This randomized Phase II trial will compare the efficacy and safety of laparoscopy-assisted D2 distal gastrectomy and open distal D2 gastrectomy after neoadjuvant chemotherapy for patients with macroscopically resectable serosa-positive gastric cancer. When R0/R1 surgery is achieved, patients receive S-1 chemotherapy for 1-year post-operatively. The primary endpoint is the 3-year disease-free survival. The sample size to test the hypothesis of the non-inferiority of laparoscopy-assisted D2 distal gastrectomy to open distal D2 gastrectomy is 80. This trial will be able to appraise the use of the laparoscopic approach as a curative D2 distal gastrectomy after neoadjuvant chemotherapy for gastric cancer.

BACKGROUND: The aim of this prospective study was to evaluate the feasibility and safety of laparoscopy-assisted distal gastrectomy (LADG) initiated by surgeons with much experience of open gastrectomy and laparoscopic surgery. METHODS: Three surgeons who each had experience with more than 300 cases of open gastrectomy, more than 100 cases of laparoscopic cholecystectomy, more than 5 cases of laparoscopic colectomy, and more than 5 cases of laparoscopic partial gastrectomy were nominated as LADG operators. All three operators received training for LADG with study materials including videotapes, a box simulator, and an animal laboratory, with lectures and assistance from LADG instructors who each had experience of more than 50 LADG operations. Then the nominated LADG operators performed LADG with the instructors, in which their skills were evaluated and certified. Thereafter, they performed LADG without assistance from the instructors. The target of this study was clinical stage I gastric cancer that was resectable by distal gastrectomy. D1 + alpha, D1 + beta, or D2 dissection was performed laparoscopically. Basically reconstruction was done extracorporeally with a Billroth-I gastroduodenostomy. An extramural review board checked the surgical quality of the operations performed by the three surgeons. The primary endpoint was morbidity and mortality. RESULTS: A total of 193 patients were enrolled in this study between August 2004 and July 2009. The median blood loss was 35 ml and the median operation time was 250 min. Conversion to open surgery was seen in 6 patients; 4 due to bleeding and 2 due to advanced disease. Overall morbidity was 1.6 %, including grade 2 anastomotic leakage in 0.5 % and grade 2 pancreatic fistula in 0.5 %. No mortality was observed. The number of cases required until the LADG operators acted as LADG surgeons without an instructor was 3 for each of the three surgeons. When comparing the data between that in the training period (n = 9) and the operators' data (n = 174), the median operation time was significantly longer in the training period (355 min) than in the latter period (247.5 min)(p = 0.015). Median blood loss was also greater in the training period (150 ml) than the latter period (32.5 ml), but the difference did not reach statistical significance (p = 0.084). During the training period, no patient developed any complications of ≥grade 2. CONCLUSION: These results suggested that LADG could be initiated and performed feasibly and safely if surgeons with much experience of open gastrectomy and laparoscopic surgery received adequate training for LADG.

PURPOSE: The purpose of the present study was to examine a hypothesis that the musculotendinous behavior during a propelling action with a counter-movement can be altered by a single practice session, through modulation of neuromuscular activities. METHODS: Eight males performed unilateral maximal plantar flexion with (CMJ) and without (noCMJ) counter-movement before and after a practice consisting of 6 sets of 3 repetitions of unilateral CMJ exercises. Measurements included electromyographic activities of the triceps surae and tibialis anterior muscles, and the fascicle behavior of the gastrocnemius by ultrasonography, and impulse was calculated from the force-time data. The tendon length change was also estimated. RESULTS: The impulse in CMJ increased after the practice, but that in noCMJ did not. After the practice, the magnitude of fascicle lengthening and shortening in CMJ decreased, which was accompanied by an increase in tendon shortening without change in the ankle joint range of motion. The time lag from the onset of reaction force to that of electromyogram activities of the triceps surae muscles was shortened after the practice. CONCLUSION: The results support the hypothesis and indicate that, as a neural modulation through a single practice, the muscle-tendon unit behavior during CMJ can be optimized to improve the performance.

There were more than 30,000 suicides in 1998 in Japan, and since then, the numbers have remained high. In 2009, the number of suicides per a day was c. 90. This phenomenon constitutes a major social problem. One of the major reasons for the rapid increase in the number of suicides appears to be the worsening economic problems. It is therefore necessary to research the relationship between economic issues and suicide. In this study, we examined the relationship between the value of the Nikkei Stock Average and suicide rates in Japan. The value of the Nikkei Stock Average may be related to suicide among men. On the basis of the results, relevant researchers and organizations should understand the factors that relate to suicide to better carry out specific suicide prevention measures.

