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Objective: This study aimed to determine whether the carbohydrate-restricted isocaloric (CRIC) diet and sodium/glucose cotransporter-2 inhibitor (SGLT2i) differed with respect to the fasting and postprandial energy expenditure (EE) and macronutrient oxidation, and insulin dose required to achieve euglycemia. Methods: This randomized 3-arm open-label prospective study enrolled 23 patients with type 2 diabetes (male/female: 14/9, age: 53.6±14.2 years, body mass index: 26.9±4.8 kg/m2, HbA1c: 12.5±1.6%) treated with titrated basal-bolus insulin subsequent to the control diet (CON) alone, administration of canagliflozin 100 mg/day (SGLT2i) to the CON, or CRIC diet for 12 weeks. The main outcome measures included the fasting and postprandial EE, respiratory quotient (RQ), and required dose of insulin. Results: Although the fasting EE was similar in all groups, postprandial EE was significantly elevated in the SGLT2i and CRIC groups compared to the CON group (p=0.03 and 0.04). The fasting RQ was lower in the SGLT2i group (p=0.049) and delta-RQ (postprandial RQ/fasting RQ) was elevated due to increased carbohydrate substrate utilization in the SGLT2i (p=0.04) and CRIC (p=0.03) groups compared to the CON group. The total required daily dose of insulin was significantly higher in the CRIC (p=0.02) group, although the amount of available carbohydrate was similar in the CRIC and SGLT2i groups. Conclusion: The CRIC diet resulted in a similar fasting and postprandial EE and substrate oxidation compared to SGLT2i. The increased insulin requirement in the CRIC diet indicates that a relatively high lipid and protein ratio (compared to the SGLT2i and CON) may influence insulin requirement.

The Hybrid Assistive Limb (HAL; CYBERDYNE, Inc., Japan) is a wearable robot device that provides effective gait assistance according to voluntary intention by detecting weak bioelectrical signals of neuromuscular activity on the surface of the skin. We used HAL for patients with amyotrophic lateral sclerosis (ALS) to determine whether HAL training had an effect on their gait ability.We conducted a single-center, single-arm, observational study. Patients with ALS underwent HAL training once per day (20-40 min per session) for 9-10 days for at least 4 weeks. Gait ability was evaluated using the 2-minute walk test, the 10-meter walk test without the assistance of HAL, and activities of daily living (ADL) using the Barthel Index and Functional Independence Measures before and after a full course of HAL training.There were no dropouts or adverse events during the observation period. Gait function improved after HAL training. The 2-minute walk test revealed a mean gait distance of 73.87 m (36.65) at baseline and 89.9m (36.70) after HAL training (p = 0.004). The 10-meter walk test showed significantly improved cadence, although gait speed, step length on the 10-m walk, or ADL measurements did not change significantly.Although HAL is not a curative treatment for ALS, our data suggest that HAL may be effective in ameliorating and preserving gait ability in patients with ALS.

Objective The coronavirus disease 2019 (COVID-19) pandemic has resulted in a shortage of medical resources, including ventilators, personal protective equipment, medical staff, and hospital beds. We investigated the impact of COVID-19 in amyotrophic lateral sclerosis (ALS) patients, their families, caregivers, and medical experts. Methods We conducted a nationwide ALS webinar about COVID-19 in May 2020 and sent a questionnaire to those enrolled. Results A total of 135 participants (31 ALS patients; 23 families and caregivers of ALS patients; 81 medical experts) responded to this cross-sectional self-report questionnaire. The results showed that tracheostomy and invasive ventilation (TIV) was used in 22.6% of ALS patients, whereas 77.4% of ALS patients were not under TIV. Among non-TIV patients (n=24), 79.2% did not want TIV in the future. However, 47.4% of non-TIV patients not wanting a tracheostomy in advanced stages replied that they would want an emergency tracheostomy if they developed COVID-19-related pneumonia. These results suggest that ALS patients may be receptive to emergency treatments for reasons other than ALS. In addition, approximately half of the ALS patients agreed with the policy of not ventilating the elderly or ALS patients in case of a ventilator shortage. Furthermore, compared with medical experts, few ALS patients reported that the chance for ALS patients to obtain work was higher due to the increasing availability of remote work. Conclusions This survey indicates that the COVID-19 pandemic might be associated with increased distress about access to care and work, inducing contradictory responses and potential hopelessness among ALS patients.

