Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]). Conclusions RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

Background: We evaluated the effectiveness of gemcitabine and paclitaxel therapy in patients with metastatic urothelial carcinoma for whom two lines of sequential chemotherapy had been unsuccessful.

Methods: A total number of 105 patients who had previously received first-line chemotherapy consisting of gemcitabine and cisplatin or carboplatin, were treated with second-line gemcitabine and docetaxel therapy between June 2006 and May 2015. Of these patients, 15 with an Eastern Cooperative Oncology Group Performance Status of 0 or 1 were administered gemcitabine and paclitaxel as third-line treatment from 2013 after failure of the second-line therapy. For each 21-day cycle, gemcitabine (1000 mg/m²) was administered on days 1, 8, and 15, and paclitaxel (200 mg/m²) on day 1. Patients were assessed for each cycle and any adverse events were noted. Furthermore, a Short Form Health Survey questionnaire was used to assess each patient’s quality of life.

Results: Third-line gemcitabine and paclitaxel treatment cycles were undertaken for a median of four times (range 2–9). The disease control rate was 80.0%. After second-line gemcitabine and docetaxel therapy was completed, median progression-free survival and median overall survival were determined as 9.8 and 13.0 months, respectively. The only prognostic factor for overall survival, as determined by univariate and multivariate analyses, was third-line gemcitabine and paclitaxel therapy. Neutropenia (66.7%) and thrombocytopenia (53.3%) were noted as the grade 3 treatment-related toxicities. After two cycles of third-line gemcitabine and paclitaxel therapy, the pre- and post-treatment quality of life scores did not differ significantly.

Conclusions: Results demonstrate that third-line combination therapy using gemcitabine and paclitaxel is a feasible option for metastatic urothelial carcinoma patients.

We report a case of ruptured chronic type B aortic dissecting aneurysm that was successfully treated with the Candy plug technique to exclude a false lumen. A 57-year-old man had undergone abdominal fenestration for complicated acute type B aortic dissection previously. He then underwent debranching TEVAR for an impending rupture because of a dilated thoracic aortic dissecting aneurysm in 2014. After one year, the aneurysm was ruptured because of continuous distal flow of the false lumen. We performed TEVAR using the Candy plug technique, and he was discharged on the 11th postoperative day. The false lumen diameter was reduced. TEVAR using the Candy plug technique for chronic type B aortic dissection was thought to be useful in high-risk patients, but we need more careful observation.

Objective To investigate the relation of 11C-methionine (11C-MET) uptake with cell proliferation and angiogenesis in human brain gliomas .Methods For 30 cases of newly diagnosed glioma patients ,positron emission tomography (PET ) examina-tion with 11C-MET was performed ,and the maximal standardized uptake value (SUVmax) of 11C-MET was measured .Expression of Ki-67 and CD34 antigens was examined by immunohistochemistry method in the same glioma samples ,both Ki-67 labeling index (Ki-67 LI) and microvessel density (MVD) were measured .Results Both 11C-MET SUVmax and Ki-67 LI increased significantly with glioma pathological grade ascending (P=0 .000 ,P=0 .000) ,and which in malignant glioma tissues were significantly higher than those in benign glioma tissues as well (P=0 .000 ,P=0 .000);however ,there were not significant differences in MVD among different grades of gliomas (P=0 .831) as well as between high and low malignant gliomas (P=0 .370) .11 C-MET SUVmax was significantly positively correlated with Ki-67 LI (P= 0 .000) ,however ,there were not significant correlations between 11C-MET SUVmax and MVD (P=0 .154) as well as between Ki-67 LI and MVD (P=0 .842) .Conclusion 11C-MET uptake and cell prolif-eration activity can better reflect the pathological grades and malignant degrees of gliomas .

