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Shinshiro Mineta,1 Takayuki Inami,2 Raldy Mariano,3 Norikazu Hirose4 1Graduate School of Sport Sciences, 2Institute of Physical Education, Keio University, Hiyoshi, Yokohama, 3Graduate School of Asia-Pacific Studies, Waseda University, Shinjuku, Tokyo, 4Faculty of Sport Sciences, Waseda University, Higashifushimi, Nishitokyo, Japan Introduction: Center of pressure (COP) is a sudden displacement at the time of a lateral ankle sprain (LAS). It has been suggested that the distribution of plantar pressure and the quantity of COP displacement are important for assessing the risk of LAS. Therefore, we evaluated the plantar pressure during a single-leg balance test with eyes closed (SLB-C) to identify the factors and characteristics of plantar pressure in people with repeated cases of LAS.Methods: We recruited 22 collegiate athletes and divided them into an instability group (IG; n=11) and a control group (CG; n=11). We measured the distribution of plantar pressure and lower extremity muscle activity during a SLB-C along with static alignment and isometric ankle strength.Results: The fibularis longus (FL) activity was significantly lower in the IG than in the CG. The lateral plantar pressure (LPP)/medial plantar pressure (MPP) ratio was also higher in the IG than in the CG. In addition, the LPP/MPP ratio was correlated with the tibialis anterior (TA)/FL ratio.Conclusion: These results suggest that increased lateral plantar pressure is related to decreased FL activity and increased TA/FL ratio. Keywords: chronic ankle instability, ankle sprain, postural stability, soccer, prevention

Abstract: Microstructures and wear properties of a recycled Fe3Al-based alloy made from high-carbon Cr steel sludge and Al can scraps were first investigated in this study. The alloy was composed of D03-type Fe3Al matrix and Fe3AlC0.5 dispersions (κ phase). Carbon in the steel sludge and Al can scraps contributes to the formation of the κ phase. Next, the recycled Fe3Al-based composites reinforced by transition metal carbides (TMC = TiC, NbC, V4C3, and ZrC) were fabricated by in-situ reactions between transition metals (TM = Ti, Nb, V, and Zr) and carbon when these transition metals are added to the molten Fe3Al-based alloy. The (Fe,Al)2Nb intermetallic compound and a Fe–Al–Zr–C carbide are also formed in the Nb- and Zr-added Fe3Al-based composites with NbC and ZrC, respectively. The Vickers hardness values of the recycled Fe3Al-based composites reinforced by TMC were higher than that reinforced only by the κ phase. Abrasive wear behavior is observed for these composites. The carbides of the κ phase, TiC, NbC, V4C3 and ZrC are still embedded in the matrix after abrasive wear without delamination or destruction. This result indicates that the carbides significantly affect the wear resistance of these composites. The wear resistance of the composites reinforced by TMCs is higher than that reinforced by the κ phase. Moreover, the wear resistance of the recycled Fe3Al-based composites reinforced by TiC is much higher than that of gray cast iron; the former value is comparable to that of high-carbon Cr steels. Thus, carbon in the steel sludge and Al can scraps is useful to synthesize hard carbides with transition metals. We have succeeded in preparing the valuable recycled Fe3Al-based composites with excellent wear resistance from the industrial steel and Al scraps. [Copyright &y& Elsevier]

This study investigates the moments generated when applying third-order bends to lingual brackets with different slot shapes and wires made of different materials. Three types of lingual brackets with different slot shapes: 0.018×0.018-inch square slot self-ligation bracket (AL-bracket); 0.018×0.025-inch slot self-ligation bracket (CL-bracket:); 0.018×0.025-inch slot self-ligation bracket (ST-bracket). Wires of three different materials were measured. The torque value generated during torque application was measured using a torque gauge. The AL-bracket had a significantly larger torque moment than the CL- and ST-brackets at the same angles. The CL-bracket had the smallest torque moment of the three for the square wire; however, the CL-bracket revealed a larger torque moment than the ST-bracket for the rectangular wire. The torque moment of Ti-Ni wires was observed the smallest. In lingual orthodontic treatment, the results suggested the shape of the lingual bracket slot and the wire material should be considered when adjusting and applying third-order bends.