The p53 protein overexpression that usually results from genetic alterations reportedly induces serum antibodies against p53. However, little information is available about the prognostic significance of perioperative serum p53 antibody (s-p53-Abs) titers in patients with esophageal squamous cell carcinoma. In this study, we retrospectively evaluated the clinical significance of perioperative s-p53-Abs in 135 patients with esophageal squamous cell carcinoma. Of these, 58 patients received neoadjuvant chemotherapy comprising 5-FU and CDDP. While the cutoff level at 1.3 U/ml indicated seropositive patients, level of 13.4 U/ml was used to identify high-titer patients. We monitored serum titers seropositive patients after surgery and evaluated the prognostic significance by the univariate and multivariate analyses. In this study, 29 patients (21.5%) were positive for s-p53-Abs before treatment. The frequency of both seropositive patients and high-titer patients (> 13.4 U/ml) was not significantly associated with tumor progression. While seropositive patients did not demonstrate significant poor overall survival, high-titer patients demonstrated significant poor overall survival based on the multivariate analysis (P

Hyperfibrinogenemia is associated with poor prognosis in various cancers; however, its clinical relevance in gastric cancer has not been well analyzed. We conducted this study to assess the clinicopathological significance and prognostic value of hyperfibrinogenemia in patients with gastric cancer. Plasma fibrinogen levels were measured preoperatively in 315 patients undergoing surgery for gastric cancer. We then evaluated the clinicopathological significance of hyperfibrinogenemia and its relationship with several biomarkers, including white blood cell (WBC), C-reactive protein (CRP), platelet count, prothrombin time (PT) and activated partial thromboplastin time (APTT). Postoperative plasma levels were compared with preoperative levels. The multivariate prognostic value of hyperfibrinogenemia was calculated using the Cox proportional hazards model. Tumor progression was significantly associated with hyperfibrinogenemia, as were the CRP level and platelet counts. Plasma fibrinogen levels decreased significantly after radical surgery. Adjusting for TNM factors, multivariate analysis indicated that hyperfibrinogenemia was an independent prognostic factor for poor survival (hazard ratio = 2.607, 95 % confidence interval = 1.180–5.761, P = 0.018). Preoperative hyperfibrinogenemia was associated with tumor progression, inflammatory mediators, and poor overall survival in patients with gastric cancer.

Inhibiting the onset of arteriosclerotic disease, which has been increasing due to the westernized diet and aging, is a significant social challenge. Curcumin, a type of polyphenol, has anti-oxidative effects and anti-inflammatory action and is expected to treat and to have prophylactic effects on different diseases. In this study, we examined the effects of long-term administration of curcumin on vascular aging and chronic inflammation&mdash, the causes of arteriosclerotic disease. Eight-week-old C57BL/6J mice were fed with high fat diet (HFD) or 0.1% curcumin-mixed HFD (HFD + Cu) until 80 weeks old (n = 20 for each group). After the breeding, we examined the expression of antioxidant enzymes, heme oxygenase-1 (HO-1), oxidative stress, vascular aging, and inflammatory changes in the aorta. In the HFD group, oxidative stress increased with decreased sirt1 expression in the aorta followed by increased senescent cells and enhanced inflammation. Whereas in the HFD + Cu group, HO-1 was induced in the aorta with the suppression of oxidative stress. Additionally, it was shown that sirt1 expression in the aorta in the HFD + Cu group remained at a level comparable to that of the 8-week-old mice with suppression of increased senescent cells and enhanced inflammation. Consequently, disorders associated with HFD were resolved. These results suggest that curcumin might be a food with a prophylactic function against arteriosclerotic disease.

Consultation and education before admission to hospitalization are very important items of perioperative management. Anxiety related to surgery has a negative impact on the post-surgery recovery. The goal of a clinical course has to be as clear as a milestone must be understandable, because patients feel safe with that feeling of goal attainment. Surgical patients have to get not only understanding but also satisfaction for preparation to receive the surgical therapy.

