapeutic agents is controversial. The aim of this study was to assess the malignancy of PanNET for optimal therapeutic drug selection.

Appropriate indications for laparoscopic repeat hepatectomy.

Background: Laparoscopic repeat hepatectomy (LRH) has increased, but appropriate indications for LRH are unclear. This study aimed to clarify appropriate indications for LRH.

Methods: We retrospectively compared surgical outcomes between open RH (ORH) (n = 57) and LRH (n = 40) groups.

[Reduction in Patient Waiting Times in Pharmacies by a Protocol to Minimize Inquiries to Doctors under an Agreement between a Hospital and Community Pharmacies].

Cooperative care between hospitals and community pharmacies is important to safe and effective pharmacotherapy for outpatients. We developed a protocol comprising three agreements about alternative drugs and dosing schedules with the aim of minimizing inquiries about prescriptions to doctors. The protocol was implemented under an agreement between core hospitals in Gifu City and community pharmacy members of the Gifu City Pharmaceutical Association from October 2019.

Development of an artificial intelligence system for real-time intraoperative assessment of the Critical View of Safety in laparoscopic cholecystectomy.

Background: The Critical View of Safety (CVS) was proposed in 1995 to prevent bile duct injury during laparoscopic cholecystectomy (LC). The achievement of CVS was evaluated subjectively. This study aimed to develop an artificial intelligence (AI) system to evaluate CVS scores in LC.

Technical and oncological safety of pancreatectomy for pancreatic cancer in older adults aged over 75 years versus younger adults: A single-center retrospective cohort study.

Aim: The number of surgeries for pancreatic ductal adenocarcinoma (PDAC) in older adults has been rising. This study aimed to evaluate the technical and oncological safety of pancreatectomy for older adults aged ≥75 years with PDAC by retrospectively comparing their short- and long-term outcomes with those of younger adults aged <75 years.

Methods: Data were collected from 117 patients who underwent pancreatectomy for PDAC in our department.

Clinical significance of colonoscopy before laparoscopic bariatric/metabolic surgery in Japanese patients.

Purpose: Obesity is known to be associated with colorectal adenoma (CRA) and colorectal cancer (CRC); yet colonoscopy is not considered an essential preoperative evaluation before bariatric/metabolic surgery. The aim of this study was to clarify the clinical significance of preoperative colonoscopy for obese Japanese patients.

Methods: The subjects of this retrospective study were 114 patients who underwent screening colonoscopy before bariatric/metabolic surgery.

Glucose metabolic upregulation via phosphorylation of S6 ribosomal protein affects tumor progression in distal cholangiocarcinoma.

Background: The prognosis of distal cholangiocarcinoma (dCCA) remains poor; thus, the identification of new therapeutic targets is warranted. Phosphorylated S6 ribosomal protein indicates a mammalian target of rapamycin complex 1 (mTORC1) activity, and mTORC1 plays a central role in controlling cell growth and regulating glucose metabolism. We aimed to clarify the effect of S6 phosphorylation on tumor progression and the glucose metabolic pathway in dCCA.

Synthesis of stable class 5 mesoionic benzo[]tetrazolo[2,3-]cinnolinium thiolate, dicyanomethylide, and amides.

Although class 5 mesoionic compounds show interesting electrical behaviour, they are generally unstable, readily undergoing ring-opening reactions. We designed and synthesized a bridged mesoionic derivative, benzo[]tetrazolo[2,3-]cinolinium (BTC), as a stable class 5 mesoionic compound, which was further transformed to the corresponding thiolate, cicyanomethylide, and amide. The intramolecular bridging imparted stability to the BTC thiolates and amides: the BTC thiolates were unsusceptible to ring-opening at high temperatures, and the BTC amides were stable in the absence of electron-withdrawing groups on the amide nitrogen.

Development of a cross-artificial intelligence system for identifying intraoperative anatomical landmarks and surgical phases during laparoscopic cholecystectomy.