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. We report an unusual case of sarcoidosis in a woman presenting with cardiac sarcoidosis and massive splenomegaly with a familial history of cardiac sarcoidosis. Cardiac sarcoidosis was diagnosed based on electrocardiogram, echocardiogram,(18)F-fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG-PET) and skin histological findings. We performed splenectomy to rule out malignant lymphoma, and histological findings confirmed sarcoidosis. After splenectomy, we initiated prednisolone therapy. After 20 months of diagnosis, she was symptom free. Echocardiography and (18)F-FDG-PET may be a key diagnostic tool and prednisolone therapy may be safe, effective, and feasible for cardiac sarcoidosis.

: To compare the effect of habitual recreational sports and exercise activity on age-related, site-specific muscle loss in young and old women in Japan.: Participants included 152 young (aged 20-35 years) and 157 old (aged 60-85 years) women who were classified into 4 subgroups on the basis of their habitual (more than once a week) sports and exercise activity: young active (n = 86), young inactive (n = 66), old active (n = 43), and old inactive (n [SUPERSCRIPT EQUALS SIGN] 114). Muscle thickness (MTH) and fat thickness (FTH) were measured by ultrasonography at 8 sites, with MTH expressed in terms relative to limb length (MTH/L) or height (MTH/Ht). Percent fat was estimated from FTH, and fat-free mass was calculated.: Fat-free mass was similar between younger and older women and between active and inactive women. MTH/L in the quadriceps (P <.001), abdomen (P <.001), and triceps surae (P <.05) was lower in the older women than in the younger women. In contrast, MTH/L in the hamstrings, subscapula, and biceps was higher (P <.01) in the older women than in the younger women. Compared with the MTH of the young inactive women, the MTH of the young active women was greater (P <.05) in 5 sites. Similarly, MTH/L in the quadriceps and triceps was higher (P <.05) in the old active women than in the old inactive women. However, quadriceps MTH/L and abdomen MTH/Ht were still lower (P <.001) in the old active women than in the young inactive women.: Age-related muscle loss remains site-specific in both active and inactive young and old women, even when habitual physical activity has an effect on muscle size.

This randomized Phase II trial will compare the outcome of neoadjuvant chemotherapy using two and four courses of S-1 plus cisplatin or S-1 plus cisplatin plus docetaxel by a two-by-two factorial design for patients with macroscopically resectable serosa-positive gastric cancer. After neoadjuvant chemotherapy, patients will receive D2 gastrectomy followed by S-1 chemotherapy for 1 year postoperatively. The primary endpoint is the 3-year overall survival. The sample size is 120 for the two hypotheses: the superiority of four courses compared with two courses and the superiority of S-1 plus cisplatin plus docetaxel compared with S-1 plus cisplatin. This trial will be able to define the more suitable number of cycles and better regimen of neoadjuvant chemotherapy for gastric cancer.

BACKGROUND Recently, serum anti-Müllerian hormone (AMH) has been used as a good marker of ovarian response during in vitro fertilization (IVF). However, in the clinical setting, we felt that ovarian response was clearly different by age with the same AMH level. Then in this study we evaluated the relationship between serum AMH, age and parameters related to ovarian response and compared these parameters in regard to age within serum AMH-matched group. METHODS AND RESULTS The relationship of these parameters were evaluated retrospectively in patients undergoing their first IVF cycle under a GnRH agonist flare up protocol (n = 456) between October 2008 and October 2010 in our clinic. To understand the relations between variables described above, principal component analysis (PCA) was performed. PCA revealed patients' age was at the different dimension from serum AMH and other variables. Therefore at first we segregated all patients into Low, Normal and High responder groups by their serum AMH using cut-off value of receiver operator characteristics curve analysis. Secondary, we divided each responder group into four subgroups according to patients' age. The high aged subgroups required a significantly higher dose of gonadotropin and a longer duration of stimulation; however, they had significantly lower peak E2 and a smaller number of total oocytes as well as M2 oocytes compared to the low aged subgroups. CONCLUSIONS The influence of aging on the ovarian response was clearly seen in all groups; the ovarian response tended to decrease as patients' age increased with the same AMH level. Therefore serum AMH in combination with age is a better indicator than AMH alone.