Associations between locomotive and non-locomotive physical activity and physical performance in older community-dwelling females with and without locomotive syndrome: a cross-sectional study.

BACKGROUND: Locomotive syndrome (LS) is a condition of reduced mobility due to a disorder of the locomotive system. Increasing moderate to vigorous physical activity (MVPA) has been recommended to prevent LS. However, to increase daily MVPA is difficult for older people with LS. The MVPA consists of not only locomotive activities such as walking but also non-locomotive activities such as household activities. The aim of this study was to examine the associations between locomotive/non-locomotive MVPA and physical performance in older females with and without LS. METHODS: Participants of this cross-sectional study were 143 older community-dwelling Japanese females. The participants were divided into two groups based on the results of the stand-up test: the normal group (NL) (n = 86) and the LS group (n = 57). Both the locomotive and non-locomotive PA seperately measured with its intensity. The intensity of physical activity (PA) was calculated as METs and classified as sedentary behavior (SB 1-1.5 metabolic equivalent tasks (METs)), low-intensity physical activity (LPA 1.6-2.9 METs), and MVPA (≥ 3 METs). For example, locomotive LPA is slow walking speed of 54 m/min, and locomotive MVPA is walking speed of 67 m/min. While non-locomotive LPA is office work and cooking, non-locomotive MVPA is housecleaning. Physical function was evaluated by handgrip strength, walking speed, and 2-step test. RESULTS: Walking speed, hand-grip strength, 2-step test, daily step counts, and all PA measurements were not significantly different between two groups. In the LS, locomotive MVPA (r = 0.293, p < 0.05) and total MVPA (r = 0.299, p < 0.05) was significantly correlated with walking speed, but not in the NL. CONCLUSIONS: Walking speed was positively correlated with locomotive MVPA and total MVPA in the LS group, but not in NL group. This result suggests that slow walking speed in older people with LS occur in connection with lower locomotive MVPA and total MVPA.

Associations among Bone Mineral Density, Physical Activity and Nutritional Intake in Middle-Aged Women with High Levels of Arterial Stiffness: A Pilot Study.

There is little consensus regarding the impacts of physical activity and nutrient intake on bone mineral density (BMD) in subjects with high or low levels of arterial stiffness. This study was performed to investigate whether physical activity and nutrient intake are associated with BMD in middle-aged women with high levels of arterial stiffness. The study population consisted of middle-aged women aged 40-64 years (n = 22). BMD was assessed by dual-energy X-ray absorptiometry. Carotid-femoral pulse wave velocity (cf-PWV) was used as an indicator of arterial stiffness. Subjects were divided into two groups by median cf-PWV. Physical activity in free-living conditions was evaluated using a triaxial accelerometer. Nutrient intake was also measured using the brief-type self-administered diet history questionnaire. In the High-PWV group, BMD showed a significant negative correlation with age. Using a partial correlation model, BMD was associated with the number of steps and unsaturated fatty acid intake in the High-PWV group. These results suggest that BMD in middle-aged women with high levels of arterial stiffness may be associated with both the number of steps and nutritional intake. Recommendations of physical activity and nutritional intake for the prevention of osteopenia should include consideration of arterial stiffness.

The effects of low-repetition and light-load power training on bone mineral density in postmenopausal women with sarcopenia: a pilot study.

BACKGROUND: Age-related reduction in bone mineral density (BMD) is generally accelerated in women after menopause, and could be even more pronounced in individuals with sarcopenia. Light-load power training with a low number of repetitions would increase BMD, significantly reducing bone loss in individuals at risk of osteoporosis. This study investigated the effects of low-repetition, light-load power training on BMD in Japanese postmenopausal women with sarcopenia. METHODS: The training group (n = 7) followed a progressive power training protocol that increased the load with a weighted vest, for two sessions per week, over the course of 6 weeks. The training exercise comprised five kinds of exercises (squats, front lunges, side lunges, calf raises, and toe raises), and each exercise contained eight sets of three repetitions with a 15-s rest between each set. The control group (n = 8) did not undergo any training intervention. We measured BMD, muscle strength, and anthropometric data. RESULTS: Within-group changes in pelvis BMD and knee extensor strength were significantly greater in the training group than the control group (p = 0.029 and 0.030 for pelvis BMD and knee extensor strength, respectively). After low-repetition, light-load power training, we noted improvements in pelvis BMD (1.6%) and knee extensor strength (15.5%). No significant within- or between-group differences were observed for anthropometric data or forearm BMD. CONCLUSIONS: Six weeks of low-repetition, light-load power training improved pelvis BMD and knee extensor strength in postmenopausal women with sarcopenia. Since this training program does not require high-load exercise and is therefore easily implementable as daily exercise, it could be an effective form of exercise for sedentary adults at risk for osteoporosis who are fearful of heavy loads and/or training that could cause fatigue. TRIAL REGISTRATION: This trial was registered with the University Hospital Medical Information Network on 31 October 2016 ( UMIN000024651 ).