Background: Epidemiological research highlights the need to understand sports injuries for effective prevention. Yet, detailed knowledge about lateral ankle sprain (LAS) in soccer, especially related to indirect contact mechanisms and specific sports movements, remains scarce. This study aimed to determine the prevalence of LAS by examining injury mechanisms, focusing on indirect contact, and analyzing sports-related movements., Study Design: Prospective study., Methods: In this prospective study, 304 high-school and college soccer players (age: 19.0 ± 2.2 years, height: 168.3 ± 10.6 cm, weight: 64.2 ± 11.1 kg) were monitored for 18.5 months. Attendance and LAS incidents were recorded daily. Injury details, including movement at the time of injury, contact presence, and direction, were collected through interviews conducted on the injury day. LAS were categorized into direct contact, indirect contact, and non-contact mechanisms. Direct contact injuries were due to external forces on the lower leg or foot. Indirect contact injuries resulted from impacts on areas other than the lower leg or foot, and non-contact injuries involved no interaction with the ball or opponent. Incidence rates per 1,000 athlete exposures and 95 % confidence intervals (CIs) were calculated, along with rate ratios (RR) to assess sex differences., Results: The study recorded 59 LAS injuries. Indirect injuries were predominant, accounting for 47.5 % (n = 28) of the cases. Men experienced a higher incidence of indirect injuries, with an RR of 2.29 (95 % CI: 1.06-4.96). Outward contact was the most common (77.8 %; n = 21), while inward contact occurred in 22.2 % of the cases (n = 6)., Conclusion: High school and college soccer players primarily sustained injuries through indirect contact mechanisms, with a significant number of injuries occurring during lateral contact. Men were more prone to indirect contact injuries. Furthermore, 47.5 % of LAS incidents involved reactive movements, and injuries frequently occurred during specific sports actions, such as ball interception., Competing Interests: Declaration of competing interest The authors report no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

There is a great demand for development of a functional tricuspid regurgitation (FTR) model for accelerating development and preclinical study of tricuspid interventional repair devices. This study aimed to develop a severe FTR model by creating a tissue-silicone integrated right ventricular pulsatile circulatory simulator. The simulator incorporates the porcine tricuspid annulus, valve leaflets, chordae tendineae, papillary muscles, and right ventricular wall as one continuous piece of tissue, thereby preserving essential anatomical relationships of the tricuspid valve (TV) complex. We dilated the TV annulus with collagenolytic enzymes under applying stepwise dilation, and successfully achieved a severe FTR model with a regurgitant volume of 45 ± 9 mL/beat and a flow jet area of 15.8 ± 2.3 cm 2 (n = 6). Compared to a normal model, the severe FTR model exhibited a larger annular circumference (133.1 ± 8.2 mm vs. 115.7 ± 5.5 mm; p = 0.009) and lower coaptation height (6.6 ± 1.0 mm vs. 17.7 ± 1.3 mm; p = 0.003). Following the De-Vega annular augmentation procedure to the severe FTR model, a significant reduction in regurgitant volume and flow jet area were observed. This severe FTR model may open new avenues for the development and evaluation of transcatheter TV devices., (© 2024. The Author(s).)

Porcine small intestinal submucosa, despite its successful use as a scaffold in regenerative medicine, has innate biomechanical heterogeneity. In this study, we hypothesized that human small intestinal submucosa could be a viable alternative bio-scaffold. For the first time, we characterize submucosal extraction from human small intestine and examine appropriate decellularization methods. In total, 16 human small intestinal submucosal samples were obtained and decellularized using three reported methods of porcine decellularization: Abraham, Badylak, and Luo. For each method, four specimens were decellularized. The remaining four specimens were designated as non-decellularized. We measured the amount of residual DNA and growth factors in decellularized human intestinal samples. Additionally, decellularized human small intestinal submucosa was co-cultured with mouse bone marrow-derived mesenchymal stem cells to examine mesenchymal stem cell survival and proliferation. The reference value for the amount of residual DNA deemed appropriate in decellularized tissue was established as 50 ng/mg of extracellular matrix dry weight or less. Abraham's method most successfully met this criterion. Measurement of residual growth factors revealed low levels observed in samples decellularized using the Abraham and Badylak methods. Co-culture of each small intestinal submucosal sample with mouse bone marrow-derived mesenchymal stem cells confirmed viable cell survival and proliferation in samples derived using protocols by Abraham and Badylak. Abraham's method most successfully met the criteria for efficient tissue decellularization and cell viability and proliferation. Thus, we consider this method most suitable for decellularization of human small intestinal submucosa., (© 2023 The Authors. International Journal of Experimental Pathology published by John Wiley & Sons Ltd on behalf of Company of the International Journal of Experimental Pathology (CIJEP).)