The first step of cancer medical treatment is to eliminate anxiety about opioids. It is recommended to use printed matter in the "Guideline for Cancer Pain Management" edited by Japanese Society of Palliative Medicine,but few medical professionals actually use it. We developed the Opioids' pamphlet designed by Aichi Prefectural Society of Hospital Pharmacists; abbreviated OPA. This pamphlet is little burdened for readers; focusing on eliminating anxiety about opioids. Evaluation of the utility of the OPA and the actual conditions of patient education about the use of opioids by medical professionals were investigated, since there have been no reports on these issues. A questionnaire survey was conducted in hospitals with more than 150 beds in Aichi Prefecture. It targeted doctors, pharmacists and nurses who were practicing palliative care using opioids. There were many pharmacists and nurses who had been consulted about opioids, and most of the consultations were about addiction. 60% of pharmacists and 30% of nurses voluntarily performed patient education. Awareness of the guideline for of cancer pain management was low. OPA, which was reviewed based on the guideline, was applicable to 99% of the cases where the nurses were consulted. Its size and contents were highly acclaimed. Therefore, OPA is extremely valuable in clinical practice. Palliat Care Res 2009; 4(1): 214-227

Transnasal esophagogastroduodenoscopy (TN-EGD) has recently become one of the frequently used methods of upper gastrointestinal endoscopy in some countries. Changes in blood pressure, heart rate, and oxygen saturation are smaller for TN-EGD than for conventional transoral esophagogastroduodenoscopy, making it a safer procedure. Lower pain and gag reflex enable TN-EGD to be performed without conscious sedation. TN-EGD is applied in various gastrointestinal (GI) procedures such as percutaneous endoscopic gastrostomy, nasoenteric feeding tube placement, endoscopic retrograde cholangiopancreaticography with nasobiliary drainage and lithotripsy, long intestinal tube placement in small-bowel obstruction, esophageal manometry, foreign body removal, botulinum toxin injection for achalasia, esophageal varix evaluation with the aid of endoscopic ultrasonography, and the double-scope technique for endoscopic submucosal dissection. The establishment of standard training programs and nationwide guidelines, the dissemination of educational information, the improvement in endoscopy devices and accessories, and the availability of insurance coverage for the procedure will obviously further widen the adoption of TN-EGD.
Adoption ; Blood Pressure ; Botulinum Toxins ; Conscious Sedation ; Drainage ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal ; Endosonography ; Esophageal Achalasia ; Foreign Bodies ; Gastrostomy ; Heart Rate ; Insurance Coverage ; Lithotripsy ; Manometry ; Oxygen ; Reflex ; Varicose Veins

In Japan, doctors inexperienced stent-graft new devices are required to secure agreement on criteria and choice of the device size in endovascular aneurysm repair (EVAR) from experienced doctors. It was hoped that strict patient selection might reduce the learning curve for initial successes in given procedures. In a leading center in Japan, a number of cases which were scheduled for operation at other institutes were evaluated anatomically. We surveyed the initial success of Zenith AAA system implantation in the remaining cases by inexperienced doctors and evaluated the results. This study aimed to verify the validity of strict patient selection in improving the success rate of inexperienced doctors. We enrolled 112 consecutive patients from 19 institutes, who were scheduled for repair between January and October in 2007. All patients were evaluated on the basis of a less-than-3mm reconstructed CT image. Mean patient age was 76±5.7 years. All cases satisfied the Zenith's anatomic prerequisites. Fifteen cases were excluded for various reasons, the major reason being insufficiency of the proximal landing zone (LZ) length, angle and contour. The second reason was difficulty to approach via the iliac artery. Ninety seven cases were included, of which 17 cases were low-risk candidates for EVAR. Medium-risk seventy two cases requiring some advice to avoid problems with device size, technique of implantation and choice of main-body side. Eight cases were high-risk, requiring the presence of an experienced surgeon. Excluded cases had significantly shorter proximal LZ, larger aortic diameters 15mm below the renal artery and tortuous access routes on preliminary measurement by inexperienced doctor. Perioperative mortality was 0%, while the major complications were injury to the iliac artery in one high-risk case and thromboembolism of the superficial femoral artery in another. Perioperative proximal type I endoleak occurred in 5 cases. In 3 of these cases, the endoleak was eliminated by implantation of a Palmatz stent. In the other 2 cases, it disappeared within a month without additional procedures. These cases had a significantly greater angle between the proximal LZ and the suprarenal aorta and significant amount of mural thromboses in the proximal LZ. Perioperative type III endoleak occurred in 3 cases. In all cases the endoleak was eliminated by additional procedure. Perioperative type II endoleak occurred 8 cases. In 3 of these cases, the endoleak disappeared within a month. In the 5 other cases, the endoleak did not disappear. Mid-term results showed iliac leg thromboembolism in one case and new type II endoleaks in 3 cases. Type II endoleak occurred in cases which had significantly greater angles between the proximal LZ and the aneurysm. The results which were evaluated in our center had excellent perioperative and mid-term outcomes. We think this evaluation system is effective for risk assessment and reduces the learning curve in EVAR. In anatomically marginal cases, it is possible for proximal type I endoleak and injury of the iliac artery to occur. It is impossible to exclude these marginal cases if treatment need for EVAR is a priority. In these cases, lessexperienced operators should be trained in troubleshooting techniques in advance.

