Search

Aim: This study aimed to examine sex and age differences of various stepping movements in the elderly and to clarify useful stepping movements for evaluation of their dynamic balance. Methods: Two hundred and eighty-six healthy elderly subjects who could walk independently (male mean age = 71.2 ± 7.1 years; female mean age = 71.5 ± 6.0) performed the following stepping tests: back and forth; up and down with a 5 cm tall step; and in-place stepping matching three tempos (44, 66 and 132 b.p.m.). Step number, single and double support times in the former two stepping tests, and time difference between metronome sound and grounding time in the latter tempo stepping tests were selected as evaluation parameters. Results: An insignificant sex difference was found in all parameters. Hence, the data of men and women was pooled to examine age differences. Significant age differences were found in the step number and double support time of back and forth and up and down stepping tests and in the time difference of three tempo stepping tests. The step number in younger age groups and the support times in older age groups tended to be larger. Conclusion: No sex difference was found in evaluation parameters of all stepping tests, and all parameters tended to be superior in the younger elderly. The elderly experienced more difficulty matching slow tempos than fast tempos in the in-place stepping test. The back and forth, up and down and in-place matching tempo stepping tests may be useful for evaluating dynamic balance ability of the elderly. [ABSTRACT FROM AUTHOR]

The height of a chair seat affects the burden on the lower limbs during the sit-to-stand (STS). To develop an objective test to evaluate muscle function of the lower limbs using floor reaction force during a STS, the relationship between chair-seat height and the burden on the lower legs must be assessed. To examine the influence of the chair-seat height, floor reaction forces during a STS performed with 5 chair heights adjusted to each subject's lower leg length were compared. The force production and quickness of movement tended to decrease in the phases of trunk flexion and knee and hip joint extension when performing a STS from a lower chair, when the chair height differed by 20% (6.2 cm) from the lower leg length, and was marked when the difference between chair height and lower leg length became larger. In 52 elderly and 50 young adults, floor reaction forces during a STS performed from a chair of the same height as subjects' lower leg lengths were compared. Elderly persons were inferior in force production (strength) and quickness of movement, which decreased as elderly stood up from a chair of a lower height. [ABSTRACT FROM AUTHOR]

This study examined the influence of visual acuity and visual field on the spectral characteristics of the center of pressure during standing. 17 men and 20 women participated in 1 High and Low visual acuity groups. Both groups underwent center of pressure measurements under three visual field conditions: No vision: subjects were given no visual information, Central vision: they were given only central visual field information, and Full vision: they were given full visual information. To assess the spectral characteristics of center of pressure, mean power frequency and frequency of maximal power were calculated from medial-lateral and anterior-posterior center of pressure directions. The Friedman test and Scheffé pairwise comparison tests showed that frequency of maximal power was higher in the No vision than in the Central and Full vision conditions in the High visual acuity group. In conclusion, people with high visual acuity are more susceptible to visual field conditions than those with low visual acuity. It is suggested that postural control characteristics differ with visual acuity or resolution in the central visual field. [ABSTRACT FROM AUTHOR]

The sit-to-stand movement strategy of each subject is different depending on whether the subjects perform voluntary movements or have concrete instructions (i.e., stand quickly), which is strongly reflected in the performance of each sit-to-stand movement phase. Thirty young-adult male subjects participated in this study (M age = 20.7 yr; SD = 2.6). Subjects performed the two movements from a chair height adjusted to the subject's lower thigh length. in the self-administered (SA) condition, subjects voluntarily stood up from the chair without instruction, and in the assigned-ordered (AO) condition subjects stood up from the chair as fast as possible. Vertical floor reaction force and electromyograms of the rectus femoris and tibialis anterior muscles were measured, and 15 parameters were selected. The parameters in the phase between the peak value of the floor reaction force and completion of the movement was highly reliable regardless of instruction. However, other parameters had different reliabilities between the instruction conditions. In particular, the parameters in the phase between starting the movement and the peak value of the floor reaction force under the assigned-order were higher than those of the self-administered condition. Moreover, the sit-to-stand movement was conducted faster in the assigned-order condition during the phase between starting the movement and buttocks-syneresis, and the peak value of the floor reaction force and completion of the movement. From the above, in the assigned-order condition "as fast as possible," the anteflexion bending movement and extension of knee and trunk joints were faster, and anteflexion movement was repeated more similarly under a concrete instruction such as moving as fast as possible. [ABSTRACT FROM AUTHOR]

