Small bowel ileus due to the parasitic infection caused by omophagia of freshwater fish is relatively rare. We present a case of small bowel ileus possibly caused by inflammatory change associated with Gnathostoma doloresi infection. A 62-year-old man underwent partial resection of the small bowel under a diagnosis of ileus due to complete obstruction of the small bowel. He had eaten a few slices of raw freshwater fish four weeks before abdominal pain appeared, and he contracted creeping disease with several welts on the abdominal wall. Chronic inflammatory change suggestive of parasite infection was observed in the resected specimen. An immunoserodiagnostic study using microenzyme-linked immunosorbent assay led to a diagnosis of Gnathostoma doloresi infection. The postoperative course was favorable, and the patient was discharged 12 days after surgery. Only two cases of ileus due to Gnathostoma doloresi infection have ever been reported.

Objectives : We analyzed the mortality and morbidity of congenital heart surgery in Japan by using the Japan Cardiovascular Surgery Database (JCVSD). Methods : Data regarding congenital heart surgery performed between January 2013 and December 2014 were obtained from JCVSD. The 20 most frequent procedures were selected and the mortality rates and major morbidities were analyzed. Results : The mortality rates of atrial septal defect (ASD) repair and ventricular septal defect (VSD) repair were less than 1%, and the mortality rates of tetralogy of Fallot (TOF) repair, complete atrioventricular septal defect (AVSD) repair, bidirectional Glenn, and total cavopulmonary connection (TCPC) were less than 2%. The mortality rates of the Norwood procedure and total anomalous pulmonary venous connection (TAPVC) repair were more than 10%. The rates of unplanned reoperation, pacemaker implantation, chylothorax, deep sternal infection, phrenic nerve injury, and neurological deficit were shown for each procedure. Conclusion : Using JCVSD, the national data for congenital heart surgery, including postoperative complications, were analyzed. Further improvements of the database and feedback for clinical practice are required.

Objective: To identify factors associated with the absence of cervical spine instability in patients with rheumatoid arthritis (RA). Methods: Cervical spine instability was defined as the presence of at least one of the following: atlantoaxial subluxation, vertical subluxation of the axis, or subaxial subluxation. In 2001–2002, 634 enrolled outpatients with “classical” or “definite” RA underwent a radiographic cervical spine checkup. In 2012–2013, 233 (36.8%) prospectively underwent routine clinical follow-ups with a >10-year radiographic evaluation. The prevalence and independent predictive factors for no instability were analyzed by multivariable logistic regression. Next, 85 of 292 outpatients (29.1%) without baseline cervical spine instability completed consecutive >5-year and >10-year radiographic examinations. The incidence and predictors for no new development of instability were assessed similarly. Results: Among 233 patients, those without cervical spine instability decreased from 114 (48.9%) to 47 (20.2%) during >10 years. Steinbrocker peripheral joint destruction stages I–II (odds ratio [OR], 3.797; p=0.001), no corticosteroid administration (OR, 2.700; p=0.007), and no previous joint surgery (OR, 2.480; p=0.020) were predictors for no instability. Then, 33 of 85 (38.8%) consecutively followed patients without baseline cervical spine lesions did not develop instability throughout. Steinbrocker stages I–II (OR, 5.355; p=0.005) and no corticosteroid therapy (OR, 3.868; p=0.010) were predictors for no new onset of instability. C-reactive protein (CRP) level≤1.0 mg/dL was marginal in both models (n=233 [OR, 2.013; p=0.057], n=85 [OR, 2.453; p=0.075]). Conclusion Steinbrocker stages I–II, no corticosteroids, no previous joint surgery, and possibly CRP ≤1.0 mg/dL are factors associated with >10-year absence of cervical spine instability in RA.

