Stretching for the triceps surae muscle in the knee flexed position (medical stretching: MS) and knee extended position (static stretching: SS) were performed and the effect on the dorsiflexion angle of the ankle joint was examined. Five elderly females were selected as subjects. We measured the maximal dorsiflexion angle of the ankle joint in the following leg positions: (1) the maximal dorsiflexion angle in the extended knee position (EDF angle) and (2) the maximal dorsiflexion angle in the 90°flexed-knee position (FDF angle). There was a significant increase in the maximal dorsiflexion angle after MS and SS were carried out (p<0.01), but there was no significant difference between MS and SS. It was concluded that MS for triceps surae is equally effective as SS in increasing the maximal dorsiflexion angle of the ankle joint.

STUDY DESIGN: Retrospective case series. PURPOSE: To calculate the prevalence of L5-S1 intervertebral disc degeneration (IDD) by evaluating gynecological disease findings, obtained by pelvic magnetic resonance imaging (MRI), and reveal the risk factors for IDD by analyzing its relationship with age, sacral structure, body mass index (BMI), number of deliveries, and intrapelvic space-occupying lesions. OVERVIEW OF LITERATURE: Age, obesity, height, smoking history, occupation, and lumbosacral structure are reportedly the main factors of lumbar IDD. However, in women, the relationship of IDD with obstetric and gynecological history is unclear. METHODS: The presence of L5-S1 IDD was evaluated on sagittal T2-weighted pelvic MRI during gynecological evaluations in 660 Japanese women. We measured the sacral table angle (STA), sacral kyphosis angle (SKA), and intrapelvic space-occupying lesion size. Age, height, weight, BMI, number of deliveries, lumbosacral structure, size of space-occupying lesions, and presence of uterine leiomyoma based on medical records were compared between the IDD-positive and IDD-negative groups. RESULTS: Lumbosacral IDD was observed in 405 cases (61.4%), and its prevalence increased with age. Differences in age, height, weight, BMI, and number of deliveries between the IDD-positive and -negative groups were significant, but differences in STA, SKA, and presence of uterine leiomyoma and space-occupying lesion size were not. Logistic regression analysis indicated that age, BMI, and STA were risk factors for lumbosacral IDD. CONCLUSIONS: Age is the biggest risk factor for lumbosacral IDD in Japanese women, with BMI and STA also contributing to its development. However, SKA and obstetric and gynecological history were not significantly involved.
Asian Continental Ancestry Group* ; Body Mass Index ; Female ; Humans ; Intervertebral Disc Degeneration* ; Kyphosis ; Leiomyoma ; Logistic Models ; Magnetic Resonance Imaging* ; Medical Records ; Obesity ; Occupations ; Prevalence ; Reproductive History ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking

Objective To investigate the level of Chinese and Japanese main caregivers′ empowerment and self-efficacy, and to explore the relationship between empowerment, self-efficacy and activities of daily living ( ADL) among disabled elderly. Methods A total of 200 disabled elderly who were over 65 years old and their caregivers from 10 medical institutes in Japan and 3 in China completed main caregivers′ empowerment measurement (MCEM), self-efficacy scale (SES), and ADL scale. Results Average age of Chinese elderly was 11 years old younger than Japanese [(71. 9 ± 6. 7) years vs (83. 2 ± 7. 9) years], and the level of ADL in Chinese elderly was higher than Japanese. MCEM and SES score of Chinese and Japanese caregivers were above average. There were positive relationships between ADL of elderly and caregiver′s MCEM score and SE score ( r=0. 29,0. 25;P <0. 01). Caregivers with higher MCEM score, the elderly they took care had higher level of ADL. Conclusions The level of empowerment and self-efficacy for Japanese and Chinese caregivers are above average, and have positive correlation with the patients′ ADL level, so as to provide a inspiration of targeted nursing intervention for main caregivers.

BACKGROUND/AIMS: Stent migration occurs frequently, but the prevention of complications resulting from covered self-expandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect. METHODS: Between February 2010 and January 2011, an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications, and overall survival. RESULTS: Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131 days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death. CONCLUSIONS: m-CZSs with antimigration properties effectively, although not completely, prevented stent migration after stent insertion.
Aged ; Aged, 80 and over ; Alloys ; Carcinoma/*complications ; Cholestasis/etiology/*therapy ; Digestive System Neoplasms/*complications ; Drainage ; Equipment Design ; Feasibility Studies ; Female ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Middle Aged ; *Prosthesis Failure ; Recurrence ; Reoperation ; *Stents/adverse effects ; Time Factors

Background/Aims: Patients with achalasia-related esophageal motility disorders (AEMDs) frequently present with dilated and sigmoid esophagus, anddevelop esophageal diverticulum (ED), although the prevalence and patients characteristics require further elucidation. Methods: We conducted a multicenter cohort study of 3707 patients with AEMDs from 14 facilities in Japan. Esophagography on 3682 patients were analyzed. Results: Straight (n = 2798), sigmoid (n = 684), and advanced sigmoid esophagus (n = 200) were diagnosed. Multivariate analysis revealed that long disease duration, advanced age, obesity, and type I achalasia correlate positively, whereas severe symptoms and integrated relaxation pressure correlate negatively with development of sigmoid esophagus. In contrast, Grade II dilation (3.5-6.0 cm) was the most common (52.9%), while grade III dilation (≥ 6 cm) was rare (5.0%). We found early onset, male, obesity, and type I achalasia correlated positively, while advanced age correlated negatively with esophageal dilation. Dilated and sigmoid esophagus were found mostly in types I and II achalasia, but typically not found in spastic disorders. The prevalence of ED was low (n = 63, 1.7%), and non-dilated esophagus and advanced age correlated with ED development. Patients with right-sided ED (n = 35) had a long disease duration (P = 0.005) with low integrated relaxation pressure values (P = 0.008) compared with patients with left-sided ED (n = 22). Patients with multiple EDs (n = 6) had lower symptom severity than patients with a single ED (P = 0.022). Conclusions The etiologies of dilated esophagus, sigmoid esophagus, and ED are considered multifactorial and different. Early diagnosis and optimal treatment of AEMDs are necessary to prevent these conditions.

