We evaluated regional differences of muscle O₂ dynamics between distal and proximal sites in the vastus lateralis (VL) muscle using near infrared spatial resolved spectroscopy (NIR_SRS). forty-one male subjects performed a 30 W ramp incremental bicycle exercise test until exhaustion. The NIR_SRS probes were attached on each distal and proximal site in the VL. The pulmonary O₂ uptake and heart rate were monitored continuously during the experiment. The TOI at rest was significantly higher in proximal than distal sites (65.0±5.2 vs. 69.7±4.6%, p<0.001). The TOI at exhaustion was also significantly higher in proximal than distal sites (39.5±6.7 vs. 47.5±7.6%, p<0.001). Moreover, a significant correlation was found between VO₂max and the TOI at exhaustion in each proximal and distal site in the VL. Half time reoxygenation, the time to reach a value of half-maximal recovery, was significantly slower in distal sites than proximal sites (27.1±5.6 vs. 25.0±6.1 sec, p<0.01). In conclusion, lower muscle oxygenation at exhaustion in higher VO₂max may be due to enhanced O₂ extraction in high oxidative capacity muscle. In addition, slower reoxygenation and lower muscle deoxygenation at the distal site in the VL may be explained by differences in O₂ supply and/or muscle fiber composition between distal and proximal sites.

The purpose of this study was to examine the association between the pedometer-determined steps per day and physical fitness in order to evaluate the usefulness of the pedometer-determined physical activity to help individuals meet the recommended exercise target level of the Ministry of Health, Labour and Welfare (MHLW). The subjects consisted of 222 men and 172 women aged 71 years in community-dwelling elderly. The subjects wore a pedometer for 7 consecutive days to measure daily steps. The functional capacity was assessed based on the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) and self-reported performance of tasks (stair-climbing and chair-rising). Physical fitness tests included handgrip strength, knee extensor strength, leg extensor power, stepping, one-leg standing time with eyes open and maximal walking speed at 10 m. The men and women took on average 6,561±2,907 and 6,329±2,451 steps/day, respectively. Our subjects seemed to be highly functioning elderly, because the total scores of TMIG-IC (maximum : 13 scores) were on average 12 for men and women. The average of steps/day was significantly correlated with stair-climbing, chair-rising and knee extensor strength in men and women, and with body weight, body mass index (BMI), percent body fat (%Fat) and leg extensor power in women. The BMI and %Fat levels were significantly lower while the handgrip strength and knee extensor strength were significantly higher in women who attained to the level of the pedometer-determined physical activity as recommended by the MHLW.The present study suggests that both men and women who take a lot of steps on a daily basis tend to demonstrate excellent leg strength and thus have a good ability to perform the tasks of daily living. In addition, the degree of obesity tends to be lower in women who regularly take a lot of steps. In addition, the number of daily steps taken has been recognized to be linked to gender, and such a link has also been suggested to be stronger in women than in men.

A 12-year-old girl had relative graft stenosis following the reconstruction of type A interrupted aortic arch. At 25 days after birth she underwent ascending aorta-descending aorta bypass with a 7mm knitted Dacron graft, ligation of the patent ductus arteriosus and pulmonary artery banding. She had patch closure of a ventricular septal defect (VSD) as well at 20 months of age. At age 12 catheterization was carried out, because she had headache and dizziness on exertion. The pressure of the ascending aorta was 163/79mmHg and the pressure gradient between the ascending and the descending aorta was 65mmHg. Aortography revealed severe stenosis of the graft, which might have occurred according to her growth. An extra-anatomic bypass was placed between the right axillary and the right common iliac artery through the intrapleural and preperitoneal route with a 10mm Dacron graft. Six months later, the blood pressure was 108/63mmHg in the upper extremities, the pressure gradient between the upper and lower extremities was reduced to 18mmHg, and headache and dizziness had disappeared.

Inflammation and pulse wave velocity (PWV) are a potential risk factor and marker, respectively, for atherosclerosis in the primary prevention setting. Atherosclerosis is now generally accepted to be an inflammatory disorder of the arterial wall, and the high-sensitivity C-reactive protein (hs-CRP) level has been reported to be a strong predictor of cardiovascular events. High-sensitivity-CRP is associated with two factors related to inflammation: (1) the local production of CRP by atheromatous tissue or coronary artery smooth muscle cells and (2) adipose tissue as a potent source of inflammatory cytokines. Based on studies in North America and Europe, hs-CRP has been established as a cardiovascular risk factor and a cut-off value has been recommended. However, Japanese have lower hs-CRP values than their Western counterparts, partly because Japanese have a lower body mass index (BMI), which correlates positively to hs-CRP, and partly because lifestyle and genetic factors can affect hs-CRP values. Therefore, a cut-off value needs to be established by cohort studies for the Japanese population. Carotid-femoral PWV is most commonly measured by applanation tonometry, particularly in Europe, but this method is critically dependent upon the accurate placing of transducers over the arteries and is both time-consuming and complex. A novel device has been recently developed in Japan that measures brachial-ankle PWV (baPWV) using a volume-rendering method. Brachian-ankle PWV is a suitable screening method because of its technical simplicity and shorter measurement time. It is associated not only with conventional cardiovascular risk factors but also with new risk factors, such as inflammation, gamma-glutamyltransferase, chronic kidney disease, and psychosocial factors. However, a suitable cut-off value has yet to be established.

Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.

Background/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding. Methods: We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared. Results: A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively. Conclusions HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.

Background/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding. Methods: We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared. Results: A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively. Conclusions HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.

Background/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs. Methods: POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up. Results: A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin. Conclusions In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.

Background/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO). Methods: Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared. Results: Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS. Conclusions No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.