A nondestructive readout (NDRO) FeRAM using a 0.18-μm CMOS technology has been developed. Readout voltages across the ferroelectric lower than the coercive voltage allowed the FeRAM to achieve high read endurance exceeding required performance for system LSIs, 1016 read cycles. The NDRO approach uses a newly developed charge compensation technique to correct the process variations in threshold voltage of neighboring readout transistors, leading to a wide NDRO operation margin over a supply voltage range from 1.1 to 1.8 V. [ABSTRACT FROM AUTHOR]

Reports a rare, depressed lesion, as yet undescribed, mimicking a submucosal invading depressed type in a 47-year-old male. Inverted colonic mucosal lesion (ICML) that is neither an "inverted hyperplastic polyp" nor a "hamartomatous inverted polyp"; Characteristics of the tubules; Evaluation of results of a positive fecal occult blood test; Pathologic findings; Immunohistochemical stainings; Estimate of the lesion to be a submucosal invading cancer from endoscopic, radiographic, and ultrasonographic points of view.

Pyogenic granuloma (PG) with hemorrhagic tendency, is often recognized in the oral mucosa and skin, but rare in the gastrointestinal tract. Only 20 cases have been reported in the gastric mucosa. There have been no reports of gastrointestinal PG treated by argon plasma coagulation (APC). We report here the first case of PG in the sigmoid colon treated by APC. The patient was a 64-year-old woman complaining of constipation who was referred to a university hospital of Kochi Medical School. She presented with easily bleeding mucosa, as revealed by a total colonoscopic study in the sigmoid colon. Magnifying colonoscopic examination showed two sessile small polyps in the sigmoid colon. Pathological examination of the biopsy specimens revealed pyogenic granuloma. We treated this lesion by endoscopic APC. No recurrence has been found as of 9 months after APC therapy. [ABSTRACT FROM AUTHOR]

Small cell carcinoma of the esophagus is a rare disease with early systemic metastasis, and the prognosis remains poor. This present case (a 60-year-old Japanese man) was a small cell carcinoma at the lower third of the esophagus complicated by multiple liver and brain metastases. After the first chemotherapy, endoscopic study showed significant shrinkage of the primary esophageal tumor. About 4 months later, however, a primary tumor formed a deep ulceration, and a CT scan of the abdomen also showed further progression of the liver metastases. One year after starting the therapy, a disturbance in the patient’s right eyesight and awkward movement of his right hand occurred. Brain magnetic resonance imaging revealed several high-density areas compatible with metastasis. Gamma knife radiosurgery for metastatic brain tumors was carried out, and all tumors had shrunk. Unfortunately, the patient’s liver function deteriorated gradually because of the aggravation of liver metastases, and the patient died 1 year and 5 months from the time of diagnosis. [ABSTRACT FROM AUTHOR]

Reports a case of early-stage gastric plasmacytoma in which the endoscopic features changed after a few month's interval. Findings from gastroendoscopic examination; Results of Billroth I partial gastrectomy; Association between Helicobacter pylori and gastric mucosa-associated lymphoid tissue lymphoma.

Several nuclear reactor diagnostic systems using neural networks have been proposed in recent years. Neural networks trained by backpropagation, the standard training algorithm, have certain problems such as local minima and long training times. In this paper, neural networks trained by genetic algorithms are used in a nuclear reactor diagnostic system to solve these problems. The system is tested by simulated data modeled on the experimental fast reactor JOYO, and two categories of abnormality (abnormal control rod vibration and abnormal coolant flow) are identified. The comparisons to networks trained by backpropagation also are discussed. [ABSTRACT FROM AUTHOR]

Force sensorless control with voice coil motor (VCM) is thought to be challenging because its thrust constant fluctuation characteristic and the flexible flat cable connected to the moving coil degrade the estimation accuracy. Modeling methods of thrust constant fluctuation have been proposed in previous studies. However, these methods were time consuming, easily affected by friction, and did not consider cable disturbance. This article presents an identification and compensation methodology for nonlinear internal disturbances in a VCM to accomplish precise force control with a linear VCM stage. In this article, a novel compensator is constructed on basis of these deterioration mechanisms. To realize the compensator, the deteriorations had to be obtained. To that end, a novel approach to identify the parameter fluctuation and cable restoring force is developed, and the compensator is applied to sensorless force control. The proposed approaches are verified through experiments using the prototype of a linear VCM stage. [ABSTRACT FROM AUTHOR]

