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The upper and lower limits of microbial colony count on agar plate are essential for microbial cell calculation of food samples. In the present study, the limits presented by the three standards of Ministry of Health, Labor, and Welfare of Japan, Food and Drug Administration of US (FDA), and Japanese Industrial Standards (JIS) were studied from the stochastic point of view. Here colony counts per plate were assumed to follow the Poisson distribution from our previous studies. The probability of acceptance of a pair of colony counts, P A for cell calculation by each standard was then calculated for various values of the mean of the Poisson distribution theoretically and by simulation with random sampling numbers. The values of P A at the lower and upper limits of the standards were low. For example, P A at the mean of 25 which is the lower limit of the FDA standard was 0.278. The values of P A of colony count pairs by the three standards were demonstrated in a wide range of the mean colony count. The largest range of the mean at P A >0.5 was observed in the JIS standard among the three. A new method to determine the limits for colony counts was developed with the risk of not acceptance. These findings would be helpful to consider the limits of colony counts for cell calculation.

The watch and wait strategy(W&W)is optional non-operative management for lower advanced rectal cancer patients who have achieved clinical complete response(cCR)following neoadjuvant treatment. However, the clinical implication of surgical intervention for the primary lesion is not well elucidated when distant metastasis appears with complete remission of the primary lesion. We report a case of a 47-year-old-woman with lower rectal cancer presenting inguinal lymph node metastasis after total neoadjuvant therapy(TNT)and managed through W&W after achieving cCR following chemotherapy. TNT was performed as a preoperative treatment for lower advanced rectal cancer, cT3N2aM0, cStage Ⅲb. Although the primary lesion and mesenteric lymph node metastasis completely disappeared, bilateral inguinal lymph node metastasis appeared immediately after TNT. The patient was treated with FOLFOX plus panitumumab for rectal cancer with RAS and BRAF wild-type. Four months after chemotherapy, the inguinal lymph node metastasis disappeared, and W&W was used for the management. She stayed alive without recurrence 1 year and 9 months after chemotherapy.

Background: The aim of this study was to evaluate the safety of laparoscopic-assisted colorectomy(LAC)for elderly patients more than 70 years old., Methods: The outcomes of 131 patients more than 70 years old who underwent LAC between April 2013 and March 2014 were retrospectively analyzed.Morbidity and mortality were evaluated using the Clavien-Dindo classification., Results: Postoperative complications exceeding Grade II in the Clavien-Dindo classification were found in 20 patients(15.3%).No mortalities were observed in this study., Conclusions: LAC can be performed safely for elderly patients older than 70 years.

A30 -year-old woman underwent total gastrectomy with D2 lymph node dissection after being diagnosed with clinical T3, N2, M0, Stage III B gastric cancer. The postoperative pathological findings revealed a T3(SE), N2, M0, Stage III B tumor. Headache, dizziness, and vomiting occurred during chemotherapy for peritoneal recurrence, using weekly paclitaxel on days 1, 8, and 15. Head CT showed a solitary tumor with a diameter of 28mm in the cerebellum, as well as cerebellar swelling and hydrocephalus. She underwent an emergency craniotomy and tumor enucleation. Pathological examination revealed a metastatic brain tumor from the gastric cancer. She received 12 courses of CPT-11 plus cisplatin until discontinuation because of an adverse event. The patient is alive 6 years after the diagnosis of the cerebellar metastasis without recurrence.

A 63-year-old man with dysphagia was referred to our hospital. He was found to have a type 2 tumor extending from the lower thoracic esophagus to the esophagogastric junction via upper gastrointestinal endoscopy. A biopsy revealed adenocarcinoma with overexpression of the human epidermal growth factor type 2(HER2). The tumor was type I according to Siewert's classification, as the epicenter of the tumor was 27mm to the oral side from the esophago-gastric junction. The clinical diagnosis was T3N1M1, stage IV according to the Japanese Classification of Gastric Carcinoma, and T3N2M0, stage III per the Japanese Classification of Esophageal Cancer. He was treated with neoadjuvant chemotherapy consisting of 6 courses of capecitabine(1,000mg/m / / 2: days 1-14)plus cisplatin(80mg/m2: day 1)and trastuzumab(8mg/kg: day 1 of the first course, 6mg/kg: day 1 after the second course). Computed tomography(CT)and upper gastrointestinal endoscopy showed shrinkage of the primary esophagogastric cancer and lymph node metastases. The patient had a partial response and underwent radical esophagectomy. The pathological findings revealed a T3N2M0, stage III tumor; the tumor was determined to be Grade 1b owing to the chemotherapeutic effect. At a follow-up examination 1 year and 7 months after the start of chemotherapy, the patient is alive without recurrence.

