Search

Background Although the importance of kinematic evaluation of the sit-to-stand (STS) test of total knee arthroplasty (TKA) patients is clear, there have been no reports analyzing STS during the 30-s chair sit-up test (30 s-CST) with a focus on kinematic characteristics. This study aimed to demonstrate the clinical utility of kinematic analysis of STS during the 30 s-CST by classifying STS into subgroups based on kinematic parameters, and to determine whether differences in movement strategies are expressed as differences in clinical outcomes. Methods The subjects were all patients who underwent unilateral TKA due to osteoarthritis of the knee and were followed up for one year postoperatively. Forty-eight kinematic parameters were calculated using markerless motion capture by cutting STS in the 30 s-CST. The principal components of the kinematic parameters were extracted and grouped by kinematic characteristics based on the principal component scores. Clinical significance was examined by testing whether differences in patient-reported outcome measures (PROMs) were observed. Results Five principal components were extracted from the 48 kinematic parameters of STS and classified into three subgroups (SGs) according to their kinematic characteristics. It was suggested that SG2, using a kinematic strategy similar to the momentum transfer strategy shown in previous studies, performed better in PROMs and, in particular, may be associated with achieving a “forgotten joint”, which is considered the ultimate goal after TKA. Conclusions Clinical outcomes differed according to kinematic strategies used STS, suggesting that kinematic analysis of STS in 30 s-CST may be useful in clinical practice. Trial registration This study was approved by the Medical Ethical Committee of the Tokyo Women’s Medical University (approval number: 5628 on May 21, 2021).

This is an interview article with Randolph H. Thrasher and Yoshinori Watanabe, leading experts on language assessment in Japan. Randolph H. Thrasher is professor emeritus at Okinawa Christian University, Japan, and International Christian University, Japan. He has made numerous significant contributions to spreading and supporting the field of language assessment. Yoshinori Watanabe is a professor at Sophia University, Graduate School of Language and Linguistics, Japan. He is also a renowned figure in language assessment and testing domestically and internationally. We interviewed them to deepen insights into various aspects of language assessment in Japan, as well as in the world. This interview was conducted in March 2021 via e-mail because of the global COVID-19 pandemic. In answering our questions for this interview, Professor Thrasher and Watanabe wrote about their own early lives and careers and their fruitful experiences with Japan Language Testing Association (JLTA), shared their passionate beliefs about language assessment and testing from domestic and international perspectives, and offered hopeful messages to young researchers. 本稿は, 日本における言語テスティング分野を開拓し, 国際的にも活躍するRandolph H. Thrasher名誉教授 (沖縄キリスト教学院大学・国際基督教大学) と渡部良典教授 (上智大学大学院) へのインタビュー記事である。Thrasher名誉教授は第2代の, 渡部教授は現在, 第4代の日本言語テスト学会 (JLTA) 会長として学会を牽引している。両名は, 言語テスティング分野の学術的発展への貢献のみにとどまらず, 得られた研究成果を社会に還元し, 国際社会の外国語教育発展に貢献してきた, まさに日本を代表する言語テスティング研究者と言える。JLTA発足時からのメンバーである両名は, その中心として, 国際言語テスト学会 (ILTA) における活動をはじめ, 国際的にも長年活躍されている。その両名から, これまでのキャリア, JLTAでの貴重な経験, 国内および国際的な観点からの言語テスティングへの知見, 言語テスティングに対する情熱と信念, そしてこれからの言語テスティングの分野を担う若手研究者に対するメッセージをいただいた。. © 2021 Taylor & Francis.

