[A Case of Gastric Cancer Invading the Pancreas with Pathological Complete Response Treated by Preoperative S-1 plus Oxaliplatin Therapy].

A 66-year-old man with severe anemia was diagnosed with gastric cancer. CT examination revealed primary gastric tumor, which involved the pancreas body, with regional lymph nodes that were enlarged(T4b[panc], cN2, cM0, cStage ⅣA). He received three courses of preoperative S-1 plus oxaliplatin therapy. Primary tumor and metastatic lymph nodes were reduced remarkably. We performed a curative distal gastrectomy(D2)without pancreas resection. Histopathological examination revealed Grade 3 pathological complete response in both primary tumor and metastatic lymph nodes.

[A Case of Intraductal Pancreatic Mallignant Tumor with Difficulty in Differentiating between IPMN and ITPN].

The patient was a male in his early 60s. Diabetes had aggravated 6 months earlier, and the patient was referred to our hospital for close examination. On contrast CT, enhanced mass shadows filling the lumen of the main pancreatic duct, which was dilated throughout the pancreas, were observed, and the mass was diagnosed as an adenocarcinoma on EUS-FNA. Based on these findings, main-duct IPMN was suspected and total pancreatectomy was performed. On macroscopic observation of the resected specimen, outgrowth of a solid tumor was observed in the main pancreatic duct, whereas only low-level mucus retention was noted in the pancreatic duct. Histopathological examination revealed a papillary/tubular tumor growth, suggesting interstitial infiltration throughout the pancreas. On immunostaining, the tumor was partially positive for MUC5AC, based on which the patient was diagnosed with an intraductal pancreatic mallignant tumor, with difficulty in differentiating between IPMC and ITPC. Clinicopathologically, many aspects regarding ITPN remain unclear. Further accumulation of such cases and investigation of the tumor pathology are necessary.

Preoperative evaluation of accessory hepatic ducts by drip infusion cholangiography with CT.

BACKGROUND: This retrospective study aimed to investigate the incidence of each type of accessory hepatic duct by drip infusion cholangiography with CT (DIC-CT). METHODS: Five hundred sixty nine patients who underwent preoperative DIC-CT and laparoscopic cholecystectomy were reviewed. Accessory hepatic ducts were classified as follows: type I (accessory hepatic ducts that merged with the common hepatic duct between the confluence of the right and left hepatic ducts and the cystic duct confluence), type II (those that merged with the common hepatic duct at the same site as the cystic duct), type III (those that merged with the common bile duct distal to the cystic duct confluence), type IV (the cystic duct merged with the accessory hepatic duct), and type V (accessory hepatic ducts that merged with the common hepatic or bile duct on the left side). RESULTS: Accessory hepatic ducts were observed in 50 patients. Type I, II, III, IV, and V accessory hepatic ducts were detected in 32, 3, 1, 11, and 3 patients, respectively. Based on their drainage areas, the accessory hepatic ducts were also classified as follows: a posterior branch in 22 patients, an anterior branch in 9 patients, a combination of posterior and anterior branches in 16 patients, a left-sided branch in 2 patients, and a caudate branch in 1 patient. None of the patients with accessory hepatic ducts suffered bile duct injuries. CONCLUSION: There are a number of variants of the accessory hepatic duct. DIC-CT is useful to detect the accessory hepatic duct.

[Metastatic Pancreatic Carcinoma from Renal Cell Carcinoma Indistinguishable from Primary Pancreatic Endocrine Tumor - A Case Report].

A hypervascularized tumor was detected in a 65-year-old man who had underwent a nephrectomy for a right renal cell carcinoma at the age of 55 years. We diagnosed the tumor as a non-functioning pancreatic neuroendocrine tumor or a metastatic tumor from the renal cell carcinoma. We performed distal pancreatectomy with splenectomy and lymph node dissection. The tumor was histopathologically diagnosed as metastatic renal cell carcinoma.

Idiopathic pulmonary hemosiderosis complicated by Down syndrome.