Purpose: The aim of this study was to evaluate the safety and feasibility of gastrectomy after neoadjuvant chemotherapy in patients with gastric cancer., Patients and Methods: Forty-five patients received neoadjuvant chemotherapy and curative gastrectomy between December 2002 and May 2011. Surgical complications were evaluated according to the Clavien- Dindo classification., Result: The median age of the patients was 63 years. Twenty-three patients received a PTX and CDDP regimen, 20 received an S-1 and CDDP regimen, 1 received an S-1 regimen, and 1 received an CPT-11 and CDDP regimen as neoadjuvant chemotherapy. Distal gastrectomy was performed in 6 patients, and total gastrectomy was performed in 39 patients. The median operation time was 268 minutes, and the median blood loss was 249.5 mL. Complications more severe than grade 2 were observed in 10 patients: anatomic bleeding( grade 3a) was observed in 2 patients; abdominal abscess( grade 2), in 1 patient; and pancreatic fistula( grade 2), in 7 patients. No surgical mortality was observed., Discussion: The results of our study suggest that gastrectomy after neoadjuvant chemotherapy for the treatment of patients with gastric cancer is safe and feasible.

A 45-year-old man was transferred to our hospital because of advanced gastric cancer and peritoneal dissemination. After he received an S-1 plus cisplatin( CDDP) regimen for 6 courses, the primary lesion and ascites had disappeared. However, the primary lesion recurred, and he underwent treatment with 16 courses of an S-1 plus docetaxel regimen. He subsequently developed peripheral neuropathy, and was switched to the irinotecan (CPT-11) regimen. As he experienced appetite loss, it was impossible to continue the chemotherapy. Therefore, he underwent a salvage surgery and an R0 resection was performed. However, 9 months after the surgery, he experienced paraaortic lymph node recurrence and peritoneal dissemination. The patient died 13 months after the surgery.

Background: Eicosapentaenoic acid-enriched oral nutritional supplements (Prosure®; Abbott Japan, Tokyo, Japan) may attenuate surgical stress and catabolism after gastric cancer surgery. The present study aimed to evaluate the effects of Prosure® on body weight loss( BWL) and compliance with S-1 adjuvant chemotherapy after gastrectomy., Patients and Methods: Patients who underwent curative total gastrectomy for gastric cancer were selected to undergo adjuvant S-1 chemotherapy at Kanagawa Cancer Center between December 2010 and October 2011. The patients received a normal postgastrectomy diet and two 240 mL packs of Prosure® for 21 postoperative days. BWL was defined as %BWL and calculated as %BWL=(preoperative body weight-1-month postoperative body weight)×100/preoperative body weight. Time to S-1 treatment failure was calculated., Results: Five patients were enrolled in this study. The median age was 62.0 years. One patient was male, and 4 were female. The 1-month postoperative BWL was 92.1%. Compared to our previous report, a 20% risk reduction was observed in this study (Prosure® group vs control group, 92.1% vs 89.7%). Moreover, all the patients continued with the S-1 adjuvant chemotherapy for longer than 6 months., Conclusion: Prosure® may inhibit BWL at 1 month after gastrectomy. Moreover, Prosure® improved the patients' compliance with the adjuvant chemotherapy after gastrectomy.

An 82-year-old man underwent total gastrectomy(D2 lymph node dissection)in August 2006. The pathological findings indicated T4a, N3, M0, Stage IIIC gastric cancer, but adjuvant chemotherapy was not initiated. In October 2009, he presented to the hospital with dyschezia. During colonoscopy, the scope could not pass through the colon, thus indicating rectal stenosis. The biopsy findings indicated the presence of signet ring cell carcinoma, which was determined to be due to the peritoneal dissemination from the gastric cancer. To avoid the need for creating a stoma, radiation therapy(2 Gy×20; total dose, 40 Gy)and chemotherapy(weekly paclitaxel and S-1)were initiated. Rectal stenosis was improved and complete remission was maintained until May 2013.

