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Silent eating-no talking during mealtimes-has been used as a measure to reduce the spread of the COVID-19 infection because the emission of droplets during conversations has been considered a risk factor for spreading the virus. Japan implemented silent eating during school lunchtimes in May 2020, and it remained in effect until November 2022. However, concerns have been raised regarding its potential negative effects on children's well-being and educational attainment. More importantly, no study to date has examined its effectiveness in reducing the risk of COVID-19 outbreaks. This study aims to address this important knowledge gap by examining the impact of silent eating on the risk of COVID-19 outbreaks. In November 2022, the Japanese government announced that silent eating in public schools was no longer needed, which resulted in discontinuation of the measure in some schools while other schools maintained it. Taking advantage of this cancelation of the silent eating requirement as a natural experiment, we investigated whether silent eating was associated with a reduced risk of COVID-19 outbreaks. We measured the probability of class closures in public schools (the government's guidelines required class closure when more than one child was infected with COVID-19) by applying a Difference-in-Differences model with two-way fixed effects to panel data. We found no evidence that silent eating was associated with a reduced probability of class closures. Heterogeneity analysis also revealed that our findings did not vary by school characteristics. Our findings indicate that policymakers should be cautious about using silent eating at schools as a potential lever to control outbreaks of infectious diseases., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Importance: Although a growing number of studies have reported negative associations of the COVID-19 pandemic with academic performance among school-aged children, less is known about the pandemic's association with early childhood development., Objective: To examine the association between the COVID-19 pandemic and early childhood development., Design, Setting, and Participants: In this cohort study conducted in all accredited nursery centers in a Japanese municipality, baseline surveys of children aged 1 and 3 years (1000 and 922, respectively) were conducted between 2017 and 2019, and participants were followed up for 2 years., Exposure: Children's development was compared at age 3 or 5 years between cohorts that were exposed to the pandemic during the follow-up and a cohort that was not., Main Outcome and Measure: Children's developmental age was measured by nursery teachers using the Kinder Infant Development Scale (KIDS). Data were analyzed between December 8, 2022, and May 6, 2023., Results: A total of 447 children (201 girls [45.0%] and 246 boys [55.0%]) aged 1 year at baseline were followed up to age 3 years, and 440 children (200 girls [45.5%] and 240 boys [54.5%]) aged 3 years at baseline were followed up to age 5 years. During the follow-up, the cohorts that were exposed to the pandemic were 4.39 months behind in development at age 5 compared with the cohort that was not (coefficient, -4.39; 95% credible interval, -7.66 to -1.27). Such a negative association was not observed in development at age 3 years (coefficient, 1.32; 95% credible interval, -0.44 to 3.01). Variations in development were greater during the pandemic than before the pandemic regardless of age. Additionally, the quality of care at nursery centers was positively associated with development at age 3 years during the pandemic (coefficient, 2.01; 95% credible interval, 0.58-3.44), while parental depression appeared to amplify the association between the pandemic and delayed development at age 5 (coefficient of interaction, -2.62; 95% credible interval, -4.80 to -0.49; P = .009)., Conclusions and Relevance: The findings of this study showed an association between exposure to the pandemic and delayed childhood development at age 5 years. Variations in development widened during the pandemic regardless of age. It is important to identify children with developmental delays associated with the pandemic and provide them with support for learning, socialization, physical and mental health, and family support.

