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Introduction: To evaluate patient–physician communication and patients' understanding of treatment goals in rheumatoid arthritis (RA). Methods: A cross-sectional online survey of patients with RA and physicians treating RA was conducted between 16 and 30 June 2021. Participants were asked to rate the importance of 17 goals on a 6-point Likert scale, and mean scores were compared between patients and physicians by the Wilcoxon rank sum test. Patients' satisfaction with physician communication and their understanding of treatment goals were also assessed. Results: The responses of 502 patients and 216 physicians were analyzed. The most common patient age group was 50–59 years (28.5%), and the mean disease duration was 10.3 years. Physicians had a mean of 19.2 years of treatment experience and were treating a mean of 44.3 patients. Among the 17 goals assessed, patients placed significantly more importance on drug tapering or discontinuation as short-term goals (3–6 months) and on performing basic activities of daily living, being able to engage in daily tasks, achieving and maintaining remission, maintaining better laboratory values, and drug tapering or discontinuation as long-term goals (5–10 years; all adjusted p < 0.05). Patient treatment satisfaction was significantly associated with disease activity, a feeling of treatment effectiveness, satisfaction with physician communication, and agreement with physician goals. Conclusion: Differences exist among patients with RA and physicians treating RA regarding the importance of short- and long-term treatment goals. Good patient–physician communication appears to be important for improving patient satisfaction. Trial registration: University Hospital Medical Information Network identifier: UMIN000044463. [ABSTRACT FROM AUTHOR]

Introduction: Activities of daily living in patients with rheumatoid arthritis (RA) have been evaluated by patient-reported outcomes. However, it has been difficult to measure activity intensity quantitively. Calories expended, exercise, and steps were measured quantitively by a wearable activity meter, and their associations with patients' background characteristics were examined. Methods: Data from a prospective, observational study (CHIKARA study) were used. Eighty-five of 100 RA patients were entered and wore a wearable activity meter for 7 days. The daily calories expended and exercise for both walking and housework and steps were evaluated. Total daily calories expended and exercise was defined as the sum of walking and housework. The relationships of DAS28-ESR, mHAQ, body composition, muscle function, and general status were analyzed. Results: The median age was 66.0 years, and the disease duration was 5.3 years. DAS28-ESR was 3.11, and mHAQ was 0.125. Total daily calories expended, exercise, and number of steps were 461.7 kcal, 3.97 METs h, and 4,788, respectively. MHAQ, walking speed, power, locomotive syndrome, and frailty were independently related to exercise. Total daily exercise and steps of the moderate and high disease activity group were significantly lower than those of the remission group. When the number of steps was < 3,333 and < 2,468, the odds ratios for locomotive syndrome and frailty increased 14.4-fold and 8.7-fold, respectively, using Fisher's exact test (P < 0.001). Conclusions: Daily physical activity and number of steps were significantly decreased in RA patients with moderate and high disease activity as measured by a wearable activity meter. Key Points • Total daily calories expended and exercise for both walking and housework and steps in patients with rheumatoid arthritis were 461.7 kcal, 3.97 METs h, and 4,788, respectively, using a wearable activity meter. • Daily physical activity, especially total daily exercise and number of steps, was significantly decreased in RA patients with moderate and high disease activity. • When total daily steps were < 3,333 and < 2,468, the odds ratios for locomotive syndrome and frailty increased 14.4-fold and 8.7-fold, respectively. [ABSTRACT FROM AUTHOR]

Purpose: Pocket-sized ultrasound devices (PUDs) are commonly adopted for bedside use despite their inferior performance compared with standard ultrasound devices (SUDs). We investigated the non-inferiority of PUDs versus SUDs for ultrasound-guided internal jugular venipuncture. Methods: All patients undergoing scheduled surgery with general anesthesia and internal jugular vein catheter placement were prospectively included in this randomized non-inferiority trial to compare the qualities of the internal jugular venipuncture between the PUD group (Group P) and SUD group (Group S). The primary endpoint was puncture time, and the secondary endpoints included number of punctures, needle and guidewire visibility, and anatomic visibility. Results: Fifty-two patients were randomized to one of the two groups (26 per group). The mean (SEM) puncture time was 56.4 (10.9) s in Group P and 45.5 (4.0) s in Group S. The mean difference of 10.9 s was within the prespecified non-inferiority margin of 100% (two-sided 95% CI: − 12.9–34.6, upper limit of the 95% CI: 45.5) for puncture time. The mean (SEM) number of punctures was 1.15 (0.12) times in Group P and 1.12 (0.06) times in Group S. The difference of 0.04 punctures was within the prespecified non-inferiority margin of 100% (two-sided 95% CI: − 0.24–0.31, upper limit of the 95% CI: 1.12) for number of punctures. Non-inferiority was not shown for needle and guidewire visibility and anatomic visibility. Conclusion: PUDs for internal jugular venipuncture are not inferior to SUDs with regard to puncture time and number of punctures, despite differences in visibility and device performance. [ABSTRACT FROM AUTHOR]

