BACKGROUND: To investigate the effects of acute kidney injury (AKI) after liver resection on the long-term outcome, including mortality and renal dysfunction after hospital discharge. METHODS: We conducted a historical cohort study of patients who underwent liver resection for hepatocellular carcinoma with sevoflurane anesthesia between January 2004 and October 2011, survived the hospital stay, and were followed for at least 3 years or died within 3 years after hospital discharge. AKI was diagnosed based on the Acute Kidney Injury Network classification within 72 hours postoperatively. In addition to the data obtained during hospitalization, serum creatinine concentration data were collected and the glomerular filtration rate (GFR) was estimated after hospital discharge. RESULTS: AKI patients (63%, P = 0.002) were more likely to reach the threshold of an estimated GFR (eGFR) of 45 ml/min/1.73 m² within 3 years than non-AKI patients (31%) although there was no significant difference in mortality (33% vs. 29%). Cox proportional hazard regression analysis showed that postoperative AKI was significantly associated with the composite outcome of mortality or an eGFR of 45 ml/min/1.73 m² (95% CI of hazard ratio, 1.05–2.96, P = 0.033), but not with mortality (P = 0.699), the composite outcome of mortality or an eGFR of 60 ml/min/1.73 m² (P =0.347). CONCLUSIONS: After liver resection, AKI patients may be at higher risk of mortality or moderate renal dysfunction within 3 years. These findings suggest that even after discharge from the hospital, patients who suffered AKI after liver resection may need to be followed-up regarding renal function in the long term.
Acute Kidney Injury* ; Anesthesia ; Carcinoma, Hepatocellular ; Classification ; Cohort Studies ; Creatinine ; Glomerular Filtration Rate ; Hepatectomy ; Hospitalization ; Humans ; Length of Stay ; Liver* ; Long Term Adverse Effects ; Mortality

Methods: This study included 50 patients with CSM and 39 with C-OPLL who underwent multi-segment laminoplasty. Decreased CL was defined as the difference between preoperative and 2-year postoperative neutral C2–7 Cobb angles. Radiographic parameters included preoperative neutral C2–7 Cobb angles, C2–7 sagittal vertical axis (SVA), T1 slope (T1S), dynamic extension reserve (DER), and range of motion. The radiographic risk factors were investigated for decreased CL in CSM and C-OPLL. Additionally, the Japanese Orthopedic Association (JOA) score was assessed preoperatively and 2 years postoperatively. Results: C2–7 SVA (p =0.018) and DER (p =0.002) were significantly correlated with decreased CL in CSM, while C2–7 Cobb angle (p =0.012) and C2–7 SVA (p =0.028) were correlated with decreased CL in C-OPLL. Multiple linear regression analysis revealed that greater C2–7 SVA (B =0.22, p =0.026) and small DER (B =−0.53, p =0.002) were significantly associated with decreased CL in CSM. By contrast, greater C2–7 SVA (B =0.36, p =0.031) was significantly associated with decreased CL in C-OPLL. The JOA score significantly improved in both CSM and C-OPLL (p <0.001). Conclusions C2–7 SVA was associated with a postoperative decreased CL in both CSM and C-OPLL, but DER was only associated with decreased CL in CSM. Risk factors for decreased CL slightly differed depending on the etiology of the condition.

Introduction: We analyzed the concentrations of the trace elements [chromium (Cr), arsenic (As), cadmium (Cd), cesium (Cs), lead (Pb), thorium (Th), and uranium (U)] in commercial bottled water consumed in the town of Angono, Rizal province, Luzon island, Philippines to evaluate the health risks of the trace elements in drinking water. There are some arguments that water resources available in the Philippines are heavily polluted by various materials, inparticular heavy metal elements. Method: The concentrations of seven trace elements in commercial bottled water produced and consumed in the Philippines were analyzed using a solution nebulization inductively coupled plasma mass spectrometry (SN−ICP−MS). Result: The concentrations of the trace elements except for Cs, which does not yet have a WHO guideline value, in the locally produced bottled water were below the WHO guideline values. The Cs concentrations (<0.6 μg/L) of the bottled water of the Philippines were generally similar to those of the bottled water produced and consumed in other countries such as Japan, China, and Indonesia. Conclusion The concentrations of trace elements in bottled water consumed in Angono, Philippines can be regarded as being at safe levels, as well as those of daily life water (i.e. tap, well, and spring water) consumed in the said town.
Drinking Water ; Trace Elements ; Philippines

Objective: The present study aims to determine the concentrations of seven trace elements [chromium (Cr), arsenic (As), cadmium (Cd), cesium (Cs), lead (Pb), thorium (Th), and uranium (U)] in tap, well, spring, river, and lake waters in the town of Angono, Rizal in the Philippines, consumed for drinking, cooking, bathing, and washing. In the town of Angono, both of the tap and purified tap waters produced in the refilling station are consumed as the water for drinking. Methods: Water samples from six unpurified tap, six purified taps, 10 wells, two springs, two rivers, and one lake water were obtained in October 2015. Samples were analyzed using solution nebulization inductively coupled plasma mass spectrometry. Results were evaluated for health risks of the trace elements in the water samples using WHO guideline values. The provisional WHO guideline values are as follows: Cr: 50 μg/L, As: 10 μg/L, Cd: 3 μg/L, Pb: 10 μg/L, and U: 30 μg/L. That of Cs has not been proposed yet. The WHO guideline value for the naturally occurring radioactive isotope 232Th in drinking water is 1 Bq/L, which is equivalent to 250 μg/L. Results: The concentrations of the trace elements in the tap water samples were <0.5% of the WHO guideline values, except Cs and Cd, with those of Cd being ~9% of the WHO guideline value. Purified tap waters contained the seven trace elements in lower concentrations, with the exception of Pb, which may have been added in small amounts from equipment used for water purification. The concentrations of the trace elements in water samples from the wells and springs in Angono were more variable than those of the tap waters, and these were also below the WHO guideline values. The concentrations of Cs in all water samples were <0.3 μg/L. The trace-element concentrations of the waters from Angono River and Laguna Lake were almost the same as those of the well and spring waters. Conclusion At present, the concentrations of trace elements in daily life water consumed in Angono are at safe levels.
Trace Elements

Objectives: The authors considered the community-based on-site water sampling-surveys case-study in Angono, Rizal, in the Republic of the Philippines. The study was designed to determine whether individual citizens within the community could successfully collaborate in order to develop a method for quantification of E. coli levels in water (especially underground water) for domestic use.

Methods: We used techniques that had been validated in Japan for on-site evaluation of E. coli. These simple techniques enabled the on-site quantification of E. coli levels in multiple water sources, including underground water.

Results: The techniques used in Japan were successfully adopted in the Philippines, and we cooperated with regional medical technicians, scientists, and citizens, in order to develop a system where ultimately, the people in Angono can perform all the tasks related to on-site water quality evaluation. From societal and economic perspectives, we were able to reduce the traditionally high laboratory cost (including testing cost and samples transit cost) of coliform bacteria and E. coli evaluation to a lower, fixed cost level that is affordable for regional health centers and other sites.

Conclusion: The transfer of a simple inspection method technology, under the supervision of an experienced Japanese research team, allowed us to validate the E. coli on-site quantification strategy at a regional level as "co-creation of science and society". In addition, beyond technology transfer, our collaborative efforts with scientists, regional medical engineers, and citizens, led to the creation of an NGO (non-governmental organization) that serves citizens in the town of Angono with regard to water quality assessment and certification activities.

Key Words: water quality, water management, community, local people, participatory approach, underground water, Escherichia coli, coliform bacteria, Philippines