Nomadic pastoralism as a subsistence in Mongolia is mainly determined by natural ecology in steppe. However, as pastoralists live in state and society, and so social elements also severely affect ...their practice of pastoralism. In modern age, political and economic changes such as socialization and democratization affected it, for instance. This article mainly discusses the infrastructures as an element affected by technology and social system. As an example of qualitative change which occurred in modern Mongolia, emergence of constructions such as buildings made of concrete by machines can be pointed out. Construction of infrastructure which started in late 50s by collective farms brought about a new style of space usage that pastoralists choose their seasonal camps and movement routes considering sedentary area where school-age children and elderly people live in winter and grassland as a workplace. This space usage model is effective even now. Motorization which is linked to technology of movement is another example of qualitative change in modern age. Especially after 2000, it became popular among pastoralists to hold a private car as a means of seasonal movement and a motorbike used for short range movements including daily herding. Among commodities prevailing in this age, generators, batteries, mobile phones, and plastic containers seem to have especially large influence. Plastic containers are significant in that they enable to carry dairy products which in former were difficult to sell by an individual household. However, this change was assisted by spread of mobile phone which made personal communications easier, and by access to electricity which was necessary for use of mobile phone. Now we can predict that influence of internet access to their mobile pastoralism is becoming larger and larger. Recently, in accordance with prevailing of smartphones, usage of applications such as SNS is getting popular. As a result, availability of internet access largely affects pastoralists’ choice on the place of seasonal herding camp. Prevalence of this new infrastructure has a possibility to change their pastoral strategy again, as with past changes of social system and disasters.
This presentation will compare pastoralists’ pastoral strategies in the Mongolian plateau, which is divided into Northern and Southern Mongolia politically.The Mongolian Plateau is one of the central ...places of pastoralism in inner Asia. Because of its dry and cold climate, mobile pastoralism was traditionally prominent.However, global capital investment started to involve pastoralists into cash economy more and more deeply, by way of paved roads and availability of mobile phones after 2000s. The characteristic of today’s situation is coexistence of two pastoralists’ pastoral strategies according to the place they live; that is, suburban pasture and remote pasture.In Northern Mongolia, the trigger which made change of pastoralists’ pastoral strategies happen was a nationwide cold and snow disaster from 1999 winter to 2002 spring.It drastically reduced number of livestock, which rapidly increased during 1990s after the collapse of socialistic economic system. However, the lowest number by which they could keep sustainable life as pastoralists varied depending on the place pastoralists live. At suburban pasture where is close to cities or major roads, a smaller number of livestock is required. There are two major reasons for it; they can sell dairy products in addition to livestock and cashmere which are traditional commodity for sale, and costs for transportation are cheaper, comparing to remote pasture where mobile phone, which is necessary for selling dairy products, is generally out of service.As a result, pastoralists who migrated into suburban pasture increased, where density of pastoralists had not been dense at socialistic era. On the other hand, not a little number of pastoralists decide to remain in remote pasture for some reason; large number of livestock is more suitable for sparse remote pasture, for instance.This dichotomy is not only true to Northern Mongolia, but also to Southern Mongolia. Because the number of livestock which pastoralists can keep is controlled rather strictly according to carrying capacity set by local government, pastoralists in remote area who generally own wider pasture keep larger number. On the other hand, pastoralists in suburban area often started to get cash income by new way; tourist camps or fermented mare’s milk for instance. This phenomenon in Southern Mongolia also emerged after 2000s, when the central government recognized environmental problem in pastoral area and attributed it to overgrazing of pastoralists which was caused by privatization of livestock and pasture after 1980s.
This article compares pastoral strategies on the Mongolian Plateau, which is politically divided into northern and southern parts. Beginning in the 2000s, global capital investment has brought ...pastoralists into the market economy more deeply through paved roads and the availability of mobile phones. At present, two main pastoral strategies coexist, each predominant in a different environment, namely, in suburban pastures and in remote pastures. In north Mongolia (=outer Mongolia), pastoral strategies changed after a nationwide disaster of extreme cold and snow from the winter of 1999 to the spring of 2002, which drastically reduced the amount of livestock. In suburban pastures that are close to cities or major roads, fewer livestock are required. As a result, the number of pastoralists who migrate into suburban pasture increased, although there had been a low density of pastoralists during socialist era. However, a significant number of pastoralists decided to remain in remote pasture. This dichotomy is also seen in south Mongolia (=inner Mongolia). Because the number of livestock that pastoralists keep is strictly controlled according to the carrying capacity set by local government, pastoralists in remote areas who generally have a greater extent of pasture keep larger number. On the other hand, pastoralists in suburban areas often acquired cash income in new ways. This phenomenon also emerged in south Mongolia after 2000s, when the central government recognized environmental problems of pastoral areas and attributed them to the overgrazing of pastoralists.