An 82-year-old, male. He visited his local doctor with a chief complaint of dyspnea on exertion. Anemia was noted, and upper gastrointestinal endoscopy was performed, which revealed an ulcerative lesion in the gastric antrum. A biopsy revealed Group 5, tub2, and HER2 negative, with PD-L1≥5%. cT3N1H1(M1 HEP), cStage ⅣB was diagnosed based on CT scan showing enlarged #8 lymph node and a single liver metastasis in the 2 cm range in S6 of the liver. The patient was deemed unresectable and was started on SOX plus nivolumab therapy. On day 11 after initiation, the patient had Grade 3 diarrhea by CTCAE v5.0, and S-1 was withdrawn for 3 days, but was administered for 2 courses. CT and MRI after chemotherapy showed shrinkage of both the primary tumor and liver metastases; R0 resection was deemed possible, and pyloric gastrectomy, D2 lymph node dissection, and partial hepatic S6 resection were performed. The histological evaluation of response to treatment was Grade 1b, and the patient was in ypStage ⅠA. The patient has been alive without recurrence for 6 months postoperatively while receiving S-1 monotherapy on an outpatient basis.

A 68-year-old male patient was referred to our hospital because of unfit to treat his recto-sigmoidal cancer massively invaded to bladder at the former hospital. During drug administration to treat heart failure, we could perform a transverse colostomy and initiated mFOLFOX plus Pmab. During chemotherapy, he improved malnutrition. After 7 courses, CT scan showed a marked reduction in tumor diameter, which was PR. Since his nutritional and heart status were improved, he underwent a high anterior resection with partial bladder resection. Pathological findings showed that a few cancer cells were remained at bladder and bowel wall. He was diagnosed as Stage Ⅱc. His postoperative course was almost uneventful. No symptom of recurrence has been observed at 9 months after surgery without adjuvant chemotherapy.

Single-leg landing (SLL) stability deficits are common dysfunctions after lateral ankle sprain (LAS), and are associated with reinjury and needs to be addressed. SLL stability deficits could be associated with impact absorption ability. Thus, we evaluated these relationships. We recruited 46 patients with chronic ankle instability (CAI) and 64 control patients and measured their kinematics, SLL stability, and impact absorption ability. The SLL stability was evaluated by calculating the anterior-posterior stability index (APSI) and medial-lateral stability index (MLSI). The impact absorption ability was evaluated by calculating the energy absorption (EA). The large negative value of the EA indicated the absorption of a large amount of energy. The Japanese version of identification of functional ankle instability (IdFAI-J) score (P < 0.001), MLSI value (P = 0.004), and sagittal plane ankle EA value (less EA at ankle joint) (P < 0.001) were significantly high in CAI, and sagittal plane knee EA value (more EA at knee joint) (P < 0.041) was significantly low in CAI than in the control group. Multiple regression analysis showed that the APSI was associated with sagittal plane ankle EA (β = 0.275, P = 0.004). The MLSI was associated with sagittal plane ankle EA (β = 0.204, P = 0.034) and the idFAI score (β = 0.234, P = 0.015). The SLL stability impairment after LAS was related to decreased impact absorption ability at the ankle joint., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

A 57-year-old man was diagnosed with a tumor in the pancreatic body at a nearby hospital and consulted our hospital. Examinations revealed that carbohydrate antigen 19-9(CA19-9)levels were 1,765.0 U/mL. We confirmed metastatic liver tumors in S4 and S8 of the liver by EOB-MRI. We diagnosed unresectable pancreatic cancer(T3N0M1, cStage Ⅳ)and administered 10 courses of gemcitabine(GEM)plus nab-paclitaxel(nab-PTX)therapy. The main lesion and the lesion in S4 subsequently disappeared, and the lesion in S8 degenerated into a cyst. CA19-9 levels were 113 U/mL. Surgery was determined as the best course of action after normalizing CA19-9 levels. Therefore, we further administered 6 courses of FOLFIRINOX therapy and 4 courses of GEM plus nab-PTX therapy, but CA19-9 was not normalized. We decided that it would be difficult to normalize CA19-9, and thus proceeded with surgery. During the operation, cystic degenerative lesions were found in S8 and peritoneal dissemination was found in the transverse mesentery. Because the ascites cytopathology was negative, it was judged that the peritoneal dissemination was localized. We performed distal pancreatectomy(D2)plus partial hepatectomy(S8)plus peritoneal dissemination resection. On day 52 after surgery, we resumed GEM plus nab-PTX. The patient has survived without any recurrence for 3 years after the initial surgery.