We report the case of a 9-year-old girl with Down syndrome (DS) diagnosed with idiopathic pulmonary hemosiderosis (IPH). Although acute pneumonia complicated by hemolytic anemia was suspected, IPH was finally diagnosed on bronchoscopy. Treatment with prednisolone achieved good clinical response. An association between IPH and DS was not able to be identified, but immunological issues in DS may contribute to the onset of IPH. Recurrent and intractable respiratory symptoms with marked infiltrative shadows in the bilateral lungs and complicated by severe anemia in patients with DS should suggest IPH.

Development of a Microminipig Model of Atherosclerosis for the Evaluation of a HMGCR Inhibitor.

BACKGROUND/AIM: Atherosclerosis is known as a major risk factor for cardiovascular disease, and development of an animal model of atherosclerosis is required to investigate its clinical pathogenesis. We studied the optimal amount of cholesterol in the diet and the optimal experimental period for development of a Microminipig model of atherosclerosis for the evaluation of a hydroxymethylglutaryl-CoA reductase (HMGCR) inhibitor (atorvastatin). MATERIALS AND METHODS: Eighteen male animals (3-4 months old) were divided into 3 groups. Group 1 consisted of control animals receiving a normal chow diet, Group 2 animals received a high fat (12% w/w) and low cholesterol (0.1% w/w) diet (HFLCD), and Group 3 animals received HFLCD+statin for 12 weeks. Animals received statin at 3 mg/kg body weight per day. HFLCD did not down-regulate the hepatic expression of HMGCR mRNA. RESULTS: HFLCD increased body, omentum, and mesenteric adipose tissue weight, and induced hypercholesterolemia and atherosclerotic lesions in the abdominal aorta. HFLCD+statin inhibited hypercholesterolemia and atherosclerotic lesions, but not obesity. CONCLUSION: A microminipig atherosclerosis model induced by HFLCD can be used in the evaluation of HMGCR inhibitors for the treatment of hypercholesterolemia and atherosclerosis.

A dermal phototoxicity study following intravenous infusion administration of ciprofloxacin hydrochloride in the novel microminipigs.

The authors evaluated dermal phototoxicity using the world smallest minipig (MMPig: Microminipig). MMPigs were administered 100 mg/kg ciprofloxacin hydrochloride with an infusion pump. The dorsal area of each animal was irradiated with ultraviolet-A irradiation. The left dorsal skin was irradiated at intensities of 5, 10, 15, and 20 J/cm(2), and the right dorsal back skin was set as a nonirradiated site. Gross and histopathological examinations were conducted before irradiation and from 1 to 72 hr after irradiation. Initial changes in the skin were necrosis of the basal and/or prickle cell layer and cellular infiltration from 24 hr after irradiation. Vesicle formation observed from 48 hr after irradiation was considered similar to bullous eruptions, a known side effect of fluoroquinolones in humans. Therefore, the authors suggest that the MMPig may be a useful experimental animal model for dermal phototoxicity studies.

[The role of ergonomics in occupational health - past and future].

The aim of working condition and ergonomics is to control the task method and condition for the best productive activity with the highest efficiency and sustainability. The Principles of Scientific Management by Frederick Winslow Taylor and its criticism by Gito Teruoka, the 1st director of The Institute for Science of Labour, are introduced for a better understanding of work condition and ergonomics in this article. Occupational physician have a duty to control working method and condition to reduce the health hazards induced by job duty. Not only the technical knowledge of medicine, but also a fundamental knowledge of manufacturing is needed for the occupational physician. The development of tools for early detection of health hazards and workload evaluation, the introduction of work management systems with cooperation between occupational physicians and technical experts of manufacturing are needed for effective control of the workplace. The strengthening of the Industrial Safety and Health Law should help to drive these improvements.

Reduction in disialyl-T antigen levels in mice deficient for both St6galnac3 and St6galnac4 results in blood filling of lymph nodes.