Hydrogen chloride (HCl) is the most abundant (more than 95 %) among inorganic chlorine compounds Cly in the upper stratosphere. The HCl molecule is observed to obtain long-term quantitative estimations of the total budget of the stratospheric chlorine compounds. In this study, we provided HCl vertical profiles at altitudes of 16–100 km using the Superconducting Submillimeter-Wave Limb-Emission Sounder (SMILES) from space. The HCl vertical profile from the upper troposphere to the lower thermosphere is reported for the first time from SMILES observations; the data quality is quantified by comparison with other measurements and via theoretical error analysis. We used the SMILES level-2 research product version 3.0.0. The period of the SMILES HCl observation was from 12 October 2009 to 21 April 2010, and the latitude coverage was 40 ∘ S–65 ∘ N. The average HCl vertical profile showed an increase with altitude up to the stratopause (∼ 45 km), approximately constant values between the stratopause and the upper mesosphere (∼ 80 km), and a decrease from the mesopause to the lower thermosphere (∼ 100 km). This behavior was observed in all latitude regions and reproduced by the Whole Atmosphere Community Climate Model in the specified dynamics configuration (SD-WACCM). We compared the SMILES HCl vertical profiles in the stratosphere and lower mesosphere with HCl profiles from Microwave Limb Sounder (MLS) on the Aura satellite, as well as from the Atmospheric Chemistry Experiment Fourier Transform Spectrometer (ACE-FTS) on SCISAT and the TErahertz and submillimeter LImb Sounder (TELIS) (balloon borne). The TELIS observations were performed using the superconductive limb emission technique, as used by SMILES. The globally averaged vertical HCl profiles of SMILES agreed well with those of MLS and ACE-FTS within 0.25 and 0.2 ppbv between 20 and 40 km (within 10 % between 30 and 40 km; there is a larger discrepancy below 30 km), respectively. The SMILES HCl concentration was smaller than those of MLS and ACE-FTS as the altitude increased from 40 km, and the difference was approximately 0.4–0.5 ppbv (12 %–15 %) at 50–60 km. The difference between SMILES and TELIS HCl observations was about 0.3 ppbv in the polar winter region between 20 and 34 km, except near 26 km. SMILES HCl error sources that may cause discrepancies with the other observations are investigated by a theoretical error analysis. We calculated errors caused by the uncertainties of spectroscopic parameters, instrument functions, and atmospheric temperature profiles. The Jacobian for the temperature explains the negative bias of the SMILES HCl concentrations at 50–60 km. [ABSTRACT FROM AUTHOR]

Hydrogen chloride (HCl) is the most abundant (more than 95%) among inorganic chlorine compounds Cly in the stratosphere. The HCl molecule has been observed to obtain long-term quantitative estimations of total budget of the stratospheric anthropogenic chlorine compounds. In this study, we provided HCl vertical profiles at altitudes of 16-100km using the superconducting submillimeter-wave limb-emission sounder (SMILES) from space. We used the SMILES Level-2 research product version 3.0.0. The period of the SMILES HCl observation was from October 12, 2009 to April 21, 2010, and the latitude coverage was 40S-65N. The average HCl vertical profile showed an increase with altitude up to the stratopause (~45km), approximately constant values between the stratopause and the upper mesosphere (~80km), and a decrease from the mesopause to the lower thermosphere (~100km). This behavior was observed in the all latitude regions, and reproduced by the SD-WACCM model. We compared the SMILES HCl vertical profiles in the stratosphere and lower mesosphere with HCl profiles from MLS on the Aura satellite, as well as from ACE-FTS on SCISAT and from TELIS (balloon-borne). The TELIS observations were performed using the superconductive limb emission technique, as used by SMILES. The globally averaged vertical HCl profiles of SMILES well agreed with those of MLS and ACE-FTS within 0.25 and 0.2ppbv between 20 and 40km, respectively. The SMILES HCl concentration was smaller than those of MLS and ACE/FTS as the altitude increased from 40km, and the difference was approximately 0.4-0.5ppbv at 50-60km. The difference between SMILES and TELIS HCl observations was about 0.3ppbv in the polar winter region between 20 and 34km, except near 26km. SMILES HCl error sources that may cause discrepancies with the other observations are investigated by a theoretical error analysis. We calculated errors caused by the uncertainties of spectroscopic parameters, instrument functions, and atmospheric temperature profiles. The jacobian for the temperature explains the negative bias of the SMILES HCl concentration at 50-60km. The HCl vertical profile from the middle troposphere to the lower thermosphere is reported for the first time from SMILES observations; the data quality is quantified by comparisons with other measurements and via theoretical error analysis. [ABSTRACT FROM AUTHOR]

