Purpose: We identified the risk factors for remnant gastric cancer (RGC) based on remnant gastric mucosal characteristics and gastritis morphology in patients undergoing distal gastrectomy. Materials and Methods: This multicenter retrospective study included 100 patients with RGC after distal gastrectomy and 550 patients without RGC treated between 2013 and 2020.Endoscopic findings, including anastomotic redness, red streaks, enlarged folds, bile reflux as anastomotic findings, as well as disappearance of the regular arrangement of collecting venules (RAC), atrophic gastritis, and intestinal metaplasia as background gastric mucosal findings, were evaluated. Disease risk score matching (1:1) was adjusted for baseline characteristics. Logistic regression analysis was used to develop a risk score model to stratify RGC risk into low, moderate, and high categories. Results: After matching, 96 patients with RGC and 96 controls were analyzed. Anastomotic redness and red streaks, as well as the disappearance of RAC and atrophic gastritis, were significantly more frequent in the RGC group than in the control group, whereas enlarged folds and bile reflux showed no significant differences. Risk scores were assigned as follows:anastomotic redness, 2; red streaks, 3; disappearance of RAC, 7; and atrophic gastritis, 3. The total score stratified patients into high (≥15), moderate (7–14), and low risk (≤6). The positive and negative predictive values were 67.7% and 83.3%, respectively. Conclusions The endoscopic findings of anastomotic redness, red streaks, RAC disappearance, and atrophic gastritis were significantly associated with RGC development.The proposed risk-scoring model could serve as a stratification tool for RGC surveillance.

Objective: To investigate the factors that induce strong contractions during repetitive peripheral magnetic stimulation (rPMS) and compare the muscle torque induced by two stimulators (Stim A and Stim B) with different coil properties. Methods: rPMS was applied to the right vastus lateralis of 30 healthy young adults. Stim A contained a 10.1 cm2 rectangular iron core coil, while Stim B contained a 191 cm2 round coil. The knee extensor torque (KET) induced by rPMS at 30 Hz was measured isometrically and divided by the maximum voluntary contraction (MVC) to obtain a relative value of MVC (%MVC). KET at 100% intensity of Stim A (A100%, 1.08 T) was compared to those at 100% or 70% intensity of Stim B (B100%, 1.47 T vs. B70%, 1.07 T). Additionally, we conducted a comprehensive literature search for studies that measured the KET during rPMS. Results: Both the mean values of %MVC using B100% and B70% were significantly greater than that using A100%. Furthermore, the KET induced by Stim B was found to be larger than that described in previous reports, unless booster units were used to directly stimulate the main trunk of the femoral nerve. Conclusion Stim B induced a stronger muscle contraction force than Stim A did. This may be because the larger the coil area, the wider the area that can be stimulated. Additionally, a circular coil allows for deeper stimulation.

Higher brain dysfunctions commonly interfere with functional reconstruction during rehabilitation. Most culprit lesions causing higher brain dysfunctions are observed in the cerebral cortex. However, recently, higher brain dysfunction caused by cerebellar lesions, termed cerebellar cognitive affective syndrome (CCAS), has attracted attention. Here, we report a case of CCAS in a patient with cerebellar infarction exhibiting aphasia, where arterial spin labeling (ASL) method of magnetic resonance imaging (MRI) was used to confirm decreased blood flow due to crossed cerebello-cerebral diaschisis (CCCD). The patient was a 5x years old, left-handed female. She was initially admitted to a neurosurgical hospital for dizziness. MRI demonstrated cerebellar infarction in the left posterior inferior cerebellar artery area. The next day, she was admitted to our hospital for surgery after the diagnosis of hemorrhagic cerebellar infarction due to progressive loss of consciousness. Craniotomy was performed to remove the hematoma. Neurological examination revealed fluent aphasia and ataxia in the left upper and lower extremities and trunk. ASL demonstrated decreased cerebral blood flow in the left cerebellar hemisphere and right front-temporal lobe. Therefore, we detected that CCCD resulted in higher brain dysfunction. After 3 months of inpatient rehabilitation, the patient's auditory comprehension, word conversion, and word recall improved. The patient was discharged unaided. This study used ASL to confirm the diagnosis and rehabilitation of the CCAS incidence effectively.

