Methods: Five formalin-embalmed human cadavers were used. We assessed the proportion of segmental arteries and veins that intersected the IVD in the L2–L5 range and their course on the anterior part of the spinal column. Results: The segmental arteries and veins commonly intersect the anterior part of the IVD (artery, 28.1%; vein, 42.1%). Seven of 10 (70%) segmental arteries at L2 intersected the IVD, but only one artery intersected the IVD at L3 and L4. The proportions of segmental veins that intersected the IVD were 60%, 50%, and 16.7% at L2, L3, and L4, respectively. Conclusions The segmental arteries and veins frequently intersect the IVD in the anterior part of the spinal column. Therefore, it is necessary to consider these individual anatomical features to prevent vascular damage during lateral lumbar interbody fusion surgery.

Background/Aims: Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety. Methods: Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment. Results: Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed. Conclusions Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis Clinical trial number (UMIN000037567).

Methods: HFCs were obtained from patients with LSS who underwent surgery. HFCs were stimulated by tumor necrosis factor-α (TNF-α) and a p38 MAP kinase inhibitor, SB203580. Phosphorylation of the p38 MAP kinase was analyzed by western blotting. The concentration of interleukin-6 (IL-6) in the conditioned medium was measured by enzyme-linked immunoassay and IL-6 messenger RNA expression levels were determined by real-time polymerase chain reaction. Results: TNF-α induced the phosphorylation of p38 MAP kinase in a time-dependent manner, which was suppressed by the p38 MAP kinase inhibitor, SB203580. TNF-α also stimulated IL-6 release in both a time- and dose-dependent manner. On its own, SB203580 did not stimulate IL-6 secretion from HFCs; however, it dramatically suppressed the degree of IL-6 release stimulated by TNF-α from HFCs. Conclusions This is the first report suggesting that TNF-α stimulates the gene expression and protein secretion of IL-6 via p38 MAP kinase in HFCs. A noted association between tissue hypertrophy and inflammation suggests that the p38 MAP kinase inflammatory pathway may be a therapeutic molecular target for LSS.

Background/Aims: Three-dimensional (3D) flexible endoscopy, a new imaging modality that provides a stereoscopic view, can facilitate endoscopic hand suturing (EHS), a novel intraluminal suturing technique. This ex-vivo pilot study evaluated the usefulness of 3D endoscopy in EHS. Methods: Four endoscopists (two certified, two non-certified) performed EHS in six sessions on a soft resin pad. Each session involved five stitches, under alternating 3D and two-dimensional (2D) conditions. Suturing time (sec/session), changes in suturing time, and accuracy of suturing were compared between 2D and 3D conditions. Results: The mean suturing time was shorter in 3D than in 2D (9.8±3.4 min/session vs. 11.2±5.1 min/session) conditions and EHS was completed faster in 3D conditions, particularly by non-certified endoscopists. The suturing speed increased as the 3D sessions progressed. Error rates (failure to grasp the needle, failure to thread the needle, and puncture retrial) in the 3D condition were lower than those in the 2D condition, whereas there was no apparent difference in deviation distance. Conclusions 3D endoscopy may contribute to increasing the speed and accuracy of EHS in a short time period. Stereoscopic viewing during 3D endoscopy may help in efficient skill acquisition for EHS, particularly among novice endoscopists.

