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Although the global leadership initiative on malnutrition (GLIM) criteria for malnutrition were published in 2018, few studies have correlated them with postoperative outcomes of gastric cancer. This study aimed to investigate the validity of predicting prognosis after gastrectomy in patients with advanced gastric cancer by dividing the patients according to the severity of malnutrition using the body mass index (BMI) and body weight loss (BWL), as defined by the GLIM criteria.This study included patients with c-stage II-III primary gastric cancer who underwent gastrectomy between April 2008 and June 2018. Patients were divided into normal, moderate malnutrition, and severe malnutrition groups according to the GLIM criteria of BMI and BWL. The primary endpoint was overall survival (OS).Of the 512 patients, 340 (66.4%) were included in the normal group, 84 (16.4%) in the moderate group, and 88 (17.2%) in the severe group. Comparing the long-term prognosis in the three groups, the prognosis was worse in the moderate and severe groups than in the normal group for OS (p0.001). Multivariate analysis for OS showed that moderate malnutrition [hazard ratio (HR)=1.689, 95% confidence interval (CI)=1.017-2.576, p=0.015] and severe malnutrition (HR=1.918, 95% CI=1.275-2.884, p=0.002) were independent poor prognostic factors.Using two simple indices from the GLIM criteria, preoperative BMI and BWL, this study found that moderate and severe malnutrition were independent poor prognostic factors for OS.

Post-operative paralytic ileus (POI) occurs after surgery because of gastrointestinal dysfunction caused by surgical invasion. We therefore investigated the frequency of POI after laparoscopic colorectal surgery in patients with colorectal cancer using a strictly defined POI diagnosis and identified associated risk factors.Patients who underwent initial laparoscopic surgery for colorectal cancer between January 2014 and December 2018 were included. The primary end point was the incidence of POI. A multivariate logistic regression analysis revealed the contributing risk factors for POI.Of the 436 patients, 94 (21.6%) had POI. Compared with the non-POI group, the POI group had significantly higher frequencies of infectious complications (p 0.001), pneumonia (p 0.001), intra-abdominal abscess (p = 0.012), anastomotic leakage (p = 0.016), and post-operative bleeding (p = 0.001). In the multivariate analysis, the right colon (odds ratio [OR] 2.180, p = 0.005), pre-operative chemotherapy (OR 2.530, p = 0.047), pre-operative antithrombotic drug (OR 2.210, p = 0.032), and post-operative complications of CD grade ≥ 3 (OR 12.90, p 0.001) were independent risk factors for POI.Post-operative management considering the risk of post-operative bowel palsy may be necessary for patients with right colon, pre-operative chemotherapy, pre-operative antithrombotic drug or severe post-operative complications.

We investigated the long-term prognostic impact of diabetes mellitus (DM) after gastrectomy for advanced gastric cancer.This was a retrospective cohort study of consecutive patients who underwent gastrectomy for primary p-T2 or more advanced-stage gastric cancer, between April, 2008 and June, 2018. The overall survival (OS) of patients with DM and those without DM were compared using Kaplan-Meier survival analysis after adjusting for group differences using propensity score matching (PSM).Among the 512 patients who met the eligibility criteria, 92 (18.0%) had DM and 420 (82.0%) did not. After PSM, the subjects of this analysis were 72 patients in the DM group and 216 patients in the non-DM. OS was significantly worse in the DM group than in the non-DM group (P = 0.037). Multivariate analysis revealed that a low skeletal muscle mass index was a significant independent prognostic factor for OS in the patients with DM (hazard ratio, 2.284; 95% confidence interval, 1.005-5.189; P = 0.048).DM in patients with advanced gastric cancer is associated with poor OS. A low skeletal muscle mass in patients with DM is a particularly poor prognostic factor for OS after surgery for gastric cancer.

For total laparoscopic distal gastrectomies for gastric cancer, the reconstruction method is critical to the clinical outcome of the procedure. However, which reconstruction technique is optimal remains controversial. We originally reported the augmented rectangle technique (ART) as a reconstruction option for total laparoscopic Billroth I reconstructions. Still, little is known about its effect on long-term outcomes, specifically the incidence of postgastrectomy syndrome and its impact on quality of life.To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaire.At Juntendo University, a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 questionnaire. Multidimensional analysis was performed, comparing those 94 ART cases from our institution (ART group) to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database (PGSAS group).Patients in the ART group had significantly better total symptom scores in all the symptom subscales (ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.

