The Effect of the Postural Control Strategy on the Recognition Error of Center-of-Pressure Sway.

The purpose of this study was to examine the effect of postural control strategies on the recognition error (RE) of center-of-pressure (COP) sway forward based on perceived exertion. Participants were 43 middle-aged or elderly people. We measured the maximum COP sway forward (100% center-of-pressure distance(COP-D)), 60% and 30% COP-D of 100% COP-D based on perceived exertion, and participants were classified into the good balance group and bad balance group by RE. The RE and trunk and leg angles were evaluated during COP sway forward. Results showed that RE being significantly higher for 30% COP-D and the group with a larger RE had a significantly larger trunk angle. Therefore, they may have used hip strategy predominantly to perform postural control ability, not only maximum values, but also on perceived exertion.

[Relationship between exercise adherence and personality characteristics in persons experienced in the Medical Fitness program].

Objective　We examined effective exercise adherence support methods for persons experienced in the Medical Fitness (MF) program to clarify the relation of personality traits with exercise adherence and the factors that improve exercise adherence.Methods　Subjects were 283 adults who had registered as members in the MF program at an affiliate of Hospital A. We implemented an anonymous self-administered questionnaire by postal mail. Using the Japanese version of the Ten Item Personality Inventory (which contains 10 items that measure the Big Five personality traits), we evaluated the following characteristics: "Extraversion", "Agreeableness", "Conscientiousness", "Neuroticism", and "Openness". The subjects who reported exercising regularly at the time of survey were considered persons with subjective exercise adherence.Results　In persons with subjective exercise adherence, "Conscientiousness" was significantly lower (P=0.003) among men and "Neuroticism" was significantly higher (P=0.018) among women when compared to persons with subjective exercise adherence. There was no correlation between the things that emphasize exercise adherence and "Conscientiousness" among men. There was a negative correlation between "can achieve goal" and "Neuroticism" among women.Conclusions　It is essential to consider personality and gender differences when devising exercise adherence support measures for the MF program. Our results suggest that women with high neuroticism do not need "can achieve goal" to maintain their exercise habits; therefore, it is necessary to examine teaching methods that do not focus on only goal achievement as part of exercise adherence support for MF.

Low body mass index is associated with impaired quality of life in patients with rheumatoid arthritis.

AIM: To investigate the relationship between quality of life (QOL) and rheumatoid chachesia, malnutrition in patients with rheumatoid arthritis (RA). METHODS: EuroQol Group 5-Dimension Self-Report Questionnaire (EQ5D) and Japanese Health Assessment Questionnaire (JHAQ) scores, body mass index (BMI), arm muscle area (AMA) and clinical indicators were measured in 385 RA patients. One-way analysis of variance for obtained data was conducted among three groups: 131 with low BMI (< 20), 163 with moderate (20-25) and 91 with high BMI (≥25). Then multiple regression analyses for JHAQ and EQ5D scores with nutritional and clinical indicators as independent variables were performed. RESULTS: EQ5D and JHAQ scores were significantly lower and higher, respectively, in the low BMI group than those in the moderate BMI group. Clinical indicators including doses of corticosteroid were similar among the three groups except for disease duration. Disease activity score (DAS) 28, disease duration, C-reactive protein and AMA were significant variables in the regression model for EQ5D. CONCLUSION: Low BMI deteriorates the QOL of RA patients. Muscle protein loss apparently leads to a reduction in BMI and QOL.

Intramural and mesorectal distal spread detected by whole-mount sections in the determination of optimal distal resection margin in patients undergoing surgery for rectosigmoid or rectal cancer without preoperative therapy.

