During the eleven years from January 1978 to December 1988, we experienced 1, 287 cases of gastric cancer, hospitalized in the surgical department of Tsuchiura Kyodo Hospital which is located in the southern agricultural district of Ibaraki Prefecture.
Among these 1, 287 cases, 1, 233 patients were operated on. Gastric resection was performed in 1, 059 cases including 337 cases of total gastrectomy with the resection rate of 85.9 percent (1, 059/1, 233). In 863 cases, resection gave histologically satisfactory results, and our curative resection rate was 70.0 percent (863/1, 233). Direct mortality rate was 2.35% in all operated cases and 1.32% in resected cases.
The five-year survival rate over the period from 1978 to 1983 was 57.7% in all resected cases and 69.3% in curatively resected cases.
Annual follow up observation showed increases in resection rate, curative resection rate, and five-year survival rate. However, there were no remarkable changes in the rate of total gastrectomy, rate of combined resection of other organs, and degree of lymph nodes dissection.
The main factor contributing to the improvement in the results of surgical treatment of gastric cancer was the increase in the detection rate of cancer in relatively early stages, through gastric mass survey or total check-up in the asymptomatic stage.

STUDY DESIGN: Cross-sectional study. PURPOSE: To determine the association between fatty degeneration of the multifidus muscle (Mm) and intervertebral disc degeneration (IVDD) using quantitative magnetic resonance imaging (MRI). OVERVIEW OF LITERATURE: Few studies have reported on quantitative MRI analysis of the relation between the Mm and IVDD. METHODS: The subjects with chronic low back pain comprised 45 patients (19 males, 26 females; mean age, 63.8±2.0 years; range, 41–79 years). We analyzed the intramyocellular lipids (IMCL) and extramyocellular lipids (EMCL) of the Mm using magnetic resonance spectroscopy. The T2 values of the anterior annulus fibrosus (AF), nucleus pulposus (NP), and posterior AF were evaluated using MRI T2 mapping. We compared the possible correlations of IMCL and EMCL of the Mm with the T2 values of anterior AF, NP, and posterior AF. RESULTS: There was a significant negative correlation between IMCL and T2 values of the anterior AF (r=−0.65, p<0.01). There were no significant correlations between the IMCL and T2 values of NP (r=−0.16, p=0.30) and posterior AF (r=0.07, p=0.62). There were no significant correlations between the EMCL and T2 values of the anterior AF (r=−0.11, p=0.46), NP (r=0.15, p=0.32), and posterior AF (r=0.07, p=0.66). After adjustment for age and sex using multiple linear regression analysis, there was a significant negative correlation between the IMCL and T2 values of anterior AF (standardized partial regression coefficient=−0.65, p<0.01). CONCLUSIONS: The results indicated that IMCL of the Mm might be accompanied with anterior AF degeneration. Therapeutic exercises using IMCL of the Mm as evaluation index might have the potential to identify novel targets for the treatment and prevention of IVDD.
Cross-Sectional Studies ; Exercise ; Female ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc ; Linear Models ; Low Back Pain ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Male ; Muscles ; Paraspinal Muscles

STUDY DESIGN: Prospective study based on magnetic resonance (MR) imaging of the lumbar spinal root of the intervertebral foramen. PURPOSE: This study was to compare MR three-dimensional (3D) sequences for the evaluation of the lumbar spinal root of the intervertebral foramen. OVERVIEW OF LITERATURE: The diagnosis of spinal disorders by MR imaging is commonly performed using two-dimensional T1- and T2-weighted images, whereas 3D MR images can be used for acquiring further detailed data using thin slices with multi-planar reconstruction. METHODS: On twenty healthy volunteers, we investigated the contrast-to-noise ratio (CNR) of the lumbar spinal root of the intervertebral foramen with a 3D balanced sequence. The sequences used were the fast imaging employing steady state acquisition and the coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC). COSMIC can be used with or without fat suppression (FS). We compared these sequence to determine the optimized visualization sequence for the lumbar spinal root of the intervertebral foramen. RESULTS: For the CNR between the nerve root and the peripheral tissue, these were no significant differences between the sequences at the entry of foramen. There was a significant difference and the highest CNR was seen with COSMIC-FS for the intra- and extra-foramen. CONCLUSIONS: In this study, the findings suggest that the COSMIC-FS sequences should be used for the internal or external foramen for spinal root disorders.
Diagnosis ; Healthy Volunteers ; Magnetic Resonance Imaging ; Prospective Studies ; Spinal Nerve Roots

In the areas of home medical care and self-medication, the role of the pharmacist is growing, partly as a result of Japan’s aging society and the need to reduce medical costs. In response, the Kinki University Faculty of Pharmacy implemented a physical assessment practical training seminar in order to improve the physical assessment skills of practicing pharmacists. A series of questionnaires were conducted among pharmacists to investigate their perceptions of physical assessment practical training seminars. The results of the questionnaires were analyzed using Customer Satisfaction (CS) analysis and text mining. Based on a 5-point scale (1-low∼5-high), questionnaires revealed satisfaction for physical assessment practical training seminars was 4.6±0.6 (Ave.±S.D.). CS analysis revealed that the items “lectures” and “case seminars” had the highest level of satisfaction. However, items showing low levels of satisfaction were “auscultation of respiratory sounds” and “SBAR (Situation, Background, Assessment, Recommendation).” Results of text mining suggested a relationship between “physical assessment” and “difficult”. Analysis of the questionnaires showed a high level satisfaction with physical assessment practical training seminars, notably physical assessment practice methods. However, CS analysis and text mining indicate the finer techniques of physical assessment were difficult to acquire.