Background: To evaluate the utility of robot-assisted laparoscopic transabdominal preperitoneal repair (R-TAPP) of postprostatectomy inguinal hernia (PIH) in patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP)., Patients and Methods: This was a prospective, single-centre retrospective cohort study. R-TAPP was conducted in 74 consecutive patients from September 2016 to March 2020. With the exception of women and patients who underwent previous abdominal surgery, 70 patients were classified into two groups based on the absence or presence of PIH. Their data were retrospectively compared to those who had not undergone RALP., Results: The median operative time for the PIH group was longer compared to the non-PIH group. However, postoperative complications, including seroma formation, haematoma and surgical site infections, were not significantly different between the groups. The estimated blood loss was small, and hospitalisation duration was 1 day in all cases. Moreover, there were no hernia recurrences within the 90-day follow-up period in either group., Conclusion: R-TAPP is a feasible and safe approach for inguinal hernia repair, even in patients who undergo RALP for prostate cancer., (Copyright © 2022, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Hamstring strain often occurs when an opponent unanticipatedly perturbs an athlete's movements. We examined the neuromuscular responses of hamstring and trunk muscles during unanticipated trunk perturbations in athletes with and without a history of hamstring strain injury. Male college athletes (11 with a history of a unilateral hamstring injury and 10 without prior injury) knelt while wearing a chest harness attached to a cable that was pulled backward. They were instructed to resist the force isometrically and maintain their position when the perturbations were applied. The pressure was released with or without a cue (CUE or NoCUE). We measured trunk acceleration, three-dimensional kinematic data, and surface electromyography (EMG) signals of the erector spinae, internal oblique, gluteus maximus, biceps femoris long head, and semitendinosus muscles. Maximum trunk acceleration and displacement were greater with NoCUE in both groups ( p < 0.05). EMG amplitude did not differ after perturbation of any investigated muscle. The injured group demonstrated a delayed onset of the gluteus maximus and erector spinae muscles in NoCUE versus CUE stimuli ( p < 0.05). Athletes with a history of hamstring strain injury exhibited a reduced neuromuscular coordination of the lumbopelvic muscles in response to unanticipated trunk movement.

A 70-year-old man with the history of diabetes mellitus complained of lower abdominal discomfort. Abdominal ultrasonography revealed a pancreatic mass. Contrast enhanced CT showed a 2.6 cm-enhanced tumor ventral to the pancreatic head. It was diagnosed with a pancreatic neuroendocrine carcinoma(PanNEC-G3)by EUS-FNA. The patient underwent pancreatoduodenectomy with the wedge resection of the portal vein and partial resection of the transverse colon. We administered 6 cycles of adjuvant therapy with CDDP plus CPT-11. With the presentation of lymph node metastases and the local recurrence in the anastomotic site of the transverse colon 15 months after surgery, the patient received carboplatin plus etoposide(CE)therapy. Although local recurrence completely responded to the CE therapy, bone metastases were detected 27 months after surgery. Metastatic lesion did not respond to systemic chemotherapy including gemcitabine plus nab-paclitaxel and nal-IRI plus 5-FU/LV, and the patient eventually died 37 months after the surgery. PanNECs represent for less than 1% of all pancreatic tumor. They are characterized by high malignant potential and short time survival with the reported OS of 8.5 to 21 months. This case served as an important reminder to consider multimodal treatment for PanNEC patients to obtain longer survival.