Sialic acid (SA) is present at the terminal ends of carbohydrate chains in glycoproteins and glycolipids and is involved in various biological phenomena. The biological function of the disialyl-T (SAα2-3Galß1-3(SAα2-6)GalNAcα1-O-Ser/Thr) structure is largely unknown. To elucidate the role of disialyl-T structure and determine the key enzyme from the N-acetylgalactosaminide α2,6-sialyltransferase (St6galnac) family involved in its in vivo synthesis, we generated St6galnac3- and St6galnac4-deficient mice. Both single-knockout mice developed normally without any prominent phenotypic abnormalities. However, the St6galnac3::St6galnact4 double knockout (DKO) mice showed spontaneous hemorrhage of the lymph nodes (LN). To identify the cause of bleeding in the LN, we examined podoplanin, which modifies the disialyl-T structures. The protein expression of podoplanin in the LN of DKO mice was similar to that in wild-type mice. However, the reactivity of MALII lectin, which recognizes disialyl-T, in podoplanin immunoprecipitated from DKO LN was completely abolished. Moreover, the expression of vascular endothelial cadherin was reduced on the cell surface of high endothelial venule (HEV) in the LN, suggesting that hemorrhage was caused by the structural disruption of HEV. These results suggest that podoplanin possesses disialyl-T structure in mice LN and that both St6galnac3 and St6galnac4 are required for disialyl-T synthesis.

Acupuncture Improves Sleep Conditions of Minipigs Representing Diurnal Animals through an Anatomically Similar Point to the Acupoint (GV20) Effective for Humans.

Acupuncture, an alternative medicine, has been widely applied for people with sleep disturbances; therefore, the effects should be evaluated objectively. Micro-minipigs (MMPigs), the smallest miniature pigs for animal experiments, were used. Acupuncture was performed at two different points: Dafengmen is located on the head and is an anatomically similar point to human-Baihui (GV20), an effective acupoint for sleep disturbances in humans; pig-Baihui is on the back. The procedure was performed as follows: shallow, within 5 mm depth for several seconds; deep, 10-20 mm depth for 20 min. The sleep conditions were evaluated by actigraph, and the amount of catecholamine in pooled urine after acupuncture treatment. MMPigs with deep acupuncture at Dafengmen showed significantly efficient values on actigraph and catecholamine analysis as compared with untreated MMPigs. The effective acupoint for sleep conditions in the porcine model is at an anatomically similar point to humans, rather than the point determined by traditional Chinese medicine.

[Relationship between performance rating and risk of low back pain in manufacturing line workers].

It is possible that the performance rating of line workers is affected by the risk factors for musculoskeletal disorders that are included in their work more so than by the actual takt time. To investigate whether performance rating relates to the risk factors for musculoskeletal disorders, we analyzed a dataset obtained from a self-administered questionnaire answered by assembly line workers (n=1579). As a result, performance rating had a significant association with unsuitable work environments, poor working postures and handling of heavy loads. The workers who reported the fastest rating had a higher exposure than others to the risk factors for occupational low back pain. The results of our study support the effectiveness of performance rating as an index of work burden.

The effects of static trunk flexion on oxygenation and electromyographic activity of erector spinae muscles.

In the workplace, localized muscle fatigue can be a limiting factor for prolonged static work. It is important to study the etiology of fatigue in the muscle to prevent discomfort and potential muscle injury. The purpose of this study was to investigate the effect of sustained trunk flexion and loading on the erector spinae muscles (ESM) fatigue using electromyography (EMG) and muscle oxygenation (Mox) changes. Twelve healthy male volunteers, aged between 19 and 28 years (mean age 23 +/- 2.6), participated in this study. The subjects held a load (5, 10 and 15 kg) and no load in their hands whilst sustaining trunk flexion at 60 degrees and also in an upright standing posture for 30 seconds. Five minutes rest was given between the conditions, and each condition was randomly repeated three times. Surface EMG and near-infrared spectroscopy were recorded. Root mean square and median frequency (MF) of EMG, and Mox were calculated. The results showed a greater decrease in Mox with an increase in loads over time (P = 0.015). Using unloaded trunk flexion as a control to ascertain load effect resulted in a significant difference in Mox in the unloaded condition and in the 15 kg condition (P = 0.027). EMG results showed a significant decrease in the MF over time in trunk flexion while holding a load (P < 0.001). These results show objectively that trunk flexion while holding loads causes ESM fatigue.

