Matched-pair analysis of postoperative morbidity and mortality for pancreaticogastrostomy and pancreaticojejunostomy using mattress sutures in soft pancreatic tissue remnants

BACKGROUND:After pancreaticoduodenectomy,the incidence of postoperative pancreatic fistula remains high,especially in patients with 'soft' pancreatic tissue remnants.No 'gold standard' surgical technique for pancreaticoenteric anastomosis has been established.This study aimed to compare the postoperative morbidity and mortality of pancreaticogastrostomy and pancreaticojejunostomy for 'soft' pancreatic tissue remnants using modified mattress sutures.METHODS:Seventy-five patients who had undergone pancreaticogastrostomy and 75 who had undergone pancreaticojejunostomy after pancreaticoduodenectomy between 2002 and 2008 were retrospectively compared using matched-pair analysis.A modified mattress suture technique was used for the pancreaticoenteric anastomosis.Patients with an underlying 'hard' pancreatic tissue remnant,as in chronic pancreatitis,were excluded.Both groups were homogeneous for age,gender,and underlying disease.Postoperative morbidity,mortality,and preoperative and operative data were analyzed.RESULTS:There were no significant differences between the groups for the incidence of postoperative pancreatic fistula (10.7% in both).Postoperative morbidity and mortality,median operation time,median length of hospital stay,intraoperative blood loss,and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ between the groups.Patient age >65 years (P=0.017),operation time >350minutes (P=0.001),and intraoperative transfusion of erythrocyte concentrates (P=0.038) were identified as risk factors for postoperative morbidity.CONCLUSIONS:Our results showed no significant differences between the groups in the pancreaticogastrostomy and pancreaticojejunostomy anastomosis techniques using mattress sutures for 'soft' pancreatic tissue remnants.In our experience,the mattress sutures are safe and simple to use,and pancreaticogastrostomy in particular is feasible and easy to learn,with good endoscopic accessibility to the anastomosis region.However,the location of the anastomosis and the surgical technique need to be individually evaluated to further reduce the incidence of postoperative pancreatic fistula.

Modified membrane fixation technique in a severe continuous horizontal bone defect:A case report

BACKGROUND Continuous severe horizontal bone defect is common in the aesthetic maxillary anterior area,and presents a major challenge in implant dentistry and requires predictable bone augmentation to increase the width of the alveolar bone.CASE SUMMARY A 24-year-old man,with a history of well-controlled IgA nephropathy,presented to the Dentistry Department of our hospital complaining of missing his right maxillary anterior teeth 1 mo ago.Severe horizontal alveolar bone defects at sites of teeth 12,13 and 14 were diagnosed.A modified guided bone regeneration surgical approach stabilizing the absorbable collagen membrane and particulate graft materials by periosteal diagonal mattress suture(PDMS)combined with four corner pins was used for this severe continuous horizontal bone defect.The outcome revealed that the newly formed alveolar ridge dimension increased from 0.72 mm to 11.55 mm horizontally 10 mo postoperatively,with no adverse events.The implant surgery was successfully performed.CONCLUSION This case highlights that PDMS combined with four corner pins is feasible to maintain the space and stabilize the graft and membranes in severe continuous horizontal bone defect.

Effect of a commercial air ionizer on dust mites Dermatophagoides pteronyssinus and Dermatophagoides farinae(Acari:Pyroglyphidae) in the laboratory

Objective:To investigate the short and long tenn efficacy of a commercial air ionizer in killing Dermatophagoides pteronyssinus(D.pteronyssinus)and Dermalophagoides farinae(D.farinae)mites.Methods:The effect of a commercial ionizer on D.pteronyssinus and D.farinae was evaluated in the laboratory,using a specially designed test.Mortality was assessed after 6,16and 24 hours for direct exposure and after 24,36,48,60 and 72 hours for exposure in simulated mattress.New batches of mites were used for each exposure time.Results:LT_(50)for direct exposure of ionizer was 10 hours for D.pteronyssinus and 18 hours for D.farinae.The LT_(50)for exposure in simulated mattress was 132 hours or 5.5 days for D.pteronyssinus and 72 hours or 3days for D.farinae.LT_(95)for direct exposure of ionizer was 36 hours for D.pteronyssinus and D.farinae.Meanwhile,the LT_(95)for exposure in simulated mattress was 956 hours or 39.8 days for D.pteronyssinus and 403 hours or 16.8 days for D.farinae.Conclusions:This study demonstrates the increasing mite mortalities with increasing exposure time of a commercial ionizer and suggests that negative ions produced by an ionizer kill dust mites and can be used to reduce natural mile populations on exposed surfaces such as floors,clothes,curtains,etc.However,there is reduced efficacy on mites inside stuffed materials as in mattresses and furniture.

A Novel Innovative Sleeping Mattress Could Possibly Save Lives and the National Economy: Small but Solid Evidence from a Medical Perspective

The RAND Corporation reported that insufficient sleep causes an economic loss of $138 billion (2.92% of GDP) in Japan every year. In this study, we investigated the sleep improvement effect of a novel innovative sleeping mattress called “AiR SI” (Nishikawa Co., Ltd.) to find a simple method to solve the problem of sleep deprivation. We conducted a 2-week randomized, open-label, crossover, self-controlled study in 14 healthy adults in their 30s to 50s (control: 1 week, AiR SI: 1 week), with sleep quality as the primary endpoint as well as salivary components (cortisol, melatonin) and autonomic nervous function (sympathetic nerve, parasympathetic nerve) as secondary endpoints. Trends toward improvement in sleep were suggested for all the endpoints, regardless of differences in the subject background. The results suggested that the use of AiR SI for 1 week not only improved sleep but normalized both the endocrine and autonomic functions as well. We conclude that, by using a sleeping mattress with a high sleep improvement effect, the user may easily achieve higher labor productivity and have a lower mortality risk. Eliminating sleep deprivation with a sleeping mattress may lead to a reduction in national economic losses and ultimately produce significant economic effects.

微动敏感床垫睡眠监测系统在OSAHS诊断中的应用

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种比较常见的睡眠疾病,由于可以引发多种全身性疾病,尤其使中重度患者心脑血管并发症的危险性及死亡率均显著提高,是目前睡眠障碍的研究热点[1,2]。对于该疾病的诊断主要依靠睡眠过程中的多道睡眠监测（PSG）和食管压力测定2种方法。

便携式睡眠监测阻塞定位仪和床垫式睡眠监测系统在OSAHS诊断中的应用

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）严重危害公共健康。据估算,美国因睡眠疾病造成的年经济损失（包括生产力降低及医疗费用等）为180亿美元[1]。OSAHS发病率很高,在一般中年人群中发病率可达2%～4%[2]。Jennum等[3]一项回顾性研究甚至显示出更高发病率,

How we do it:the Running-X suture technique

There are a myriad of suture techniques available to close incisions of the brow and forehead,each with their own advantages and disadvantages.The ideal suture technique would provide excellent cosmetic results,offer expedient wound closure,optimize skin eversion and wound edge apposition,and provide excellent cosmetic results.The authors describe a new suture technique,the Running-X suture,a running horizontal mattress suture that has successfully been used by the senior author for many years to re-approximate surgical wounds of the brow and forehead in an expeditious and aesthetic manner.