Preoperative hyperfibrinogenemia is associated with inflammatory mediators and a poor prognosis in several types of cancer. However, there is no published information on the monitoring of patients with preoperative hyperfibrinogenemia after surgery. The aim of the study reported here was to assess the clinicopathological and prognostic significance of plasma fibrinogen levels in patients with esophageal squamous cell carcinoma before and after surgical treatment. Plasma fibrinogen levels were analyzed before surgical treatment (endoscopic submucosal dissection and surgery) in 82 patients with esophageal squamous cell carcinoma. The clinicopathological significance of plasma fibrinogen levels and the relationship of plasma fibrinogen levels with several biomarkers were evaluated. The cutoff value for hyperfibrinogenemia was 321 mg/dl. Univariate and multivariate analysis using the Cox proportional hazards model were performed to evaluate the prognostic significance of plasma fibrinogen levels. The changing patterns of plasma fibrinogen were monitored after surgical treatment to evaluate prognostic impact. Hyperfibrinogenemia was significantly associated with advanced pathological stage of cancer and high C-reactive protein levels. Plasma fibrinogen levels significantly decreased after surgical treatment in recurrence-free patients but did not decrease in patients with recurrence. The multivariate analysis indicated that preoperative hyperfibrinogenemia was an independent prognostic factor for poor survival (hazard ratio 1.005, 95% confidence interval 1.000–1.010; P = 0.039). Preoperative hyperfibrinogenemia was associated with inflammatory mediators, tumor progression, and poor survival in patients with esophageal squamous cell carcinoma. The absence of a decrease in plasma fibrinogen levels after surgical treatment may indicate the possibility of tumor recurrence.

Limited data in animal models suggest that colonic mucosa undergoes adaptive growth following massive small bowel resection (SBR). In vitro data suggest that intestinal cell growth is regulated by reactive oxygen species and redox couples [e.g., glutathione (GSH)/glutathione disulfide (GSSG) and cysteine (Cys)/cystine (CySS) redox]. We investigated the effects of SBR and alterations in redox on colonic growth indexes in rats after either small bowel transection (TX) or 80% midjejunoileal resection (RX). Rats were pair fed ± blockade of endogenous GSH synthesis with buthionine sulfoximine (BSO). Indexes of colonic growth, proliferation, and apoptosis and GSH/GSSG and Cys/CySS redox potentials (Eh) were determined. RX significantly increased colonic crypt depth, number of cells per crypt, and epithelial cell proliferation [crypt cell bromodeoxyuridine (BrdU) incorporation]. Administration of BSO markedly decreased colonic mucosal GSH, GSSG, and Cys concentrations in both TX and RX groups, with a resultant oxidation of GSH/GSSG and Cys/CySS Eh. BSO did not alter colonic crypt cell apoptosis but significantly increased all colonic mucosal growth indexes (crypt depth, cells/crypt, and BrdU incorporation) in both TX and RX groups in a time- and dose-dependent manner. BSO significantly decreased plasma GSH and GSSG, oxidized GSH/GSSG Eh, and increased plasma Cys and CySS concentrations. Collectively, these data provide in vivo evidence indicating that oxidized colonic mucosal redox status stimulates colonic mucosal growth in rats. The data also suggest that GSH is required to maintain normal colonic and plasma Cys/CySS homeostasis in these animal models.

Glutathione (GSH) concentration affects cell proliferation and apoptosis in intestinal and other cell lines in vitro. However, in vivo data on gut mucosal GSH redox status and cell turnover are limited. We investigated the effect of altered GSH redox status on the ileal mucosa in a rat model of short bowel syndrome following massive small bowel resection (SBR). Rats underwent 80% mid-jejunoileal resection (RX) or small bowel transection (TX; as operative controls), with administration of either saline or o, L-buthionine-sulfoximine (BSO), a specific inhibitor of cellular GSH synthesis. Ileal mucosal redox, morphology, and indices of cell proliferation and apoptosis were determined at different days after surgery. Ileal GSH redox status was assessed by GSH and GSH disulfide (GSSG) concentrations and the redox potential of GSH/GSSG (E h ). Ileal lipid peroxidation [free malondialdehyde (MDA)] was measured as an index of lipid peroxidation. BSO markedly decreased ileal mucosal GSH, oxidized GSH/GSSG E h , and increased MDA content without inducing morphological damage as assessed by light or electron microscopy. As expected, SBR stimulated adaptive growth of ileal villus height and total mucosal height at 7 d after surgery, but this response was unaffected by BSO treatment despite a modest increase in crypt cell apoptosis. Ileal cell proliferation (crypt cell bromodeoxyuridine incorporation) increased at 2 d after SBR but was unaffected by BSO. Collectively, our in vivo data show that marked depletion of ileal GSH and oxidation of the GSH redox pool does not alter indices of ileal epithelial proliferation or SBR-induced ileal mucosal adaptive growth.

