In recent years, the Westernization of dietary habits and increasingly sedentary lifestyles have contributed to a marked increase in the number of patients with lifestyle-related diseases, including type 2 diabetes (T2D), worldwide. Epidemiological studies of physical exercise, such as the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study, have shown that lifestyle intervention programs involving diet and/or exercise reduce the progression of impaired glucose tolerance to T2D. In Japan, a nationwide survey regarding exercise therapy for diabetic patients revealed that relatively few physicians provide patients with exercise guidance because of time constraints, that the physicians do not receive additional consultation fees, and there is a lack of specialized physical exercise educators. It has been demonstrated in well-controlled diabetic patients that physical exercise promotes the utilization of blood glucose and free fatty acids in the muscles and lowers blood glucose levels. Furthermore, long-term, mild, regular jogging increases the action of insulin without affecting body mass index or maximum oxygen uptake. It is suggested that people with T2D undertake at least 150 min/week of moderate-to-vigorous aerobic exercise spread out over at least 3 days/week, with no more than 2 consecutive days between bouts of aerobic activity. Mild-intensity resistance training using light dumb-bells and stretch cords is recommended for elderly individuals who have decreased muscle strength and mass (sarcopenia). An active lifestyle is essential for the management of diabetes, a typical lifestyle-related disease.

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Transthoracic subtotal esophagectomy for esophageal cancer is a highly invasive procedure, associated with high mortality and morbidity rates. We examined the use of video-assisted thoracoscopic and laparoscopic surgery for esophagectomy (VATS-E). Further, incentive spirometry (IS) is commonly used in perioperative rehabilitation for esophagectomy. We investigated whether pulmonary complications after VATS-E are related to changes in the perioperative IS volumes and whether such changes could be predictive of these complications. This study included 63 patients who underwent VATS-E from June 2008 to December 2009. IS volumes before and after surgery were recorded for all patients. The perioperative IS volumes and clinicopathological factors were correlated with the incidence of postoperative pneumonia and atelectasis. Nine patients (14.5%) had postoperative pneumonia, and thirteen (22.2%) had atelectasis. Univariate analysis showed an increased risk of atelectasis in patients with diabetes and an increased risk of pneumonia in patients with a long operating time and for whom the lung was adhered to the thoracic wall. The vital capacity (VC) correlation coefficient was 0.674. Further, the risk of pneumonia was high in patients with 13% less than the minimum IS volume/preoperative VC ratio and 22% with less than the average IS volume/preoperative VC ratio. Multivariate regression models for pneumonia showed the same results regarding the IS volume/VC ratio. The results indicated that IS volumes could be used to predict the incidence of complications after VATS-E, and thereby facilitate early application of interventions to prevent pulmonary complications.

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Aims: We compared the clinicopathologic features of three types of colorectal serrated polyps, namely, hyperplastic polyps (HPs), sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs), and analyzed the expression pattern of maspin in these serrated lesions. We retrospectively examined 173 polypoid lesions that were endoscopically excised from 136 patients and diagnosed as hyperplastic or adenomatous serrated lesions, and histologically classified as HPs, SSA/Ps, or TSAs. Maspin expression was immunohistochemically examined in all lesions. Overall, 59 lesions (34%) were classified as HPs, 70 (40%) as SSA/Ps and 44 (25%) as TSAs. There were no significant differences in mean age or gender of patients between types, but SSA/Ps frequently developed on the right colon and showed a superficial/flat elevation, whereas HPs and TSAs frequently developed on the left colon and showed protruded lesions. The average diameters of HPs, SSA/Ps, and TSAs were 7.2, 9.9, and 12.9mm, respectively, showing significant differences. Diffuse cytoplasmic expression of maspin was observed in the serrated glands of all three types. In addition, focal or diffuse intranuclear localization of maspin was observed in 15% of HPs, 13% of SSA/Ps, and 84% of TSAs, showing significant differences between TSAs and the other two types. The three types of serrated polyp examined in this study showed distinct clinicopathological features. The presence of maspin expression in these polyps, regardless of whether they were hyperplastic or neoplastic, indicates that maspin might be commonly associated with cell proliferation, although the underlying mechanism might be different between types.

