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Purpose: Dietary fiber is a possible nutritional component which aids in the prevention of visceral fat accumulation. We examined the association between dietary fiber intake and visceral fat volume (VFV) by sex, and further analysed the association by major food sources of dietary fiber. Methods: In this cross-sectional study, we measured VFV in 2779 Japanese (1564 men and 1215 women) aged 40–89 who underwent positron emission tomography/computed tomography for cancer screening between 2004 and 2005. Dietary fiber intake was calculated based on a validated semi-quantitative food frequency questionnaire. The association between dietary fiber intake and VFV was investigated using multivariate linear regression models after adjustment for potential confounders. Results: Total, soluble, and insoluble fiber intakes were inversely associated with VFV in men (Q1: 3740 cm3, Q4: 3517 cm3, Ptrend: 0.0006 for total fiber), but not in women (Q1: 2207 cm3, Q4: 2193 cm3,Ptrend: 0.88 for total fiber). Statistically significant sex difference was observed (Pinteraction = 0.001 for total fiber). Subgroup analyses by major food sources revealed that dietary fiber intakes from beans, vegetables and fruits showed an inverse association with VFV in men, while cereal fiber intake showed a tendency toward a positive association in both sexes (Q1: 3520 cm3, Q4: 3671 cm3, Ptrend: 0.05 in men, Q1: 2147 cm3, Q4: 2227 cm3, Ptrend: 0.10 in women). Conclusion: We observed a sex-specific association between dietary fiber intake and VFV in Japanese adults. This study suggests that efforts against visceral fat accumulation should take account of the source of dietary fiber. [ABSTRACT FROM AUTHOR]

Background: Multiple development of squamous cell carcinoma (SCC) in the upper aerodigestive tract has been explained by the 'field cancerization phenomenon' associated with alcohol drinking. Squamous dysplastic lesion is clinically visualised as a Lugol-voiding lesion (LVL) by chromoendoscopy. Whether cessation or reduction of alcohol drinking improves multiple LVL and reduces the risk of field cancerization has not been elucidated. Methods: We analysed 330 patients with newly diagnosed superficial esophageal SCC (ESCC) enrolled in the cohort study. The grade of LVL was assessed in all patients every 6 months. We instructed the patients to stop smoking and drinking and recorded their drinking and smoking status every 6 months. Results: Among 330 patients, we excluded 98 with no LVL or no drinking habit. Of the remaining 232 patients, 158 continuously ceased or reduced their drinking habit. Patients who ceased or reduced their drinking habit significantly showed improvement in the grade of LVL. Multivariate analysis showed that continuous cessation or reduction of drinking habit improved the grade of LVL (hazard ratio [HR] = 8.5, 95% confidence interval [CI] 1.7–153.8, p = 0.0053). Higher grade of LVL carried a high risk of multiple ESCC and head and neck SCC (HNSCC) (HR = 3.7, 95% CI 2.2–6.4, p < 0.0001). Improvement in LVL significantly decreased the risk of multiple ESCC and HNSCC (HR = 0.2, 95% CI 0.04–0.7, p = 0.009). Conclusions: This is the first report indicating that field cancerization was reversible and cessation or reduction of drinking alcohol could prevent multiple squamous dysplastic lesion and multiple ESCC and HNSCC development. Clinical trials registry number: UMIN000001676. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify the prevalence of family history of cancer using cohorts participating in the Japanese National Center Cohort Collaborative for Advancing Population Health (NC-CCAPH). We pooled data from seven eligible cohorts of the Collaborative with available data on family history of cancer. Prevalence of family history of cancer and corresponding 95% confidence intervals are presented for all cancers and selected site-specific cancers for the total population and stratified by sex, age, and birth cohort. Prevalence of family history of cancer increased with age ranging from 10.51% in the 15 to 39 year age category to 47.11% in 70-year-olds. Overall prevalence increased in birth cohorts from ≤ 1929 until 1960 and decreased for the next two decades. Gastric cancer (11.97%) was the most common site recorded for family members, followed by colorectal and lung (5.75%), prostate (4.37%), breast (3.43%) and liver (3.05%) cancer. Women consistently had a higher prevalence of family history of cancer (34.32%) versus men (28.75%). Almost one in three participants had a family history of cancer in this Japanese consortium study highlighting the importance of early and targeted cancer screening services. [ABSTRACT FROM AUTHOR]

