A specific and reliable method for monitoring analgesia during general anesthesia is urgently required. Previously, we introduced a method that indicates arterial mechanical properties for estimating arterial wall stiffness (K). However, whether the response of K actually indicates changes in remifentanil target concentrations under continuous surgical stress, is unclear. Thus, we aimed to evaluate how K responds to different remifentanil target concentrations.

This prospective study enrolled 30 patients who underwent laparoscopic colectomy. The patients received 3 different effect-site concentrations (2, 4, and 6 ng/ml) of remifentanil 3 times during the study period. The K values at 4-ng/ml administration were used as control values (K_control). K values at 6-ng/ml administration (K_6ng) and those at 2-ng/ml administration (K_2ng) were normalized by dividing them by the control values. The results showed that K responded to the changes in remifentanil concentration, significantly decreasing at 6-ng/ml remifentanil effect-site concentration and increasing at 2-ng/ml concentration. The stress response at low analgesia was higher than that at high analgesia, and, as predicted, normalized K_2ng was significantly greater than normalized K_6ng. In conclusion, we found that K is a sensitive stress response monitor and dynamically responds to changes in remifentanil concentration in invasive stimulation during laparoscopic colectomy.

The purpose of this study was to evaluate the detectability of hyper-dense nodules using dual-energy computed tomography (DECT) in a phantom. Arterial-phase hepatic dynamic computed tomography (CT) was conducted on small, medium, and large liver-simulating phantoms harboring simulated hypervascular tumors. We acquired 150 single-energy CT (SECT) and 150 DECT scans and measured the contrast-to-noise ratio (CNR) of the nodules. Alternative free response receiver observer characteristic (AFROC) curves of five radiologists’ readings of the SECT and DECT scans were compared to assess detectability of the hyper-dense nodules. For all phantoms, the CNR of nodules measured using DECT was significantly higher than that by using SECT (p < 0.001, all). In the AFROC study, DECT showed a significantly larger area under the curve than that with SECT (0.778 vs 0.499, p = 0.012). Detectability of high-density nodules was better with DECT scans than with SECT scans.

Objective: Cardiopulmonary bypass during cardiac surgery is an essential procedure, and the perfusionist needs to have sufficient education and training. Simulation training is suitable in such cases. We have developed a simulation system for cardiopulmonary bypass training (extracorporeal circulation simulator [ECCSIM]) and reported its efficacy. ECCSIM had no pulse pressure generator, so some perfusionists have mentioned that the operational feeling during training differs from that in real clinical cases.

In this study, we have developed a new pulse pressure generator and examined the efficacy of this system during cardiopulmonary bypass training using ECCSIM.

Materials and Methods: Results were observed as wave patterns during simulation of extracorporeal circulation with and without pulse pressure flow. Operational feeling during training of extracorporeal circulation was compared using a questionnaire survey, based on the Japanese version of the NASA Task Load Index (NASA-TLX), a subjective index, completed by seven perfusionists.

Results: With the addition of pulse pressure flow, fluctuation of arterial flow at low speed with the centrifugal pump increased, and operation of extracorporeal circulation became unstable. The questionnaire survey, including ‘Operational feeling of centrifugal pump’, ‘Feeling of afterload’, and ‘Display of pressure monitor’, showed results similar to that of the clinical situation using pulse pressure flow. The difficulty of simulator operation in extracorporeal circulation was significantly greater in the group with pulse pressure flow. Mental/physical load examined with NASA-TLX increased with pulse pressure flow.

Conclusion: Using a new pulse pressure generator with ECCSIM was effective in extracorporeal circulation training.

Background: In Cambodia, there is no national health check-ups system for the schoolchildren and the general population. This pilot study aimed to promote a school health check-ups system in collaboration with the government of Cambodia.

Method: From 2016 to 2017, we conducted a survey in an elementary school in Siem Reap province, Cambodia. Two hundred and ninety-two students were eligible for data analysis. Physical examination, questionnaire and urinalysis were conducted using the Japanese school health check-ups model. Anthropometry was measured using the World Health Organization’s growth reference data for school-age children.

Results: Among 292 schoolchildren, 88.7% were diagnosed as healthy. Based on the evaluation criteria of health examination in the study, two (0.7%) students with rale, one (0.3%) student with abnormal urinalysis, and another 27 students complaining of cardiopulmonary symptoms were recommended for further consultation at hospital. The prevalence of overweight (15.1%) was higher than that of underweight (8.6%). According to parents’ questionnaires responses, the coverage rate of the National Immunization Program varied from 41.8% to 79.8% depending on each particular vaccine.

Conclusion: In this pilot study, we showed the prevalence of healthy among Cambodian schoolchildren and detected the students having possibility of health problem through this health check-ups and then recommended for further hospital visit. Based on the results, we assume that health check-ups system in elementary school as a whole Cambodia will be effective to assess the current health status in ordinary time and possibility of early detection of disease.

Spontaneous oesophageal perforation is an uncommon and life-threatening disease. Although several methods of treatment have been proposed, surgical treatment is considered the standard procedure. Primary repair using the transthoracic approach is the most common. However, few studies have evaluated the characteristics of the transabdominal approach. This study aimed to investigate the clinical outcomes of spontaneous oesophageal perforation that was surgically treated using the transabdominal approach. We retrospectively reviewed all patients with spontaneous oesophageal perforation who were admitted to the surgical department of our institution between November 2010 and April 2017, and identified a total of four patients. Data including demographic factors (age and sex), location of perforation, time to operation, operative method, complications, length of hospital stay, and postoperative recovery were reviewed. In all four cases, we treated the defect using the transabdominal approach, which provides a good surgical field of view. The aims of operative intervention, namely primary repair and access for enteral feeding, can be achieved using this approach. The most commonly observed complication was pyothorax, and we suggest the addition of intrapleural drainage for its prevention. Dysgraphia was observed in two patients, which improved with conservative treatment. The overall mortality rate was 0%. Our results demonstrate that primary repair using the transabdominal approach is safe and effective for the management of spontaneous oesophageal perforation. Addition of intrapleural drainage can improve the outcome associated with this approach.