Introduction: Patients with rheumatoid arthritis (RA) are at higher risk of sarcopenia because of joint dysfunction and chronic inflammation. The present study aimed to investigate the predictors or risk factors for developing sarcopenia in RA patients using the prospective observational CHIKARA database. We hypothesized that older age, higher disease activity, lower physical function, and glucocorticoid (GC) use are risk factors for sarcopenia. Methods: A total of 100 consecutive RA patients participated in the CHIKARA study. Their body compositions were examined using a body composition analyzer. Laboratory data, disease activity, physical function, and treatment were investigated. Sarcopenia was assessed at baseline and at 1 year. Predictors or risk factors for sarcopenia development at 1 year were investigated by univariate and multivariate analyses. Results: Of 68 patients without sarcopenia at baseline, 9 (13.4%) developed sarcopenia over the year. Univariate analysis showed that age (r = 0.28, p = 0.022), average GC dose over the year (r = 0.25, p = 0.043), and body mass index (r = − 0.28, p = 0.019) were significantly associated with the development of sarcopenia. Average GC use at ≥ 3.25 mg/day was a significant factor on multivariate analysis (odds ratio 8.81, 95% confidence interval 1.14–67.9, p = 0.037). Conclusions: RA patients using GCs at an average dose ≥ 3.25 mg/day over 1 year were at higher risk for developing sarcopenia. Reduction or withdrawal of GCs may prevent sarcopenia. Key Points • Patients with RA are at higher risk of sarcopenia. • Predictors or risk factors for developing sarcopenia over 1 year in RA patients were investigated using the prospective observational CHIKARA database. • RA patients using GCs at an average dose ≥ 3.25 mg/day over 1 year were at higher risk for developing sarcopenia. • Reduction or withdrawal of GCs may be essential to prevent sarcopenia. [ABSTRACT FROM AUTHOR]

To evaluate work disability and associated factors in patients with rheumatoid arthritis (RA) who participated in the TOMORROW study, a 10-year cohort study in Japan. Subjects in this cross-sectional analysis comprised 191 RA patients and 191 age- and sex-matched non-RA individuals. Work-related outcomes were measured using the Work Productivity and Activity Impairment questionnaire by employment status (full-time worker (FTW), employed ≥ 35 h/week; part-time worker (PTW), < 35 h/week; home worker (HW), non-employed). In addition, we assessed the EuroQol-5 Dimensions (EQ-5D) and Health Assessment Questionnaire (HAQ) to evaluate quality of life and activities of daily living. No significant differences were evident between groups in percentages of participants in each employment status (p = 0.11), percentages of absenteeism (FTW, p = 1.00; PTW, p = 0.29), presenteeism (FTW, p = 0.23; PTW, p = 0.54), overall work impairment (FTW, p = 0.23; PTW, p = 0.73), or percentage of activity impairment (AI) (FTW, p = 0.62; PTW, p = 0.60). In the HW group, percentage of AI was higher in RA patients than that in non-RA patients (p < 0.01). Among RA patients, HW showed lower EQ-5D and higher HAQ than FTW or PTW (p < 0.001 each). Higher disease activity was observed in HW than FTW (p < 0.01). In terms of the effect of biological disease-modifying anti-rheumatic drugs, no significant differences in work-related outcomes, health status, or daily activity were evident between users and non-users. No significant differences in employment status or work impairment were seen between RA and non-RA groups among paid workers. HW with RA showed more impaired daily activity and higher disease activity compared to working RA patients. Trial registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000003876. Registered 1 Jun 2010. [ABSTRACT FROM AUTHOR]

Although patients with rheumatoid arthritis (RA) are prone to osteoporosis, tight control of disease activity might have a positive effect on bone metabolism. We aimed to determine whether bisphosphonate use is still important to improve bone mineral density (BMD) in RA patients whose disease activity was tightly controlled and the dose of glucocorticoid was reduced. This study was a sub-analysis of the 10-year prospective cohort TOtal Management Of Risk factors in Rheumatoid arthritis patients to lOWer morbidity and mortality: the TOMORROW which started from 2010. We compared BMD between 192 patients with RA and age- and sex-matched volunteers between 2010 and 2013 using dual-energy X-ray absorptiometry (DXA) in whole body mode. We then determined ratios of changes in BMD (%ΔBMD) to assess factors influencing increases in BMD among the patients using multivariate logistic regression analysis. The BMD was significantly lower in the patients than in the controls at all sites surveyed during 2010 and 2013. The %ΔBMD of the total spine was significantly higher among the patients treated with, than without bisphosphonate (6.2 vs. 1.8%, P = 0.0001). Multivariate logistic regression analysis revealed that use of bisphosphonate was a significant factor contributing to BMD increase (odds ratio 2.13; 95% confidence interval, 1.03-4.38, P = 0.041). Meanwhile, use of biologic agents, reducing glucocorticoid dose, and control of disease activity were not significant factors for gain of BMD. The BMD was lower among patients with RA than non-RA controls. Use of bisphosphonate significantly increased the BMD of the spine in patients over a period of 3 years and was important for maintaining the BMD among patients with RA under the control of inflammation and disease activity. [ABSTRACT FROM AUTHOR]