ObjectiveAs the progression of knee osteoarthritis (OA) is associated with large biomechanical loads, an optimally designed intervention is needed to prevent disease progression and symptoms. We aimed to investigate the effect of exercise therapy—the gold standard intervention—on biomechanical loads in patients with knee OA and identify its modification factors.DesignSystematic review and meta-analysisData sourcesPubMed, PEDro, and CINAHL; from study inception to May 2021Eligibility criteriaStudies evaluating the first peak knee adduction moment (KAM), peak knee flexion moment (KFM), maximal knee joint compression force (KCF), or co-contraction during walking before and after exercise therapy in patients with knee OARisk of BiasPEDro scale and NIH scale.ResultsAmong 11 RCTs and nine non-RCTs, 1100 patients with knee OA were included. First peak KAM (SMD 0.11; 95% CI: -0.03–0.24), peak KFM (SMD 0.13; 95% CI: -0.03–0.29), and maximal KCF (SMD 0.09; 95% CI -0.05–0.22) tended to increase. An increased first peak KAM was significantly associated with a larger improvement in knee muscle strength and WOMAC pain. The quality of evidence regarding the biomechanical loads was low-to-moderate according to the GRADE approach.ConclusionsExercise therapy tends to increase biomechanical loads. The improvement in pain and knee muscle strength may mediate the increase in first peak KAM, suggesting difficulty in balancing symptom relief and biomechanical load reduction. Therefore, exercise therapy may satisfy both aspects simultaneously when combined with biomechanical interventions, such as a valgus knee brace or insoles.FundingGrant-in-Aid for JSPS Research Fellows, 19J23020.RegistrationPROSPERO (CRD42021230966)

Carbon nanotubes (CNTs) are potentially important biomaterials because of their chemical, physical, and biological properties. Our research indicates that CNTs exhibit high compatibility with bone tissue. The guided bone regeneration (GBR) technique is commonly applied to reconstruct alveolar bone and treat peri-implant bone defects. In GBR, bone defects are covered with a barrier membrane to prevent the entry of nonosteogenic cells such as epithelial cells and fibroblasts. The barrier membrane also maintains a space for new bone formation. However, the mechanical and biological properties of materials previously used in clinical practice sometimes delayed bone regeneration. In this study, we developed a CNT-based membrane for GBR exhibiting high strength to provide a space for bone formation and provide cellular shielding to induce osteogenesis. The CNT membrane was made via the dispersion of single-walled CNTs (SWCNTs) in hyaluronic acid solution followed by filtration. The CNT membrane assumed a nanostructure surface due to the bundled SWCNTs and exhibited high strength and hydrophilicity after oxidation. In addition, the membrane promoted the proliferation of osteoblasts but not nonosteogenic cells. CNT membranes were used to cover experimental bone defects made in rat calvaria. At 8 weeks after surgery, more extensive bone formation was observed in membrane-covered defects compared with bone defects not covered with membrane. Almost no diffusion of CNTs was observed around the membrane. These results indicate that the CNT membrane has adequate strength, stability, and surface characteristics for osteoblasts, and its shielding properties promote bone formation. Demonstration of the safety and osteogenic potential of the CNT membranes through further animal studies should facilitate their clinical application in GBR.

During walking, the slip velocity relative to the center of mass velocity can be one of the determinants of falls. We hypothesized that participants would select their strategy (classified by strategy type and measured by the distance of recovery landing or next forward stepping) according to both walking velocity and stance of legs. This study aimed to assess the relationship between the walking velocity relative to the slip velocity (maximum 1.6 m/s) and the corrective response and evaluated the element of the posture at the moment of slipping associated with the corrective response. Ten healthy young adults showed leading leg perturbation in two isolated velocity conditions during over ground walking (slow: 0.9 m/s, fast: 1.6 m/s) using a built-in, double-belt treadmill. We defined the corrective response to perturbation as the change in the heel marker distance post-perturbation. We examined the postural parameters affecting the difference in corrective response. During fast walking, at a velocity near the maximum slip velocity, all participants overcame slipping and kept walking. During slow walking, at a velocity less than the maximum slip velocity, most of the participants took wide steps or stepped backwards and stopped walking. During slow walking, the step length (r = 0.84, p

It remains unknown whether the histology of vascular invasion during secondary ossification of epiphyseal cartilage is the same as that seen in primary ossification; we examined the initial processes of vascular invasion of secondary ossification in the murine femora. Many endomucin-immunoreactive blood vessels gathered at the central region of the articular surface, and buds of soft tissue, including glomerular loops of endomucin-immunoreactive blood vessels and TNALPase- immunopositive osteoblastic cells accompanied by TRAP-positive osteoclasts, had begun to invade the epiphyseal cartilage. The invading soft tissues formed cartilage canals displaying MMP9 immunoreactivity in the tip region, and cartilaginous collagen fibrils were not visible in the vicinity of the vascular wall of the blood vessels. Thus, the histological profile marked by invading glomerular vasculature and the erosion of the cartilage matrix near the vascular walls during secondary ossification differs from that seen during primary ossification.