Background: Attention to anatomical landmarks in the appropriate surgical phase is important to prevent bile duct injury (BDI) during laparoscopic cholecystectomy (LC). Therefore, we created a cross-AI system that works with two different AI algorithms simultaneously, landmark detection and phase recognition. We assessed whether landmark detection was activated in the appropriate phase by phase recognition during LC and the potential contribution of the cross-AI system in preventing BDI through a clinical feasibility study (J-SUMMIT-C-02).

An intraoperative artificial intelligence system identifying anatomical landmarks for laparoscopic cholecystectomy: a prospective clinical feasibility trial (J-SUMMIT-C-01).

Background: We have implemented Smart Endoscopic Surgery (SES), a surgical system that uses artificial intelligence (AI) to detect the anatomical landmarks that expert surgeons base on to perform certain surgical maneuvers. No report has verified the use of AI-based support systems for surgery in clinical practice, and no evaluation method has been established. To evaluate the detection performance of SES, we have developed and established a new evaluation method by conducting a clinical feasibility trial.

Use of a novel endoscopic overtube with bilateral tool channels for endoscopic resection of experimental lesions and repair of intestinal defects in the right colon: preclinical trial.

Background: Endoscopic tumor resection and intestinal defect repair are technically challenging leading to invasive surgery and colectomy performed for resection of benign polyps. In this study, we evaluated the use of an endoscopic overtube with bilateral tool channels for these procedures.

Methods: Using a fresh porcine colorectum in a 3D ex vivo model, 3 cm lesions at the posterior wall of the transverse colon were removed by two different techniques: standard endoscopic submucosal dissection (ESD) technique (STD, n = 12) and ESD using the overtube with an endoscopic snare and grasper through the bilateral channels (OT, n = 12).

Influence of using history of immune checkpoint inhibitor therapy for neutropenia caused by combination therapy of ramucirumab and docetaxel.

Recently, pretreatment with immune checkpoint inhibitors (ICIs) has been shown to enhance the therapeutic effects of the combination therapy of ramucirumab (RAM) and docetaxel (DTX); however, its influence on the drug's side effects remains unclear. This study investigated the influence of pretreatment with ICIs on the incidence of neutropenia caused by RAM + DTX therapy in patients with non-small cell lung cancer (NSCLC). Patients with NSCLC who received RAM + DTX therapy at Gifu Prefectural General Medical Center between April 2016 and December 2020 were enrolled.

Predictive factors for early recurrence after pancreaticoduodenectomy in patients with resectable pancreatic head cancer: A multicenter retrospective study.

Background: Patients diagnosed with resectable pancreatic ductal adenocarcinoma often experience early recurrence even after upfront R0 resection. This study aimed to define early recurrence and identify preoperative risk factors for early recurrence after upfront pancreaticoduodenectomy in patients with resectable pancreatic ductal adenocarcinoma of the pancreatic head.

Methods: This multicenter, retrospective study involved 500 patients who underwent pancreaticoduodenectomy resectable pancreatic ductal adenocarcinoma of the pancreatic head at 10 institutions between 2007 and 2016.

Pancreas-preserving partial duodenectomy for non-ampullary duodenal neoplasms: three case reports.

Background: There are multiple surgical procedures for resecting non-ampullary duodenal neoplasms (NADNs), and the appropriate method is selected depending on the tumor location and diagnosis. We herein report 3 cases of NADNs that were resected using pancreas-preserving partial duodenectomy (PPD).

Case Reports: The first patient, a 73-year-old woman with a circumferential duodenal adenoma in the supra-ampullary duodenum, underwent surgery.

Changes of Short-Chain Fatty Acids and Their Receptors in an Obese Rat Model After Sleeve Gastrectomy.

Background: Short-chain fatty acids (SCFAs) and gut microbiota have health-related effects and are associated with a wide range of disorders. However, the changes of SCFAs and their receptors after sleeve gastrectomy (SG) remain unclear. This study aimed to examine changes of SCFAs and their receptors after SG in an obese rat model.