Abstract: Yoshimura, A, Inami, T, Schleip, R, Mineta, S, Shudo, K, and Hirose, N. Effects of self-myofascial release using a foam roller on range of motion and morphological changes in muscle: a crossover study. J Strength Cond Res 35(9): 2444-2450, 2021-Self-myofascial release using a foam roller (FR) is effective in improving range of motion (ROM) in at least some conditions. However, its mechanism is still unclear. Therefore, this study investigated potential acute muscle morphological changes after the FR intervention and aimed to clarify the mechanism of increases in ROM by the FR intervention. We hypothesized that the FR intervention may increase ROM because of changes in fascicle length (FL) and aponeurosis displacement. This crossover study, involving 22 male university students (21.5 ± 1.3 years, 170.6 ± 4.0 cm, and 64.1 ± 8.9 kg; mean ± SD), compared the FR intervention targeting the gastrocnemius muscle with the control trial. The outcome measures were maximum passive ankle ROM, morphology of the gastrocnemius muscle (FL and aponeurosis displacement) during passive ankle plantar flexor movement, degree of pain during the FR intervention, and sensation of the triceps surae muscle. Although ROM of both dorsiflexion and plantar flexion increased significantly after the FR intervention (p < 0.01), no significant differences were found in FL and aponeurosis displacement before and after the FR intervention. The mean perception of pain during the FR intervention was rated as "slightly uncomfortable," corresponding to a 2.3 ± 2.4-cm on a 9.5-cm visual analog scale. We found that the FR intervention did not influence the morphology of muscle. It is necessary to investigate other factors related to ROM as the next step of this study., (Copyright © 2019 National Strength and Conditioning Association.)

Objectives: This study aimed to clarify the kinematic, kinetic characteristics associated with lateral ankle sprain., Design: A 16-month prospective cohort study., Setting: Laboratory., Participants: A total of 179 college athletes., Main Outcome Measures: Joint kinematics, moment during single-leg landing tasks, and ankle laxity were measured. The attendance of each participating team, injury mechanism, existence of body contact, presence of orthosis, with or without medical diagnosis, and periods of absence were recorded., Results: Twenty-nine participants incurred lateral ankle sprain during non-contact motion. The Cox regression analysis revealed that greater knee varus peak angle (hazard ratio: 1.16 [95% confidence interval: 1.10-1.22], p < 0.001) and greater pelvic internal rotation peak angle toward the support leg were associated with lateral ankle sprain (hazard ratio: 1.08 [95% confidence interval: 1.02-1.15], p = 0.009). The cut-off values for each predictive factor were -0.17° (area under the curve = 0.89, p < 0.001) and 6.63° (area under the curve = 0.74, p < 0.001), respectively., Conclusions: A greater knee varus peak angle and pelvic internal rotation peak angle after single-leg landing are predictive factors for lateral ankle sprain., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: We studied whether perioperative nutritional, immunological factors or postoperative inflammatory responses predicted esophageal cancer (EC) progression and prognosis in patients who received esophagectomies., Methods: We evaluated preoperative prognostic nutritional index (PNI), BMI, neutrophil-to-lymphocyte ratio (NLR), intraoperative blood loss, postoperative C-reactive protein (CRP) max, recurrence-free survival (RFS), and overall survival (OS) in 111 patients with pStage I-IV squamous cell EC who received esophagectomies. Optimal cutoff values for each continuous parameter were determined by receiver operating characteristic curves and Youden indices. Univariate and multivariate Cox analyses were used to derive independent prognostic factors. Propensity score matching using inverse probability of treatment weighting was used in groups divided by Youden indices, as appropriate., Results: Cutoff values of continuous variables were NLR: 2.27, PNI: 44.2, blood loss: 159 mL, and CRPmax: 21.7 mg/dL. In multivariate analyses, PNI, CRPmax, and intraoperative blood loss were independent prognostic factors for OS and RFS. Among patients with stage II-IV disease, low PNI was associated with shorter RFS. Postoperative respiratory complications were associated with both higher CRP and shorter RFS., Discussion/conclusions: Low preoperative PNI and high postoperative inflammatory response were associated with postoperative EC progression after esophagectomy. Preoperative nutritional interventions or suppression of postoperative inflammatory response, including respiratory complications, may improve patient prognosis., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 by S. Karger AG, Basel.)