Biological disease-modifying antirheumatic drugs (bDMARDs) have become more popular for treating rheumatoid arthritis (RA). Whether or not bDMARDs increase the postoperative risk of surgical site infection (SSI) has remained controversial. We aimed to clarify the effects of bDMARDs on the outcomes of elective orthopedic surgery. We used multivariate logistic regression analysis to analyze risk factors for SSI and delayed wound healing among 227 patients with RA (mean age, 65.0 years; disease duration, 16.9 years) after 332 elective orthopedic surgeries. We also attempted to evaluate the effects of individual medications on infection. Rates of bDMARD and conventional synthetic DMARD (csDMARD) administration were 30.4 and 91.0 %, respectively. Risk factors for SSI were advanced age (odds ratio [OR], 1.11; P = 0.045), prolonged surgery (OR, 1.02; P = 0.03), and preoperative white blood cell count >10,000/μL (OR, 3.66; P = 0.003). Those for delayed wound healing were advanced age (OR, 1.16; P = 0.001), prolonged surgery (OR, 1.02; P = 0.007), preoperative white blood cell count >10,000/μL (OR, 4.56; P = 0.02), and foot surgery (OR, 6.60; P = 0.001). Risk factors for SSI and medications did not significantly differ. No DMARDs were risk factors for any outcome examined. Biological DMARDs were not risk factors for postoperative SSI. Foot surgery was a risk factor for delayed wound healing. [ABSTRACT FROM AUTHOR]

Predicting the responses of patients with rheumatoid arthritis (RA) to tocilizumab is difficult, because inflammatory markers such as C-reactive protein rapidly normalize regardless of clinical efficacy. We aimed to identify factors that could predict response to tocilizumab. Sixty-five patients completed 52 weeks of tocilizumab therapy. Serum fibrinogen, D-dimer and interleukin (IL)-1β levels were measured at baseline and after 4 weeks of therapy. Clinical responses to tocilizumab were assessed using disease activity score 28-erythrocyte sedimentation rate and the clinical disease activity index at baseline and after 52 weeks of therapy (UMIN Clinical Trials Registry No. UMIN000002246). Mean age was 60.5 years (range 22-85 years). Mean disease duration was 11.2 years (range 0-45 years). All patients had moderate-to-severe disease activity and were resistant to disease-modifying anti-rheumatic drugs and/or other biologics. Baseline IL-1β levels were significantly lower in responders than in non-responders ( p = 0.045), but multiple logistic regression analysis found no significant difference (adjusted odds ratio 2.74; 95 % confidence interval 0.84-8.95; p = 0.096). Low D-dimer and IL-1β levels at 4 weeks predicted greater decrease in disease activity after 52 weeks of treatment ( p = 0.005 and p < 0.001, respectively). Effects of tocilizumab at 52 weeks could be predicted from D-dimer and IL-1β levels after 4 weeks of tocilizumab treatment. These markers might be more useful than current inflammatory markers for early-stage prediction of response to tocilizumab in RA. [ABSTRACT FROM AUTHOR]

We investigated the effects of biologics for rheumatoid arthritis (RA) patients on bone mineral density (BMD) and bone metabolic markers (BMM), retrospectively, and also clarified the effects of bisphosphonates (alendronate or risedronate 35 mg/week) and glucocorticoids. Participants in this study comprised 219 patients with RA, including 117 patients treated with biologics (infliximab, n = 90; etanercept, n = 27) and 102 patients with conventional disease-modifying anti-rheumatic drugs (DMARDs) for 1 year. Changes in BMD at the lumbar spine and total hip and BMMs [urinary type I collagen cross-linked N-telopeptide (NTX) and bone-specific alkaline phosphatase] were measured. BMD of the lumbar spine in both groups and total hip BMD in the biologics group were unchanged during treatment with biologics. However, BMD of the total hip was significantly decreased in the DMARDs group (from 0.731 ± 0.135 to 0.706 ± 0.135 g/cm). Patients receiving glucocorticoids without bisphosphonates showed significant decrease in BMD of the total hip compared with patients not receiving glucocorticoids or receiving glucocorticoids with bisphosphonates in both biologics and DMARDs groups. Furthermore, BMD of the lumbar spine increased ( p < 0.05) for patients in the biologics group who received bisphosphonates. NTX was significantly decreased only in the biologics group. Multiple regression analysis showed that BMD and bone metabolic marker levels correlated positively with bisphosphonate and biologics use and negatively with glucocorticoid use. BMD of the total hip was maintained in the patients using biologics without glucocorticoids or with bisphosphonates, but it was not maintained in the DMARDs patients, even without glucocorticoids or with bisphosphonates. Even if biologics have protective effect against bone loss of RA patients, we should consider reducing the dose of glucocorticoids and adding bisphosphonates for the treatment of osteoporosis. [ABSTRACT FROM AUTHOR]