Introduction: We started the gender-specific clinic for women to provide sufficient treatment for female patients. The purpose of this study was to clarify the characteristics of patients using the gender-specific clinic for women, and to assess the association among depression, physical and mental subjective symptoms.Methods: This observational study included female patients aged 16-84 years who visited our clinic between June 2012 and December 2015 (N=97). In addition to general attributes, we collected data on physical and mental symptoms, and depression status using the Cornell Medical Index (CMI) and Self-rating Depression Scale (SDS), respectively, at the first visit. We conducted analyses to assess patient characteristics and the association between subjective symptoms and depression, and between physical and mental symptoms by estimating odds ratios (ORs) and 95% confidence intervals (CIs).Results: The average age of subjects was 50.4 years. The average CMI score was 42.7 points and 55.9% of the subjects were suggested to be neurotic. The average SDS score was 45.0 points and 64.0% of them were suggested to be depressed. The association with depression by SDS was observed in subjective symptoms of CMI such as fatigue (OR [95%CI]: 7.66 [2.26-25.99], p-value: 0.001) and anxiety (OR [95%CI]: 11.73 [1.80-∞], p-value: 0.006). Physical symptoms in the cardiovascular system were positively association with some mental symptoms such as tension.Conclusion: As female patients often have mental symptoms, it is essential for doctors engaging in gender-specific medicine for women to approach patients while considering psychological and mental aspects.

BACKGROUND: We aimed to examine the association of exposure to environmental tobacco smoke with dental caries among preschool children. Exposure to environmental tobacco smoke was assessed in terms of urinary cotinine concentrations and pack-years of exposure to smoking by parents and other family members at home. METHODS: This cross-sectional study included 405 preschool children aged 3-6 years from two preschools in Japan in 2006. Information on the smoking habits of family members living with the child was obtained from parent-administered questionnaires. Dental examination was conducted to assess dental caries, that is, decayed and/or filled teeth. Urinary cotinine levels were measured using first-void morning urine samples. RESULTS: Overall, 31.1% of the children had dental caries, and 29.5% had decayed teeth. Exposure to current maternal and paternal smoking was positively associated with the presence of dental caries after controlling for covariates. More than three pack-years of exposure to maternal smoking and more than five pack-years of exposure to smoking by all family members were significantly associated with the presence of dental caries as compared with no exposure (odds ratio [OR] = 5.55, 95% confidence interval [CI] = 2.17-14.22, P for trend < 0.001 and OR = 2.00, 95% CI = 1.12-3.58, P for trend = 0.004, respectively). These exposure variables were similarly associated with the presence of decayed teeth (OR = 2.92, 95% CI = 1.23-6.96, P for trend = 0.01 and OR = 1.75, 95% CI = 0.96-3.20, P for trend = 0.03, respectively). As compared with lowest tertile of the urinary cotinine level, the highest tertile of the urinary cotinine level was significantly associated with the presence of dental caries as well as decayed teeth; the ORs for the highest vs. lowest tertile of urinary cotinine levels were 3.10 (95% CI = 1.71-5.63, P for trend = 0.012) and 2.02 (95% CI = 1.10-3.70, P for trend = 0.10), respectively. CONCLUSIONS These data suggest that exposure to tobacco smoke may have a dose-dependent influence on the development of caries.
Child ; Child, Preschool ; Cotinine ; urine ; Cross-Sectional Studies ; Dental Caries ; epidemiology ; etiology ; Female ; Humans ; Japan ; epidemiology ; Logistic Models ; Male ; Maternal Exposure ; adverse effects ; Parents ; Paternal Exposure ; adverse effects ; Risk Factors ; Surveys and Questionnaires ; Tobacco Smoke Pollution ; adverse effects ; Tobacco Smoking ; adverse effects ; epidemiology

This study aimed to explore the association between various levels of training-energy expenditure (TrEE) and nutritional response during the phases of periodization among male collegiate rugby players. Seventeen Japanese male collegiate rugby players were enrolled in the study. Their TrEE and dietary intake were assessed each day during three separate microcycle training phases in the preparatory phase of periodization (P1 and P2: general training phase consisting of two sessions per day over the term during which the school held classes and during a summer vacation, respectively; and P3: intensive training phase consisting of four sessions per day during a summer vacation) using the factorial method and dietary records, respectively. The TrEE for P3 (1644±273 kcal) was significantly higher than that for P1 (891±230 kcal). However, the total energy intake (EI) for P3 (3274±889 kcal) was significantly lower than that for P1 (3978±938 kcal). The daytime (after waking in the morning and before the evening training session) EI (242±159 kcal) and protein intake (19±12 g) from the ‘high-protein foods group’ during P3 was significantly reduced compared with that during P1 (465±252 kcal, 37±15 g), whereas, EI and carbohydrate intake from the ‘supplements group’ of P3 was significantly increased compared with P1. The increased TrEE during P3 was not compensated by EI; instead, there was a decreased nutrient intake from the high-protein foods group and increased intake from the supplements group. The time of day of multiple or intensive training sessions, i.e. different TrEE, might affect the food choices made by male rugby players.

