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Background: Functional electrical stimulation (FES) for patients with stroke and foot drop is an alternative to ankle foot orthoses. Characteristics of FES responders and nonresponders have not been clarified., Objectives: (1) To investigate the effects of treatment with FES on patients with stroke and foot drop and (2) to determine which factors may relate to responders and nonresponders., Design: Multicenter, nonrandomized, prospective study., Setting: Multicenter clinical trial., Participants: Participants included those who experienced foot drop resulting from stroke, were older than 20 years, and could provide consent to participate; they were enrolled from hospitals between January 2013 and September 2015 and performed rehabilitation with FES., Methods: Stroke Impairment Assessment Set Foot-Pat Test (SIAS-FP), Fugl-Meyer Assessment for Lower Extremity (FMA-LE), Modified Ashworth scale (MAS) for ankle joint dorsiflexion and plantar flexion muscles, range of motion (ROM) for ankle joint, 10-m walking test (10mWT), Timed Up & Go test (TUG), and 6-minute walking test (6MWT) were evaluated pre- and postintervention. Age, gender, type of stroke, onset times of stroke, paretic side, Brunnstrom stage of the lower extremity (Br. stage-LE), Functional Independence Measure (FIM), Functional Ambulation Category (FAC), poststroke months, number of interventions, total hours of interventions, and whether a brace was used were extracted from patients' medical records and collected on the physiological examination day., Main Outcome Measurements: The authors examined 10mWT and age, gender, type of stroke, onset times of stroke, paretic side, Br. stage-LE, FIM, FAC, poststroke months, number of interventions, total hours of interventions, whether a brace was used, SIAS-FP, FMA-LE, MAS, ROM, TUG, and 6MWT before intervention. Participants were divided into nonresponders and responders with a change in 10mWT of <0.1 and ≥0.1 m/s, respectively. Single and multiple regression analyses were used for data analysis. Additionally, the changes between groups were compared., Results: Fifty-eight responders and 43 nonresponders were enrolled. The between-group differences, compared for changes between pre- and postintervention, were significant in terms of changes in SIAS-FP (P = .02), 10mWT (P < .001), 10-m gait steps (P < .001), TUG (P = .04), and 6MWT (P = .006). In the adjusted regression model, gender (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.426-12.25; P = .007), number of interventions (OR, 1.028; 95% CI, 1.003-1.070; P = .03), and active ankle joint dorsiflexion ROM (OR, 1.047; 95% CI, 1.014-1.088; P = .005) remained significant., Conclusion: The factors related to 10mWT showing changes beyond the minimal clinically important difference were found to be patient gender, number of interventions, and active ankle joint dorsiflexion ROM before intervention. When patients with stroke who have greater active ankle joint ROM, and are female, use FES positively, they may benefit more from using FES., Level of Evidence: II., (Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Of 25 cases of cancer in the intrahepatic bile ducts, 44 cases of cancer in the extrahepatic bile ducts, 30 cases of adenoma in the gallbladder, and 100 cases of infiltrating carcinoma in the gallbladder, several to about 20% of the cases showed Paneth's cell metaplasia and/or enterochromaffin cell metaplasia within the tumor mass or in its surrounding mucosa. These metaplasia were not found in small adenomata of the gallbladder, but they were frequently seen in large adenomata. Goblet cell metaplasia and marked hyperplasia of mucous glands were seen more frequently in the mucosa surrounding cancer than in the mucosa of 500 non-neoplastic gallbladders. Although cancer in the gallbladder occasionally developed on the basis of intestinal metaplasia alone, intestinal metaplasia was not likely to be related to induction of most adenomata, but it was likely to be associated with growth and cancerous change of adenoma.

The histopathology of 43 cases of carcinoma in the extrahepatic bile ducts was reported. All four cases of noninfiltrating carcinoma were papillary or polypoid in gross shape. Only one of the eight cases of papillary or polypoid cancers penetrated beyond the fibromuscular layer of the bile ducts, while most cases of nodular or flat cancers spread deeper than the fibromuscular layer. Adenomatous residue was found in 9 (21.4%) of the total 43 cases, and was particularly frequent in papillary or polypoid cancers (6 [75.0%] of 8 cases). It is likely that early cancers were usually polypoid or papillary in gross shape and that most carcinomas arose from a pre-existing adenoma. Carcinoma associated with a choledochal cyst was found in two cases. Multiple carcinomas were seen in one case. Three cases of carcinoma in the extrahepatic bile ducts were associated with carcinoma of the gallbladder.

In order to clarify the relation of adenoma to carcinoma in the gallbladder, histopathologic examination was made on surgical specimens of 1605 cholecystectomies. Among them, 11 benign adenomas, seven adenomas with malignant change, and 79 invasive carcinomas were found. All of the benign adenomas were 12 mm or less in diameter (average diameter, 5.5 +/- 3.1 mm), while the adenomas having cancerous foci were 12 mm or more in diameter (average diameter, 17.6 +/- 4.4 mm). Most invasive carcinomas were more than 30 mm in diameter. The average patient age was 50.5 +/- 16.3 years for benign adenomas, 58.3 +/- 12.6 years for adenomas with malignant change, and 64.8 +/- 9.6 years for invasive carcinomas. Transition of benign adenoma into carcinoma was histologically traceable. Adenomatous residue was found in 15 (19.0%) of 79 cases of invasive carcinoma.