Background Major surgery is believed to contribute to immune dysregulation and high susceptibility to microbes. Recently, the inflammatory “two-hit” model has been accepted to elucidate development of multiple organ failure in surgical patients. Our purpose was to examine whether intestinal surgery, which causes a minor insult with no septic shock, may modify the immune response to exogenous LPS as a second stimulus. Materials and methods Using a rat intestinal transection and anastomosis surgery model, we sequentially examined blood cell counts, body temperatures, and plasma cytokines. Rats were administered with LPS intravenously or intratracheally various days after surgery. Phagocytic activity and TNFα production in bronchoalveolar lavage (BAL) cells, plasma cytokines, and survival rates were evaluated. Results The surgery itself caused no severe shock or circulating cytokine elevation, whereas the number of granulocytes in the blood was significantly elevated after surgery. LPS-induced elevation of circulating IFNγ attenuated 3 days after surgery. In contrast, IL-10 was enhanced 3–10 days after surgery. Hyporesponsiveness of BAL cells to LPS was observed 3 days after surgery but not the next day after surgery. However, rats intratracheally exposed to LPS 10–13 days after surgery exhibited higher mortality. Conclusions Although our surgical procedure was not supposed to be a severe insult, it sufficiently primed rats for an altered response to a second stimulus (endotoxin), which included enhanced mortality. This study provided an improved understanding of pathophysiological changes following surgery and described a useful model for developing preventive and therapeutic strategies for complications after surgery.

目的:壊死型手術症例の臨床的特徴,早期手術適応決定におけるSIRSの有用性,術後PMXの有効性を検討した.対象と方法:壊死型手術症例13例の臨床的特徴を一過性型20例と比較検討した.さらに入院時SIRSスコアー,術前SIRS陽性率を算出し,手術適応の判定に有用であるかを検討した.また術前術後のAPACHE IIスコアの推移を生存群11例と死亡群2例で検討した.さらにPMXの有効性を検討するために生存群の術後SIRS陽性期間,術後APACHE IIスコアーの推移をPMX施行群5例,未施行群8例で比較検討した.(結果)壊死型は高齢者で基礎疾患を有し,入院時にSIRSを呈する症例に発症していた.手術適応の判定にSIRSの有無,持続期間は有用であった.PMX群では術後SIRS期間の短縮やAPACHE IIスコアの早期低下がみられたが,術前APACHE IIスコアが高値の症例には無効で,早期診断と手術適応決定が望まれる.

Management of nutrition in cancer patients plays an important role in supporting anti-cancer treatment. Parenteral nutrition is considered to assist with nutrition in cancer patients. Central venous catheters(CVC)are useful for intravenous infusion of not only nutrients with high osmotic pressure but also chemotherapeutic drugs and other substances. Central venous access through CV ports reduces patient's burden and complications, and it contributes to maintaining a patient's quality of life(QOL).

Using the quantitative computed tomography (QCT) technique, we investigated the vertebral trabecular bone mineral density of 24 subjects with gastric cancer who had undergone a gastrectomy 6 years ago previously. The purpose of this clinical study was to create a guide to therapy for osteoporosis after gastrectomy. QCT values 6 years after surgery had decreased to 108.00±83.38mg/cm3 from 140.52±63.87mg/cm3. The rate by contrast with non-operated age-group standard values 6 years after surgery (119.60±86.46%) was also significantly lower than during the perioperative period (139.64±55.11%). 15 male subjects including 5 who were taking alfacalcidol for 3 year, made a similar reduction. The QCT values in 9 male patients who were taking menatetrenone increased to 97.35±77.59mg/cm3 from 89.89±69.63mg/cm3 after medication, accompanied by the reduction of urine pyridinolin and urine deoxypyridinolin concentrations. Therefore, the possibility that menatetrenone is effective for osteoporosis after gastrectomy is suggested.