Acetonitrile (CH3CN) is a volatile organic compound (VOC) and a potential tracer of biomass burning. We evaluated the capability of using observations derived from the Superconducting Submillimeter-Wave Limb-Emission Sounder (SMILES) on the International Space Station (ISS) to measure CH3CN profiles. The error in a CH3CN vertical profile from the Level-2 research (L2r) product version 3.0.0 was estimated by theoretical error analysis and also compared with other instrumental measurements. We estimated the systematic and random errors to be ∼5.8 ppt (7.8 %) and 25 ppt (60 %), respectively, for a single observation at 15.7 hPa in the tropics, where the CH3CN measurements are enhanced. The major source of systematic error was the pressure-broadening coefficient, and its contribution to the total systematic error was approximately 60 % in the middle stratosphere (15.7–4.8 hPa). The random error decreased to less than 40 % after averaging 10 profiles in the pressure range of 28.8–1.6 hPa. The total error due to uncertainties in other molecular spectroscopic parameters (2.8 ppt) was comparable to that of CH3CN spectroscopic parameters. We compared the SMILES CH3CN profiles with those of the microwave limb sounder (MLS) on the Aura satellite (version 4.2). The SMILES CH3CN values were consistent with those from MLS within the standard deviation (1σ) of the MLS observations. The difference between the SMILES and MLS CH3CN profiles increased with altitude and was within 20–35 ppt (20 %–260 %) at 15.7–1.6 hPa. We observed discrepancies of 5–10 ppt (10 %–30 %) between the SMILES CH3CN profiles observed by different spectrometers, and hence, we do not recommend merging SMILES CH3CN profiles derived from different spectrometers. We found that the SMILES CH3CN volume mixing ratio (VMR) in the upper stratosphere has a seasonal maximum in February. [ABSTRACT FROM AUTHOR]

In this paper, we address the affine template matching of general images. The extensive search space of affine transformations necessitates effective searches of the global optimum. The proposed method utilizes differential evolution (DE), which is a method of metaheuristic optimization, to achieve that goal. Self‐adaptive DEs can be useful and are applicable in a wide range of studies as they tune crossover rate and scaling factor (F) themselves over generation iteration. However, this approach is not particularly good for affine template matching because the population often converges to local optima. In order to solve this problem, the population is divided into two equal groups for exploitation and exploration. The former group utilizes current‐to‐best/1, and the latter group adopts improved current‐to‐rand/1 for the mutation scheme. Furthermore, the proportion of the population sizes of the two groups are linearly changed on the basis of the best sum of absolute difference error measurements over each generation. These ideas are easy and simple, but experimental results have revealed our method to be more accurate than the state‐of‐the‐art method. © 2018 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc. [ABSTRACT FROM AUTHOR]

Abstract: The maximal double step length (MDSL) test is a modified version of the maximal step length (MSL) test used to evaluate the dynamic balance related to falls in the elderly. Although this test can evaluate their physical function using movements similar to daily activities as compared to MSL, it has not been clarified whether it can adequately evaluate the activities of daily living (ADL) abilities of the elderly, as they decrease with age. This study aimed to examine the relationship between both MSL and MDSL on age and ADL in elderly subjects. Fifty-seven elderly females who live independently (age 74.8±5.6 years) were recruited. MSL and MDSL were conducted twice after completing an ADL questionnaire. Intra-class correlation coefficients (ICCs) of both tests were high (for MSL: ICC=0.95, for MDSL: ICC=0.81–0.82). Age and ADL significantly correlated to MDSL (age: r =−0.32–0.41, ADL: r =0.28–0.48), but not to MSL (age: r =−0.19, ADL: r =0.15). MDSL has high reliability as it relates to age and ADL. It may be more useful to evaluate ADL required for independent living and prevent falls in the elderly better than MSL. [Copyright &y& Elsevier]