Objective This study aimed to demonstrate the immunolocalization and gene expression of tissue nonspecific alkaline phosphatase (TNALP) and ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) in osteoblasts, preosteoblasts, and osteocytes of murine bone to provide clues for a better understanding of the supply of phosphate ions (Pi) during bone mineralization. Methods Six-week-old male C57BL/6J mice (n = 6) were fixed with a paraformaldehyde solution, and the right femora were extracted for immunodetection of TNALP and ENPP1, while the left tibiae were used for reverse transcription polymerase chain reaction to evaluate Tnalp and Enpp1 gene expression. Results TNALP was intensely localized on the basolateral cell membranes of mature osteoblasts and preosteoblastic cells. There was little immunoreactivity of TNALP on the secretory surface of the osteoblasts and no TNALP reactivity in the osteocytes. In contrast, ENPP1 was observed throughout the cytoplasm of mature osteoblasts and osteocytes embedded in bone but was not observed in preosteoblasts. Together, despite the fact that the osteoid is a site of matrix vesicle-mediated mineralization, ENPP1, which inhibits mineralization by providing pyrophosphates, was localized in close proximity of the osteoid, whereas TNALP, which facilitates mineralization by providing Pi, was relatively distant from the osteoid. Conclusion It seems likely that the differential localization of TNALP and ENPP1 around the osteoid observed at the microscopic level may provide preferential micro-circumstance for a balanced concentration of Pi and pyrophosphate for bone mineralization.

Background Adaptation to split-belt treadmill walking differs between individual stroke survivors. Many discussions only address spatiotemporal parameters that are related to movement, and the changes in interlimb spatiotemporal parameters as a consequence of adaptation are poorly understood. Objectives To investigate symmetry of the center of pressure (CoP) position relative to the center of mass (CoM), and ascertain whether this can be used to identify differences in adaptation of interlimb spatiotemporal parameters among stroke survivors during split-belt walking. Methods Twenty-two chronic post-stroke patients and nine elderly controls walked in tied- then split-belt (2:1 ratio of fast:slow) conditions. Spatiotemporal parameters were compared within groups to assess symmetry of the CoM-CoP angle at foot contact. Results Asymmetry of the CoM-CoP angle was associated with asymmetry of spatiotemporal parameters. Re-establishment of symmetry of CoM-CoP angle was reflected in re-established symmetry of spatiotemporal parameters in post-stroke and control participants. Conclusions Post-stroke patients who re-establish symmetry of the COM-COP angle are able to adapt their walking for split-belt perturbation. This suggests that predictively symmetric foot placements on the fast and slow sides are necessary for adaptation in walking. Symmetrical foot placement is achieved by interlimb coordination and may contribute to dynamic stability.

Objective: To clarify whether there are any muscle synergy changes in individuals with knee osteoarthritis, and to determine whether muscle synergy analysis could be applied to other musculoskeletal diseases. Methods: Subjects in this study included 11 young controls (YC), 10 elderly controls (EC), and 10 knee osteoarthritis patients (KOA). Gait was assessed on a split-belt treadmill at 3 km/h. A non-negative matrix factorization (NNMF) was applied to the electromyogram data matrix to extract muscle synergies. To assess the similarity of each module, we performed the NNMF analysis assuming four modules for all of the participants. Further, we calculated joint angles to compare the kinematic data between the module groups. Results: The number of muscle modules was significantly lower in the EC (2–3) and KOA (2–3) groups than in the YC group (3–4), which reflects the merging of late swing and early stance modules. The EC and KOA groups also showed greater knee flexion angles in the early stance phase. Contrarily, by focusing on the module structure, we found that the merging of early and late stance modules is characteristic in KOA. Conclusion: The lower number of modules in the EC and KOA groups was due to the muscle co-contraction with increased knee flexion angle. Contrarily, the merging of early and late stance modules are modular structures specific to KOA and may be biomarkers for detecting KOA. Significance: Describing the changes in multiple muscle control associated with musculoskeletal degeneration can serve as a fundamental biomarker in joint disease.

