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BackgroundObesity is a known risk factor for complications after digestive surgery. Body mass index (BMI) is commonly used as an index of obesity but does not always reflect the degree of obesity. Although some studies have shown that high visceral fat area (VFA) is associated with poor outcomes in digestive surgery, few have examined the relationship between VFA and total gastrectomy. In this study, we demonstrated that VFA is more useful than BMI in predicting complications after total gastrectomy.MethodsSeventy-five patients who underwent total gastrectomy for gastric cancer were enrolled in this study; they were divided into two groups: a high-VFA group (n = 26, ≥100 cm2) and a low-VFA group (n = 49, <100 cm2). We retrospectively evaluated the preoperative characteristics and surgical outcomes of all patients and examined postoperative complications within 30 days of surgery (including cardiac complications, pneumonia, ileus, anastomotic leakage, pancreatic fistula, incisional surgical site infection [SSI], abdominal abscess, and hemorrhage).ResultsThe incidence of anastomotic leakage (p = 0.03) and incisional SSI (p = 0.001) were higher in the high-VFA group than in the low-VFA group. No significant differences were observed in the other factors. We used univariate analysis to identify risk factors for anastomotic leakage and incisional SSI. Age and VFA were risk factors for anastomotic leakage, and BMI and VFA were risk factors for incisional SSI. A multivariate analysis including these factors found that only VFA was a predictor of anastomotic leakage (hazard ratio [HR] 4.62; 95 % confidence interval [CI] 1.02–21.02; p = 0.048) and incisional SSI (HR 4.32; 95 % CI 1.18–15.80; p = 0.027].ConclusionsHigh VFA is more useful than BMI in predicting anastomotic leakage and SSI after total gastrectomy. Therefore, we should consider the VFA value during surgery

The present study demonstrates the long-term outcomes and risk factors for mortality of salvage esophagectomy. To improve OS after salvage surgery, the development of a means of decreasing pulmonary complications is needed.

SummaryIf a dialog system can respond to the user as reasonably as a human, the interaction will become smoother. Timing of the response such as back-channels and turn-taking plays an important role in such a smooth dialog as in human-human interaction. We developed a response timing generator for such a dialog system. This generator uses a decision tree to detect the timing based on the features coming from some prosodic and linguistic information. The timing generator decides the action of the system at every 100 ms during the user's pause. In this paper, we describe a robust spoken dialog system using the timing generator. Subjective evaluation proved that almost all of the subjects experienced a friendly feeling from the system.