Purpose: The aim of this study was to clarify the human epidermal growth factor receptor 2( HER2) positivity, clinicopathological characteristics, and survival of patients with recurrent HER2-positive gastric cancer who received S-1 adjuvant chemotherapy., Methods: Thirty-eight patients with recurrent gastric cancer who underwent curative D2 surgery and received S-1 adjuvant chemotherapy between June 2002 and December 2011 were examined. HER2 positivity was determined as defined in the ToGA study., Results: The positivity score was assessed by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) as follows: IHC 0 in 27 patients, IHC 1+in 4, IHC 2+/FISH-in 3, IHC 2+/FISH+in 1, and IHC 3+in 3. The HER2 positivity rate was 10.5% (4/38). HER2-positive recurrent gastric cancer was characterized by a differentiated histological feature and frequent blood vessel invasion. However, the recurrence and survival rates were not significantly different between the HER2-negative and HER2-positive tumors., Conclusions: The HER2 positivity rate after S-1 adjuvant chemotherapy did not differ significantly between patients with recurrent gastric cancer and those with primary Stage II/III gastric cancer, suggesting that S-1 adjuvant chemotherapy was equally effective, regardless of HER2 status.

A 76-year-old woman visited the hospital for difficulty during swallowing. Endoscopy revealed the presence of an esophageal tumor, and she was referred to our hospital for further examination. A subsequent endoscopy revealed a whole rounded type 3 tumor in the lower esophagus. Computed tomography( CT) scan showed swelling of the lymph node( number 106recL), and no remote metastasis was observed. A diagnosis of Lt type 3, T3N1M0, clinical Stage III esophageal cancer was made, and neoadjuvant chemotherapy( NAC) with 5-fluorouraci(l 5-FU) plus cisplatin( CDDP) was administered. The only side effect noted was grade 1 anorexia. Endoscopy after 2 courses of NAC revealed only scars, and no tumor was detected. CT showed remarkable reduction of the lymph nodes and esophageal wall thickness. Subtotal esophagectomy by right thoracotomy, retrosternal gastric tube reconstruction, and 3-field lymph node dissection were performed. Histopathological examination of the resected specimen revealed the absence of malignant cells in the esophagus and presence of metastasis in the lymph node (Effect 3). Although we have encountered 49 cases of esophageal cancer treated with NAC at our center, this was the first case in which pathologically complete response was achieved. Here, we report a rare case of esophageal carcinoma, which was curatively resected after complete response was achieved following treatment with 5-FU/CDDP as NAC.

A 52-year-old woman visited our hospital with epigastralgia. Detailed examination revealed a duodenal cancer of the ascending limbs. Since she refused the resection, the administration of S-1 alone was commenced. After one course of this treatment, oral intake became impossible. Duodenography and endoscopy showed duodenal obstruction, and she underwent surgery. The tumor proved to be unresectable due to direct invasion of the inferior vena cava. Duodenojejunostomy was performed. After surgery, she was treated by S-1 and survived 2 years and 11 months, which resulted in 3 years and 2 months' long survival from her first visit. The intervals of the intake and home stay, after the operation, were 2 years and 8 months and 2 years and 5 months, respectively. The combination of S-1 administration and bypass operation provides a useful alternative for the treatment of unresectable duodenal cancer with stenosis.

A 70-year-old man visited our outpatient clinic with chief complaints of severe upper abdominal pain and fever. Blood tests revealed a markedly enhanced inflammatory reaction. He was hospitalized and diagnosed with phlegmonous gastritis based on findings of esophagogastroduodenoscopy and multidrug-resistant streptococcus detected by gastric juice culture. The clinical symptoms promptly resolved after starting concomitant treatment with vancomycin hydrochloride and levofloxacin. Administration of vancomycin hydrochloride for phlegmonous gastritis was not found in our literature search and the present case is thus considered to provide a valuable example of such use.

A predictive program for microbial growth under various temperature conditions was developed with a mathematical model. The model was a new logistic model recently developed by us. The program predicts Escherichia coli growth in broth, Staphylococcus aureus growth and its enterotoxin production in milk, and Vibrio parahaemolyticus growth in broth at various temperature patterns. The program, which was built with Microsoft Excel (Visual Basic Application), is user-friendly; users can easily input the temperature history of a test food and obtain the prediction instantly on the computer screen. The predicted growth and toxin production can be important indices to determine whether a food is microbiologically safe or not. This program should be a useful tool to confirm the microbial safety of commercial foods.

Food hygiene in Japanese-style confectionery factories is hard to practice because the businesses are small. In a supporting system of voluntary-based hygienic management in this field, we microbiologically investigated the production processes of "Monaka" in a workshop in Tokyo. We microbiologically assessed the processing environments as well as the products in the workshop, then proposed some improvements in the production of the confectionery. After the improvements, microbial contamination of the processing environments was reduced and no microbial contamination was found in the sugared bean, or "An" produced, though the product "Monaka" was still contaminated, especially by molds. It was clarified that the molds came from contaminated baked wheat shells, or "Kawa" and further that the wheat shells were contaminated by molds during storage.