Abstract: This study examined the reliability of ground reaction force (GRF) parameters during sit-to-stand (STS) movements and the relationships between the GRF parameters and lower limb muscle mass and knee extension muscle strength. Fifty elderly females performed an STS movement twice from a chair adjusted to their knee height and the GRF, lower limb muscle mass and isometric knee extension muscle strength were measured. Reliabilities of GRF parameters were high (intra-class correlation coefficient=ICC=0.70–0.95). Parameters on force output during trunk flexion phase (ground reaction force at hip-lift off, sum of force output between beginning of STS movement and hip-lift off) differed significantly between trials, but their effect sizes were small (0.15–0.23). GRF parameters during hip-lift off and knee–hip joint extension phases significantly correlated with knee extension strength (|r|=0.29–0.64) but not lower limb muscle mass. In conclusion, the reliability of GRF during STS movement is good in hip-lift off and knee–hip joint extension phases and these phases relate significantly with lower limb muscle function. These two phases are useful for evaluation of leg muscle function of the elderly. [Copyright &y& Elsevier]

Background: Opportunistic infections associated with immunosuppressive treatments for inflammatory bowel disease pose an important safety concern. Here we report the case of a patient with active ulcerative colitis and cryptococcal pneumonia who was treated with vedolizumab combined with fluconazole. Case presentation: A 56-year-old Japanese man with ulcerative colitis and a history of Sweet's syndrome who was taking prednisolone and azathioprine presented with a moderate exacerbation of ulcerative colitis, abdominal pain, diarrhea, and bloody stools along with cytomegalovirus infection. Increasing the prednisolone dose without using antiviral drugs improved cytomegalovirus infection; however, ulcerative colitis did not improve, and cryptococcal pneumonia occurred. Thus, treatment with fluconazole followed by vedolizumab was initiated for ulcerative colitis. The patient gradually recovered and achieved clinical remission without the exacerbation of pneumonia. Conclusions: We reported the first case of a patient with ulcerative colitis who was treated with vedolizumab and concomitant fluconazole for active cryptococcal pneumonia. Vedolizumab constitutes a high-potential treatment regimen owing to its safety in inflammatory bowel disease associated with opportunistic infections. [ABSTRACT FROM AUTHOR]

L-Ornithine plays an important role in ammonia metabolism via the urea cycle. This study aimed to examine the effect of L-ornithine hydrochloride ingestion on ammonia metabolism and performance after intermittent maximal anaerobic cycle ergometer exercise. Ten healthy young adults (age, 23.8 ± 3.9 year; height, 172.3 ± 5.5 cm; body mass, 67.7 ± 6.1 kg) with regular training experience ingested L-ornithine hydrochloride (0.1 g/kg, body mass) or placebo after 30 s of maximal cycling exercise. Five sets of the same maximal cycling exercise were conducted 60 min after ingestion, and maximal cycling exercise was conducted after a 15 min rest. The intensity of cycling exercise was based on each subject's body mass (0.74 N kg(-1)). Work volume (watt), peak rpm (rpm) before and after intermittent maximal ergometer exercise and the following serum parameters were measured before ingestion, immediately after exercise and 15 min after exercise: ornithine, ammonia, urea, lactic acid and glutamate. Peak rpm was significantly greater with L-ornithine hydrochloride ingestion than with placebo ingestion. Serum ornithine level was significantly greater with L-ornithine hydrochloride ingestion than with placebo ingestion immediately and 15 min after intermittent maximal cycle ergometer exercise. In conclusion, although maximal anaerobic performance may be improved by L-ornithine hydrochloride ingestion before intermittent maximal anaerobic cycle ergometer exercise, the above may not depend on increase of ammonia metabolism with L-ornithine hydrochloride. [ABSTRACT FROM AUTHOR]