The phonon thermal conductivity of misfit-layered CaCoO has been calculated by perturbed molecular dynamics using a classical force field. Detailed numerical analyses reveal that, in spite of its smaller cross-sectional area, the CoO layer transports more heat than the thicker rock salt (RS) layer, although its local thermal conduction is more suppressed than in another layered cobaltite, NaCoO. The origins of these differences have been elucidated through careful examination of the atomic arrangements in each layer. Since thermal conduction in the RS layer can be reduced without deteriorating electronic properties for which the CoO layer is responsible, it is suggested that the RS layer should be modified to further suppress the overall in-plane thermal conductivity. Computational experiments with increasing number of Ca-O planes in the RS layer showed the opposite trend to what can be predicted based on the misfit between two dissimilar layers. Further analyses to reveal the origin of these unexpected results provide yet another strategy to further decrease the thermal conductivity, namely to control the dynamic interference between atoms across the interface between two layers. [ABSTRACT FROM AUTHOR]

Background: Screening and prophylactic treatment for hepatitis B virus (HBV) reactivation is recommended for patients who receive immunosuppressive or cytotoxic therapy. The aim of this study was to clarify the prevalence of HBV reactivation in rheumatoid arthritis (RA) patients who had received more than 1 year of immunosuppressive therapy. This study also evaluated guidelines for determining HBV reactivation in patients with RA. Methods: This was a prospective non-randomized, non-controlled study. We enrolled 50 patients with RA who had antibodies against hepatitis B core antigen (anti-HBc) and who had started treatment with disease-modifying anti-rheumatic drugs, including those who had additionally received anti-tumor necrosis factor-α (anti-TNF-α). HBV DNA levels were measured every 2-3 months by a real-time, polymerase chain reaction-based method. Entecavir was administered to patients with HBV DNA levels >2.1 log/ml. Results: The mean observation period was 23 months (range 12-32 months). HBV reactivation occurred in 2 of 5 patients with HBV surface antigen (HBsAg) and in 1 of 45 patients without HBsAg. In patients who received anti-TNF-α therapy, antibodies against HBsAg decreased significantly. Entecavir therapy inhibited HBV amplification and prevented HBV-associated flares of hepatitis. Conclusions: The incidence of HBV reactivation was low in RA patients in whom HBV infection had been resolved. Screening for HBV reactivation and prophylactic therapy with entecavir were effective means of preventing HBV-associated hepatic failure in patients with HBsAg, as well as in those with only anti-HBc who received immunosuppressive therapy for RA. [ABSTRACT FROM AUTHOR]

First principles calculations using the generalized gradient approximation to density functional theory have been carried out to evaluate formation energies of defects and the resultant changes in electronic structure of NaCoO and NaCoO. The calculated formation energies confirm that Na vacancies form readily in this material, particularly through volatilization at elevated temperatures, consistent with experimentally observed behavior. Numerical analysis of the change in charge distribution upon Na vacancy formation shows that the vacancy plays a crucial role in modifying the electronic properties of the material. In these p-type thermoelectric materials, Na vacancies act as a reservoir for the minority carrier (electrons), removing them from the CoO layer while simultaneously increasing the concentration of majority carriers (holes) available for conduction in the CoO layer. [ABSTRACT FROM AUTHOR]

Phonon thermal conductivity calculations for LiCoO, NaCoO, and KCoO ( x = 1, 0.5) have been carried out by perturbed molecular dynamics to clarify the dependence of thermal conductivity on alkali-metal vacancy concentration in these materials. While thermal conductivity decreased for all compounds upon introduction of alkali-metal vacancies, the magnitude of the decrease is strongly dependent on the size of the alkali-metal ion. Further numerical analyses using fictitious physical parameters reveal that, with increasing ionic radius, the two-dimensionality of the phonons in the CoO layers, which are responsible for overall thermal conductivity, is enhanced, resulting in lower thermal conductivity in vacancy-free compounds as well as ineffectiveness of alkali-metal vacancies in lowering thermal conductivity. In contrast, for systems with smaller alkali-metal ionic radius, even though higher thermal conductivity is predicted when no vacancies are present, vacancies are quite effective in significantly lowering thermal conductivity by modifying phonon states in the CoO layers, more so than in systems with larger alkali-metal vacancies. [ABSTRACT FROM AUTHOR]