The effects of visual information about object size on grip force programming were investigated. Fifteen subjects (26.1±7.6 yrs) repeated lifts of a cube-like grip apparatus (30×30×30 mm, 30g) using a thumb and index finger, while three boxes of different sizes but equal weight (small : 10×10×60 mm, medium : 30×30×60 mm, large : 60×60×60 mm, 25g) were pseudorandomly presented by attaching beneath the grip apparatus. Lifting tasks were performed in two visual conditions. In the full-vision condition, subjects could perceive the box size prior to the lift-off of the grip apparatus, similar to normal everyday conditions. In the obstructed-vision condition, subjects could not perceive the box size due to the placement of a screen during the initial lifting phase, and only the grip apparatus were visible over the screen. The grip apparatus measured grip and load forces during the trial and we found that the grip and load force applied to the grip apparatus in the full-vision condition significantly increased with box size regardless of equal weight. In contrast, when the size information was removed in the obstructed-vision condition, the force applied for a given box of any size was always that adequate for the largest box, suggesting that the scaling of fingertip force by utilizing size information may be achieved by reducing forces for the smaller boxes on the basis of the force output applied for the largest box, but not by increasing forces on the basis of the force output applied for the smallest box.

The effects of aging on adaptive force control of precision grip while manipulating a small object were compared between older (84.2±8.9 yrs, n=33) and young adults (19.1±0.24 yrs, n=18) from the following perspectives: (1) adaptation to an unfamiliar object with uncertain physical properties during 16 consecutive lifts ; (2) adaptation to an object with a non-slippery (sandpaper) surface during 12 consecutive lifts, followed by 12 consecutive lifts with a slippery (silk) surface ; and (3) adaptation to objects with different weights (0.49, 0.98, 1.96 and 2.94 N) during 24 lifts (6 consecutive lifts for each weight) .During each trial, grip and load forces were monitored. Safety margin force and slip force were evaluated from the data obtained.
The majority of older adults employed a considerably greater safety margin for an unfamiliar object in the initial trials than did young adults, while the minority of the older adults were able to adapt their safety margin force with a few trials, like the young adults. The older adults who overestimated the safety margin force, however, successfully adjusted their grip force to more optimal levels with repeated lifts, suggesting that the adaptive capability of grip force remained even at 90 years of age. The adaptation of older adults, however, was found to be slower (i. e., required more trials) than that of young adults. Upon encountering surface friction change, the safety margin forces in older adults were more strongly affected by the previous surface condition than those in the young adults. In addition, adaptation to a non-slippery surface seemed more difficult than that to a slippery surface with aging. Upon encountering weight change, older adults showed more difficulties in scaling their safety margin forces according to object weights.
Slower adaptation and difficulty in adaptation to the friction or weight change in older adults may reflect the agerelated decline of tactile sensitivity which impaired the signaling of frictional conditions and various discrete events in the hand. In addition, the lift repetition for force adaptation may possibly reflect the age-related deficit or slowing of central processing capacities related to grip force production.