One variety of anti-mitochondrial antibody(AMA) is characteristically found in sera from patients with primary biliary cirrhosis(PBC). The major target antigens of this type of AMA are M2s. It is well known, however, that AMA-negative PBC also exists. An alternative disease concept, called autoimmune cholangiopathy, recently has been advocated. This new concept is defined by the following criteria: 1)the failure to detect AMA and anti-M2, 2)the detection of a diffuse type of anti-nuclear antibody and anti-smooth muscle antibody, 3)pathological findings compatible with PBC, and 4)the effectiveness of prednisolone. However, the difference between AMA-negative PBC and autoimmune cholangiopathy is controversial. Therefore, we analyzed antibodies to four major M2 proteins with Western blotting in 34 cases of immunofluorescent AMA-negative PBC. In 31(91.2%) of these 34 AMA-negative sera, antibodies to at least one of these four major M2 proteins was detected. In serum samples from 34 control patients with AMA-positive PBC, antibodies to at least one of these four proteins were detected in all cases. In addition, we studied the frequency of cases which satisfied the serological criteria of autoimmune cholangiopathy. In only one(0.7%) of 141 cases was the serological criteria met. We conclude that to clarify the serological differences between autoimmune cholangiopathy and AMA-negative PBC, the analysis of M2 proteins by Western blotting is essential.

We describe here interferon(IFN) and cyclosporine(CyA) therapy for GBV/HGV hepatitis. Up to the present, reported cases with IFN therapy in Japan were all most co-infected with chronic hepatitis C virus by retrospective studies. According to these results, IFN induced a transient decrease of serum GBV-C RNA levels during the administration, but, after the administration, these returned to levels at the pretreatment. We summarized in this review these therapeutic effects of previous reports in Japan. And, we reported our experienced case of GBV-C RNA-positive fulminant hepatitis treated with IFN and CyA. These observations induced that IFN was effective for decreasing serum levels of GBV-C RNA, and CyA was effective for increasing these levels. However, effects of IFN were transient. Therefore, we are planning re-treatment of IFN for this patient in near feature. Further study about the epidemical analysis of GBV-C/HGV hepatitis and therapeutic analysis of IFN for this disease are needed.

The bone mineral density in reproductive aged and pregnant women was measured with an ultrasound bone densitometer (Achilles, Luner Co, USA). Both parameters of bone density on Os calsis, sound of speed (SOS) and broad ultrasound attenuation (BUA) were significantly correlated with bone mineral density in lumbar2-4 measured by dual energy X-ray absorptiometry (DXA) (p < 0.01) in reproductive aged women (mean age; 24.5 +/- 2.3, n = 30). The changes in bone density during pregnancy and at delivery were studied. In a cross-sectional study, no significant changes in SOS, BUA and stiffness were observed, but in a longitudinal study (n = 21), all of these parameters decreased as pregnancy advanced. The markers of bone turnover (serum Ca, alkaline phosphatase, procollagen type 1-C peptide, urinary Ca/Cr and deoxypyridinoline/Cr) did not change during pregnancy. Ten pregnant women with low bone density (less than-1.5 SD mean value) were found. There was no significant difference between the markers of bone turnover in pregnant women with low and normal bone density. The clinical usefulness of the screening of bone density of reproductive aged and pregnant women to detect osteopenia is suggested.

Bone is known to be a target organ of not only estrogens, but also androgens. The mechanism by which these steroids exert their action on bone cells is still poorly understood. In the present study, the effect of 17 beta-estradiol (E2) on 5 alpha-reductase activity, converting testosterone (T) to a more potent biological androgen, dihydrotestosterone (DHT), was assessed in an osteoblast-like cell line of rat origin (UMR106-01). Cells were incubated under standardized conditions with varying concentrations of E2 (10(-12)-10(-6) M) for 48 hours. Incubation medium was replaced when the cells were preconfluent and thereafter at 24 hour intervals. Then the cells were harvested. Each cell homogenate was incubated with [4-14C]-T. DHT was detected as a single metabolite on silicagel thin layer chromatography. 5 alpha-reductase activity was determined by measuring the amount of labeled DHT from T. The radiochemical purity of DHT recovered after incubation was confirmed by recrystallization to constant specific activity. Under the conditions used, no estrogen was detected. Production of insulin-like growth factor-I and alkaline phosphatase in UMR106-01 was increased when E2 was added into the culture medium, however, 5 alpha-reductase activity was significantly decreased by the addition of 10(-12) M to 10(-6) M of E2. Maximum inhibition was noticed at 10(-10) M. Our results demonstrate that UMR106-01 cells have a capacity to transform T into the biologically more potent androgen, DHT. The result, that the enzyme activity was influenced by E2, suggests the regulatory mechanism of both sex steroids on the steroid metabolism in osteoblasts.