Objective: To identify factors associated with the absence of cervical spine instability in patients with rheumatoid arthritis (RA). Methods: Cervical spine instability was defined as the presence of at least one of the following: atlantoaxial subluxation, vertical subluxation of the axis, or subaxial subluxation. In 2001–2002, 634 enrolled outpatients with “classical” or “definite” RA underwent a radiographic cervical spine checkup. In 2012–2013, 233 (36.8%) prospectively underwent routine clinical follow-ups with a >10-year radiographic evaluation. The prevalence and independent predictive factors for no instability were analyzed by multivariable logistic regression. Next, 85 of 292 outpatients (29.1%) without baseline cervical spine instability completed consecutive >5-year and >10-year radiographic examinations. The incidence and predictors for no new development of instability were assessed similarly. Results: Among 233 patients, those without cervical spine instability decreased from 114 (48.9%) to 47 (20.2%) during >10 years. Steinbrocker peripheral joint destruction stages I–II (odds ratio [OR], 3.797; p=0.001), no corticosteroid administration (OR, 2.700; p=0.007), and no previous joint surgery (OR, 2.480; p=0.020) were predictors for no instability. Then, 33 of 85 (38.8%) consecutively followed patients without baseline cervical spine lesions did not develop instability throughout. Steinbrocker stages I–II (OR, 5.355; p=0.005) and no corticosteroid therapy (OR, 3.868; p=0.010) were predictors for no new onset of instability. C-reactive protein (CRP) level≤1.0 mg/dL was marginal in both models (n=233 [OR, 2.013; p=0.057], n=85 [OR, 2.453; p=0.075]). Conclusion Steinbrocker stages I–II, no corticosteroids, no previous joint surgery, and possibly CRP ≤1.0 mg/dL are factors associated with >10-year absence of cervical spine instability in RA.

Objective: To identify factors associated with the absence of cervical spine instability in patients with rheumatoid arthritis (RA). Methods: Cervical spine instability was defined as the presence of at least one of the following: atlantoaxial subluxation, vertical subluxation of the axis, or subaxial subluxation. In 2001–2002, 634 enrolled outpatients with “classical” or “definite” RA underwent a radiographic cervical spine checkup. In 2012–2013, 233 (36.8%) prospectively underwent routine clinical follow-ups with a >10-year radiographic evaluation. The prevalence and independent predictive factors for no instability were analyzed by multivariable logistic regression. Next, 85 of 292 outpatients (29.1%) without baseline cervical spine instability completed consecutive >5-year and >10-year radiographic examinations. The incidence and predictors for no new development of instability were assessed similarly. Results: Among 233 patients, those without cervical spine instability decreased from 114 (48.9%) to 47 (20.2%) during >10 years. Steinbrocker peripheral joint destruction stages I–II (odds ratio [OR], 3.797; p=0.001), no corticosteroid administration (OR, 2.700; p=0.007), and no previous joint surgery (OR, 2.480; p=0.020) were predictors for no instability. Then, 33 of 85 (38.8%) consecutively followed patients without baseline cervical spine lesions did not develop instability throughout. Steinbrocker stages I–II (OR, 5.355; p=0.005) and no corticosteroid therapy (OR, 3.868; p=0.010) were predictors for no new onset of instability. C-reactive protein (CRP) level≤1.0 mg/dL was marginal in both models (n=233 [OR, 2.013; p=0.057], n=85 [OR, 2.453; p=0.075]). Conclusion Steinbrocker stages I–II, no corticosteroids, no previous joint surgery, and possibly CRP ≤1.0 mg/dL are factors associated with >10-year absence of cervical spine instability in RA.

Objective: To identify factors associated with the absence of cervical spine instability in patients with rheumatoid arthritis (RA). Methods: Cervical spine instability was defined as the presence of at least one of the following: atlantoaxial subluxation, vertical subluxation of the axis, or subaxial subluxation. In 2001–2002, 634 enrolled outpatients with “classical” or “definite” RA underwent a radiographic cervical spine checkup. In 2012–2013, 233 (36.8%) prospectively underwent routine clinical follow-ups with a >10-year radiographic evaluation. The prevalence and independent predictive factors for no instability were analyzed by multivariable logistic regression. Next, 85 of 292 outpatients (29.1%) without baseline cervical spine instability completed consecutive >5-year and >10-year radiographic examinations. The incidence and predictors for no new development of instability were assessed similarly. Results: Among 233 patients, those without cervical spine instability decreased from 114 (48.9%) to 47 (20.2%) during >10 years. Steinbrocker peripheral joint destruction stages I–II (odds ratio [OR], 3.797; p=0.001), no corticosteroid administration (OR, 2.700; p=0.007), and no previous joint surgery (OR, 2.480; p=0.020) were predictors for no instability. Then, 33 of 85 (38.8%) consecutively followed patients without baseline cervical spine lesions did not develop instability throughout. Steinbrocker stages I–II (OR, 5.355; p=0.005) and no corticosteroid therapy (OR, 3.868; p=0.010) were predictors for no new onset of instability. C-reactive protein (CRP) level≤1.0 mg/dL was marginal in both models (n=233 [OR, 2.013; p=0.057], n=85 [OR, 2.453; p=0.075]). Conclusion Steinbrocker stages I–II, no corticosteroids, no previous joint surgery, and possibly CRP ≤1.0 mg/dL are factors associated with >10-year absence of cervical spine instability in RA.