This study aimed to determine the different changes of muscle hardness between the human rectus femoris (RF) and vastus intermedius muscle (VI) after maximal knee extension exercise. Eight healthy men (23.0±2.6 years) performed maximal isometric contraction (IM), concentric contraction (CC), and eccentric contraction (EC) exercises of the knee extensors. Muscle hardness (i.e., strain ratio, SR) and thickness in the proximal, middle, and distal parts of RF and VI were measured by using strain elastography before and after exercises. The rates of change between the values were calculated as values before exercise 100%. For VI, a significant main effect in “part” was found in IM and EC exercises in SR. Results show that SR in the distal part (IM, 89.0±27.2%; EC, 78.2±26.9%) was significantly lower than that in the middle part (IM, 105.5±34.3%; EC, 91.8±30.4%) for each exercise (p<0.05). However, no significant main effect in “part” was found in SR of RF in any exercise. A significant main effect was found in “part” in muscle thickness of RF in the IM exercise. Also, muscle thickness in the distal part (104.5±7.7%) was significantly higher than that in the proximal part (102.5±4.3%) for each exercise (p<0.05). These results suggest that changes of muscle hardness and thickness in the proximal, middle, and distal parts of the human rectus femoris and vastus intermedius muscle after maximal knee extension exercises are different.

BACKGROUND/AIMS: We applied a back light system (BLS) with a magnifying glass to improve the ability to assess the adequacy of specimen sampling using endosonography. We conducted this study to evaluate the efficacy of the BLS in sampling of specimens by endoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses. METHODS: This was a prospective, randomized, crossover, single-center clinical trial. An endosonographer evaluated adequacy on gross visual inspection and identified whitish specimen sampling sites with and without the BLS according to a randomization sequence in the first and second passes with a 25-G needle. On cytological evaluation, the presence of well-defined pancreatic ductal epithelium was evaluated by a cytopathologist who was blinded to any clinical information. RESULTS: A total of 80 consecutive patients were eligible during the study period. Adequacy was observed for 52 specimens (65%) with the BLS and 54 (68%) without the BLS (p=0.88). In assessment of specimen adequacy on gross examination, only fair agreement was observed both with and without BLS (kappa score 0.40 and 0.29, respectively). CONCLUSIONS: The BLS did not influence the ability to identify specimen sampling sites or reliable assessment of specimen site adequacy using gross visual inspection.
Biopsy, Fine-Needle ; Cross-Over Studies ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Epithelium ; Glass ; Humans ; Needles ; Pancreatic Ducts ; Pancreatic Neoplasms ; Prospective Studies ; Random Allocation

Background/Aims: ManoScan and Sandhill high-resolution manometry (HRM) systems are used worldwide; however, the diagnosis of achalasia on the Starlet HRM system is not fully characterized. Furthermore, the impact of calcium channel blockers and nitrites in treating achalasia has not been investigated using HRM. Management of recurrent cases is a priority issue, although few studies have examined patient characteristics. Methods: We conducted a multicenter, large-scale database analysis. First, the diagnosis of treatment-naive achalasia in each HRM system was investigated. Next, patient characteristics were compared between type I-III achalasia, and the impact of patient characteristics, including calcium channel blocker and nitrite use for integrated relaxation pressure (IRP) values, were analyzed. Finally, patient characteristics with recurrent achalasia were elucidated. Results: The frequency of type I achalasia with Starlet was significantly higher than that with ManoScan and Sandhill HRM systems. In achalasia, multivariate analysis identified male sex, advanced age, long disease duration, obesity, type I achalasia, and sigmoid type as risk factors related to normal IRP values (< 26 mmHg). Calcium channel blockers and nitrites use had no significant impact on the IRP values, although achalasia symptoms were indicated to be alleviated. In recurrent cases, the IRP value was significantly lower, and advanced age, long disease duration, and sigmoid type were more common than in treatment-naive patients. Conclusions We should cautiously interpret the type of achalasia and IRP values in the Starlet HRM system. Symptoms of recurrent cases are related to disease progression rather than IRP values, which should be considered in decision making.

We report a case of 2X-year-old man with G4 chronic kidney disease (CKD G4). He had a decline in estimated glomerular filtration rate (eGFR) after the initiation of BEP (cisplatin, etoposide, bleomycin) therapy followed by VelP (ifosfamide, cisplatin, vinblastine) therapy for mixed germ cell testicular tumor. The patient’s eGFR did not recover during 59 months after chemotherapy, but showed a tendency to improve after treatment with yojinkodakuto. Yojinkodakuto was prepared by the IPCD (immersing powdered crude drugs) method. The IPCD method was adopted to ensure convenience and good quality prescription herbal medicines. Although eGFR fluctuated after yojinkodakuto treatment, at 3 years, serum creatinine (sCr) and eGFR progressed well, with sCr reducing from 3.98 mg/dL at initiation to 2.6 mg/dL and eGFR increasing from 16 mL/min/1.73 m2 to 25.4 mL/min/1.73 m2. In addition, a long-term eGFR plot analysis confirmed the 3-year improvement trend.