It has been well established that reflux of gastroduodenal contents causes reflux esophagitis. Experimental model of reflux esophagitis in rats was devised by 24hrs ligature on both lower portion of duodenum and most of forestomach. Erosion of esophageal mucosa and thickening of esophageal wall developed in macroscopic findings. Histologically, many neutrophils were found from lamina propria to muscular layer, mainly in lamina propria. Edema and thickening of submucosal layer developed in cases with 24hrs ligature. These severe inflammatory changes in submucosal layer suggested that it caused thickening of esophageal wall. Bile reflux was found in gastric contents of this model. No mucosal lesions were found in cases with ligature on lower portion of duodenum. Findings in this experimental model of reflux esophagitis suggested significant roles of gastric juice and bile acids in the pathogenesis of reflux esophagitis. This model was thought to be useful for studies of pathophysiology of reflux esophagitis caused by reflux of gastroduodenal contents.

We performed 7 cases of pancreas transplantation (PTX), simultaneous pancreas and kidney transplantation in 4 cases, and PTX after kidney transplantation in 3 cases. The pancreas and kidney were extirpated after in situ perfusion using UW solution and stored in UW solution. The pancreas was transplanted in the left iliac fossa with bladder drainage, and the kidney was placed in the contralateral iliac fossa. The immunosuppressive regimen consisted of cyclosporine, methylprednisolone, azathioprine and antilymphocyte globulin. Gabexate mesilate (30-40 mg/kg/day) and PGE1 (5 ng/kg/min) was administered intravenously to prevent the vascular thrombosis. The original diseases of 7 patients were insulin-dependent diabetes mellitus (IDDM) with chronic renal failure, retinopathy and neuropathy. Six out of 7 patients became insulin-free after PTX, while one patient developed the vascular thrombosis in the pancreatic graft which was removed after 12 hours after the transplantation. All patients became dialysis-free and serum creatinine was ranging from 1.5 to 2.0 mg/dl. HbAlc remained within normal range in 6 out of 7 patients, who showed normal to borderline glucose tolerance in 75g oral glucose tolerance test. Although further investigation will be required, PTX from cardiac-arrest donor will be promising as one of the therapeutic modalities for IDDM patients.

The difficulty in obtaining suitable organs for the transplantation is a major problem in Japan. In this study, we assessed the suitable procedure for multiple organ preservation and evaluated organ viabilities after preservation with an unique technique. The heart and lung were preserved with UCLA Formula alone and the liver was preserved with Euro-Collins' solution. The mean ischemic times of the heart, lung and liver were 4.3 hours, 7.5 hours, and 6 hours, respectively. The viability of the heart graft following orthotopic transplantation was evaluated with cardiac output and Left Ventricular End-Diastolic Pressure (LVEDP) under the constant pre-load (CVP 7 mmHg). Cardiac outputs (ml/min.) were 4.01 +/- 1.36 before operation, 3.26 +/- 0.26 at 1 hour after transplantation, 3.24 +/- 0.26 at 4 hours after transplantation (NS). LVEDP (mmHg) was 7.1 +/- 0.8 before operation, 6.5 +/- 0.86 at 1 hour, and 7.4 +/- 1.2 at 4 hours after transplantation (NS). The viability of transplanted lung was evaluated with pressure-tidal volume curve and arterial oxygen tension (PO2) when right pulmonary artery and bronchus were occluded. There was no statistical difference in pressure-volume curve and PO2 tension between the phases of pre- and post-transplantation. After liver transplantation, ICG test (15 min.) showed a sufficient value of 35-40%. In conclusion, the procedures of multiorgan preservation using UCLA Formula and Euro-Collins' solution were successfully performed and its viability of grafts after transplantation remained sufficient.

This case involves a 16-year-old woman with a posterior cervical tumor. Histologically, it was found to be a extramedullary plasmacytoma (EMP). Immunohistochemically, IgG was present in the plasma cells that were shown to be atypia by the PAP method. Laboratory data revealed no other abnormalities. A surgical excision of the tumor was performed with a dissection of the relevant lymph nodes. Although irradiation and chemotherapy were administered postoperatively, multiple bone metastasis was found a month after the operation, and the patient died 8 months later.