The influence of leakage on host immunity and prognosis were studied in 16 gastric cancer patients (stage II and III) complicated after distal gastrectomy and compared them with 30 patients without leakage. Postoperative changes of immunologic parameters (IL-2, IL-6 and T cell subsets) were observed and 5-year survival rates of each stage were investigated and compared with the no-leakage group. In the group with leakage, the average number of SIRS positive days (9.2 days) was prolonged significantly when compared with the control group (2.1 days). Furthermore serum level of IL-6 had a second elevation and IL-2 production was decreased postoperatively for a longer period, CD4+2H4-cell ratio (helper T) stayed at a low level for 3 months, CD11b+CD8 bright+cell ratio (suppressor T) increased for 1 month. Deterioration of 5-year survival rates was seen in the group with leakage and in both stages, but a ignificant difference was not seen. Based on these results, we think that prolonged SIRS after cancer surgery due to leakage suppressed host immunity and this fact caused cancer recurrence and poorer prognosis.

In order to evaluate the influence of pre-and postoperative adjuvant immunochemotherapy upon hosts, we selected 34 patients with stage II & III advanced gastric cancer who underwent an operation with curability A or B from 1988 to 1993 and whose immunological parameters were measured for one year. These 34 cases were divided into three groups; chemotherapy only (UFT and MMC) group (n=16) served as control, pre-and postoperatively OK432-combined group (n=10). and postoperatively PSK-combined group (n=8). In the OK432 group, the CD4 (+) CD45RA (-) cell ratio increased since at the 1 month after the operation, CD11b(+) CD8bright(+) cell ratio increased at the 3rd and 6th month after the operation. In the PSK group, CD11b (+) Cd8brigh t(+) cell ratio decreased after 2 weeks of the operation. We conclude that pre-and postopetrative immunochemotherapy is useful to improve the host immunity in the patients with advanced gastric cancer.

BACKGROUND/AIMS A 13C breath test was applied to evaluate the early stage of postoperative liver function after hepatectomy. It was examined in comparison with functional and morphological recovery. METHODOLOGY Rats were subjected to 70% partial hepatectomy (H group) and control group (S group). Expired air, blood and remnant liver tissue were collected at 12, 24, 48 and 72h, and 7 and 14 days postoperatively. Phenylalanine and leucine were used as the 13C-labeled substrates. The 13CO2 was collected until 120min. The mean values of the H and S groups were compared using the highest mean level of 13CO2 excreted in breath (Cmax). The liver regenerative ability was evaluated by Ki-67. RESULTS In the 13C-phenylalanine breath test, the Cmax value tended to be lower for the H group 12h postoperatively (p=0.06). Cmax was significantly lower for the H group 24h postoperatively (p

Background To examine the effects of percutaneous endoscopic gastrostomy (PEG) on quality of life (QOL) in patients with dementia. Methods We retrospectively included 53 Japanese community and tertiary hospitals to investigate the relationship between the newly developed PEG and consecutive dementia patients with swallowing difficulty between Jan 1st 2006 and Dec 31st 2008. We set improvements in 1) the level of independent living, 2) pneumonia, 3) peroral intake as outcome measures of QOL and explored the factors associated with these improvements. Results Till October 31st 2010, 1,353 patients with Alzheimer’s dementia (33.1%), vascular dementia (61.7%), dementia with Lewy body disease (2.0%), Pick disease (0.6%) and others were followed-up for a median of 847 days (mean 805 ± 542 days). A total of 509 deaths were observed (mortality 59%) in full-followed patients. After multivariate adjustments, improvement in the level of independent living was observed in milder dementia, or those who can live independently with someone, compared with advanced dementia, characterized by those who need care by someone: Odds Ratio (OR), 3.90, 95% confidence interval (95%CI), 1.59 - 9.39, P = 0.003. Similarly, improvement of peroral intake was noticed in milder dementia: OR, 2.69, 95%CI, 1.17 - 6.17, P = 0.02. Such significant associations were not observed in improvement of pneumonia. Conclusions These results suggest that improvement of QOL after PEG insertion may be expected more in milder dementia than in advanced dementia.

Eight cases of acute cholecystitis following gastrectomy for gastric cancer were clinically investigated for the cause and characteristics. It was possible that the cause in early onset cases was related to circulatory disturbance. In late onset cases, the cause was relevant to additional infection after a preperatory stage by vagotomy or lymphadenectomy in hepatoduodenal ligament. On the other hand, there was no complication in 37 patients who were followed for more than one year after additional cholecystectomy with gastrectomy. These results suggest that we should take an aggresive attitude for additional cholecystectomy in case with a possibility of postoperative cholecystitis.