This study presents the first quantitative evaluation of the quality of early childhood education and care (ECEC) in Japan to make a significant contribution to the body of knowledge accumulated on ECEC in countries where research has been limited. We observed 30 classes comprising 3-year-olds, 28 classes comprising 5-year-olds, and 30 classes comprising mixed-ages from publicly provided nursery centers under the jurisdiction of the Kanto metropolitan area, Japan. An internationally-recognized quality rating scale for ECEC called the Early Childhood Environment Rating Scale, 3rd edition, which consists of six subscales, was used for this study. In contrast to previous studies conducted in the US, the results of this study showed that the Japanese ECEC is characterized as showing higher scores in the two subscales, "Personal Care Routines" and "Interaction," and showing lower score in the subscale, "Learning Activities." In addition, this study showed that the quality of ECEC varied across nursery centers. Furthermore, with regard to the two subscales, "Interaction" and "Language and Literacy," the degree of variation within centers differed across nursery centers. This study analyzed how these characteristics of Japanese ECEC can be partly produced by the existence of national guideline for nursery centers authorized by the Japanese government. In addition, mechanisms producing differences in the quality of ECEC among and within centers were also discussed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Fujisawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study conducted randomized controlled trials to evaluate the effectiveness of an environmental education class and the impacts of nudges and boosts implemented in this program on high school students' basic knowledge, attitudes, and behaviors regarding environmental issues in Japan. This environmental education class consisted of a lecture on reducing the use of plastic products for energy conservation in daily life, a board game for learning how to reduce plastic waste, and a worksheet for reflection. Four types of worksheets were randomly distributed: nudges, in which students were asked to set a goal regarding their level of effort in not throwing away plastic products such as plastic bags, wet wipes, and plastic bottles; boosts, in which participants were asked to write an essay to help increase their empathy for the parties impacted by environmental issues; both nudges and boosts; and none (neither nudges nor boosts). After environmental education, an end-line survey was conducted to evaluate the effectiveness of this class. This study found that the environmental education class significantly improved students' basic environmental knowledge and promoted their concerns about plastic waste. Although there was no evidence that nudges and boosts amplify the effects of the environmental education class on the students' knowledge, nudges were successful in making them more concerned about plastic waste. The results showed that students who received nudges or boosts were more likely to refuse free wet wipes offered at convenience stores but were not more likely to refuse plastic bottles. These results also indicated that interventions through environmental education can change students' pro-environmental behaviors only if the cost of behavioral change is low. The environmental education class not only increased students' environmental knowledge and attitudes, but the use of worksheets in administering nudges and boosts ensured the effectiveness of environmental education., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

We experienced a case of early gastric cancer. A 69-year-old woman with a thick gastric wall, thickened folds, and undifferentiated cancer cells in biopsy was diagnosed with scirrhous gastric cancer. The patient underwent total gastrectomy for scirrhous gastric cancer and was found to have only an early gastric cancer lesion located on the upper gastric wall. The thick wall diagnosed before surgery was diagnosed as angiodysplasia occupying the submucosal layer.

Some of scirrhous gastric cancer are difficult to diagnose on the surface view or to take correct biopsy specimen.A 85-yearold man with dysphagia was diagnosed scirrhous gastric cancer endoscopically, but could not be taken a biopsy specimen showing cancer.We informed cases of scirrhous gastric cancer difficult to take correct biopsy specimen and recommended surgical operation to take correct specimen and to start a treatment.Patient underwent total gastrectomy after cancer diagnosis( P0CY0cT4aN0).He can eat more food and survive longer than 1 year without any chemotherapies.Scirrhous gastric cancer needs early diagnosis and treatment to improve patient prognosis.

A 83-year-old man was diagnosed an earlygastric remnant cancer on the site of jejuno-gastrostomyafter proximal gastrectomywith jejunum interposing reconstruction 23 years ago. A total gastrectomywas performed due to the difficultyof endoscopic submucosal resection. The surgical operation took 200 minutes and the blood loss was 180 mL. Histologically, tumor size was 28×22mm invading to submucosal layer with a lymph node metastasis. To reduce the risk of surgical operation for gastric remnant cancer of aged patients, a simple reconstruction method is important for proximal gastrectomy, like a esophagogastrostomyplacing a gastric tube in the mediastinum.

A72 -year-old woman who complained of abdominal pain and distention visited the emergency clinic of our hospital in April 2014. Computed tomography(CT)showed an omental mass and a pelvic mass with massive ascites. The fluid was removed by abdominal aspiration, and the patient showed perforative peritonitis next day. An emergency operation was performed. The surgical operation showed that the rectum was perforated due to stenosis covered by the ovarian cancer metastases. Aleft colectomy combined with a transverse colostomy was performed. After 4 weeks of rest, 6 courses of tri- weekly TC chemotherapy were administered, and the CA125 level decreased from 140 U/mL to 11.8 U/mL. She underwent a complete cytoreductive surgery in February 2015. She was histologically diagnosed with Grade 2b serous adenocarcinoma. After these 2 surgical operations, she underwent a splenectomy to remove a single metastasis in February 2016 and consecutive chemotherapy. For ovarian cancer, if dissemination occurs, rectal perforation can be a treatment target with a gastrointestinal surgeon's help.