We examined the current status and diagnostic accuracy of currently available techniques for tumor staging and assessed treatment outcomes in patients with superficial esophageal cancer who received esophaguspreserving therapy, such as endoscopic mucosal resection (EMR) alone or combined with chemoradiotherapy (CRT). In 274 patients with superficial esophageal cancer, we examined the depth of tumor invasion and the degree of lymph node metastasis by means of endoscopy, magnifying endoscopy, endoscopic ultrasonography (EUS), computed tomography (CT), and cervical and abdominal ultrasonography (US). We compared treatment outcomes among treatment groups according to the depth of tumor invasion. The rates of correctly diagnosing the depth of tumor invasion were 89.6% on conventional endoscopy, 90.1% on magnifying endoscopy, and 85% on scanning with a high-frequency miniature ultrasonic probe (miniature US probe). Diagnostic accuracy for the m3 or sm1 cancers was poor. Magnifying endoscopy allowed invasion to be more precisely estimated, thereby improving diagnostic accuracy. However, lesions that maintained their surface structure despite deep invasion were misdiagnosed on magnifying endoscopy. A miniature US probe was useful for the assessment of such lesions. The diagnostic accuracy of EUS for lymph node metastasis was 83%, with a sensitivity of 76%. The sensitivity of CT was 29%, and that of cervical and abdominal US was 17%. Patients with m1 or m2 cancer had good outcomes after esophagus-preserving therapy. Although there were no significant differences in survival rates, many patients with sm2 or sm3 cancer who received CRT died of their disease. Nodal recurrence was diagnosed by EUS. In patients who received CRT, the time to the detection of recurrence was slightly prolonged. Long-term follow-up at regular intervals is essential in patients with m3 or sm esophageal cancers who receive esophagus-preserving treatment. At present, EUS is the most reliable technique for the diagnosis of lymph node metastasis and is therefore essential for pretreatment evaluation as well as for follow-up. Earlier detection of recurrence at a level that would potentially salvage treatment remains a topic for future research. [ABSTRACT FROM AUTHOR]

Magnifying endoscopy with dye or acetic acid is useful for evaluating mucosal surface patterns in patients with Barrett's epithelium. Barrett's epithelium can be diagnosed on the basis of the presence of translucent longitudinal vessels. Specialized intestinal metaplasia frequently occurs in villous- or gyrus-type mucosa. Superficial Barrett's adenocarcinoma is associated with irregularities or destruction of mucosal surface patterns. Magnifying endoscopy combined with optical chromoendoscopy by new techniques for enhancement of vascular images, such as narrow-band imaging (NBI) and Fuji intelligent color enhancement (FICE), may further improve diagnostic accuracy. Irregularly arranged abnormal vessels appear in cancerous lesions. However, classification systems for characteristic vascular patterns have not been established. Whether vascular patterns are useful for diagnosing cancers with mild atypia remains an open question. [ABSTRACT FROM AUTHOR]

The reported outcomes of endoscopic resection (ER) for early gastric cancer (EGC) remain limited to several single-institution studies. A multicenter retrospective study was conducted at 11 Japanese institutions concerning their results for ER, including conventional endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). A total of 714 EGCs (EMR, 411; ESD, 303) in 655 consecutive patients were treated from January to December 2001. Technically, 511 of the 714 (71.6%) lesions were resected in one piece. The rate of one-piece resection with ESD (92.7%; 281/303) was significantly higher compared with that for EMR (56.0%; 230/411). Histologically, curative resection was found in 474 (66.3%) lesions. The rate of curative resection with ESD (73.6%; 223/303) was significantly higher compared with that for EMR (61.1%; 251/411). Blood transfusion because of bleeding was required in only 1 patient (0.1%) with EMR of 714 lesions. Perforation was found in 16 (2.2%). The incidence of perforation with ESD (3.6%; 11/303) was significantly higher than that with EMR (1.2%; 5/411). All complications were managed endoscopically, and there was no procedure-related mortality. The median follow-up period was 3.2 years (range, 0.5–5.0 years). In total, the 3-year cumulative residual-free/recurrence-free rate and the 3-year overall survival rate were 94.4% and 99.2%, respectively. The 3-year cumulative residual-free/recurrence-free rate in the ESD group (97.6%) was significantly higher than that in the EMR group (92.5%). ER leads to an excellent 3-year survival in clinical practice and could be a possible standard treatment for EGC. ESD has the advantage of achieving one-piece resection and reducing local residual or recurrent tumor. [ABSTRACT FROM AUTHOR]