BACKGROUND: The current Japanese general rules for clinical and pathologic studies on cancer of the colon, rectum, and anus state that a 3-cm distal resection margin is needed in resecting rectosigmoid cancer and rectal cancer with a distal edge above the peritoneal reflection, and 2 cm is needed for rectal cancer with a distal edge below the peritoneal reflection. The appropriateness of these rules has not been proved. OBJECTIVE: Our aim was to evaluate the appropriateness of the Japanese rules. DESIGN AND SETTING: We retrospectively analyzed surgical and pathology records of patients who underwent surgery at a tertiary care cancer center in Japan. PATIENTS: The study included 381 consecutive patients with stage I to IV rectosigmoid or rectal cancer without preoperative chemotherapy or radiotherapy. MAIN OUTCOME MEASURES: We investigated both intramural and mesorectal distal spread, using whole-mount sections to measure the maximum length of distal spread. Long distal spread was defined as distal spread longer than the distal resection margin stated in the Japanese general rules. Risk factors for both distal spread and long distal spread were evaluated. RESULTS: Of 381 patients, 325 (85.3%) had no distal spread and a total of 56 (14.7%) had distal spread. Distal spread was within the limits specified by the Japanese general rules in 48 of the 381 patients (12.6%) and beyond the Japanese limits (long distal spread) in 8 patients (2.1%). The prevalence of distal spread increased with TNM stage (stage I, 2.7%; stage II, 5.3%; stage III, 17.4%; stage IV, 46.2%). Long distal spread was not observed in stage I or II, was found in only 1.4% of patients with stage III disease and in 11.5% of patients with stage IV. The maximum extent of distal spread in patients with rectosigmoid cancer or rectal cancer with the distal edge above the peritoneal reflection was 38 mm; in patients with rectal cancer with the distal edge below the peritoneal reflection, 35 mm. Multivariable analyses showed that nodal involvement and distant metastasis were independent risk factors for distal spread; distant metastasis was the only independent risk factor for long distal spread. CONCLUSIONS: The Japanese general rules specifying the distal resection margin are appropriate for most patients who undergo surgery for rectosigmoid and rectal cancer without preoperative chemotherapy or radiotherapy. A further increase of 1 to 2 cm beyond the recommended distal resection margin may contribute to improved local control for patients with distant metastasis.

[A case of advanced colon cancer treated with preoperative chemotherapy (IRIS) leading to clinical complete response].

The patient was a 68-year-old male who had advanced rectal cancer with aortic bifurcation lymph node metastasis, who was given neo-adjuvant chemotherapy by IRIS, a combination of S-1 80 mg/m(2)/day (2-week administration and 1-week rest) and CPT-11 100 mg/day (day 1, 15). After 2 courses of this neo-adjuvant chemotherapy, a complete response (CR) was noted by CT scan and endoscopy. We were able to conduct a super low anterior resection of the colon and rectum. Postoperative histopathological examination of the resected rectum and lymph nodes showed only the spot of residual cancer tissue and the degeneration of cancer cells and fibrosis, revealing that the operation had been conducted radically. The changes from neo-adjuvant chemotherapy were judged to be Grade 2. And we could thus conduct the radical operation. The treatment was completed without adverse events. IRIS therapy can be an effective method as neo-adjuvant chemotherapy.

A new histological classification for intra-operative histological examination of the ductal resection margin in cholangiocarcinoma.

The purpose of this study was to establish a standard histological classification for intra-operative histological examination of ductal resection margins in cholangiocarcinoma to distinguish between epithelial and intramural lesions and to clarify correlations between the new classification and clinical outcomes. Intra-operative diagnosis of ductal margins was performed for 357 stumps from 216 patients undergoing surgical resection of cholangiocarcinoma at the National Cancer Center, Japan. Three expert pathologists reviewed the materials and established a histological classification defined by grade of atypia. The new classification comprised four categories: 'insufficient', insufficient for diagnosis due to distortion of specimen; 'negative for malignancy', no atypia suggestive of neoplasia; 'undetermined lesion', specimen showing either cellular or structural atypia; and 'positive for malignancy', specimen showing both cellular and structural atypia. Each category was defined to distinguish between epithelial and intramural lesions. Validity and reproducibility of the proposed classification were found to be moderate to substantial. Multivariate analyses using the clinicopathological factors identified to be associated with overall survival by univariate analyses indicated that patients diagnosed with 'positive for malignancy' in intramural lesions of the proximal margin displayed significant poor prognosis. Meanwhile, in patients diagnosed with 'positive for malignancy' or 'undetermined lesion' in epithelial lesions of the proximal margin, no difference in overall survival was apparent compared to patients diagnosed with 'negative for malignancy'. We propose new histological classification for intra-operative histological examination of ductal resection margins in cholangiocarcinoma that shows a correlation with patients' prognosis and should facilitate the determination of ductal resection margin status for cholangiocarcinoma.