In this study, we investigated differences in electromyographic activity in the biceps femoris long head (BFl), semitendinosus, and semimembranosus muscles during 45° hip extension with different knee angles during eccentric, concentric, and isometric hip 0°, and isometric hip 45° conditions with non-external resistance and 5-kg load. Twenty-two male volunteers performed 45° hip extension with knee flexion angles of 0°, 45° and 90° with non-external resistance and 5-kg load eccentric, concentric, isometric hip 0°, and isometric hip 45° conditions. The electromyographic data obtained during each condition were normalized with the values collected during maximal voluntary isometric contraction of each muscle. A multivariate analysis of variance with repeated measures using syntax was used to compare the normalized electromyography of each muscle across different knee joint angles in each weight condition. Electromyographic activities of the BFl, semitendinosus, and semimembranosus at 45° and 90° knee flexion angles were significantly greater than at 0° in the eccentric, concentric, isometric hip 0°, and in isometric hip 45° conditions with both non-external resistance and 5-kg load (p<0.05), except for that of the BFl and semitendinosus in isometric hip 45° with 5-kg load. The electromyographic activity of the BFl was significantly higher than that of the semimembranosus at 90° knee flexion in all conditions (p < 0.05), except during eccentric with non-external resistance. There was no significant difference in electromyographic activity in the hamstring muscles among different knee angles and muscular contraction conditions. This study showed that 45° hip extension with 45° and 90° knee flexion might be better in terms of the recruiting hamstring activity compared to 0° knee flexion, regardless of the training intensity. We recommend 45° hip extension exercises with knee flexion angles of 45° and 90° to activate the BFl, in preventing hamstring strain., (© Journal of Sports Science and Medicine.)

Background: Nivolumab is effective for gastric cancer and lung cancer, but complete response is rare. We experienced a case of synchronous gastric cancer and lung cancer who was treated by nivolumab and laparoscopic gastrectomy., Case Presentation: A 63-year-old male consulted our institution and was found to have gastric cancer cT1(SM)N0M0 Stage IA and lung cancer cT2N2M1(PUL) Stage IV. He received eight chemotherapy treatments plus radiation, but the lung disease remained progressive. Finally, he received nivolumab therapy and complete response of both cancers was obtained. The gastric cancer recurred, but was successfully treated by laparoscopic gastrectomy. The resected specimen revealed three lesions, each being pT1aN0M0 Stage IA. The primary gastric cancer seemed to have completely vanished without scarring., Conclusions: This was thought to be a rare case of gastric cancer recurrence after complete response of gastric cancer and lung cancer to nivolumab.

A 68-year-old man presented to our hospital. An upper gastrointestinal tract endoscopy performed elsewhere revealed an elevated lesion with a circumferential esophageal cancer(identified as small cell carcinoma). Perthe treatment forsmall cell cancer and the standard treatment for esophageal neuroendocrine carcinoma, 7 courses of CBDCA(5mg/m2)plus ETP (100mg/m2)were administered. The lesion shrank and the lymph node swelling disappeared and the patient was deemed to be in partial remission. Nine months later, however, the primary tumor increased in size. A transthoracic subtotal esophagectomy( laparoscope-assisted), 2 area dissection, and gastric tube reconstruction(post-sternal)were performed at 2 years and 10 months afterdiagnosis.

An 82-year-old man with Stage Ⅳ advanced gastric cancer and multiple liver metastases was referred to our hospital. Chemotherapy using S-1 was administered, resulting in withdrawal from the usual course because of an adverse event of grade 4 anorexia. GIS and EOB-MRI showed a prominent tumor reduction in both lesions; however, despite this, distal gastrectomy, D2 lymph node dissection, liver biopsy for S3 lesion, partial liver resection for S6 lesion, and cholecystectomy were performed to obtain a therapeutic diagnosis. Pathology revealed that the tumor cells remained in the main liver metastatic lesions. Therapeutic effect was assessed as Grade 2. Although weekly paclitaxel followed by reduced S-1 dosage was introduced after surgery, the recurrent mass was observed in the para-aortic region after 2 years. Subsequently, para-aortic lymph node dissection was performed because no new lesion was detected. More than 10 years have passed without any recurrence since the first surgery. As part of a multidisciplinary treatment for far advanced gastric cancer with multiple liver metastases (Stage Ⅳ), conversion surgery might be considered effective.