Scopolamine raises cardiac demand in the elderly during gastrointestinal endoscopy.

BACKGROUND/AIMS: We measured changes in cardiopulmonary function of elderly patients during upper gastrointestinal endoscopy to examine the effects of antispasmodics. METHODOLOGY: This study was conducted on 174 subjects older than 60 years (101 male and 73 female, mean age 71.0). Subjects were divided into 3 groups based on the antispasmodic used for pre-medication: 76 received recombinant glucagon (Group G); 63 scopolamine butylbromide (group B); and 35 had no antispasmodic (group N). After informed consent a pulse oximeter was used to measure heart rate and oxygen saturation at five points during the endoscopic procedure. RESULTS: Maximum heart rate increase and oxygen saturation decrease occurred in all groups when the endoscope passed through the esophago-cardiacjunction. Heart rate was significantly higher in group B than G or N after administration of antispasmodic drugs. CONCLUSIONS: Scopolamine butylbromide should be administered with caution in upper gastrointestinal endoscopy of elderly patients because it may increase cardiac load.

The efficacy of endoscopic mucosal resection in the diagnosis and treatment of group III gastric lesions.

BACKGROUND: The efficacy of endoscopic mucosal resection (EMR) in diagnosing and treating group III lesions was analyzed. PATIENTS AND METHODS: Forty-three patients, with group III lesions confirmed by histopathological examination of the biopsy specimens, were included. All of these patients underwent EMR. The final diagnosis after EMR broadly classified the lesions as adenocarcinoma or adenoma. The clinicopathological features and therapeutic results were analyzed. RESULTS: Adenocarcinoma was identified in 16 patients (37.2%) and adenoma in 27 patients (62.8%). There were no differences in gender, age, lesion site, macroscopic type, or maximum diameter between the two groups. A significant difference in the maximum diameter of elevated lesions (p<0.05) was found between adenocarcinomas and adenomas, with the elevated lesions of adenocarcinomas measuring more than 10 mm. No residual focus recurrence was found among the adenomas. CONCLUSION: We conclude that EMR is effective and useful in diagnosing and treating group III lesions.

[A case of gastric cancer with paraaortic lymph node metastasis responding to TS-1/CDDP combination therapy].

A 53-year-old man had consulted another physician regarding his epigastralgia and anorexia. Since gastric cancer was detected, he was referred to our department. An upper gastrointestinal endoscopy revealed a type-2 gastric cancer at the upper portion of the lesser curvature of the stomach, and an abdominal CT scan showed marked swelling of periaortic lymph nodes. Since a radical resection appeared impossible, we used preoperative chemotherapy with a combination of TS-1 and CDDP. The patient was administered TS-1 for 3 weeks at 120 mg/ day, received an intravenous drip infusion of 90 mg/body of CDDP on day 8, and then discontinued chemotherapy for 2 weeks, which was regarded as one course. After 2 courses of the chemotherapy, an upper gastrointestinal endoscopy showed that the primary tumor was reduced in size, the periphery of the tumor almost flattened, and an abdominal CT scan confirmed the loss of swelling in the periaortic lymph nodes. The responsive rate was evaluated as PR. Since a radical resection was considered possible, we performed a total gastrectomy with complete D3 extirpation combined with a splenectomy. Histological efficacy was evaluated as grade 2 in primary cancer, and grade 3 in lymph nodes. Regrettably, the patient died one year and 7 months postoperatively. However, we consider the TS-1 and CDDP in combination useful as preoperative chemotherapy for advanced gastric cancer with periaortic lymph node involvement.

Perforated duodenal ulcer at seven years after heart-renal transplantation: a case report.

We experienced a rare case of perforated duodenal ulcer that occurred at seven years after heart-kidney transplantation. This patient is reported here together with a discussion of the etiology, the selection of treatment, and perioperative management. The patient was a 46-year-old man who presented with precordial pain. In 1995, he had undergone simultaneous heart and kidney transplantation in the United States and had been on long-term immunosuppressive and corticosteroid therapy. His precordial pain started from May 24, 2002. He was examined at our hospital on May 27 and underwent emergency surgery with a diagnosis of upper gastrointestinal perforation. A 4-mm perforation was observed on the anterior wall of the duodenal bulb and panperitonitis was also present. Patch closure of the perforation was performed by pulling the omentum over the defect. Perioperative management consisted of his usual immunosuppressants together with antacid therapy. The postoperative course was good and he was discharged on hospital day 15. In this patient, the mechanism of perforation was assumed to involve sudden irritation combined with poor circulation in the duodenum and tissue ischemia, as well as a decrease of mucosal protective factors based on long-term corticosteroid therapy. Perforated duodenal ulcer is a rare problem after heart transplantation. Because the time that elapses after perforation is an important determinant of the prognosis, early diagnosis and appropriate surgical repair are essential.

