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: Transvaginal removal of large specimens during laparoscopic hysterectomy can be a complex surgical procedure that poses a risk of organ injury and tissue spillage into the abdominal cavity and is associated with extraction of the specimen and manual morcellation. Our objective was to demonstrate a technique for transvaginal removal of large specimens using the Alexis Contained Extraction System (CES) in laparoscopic hysterectomy. Methods: The technique used for transvaginal removal of large specimens using the Alexis CES was presented in this video. Surgery was performed at a tertiary hospital. Results: Following resection of the specimen during laparoscopic hysterectomy, the Alexis CES was inserted into the abdominal cavity through the umbilical trocar wound. The specimen was placed in a bag to prevent tissue spillage. The ring retractor was guided to the vagina and pulled out transvaginally. By repeatedly turning the ring retractor, tension was applied to the specimen bag, and the vaginal wall was unfolded all around to enable a secure surgical field. During manual morcellation of the specimen in the bag, the retractor was pulled and additionally turned to roll and re-tension the specimen bag when the bag was loosened. The specimen was pushed out of the vagina and safely and effectively extracted without concerns about tissue spillage in the abdominal cavity or related organ injuries. Conclusion The technique for transvaginal removal of large specimens using the Alexis CES enables simple, effective, and safe tissue extraction with contained manual morcellation during laparoscopic hysterectomy.

As a screening tool for detecting latent pre-locomotive syndrome (latent pre-LS) in women over the age of 40, measuring handgrip strength with a cut-off value of 26 kg was proposed in a previous report. However, this screening method missed 22% of latent pre-LS. It would be beneficial to screen almost persons with latent pre-LS in community pharmacies. In this study, it was investigated whether screening using the combination of measuring handgrip strength and the questionnaire, “Loco-check,” which was proposed by the Japanese Orthopaedic Association, improved the detection of latent pre-LS in the same group mentioned above. Combining only one of the “Loco-check” questions, “I cannot put on a pair of socks while standing on one leg,” with the measurement of handgrip strength with the cut-off value of 26 kg, the detection of latent pre-LS was increased to 90.2%. The odds ratio was 9.72 in logistic regression analysis. Using the combination of the measurement of handgrip strength and the response to one question is both rapid and convenient. Therefore, in this study, this screening combination is proposed to be a useful tool in community pharmacies for detecting early latent pre-LS.

STUDY DESIGN: Animal study. PURPOSE: To review the present warning point criteria of the compound muscle action potential (CMAP) and investigate new criteria for spinal surgery safety using an animal model. OVERVIEW OF LITERATURE: Little is known about correlation palesis and amplitude of spinal cord monitoring. METHODS: After laminectomy of the tenth thoracic spinal lamina, 2-140 g force was delivered to the spinal cord with a tension gage to create a bilateral contusion injury. The study morphology change of the CMAP wave and locomotor scale were evaluated for one month. RESULTS: Four different types of wave morphology changes were observed: no change, amplitude decrease only, morphology change only, and amplitude and morphology change. Amplitude and morphology changed simultaneously and significantly as the injury force increased (p<0.05) Locomotor scale in the amplitude and morphology group worsened more than the other groups. CONCLUSIONS: Amplitude and morphology change of the CMAP wave exists and could be the key of the alarm point in CMAP.
Action Potentials* ; Animals* ; Contusions ; Gravitation ; Laminectomy ; Models, Animal* ; Spinal Cord

Exercise intensity has been identified as a major determinant of the excess post-exercise oxygen consumption (EPOC). However, no studies have compared the prolonged EPOC after supramaximal intermittent exercise and supramaximal continuous exercise. Six young healthy male [age=26±3 (mean±SD) yr ; stature=175.4±5.7 cm ; body weight=66.8±6.7 kg ; maximal oxygen uptake (VO₂max)=44.1±8.5 ml/kg/min] xercised on separate days on a cycle ergometer at two equated total energy expenditures (intermittent exercise : 7×30-second intervals at 150%VO₂max with intervening 15-seconds rest periods ; continuous exercise : 5 min at 105%VO₂max) and then sat quietly in an armchair for 3h. A control trial without any exercise was also performed in a counterbalanced research design. The VO₂, carbon dioxide output (VCO₂), pulmonary ventilation (VE), respiratory exchange ratio (RER), heart rate (HR) and blood lactate concentration (LA) were measured before exercise, during exercise and during the 3-h recovery period. The mean VO₂ after intermittent trial at 150%VO₂max were higher than these of the control trial and the continuous trials at 105%VO₂max for 3-h recovery periods (p<0.05). The 3-h EPOC value for intermittent exercise trial (10.5±2.4L) was significantly greater than that of continuous exercise trial (4.8±2.7L) (p<0.05). The mean RER values for intermittent exercise trial were significantly lower than those of the control trial during 60-180 min post-exercise (p<0.05). We examined the effect of supramaximal exercise intensity on the magnitude of 3-h EPOC after 12-fasting. In the present study, 3-h EPOC was significantly greater for supramaximal intermittent exercise compared with the supramaximal continuous exercise when the amounts of work output performed are same. Therefore, our results indicate that exercise intensity may be a primary factor of 3-h EPOC even in a supramaximal exercise and that one of mechanisms for the 3-h EPOC would be related to the promoted lipid metabolism.

We examined the child-rearing environmental factors that affect the occurrence of sudden infant death syndrome (SIDS) using a nationwide survey. Infants who died due to SIDS between January 1996 and June 1997 in Japan were identified from death certificates. Controls of the same gender, birthplace, and birth months as the corresponding SIDS were chosen from birth certificates. Interviews of both cases and controls were undergone in January and February, 1998 by public health nurses. The following child-rearing factors exhibited a significant relationship with the occurrence of SIDS: Concerning the sleeping position, the prone position was associated with increased risk compared with the supine position, with an odds ratio of 3.02 (95% c.i. 2.07~4.65). Regarding the feeding method, artificial feeding alone demonstrated a higher risk than breast feeding alone, with an odds ratio of 4.92 (95% c.i. 2.78~9.63). With regard to smoking, infants with both parents who smoked exhibited a higher risk than infants where neither parent smoked, with an odds ratio of 3.50 (95% c.i. 1.74~8.32).
Sudden infant death syndrome ; occurrence ; Lower case sea ; Risk ; Affect

Aneurysm of peripheral pulmonary artery was rarely reported. A 51-year-old man who was pointed out a coin lesion at the right hilus region on the chest X-ray film complained back chest pain. Selective pulmonary arteriography revealed the peripheral pulmonary aneurysm of saccular dilatation running into the middle lobe. Aneurysmectomy was performed successfully and the patient returned to social work. Pathologic specimen revealed partly necrosis of medial cell. Eleven surgical cases including this case were reported in Japan. A brief review of the literature was made.