Background and aims: Colorectal neoplastic lesions (≥ 20 mm) are commonly treated via piecemeal endoscopic mucosal resection (p-EMR) but have a high rate of local recurrence. We aimed to clarify the optimal surveillance interval after p-EMR for these neoplasias. Methods: In this multicenter (15 participating institutions) prospective, randomized trial, 180 patients recruited over a 4-year period and were classified based on tumor location, tumor diameter, histological diagnosis, institution, and number of resected specimens. The patients underwent curative p-EMR followed by scheduled surveillance colonoscopy at 3, 6, 12, and 24 months after p-EMR (group A; n = 90) or at 6, 12, and 24 months after p-EMR (group B; n = 90). The primary endpoint was cumulative local recurrence at 6 months after p-EMR. Secondary endpoints included local recurrence and the cumulative surgical resection rate of recurrent tumors during the 24-month follow-up period. Results: The median tumor diameter was 25 mm (IQR 20–30). Six months after p-EMR, 12 and 6 local recurrences were noted in groups A and B, which corresponded to 13 and 8 recurrences, respectively, during the 24-month surveillance period. The primary and secondary endpoints of recurrence were not significantly different between the groups on either intention-to-treat or per-protocol analysis; no surgery case was observed in group B when a strict surveillance protocol of 6-, 12-, and 24-month follow-up post-EMR was followed. Conclusions: For patients who underwent p-EMR for neoplastic lesions, additional postprocedural 3-month surveillance did not show superior results in detecting recurrence compared with a 6-month surveillance interval. Clinical trial registration: UMIN000015740. [ABSTRACT FROM AUTHOR]

As a sequel to previous work, we extend the study of the ground state configuration of the D = 3, Wilson-Fisher conformal O(4) model. In this work, we prove that for generic ratios of two charge densities, ρ1/ρ2, the ground-state configuration is inhomogeneous and that the inhomogeneity expresses itself towards longer spatial periods. This is the direct extension of the similar statements we previously made for ρ1/ρ2 ≪ 1. We also compute, at fixed set of charges, ρ1, ρ2, the ground state energy and the two-point function(s) associated with this inhomogeneous configuration on the torus. The ground state energy was found to scale (ρ1 + ρ2)3/2, as dictated by dimensional analysis and similarly to the case of the O(2) model. Unlike the case of the O(2) model, the ground also strongly violates cluster decomposition in the large-volume, fixed-density limit, with a two-point function that is negative definite at antipodal points of the torus at leading order at large charge. [ABSTRACT FROM AUTHOR]

We consider the structure of the operator product expansion (OPE) in conformal field theory by employing the OPE block formalism. The OPE block acted on the vacuum is promoted to an operator and its implications are examined on a non-vacuum state. We demonstrate that the OPE block is dominated by a light-ray operator in the Regge limit, which reproduces precisely the Regge behavior of conformal blocks when used inside scalar four-point functions. Motivated by this observation, we propose a new form of the OPE block, called the light-ray channel OPE block that has a well-behaved expansion dominated by a light-ray operator in the Regge limit. We also show that the two OPE blocks have the same asymptotic form in the Regge limit and confirm the assertion that the Regge limit of a pair of spacelike-separated operators in a Minkowski patch is equivalent to the OPE limit of a pair of timelike-separated operators associated with the original pair in a different Minkowski patch. [ABSTRACT FROM AUTHOR]

We study the large N limit of O(N) scalar field theory with classically marginal ϕ6 interaction in three dimensions in the presence of a planar boundary. This theory has an approximate conformal invariance at large N. We find different phases of the theory corresponding to different boundary conditions for the scalar field. Computing a one loop effective potential, we examine the stability of these different phases. The potential also allows us to determine a boundary anomaly coefficient in the trace of the stress tensor. We further compute the current and stress-tensor two point functions for the Dirichlet case and decompose them into boundary and bulk conformal blocks. The boundary limit of the stress tensor two point function allows us to compute the other boundary anomaly coefficient. Both anomaly coefficients depend on the approximately marginal ϕ6 coupling. [ABSTRACT FROM AUTHOR]

We study the large N limit of O(N) scalar field theory with classically marginal ϕ6 interaction in three dimensions in the presence of a planar boundary. This theory has an approximate conformal invariance at large N. We find different phases of the theory corresponding to different boundary conditions for the scalar field. Computing a one loop effective potential, we examine the stability of these different phases. The potential also allows us to determine a boundary anomaly coefficient in the trace of the stress tensor. We further compute the current and stress-tensor two point functions for the Dirichlet case and decompose them into boundary and bulk conformal blocks. The boundary limit of the stress tensor two point function allows us to compute the other boundary anomaly coefficient. Both anomaly coefficients depend on the approximately marginal ϕ6 coupling. [ABSTRACT FROM AUTHOR]