Objective: To identify factors associated with the absence of cervical spine instability in patients with rheumatoid arthritis (RA). Methods: Cervical spine instability was defined as the presence of at least one of the following: atlantoaxial subluxation, vertical subluxation of the axis, or subaxial subluxation. In 2001–2002, 634 enrolled outpatients with “classical” or “definite” RA underwent a radiographic cervical spine checkup. In 2012–2013, 233 (36.8%) prospectively underwent routine clinical follow-ups with a >10-year radiographic evaluation. The prevalence and independent predictive factors for no instability were analyzed by multivariable logistic regression. Next, 85 of 292 outpatients (29.1%) without baseline cervical spine instability completed consecutive >5-year and >10-year radiographic examinations. The incidence and predictors for no new development of instability were assessed similarly. Results: Among 233 patients, those without cervical spine instability decreased from 114 (48.9%) to 47 (20.2%) during >10 years. Steinbrocker peripheral joint destruction stages I–II (odds ratio [OR], 3.797; p=0.001), no corticosteroid administration (OR, 2.700; p=0.007), and no previous joint surgery (OR, 2.480; p=0.020) were predictors for no instability. Then, 33 of 85 (38.8%) consecutively followed patients without baseline cervical spine lesions did not develop instability throughout. Steinbrocker stages I–II (OR, 5.355; p=0.005) and no corticosteroid therapy (OR, 3.868; p=0.010) were predictors for no new onset of instability. C-reactive protein (CRP) level≤1.0 mg/dL was marginal in both models (n=233 [OR, 2.013; p=0.057], n=85 [OR, 2.453; p=0.075]). Conclusion Steinbrocker stages I–II, no corticosteroids, no previous joint surgery, and possibly CRP ≤1.0 mg/dL are factors associated with >10-year absence of cervical spine instability in RA.

The JCVSD (Japan Cardiovascular Surgery Database) was organized in 2000 to improve the quality of cardiovascular surgery in Japan. Web-based data harvesting on adult cardiac surgery was started (Japan Adult Cardiovascular Surgery Database, JACVSD) in 2001, and on congenital heart surgery (Japan Congenital Cardiovascular Surgery Database, JCCVSD) in 2008. Both databases grew to become national databases by the end of 2013. This was influenced by the success of the Society for Thoracic Surgeons' National Database, which contains comparable input items. In 2011, the Japanese Board of Cardiovascular Surgery announced that the JACVSD and JCCVSD data are to be used for board certification, which improved the quality of the first paperless and web-based board certification review undertaken in 2013. These changes led to a further step. In 2011, the National Clinical Database (NCD) was organized to investigate the feasibility of clinical databases in other medical fields, especially surgery. In the NCD, the board certification system of the Japan Surgical Society, the basic association of surgery was set as the first level in the hierarchy of specialties, and nine associations and six board certification systems were set at the second level as subspecialties. The NCD grew rapidly, and now covers 95% of total surgical procedures. The participating associations will release or have released risk models, and studies that use 'big data' from these databases have been published. The national databases have contributed to evidence-based medicine, to the accountability of medical professionals, and to quality assessment and quality improvement of surgery in Japan.
Adult ; Asian Continental Ancestry Group ; Certification ; Evidence-Based Medicine ; Humans ; Japan* ; Patient Safety ; Quality Improvement* ; Social Responsibility ; Thoracic Surgery