Association between the location of diverticular disease and the irritable bowel syndrome: a multicenter study in Japan.

OBJECTIVES: No previous reports have shown an association between location of diverticular disease (DD) and the irritable bowel syndrome (IBS). METHODS: We included 1,009 consecutive patients undergoing total colonoscopy in seven centers in Japan from June 2013 to September 2013. IBS was diagnosed using Rome III criteria, and diverticulosis was diagnosed by colonoscopy with transparent soft-short-hood. Left-sided colon was defined as sigmoid colon, descending colon, and rectum. Right-sided colon was defined as cecum, ascending colon, and transverse colon. We divided the patients into IBS and non-IBS groups and compared characteristics. RESULTS: Patient characteristics included mean age, 64.2±12.9 years and male:female ratio, 1.62:1. Right-sided DD was identified in 21.6% of subjects. Left-sided and bilateral DD was identified in 6.6 and 12.0% of subjects, respectively. IBS was observed in 7.5% of subjects. Multiple logistic regression analysis showed left-sided DD (odds ratio, 3.1; 95% confidence interval (CI): 1.4-7.1; P=0.0060) and bilateral DD (odds ratio, 2.6; 95% CI, 1.3-5.2; P=0.0070) were independent risk factors for IBS. Right-sided DD was not a risk factor for IBS. CONCLUSIONS: Our data showed that the presence of left-sided and bilateral DD, but not right-sided disease, was associated with a higher risk of IBS, indicating that differences in pathological factors caused by the location of the DD are important in the development of IBS. Clarifying the specific changes associated with left-sided DD could provide a better understanding of the pathogenic mechanisms of IBS (Trial registration # R000012739).

Current-voltage characteristics of organic photovoltaic cells following deposition of cathode electrode.

The current-voltage characteristics of benzoporphine-fullerene solar cells were measured subsequent to the deposition of Al as a cathode material. Even in vacuum, a shift in the open circuit voltage was observed at 20 min after Al deposition. Moreover, the displacement of inert gases (N(2)or Ar) in the evaporation chamber enhanced the photovoltaic parameters. The power conversion efficiency was increased by 24% over the initial characteristics (from 1.04% to 1.29%), which indicates that the structure of the organic-metal interface changed rapidly after Al deposition, even if the process was performed in an air-free glovebox.

Evaluation of gastric cancer by high-resolution three-dimensional CISS MR imaging in vitro.

OBJECTIVE: The objective of this study was to demonstrate the usefulness of high-resolution three-dimensional (3D) constructive interference in steady-state (CISS) MR imaging for evaluating mural invasion and the morphologic features of gastric cancers in vitro. MATERIALS AND METHODS: High-resolution 3D-CISS MR images were obtained in three surgical specimens containing three different gastric cancers. RESULTS: In early carcinoma, advanced carcinoma, and leiomyosarcoma, the depth of mural invasion at 3D-CISS MR imaging correlated well with the histopathologic stage. CONCLUSION: High-resolution 3D-CISS MR imaging is a useful method for evaluating mural invasion and the macroscopic features of gastric cancers in vitro.

Medium- and long-term results of jejunal pouch reconstruction after a total and proximal gastrectomy.

PURPOSE: We developed several kinds of jejunal (J)-pouch reconstruction after a gastrectomy for gastric cancer. The aim of this study was to investigate the advantages of these methods. METHODS: As for the treatment of malignant gastric diseases at stage II or earlier, we employed the J-pouch reconstruction (Roux-en-Y method: JPRY, or J-pouch interposing: JPI) following a total gastrectomy. We also used JPI after a proximal gastrectomy for early gastric cancer located in the upper third of the stomach. RESULTS: Out of a total of 80 patients, JPRY was performed in 40 patients and JPI in 40. No anastomotic leaks were associated with the use of an automatic stapler. The stapler (Endo GIA; U.S. Surgical, Norwalk, CT, USA) with a 60-mm-long white cartridge minimized bleeding from the anastomotic site and reduced the operative time. While two patients died of recurrence, all other patients are alive and well for a maximum of 15 years after surgery. The motility of the J pouch was satisfactory after both surgical procedures, as measured by the bile regurgitation test or the transit test employing radiopaque markers. The mean percentage of the radiopaque markers eliminated from the J pouch 1 h after breakfast was 7.5% in the JPRY group and 0%-33% in the JPI group. After another hour, the corresponding percentage was 19.5% in the JPRY group and 14%-60% in the JPI group. CONCLUSION: Our procedures for J-pouch reconstruction are considered to result in a favorable postoperative quality of life and prognosis. J-pouch reconstruction is therefore advantageous in terms of operative morbidity, postoperative clinical signs, symptoms, and dietary status.