[A case of advanced gastric cancer responding to neoadjuvant S-1/CDDP therapy].

A 77-year-old male had complaints of epigastralgia. Gastrointestinal endoscopic examination revealed type 2 advanced gastric cancer. Computed tomography revealed metastatic Bulkey group 2 lymph nodes. The diagnosis was sStage IIIB gastric cancer (sT3 sN2sH0 sP0 CY0) at staging laparoscopy. S-1 (100 mg/body/day) was orally administered for 3 weeks followed by a drug-free 2 weeks, and CDDP (74 mg/body/day) was given intravenously on day 8. After 3 courses of chemotherapy, the primary lesion and the regional lymph nodes were significantly reduced in size. He was judged as clinical PR, followed by total gastrectomy, splenectomy and lymph node dissection. The pathological findings showed that there were very few cancer cells in the primary lesion, and lymph nodes had become scarred and fibrous. The final diagnosis was T2N0 H0 P0, fStageIB and curability A.

[Advanced gastric cancer responding to pathological CR after neoadjuvant TS-1 combined with CDDP therapy--report of a case].

A 54-year-old woman with advanced gastric cancer was referred to our hospital. Because it was the yearend, we selected neoadjuvant TS-1 combined with CDDP therapy. TS-1 (60 mg bid) was administered orally for 21 consecutive days, and CDDP (60 mg/m(2)) was infused intravenously on day 8. One course was completed without serious toxicities. The primary tumor revealed partial response (PR) with no lymph node metastasis judged from barium meal study and upper GI endoscopic findings. After 3 weeks, a simple total gastrectomy with lymph node dissection was performed. The pathological diagnosis proved that there were no cancer cells in the primary lesion or regional lymph nodes, suggesting a complete response (CR) to chemotherapy. The postoperative course was uneventful, and she has been fine as an outpatient.

[GVHD gastro-duodenitis].

Graft-versus-host disease(GVHD) colitis after allogeneic bone marrow transplantation or peripheral blood stem cell transplantation was often accompanied with upper gastro-intestinal symptoms such as upper abdominal pain. We investigated 7 cases of gastro-duodenal lesions with GVHD colitis. Endoscopic features of gastric lesions with GVHD were turbidity(100%), erythema(100%), erosions(85.7%), easy bleeding of mucosa(71.4%) and duodenal involvement(71.4%), histological findings of those were infiltration of inflammatory cells(100%), dilatation of capillaries(100%), hemorrhage(71.4%), stromal edema(85.7%), degenerated glands and apoptotic bodies(100%). Those findings resembled with endoscopic and histological features of GVHD colitis, so we diagnosed those lesions as GVHD gastro-duodenitis. Clinically GVHD colitis with gastro-duodenitis was severe compared with colitis without gastro-duodenitis.

[A case of advanced gastric cancer responding to neoadjuvant TS-1/CDDP therapy].

A 62-year-old advanced gastric cancer patient with bulky N2 lymph node metastases was treated by neoadjuvant chemotherapy with TS-1 and CDDP. TS-1 (100 mg/body/day) was orally administered for 3 weeks followed by a drug-free 2-week period as 1 course, and 75 mg/body/day of CDDP was administered by intravenous drip on day 8. After the first course, the primary lesion and the regional lymph node metastases showed partial response in terms of size. No serious drug adverse reaction was observed. During the second course, urgent total gastrectomy with distal pancreatectomy and splenectomy was performed for massive bleeding from a deep gastric peptic ulcer. The histopathological findings showed complete response of the carcinoma as primary lesion except for two sites of minimal lymphatic permeation and one lymph node (No. 8a) metastasis. The combined use of TS-1 and CDDP is useful as neoadjuvant chemotherapy for advanced gastric cancer.