Recently, the concept of interfascial planes has become the prevalent theory among radiologists for understanding the retroperitoneal anatomy, having replaced the classic tricompartmental theory. However, it is a little known fact that the concept remains incomplete and includes embryological errors, which have been revised on the basis of our microscopic study. We believe that the concept not only provides a much clearer understanding of the retroperitoneal anatomy, but it also allows further development for diagnosis and treatment of retroperitoneal injuries and diseases, should it become an accomplished theory. We explain the history and outline of the concept of interfascial planes, correct common misunderstandings about the concept, explain the unconsciously applied therapeutic procedures based on the concept, and present future perspectives of the concept using our published and unpublished data. This knowledge could be essential to acute care physicians and surgeons sometime soon.

While studies on effort (e.g., Carbonaro, 2005; Kariya, 2000, 2013) have revealed relationships among students' effort (e.g., self-reported learning time), socioeconomic status, and school-related factors (e.g., tracking) through secondary education data, whether and how the effort gap emerges and widens in the early years of compulsory education have not been researched. This study investigates the beginning of inequality in effort by using four waves (from first- to fourth-grade students) of the Longitudinal Survey of Babies in the 21st Century, collected in Japan. The results indicate that college-educated parents tend to employ parenting practices that directly and indirectly shape children's learning time; inequality in effort exists, and it becomes exacerbated partly because of parenting differences in a society with a relatively equal elementary education system., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: Recently, the radiological concept of retroperitoneal interfascial planes has been widely accepted to explain the extension of retroperitoneal pathologies. This study aimed to explore embryologically based corroborative evidence, which remains to be elucidated, for this concept., Methods: Using serial or semi-serial transverse sections from 29 human fetuses at the 5th-25th week of fetal age, we microscopically observed the development of the retroperitoneal fasciae and other structures in the retroperitoneal connective tissue. A hypothesis for the formation of the interfascial planes was generated from the developmental study and analysis of retroperitoneal fasciae in computed tomography images from 224 patients., Results: Whereas the loose connective tissue was uniformly distributed in the retroperitoneum by the 9th week, the primitive renal and transversalis fasciae appeared at the 10th-12th week, as previous research has noted. By the 23rd week, the renal fascia, transversalis fascia, and primitive adipose tissue of the flank pad emerged. In addition, the primitive lateroconal fascia, which runs parallel to and close to the posterior renal fascia, emerged between the renal fascia and the adipose tissue of the flank pad. Conversely, pre-existing loose connective tissue was sandwiched between the opposing fasciae and was compressed and narrowed by the developing organs and fatty tissues., Conclusion: Through this developmental study, we provided the hypothesis that the compressed loose connective tissue and both opposed fasciae compose the interfascial planes. Analysis of the thickened retroperitoneal fasciae in computed tomography images supported this hypothesis. Further developmental or histological studies are required to verify our hypothesis.

Drying dissipative structures of aqueous dispersions of lycopodium particles (31 microm in average diameter) from the spores of Lycopodium clavatum were studied as a function of the particle concentrations in the presence and the absence of sodium chloride. The drying patterns formed on a cover glass, a watch glass and a Petri glass dish were observed macroscopically and microscopically. Lycopodium particles were the combination of hemisphere and tetrahedron in their shape and possessed the weakly acidic groups on their surfaces. The vague broad ring structure was observed even for the very large colloidal particles, and their size on a cover glass decreased as particle concentration decreased. Microscopic drying patterns almost disappeared except the short chain-like patterns. These observations support that the convectional contribution on the dissipative drying pattern formation is still effective in the lycopodium suspensions, though the convectional forces in the suspension are very weak compared with the sedimentation forces., (Copyright (c) 2010 Elsevier B.V. All rights reserved.)

A 73-year-old woman presented to our hospital with epigastric pain and swelling of the left upper limb. Enlarged lymph nodes with adhesion were palpable in the left cervical region and supraclavicular fossa. Tests were performed with the thought that the left upper limb swelling was secondary to venous compression by the enlarged lymph nodes. Gastroscopy detected a torose lesion on the anterior wall at the gastric angle and biopsy revealed that it was moderately differentiated adenocarcinoma. MRI showed metastasis to the sixth cervical vertebra and the first thoracic vertebra. Based on these findings, she was diagnosed as having progressive gastric cancer with metastasis to Virchow's lymph node and the cervical and thoracic vertebrae. Because it was considered impossible to perform radical gastrectomy, chemotherapy was given. Since renal dysfunction was suggested by a serum Cr of 1.5 mg/ml and a Ccr of 26.2 ml/min, TS-1 was administered at a lower dose (50 mg/day for 4 weeks) than usual, followed by 2 weeks off therapy to complete 1 course. During TS-1 therapy, the plasma 5-FU concentration at 4 h was 129.5 ng/ml, indicating that an effective plasma level of the drug was achieved. TS-1 therapy was considered effective because it reduced the diameter of the primary tumor and the lymph node metastasis, with only mild adverse reactions including myelosuppression.