Clinical experience of transjugular intrahepatic portosystemic shunt (TIPS) and its effects on systemic hemodynamics.

We performed TIPS (transjugular intrahepatic portosystemic shunt) in patients with intractable esophageal varices accompanied by repeated hematemesis or with refractory ascites for the purpose of portal venous decompression, and successfully obtained complete elimination of esophageal varices or a marked decrease in ascites. While TIPS caused no particular variations in mean blood pressure or heart rate, cardiac output increased markedly on the 2nd and 3rd postoperative days before declining on the 5th postoperative day. Along with this, right atrial pressure, pulmonary arterial pressure and pulmonary capillary wedge pressure also increased transiently. TIPS has the potential to become an established effectual therapy for intractable esophageal varices and refractory ascites. However, careful attention should be paid to its hemodynamic effects, including the occurrence of cardiac failure.

Case report: a young woman with advanced esophageal cancer showing pathological complete response to neoadjuvant chemotherapy (CDDP, 5-FU and ADM).

A 32-year-old woman was admitted to our hospital with dysphagia. An upper gastrointestinal series revealed Borrmann type 2 esophageal cancer in the lower thoracic esophagus. Because direct invasion of the thoracic aorta was suspected, FAP therapy (CDDP, 5-FU and ADM) was given as neoadjuvant chemotherapy. After completion of two courses, her dysphagia resolved and the tumor shrank by over 90%, so radical surgery was performed. No lesions were found when the resected specimen was examined macroscopically. The only histological change was hyperplasia of collagen fibers in the submucosa, lamina propria and adventitia of the esophagus. No cancer cells and no metastases to the lymph nodes were observed. Because the tumor had completely disappeared, the histological effect of chemotherapy was classified as grade 3, i.e., pathological complete response (PCR). The response to FAP therapy was excellent and no serious adverse events occurred. Therefore, this is one of the treatments that should be actively applied in patients who have advanced esophageal cancer with suspected lymph node metastasis and invasion of other organs.

Modification of endoscopic aspiration mucosectomy (EAM) for early gastric cancer: EAM with pre-cutting.

BACKGROUND/AIMS: We have performed endoscopic aspiration mucosectomy for early gastric cancer since June 1993. In order to increase the complete resection rate, it is necessary to place the cancer in the center of the resection field. To facilitate complete resection, a circular incision to guide aspiration mucosectomy was made with a cutting knife (pre-cutting) before endoscopic aspiration mucosectomy, a procedure that we call endoscopic aspiration mucosectomy, with pre-cutting. METHODOLOGY: Eleven patients who had undergone endoscopic aspiration mucosectomy with pre-cutting for early gastric cancer at our department were included in this study. All resected specimens were examined macroscopically and histopathologically to assess the curative potential of this modified method of mucosectomy. RESULTS: The resected specimens ranged from 22 to 28 mm (mean: 25 mm) in maximum diameter, while the tumors ranged from 10 to 18 mm (mean: 12 mm) in size. Each resected specimen had the tumor at its center. The resection rating was EA in 10 (90.9%) of the 11 lesions and EC in 1 lesion (9.1%). CONCLUSIONS: For curative endoscopic surgery, there is no dispute that complete resection is essential. Thus, endoscopic aspiration mucosectomy with pre-cutting should contribute to the cure of early gastric cancer.

Prevalence of Helicobacter pylori in the residual stomach after gastrectomy for gastric cancer.

BACKGROUND/AIMS: In recent years, the role of Helicobacter pylori in gastritis of the residual stomach has attracted much attention. We investigated the prevalence of Helicobacter pylori in the residual stomach after distal gastrectomy for gastric cancer, as well as the correlations between Helicobacter pylori positivity and clinical characteristics or the severity of gastritis in the residual stomach. METHODOLOGY: The subjects were 66 patients with gastric cancer who underwent distal gastrectomy with Billroth I reconstruction at our department. Helicobacter pylori was detected by the 13C-urea breath test, and patients were considered to be Helicobacter pylori-positive if the delta 13C value was > 2.5@1000. RESULTS: The overall Helicobacter pylori positivity rate of the gastrectomy patients was a high 80.3%, with the rate being especially high in patients under 60 years of age and in those tested less than 5 years after surgery. There was a close relationship between Helicobacter pylori positivity and the severity of gastritis. CONCLUSIONS: Helicobacter pylori infection appears to cause the development of gastritis. Helicobacter pylori eradication needs to be taken into consideration in the management of Helicobacter pylori-positive patients after gastrectomy.