Summary Objective Abnormal load stress caused by joint instability has been reported to be one of the factors responsible for the development of osteoarthritis (OA). However, few studies have investigated the efficacy of exercise therapy for patients with knee instability-induced OA, and there are no specific treatment guidelines or effects for this form of OA. Therefore, the purpose of this study was to examine the effect of exercise treatments for joint instability in patients with knee OA by a systematic review. Design Systematic review. Results Searches in three databases, PubMed, Cochrane, and the Physiotherapy Evidence Database, yielded 14 articles that were scrutinized, and 6 articles that met the inclusion criteria were selected. Conclusions Exercise therapy focusing on joint instability, including muscle maintenance and strength training, and specific training targeting knee instability have no additional beneficial effects on knee joint instability. However, because of the benefits of treatment protocols based on patient attributes in exercise treatment focused on joint instability, it is necessary to investigate the effects in more detail in the future.

Background Delirium is an important and common medical condition, particularly in hospitalized patients, that is associated with adverse outcomes. The identification, prevention, and treatment of delirium are increasingly regarded as major public health priorities. Purpose The aim of this study was to create a simple-to-use screening tool for delirium in hospitalized patients using clinical manifestations of delirium regularly observed by nurses. Methods This study was conducted using data on 2,168 patients who had been admitted to the surgical ward between January 2011 and December 2014. Data were collected retrospectively from medical records. Univariate and multivariate analyses were performed, and a logistic regression model was constructed for the development of a predictive screening tool. After constructing a new screening tool for delirium, a receiver operating characteristic curve was drawn, the most appropriate cutoff value was decided, and the area under the curve was obtained. Bootstrapping was used for the internal model validation. Results A screening tool for delirium (Subjective Delirium Screening Scale by Nurse) with a total score of 5 points was constructed as follows: 2 points for disorientation and 1 point each for restlessness, somnolence, and hallucination. The area under the curve for the Subjective Delirium Screening Scale by Nurse was 81.9% (95% CI [77.9%, 85.8%]), and the most appropriate cutoff value was determined to be 2 (sensitivity of 61.0% and specificity of 96.7%). Bootstrapped validation beta coefficients of the predictive factors were similar to the original cohort beta coefficients. Conclusions We created a screening tool for delirium using factors that were regularly observed and recorded by nurses. This tool is simple and practical and has adequate diagnostic accuracy.

People walking on a split-belt treadmill, where each belt moves at a different speed, adapt step length to re-establish symmetry. However, kinematic changes that occur when re-establishing step length symmetry have not yet been clarified. This study aims to clarify the changing lower limb joint kinematics of each leg when re-establishing step length symmetry. We examined ten young adults who walked on a double-belt treadmill under symmetric and asymmetric conditions of belt velocity using a motion capture system. The results showed that the hip flexion angle at heel strike on one side was not significantly different between the symmetric and asymmetric conditions (p = 0.38) thereby demonstrating that the hip flexion angle of the leading leg re-established symmetry at heel strike (HS) of the fast and slow sides. However, the knee extension angle of the leading leg expanded asymmetrically at HS on both sides. The shank of the fast leg possibly accelerated more to move the heel further forward. The results indicated that subjects with limited knee extension function must increase their hip flexion movement of the fast-side limb to accelerate the shank in the swing phase. The present study suggests securing the range of motion and treatment of the knee extension to reduce the spasticity of hamstrings or plantarflexor before split-belt training. Moreover, split-belt training may be undesirable for improving step length symmetry in impaired subjects who are unlikely to improve the function of knee extension movement. The present study contributes toward developing a rehabilitation protocol that improves the gait asymmetry of patients through split-belt training.