Ankle sprains are the most prevalent injuries, and elevated fear avoidance beliefs after ankle sprain episodes could inhibit athletic performance and contribute to residual symptoms, such as functional and/or mechanical instability. However, it remains unclear how fear avoidance beliefs differ according to conditions of posttraumatic sequelae. The purpose of this study was to determine whether fear of movement/reinjury differed between individuals with and without functional ankle instability (FI, NFI) and healthy controls (CON) and to examine the relationship between fear and ankle joint laxity by sex. Participants (115 male athletes, 105 female athletes) completed the Identification of Functional Ankle Instability, Athlete Fear Avoidance Questionnaire (AFAQ), Tampa Scale for Kinesiophobia (TSK), and ankle joint laxity test. Total 168 athletes (79 males, 89 females) data were eligible for analysis. The results demonstrated that fear of movement/reinjury was lower in individuals in the absence of functional ankle instability although they experienced ankle sprain (FI; TSK=38.6±4.5, AFAQ=27.4±6.2, NFI; TSK=35.7±5.6, AFAQ=24.5±6.6). The fear of movement/reinjury had correlation with ankle joint laxity only in female athletes (TSK; r=0.285, p=0.013, AFAQ; r 0=0.322, p=0.045)., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Neoadjuvant chemoradiotherapy(NACRT)was administered at our hospital to 3 patients with lower advanced rectal cancer; NACRT resulted in pathological complete response(pCR). Case 1: A 65-year-old man was diagnosed with T4aN1M0, cStage Ⅲb disease; after chemoradiotherapy(CRT), the clinical stage improved to T4aN0M0, ycStage Ⅱb. Laparoscopic Hartmann's procedure and D3 lymph node dissection were performed 51 days after CRT. No recurrence was observed 31 months after surgery. Case 2: A 67-year-old man was diagnosed with T4aN2M0, cStage Ⅲb disease; after CRT, the clinical stage improved to T4aN1M0, ycStage Ⅲa. Laparoscopic abdominoperitoneal resection and D3 lymph node dissection were performed 57 days after CRT. No recurrence was observed 21 months after surgery. Case 3: An 83-year-old woman was diagnosed with T4aN2M0, cStage Ⅲb disease; after CRT, the clinical stage improved to T4aN0M0, ycStageⅡb. Laparoscopic abdominoperitoneal resection and D3 lymph node dissection were performed 64 days after CRT. No recurrence was observed 16 months after surgery. Here, we report 3 cases of lower advanced rectal cancer involving curative resection following CRT, and we provide a short literature review.

A 71-year-oldman with voice hoarseness was referredto our hospital for further examination. He was diagnosedwith unresectable Stage Ⅳb esophageal cancer, with direct invasion to the aorta andtrachea andmultiple metastases to the lymph nodes, lungs, and adrenal gland. Because his performance status(PS)was deemedto be favorable, he receivedchemotherapy with docetaxel(DOC), cisplatin, and5 -FU(DCF therapy). After 2 cycles of DCF therapy, the primary lesion was scarred. No malignant lesions were detected in the biopsy performed. No distant metastases were identified on PET-CT. As a subsequent treatment, S-1 plus DOC therapy was administered. Finally, single S-1 administration was continued. The treatment periodwas 14 months. Treatment was concludedbecause a complete response(CR)was maintained. Three years after the conclusion of treatment, CR remains maintained. The overall survival in cases of unresectable advanced esophageal cancer is saidto be 3-10 months, but there are remarkable cases such as this one. If a goodPS is maintained, treatment shouldbe actively considered because CR is possible.

A 56-year-old woman diagnosed with type 2 gastric cancer and multiple lymph node metastases(T3N3M1[lym], cStage Ⅳ)was treated with chemotherapy using trastuzumab with S-1 plus cisplatin for 6 cycles. The primary lesion showed PR, and lymph node metastases disappeared after the chemotherapy. Because of adverse events, she was administered with 2 additional cycles of trastuzumab with S-1 plus cisplatin and 6 cycles of trastuzumab with capecitabine plus oxaliplatin. However, the primary lesion increased in size. Therefore, she underwent distal gastrectomy and D1+ lymphadenectomy with para-aortic lymph node sampling as a conversion surgery. The pathological diagnosis was T2N0M0, pStage ⅠB, and the primary cancer was Grade 1a owing to the chemotherapeutic effect. She survives without recurrence or postoperative adjuvant therapies 3 years after the surgery.