Microbiological evaluation after gastrectomy and reconstruction for gastric cancer.

The purpose of this study was to evaluate microbial flora in the mucosa of reconstructed organs after gastrectomy for gastric cancer and improve postoperative quality of life by treating the flora. The number of aerobes was significantly higher in the gastric remnant in the proximal gastrectomy-jejunal pouch interposition group (n=8) than the distal gastrectomy-Billroth II reconstruction (G-BII) group (n=2) or the pylorus-preserving gastrectomy (PPG) group (n=8). The mean number and positive rate of anaerobes tended to be higher in jejunal pouch reconstruction groups. No Helicobacter pylori were detected in any specimens after the G-BII and jejunal pouch reconstruction. However, the gastric remnant and duodenum in the distal gastrectomy-Billroth I reconstruction group (n=5; positive rate of 80% and 20%, respectively) and the PPG group (positive rate of 63% and 25%, respectively) showed H. pylori. We concluded that more anaerobes tended to grow in the mucosa of reconstructed organs after jejunal pouch reconstruction than other procedures. Some patients after jejunal pouch reconstruction worried about their halitosis. Therefore, elimination of anaerobes may relieve it and improve postoperative quality of life.

[Progress of diagnosis for esophageal cancer].

Although the possible existence of micrometastasis in superficial esophageal cancer cases is the most important factor in deciding the therapeutic strategy, it is difficult. There are also limits to the diagnosis of the depth of tumor invasion by endoscopy and EUS. Therefore, the extension of the indication of EMR is planned. Then, the complement of diagnostic ability by EMR is being tried. Sentinel lymph node (s) identification and its biopsy also seem to be useful. In advanced esophageal cancer cases, diagnostic accuracy has been improving by speedup of CT and MRI scans and various image processing technology. More accurate diagnosis of metastasis using PET is much awaited. However, there is still insufficient ability to detect micrometastasis to date. Molecular bio-markers with comprehensiveness are not a valuable selection at this stage. Although advanced equipment has brought more diagnostic accuracy, ways to integrate or use these tools at the clinical level are sought. Some equipment developing and how to integrate them and how to select the appropriate examination in each patient are problems which are required in clinical practitioners.

Ectopic expression of homeodomain protein CDX2 in intestinal metaplasia and carcinomas of the stomach.

The roles of CDX2 and CDX1 homeobox genes during gastric carcinogenesis remain poorly defined. We have studied the expression of CDX2/1 in gastric cancers and intestinal metaplasia (IM) of 69 gastric carcinoma patients by immunohistochemistry. CDX2/1 were shown to be ectopically overexpressed in IM in 41 (85%) of 48, and 47 (90%) of 52 cases, respectively. The expression of CDX2/1 was detected in 38 (55%) and 51 (74%) of the 69 gastric carcinomas, respectively. The histological type of the gastric carcinomas was independently associated with CDX2 expression, but not with that of CDX1, with higher CDX2 expression in intestinal type (differentiated type) than in diffuse type (undifferentiated type) gastric carcinomas. Our results thus suggest that CDX2 and CDX1 may play a role during IM formation and gastric carcinogenesis.

Clinicopathological study of gastric carcinoma in high- and low-mortality countries: Comparison between Japan and the United States.

BACKGROUND: Gastric carcinoma is a tumor that shows marked differences in geographic distributions. The incidence of the gastric carcinoma has been falling dramatically in Western countries. In sharp contrast, the incidence in Japan is still quite high.METHODS: A comparative clinicopathological study was performed, examining gastric carcinomas in 978 Japanese patients (Tokyo) and 157 United States patients (San Diego), that had been surgically resected over the 11-year period 1980-1991.RESULTS: The median age of US the patients (64.1 years) was higher than that of the Japanese patients (59.0 years). There was no difference in the sex ratios. Forty-five of the Japanese patients had early gastric cancer, while this occurred in 10% of the US patients. In terms of tumor location, 47% were in the upper portion of the stomach in the US patients, while, in contrast, this proportion in Japanese patients was 23%. In association with the marked difference in tumor location, 36.5% of the US patients underwent operations with the thoraco-abdominal approach, while this approach was used in 7.5% of the Japanese patients. The distribution of histological types was similar in the two countries' samples. There was also no significant difference in the distribution of the histological types in the same age groups in the two countries' samples. The rate of the well differentiated type increased with age while the rate of poorly differentiated type decreased. In US patients, 35.8% had marked neural invasion, while this occurred in 8.5% of Japanese patients.CONCLUSION: This study revealed marked differences in the features of gastric cancer between the US and Japan in terms of tumor location and surgical procedures.