This case was a 62-year-old female patient who had received a home parenteral nutrition therapy for the past 15 years.In order to simplify a management of home parenteral nutritional therapy, she tried to exchange a current use of popular TPN one bag solution to a new type one bag solution containing all elements of essential nutritionals, which could reduce a number of mixing procedures.However, she unfortunately encountered a new problem increasing a number of solution contained boxes(from 7 popular solution bags per box to 5 bags per box)to be brought into her house.Consequently, her living space was limited with more new boxes in the house.Moreover, a new solution bag was not easy to mix all elements of nutritionals, and a 1, 500 mL bag was too heavy for her to lift.In conclusion, there are many different problems associated with each patient, so that we ought to consider each patient's living environment as one of the important issues.

Hospitals in Shinagawa-ku and Ota-ku, the secondary medical sphere of Tokyo, have been working on various medical care tasks in order to provide a seamless transition from hospital to home medical care. In the area of nutritional medical therapy, the Shinagawa and Ota nutrition workshop was founded in 2006 to share the information, which contains thoroughly from a special nutrition therapy to a general therapy. In September 2007, a nutrition questionnaire survey was conducted for the members of Ebara-, Shinagawa-, Omori-, Kamata- and Denen-Chofu-medical association to make themes of nutrition related cooperation pass candidates. Then, we debated on the theme of priorities based on the result of the survey. In the scientific meeting held in May 2010, we examined the candidates, and decided to enrich the present diabetes passes and to a new establishment of PEG management.

We experienced a case in which the hepatic artery catheter system could be used long term. Even after 5 years and five months, there was no damage to the hepatic artery, and we could still use this system. For insertion of the catheter, a fine catheter with the tip tapered at 2.7 F was selected. This catheter was inserted into the hepatic artery peripheral branch in the liver, after a side hole was created 11 cm from the tip, and the side hole was adjusted to stay in the common hepatic artery. We speculated that the reason for little injury to the hepatic artery was use of a fine catheter despite possible damage to the hepatic artery wall like saw cutting in this case. We classified the patterns according to which a catheter damaged the inner wall of the hepatic artery into 5: "straight punch type", "hook punch type", "whiplash type", "elbow blow type", "and saw type".

Alcohol is commonly consumed with, or soon after, a meal that affects gastric emptying and thus, absorption and metabolism of alcohol. The aim of this study is to evaluate the effect of liquid test meal ingested soon after, alcohol ingestion on alcohol metabolism, as is common in the social setting. First, a 100 mL of water containing of 80 mg of 13C-ethanol was administrated orally in 7 healthy subjects, and 200 mL of liquid meal (200 kcal) was administrated 5 min after alcohol ingestion. Breath samples were taken at baseline and at 10-min interval for 150 min. Next, 13C-ethanol breath test was performed without ingestion of liquid meal. Cmax was decreased after ingestion of liquid meal, whereas Tmax was unchanged. The descending gradient of 13CO2 excretion curves after ingestion of liquid meal is parallel to that without liquid meal, while the ascending gradient of 13CO2 excretion curves in the first 10 min had a tendency to be greater after ingestion of liquid meal than without ingestion of liquid meal. A significant delay in breath 13CO2 excretion after ingestion of liquid meal was found and the AUC values were lower after ingestion of liquid meal in each time point, indicating that liquid meal ingested soon after alcohol ingestion may not affect elimination but absorption and/or metabolism of a small amount of alcohol.

胃癌治癒切除例51例を対象とし, 4群に分類し, 術前, 術後2週, 1, 3, 6, 12か月で免疫パラメーターを計測し手術侵襲によりどの様に推移するかを検討した.リンパ球数, PHA, ConAリンパ球幼若化反応, PPD, Su-PS皮内反応は術後2週で低下を示し, OKT4細胞比とOKT4/OKT8比はやや遅れて1～3か月で低値を示し, 侵襲の大きかった群で回復が遅れた.さらに23例を対象とし, two colorを用いたリンパ球サブセットの解析を術前, 術中, 術後に行った.術中よりsuppressor T細胞の増加, helper T細胞とcytotoxic T細胞の減少を認め, これらは術式や進行度に応じて推移した.また胃癌48例に対し, 教室のregimenに従い術前より免疫化学療法を施行しパラメーターを観察した.術後2週に各パラメーターの低下を認めたが, 進行度や侵襲の軽い群ではPHA, ConAリンパ球幼若化反応, PPD, SuPS皮内反応において, 1～3か月以降に術前値以上の上昇を認めた.