Purpose: Intraoperative identification of the cancer location is often difficult to conduct during laparoscopic surgery, especially in early-stage cancers. This study aimed to investigate the feasibility and accuracy of a novel endoscopic clip resin-conjugated fluorescent indocyanine green during laparoscopic surgery for gastrointestinal cancer. Methods: Preoperative placement of endoscopic marking clips equipped with resin-conjugated fluorescent indocyanine green was performed to determine the resection margin in eight patients with gastrointestinal cancer. During laparoscopic surgery, a dedicated laparoscopic system with a xenon light source was used to detect fluorescence. The evaluation determined whether the fluorescent from the clips was visualized during laparoscopic surgery. Results: Fluorescent signal emitted from ICG in the resin of the clips was detected in six patients from the outer layer of the serosal surfaces of the gastrointestinal tract, and the clips aided in accurate resection line of the organ. There were no significant differences of age, gender, and BMI between the patients in whom we could and could not detect ICG fluorescence. Conclusions: The results demonstrated the usefulness of a novel clip-equipped fluorescent resin, which is a promising diagnostic tool to detect accurate tumor location during laparoscopic surgery. [ABSTRACT FROM AUTHOR]

We present a feasibility study for a submillimeter instrument on a small Mars platform now under construction. The sensor will measure the emission from atmospheric molecular oxygen, water, ozone, and hydrogen peroxide in order to retrieve their volume mixing ratios and the changes therein over time. In addition to these, the instrument will be able to limit the crustal magnetic field, and retrieve temperature and wind speed with various degrees of precision and resolution. The expected measurement precision before spatial and temporal averaging is 15 to 25 ppmv for the molecular oxygen mixing ratio, 0.2 ppmv for the gaseous water mixing ratio, 2 ppbv for the hydrogen peroxide mixing ratio, 2 ppbv for the ozone mixing ratio, 1.5 to 2.5 µ T for the magnetic field strength, 1.5 to 2.5 K for the temperature profile, and 20 to 25 m s -1 for the horizontal wind speed. [ABSTRACT FROM AUTHOR]

Lipid bilayer transformations are involved in biological phenomena including cell division, autophagy, virus infection, and vesicle transport. Artificial materials to manipulate membrane dynamics play a vital role in cellular engineering and drug delivery technology that accesses the membranes of cells or liposomes. Transformation from 3D lipid vesicles to 2D nanosheets is thermodynamically prohibited because the apolar/polar interfaces between the hydrophobic bilayer edges and water are energetically unfavorable. We recently reported that cell-sized lipid vesicles (or giant vesicles) can be thoroughly transformed to 2D nanosheets by the addition of the amphiphilic E5 peptide and a cationic graft copolymer. Here, to understand the mechanisms underlying the lipid nanosheet formation, we systematically investigated the structural effects of the cationic copolymers on nanosheet formation. We found that lipid nanosheet formation is controlled in an all-or-nothing manner when the graft content of the copolymer is increased from 5.7 mol % to 7.7 mol %. This finding prompted us to obtain autonomous 2D/3D transformation system. A newly designed hetero-grafted cationic copolymers with thermoresponsive poly( N -isopropylacrylamide) grafts enables spontaneous 3D vesicle/2D nanosheet transformation in response to temperature. These findings would enable us to obtain smart nanointerfaces that trigger cell-sized lipid membrane dynamics in response to diverse stimuli and to create 2D-3D convertible lipid-based biomaterials.

Background and Aims: Endoscopic submucosal dissection (ESD) seems to be a reasonable option for gastrointestinal subepithelial lesions (SELs) localized within the submucosa. Indications for ESD include small neuroendocrine tumors (NETs) and indeterminate SELs. However, the prospective data regarding ESD and surveillance remain unclear. This study was performed to prospectively investigate the outcomes of ESD, including organ-specific outcomes and the mid-term prognosis., Methods: This prospective multicenter study included 57 patients who underwent ESD for SELs localized within the submucosa [definite NETs (n = 42) and indeterminate SELs (n = 15)]. The efficacy and safety of ESD were evaluated in the whole cohort and in subgroups (NETs and indeterminate SELs). All patients were followed up., Results: The rates of en bloc resection, curative resection, and complications were 98.2%, 66.7%, and 7.7% for the overall population (n=57); 100%, 61.9%, and 2.4% for NETs (n=42); and 93.3%, 80.0%, and 20.0% for indeterminate SELs (n=15), respectively. The rates of curative resection for NETs were poorer in the stomach (20%, n=5) and duodenum (33%, n=3) than in the rectum (71%, n=34). Including 11 of 16 patients with NETs who underwent a conservative approach resulting in non-curative resection, no patients developed tumor recurrence during the follow-up period (median, 24.5 months; range, 1-60 months). ESD followed by surveillance demonstrated acceptable mid-term outcomes for non-curative NETs., Conclusions: ESD can be an efficient therapy for SELs localized within the submucosa. However, gastric and duodenal ESD for NETs may be limited in terms of its curative and technical aspects. Clinicians should be aware of the potential complications of ESD for indeterminate SELs.