Fatigue sensation, electromyographical and hemodynamic changes of low back muscles during repeated static contraction.

The effects of work strategy and a rest condition on the physiological changes of the erector spinae muscle were studied. Eleven volunteers repeated fatiguing static contractions of holding an industrial box in 30° trunk flexion for a repetition of 12 times interrupted by rests for which the duration was equal to the duration of each preceding contraction. Each contraction was stopped at two fatigue sensation levels; moderate or strong, which corresponded to Borg's CR-10 3 and 5, as the work strategy conditions. The repeated contractions were performed for a total of eight conditions combined with the two rest conditions, with and without stretch exercise, and two contraction levels of 10 and 40% maximum pulling force in flexed posture (MVC) on separate days. Near-infrared spectroscopy and surface electromyography (EMG) were recorded. Amplitude and median frequency (MF) of EMG, oxy-hemoglobin, and deoxy-hemoglobin were calculated. MF related to fatigue sensation most closely. Oxy-hemoglobin decreased during each contraction. It, however, increased with repetition especially at 10% MVC and the increase was interpreted as adaptation to the work. The effect of the work strategy and the rest conditions was weak. MF decreased more in a strong work strategy condition than in a moderate one.

Biering-Sorensen test performance of Japanese young males: comparison with other ethnicities and relationship to electromyography, near-infrared spectroscopy and exertion ratings.

Back muscle endurance is a predictor of future low back pain and is commonly assessed using the Biering-Sorensen Test (BST). Differences exist between ethnic groups that may affect the performance and interpretation of the BST and should be investigated. This study's aim was to explore objective and subjective measures of the BST in a Japanese group in comparison with previous studies in other ethnic groups. A total of 27 young male Japanese students performed the BST while measures of muscle fatigue were collected. The mean BST time (152.7 (32.5) s) was greater than the median of the reported mean times in other ethnic groups over the previous decade (128.6 s). Objective measures indicated that the Japanese subjects' lumbar muscles were as fatigued as those of previous studies, while subjective measures appear to indicate that subjects under-reported exertion. The better performance of the Japanese subjects in the BST may reflect physical, psychosocial and lifestyle differences related to ethnicity. STATEMENT OF RELEVANCE: Ergonomics research and practice needs to be applicable to different ethnic groups. Despite the substantial body of evidence on back muscle endurance and indications of potential ethnicity related differences, this had not been previously investigated. These results help ergonomists to interpret physical ergonomics evidence in a multi-ethnic world.

Ability of ergonomic timeout to reduce musculoskeletal discomfort related to fluoroscopic endoscopy.

Endoscopists performing fluoroscopy procedures often suffer from musculoskeletal disorders (MSDs) due to persistent static muscle contraction and the load imposed by radiation personal protective equipment. We devised the "practical load-on-the-shoulders releasing technique" (PoRT), integrated it within the work-rest schedule, and investigated its ability to reduce muscular discomfort. The results showed that PoRT lowered discomfort, including by maintaining the head angle closer to the neutral position and keeping the trunk in a stable state, which together resulted in an ideal posture. As a simple, no-cost intervention based on an ergonomic approach, PoRT may contribute to reducing MSDs.

Data on long-term survival of the NOD/Shi-scid IL-2Rγnull (NOG) mouse in two facilities.