Background/Purpose
Laparoscopic liver mono‐segmentectomy (LLMS) may improve patient outcomes, but it is difficult and its accuracy and safety are unknown. We evaluated the accuracy of LLMS using ...Glissonian approach with indocyanine green fluorescence (ICG) negative staining.
Methods
Seventy‐four patients eligible for LLMS except for segment 1 were enrolled. Preoperative three‐dimensional CT‐based surgical simulation was used to determine estimated liver resection volume (ELRV), which was compared with modified actual liver resection volume (ALRV) obtained from actual liver resection mass. The LLMS accuracy was also evaluated based on operator's experience (attending surgeon AS or trainee surgeon TS).
Results
Estimated liver resection volumes significantly correlated with ALRVs (r = .82) in all cases. Moreover, TS‐conducted LLMS also showed acceptable difference between ELRV and ALRV compared with AS‐conducted LLMS. There were no intergroup differences in estimated blood loss, operation time, time of Pringle maneuver, postoperative complications, and length of postoperative hospitalization (P < .05). Moreover, R0 resection was comparable between the AS and TS groups.
Conclusions
Laparoscopic liver mono‐segmentectomy with Glissonian approach using ICG negative imaging ensured safe and accurate procedure owing to facilitated visualization of the resection line. Our approach was effective in avoiding postoperative liver dysfunction and securing radical resection. In addition, it might be helpful in TS education of LLMS.
Highlight
Funamizu and colleagues compared the outcomes of laparoscopic liver mono‐segmentectomy using the Glissonian approach with indocyanine green fluorescence negative staining when conducted by attending surgeons and by trainee surgeons. The outcomes were acceptable without significant differences between the operator experience groups, indicating that the procedure is feasible, safe and accurate.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
This paper provides an insight into the framework employed to revisit Mongolian modern history. The term "environmental disaster" signifies the social process of entanglement in human-environmental ...interactions, emphasizing the failure of human actions. The Mongolian pastoral society is vulnerable to various kinds of disasters, among which the most problematic is dzud (cold and snow disaster), resulting in heavy damage to livestock. A severe disaster can be a cue to initiate social change, which emerges at the phase of resilience, as disasters may be recognized as a result of social instability. Although there were two severe dzud, the total number of livestock was relatively stable during the collectivization era (1959-1992). After the collapse of the socialist regime and the end of economic dependency on the USSR, the nation's total number of livestock increased until 1999. However, it saw a sharp decrease during the nationwide dzud (in 1999-2002), which continued for three years. This unprecedented dzud also brought about a change in pastoralism. Nowadays, even the people in pastoral lands depend on imported commodities associated with globalization. The rural landscape in Outer Mongolia has changed into two types: suburban areas, including areas around cities and near major roads; and remote areas, including typical Mongolian rural areas that do not have up-to-date socio-economic services. This distinction makes it a complex situation, especially when the questions of disasters arise for the Mongolian people.
Purpose
Postoperative acute kidney injury (AKI) remains a serious complication of liver resection with restrictive fluid therapy. However, unlike open hepatectomy, laparoscopic liver resection (LLR) ...does not have established anesthesia management strategies. We compared our goal-directed therapy (GDT) protocol for LLR with/without carperitide and the conventional restrictive method regarding AKI prevention.
Methods
The GDT thresholds in this retrospective observational cohort study were as follows: stroke volume variation, ≤ 15%; pulse pressure variation, ≤ 13%; oxygen delivery index, ≥ 600 mL/min/m
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; and mean arterial pressure (MAP), ≥ 55 mmHg. If the thresholds were not achieved, a 250 mL infusion fluid bolus was administered. The MAP target was changed to > 65 mmHg if the urine output was < 0.3 mL/kg/h. Postoperative AKI within 48 h and perioperative outcomes within 90 days were analyzed.
Results
Forty-seven propensity score-matched pairs from 127 patients were investigated. We adjusted for AKI risk factors and surgical difficulty; 46.8% of the GDT group received carperitide. The GDT group had a lower postoperative AKI rate (10.6% vs. 27.7%,
P
= 0.04) and shorter overall (
P
= 0.04) and postoperative (
P
< 0.01) hospital stays than the conventional group. Furthermore, the GDT group received more intraoperative fluid (
P
= 0.001) and phenylephrine (
P
= 0.02), without significant increases in blood loss and transfusion volume, than the conventional group.
Conclusions
GDT reduced the AKI rates post-LLR.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Laparoscopic liver resection has been increasingly utilized due to its less invasiveness approach compared with open surgery,
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but often creates challenges. Hepatocellular carcinoma ...(HCC) with bile duct tumor thrombus (BDTT) portends a poorer prognosis and often precludes patients from potential liver resection.