In patients with gastric cancer undergoing initial operation, the correlation between the albumin level as the index for preoperative nutritional state and the non-specific immunity was studied in consideration of the degree of advancement. The subjects were 69 cases operated on from February 1985 till December 1988, and the albumin level and 12 non-specific immunity parameters were measured before operation. There were multiple correlations between the preoperative albumin level and non-specific immunity parameters, and the correlation coefficient was as high as 0.8237 in the patient group in stage III+IV. PHA·ConA lymphocyte blastogenetic reaction in the stage I+II group and the WBC·PPD intradermal reaction in the stage III+IV group were highly contributing parameters. That is, in the stage I+II group, it was found that the function of PHA was more contributable than the number of helper T-cells, and the function of Con A did than the number of suppressor T-cells, to the preoperative albumin level. While in the stage III+IV group, the contribution of the entire cellular immunity was great. Improvement of nutritional state and the preoperative immunotherapy are expected to be of help to the surgical therapeutics.

We have observed interesting findings in twice performed direct sagittal CT scan in the course of the elongation method treating of esophageal atresia without tracheoesophageal fistula. A patient with esophageal atresia type A was placed in the plane of the gantry so that sagittal scanning could be performed for the mediastinum and peritoneal cavity. So far, plain esophagogram with stretched pouches by the bougies has been routinely carried out for the planning of surgery of esophageal atresia. As compared to the plain esophagogram, however, direct sagittal CT scan is less invasive and able to provide more accurate information of the pouches in natural state.

Glutathione (GSH) concentration affects cell proliferation and apoptosis in intestinal and other cell lines in vitro. However, in vivo data on gut mucosal GSH redox status and cell turnover are limited. We investigated the effect of altered GSH redox status on the ileal mucosa in a rat model of short bowel syndrome following massive small bowel resection (SBR). Rats underwent 80% mid-jejunoileal resection (RX) or small bowel transection (TX; as operative controls), with administration of either saline or D, L-buthionine-sulfoximine (BSO), a specific inhibitor of cellular GSH synthesis. Ileal mucosal redox, morphology, and indices of cell proliferation and apoptosis were determined at different days after surgery. Ileal GSH redox status was assessed by GSH and GSH disulfide (GSSG) concentrations and the redox potential of GSH/GSSG (Eh). Ileal lipid peroxidation [free malondialdehyde (MDA)] was measured as an index of lipid peroxidation. BSO markedly decreased ileal mucosal GSH, oxidized GSH/GSSG Eh, and increased MDA content without inducing morphological damage as assessed by light or electron microscopy. As expected, SBR stimulated adaptive growth of ileal villus height and total mucosal height at 7 d after surgery, but this response was unaffected by BSO treatment despite a modest increase in crypt cell apoptosis. Ileal cell proliferation (crypt cell bromodeoxyuridine incorporation) increased at 2 d after SBR but was unaffected by BSO. Collectively, our in vivo data show that marked depletion of ileal GSH and oxidation of the GSH redox pool does not alter indices of ileal epithelial proliferation or SBR-induced ileal mucosal adaptive growth.

Serum albumin (Alb) sampling is used for patients who object to screening by NST. As Alb is decreased by malnutrition, it is available for nutritional assessment, reflecting the long-term nutritive condition. Recently, Alb was correlated with nutritional assessment proteins with RTP, like RBP, TTR and Tf. We recently set up a screening line of Albor =3.0g/dl; however, we will gradually elevate it toor =3.5g/dl. The role of the medical technologist is to estimate the number of patients withor =3.5g/dl, and investigate correlations between the Alb concentration and other markers, including ChE, TTR, TP and CRP.