Aim: To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method., Methods: This retrospective study at 5 medical centers involved 58 consecutive patients undergoing over-the-scope clips (OTSCs) placement. The overall rates of technical success (TSR), clinical success (CSR), complications, and procedure time were analyzed as major outcomes. Subsequently, 56 patients, excluding two cases that used the Anchor device, were divided into two groups: 14 cases of simple suction (SS-group) and 42 cases using the Twin Grasper (TG-group). Secondary evaluation was performed to clarify the predictors of OTSC success., Results: The TSR, CSR, complication rate, and median procedure time were 89.7%, 84.5%, 1.8%, and 8 (range 1-36) min, respectively, demonstrating good outcomes. However, significant differences were observed between the two groups in terms of the mean procedure time (5.9 min vs 14.1 min). The CSR of the SS- and TG-groups among cases with a maximum defect size ≤ 10 mm and immediate or acute refractory bleeding was 100%, which suggests that SS is a better method than TG in terms of time efficacy. The CSR in the SS-group (78.6%), despite the technical success of the SS method (TSR, 100%), tended to decrease due to delayed leakage compared to that in the TG-group (TSR, CSR; 88.1%), indicating that TG may be desirable for leaks and fistulae with defects of the entire layer., Conclusion: OTSC system is a safe and effective therapeutic option for gastrointestinal defects. Individualized selection of the suction method based on particular clinical conditions may contribute to the improvement of OTSC success., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to report.

Many elderly people experience difficulty with independent living after injuries associated with falls. This study aimed to examine the influence of fall characteristics and physical function level on the severity of fall related injuries. The surveys were conducted in 1955 community dwelling elderly. The questions regarded the following: fall experience within the past year, fall direction, fall cause, injured parts and degree of injury, and an activity of daily living (ADL) questionnaire from the Ministry of Education, Culture, Sports, Science and Technology Japan. Data of 1850 subjects with available and complete responses were used for analysis. Three hundred and eighty-six (20.9%) elderly people experienced a fall within the past year and 257 (66.7%) were injured. ADL score was significantly higher in the elderly without fall experience than the elderly with fall experience. No significant difference was found in frequency of fall cause and fall direction between the elderly with and without injuries caused by falling. Significant correlations were found between fall direction and fall cause and injured parts (φ=0.49 and 0.32). ADL score of the elderly who fell by leg backlash was significantly lower than that of the elderly who fell by tripping, slipping and staggering. A decrease of ADL affects the rate of falls in the elderly, but not the degree of injury. Fall characteristics may not be related to the extent of fall injury., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

