Purpose: Surgical resection of remnant gastric cancer (RGC) is technically challenging and difficult. Minimally invasive surgery (MIS) has been adopted for various procedures, but reports of MIS for RGC remain limited. Herein, we report the surgical techniques and short-term outcomes of MIS for RGC. Methods: We conducted a retrospective cohort study involving 61 consecutive RGC patients who underwent open or minimally invasive (laparoscopic or robotic) total gastrectomy for potentially curable RGC at our institution (January 1999–August 2025). A propensity scorematched cohort was used for an exploratory evaluation of the safety and efficacy of MIS for RGC, focusing on feasibility rather than superiority over open surgery. Results: Of these 61 patients, 53 underwent open surgery and eight underwent MIS gastrectomy for RGC. The median age was 70 years. The cohort comprised 53 men and eight women. The initial procedure was open surgery in 58 patients and MIS in three patients.Propensity score matching showed significantly reduced intraoperative blood loss in the MIS group compared with the open surgery group (39 mL vs. 576 mL, p < 0.05), and significantly longer operation time in the MIS group (352 minutes vs. 297 minutes, p < 0.05). Postoperative hospital stay was significantly shorter in the MIS group (12 days vs. 17 days, p < 0.05). The incidence of postoperative pancreatic fistula was lower in the MIS group, although not significantly different (0% vs. 16.7%). Conclusion MIS, including robotic gastrectomy, is feasible and safe for RGC, with potential perioperative benefits requiring multicenter validation.

OBJECTIVES: One of the important risk factors of falling is decreased muscle mass and muscle strength. Recently, there has been an increasing concern on the role of vitamin D in muscle strength and physical activity. Aim of our study is to examine the relationships between vitamin D status and muscle mass and muscle strength in middle-aged healthy adults. METHODS: Subjects were 40 healthy volunteers aged 42.0 ± 10.6 years old. Evaluation was made for serum vitamin D₃ metabolites including 25-hydroxyvitamin D₃ [25(OH)D₃] and 24,25-dihydroxyvitamin D₃ [24,25(OH)₂D₃] concentrations, lower limb muscle strength, and dietary intake by food frequency questionnaire. Body composition was measured by dual-energy X-ray absorptiometry (DXA), and appendicular skeletal mass index (ASMI) was calculated as skeletal muscle mass/squared height. RESULTS: 70% of the subjects had vitamin D insufficiency/deficiency (serum total 25(OH)D < 20 ng/mL), and female subjects had significantly lower serum total 25(OH)D level compared with males. Vitamin D insufficiency/deficiency group had significantly higher body fat, lower SMI and muscle strength, probably reflecting higher percentage of female subjects. Serum vitamin D₃ metabolites levels were significantly correlated with whole and site-specific ASMI, and lower limb muscle strength, except for the correlation between serum 24,25(OH)₂D₃ concentration and lower limb muscle strength. In addition, serum 25(OH)D₃ level was a positive significant predictor for both ASMI and lower limb muscle strength, while serum 24,25(OH)₂D₃ level was not their significant predictor. CONCLUSIONS: Serum 25(OH)D₃ level was significantly correlated with both skeletal muscle mass and lower limb muscle strength.
Absorptiometry, Photon ; Accidental Falls ; Adipose Tissue ; Adult ; Asian Continental Ancestry Group* ; Body Composition ; Calcifediol* ; Female ; Healthy Volunteers ; Humans ; Lower Extremity* ; Male ; Motor Activity ; Muscle Strength* ; Muscle, Skeletal* ; Risk Factors ; Vitamin D ; Vitamins

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.
Parkinson Disease

We evaluated the efficacy of evoked spinal potential (ESP) monitoring during thoracoabdominal aortic replacement to prevent intra-operative spinal ischemia. Nine patients underwent intraoperative ESP monitoring. The ESP was unchanged in 5 patients and decreased in 4 patients. However, ESP recovered in 2 of them by the following techniques: (1) perfusion of intercostal arteries, (2) elevation of distal bypass perfusion pressure, (3) slight hypothermia. Postoperative paraplegia occurred only 1 patient of the 2 whose ESP was not restored. The sensitivity and specificity of the efficacy of ESP monitoring were 100% and 87.5%, respectively. We concluded that ESP is the most useful monitoring for prevention of operative spinal ischemia during thoracoabdominal aortic replacement.