Of 26 patients who underwent both coronary artery bypass grafting and abdominal surgery at our institution between 1977 and 1992, nine had severe coronary artery disease associated with UICC stage I gastric cancer. They were treated by coronary artery bypass grafting followed by a curative operation for gastric cancer; the initial four patients underwent two-staged surgery (group A), and the most recent five patients underwent simultaneous surgery (group B). The cardiac surgery was performed first in all patients, and in group A the interval between the two procedures was 2 to 7 weeks. There were no significant differences between the two groups in terms of preoperative characteristics: sex, age, preoperative complications, NYHA class, prior myocardial infarction, ejection fraction, cardiac index, number of vessels diseased, or number of grafts. There were no significant differences between the two groups in terms of blood loss during the gastric operation (A: 649 +/- 194 ml; B: 842 +/- 326 ml) or the operating time (A: 371 +/- 106 minutes; B: 343 +/- 46 minutes). Two group A patients had postoperative complications (one had arrhythmia, and one died of sepsis caused by sutural insufficiency). On the other hand, four group B patients had complications (three cases of transient hyperbilirubinemia and one case of postoperative bleeding; none died). The postoperative hospital stay after gastrectomy was not prolonged in group B compared with group A (A: 41.7 +/- 22.7 days; B: 46.0 +/- 25.0 days). In conclusion, simultaneous procedure of coronary artery bypass grafting and gastric surgery can be performed safely, although careful management is indispensable.

A 51-year-old Japanese man who underwent a standard distal gastrectomy for cancer of the stomach developed abdominal pain when oral intake was commenced on the 6th postoperative day after an uneventful postoperative course. Complete obstruction of the jejunum led to a sudden deterioration in his general condition and a laparotomy was performed, revealing counterclockwise rotation of the mesenterium. The necrotic portion of the small intestine was removed, while 10 cm of the upper jejunum and 100 cm of the terminal ileum were preserved. His second postoperative course was uneventful apart from the development of "intestinal hurry," which is now under medical control 9 months after his second laparotomy.

An aggressive pancreatectomy was performed on a 53 year old Japanese man with advanced cancer of the pancreas. The tumor originated from the body of the pancreas and invaded the stomach, duodenum, left kidney, transverse colon and common hepatic artery. An unexpected cancer was also found in the head of the pancreas during the operation. Therefore, total pancreatectomy, total gastrectomy, left adrenonephrectomy, resection of the left transverse colon and dissection of the regional lymph nodes were performed. Resection of the common hepatic artery was also performed, followed by an end-to-end anastomosis between the common hepatic artery and celiac trunk. The postoperative course was uneventful and the patient was doing well until nine months after the operation when multiple metastatic lesions were noted in the liver. He died 391 days after the operation from hepatic failure.

A case of pancreatic pseudocyst complicating with pregnancy and delivery was reported. This primipara patient with pancreatic pseudocyst was able to achieve a full-term, transvaginal delivery of a mature baby. The usefulness of ultrasonic monitoring of the pseudocyst during labor was clinically demonstrated. When intra-abdominal pressure increased, pancreatic pseudocyst was deformed.

Two patients with Budd-Chiari syndrome who underwent a new surgical procedure developed by Senning are reported. A 33-year-old man was diagnosed as having Budd-Chiari syndrome with a membranous obstruction of the inferior vena cava (IVC) and right hepatic vein and short segmental obstruction of the left hepatic vein. Removal of the obstruction by dorsocranial resection of the liver and reconstruction of the veins by hepatoatrial anastomosis was carried out. In a 53-year-old female, the same procedure was carried out for a short segmental obstruction of the IVC and left hepatic vein. In both patients, postoperative examination revealed good patency of the IVC and the hepatic veins and increased portal venous flow as measured by Doppler-echography. This procedure is considered the method of choice for Budd-Chiari syndrome with membranous and/or short segmental obstruction of the IVC and hepatic veins.