This study aimed to examine the effect of shoes with a rounded soft sole (Stretch Walker: SW) on gait. Fifteen healthy male (mean age: 23.2) walked under three conditions (SW, Flat-bottomed Shoe: FS, Barefoot: BF). Including walking speed, stance time, step length were selected as temporal-spatial parameters. The angle of hip, knee, and ankle joints during particular phases were selected as kinematic parameters. Walking speed, stance time, step length and flexion angle of the ankle joint at initial contact were greater when wearing either shoe than walking BF; cadence was faster walking BF than wearing either shoe; double support time increased (FS>SW>BF); step width was greater (FS>SW>BF); walking angle was greater wearing the SW than wearing the FS and walking BF; and range of motion and maximum flexion angle of the hip and knee joints were greater wearing the FS than walking BF. In conclusion, wearing the SW with a heel-to-toe rocker and soft sole changes the double support time, step width, and walking angle and increases step length and walking speed compared to walking BF. The difference of the range of motion in hip and knee joints was larger between walking BF and wearing the FS than between walking BF and wearing the SW., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study aimed to examine useful items for screening the fall risk of community dwelling elderly from various perspectives, including fall experience, physical function level, and age level difference. 968 independently living elderly persons over the age of 60 (age: 70.0 ± 7.0) responded to 80 fall risk items representing 7 factors (physical function, fall history, using devices, fear of falling and inactivity, dosing, disease and disability, and environment) and an ADL questionnaire. The high fall risk response rate was calculated for each item and tested for statistical significance among age groups and those with and without fall experience. Cramer's V was calculated to examine the relationship between each item and the ADL. In addition, we selected items with significant differences in the high fall risk response rates between the faller and the non-faller groups, a significant relationship with ADL, and a significant difference among age groups. A total of 40 useful items were selected from each fall risk factor (decrease in physical function: 21 items, fall history: 2 items, device usage: 3 items, fear of falling and inactivity: 5 items, dosing: 0 items, disease and disability: 8 items, and environment: 1 item). Selected items can comprehensively and properly assess the fall risk of the healthy elderly as compared with existing questionnaires., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Having noted a discrepancy between endoscopic and histopathological diagnoses in cases of minute adenomas of the colon, a prospective study was designed to clarify which is appropriate, magnifying chromoendoscopy or histopathology of a specimen obtained by biopsy forceps. A total of 208 patients comprised the study population. The endoscopic diagnoses were performed with magnifying colonoscopies. We separated the detected lesions with type III(L) pit pattern following Kudo's classification into two groups at random: in group A (n = 104) resected specimens were fixed with 20% buffered formalin without being flattened, whereas in group B (n = 104) the resected specimens were flattened using forceps before fixation and the specimens were cut under observation of their surface structure with stereomicroscopy. Comparison of the initial diagnoses between groups A and B showed that a total of 84.6% (88/104) of the lesions were diagnosed to be tubular adenomas histopathologically in group A, compared with 100% (104/104) in group B (P < 0.0001). Results for comparison of the secondary diagnoses between group A and group B showed that 14 of the 16 lesions were diagnosed as tubular adenomas histopathologically. Thereafter, 98.1% (102/104) of the lesions were diagnosed to be tubular adenomas histopathologically in group A (P = 0.4976). In conclusion, high-resolution magnifying chromoendoscopy is an appropriate procedure for the diagnosis of minute adenomas in comparison with histopathology of specimens obtained by biopsy forceps in this prospective study.

This study aimed to examine the relationships between ground reaction force during a sit-to-stand (STS) movement and physical activity and falling risk of the elderly and the difference of the movement characteristics between the young and the elderly. Sixty elderly females who can achieve a STS movement by themselves and 30 healthy young females were measured for ground reaction force during STS movement from a chair, adjusted for lower leg length height. The elderly's physical activity and falling risk were also assessed. Physical activity and falling risk significantly correlated with parameters on force exertion during hip lift-off and knee-hip joint extension phases (|r|=0.26-0.41). Significant differences were found in ground reaction force parameters of all phases between the young and the elderly and STS movement of the elderly was suggested to result in poor force exertion and slowing down. The above tendency was noticeable in the hip lift-off and knee-hip joint extension phases. In conclusion, force exertion in hip lift-off and knee-hip joint extension phases of STS movement is related to physical activity and falling risk in the elderly. These phases may be useful to evaluate the elderly's physical activity and falling risk.

This study aimed to compare the center of foot pressure (CFP) during different ischemia periods by cuff compression. Ten healthy young adult males held their CFP for 1 min before and after cuff compression (250 mmHg) of lower limb blood vessels during two different compression periods (10 min and 26 min). Two-point discrimination thresholds and electric stimulus perception thresholds of each subject's right foot sole were measured during cuff compression to examine changes in the perceived level of cutaneous and proprioceptive sensation by blood flow inhibition. In addition, oxygenation kinetics in the anterior tibial muscle tissue was examined by near-infrared spectroscopy during cuff compression. The CFP was evaluated by using 36 parameters. CFP deflection tended to increase after cuff compression and to be larger over a long ischemic time (26 min) as compared with a short ischemic time (10 min). The proprioceptive perception threshold using electric stimulation showed a significant interaction and was higher after 26 min ischemia than at the initial timepoint and after 10 min ischemia. The delta[Oxy Hb/Mb], delta[Deoxy Hb/Mb] and Tissue oxygenation index (TOI) changed significantly after both ischemic conditions than at the initial condition. There was no significant difference in the Tissue oxygenation index and delta[Deoxy Hb/Mb] between both ischemic conditions. Many parameters regarding the deflection velocity and anteroposterior and lateral deflection had significantly larger values after 26 min ischemia than at the initial time point and after 10 min ischemia. Postural deflection may not be affected by the oxygen deficiency of muscle tissues caused by the compression of blood vessels for 10 min, but strongly affected by the cutaneous and proprioceptive sensation disturbances occurring from compression lasting over 10 min.