Sarcopenia, as assessed by body composition, can affect morbidity and survival in several gastrointestinal cancer. However, the impact of sarcopenia, referring to both quantity and quality of skeletal muscle, in biliary tract cancer (BTC) is debatable. We aimed to investigate the impact of sarcopenia on morbidity and mortality in patients with BTC.Electronic databases and trial registries were searched through July 2021 to perform random-effects meta-analyses. Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.Twenty-nine studies (4443 patients) were included; 28 used computed tomography and one used dual-energy X-ray absorptiometry to assess body composition. Eighteen studies reported the impact of pre-operative sarcopenia on postoperative outcomes; namely, sarcopenia increased postoperative complications (risk ratio = 1.23, 95% confidence interval [CI] = 1.07 to 1.41; IIn sarcopenia, low muscle quantity and quality by body composition conferred an independent risk of morbidity and mortality in patients with BTC. Further studies are needed to confirm these findings and mitigate risk.

BACKGROUND As cervical myelopathy (CM) is a progressive disease, early detection and intervention are essential for its mitigation. While several screening methods exist, they are difficult to understand for community-dwelling people, and the equipment required to set up the test environments is expensive. Thus, a simple screening system is necessary to ensure early consultation by a physician. OBJECTIVE This study investigated the viability of a CM screening method based on the 10-s grip-and-release test using a machine learning algorithm and a smartphone equipped with a camera. METHODS The group of CM patients and the control group consisted of 22 and 17 participants, respectively. A spine surgeon diagnosed the presence of CM. Patients performing the 10-s grip-and-release test were filmed, and the videos were analyzed. The probability of the presence of CM was estimated using a support vector machine algorithm, and the sensitivity, specificity, and area under the curve (AUC) were calculated. Two assessments of the correlation between estimated scores were conducted. The first used a random forest regression model and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (C-JOA). The second assessment used a different model, random forest regression, and the Disabilities of the Arm, Shoulder, and Hand (DASH). RESULTS The final classification model had a sensitivity of 90.9%, specificity of 88.2%, and AUC of 0.93. The correlations between each estimated score and the C-JOA and DASH scores were 0.79 and 0.67, respectively. CONCLUSIONS The proposed model could be a helpful screening tool for CM as it showed excellent performance and high usability for community-dwelling people and non-spine surgeons.

BACKGROUND Cervical myelopathy (CM) causes several symptoms such as clumsiness of the hands, and often requires surgery. Screening and early diagnosis of CM are important because some patients are unaware of their early symptoms and consult a surgeon only after their condition has become severe. The 10-second hand grip and release (10-s) test is commonly used to check for the presence of CM. The test is simple, but would be more useful for screening if it could objectively evaluate the changes in movement specific to CM. A previous study analyzed finger movements in the 10-s test using the Leap Motion, a non-contact sensor, and a system was developed that can diagnose CM with high sensitivity and specificity using machine learning. However, the previous study had limitations in that the system recorded a few parameters and did not differentiate CM from other hand disorders. OBJECTIVE To develop a system that can diagnose CM with higher sensitivity and specificity, and distinguish CM from carpal tunnel syndrome (CTS), a common hand disorder. We then validated the system with a modified Leap Motion that can record the joints of each finger. METHODS In total, 31, 27, and 29 participants were recruited into the CM, CTS, and control groups, respectively. We developed a system using Leap Motion that recorded 229 parameters of finger movements while participants gripped and released their fingers as rapidly as possible. A support vector machine was used for machine learning to develop the binary classification model and calculated the sensitivity, specificity, and area under the curve (AUC). We developed two models, one to diagnose CM among the CM and control groups (CM/control model), and the other to diagnose CM among the CM and non-CM groups (CM/non-CM model). RESULTS The CM/control model indexes were as follows: sensitivity, 74.2%; specificity, 89.7%; AUC, 0.82. The CM/non-CM model indexes were as follows: sensitivity, 71.0%; specificity, 72.8.7%; AUC, 0.74. CONCLUSIONS We developed a screening system capable of diagnosing CM with higher sensitivity and specificity. This system can differentiate CM from CTS patients as well as healthy subjects and has the potential to screen for CM in a variety of subjects. INTERNATIONAL REGISTERED REPORT RR2-10.1097/BRS.0000000000004243