Background Physiological evidence suggests that the nervous system controls motion by using a low-dimensional synergy organization for muscle activation. Because the muscle activation produces joint torques, kinetic changes accompanying aging can be related to changes in muscle synergies. Objectives We explored the effects of aging on muscle synergies underlying sit-to-stand tasks, and examined their relationships with kinetic characteristics. Methods Four younger and three older adults performed the sit-to-stand task at two speeds. Subsequently, we extracted the muscle synergies used to perform these tasks. Hierarchical cluster analysis was used to classify these synergies. We also calculated kinetic variables to compare the groups. Results Three independent muscle synergies generally appeared in each subject. The spatial structure of these synergies was similar across age groups. The change in motion speed affected only the temporal structure of these synergies. However, subject-specific muscle synergies and kinetic variables existed. Conclusions Our results suggest common muscle synergies underlying the sit-to-stand task in both young and elderly adults. People may actively change only the temporal structure of each muscle synergy. The precise subject-specific structuring of each muscle synergy may incorporate knowledge of the musculoskeletal kinetics.

For clinicians to provide more efficient early mobilization in patients with acute stroke, they must quantitatively evaluate the motion characteristics of the patients. To measure the motion in the acute phase, it is necessary to prevent physical interference between the measurement and medical equipment. This study classified abnormal muscle synergies during sit-to-stand motion in patients with acute stroke by using small, wirelessly operable, noninvasive surface electromyography devices. Four patients with acute stroke and four healthy adults performed a six-directional isometric contraction task and a sit-to-stand motion task. A nonnegative matrix factorization algorithm was applied to the muscle activity data to extract the muscle synergies. Hierarchical cluster analysis was used to classify these synergies. The results suggest that sit-to-stand motion characteristics according to the severity of effects in patients with acute stroke can be quantitatively classified by muscle synergy analysis. The spatial structure of muscle synergies of patients was classified into different clusters from that of the healthy adults. The abnormal muscle synergy in patients with severe paresis is considered severe in that it cannot be modulated according to the task. The muscle synergies in patients with moderate paresis were modulated in the sit-to-stand motion to compensate for extensor muscle weakness. Such abnormal muscle synergy in the sit-to-stand motion is useful as a reference for motion practice, especially for early mobilization after the onset of a stroke. In addition, the results verify that the early to late stages of recovery can be consistently evaluated with this small, wireless noninvasive electromyography device.

We selected a fungus secreting a neutral protease from soil and identified it as the basidiomycete fungus Cerrena albocinnamomea according to its ITS-5.8S rDNA and 28S rDNA-D1/D2 sequences. A major extracellular protease isolated from C. albocinnamomea was purified approximately 44-fold through two purification steps. SDS-PAGE analyses of the purified protease revealed a single band, and its molecular mass of 39,756 Da was determined using MALDI-TOF-MS. The enzyme was optimally active at approximately pH 7.0 and 45°C. The Km and Vmax values for the hydrolysis of azocasein were 2.46 mg/mL and 989 units/min/mg protein, respectively. The enzyme was stable at pH 3.6-8.6 for 16 h and at temperatures ≤35°C for 1 h. Enzymatic activity was completely inhibited by Cu2+ and Zn2+ and markedly by EDTA and phosphoramidon. The N-terminal amino acid sequence ASYRVLPIT is highly similar to those of the members of the metalloprotease family M36, such as keratinase and elastinase. However, the protease did not detectably hydrolyze keratin or elastin. In contrast, the protease hydrolyzed fibrinogen, although there were no significant sequence similarities to the N-terminal amino acid sequences of other fibrinolytic enzymes. These results suggest that the purified protease represents a new neutral metalloprotease with fibrinogenolytic activity.

The aim of this study was to compare segment angles and mechanical energies obtained via inertial measurement unit (IMU) sensors attached to body segments and an optoelectronic motion capture (OMC) system during sit-to-stand motion, relevant for the assessment of movement disorder in elderly persons. seven elderly subjects were included in this study. Each subject performed sit-to-stand motions under the following two conditions: (1) rising with natural speed and posture (NORMAL) and (2) rising with trunk inclined forward (TILT). We calculated not only the segment angle but also the mechanical energy of each segment. Temporal profiles of the angles and mechanical energies of each segment were compared between the OMC data and the IMU data based on the Pearson's correlation coefficient (r) and root mean squared error (RMSE). The estimation error of the peak values of the data was also investigated with Bland-Altman bias and 95% limits of agreement. It was found that the value of r was >0.90 and the RMSE was