Background: Macrocytosis is associated with an increased risk of squamous cell carcinoma (SCC) arising in the esophagus in men. The aim of this study was to evaluate the association between macrocytosis and metachronous SCC of the esophagus after endoscopic resection (ER) of early esophageal SCC in men. Methods: The study group comprised 278 men with early esophageal SCC after ER. The main study variables were as follows: (1) cumulative incidence and total number of metachronous SCC of the esophagus according to the presence or absence of macrocytosis (mean corpuscular volume ≥ 106 fl) and (2) predictors of metachronous SCC of the esophagus as assessed with a multivariate Cox proportional-hazards model. Results: The median follow-up was 50.3 months. Macrocytosis was associated with a higher 2-year cumulative incidence of metachronous SCC of the esophagus (without macrocytosis vs. with macrocytosis: 11.4% vs. 38.1%, p = 0.002). Macrocytosis was also associated with a higher total number of metachronous SCC of the esophagus per 100 person-years (without macrocytosis vs. with macrocytosis: 7.7 vs. 31.5 per 100 person-years, p < 0.0001). In addition, macrocytosis was a significant predictor of metachronous SCC of the esophagus on multivariate Cox proportional-hazards analysis (relative risk 2.23). Conclusion: Macrocytosis is a useful predictor of the risk of metachronous SCC of the esophagus after ER of early esophageal SCC in men. [ABSTRACT FROM AUTHOR]

We consider the operator product expansion (OPE) structure of scalar primary operators in a generic Lorentzian CFT and its dual description in a gravitational theory with one extra dimension. The OPE can be decomposed into certain bi-local operators transforming as the irreducible representations under conformal group, called the OPE blocks. We show the OPE block is given by integrating a higher spin field along a geodesic in the Lorentzian AdS space-time when the two operators are space-like separated. When the two operators are time-like separated however, we find the OPE block has a peculiar representation where the dual gravitational theory is not defined on the AdS space-time but on a hyperboloid with an additional time coordinate and Minkowski space-time on its boundary. This differs from the surface Witten diagram proposal for the time-like OPE block, but in two dimensions we reproduce it consistently using a kinematical duality between a pair of time-like separated points and space-like ones. [ABSTRACT FROM AUTHOR]

We study the operator product expansion (OPE) for scalar conformal defects of any codimension in CFT. The OPE for defects is decomposed into 'defect OPE blocks', the irreducible representations of the conformal group, each of which packages the contribution from a primary operator and its descendants. We use the shadow formalism to deduce an integral representation of the defect OPE blocks. They are shown to obey a set of constraint equations that can be regarded as equations of motion for a scalar field propagating on the moduli space of the defects. By employing the Radon transform between the AdS space and the moduli space, we obtain a formula of constructing an AdS scalar field from the defect OPE block for a conformal defect of any codimension in a scalar representation of the conformal group, which turns out to be the Euclidean version of the HKLL formula. We also introduce a duality between conformal defects of different codimensions and prove the equivalence between the defect OPE block for codimension-two defects and the OPE block for a pair of local operators. [ABSTRACT FROM AUTHOR]

Background: For almost 30 years, transanal endoscopic microsurgery (TEM) has been the mainstay treatment for large rectal lesions. With the advent of endoscopic submucosal dissection (ESD), flexible endoscopy has aimed at en bloc R0 resection of superficial lesions of the digestive tract. This systematic review and meta-analysis compared the safety and effectiveness of ESD and full-thickness rectal wall excision by TEM in the treatment of large nonpedunculated rectal lesions preoperatively assessed as noninvasive. Methods: A systematic review of the literature published between 1984 and 2010 was conducted (Registration no. CRD42012001882). Data were integrated with those from the original databases requested from the study authors when needed. Pooled estimates of the proportions of patients with en bloc R0 resection, complications, recurrence, and need for further treatment in the ESD and TEM series were compared using random-effects single-arm meta-analysis. Results: This review included 11 ESD and 10 TEM series (2,077 patients). The en bloc resection rate was 87.8 % (95 % confidence interval [CI] 84.3-90.6) for the ESD patients versus 98.7 % (95 % CI 97.4-99.3 %) for the TEM patients ( P < 0.001). The R0 resection rate was 74.6 % (95 % CI 70.4-78.4 %) for the ESD patients versus 88.5 % (95 % CI 85.9-90.6 %) for the TEM patients ( P < 0.001). The postoperative complications rate was 8.0 % (95 %, CI 5.4-11.8 %) for the ESD patients versus 8.4 % (95 % CI 5.2-13.4 %) for the TEM patients ( P = 0.874). The recurrence rate was 2.6 % (95 % CI 1.3-5.2 %) for the ESD patients versus 5.2 % (95 % CI 4.0-6.9 %) for the TEM patients ( P < 0.001). Nevertheless, the rate for the overall need of further abdominal treatment, defined as any type of surgery performed through an abdominal access, including both complications and pathology indications, was 8.4 % (95 % CI 4.9-13.9 %) for the ESD patients versus 1.8 % (95 % CI 0.8-3.7 %) for the TEM patients ( P < 0.001). Conclusions: The ESD procedure appears to be a safe technique, but TEM achieves a higher R0 resection rate when performed in full-thickness fashion, significantly reducing the need for further abdominal treatment. [ABSTRACT FROM AUTHOR]