Background: Borderline resectable pancreatic adenocarcinoma (BR-PAC) is defined as locally advanced tumor of the pancreas without metastasis that is, although potentially resectable (R), at high risk for positive resection margin following surgery. The therapeutic strategy has remained unestablished because BR-PAC is biologically a heterogeneous subset in which the preoperative prognostic factors are undetermined. Recently, several prognostic factors related to systemic inflammation have been explored in various kinds of cancers: the combination of serum C-reactive protein (CRP) and albumin as the modified Glasgow prognostic factor; a combination of CRP and white blood cell count in the prognostic index; a combination of albumin and lymphocyte counts in Onodera’s prognostic nutritional index; the neutrophil-lymphocyte ratio (NLR); and the platelet-lymphocyte ratio (PLR). Although these prognostic factors have been explored in some small cohort studies of PAC patients, the results still remain controversial especially because PAC patients with diverse clinical stages were included in the cohorts. It has never been reported whether or not the systemic inflammatory response is validated as a predictive risk factor in cohorts of only advanced BR-PAC patients. Method: Between January 2003 and June 2012 at Kobe University Hospital, 136 consecutive pancreatic adenocarcinoma (PAC) patients who underwent surgical curative resection were retrospectively studied. Prior to surgery, the PAC patients were stratified into R- and BR-PAC patients according to the National Comprehensive Cancer Network guidelines. To evaluate the independent prognostic significance of NLR and PLR, univariate and multivariate Cox proportional-hazard models were applied. Results: The median survival in PAC patients with preoperative NLR > 3 (n=45) and NLR < 3 (n=91) was 17.5 months and 31.1 months, respectively (P=0.0037). However, the median survival in PAC patients with PLR > 225 (n=32) and PLR < 225 (n=104) was 21.8 months and 26.2 months, showing no significant difference in overall survival between the two groups (P=0.2526). The median survival in the R-PAC patients with NLR > 3 (n=38) and NLR < 3 (n=70) was 18.1 months and 33.1 months, respectively (P=0.0138). However, the median survival in the R-PAC patients with PLR > 225 (n=27) and PLR < 225 (n=81) was 24.1 months and 25.8 months, showing no significant difference in overall survival between the two groups (P=0.6533). The median survival in BR-PAC patients with preoperative NLR > 3 (n=7) and NLR < 3 (n=21) was 14.8 months and 27.2 months, respectively (P=0.0068). In addition, median survival in BR-PAC patients with preoperative PLR > 225 (n=5) and PLR < 225 (n=23) was 14.8 months and 26.2 months, respectively (P=0.0050). Preoperative NLR > 3 (HR=21.437, 95% CI=4.119-142.980; P=0.0002) and PLR > 225 (HR=30.993, 95% CI=3.844- 384.831; P=0.0009) were the only independent prognostic factors in BR-PAC patients. Conclusion: Preoperative NLR and PLR offer independent prognostic information regarding overall survival in BR-PAC patients following curative resection. The workup is only to obtain a blood sample of 3 mL from PAC patients immediately before treatment. In the near future, these factors associated with the systemic inflammatory response may have the potential to become criteria for BRPAC candidates to undergo neoadjuvant chemotherapy and/or neoadjuvant chemoradiation followed by surgical resection