Endoscopic findings have traditionally been evaluated on the basis of differences in color and changes in surface structure. We examined whether microvascular patterns on magnifying endoscopy could be used to diagnose benign and malignant superficial esophageal lesions and to estimate the depth of tumor invasion. Magnifying endoscopic findings were compared with histopathological features for 405 superficial lesions arising in the esophagus, including 191 esophageal cancers. Microvascular patterns on magnifying endoscopy were classified into 4 types. Type 1 was characterized by thin, linear capillaries in the subepithelial papilla and was generally seen in normal mucosa. Type 2 was characterized by distended, dilated vessels, and the shape of capillaries in the subepithelial papilla was preserved. Type 2 was generally seen in inflammatory lesions. Type 3 was characterized by spiral vessels with an irregular caliber and crushed vessels with red spots, and the arrangement of the vessels was irregular. Type 3 was generally seen in m1 or m2 cancers. Type 4 was characterized by multilayered, irregularly branched, reticular vessels with an irregular caliber. Type 4 was generally seen in cancers with m3 or deeper invasion. Avascular areas (AVAs) and stretched type 4 vessels were seen in cancers with downward growth. The size of AVAs was closely related to the depth of tumor invasion. Histopathological features of superficial esophageal cancers can be diagnosed by evaluating microvascular patterns on magnifying endoscopy. The size of AVAs and associated type 4 vessels can be used to assess the extent and depth of tumor invasion. [ABSTRACT FROM AUTHOR]

To increase the options for agents for gastric cancer chemotherapy, we performed a phase II clinical trial on the use of a 3-h infusion of paclitaxel to confirm its efficacy and the feasibility of its use in patients with advanced gastric cancer. Thirty-two (32) patients with measurable metastatic gastric cancer were enrolled in this study. Seventeen patients (53%) had received prior chemotherapy for metastatic disease, 4 patients (13%) had adjuvant chemotherapy alone, and 11 patients (34%) were chemotherapy-naive. Paclitaxel was intravenously infused for 3 h, at a dose of 210 mg/m2, once every 3 weeks. To prevent hypersensitivity reactions, standard premedication was administered to all patients. Nine (28%; 9/32 ) objective partial responses (PRs) were observed (95% confidence interval [CI], 14%–47%), and the remaining 23 patients showed stable (12 patients; 37.5%) and progressive disease (11 patients; 34.4%). The median time to response was 20 days (range, 14–38 days). The median response duration was 87 days (range, 50–103 days). The median survival of all patients was 234 days (range, 13–646+ days). The major adverse reactions were myelosuppression (grade 3/4 leukopenia and neutropenia were observed in 59% and 88% of the patients, respectively), alopecia, and peripheral neuropathy. Peripheral neuropathy was observed in 19 patients, however, most of the patients recovered after the completion of treatment. A 3-h infusion of paclitaxel is an effective therapy for advanced gastric cancer and is clinically well tolerated by the patients. [ABSTRACT FROM AUTHOR]

Pericryptal myofibroblasts (PMFs) are thought to be involved in the production of the basement membrane (BM) of the colonic epithelium. To clarify the involvement of PMFs in the formation of the BM during the growth of colon cancer, we conducted an immunohistological study of tumor specimens from 85 patients with colorectal epithelial tumor to detect the presence of PMFs. The tumor specimens were classified as adenoma with low-grade dysplasia, adenoma with high-grade dysplasia, or colon cancer. PMFs were detected in 66.6% of the specimens from patients with adenoma with low-grade dysplasia; 20% of specimens of adenoma with high-grade dysplasia; and 3.2% of specimens of colon cancer. As the degree of dysplasia of the tumor increased, the probability that PMFs existed decreased. We also tested 49 of the tumor specimens for the presence of laminin, a component of the BM, and found that in most of these 49 cases, the BM and PMFs co-existed. This provides further evidence that PMFs are involved in the production of the BM. These findings are important in gaining an understanding of the cause and growth of colorectal epithelial tumors. [ABSTRACT FROM AUTHOR]

A seroepidemiologic, nested case-control study was conducted to evaluate the risk for atrophic gastritis associated with Helicobacter pylori infection. Atrophic gastritis was diagnosed on the basis of serum pepsinogen levels: pepsinogen I level < or = 70 ng/ml and pepsinogen I/pepsinogen II ratio < or = 3.0. Cases were 23 men and 39 women who were not diagnosed with atrophic gastritis in 1987, but who were diagnosed with the condition in 1992. Controls were the 120 men and 282 women who did not meet the serologic criteria for atrophic gastritis in either time period. Neither cases nor controls had a history of upper gastrointestinal operations. Helicobacter pylori infection at the initial survey was associated with a significantly increased risk of atrophic gastritis incidence for both sexes combined (odds ratio = 3.72; 95% confidence interval, 1.78-7.79; P = 0.0005). Cigarette smoking and consumption of alcohol and green-yellow vegetables were not associated with incidence of atrophic gastritis. [ABSTRACT FROM AUTHOR]