Background Administration of specific growth factors exert gut-trophic effects in animal models of massive small bowel resection (SBR); however, little comparative data are available. Our aim was to compare effects of a human glucagon-like peptide-2 (GLP-2) analog, recombinant growth hormone (GH) and recombinant keratinocyte growth factor (KGF) on jejunal, ileal, and colonic growth and functional indices after 80% SBR in rats. Methods Thirty-seven male rats underwent small bowel transection (sham operation) with s.c. saline administration (control; Tx-S; n = 7) or 80% midjejuno-ileal resection (Rx) and treatment with either s.c. saline (Rx-S, n = 7), GLP-2 at 0.2 mg/kg/d (Rx-GLP-2; n = 8), GH at 3.0 mg/kg/d (Rx-GH; n = 8), or KGF at 3.0 mg/kg/d (Rx-KGF; n = 7) for 7 days. All groups were pair-fed to intake of Rx-S rats. Gut mucosal cell growth indices (wet weight, DNA and protein content, villus height, crypt depth, and total mucosal height) were measured. Expression of the cytoprotective trefoil peptide TFF3 was determined by Western blot. Gut mucosal concentrations of the tripeptide glutathione (L-glutamyl-L-cysteinyl-glycine) and glutathione disulfide (GSSG) were measured by high-performance liquid chromatography and the glutathione/GSSG ratio calculated. Results SBR increased adaptive growth indices in jejunal, ileal, and colonic mucosa. GLP-2 treatment increased jejunal villus height and jejunal total mucosal height compared with effects of resection alone or resection with GH or KGF treatment. Both GH and KGF modestly increased colonic crypt depth after SBR. SBR did not affect small bowel or colonic goblet cell number or TFF3 expression; however, goblet cell number and TFF3 expression in both small bowel and colon were markedly up-regulated by KGF treatment and unaffected by GLP-2 and GH. SBR oxidized the ileal and colonic mucosal glutathione/GSSG redox pools. GLP-2 treatment after SBR increased the glutathione/GSSG ratio in jejunum, whereas KGF had an intermediate effect. In addition, GLP-2 (but not GH or KGF) prevented the SBR-induced oxidation of the glutathione/GSSG pools in both ileum and colon. Conclusions GLP-2 exerts superior trophic effects on jejunal growth and also improves mucosal glutathione redox status throughout the bowel after massive SBR in rats. Both GH and KGF increase colonic mucosal growth in this model. KGF alone potently increases gut mucosal goblet cell number and expression of the cytoprotective trefoil peptide TFF3. The differential effects of GLP-2, GH and KGF administration in this model of short bowel syndrome suggest that individual therapy with these growth factors may not be an adequate strategy to maximally improve adaptive gut mucosal growth and cytoprotection after massive small intestinal resection. Future research should address the use of these agents in combination in short bowel syndrome.

We report a case in which low-dose CPT-11 chemotherapy was effective for metastatic liver tumor of sigmoid colon cancer. A 49-year-old male with metastatic liver tumor, who had undergone sigmoidectomy with D2 lymphadenectomy, was treated by low-dose CPT-11 chemotherapy (CPT-11 30 mg/m2 x 3 days, every 2 weeks). After 7 courses of this chemotherapy, CT and ultrasound examinations showed a reduction of tumor size in the liver. This chemotherapy also showed no high grade toxicities. Therefore, low-dose CPT-11 chemotherapy seems to be effective for metastatic colorectal cancer, and safe in view of toxicities.

AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient’s characteristics at PEG using log-rank tests and Cox proportional hazard models. RESULTS: Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors. CONCLUSION: These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors.

カルチノイド3例, 平滑筋腫2例, 良性リンパ炉胞性ポリープ2例4病変, 血管脂肪腫1例, リンパ管腫2例, 血管腫2例4病変の6疾患12例16病変の内視鏡所見につき検討した.対象例は正常粘膜に覆われた平滑な病変が多く, 結節状の2病変, 径3mmの微小な1病変以外は粘膜下腫瘍の診断は比較的容易であった.血管腫では4病変中青色調が1病変, 暗赤色2病変, カルチノイドは3例中1例は黄色調であった.リンパ管腫はやや灰白色調で, 光沢, 透明感があり, 軟らかくcushion signが認められ, 大きいものでは体位変換により形状の変化がみられた.平滑筋腫, 良性リンパ炉胞性ポリープ, 血管脂肪腫ではその疾患に特有な所見に乏しく, 診断の困難な症例が多いと思われた.充実性の腫瘍は弾性硬で, とくにカルチノイドは硬く感じられた.粘膜下腫瘍の質的診断には肉眼所見だけではなく, 触診所見も重要であると思われた.