The main purpose of this study was to demonstrate that adaptive walking re-establishes dynamic stability at the time of foot contact in split-belt treadmill walking. First, we examined whether the relative positions of the center of mass (COM) and the center of pressure (COP) were re-established at foot contact during walking adaptation. We found that the symmetry of the COM-COP angles was re-established more completely than any other parameters (foot and pelvis markers) on both the fast and slow belt sides during the adaptation phase. Moreover, we examined whether the dynamic relationship between the COM and the COP was the same during tied- and split-belt walking. Our results showed that the equations related to the trailing leg relative to the COM re-converged around 0 at foot contact on both the fast and slow sides during the adaptation phase. We also showed that the COM-COP angle at foot contact is an adaptive parameter and is consistent between the fast and slow belt sides. At foot contact, the relative positions between the leading leg and the whole body can also be seen to be adjusted during trial-and-error adaptation to split-belt perturbation in which the belts move at different speeds. Therefore, we suggest that the relative positions of the COM and the COP at foot contact is the spatial reference for the gait cycle contribution to dynamic stabilization during adaptive walking.

Motor learning issues for hemiplegics not only include motor impairments such as spastic paralysis, but reportedly also an inability to appropriately recognize somatic sensations. In this regard, biofeedback of movement information through visual information and auditory information has been found effective as a method for drawing attention to appropriate somatic sensations. In this context, here, we propose a novel eccentric training system utilizing visual biofeedback of force information. We first develop a compact and highly portable rehabilitation robot for home use. The robot estimates the force on the tiptoe without the use of a force sensor, and a display connected to the robot presents the force information to the trainee. Clinical trials with two chronic hemiplegics have been conducted. The results show that the timed up and go tests of both trainees are shortened after training twice a week for three weeks (six times in total). Simultaneously, the co-contraction index scores of the tibialis anterior and gastrocnemius muscles decrease. These findings in conjunction with previous results suggest that training with visual biofeedback of force information may enhance reciprocal inhibition of the tibialis anterior muscle and reduces co-contraction.

Introduction The aim of this study was to introduce and examine a modified mechanical end-to-side esophagogastrostomy method (“reverse-Tornado" anastomosis) in laparoscopy-assisted proximal gastrectomy. Methods Five patients with gastric cancer who underwent laparoscopy-assisted proximal gastrectomy were analyzed retrospectively. Esophagogastrostomy in the anterior wall was performed in three patients, and esophagogastrostomy in the posterior wall was performed in two patients. Clinicopathological features, operative outcomes (operative time, operative blood loss), and postoperative outcomes (complications, postoperative hospital stay, reflux esophagitis) were evaluated. Results Operative time was normal (278 min). There was no marked operative blood loss, postoperative complications, prolonged hospital stay, or reflux esophagitis. Conclusion Esophagogastrostomy was completed in a normal time with reverse-Tornado anastomosis. This method can be safe and can enable good postoperative quality of life.

Background/Aims: Preoperative lymph node staging in gastric cancer patients is important. The aim of this study was to assess the diagnostic accuracy of computed tomography (CT) in assessing lymph nodes in patients with gastric cancer. Methods: A total of 56 patients had undergone standardized gastric resection with lymphadenectomy between October 2013 and June 2015 were reviewed retrospectively. The short axis diameter of the largest lymph node per station was recorded when reviewing the preoperative CT images. Diagnostic accuracy was calculated by comparing CT with histopathological findings. Results: In 518 stations dissected at surgery, 56 included lymph nodes with metastasis. Among them, lymph nodes were visualized on preoperative CT in 26 stations. No lymph node was detected in 382 stations among 462 infiltration-negative stations. The cutoff of 12 mm had the highest accuracy rate of 0.896. Conclusion: The accuracy of CT in the preoperative diagnosis of lymph node metastasis in patients with gastric cancer remains poor. Therefore, surgeons should pay attention to the visibility of lymph nodes on CT. Detection of lymph nodes on CT can be utilized for a more accurate diagnosis such as fine-needle aspiration biopsy.