BACKGROUND/AIMS: Both fecal immunochemical test (FIT) and fecal calprotectin (Fcal) results are useful biomarkers for ulcerative colitis (UC). However, the situations in which each marker should be used are largely unknown. METHODS: A total of 110 colonoscopy intervals of UC patients were assessed, and correlations between changes in colonoscopic findings and changes in the two aforementioned fecal markers were examined. RESULTS: Among patients with mucosal healing (MH) and negative FIT or Fcal results at the initial colonoscopy, FIT and Fcal findings exhibited accuracies of 93% (38/41) and 79% (26/33), respectively, for predicting the results of the subsequent examination. Among the 24 patients who showed endoscopic activity at the precedent colonoscopy and MH at the subsequent examination, positive-to-negative conversion of FIT and Fcal findings at the subsequent examination was observed in 92% (12/13) and 62% (8/13) of patients, respectively. Among the 43 patients who showed endoscopic activity at both the precedent and subsequent examinations, Fcal findings reflected the change in endoscopic activity better than FIT results (r=0.59, p<0.0001 vs r=0.30, p=0.054). CONCLUSIONS: The FIT is useful for confirming MH and the occurrence of relapse. In contrast, Fcal is useful for monitoring the mucosal status of patients with active inflammation.
Biomarkers ; Colitis ; Colitis, Ulcerative* ; Colonoscopy ; Humans ; Inflammation ; Leukocyte L1 Antigen Complex* ; Recurrence ; Ulcer*

BACKGROUND/AIMS: Although mucosal healing (MH) has been considered a treatment goal for patients with ulcerative colitis (UC), the risk factors predictive of relapse in patients who achieve MH are unknown. Because the platelet count has been shown to be a marker of inflammation in inflammatory bowel diseases, this study aimed to assess whether the platelet count could predict relapse in UC patients with MH. METHODS: A prospective observational study was performed. UC patients with MH were consecutively enrolled in the study and monitored for at least 2 years or until relapse. The correlation between the incidence of relapse and the platelet count at the time of study enrollment was examined. RESULTS: In total, 43 patients were enrolled, and 14 patients (33%) relapsed. The median platelet count at the time of enrollment in the patients who relapsed significantly differed from that in the patients who did not relapse (27.2×104/μL vs 23.8×104/μL, respectively; p=0.016). A platelet count >25.0×104/μL was a significant risk factor for relapse based on a multivariate analysis (hazard ratio, 4.85; 95% confidence interval, 1.07 to 25.28), and according to the Kaplan-Meier analysis, this cutoff could identify patients susceptible to relapse (p=0.041, log-rank test). CONCLUSIONS: The platelet count could be used as a predictor of relapse in UC patients with MH.
Blood Platelets* ; Colitis ; Colitis, Ulcerative* ; Humans ; Incidence ; Inflammation ; Inflammatory Bowel Diseases ; Kaplan-Meier Estimate ; Multivariate Analysis ; Observational Study ; Platelet Count* ; Prospective Studies ; Recurrence* ; Risk Factors ; Ulcer*

Methods: The participants were 50 patients with CLBP (23 men and 27 women; mean age, 63.1±17.8 years; range, 41–79 years). We compared the Visual Analog Scale (VAS) scores, intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs) of the Mm in NocP and NeP groups, as evaluated with the Japanese NeP screening questionnaire. Results: The patients were categorized into the NocP (n=32) and NeP (n=18) groups. The mean VAS score of the NocP group was 59.3±3.1 mm and that of the NeP group was 73.6±4.6 mm. The mean VAS score was significantly higher in the NeP group as compared to that in the NocP group (p<0.01). As per the analysis of covariance for the VAS score, the mean IMCL levels of the Mm in the NocP and NeP groups were 722.3 mmol/L (95% confidence interval [CI], 611.4–833.1) and 484.8 mmol/L (95% CI, 381.1–588.5), respectively. The mean IMCL level was significantly higher in the NocP group than in the NeP group (p<0.05). The mean EMCL levels of the Mm for the NocP and NeP groups were 6,022.9 mmol/L (95% CI, 4,510.6–7,535.2) and 5,558.1 mmol/L (95% CI, 4,298.3–6,817.9), respectively; however, the difference was not significant (p=0.72). Conclusions The results indicated an association between the IMCL level of the Mm and NocP. Our results suggest that MRS of the Mm might be beneficial for the assessment of CLBP as well as appropriate targeted analgesic therapies.