There is no consensus on the relation between visceral fat mass and long-term postoperative prognosis in patients with upper gastrointestinal (GI) cancer.The purpose of this study was to investigate the association of preoperative visceral fat mass with postoperative complications and overall survival (OS) in patients with upper GI cancer.We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE (Dialog), the WHO International Clinical Trials Platform Search Portal, and ClinicalTrials.gov and identified observational studies published from inception through 20 July 2022. We conducted a systematic review and random-effects meta-analysis of studies including patients who were surgically treated for upper GI cancer and whose visceral fat mass was assessed on the basis of body composition. We independently assessed the risk of bias and quality of evidence using the Quality In Prognosis Studies and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. The primary outcome was OS. HRs and 95% CIs for OS were pooled.Ninety-one studies (n = 20,583) were included. All studies used computed tomography (CT) to assess the body composition of patients. Twenty-four studies reported the relation between high visceral fat and postoperative outcomes, and their results were synthesized. Compared with low visceral adipose tissue, high visceral adipose tissue assessed by CT may improve OS (HR: 0.69; 95% CI: 0.55, 0.87; I2 = 65%; n = 3407). The risk of bias for OS in each study was moderate or high. The certainty of evidence for OS was very low because of inconsistency in the forest plot, the moderate or high risk of bias, and publication bias.High visceral fat may be associated with improved OS after radical resection in patients with upper GI cancer. Further studies are needed to confirm these findings and mitigate the risk.

Purpose: Death due to other diseases is one factor related to long-term prognosis after gastrectomy; however, few studies have examined the relationship between death due to other diseases and undernutrition. This study aimed to clarify the factors associated with death due to other diseases after gastrectomy for gastric cancer.Methods: This retrospective cohort study included consecutive patients who had undergone gastrectomy between April 2008 and June 2018 for primary stage II–III gastric cancer. The primary outcome was other-cause survival (OCS). To identify prognostic factors for OCS for univariate analysis, we used a Cox proportional hazards regression model.Results: A total of 512 patients met the inclusion criteria. The average age was 67.93 years, and the average body mass index was 22.75 kg/m2, with 84 (16.4%) moderately malnourished and 88 (17.2%) severely malnourished, as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria. The OCS for the malnourished group was significantly worse than that for the normal group (P < 0.001). The prognosis was worse when the severity of malnutrition was worse (P < 0.001). Multivariate analysis showed that severe malnutrition (hazard ratio [HR]: 3.259, 95% confidence interval [CI]: 1.396–7.609, P = 0.006) and severe postoperative complications (HR: 4.245, 95% CI: 2.207–8.166, P < 0.001) were significant independent prognostic factors for OCS.Conclusions: Undernutrition, as defined by the GLIM criteria, is useful for the preoperative prediction of death due to other diseases after gastrectomy in patients with advanced gastric cancer.

In 2018, the Global Leadership Initiative on Malnutrition consortium published global consensus diagnostic criteria for malnutrition and highlighted the association between malnutrition and poor postoperative outcomes in patients with gastrointestinal cancer. The aforementioned criteria consist of phenotypic and etiologic criteria to diagnose malnutrition in individuals who undergo conventional screening to determine the at-risk population. Recent studies have reported the usefulness of prediction of postoperative outcomes using body mass index, weight loss, and reduced muscle mass as phenotypic criteria. Reduced muscle mass is an essential diagnostic criterion for sarcopenia, which is associated with poor outcomes in patients with cancer. The Global Leadership Initiative on Malnutrition criteria define reduced muscle mass as undernutrition. Malnutrition diagnosed based on the Global Leadership Initiative on Malnutrition criteria is an important risk factor for postoperative complications and also an independent poor prognostic factor for long-term outcomes; greater severity of malnutrition is associated with poorer outcomes. The current Global Leadership Initiative on Malnutrition criteria for malnutrition accurately predict outcomes, including postoperative complications and long-term prognosis; however, a revision may be warranted to ensure consistency with the diagnostic criteria for sarcopenia. Patients diagnosed with malnutrition based on the Global Leadership Initiative on Malnutrition criteria should be targeted for nutritional intervention. Further accumulation of evidence is necessary to conclusively establish the role of nutritional interventions in patients with malnutrition to improve postoperative complications and long-term outcomes.