This paper reports a current-induced magnetization switching with a nanosecond-scale pulse current in a nanomagnet using a perpendicularly magnetized synthetic antiferromagnetic coupling (p-AFC) structure. The results indicate that the magnetization switching current in the p-AFC structure is less than that in the single-nanomagnet structure with perpendicular anisotropy when the differences in thickness and saturation magnetization between the upper and lower layers of the p-AFC structure are small and the Gilbert damping constant is also small. The results also show that the p-AFC structure can reduce the switching current when the pulse duration is short and its structure is effective for a high-speed switching. The results of this study shall be useful in the design of spin-transfer torque random access memory.

We performed laparoscopic surgery for three cases of colorectal cancer using an 8K ultra-high-definition endoscopic system, which offers 16-fold higher resolution than the current 2K high-definition endoscope. The weight of the camera has been successfully reduced to 370 g. To maximize the advantages of the 8K ultra-high-definition endoscope, surgery was performed by darkening the room and placing a large 85-in. display as close to the surgeon as possible. As a result, the autonomic nerve was preserved, and the membrane structure could be clearly observed. Moreover, we were able to feel the stereoscopic effect near the 3-D image. This suggests the possibility of improved curability and function preservation with the 8K endoscope. Although there are some disadvantages that need to be overcome, the 8K ultra-high-definition endoscope will surely contribute to further progress in laparoscopic surgery.

Purpose We developed a new technique, sutureless mesh fixation, using 2-octyl cyanoacrylate (Dermabond®, a surgical tissue adhesive) for incisional hernia repair. The objective of this article is to introduce the new technique and to examine whether the technique provides sufficient resistance to abdominal pressure.

Hemiplegia patients have complete paralysis of half their body, and encounter many challenges in living an independent life. Rehabilitation of the lower body is more important than that of the upper body for independent living; thus, recovering upper body functions of their paralyzed side is not enough. Rehabilitation robots may be used to assist training without therapists. In this study, a small portable rehabilitation robot was developed for use at home, and a new training method was proposed. This robot consists on an omni wheel mechanism and a force sensor, and is capable of deciding the motion based on the force value. Voluntary movement of a hemiplegia patient is recovered by the rehabilitation robot and proposed training method. Thus, verification experiments were performed using participants with hemiplegia. The CCI (Co-Contraction Index) from after training were smaller than ones of before training, thus the movement skills of the participants improved with respect to controlling force direction and magnitude. Moreover, manual function test (MFT) scores increased as reflected by improvements in the motor function of the upper limb using the proposed training method.

We selected a fungus secreting a neutral protease from soil and identified it as the basidiomycete fungus Cerrena albocinnamomea according to its ITS-5.8S rDNA and 28S rDNA-D1/D2 sequences. A major extracellular protease isolated from C. albocinnamomea was purified approximately 44-fold through two purification steps. SDS-PAGE analyses of the purified protease revealed a single band, and its molecular mass of 39,756 Da was determined using MALDI-TOF-MS. The enzyme was optimally active at approximately pH 7.0 and 45°C. The K

Background: Although the development of lymphatic invasion by gastric cancer has been solved using 'solitary lymph node metastasis' research, few facts are known about the sequential flow following the sentinel station.Aim: In this study, we investigate the lymphatic spread of gastric cancers using 'triple lymph nodes metastases' analysis.Methods: During January 2001 and December 2015, 402 subsequent patients with gastric cancer underwent gastrectomy with standardized lymph node dissection at our institute. Among them, lymph node involvement was revealed in 234 patients by a histopathological study. The lymphatic spread of gastric cancer was analyzed theoretically based on the probability of additional lymph node metastases from each station.Results: The numbers of cases were 64, 41, 17, 23, 17, 13 and 59 according to the number of metastases of 1, 2, 3, 4, 5, 6 and 7 or more, respectively. The lesser curvature lymph node (#3) was the key station and skip metastasis was sometimes seen in lymph nodes of the intermediate region at the solitary lymph node metastasis stage. Some lymphatic flows were demonstrated by double and triple lymph node metastasis analysis, especially many flows from perigastric toward intermediate regions.Conclusion: This study demonstrated theoretically a lymphatic route for gastric cancer cells using a novel methodology. The results may be applicable to making preoperative diagnosis and for deciding on optimal lymph node dissection in gastric cancer surgery.