Background: Definitive chemoradiotherapy is the standard of care for T4 and/or M1 lymph node cancers. Although the treatment strategy would depend mainly on the diagnosis of T4 disease, the diagnosis of T disease is not standardized and cases of borderline resectable T4 disease are often encountered. We have administered the triplet regimen as intensive chemotherapy for cases of borderline resectable T4 disease. Methods: We reviewed the records of patients with esophageal cancer who were treated between August 2009 and August 2010 at the Tochigi Cancer Center. Our treatment strategy for clinical stage II/III disease with unequivocal T4 disease in an adjacent organ was definitive chemoradiotherapy. Cases of clinical stage II/III disease with borderline resectable T4 disease were treated with preoperative chemotherapy via the triplet regimen of docetaxel and cisplatin plus 5-fluorouracil (DCF) followed by esophagectomy. Results: Nine patients were treated with preoperative chemotherapy. Six patients with defined borderline T4 disease were treated with DCF. DCF toxicities were tolerable and all patients underwent subsequent surgery. The R0 resection rate was 66 % (4/6), although pathological T4 disease was found in 50 % of patients (3/6). There were no major complications or mortality, although the median blood loss and operation time were relatively higher with this regimen. Although 5 patients died of recurrence or coexisting disease, oral intake was maintained at the terminal stage. Conclusion: Preoperative DCF followed by surgery seems to be a good option for select patients with T4 disease. Further investigations are warranted and a well-designed prospective trial is needed to draw a conclusion. [ABSTRACT FROM AUTHOR]

OBJECTIVE: During colonoscopy, estimation of the depth of invasion in early colorectal lesions is crucial for an adequate therapeutic management and for such task, magnifying chromoendoscopy (MCE) has been proposed as the best in vivo method. However, validation in large-scale studies is lacking. The aim of this prospective study was to clarify the effectiveness of MCE in the diagnosis of the depth of invasion of early colorectal neoplasms in a large series. METHODS: A total of 4,215 neoplastic lesions were evaluated using MCE from October 1998 to September 2005 at the National Cancer Center Hospital, Tokyo, Japan. Lesions were prospectively classified according to the clinical classification of the pit pattern: invasive pattern or non-invasive pattern. All lesions were histopathologically evaluated. RESULTS: There were 3,371 adenomas, 612 intramucosal cancers (m-ca), 232 submucosal cancers (sm-ca): 52 sm superficial (sm1) and 180 sm deep cancers (sm 2–3). Among lesions diagnosed as invasive pattern, 154 out of 178 (86.5%) were sm2–3, while among lesions diagnosed as non-invasive pattern, 4,011 out of 4,037 (99.4%) were adenomas, m-ca, or sm1. Sensitivity, specificity and diagnostic accuracy of the invasive pattern to differentiate m-ca or sm1 (<1000 μm) from sm2–3 (≥1000 μm) were 85.6%, 99.4%, and 98.8%, respectively. CONCLUSION: The determination of invasive or non-invasive pattern by MCE is a highly effective in vivo method to predict the depth of invasion of colorectal neoplasms. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Colonoscopy is considered the gold standard for the detection of colorectal polyps; however, polyps can be missed with conventional white light (WL) colonoscopy. The aim of this pilot study was to evaluate whether a newly developed autofluorescence imaging (AFI) system can detect more colorectal polyps than WL. METHODS: A modified back-to-back colonoscopy using AFI and WL was conducted for 167 patients in the right-sided colon including cecum, ascending and transverse colon by a single experienced colonoscopist. The patient was randomized to undergo the first colonoscopy with either AFI or WL (group A: AFI-WL, group B: WL-AFI). The time needed for both insertion and examination for withdrawal and all lesions detected in the right-sided colon were recorded. RESULTS: Eighty-three patients were randomized to group A and 84 to group B. The total number of polyps detected by AFI and WL colonoscopy was 100 and 73, respectively. The miss rate for all polyps with AFI (30%) was significantly less than that with WL (49%) ( P= 0.01). CONCLUSIONS: AFI detects more polyps in the right-sided colon compared to WL colonoscopy. [ABSTRACT FROM AUTHOR]

Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. [ABSTRACT FROM AUTHOR]