This study investigated whether or not the impact of malnutrition, as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria, on the long-term prognosis after gastrectomy differed between older and young patients with advanced gastric cancer.This study included patients with primary stage I-III gastric cancer who underwent gastrectomy between April 2008 and June 2018. Patients were divided into normal, moderate, and severe malnutrition groups according to the GLIM criteria for the body mass index (BMI) and body weight loss (BWL). The primary endpoint was the overall survival (OS).Of the 512 patients, 274 (53.5%) were included in the younger group ( 70 years old) and 238 (46.5%) in the older group (≥ 70 years old). The prevalence of moderate and severe malnutrition was significantly higher in the older group than in the younger group (P 0.001 and P = 0.001, respectively). A multivariate analysis showed that moderate malnutrition [hazard ratio (HR) 1.793, P = 0.028] and severe malnutrition (HR 2.374, P = 0.002) were independent prognostic factors in the older group but not in the younger group.GLIM criteria-defined malnutrition did not correlate with the prognosis in the younger group, whereas moderate and severe malnutrition were independent poor prognostic factors for the OS in the older group.

BACKGROUND Total laparoscopic distal gastrectomy (TLDG) is increasing due to some advantages over open surgery, which has generated interest in gastrointestinal surgeons. However, TLDG is technically demanding especially for lymphadenectomy and gastrointestinal reconstruction. During the course of training, trainee surgeons have less chances to perform open gastrectomy compared with that of senior surgeons. AIM To evaluate an appropriate, efficient and safe laparoscopic training procedures suitable for trainee surgeons. METHODS Ninety-two consecutive patients with gastric cancer who underwent TLDG plus Billroth I reconstruction using an augmented rectangle technique and involving trainees were reviewed. The trainees were taught a laparoscopic view of surgical anatomy, standard operative procedures and practiced essential laparoscopic skills. The TLDG procedure was divided into regional lymph node dissections and gastrointestinal reconstruction for analyzing trainee skills. Early surgical outcomes were compared between trainees and trainers to clarify the feasibility and safety of TLDG performed by trainees. Learning curves were used to assess the utility of our training system. RESULTS Five trainees performed a total of 52 TLDGs (56.5%), while 40 TLDGs were conducted by two trainers (43.5%). Except for depth of invasion and pathologic stage, there were no differences in clinicopathological characteristics. Trainers performed more D2 gastrectomies than trainees. The total operation time was significantly longer in the trainee group. The time spent during the lesser curvature lymph node dissection and the Billroth I reconstruction were similar between the two groups. No difference was found in postoperative complications between the two groups. The learning curve of the trainees plateaued after five TLDG cases. CONCLUSION Preparing trainees with a laparoscopic view of surgical anatomy, standard operative procedures and practice in essential laparoscopic skills enabled trainees to perform TLDG safely and feasibly.

Existing reinforced concrete (RC) buildings designed according to outdated codes may lack sufficient strength, stiffness or ductility to meet the seismic performance criteria of current codes. To enhance the system stiffness and re-centering capability, an elastically designed supplementary steel frame (SF) is installed in parallel with the BRBs. Near full-scale cyclic tests are conducted on such retrofit schemes for performance evaluation. The retrofitted specimens showed stable hysteretic behavior up to the retrofit target story drift of 1/150 as proposed in the Japanese seismic regulations. Tests demonstrate that the proposed system is feasible and increases both strength, ductility, and damping to an adequate seismic performance level while the elastic steel frame is effective in providing post-yield stiffness and re-centering capability even when the RC frame is subjected to moderate inelasticity. Special emphasis is placed on the composite behavior of RC members and SF. A simplified composite interaction model is proposed and results from the developed model show good agreement with the experimental data. Ductility demands are shown to concentrate in the BRBs as per the design intent.

The purpose of the study will be to assess the impact of assessment of body composition in patients with biliary tract cancer.

The outrigger system is an effective solution in mitigating seismic responses of core-tube-type tall buildings by mobilizing the axial stiffness of the perimeter columns. The concept of damped-outrigger has been proposed which introduces dampers in the outrigger system to dissipate seismic energy. This study investigates the seismic behavior of a damped-outrigger system incorporating buckling-restrained brace (BRB-outrigger). The outrigger effect combined with the energy dissipation mechanism of the buckling-restrained brace (BRB) effectively reduce the seismic response of the building. This study proposes the methods to evaluate the inelastic seismic response of structures with multiple damped-outriggers based on a spectral analysis (SA) procedure. For the structure with BRB-outriggers, the optimal outrigger elevations, and the relationships between the axial stiffness of the BRB, the axial stiffness of the perimeter column, and the flexural rigidity of the core structure in order to minimize the seismic response are the primary research objectives of this study. Analytical models with building heights of 64 m, 128 m, 256 m, and 384 m are used to perform the SA and the nonlinear response history analysis. This study concludes with a design recommendation for preliminary design purposes.