Purpose：In recent years, the proportion of older people diagnosed with lung tuberculosis is increasing in Japan. There have been no previous reports on detailed evaluation of swallowing function in patients with pulmonary tuberculosis. This study aimed to retrospectively evaluate the severity and characteristics of dysphagia using videoendoscopic evaluation of swallowing (VE) in patients with lung tuberculosis.Methods：A total of 58 patients (average age, 85.2 years) were selected. They are diagnosed with active pulmonary tuberculosis and underwent VE (performed an average 23 days after admission) at our hospital between January 2017 and March 2020. The severity of dysphagia was assessed using the functional oral intake scale (FOIS)．Activities of daily living (ADL) of the patients was evaluated by using Barthel Index (BI).Results：The average body mass index of the patients was 17 kg/m2, average serum albumin was 2.3 mg/dl, and average BI score was 8.6. Approximately, 71％ of the patients showed severe dysphagia (FOIS 1-2), and BI score of the group was significantly lower than that of the moderate group (FOIS＞3). We observed residual thickened water in 76％ of the patients. Before the VE, 45％ patients were administered oral anti-tuberculosis drugs. Only 35％ of the patients continued those drugs after VE, and 45％ of the patients died in hospital.Conclusion：The results suggest that patients with pulmonary tuberculosis might have a high frequency of severe dysphagia. Appropriate method of anti-tuberculosis drug administration should be selected based on their swallowing functions.

Higher brain dysfunctions commonly interfere with functional reconstruction during rehabilitation. Most culprit lesions causing higher brain dysfunctions are observed in the cerebral cortex. However, recently, higher brain dysfunction caused by cerebellar lesions, termed cerebellar cognitive affective syndrome (CCAS), has attracted attention. Here, we report a case of CCAS in a patient with cerebellar infarction exhibiting aphasia, where arterial spin labeling (ASL) method of magnetic resonance imaging (MRI) was used to confirm decreased blood flow due to crossed cerebello-cerebral diaschisis (CCCD). The patient was a 5x years old, left-handed female. She was initially admitted to a neurosurgical hospital for dizziness. MRI demonstrated cerebellar infarction in the left posterior inferior cerebellar artery area. The next day, she was admitted to our hospital for surgery after the diagnosis of hemorrhagic cerebellar infarction due to progressive loss of consciousness. Craniotomy was performed to remove the hematoma. Neurological examination revealed fluent aphasia and ataxia in the left upper and lower extremities and trunk. ASL demonstrated decreased cerebral blood flow in the left cerebellar hemisphere and right front-temporal lobe. Therefore, we detected that CCCD resulted in higher brain dysfunction. After 3 months of inpatient rehabilitation, the patient's auditory comprehension, word conversion, and word recall improved. The patient was discharged unaided. This study used ASL to confirm the diagnosis and rehabilitation of the CCAS incidence effectively.

Purpose：In recent years, the proportion of older people diagnosed with lung tuberculosis is increasing in Japan. There have been no previous reports on detailed evaluation of swallowing function in patients with pulmonary tuberculosis. This study aimed to retrospectively evaluate the severity and characteristics of dysphagia using videoendoscopic evaluation of swallowing (VE) in patients with lung tuberculosis.Methods：A total of 58 patients (average age, 85.2 years) were selected. They are diagnosed with active pulmonary tuberculosis and underwent VE (performed an average 23 days after admission) at our hospital between January 2017 and March 2020. The severity of dysphagia was assessed using the functional oral intake scale (FOIS)．Activities of daily living (ADL) of the patients was evaluated by using Barthel Index (BI).Results：The average body mass index of the patients was 17 kg/m2, average serum albumin was 2.3 mg/dl, and average BI score was 8.6. Approximately, 71％ of the patients showed severe dysphagia (FOIS 1-2), and BI score of the group was significantly lower than that of the moderate group (FOIS＞3). We observed residual thickened water in 76％ of the patients. Before the VE, 45％ patients were administered oral anti-tuberculosis drugs. Only 35％ of the patients continued those drugs after VE, and 45％ of the patients died in hospital.Conclusion：The results suggest that patients with pulmonary tuberculosis might have a high frequency of severe dysphagia. Appropriate method of anti-tuberculosis drug administration should be selected based on their swallowing functions.