Gastroduodenal involvement by Crohn's disease is relatively rare and occasionally causes pyloric stenosis, for which medical therapy may be ineffective and surgery may be required. We report on a 44-year-old man patient in whom corticosteroids had a marked effect in reducing pyloric stenosis caused by Crohn's disease. A proton-pump inhibitor was not effective, and Helicobacter pylori was negative. [ABSTRACT FROM AUTHOR]

Secondary amyloidosis frequently involves the gastrointestinal tract and may result in ulceration, hemorrhage, and protein-losing enteropathy. We report a patient with severe hypoalbuminemia in whom endoscopy revealed widespread ulceration of the small intestine. The protein-losing site was detected by99mTc-diethylene triamine pentaacetic acid human serum albumin (99mTc HSA-D) scintigraphy. This evidence suggests that the ulcers and mucosal lesions associated with amyloidosis contribute to abnormal protein loss from the gastrointestinal tract. [ABSTRACT FROM AUTHOR]

During the past 8 years, we performed emergency colonoscopy in 206 patients in whom severe bloody stools suggested bleeding of the lower digestive tract. The site of hemorrhage could be determined in 184 patients (89.3%). In cases with severe hemorrhage, the causes were stercoral rectal ulcer and bleeding from the small intestine or the upper GI tract. The bleeding tended to be mild in patients with other colon diseases. Determination of the bleeding site was impossible or difficult when a large amount of blood was present in the intestinal lumen or the blood was completely discharged. These observations suggest that emergency colonoscopy is effective for determination of the site of GI bleeding, but improvements are considered to be needed especially in the preparation for the examination in patients in critical condition. [ABSTRACT FROM AUTHOR]

A 60 year-old man with primary amyloidosis confined to the small intestine was reported. Multiple polyps of the small intestine were found by an upper GI series and enteroscopic polypectomy revealed massive deposition of amyloid in the lamina propria and the submucosa. No predisposing disorder or other sites of deposition were found, and the diagnosis of primary amyloidosis of the small intestine was confirmed. [ABSTRACT FROM AUTHOR]

During the last 15 years, seventeen patients with polypoid lesions or carcinoma in the colon or rectum were repeatedly examined with barium enemas. The doubling time of these colorectal tumors was calculated according to Spratt's theory of the growth rate of neoplasms. The doubling times of 6 carcinomas varied from 92.4 to 1032.2 days with those of early carcinomas being much shorter than those of advanced lesions. Advanced lesions of the proximal colon had a shorter doubling time than those of the distal colon. The doubling times of 6 adenomatous polyps ranged from 146.5 to 398.5 days, thus coinciding with the time interval of the carcinomas. However, 5 other adenomatous polyps did not grow during the follow-up period which ranged from 420 to 816 days. There was no definite correlation between the doubling time and the histology of the tumors. The difference in the doubling time of carcinomas correlated more with location than the histological grade of malignancy. [ABSTRACT FROM AUTHOR]

Although ischemic colitis is not rare in the elderly with episodes of ischemia involving the heart and brain, clinical features of mild cases (transient type) have seldom been reported. Whereas the diagnostic findings of ischemice colitis are said to be longitudinal ulcers and stricture, longitudinal ulcers were noted only in 38% of the transient type in our series. For the correct diagnosis of the transient type, it was necessary to observe slight mucosal changes such as edema, congestion and petechiae by colonoscopy. It is emphasized that for the diagnosis of the mild transient type of ischemic colitis emergency colonoscopy must be performed as soon as possible after the onset of abdominal pain or rectal bleeding. [ABSTRACT FROM AUTHOR]

Since intussusception is a common complication of the Peutz-Jeghers polyps, laparotomy should be recommended to remove them. However, all of them will not be palpable or discernible during laparotomy. Operative endoscopy was employed for removing polyps of the small intestine of a 22-year-old female who was previously diagnosed as Peutz-Jeghers syndrome. Using a newly designed enteroscope with two channels (SIF-2C, Olympus), four large polyps over 1 cm in size were removed from the ileum and jejunum with safety. Endoscopic polypectomy is one of the rapidly advancing fields and widely spread methods in gastrointestinal endoscopy since the introduction of electrosurgical techniques. Although the endoscopic removal of polyps arising from the esophagus, stomach, duodenum, colon and rectum can be performed with ease and safety, polypectomy for the polyps of the small intestine has never been performed because of the technical difficulties to handle the scope in the small intestine. Two channel enteroscope resolved this problem. Therefore, it is emphasized that double channel enteroscope makes the polypectomy in the small intestine possible and the indication of enteroscopy will be more widely extended. [ABSTRACT FROM AUTHOR]