BACKGROUND/AIMS: Fecal calprotectin (Fcal) as well as the fecal immunochemical test (FIT) are useful biomarkers for detecting activity and mucosal healing in inflammatory bowel diseases. Here, we report the performance of simultaneous measurements of Fcal and FIT for ulcerative colitis (UC) patients using the newly-developed latex agglutination turbidimetric immunoassay (LATIA) system. METHODS: Fcal and hemoglobin were measured by the LATIA system in 152 UC patients who underwent colonoscopy. Fcal was also quantified with a conventional enzyme-linked immunosorbent assay (ELISA). Fecal markers were evaluated in conjunction with the mucosal status of UC, which was assessed via the Mayo endoscopic subscore (MES) classification. RESULTS: The LATIA system could quantify calprotectin and hemoglobin simultaneously with the same fecal samples within 10 minutes. The values of the Fcal-LATIA closely correlated with those of the Fcal-ELISA (Spearman rank correlation coefficient, r=0.84; P<0.0001). The values of Fcal for each assay and the FIT all significantly correlated with the MESs (Spearman rank correlation coefficient, Fcal-LATIA: r=0.58, Fcal-ELISA: r=0.55, and FIT: r=0.72). The mucosal healing predictability (determined by an MES of 0 alone) of the Fcal-LATIA, Fcal-ELISA, and FIT-LATIA with the cutoffs determined by receiver operating characteristic curve analysis was 0.79, 0.78, and 0.92 for sensitivity, respectively, and 0.78, 0.69, and 0.73 for specificity, respectively. CONCLUSIONS: The performance of the novel Fcal-LATIA was equivalent to that of the conventional Fcal assay. Simultaneous measurements with FITs would promote the clinical relevance of fecal biomarkers in UC.
Agglutination ; Biomarkers ; Classification ; Colitis, Ulcerative ; Colonoscopy ; Enzyme-Linked Immunosorbent Assay ; Feces ; Humans ; Immunoassay ; Inflammatory Bowel Diseases ; Latex ; Leukocyte L1 Antigen Complex ; ROC Curve ; Sensitivity and Specificity

Methods: The participants were 50 patients with CLBP (23 men and 27 women; mean age, 63.1±17.8 years; range, 41–79 years). We compared the Visual Analog Scale (VAS) scores, intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs) of the Mm in NocP and NeP groups, as evaluated with the Japanese NeP screening questionnaire. Results: The patients were categorized into the NocP (n=32) and NeP (n=18) groups. The mean VAS score of the NocP group was 59.3±3.1 mm and that of the NeP group was 73.6±4.6 mm. The mean VAS score was significantly higher in the NeP group as compared to that in the NocP group (p<0.01). As per the analysis of covariance for the VAS score, the mean IMCL levels of the Mm in the NocP and NeP groups were 722.3 mmol/L (95% confidence interval [CI], 611.4–833.1) and 484.8 mmol/L (95% CI, 381.1–588.5), respectively. The mean IMCL level was significantly higher in the NocP group than in the NeP group (p<0.05). The mean EMCL levels of the Mm for the NocP and NeP groups were 6,022.9 mmol/L (95% CI, 4,510.6–7,535.2) and 5,558.1 mmol/L (95% CI, 4,298.3–6,817.9), respectively; however, the difference was not significant (p=0.72). Conclusions The results indicated an association between the IMCL level of the Mm and NocP. Our results suggest that MRS of the Mm might be beneficial for the assessment of CLBP as well as appropriate targeted analgesic therapies.

STUDY DESIGN: Cross sectional study. PURPOSE: The study aimed to analyze mechanisms underlying chronic low back pain (CLBP) using magnetic resonance imaging (MRI) T2 mapping of the intervertebral disc (IVD). OVERVIEW OF LITERATURE: MRI T2 mapping utilizes the T2 values for quantifying moisture content and collagen sequence breakdown. We previously used MRI T2 mapping for quantifying the extent of IVD degeneration (IVDD) and showed a correlation between the degeneration of the posterior annulus fibrosus (AF) and CLBP. METHODS: We enrolled 40 patients with CLBP (17 males, 23 females; mean age, 50.8±1.6 years; range, 22–60 years). IVDs were categorized as the anterior AF, nucleus pulposus (NP), and posterior AF, and T2 value for each disc was measured. T2 values, assessed using the Japanese neuropathic pain (NeP) screening questionnaire, of the NeP and nociceptive pain (NocP) groups were compared. RESULTS: T2 values of the NocP and NeP groups were 64.7±5.6 ms and 58.1±2.3 ms for the anterior AF; 67.0±4.6 ms and 59.6±2.1 ms for NP; and 70.7±4.6 ms and 51.0±1.2 ms for the posterior AF, respectively. T2 values for IVDD were significantly lower in the NeP group than those in the NocP group (p<0.01). CONCLUSIONS: The results indicate a correlation between the degeneration of posterior AF and NeP. MRI T2 mapping may be beneficial for detecting NeP caused by IVDD and can help formulate targeted analgesic therapies.
Asian Continental Ancestry Group ; Collagen ; Female ; Humans ; Intervertebral Disc ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Mass Screening ; Neuralgia ; Nociceptive Pain