Purpose: Type 4 gastric cancer (GC) has a very poor prognosis even after curative resection, and the survival benefit of splenectomy for splenic hilar lymph node (LN; #10) dissection in type 4 GC remains equivocal. This study aimed to clarify the clinical significance of splenectomy for #10 dissection in patients with type 4 GC. Materials and Methods: The data of a total of 56 patients with type 4 GC who underwent total gastrectomy with splenectomy were retrospectively analyzed. Postoperative morbidity, state of LN metastasis, survival outcomes, and therapeutic value index (TVI) of each LN station were evaluated. TVI was calculated by multiplying the incidence of LN metastasis at each nodal station and the 5-year overall survival (OS) of patients who had metastasis to each node. Results: Overall, the postoperative morbidity rate was 28.6%, and the incidence of #10 metastasis in the patients was 28.6%. The 5-year OS rate for all patients was 29.9%, and most patients developed peritoneal recurrence. Moreover, the 5-year OS rates with and without #10 metastasis were 6.7% and 39.1% (median survival time, 20.4 vs. 46.0 months; P=0.006). The TVI of #10 was as low as 1.92. Conclusions The clinical significance of splenectomy in the dissection of #10 for type 4 GC is limited and splenectomy for splenic hilar dissection alone should be omitted.

PURPOSE: Patients with pathological stage T1N+ or T2–3N0 gastric cancer may experience disease recurrence following curative gastrectomy. However, the current Japanese Gastric Cancer Treatment Guidelines do not recommend postoperative adjuvant chemotherapy for such patients. This study aimed to identify the prognostic factors for patients with pT1N+ or pT2–3N0 gastric cancer using a multi-institutional dataset. MATERIALS AND METHODS: We retrospectively analyzed the data obtained from 401 patients with pT1N+ or pT2–3N0 gastric cancer who underwent curative gastrectomy at 9 institutions between 2010 and 2014. RESULTS: Of the 401 patients assessed, 24 (6.0%) experienced postoperative disease recurrence. Multivariate analysis revealed that age ≥70 years (hazard ratio [HR], 2.62; 95% confidence interval [CI], 1.09–7.23; P=0.030) and lymphatic and/or venous invasion (lymphovascular invasion (LVI): HR, 7.88; 95% CI, 1.66–140.9; P=0.005) were independent prognostic factors for poor recurrence-free survival. There was no significant association between LVI and the site of initial recurrence. CONCLUSIONS LVI is an indicator of poor prognosis in patients with pT1N+ or pT2–3N0 gastric cancer.

STUDY DESIGN: Controlled laboratory study. PURPOSE: This study aimed to evaluate the efficacy of platelet-rich plasma (PRP) stored at room temperature (RT), frozen, or after freeze-drying. OVERVIEW OF LITERATURE: PRP enriches tissue repair and regeneration, and is a novel treatment option for musculoskeletal pathologies. However, whether biological activity is preserved during PRP storage remains uncertain. METHODS: PRP was prepared from blood of 12 healthy human volunteers (200 mL/person) and stored using three methods: PRP was stored at RT with shaking, PRP was frozen and stored at −80℃, or PRP was freeze-dried and stored at RT. Platelet counts and growth factor content were examined immediately after preparation, as well as 2, 4, and 8 weeks after storage. Platelet activation rate was quantified by flow cytometry. RESULTS: Platelet counts were impossible to determine in many RT samples after 2 weeks, but they remained at constant levels in frozen and freeze-dried samples, even after 8 weeks of storage. Flow cytometry showed approximately 80% activation of the platelets regardless of storage conditions. Almost no growth factors were detected in the RT samples after 8 weeks, while low but significant expression was detected in the frozen and freeze-dried PRP. Over time, the mean relative concentrations of various growth factors decreased significantly or disappeared in the RT group. In the frozen group, levels were maintained for 4 weeks, but decreased significantly by 8 weeks (p <0.05). The freeze-dried group maintained baseline levels of growth factors for the entire 8-week duration. CONCLUSIONS: Freeze-drying enables PRP storage while maintaining bioactivity and efficacy for extended periods.
Blood Preservation ; Flow Cytometry ; Freeze Drying ; Healthy Volunteers ; Humans* ; Intercellular Signaling Peptides and Proteins ; Pathology ; Platelet Activation ; Platelet Count ; Platelet-Rich Plasma* ; Regeneration

A 50-year-old man with an extensive thoracic aortic aneurysm underwent staged surgery which consisted of preceding total aortic arch replacement with the frozen elephant trunk technique using J Graft Open Stent Graft^®, followed by open thoracoabdominal aortic aneurysm repair. During the second operation, the descending aorta was cross clamped along with the preexisting stent graft, and Dacron graft was anastomosed directly to the stent graft using a running 4-0 monofilament suture. The anastomosis site was then covered with a short piece of Dacron graft identical with the stent graft in size to secure hemostasis. We herein discuss our approach in this complex case, focusing on prevention of inadvertent events such as deformation of the preexisting stent graft and unexpected bleeding.