Thirty cases of ulcerative colitis were examined endoscopically by means of magnifying colonoscope with dye spraying method (the combined method), and their minute mucosal structures were classified into four categories endoscopically, which correlated well with the histological findings. By this procedure, it was easy to detect the subsidence of inflammation of the mucosa in the quiescent phase or to reveal the active inflammatory involvement of the bowel. Moreover, inspecting the minute changes of the colonie mucosa detected by the combined method, remission was more correctly decided and rigid control is contributing to the decrease in the recent rate of recurrence of ulcerative colitis. [ABSTRACT FROM AUTHOR]

New insertion technique in colonoscopy with a middle length colonoscope which is easy to be handled and without guidance of fluoroscopy was reported. Forming a small N-loop at the sigmoid colon, it was easy to pass the sigmoid colon where is one of the most difficult points to pass through. Further, using a stiffening cord, the sigmoid colon and the transverse colon were easily straightened and no more loop was seen. With this technique, ileocecal area was observed in 26 of 30 cases (86.7%), and its average time for the insertion required only 17.4 minutes. Therefore, with this technique, it is emphasized that we can easily observed almost all parts of the colonic mucosa and also terminal ileum without the fluoroscopic control. [ABSTRACT FROM AUTHOR]

A rare case of carcinoma of the ileocecal valve is reported, which is endoscopically confirmed by the colonofiberscope (Olympus CF-LB type apparatus) and a biopsy examination. The characteristic endoscopical findings of this tumor reveals an irregularly shaped tumor with superficial depression circumscribed at the ileocecal valve and the lack of peristalsis. Colonofiberscopy is of value in the differential diagnosis of the ileocecal lesions when carried out in the combination with roentgenographic studies and histological examination using biopsy specimens. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the extent of inflammation and atrophy in the stomach of Helicobacter pylori-positive and -negative patients with chronic gastritis. Methods: Endoscopy with biopsies from the lesser curvatures of the antrum, angulus, middle body, and the greater curvature of the middle body of the stomach was performed in 59 patients with histologically confirmed chronic gastritis. The extent of atrophic gastritis was assessed endoscopically as well as histologically. H. pylori status was assessed by histology as well as enzyme-linked immunosorbent assay. The histological severity of chronic and acute inflammation, glandular atrophy, and intestinal metaplasia was assessed according to the Sydney system. Results: In H. pylori-positive patients, H. pylori was evenly distributed throughout the stomach when the extent of atrophic gastritis was limited to the antrum and the lesser curvature of the body, but disappeared from the antrum of patients with more extensive atrophic gastritis. The severity of acute and chronic inflammation at the greater curvature of the body increased with the extension of atrophic gastritis, in H. pylori-negative patients, the severity of chronic inflammation at the greater curvature of the body was significantly higher in patients with extensive atrophic gastritis than in those with a lesser extent of atrophic gastritis. Conclusion: At the greater curvature of the body, the development of atrophy is closely associated with the increase in the severity of inflammation, which is more marked in H. pylori-positive patients. [ABSTRACT FROM AUTHOR]

A new insertion method of push-type enteroscopy was reported. We used a new scope (SIF-10L) and a stiffening tube. By introducing the stiffening tube beyond the duodenojejunal junction, the extent of insertion was remarkably advanced. [ABSTRACT FROM AUTHOR]

Although a sliding tube made of plastics is very effective to keep the sigmoid colon in a straight position, there is some difficulty in handling the colonoscope, being restricted by the length of the scope. For the purpose of covering the demerits of the conventional sliding tube, a new slit sliding tube which is made up of three parts was devised by us. After straightening the sigmoidal loop, the three parts of the apparatus are joined together. Then the slit sliding tube is inserted into the descending colon with safety and ease. By using the slit sliding tube, handling of the colonoscope is scarcely restricted and becomes easy. Moreover, the slit sliding tube can be used even for the shorter scopes, by which the distal parts of the colon can be more easily examined in comparison with conventional techniques. [ABSTRACT FROM AUTHOR]

Background: Hereditary spastic paraplegia (HSP) is a rare, genetic neurodegenerative condition. Thus far, ideal anesthetic management is not established for patients with HSP; therefore, careful selection and dosage of anesthetic agents is required. Case presentation: A 54-year-old woman with HSP, who was diagnosed with severe lumbar spinal canal stenosis, underwent decompressive laminectomy to relieve her back pain. Preoperatively, she experienced slight difficulty in walking independently; however, she exhibited no other dysfunction. Anesthesia was maintained with desflurane after tracheal intubation. Rocuronium and sugammadex were used for neuromuscular blockade and reversal, respectively, with neuromuscular monitoring equipment. The patient showed uneventful postoperative recovery without signs of neurological deterioration after extubation. Conclusions: Our successful experience in this case implies that, for patients with neuromuscular diseases, including HSP, desflurane may be an option for anesthetic management; moreover, careful assessment (e.g., medical condition, bispectral index, and train-of-four) should be performed prior to administration of anesthesia. [ABSTRACT FROM AUTHOR]