The objective of this study was to investigate an appropriate observation period for an evaluation of tumorigenicity in NOD/Shi-scid IL-2 Rγnull (NOG) mice. At SNBL, 19 male and 19 female NOG mice were observed the general condition from 7 weeks old up to 68 weeks old and at FBRI, 7 male and 16 female NOG mice were observed the general condition throughout the lifespan from 7 weeks old. The survival rate started to decline rapidly around 54 to 56 weeks of age in both facilities without a facility difference. Based on these survival data, it seems reasonable to terminate a tumorigenicity study at 52 weeks of age.

Development of a simple measurement scale to evaluate the severity of non-specific low back pain for industrial ergonomics.

This study developed an assessment scale that hierarchically classifies degrees of low back pain severity. This assessment scale consists of two subscales: 1) pain intensity; 2) pain interference. First, the assessment scale devised by the authors was used to administer a self-administered questionnaire to 773 male workers in the car manufacturing industry. Subsequently, the validity of the measurement items was examined and some of them were revised. Next, the corrected low back pain scale was used in a self-administered questionnaire, the subjects of which were 5053 ordinary workers. The hierarchical validity between the measurement items was checked based on the results of Mokken Scale analysis. Finally, a low back pain assessment scale consisting of seven items was perfected. Quantitative assessment is made possible by scoring the items and low back pain severity can be classified into four hierarchical levels: none; mild; moderate; severe. STATEMENT OF RELEVANCE: The use of this scale devised by the authors allows a more detailed assessment of the degree of risk factor effect and also should prove useful both in selecting remedial measures for occupational low back pain and evaluating their efficacy.

[Incidental detection of thymic mucoepidermoid carcinoma with massive calcification; report of a case].

31-year-old man who complained of chest pain due to chest wall wound caused by tumble. He took chest X-ray examination and suggested of having mediastinal tumor. Computed tomography (CT) scan revealed 3.0 cm mass in diameter with irregular shaped calcification and lobulated cystic lesion (size : 21 x 17 x 41 mm). The mediastinal tumor was totaly removed by surgical operation. No invasive portion was observed between mediastinal pleura and solid tumor. Pathological examination revealed that tumor was composed of mucoepidermoid carcinoma of the thymus and postoperative adjuvant radiotherapy was performed. The patient have survived without disease for 3 years after surgery.

[A method to extract signals related to fatigue during visual display terminal (VDT) operation using independent component analysis].

With the recent, rapid developments of computers, adaptation between the human being and computer is being improved. On the other hand, mental fatigue is increased by continuous, long-time use. The problem of mental fatigue is now a new focus of research. This study proposes a method of evaluating mental fatigue. In this study, we used a method to extract signals related to fatigue using Independent Component Analysis (ICA). The subjects were 10 male students. After assuming a workload of simulated visual display terminal (VDT) operation for 30 min, the subjects sat in a relaxed position for 30 min. In this process, we measured work performance, subjective symptoms of feelings of fatigue and physiological measures. As a result, there was a high value of the correlation coefficient between these signals and the subjective symptoms of feeling of fatigue. We suggest that by using ICA we can determine the relationship between Independent Components and subjective feelings of fatigue for those under work stress, work strain and in a state of fatigue and stress. However, further experiments are needed to obtain conclusive findings of our research.

Monkeys mutant for PKD1 recapitulate human autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) caused by PKD1 mutations is one of the most common hereditary disorders. However, the key pathological processes underlying cyst development and exacerbation in pre-symptomatic stages remain unknown, because rodent models do not recapitulate critical disease phenotypes, including disease onset in heterozygotes. Here, using CRISPR/Cas9, we generate ADPKD models with PKD1 mutations in cynomolgus monkeys. As in humans and mice, near-complete PKD1 depletion induces severe cyst formation mainly in collecting ducts. Importantly, unlike in mice, PKD1 heterozygote monkeys exhibit cyst formation perinatally in distal tubules, possibly reflecting the initial pathology in humans. Many monkeys in these models survive after cyst formation, and cysts progress with age. Furthermore, we succeed in generating selective heterozygous mutations using allele-specific targeting. We propose that our models elucidate the onset and progression of ADPKD, which will serve as a critical basis for establishing new therapeutic strategies, including drug treatments.