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We herein report a case of laparoscopic hepatectomy and thrombectomy in a patient with HCC and BDTT.
Methods
CT, ERCP, and POCS showed a 40-mm tumor located in the right lobe with BDTT. A five 12-mm trocar was inserted at the umbilicus for laparoscope, the epigastrium, both sides of the hypochondrium, and right lateral region. Moreover, a 5-mm trocar was inserted at left hypochondrium. After cholecystectomy, hepatoduodenal ligament was encircled using the tourniquet through 5-mm trocar site. The right portal vein was transected by stapler following transection of the right hepatic artery. After ICG staining (0.5 mg/body i.v.),
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hepatic parenchymal transection was performed using clamp-crashing technique. Moreover, CUSA also was used near Glissonian sheath. BDTT was removed from the right BD. Moreover, the cholangioscopy confirmed no BDTT remnants. The resection stump was then sutured. Finally, the right hepatic vein was divided with a stapler. A drainage tube was placed in the right subphrenic space. Operation time was 496 min, and blood loss was 91 ml. The patient was discharged without complications on postoperative day 11. Pathological diagnosis showed moderately differentiated HCC, tumor size 40 × 45 mm with negative surgical margins.
Conclusions
Pure laparoscopic resection for HCC with BDTT is a radical, yet feasible procedure.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
In pastoral society, the reproduction of livestock is directly related to the survival and prosperity of herders. The key to domestic animal reproduction lies in the cognitive bond between mother ...livestock and their young. Herdsmen use various tools and techniques to help develop this cognitive bond. These human mediation tools have various characteristics such as ‘restorative’ or ‘destructive’. The lamb bag, a widely used tool in pastoral society, has both ‘restorative’ and ‘destructive’ natures. Based on ethnographic data collected in Inner Mongolia, China, this paper first introduces the production method of lamb bags, then describes their structure, function and the multi-dimensional relationships generated during the application process, and finally discusses the cultural implications of ‘restorative’ and ‘destructive’ human mediation in pastoral culture. This article was published open access under a CC BY-NC 4.0 licence: https://creativecommons.org/licenses/by-nc/4.0/ .
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Postpancreatectomy hemorrhage (PPH) is the most lethal complication of pancreatoduodenectomy (PD). The main risk factor for PPH is the development of a postoperative pancreatic fistula (POPF). Recent ...evidence shows that the geriatric nutritional risk index (GNRI) may be predictive indicator for POPF. In this study, we aimed to evaluate whether GNRI is a reliable predictive marker for PPH following PD. The present study retrospectively evaluated 121 patients treated with PD at Ageo Central General Hospital in Japan between January 2015 and March 2020. We investigated the potential of age, gender, body mass index, serum albumin, American Society of Anesthesiologists classification (ASA), diabetes mellitus and smoking status, time taken for the operation, estimated blood loss, and postoperative complications (POPF, bile leak, and surgical site infections) to predict the risk of PPH following PD using univariate and multivariate analyses. Ten patients had developed PPH with an incidence of 8.3%. Among them, the patients were divided into bleeding group (n = 10) and non-bleeding group (n = 111). The bleeding group had significantly lower GNRI values than those in the non-bleeding group (p = 0.001). We determined that the cut-off value of GNRI was 92 accounting for a sensitivity 80.0%, specificity 82.9%, and likelihood ratio of 4.6 using receiver operating characteristic curve analysis. A GNRI of <92 was statistically associated with PPH in both univariate (p < 0.001) and multivariate analysis (p = 0.01). Therefore, we could identify that a GNRI < 92 was an independently potential predictor of PPH risk following PD. We should alert surgeons if patients have low level GNRI before PD.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
This is the first known case report of severe intrauterine adhesion (IUA) following a life‐threatening event caused by an Epstein–Barr virus‐associated atraumatic spleen laceration. A 22‐year‐old ...nulligravid female suffered from infectious mononucleosis for approximately 1 month. Sudden severe hypovolemic shock with massive hemoperitoneum appeared and hemostasis was completely achieved by a splenectomy for an atraumatic spleen laceration, although that was followed by multiorgan failure and abdominal compartment syndrome. Complete recovery without any neurological sequelae was achieved by intensive treatment. A postoperative pathological evaluation revealed Epstein–Barr virus‐associated splenomegaly. The patient was referred to our department because of secondary amenorrhea for approximately 5 months since the last menstruation, which occurred just prior to the event. Laboratory blood test results demonstrated normal thyroid and ovarian functions. Hysterofiberscopy revealed complete obstruction at the end of the cervical canal, indicating secondary uterine amenorrhea caused by severe IUA. Hysteroscopic adhesiolysis with a rigid hysteroscope reached the opening of the uterine cavity and menstruation was restored.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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