This study evaluated the exercise profile (heart rate, cycling speed and pedal cadence) during 25-30 km cycling and fitness and health level for adults (11 males: 69.6 ± 4.7 yrs; 6 females: 66.3 ± 4.9 yrs) with a recreational cycling habit (27.6 ± 14.8 km/week). Exercise intensity at a constant speed on a flat road during male and female cycling was 71.2 ± 11.5 and 66.8 ± 11.4% heart rate reserved (HRR), respectively. Exercise intensity over 60% HRR occupied 72% of cycling time. Peak intensity during male and female cycling was 89.2 ± 8.9 and 93.1 ± 6.1% HRR, respectively. VO2max and CS (chair stand)-30 test for male and female were 40.3 ± 4.3 and 37.7 ± 2.4 ml/kg/min, and 30.8 ± 3.1 and 30.1 ± 3.2 times, respectively. The muscle cross-sectional area of thigh extensor and flexor measured by MRI were 55.4 ± 6.5 and 58.3 ± 13.3 cm² for male, and 45.5 ± 6.4 and 50.2 ± 5.7 cm² for female, respectively. Blood profile for HDL-C (cholesterol), LDL-C and HbA1c (JDS) for male and female were 65.9 ± 8.2 and 67.9 ± 10.6 mg/dl, 112.3 ± 32.0 and 130.6 ± 12.3 mg/dl, and 4.8 ± 0.4 and 4.7 ± 0.1%, respectively. Fitness level and blood profile results were superior to those of the same aged adults. We concluded that the exercise intensity of cycling by middle and older adults with a recreational cycling habit is high and their fitness and health level are higher than average adults.

The patient was a 63-years-old female with early gastric cancer in her upper stomach. Widely spreading on the mucous membrane, the cancer was too big to remove by endoscopical mucosal resection, although she wanted minimal invasive treatment. Therefore, we adopted total gastrectomy with hand-assisted laparoscopic surgery (HALS) after obtaining “informed consent” from her. Five small skin-incisions were necessary to perform it-one 7cm' for hand-port and four 1.2cm' for trocars.
The dissection was started from greater omentum and proceeded counterclockwise to remove primary lymphnodes. The abdominal esophagus and the duodenum were devided with a single or double application of Endo GIA stapler (linear stapler). All these steps were accomplished safely and securely with the effective support of the left hand of the operator. After extraction of the whole stomach through the 7cm-incision, Roux-en Y reconstruction was performed laparoscopically (esophago-jejunostomy) followed by hand sewing through the 7cm-incision (jejuno-jejunostomy). The anvil of 21mm circular stapler (EEA) was inserted orally in order to anastomose the esophagus to the jejunum. The patient had acceptable results intra-operatively as well as postoperatively by HALS total gastrectomy, which had been considered to be very hard to perform up to present time.