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The outcomes of treatment for pain disorder are generally disappointing: symptoms are poorly controlled, they are seldom managed by experts, and they are often long standing. The aim of the present study was to compare the therapeutic effectiveness of paroxetine and milnacipran for outpatients with pain disorder. The study was performed on 43 consecutive outpatients with pain disorder diagnosed according to DSM-IV-TR criteria. Patients were treated with either antidepressant for 8 weeks. Pain was self-assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ), the total Pain Rating Index (t-PRI), Present Pain Intensity (PPI), and visual analogue scale (VAS). In addition, pain was evaluated objectively using Pain Vision (a machine devised by NIPRO for semiquantitative measurements). Possible depressive symptoms were rated on the Hamilton Depression Scale (HAM-D) and the Zung Self-rating Depression Scale (SDS). Although VAS scores decreased significantly over the course of the 8-week trial in both the paroxetine- and milnacipran-treated groups (from 6.6 ± 2.3 to 4.8 ± 3.0 [P = 0.01] and from 7.5 ± 2.4 to 5.4 ± 3.3 [P = 0.03], respectively), the t-PRI decreased only in the paroxetine group (from 13.9 ± 10.1 to 7.6 ± 7.5; P = 0.01). The Pain Vision indicated a tendency for decreased pain in both groups, with no significant differences between them. There were no significant changes in the SDS in either group, but the HAM-D decreased significantly in the milnacipran-treated group (from 7.8 ± 4.0 to 6.7 ± 3.9; P = 0.04). The results of the present study suggest that both paroxetine (a selective serotonin re-uptake inhibitor) and milnacipran (a selective serotonin–noradrenaline re-uptake inhibitor) may decrease pain in individuals with pain disorder.

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Aim: The aim of the present study was to assess the changes in bone mineral density and bone turnover markers in long-term SERM. Methods: The study was performed on 25 female outpatients with primary osteoporosis treated at the Osteoporosis Department of Showa University School of Medicine. All patients had been on raloxifene (60mg/day) for ≥ 3 years. The mean patient age was 67.1 years and the women were, on average, 18.4 years postmenopausal. Levels of bone turnover markers (urinary naltrexone [NTX] and bone-specific alkaline phosphatase [BAP]) and bone mineral density (BMD; front lumbar vertebrae, three proximal femur sites, and two distal radius sites) were determined before and then annually after starting raloxifene for a period of 3 years. Results: Over the 3-year treatment period, significant decreases were seen in both urinary NTX and BAP levels. Although BMD of the lumbar vertebrae and distal radius was increased over the 3 years after initiation of raloxifene treatment, the difference failed to reach statistical significance. The BMD of the femoral neck decreased, whereas that of the femoral trochanter and femoral intertrochanter area increased. Conclusions: The selective estrogen receptor modulator raloxifene is suitable for the treatment of osteoporosis in postmenopausal patients because it reduces bone turnover while maintaining adequate bone density.

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We examined the clinicopathological profiles and cellular characteristics of 10 cases of surgically resected primary small intestinal cancers (excluding duodenal cancers). Histological examination revealed nine adenocarcinomas and one sarcomatoid carcinoma. Invasion depth was subserosal in five cases, serosal in four cases and to the adjacent transverse colon in the remaining case. Metastasis was present in lymph node in seven cases, in distant organs in six, and in the peritoneum in seven cases. Of the 10 cases, 7 underwent postoperative chemotherapy, and 6 of the eight traceable patients died from the disease (mean period of survival: 386 days). Histomorphologically, eight of nine adenocarcinomas showed an intestinal phenotype (unclassifiable in the other) in the upper layer, while in the lower layer, there showed an intestinal phenotype and five a non-intestinal phenotyp. Immunohistochemistry revealed a mean positive rate in the upper/lower layers as follows: 93%/86% and 38%/29% by intestinal markers CDX2 and MUC2; 19%/28% and 13%/32% by pancreatobiliary markers CK7 and MUC1; and 4%/19% and 2%/9% by gastric markers MUC5AC and MUC6, respectively. Thus, the intestinal phenotype predominated in almost all small intestinal cancer in this study, although some showed a transformation to non-intestinal or hybrid phenotypes with tumor progression. Flexible management for the diversity and transformation of cellular characteristics is therefore recommended treating and diagnosing small intestinal cancers.

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We report here a case of peripheral primitive neuroectodermal tumor (PNET) arising from the minor salivary gland. A 22-year-old woman was admitted to our hospital for surgical excision of a small painless cheek tumor with a 7-month history. Macroscopically, the tumor measured 10 × 5 × 6mm and was located in the minor salivary gland. Microscopically, the tumor comprised proliferating, small, round cells with scant cytoplasm and high nuclear cytoplasmic ratios. The tumor cells showed some mitotic figures and Homer-Wright-type rosettes. Immunohistochemically, the tumor cells were immunopositive for CD99, synaptophysin, CD56, S-100 protein, and vimentin. Based on these findings, the patient was diagnosed as having PNET arising from the minor salivary gland. There are very few case reports of PNET in the head and neck region, and to the best of our knowledge, this is the first case report of PNET arising from the minor salivary gland.

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A 38-year-old man with a submucosal tumor (SMT) at the anterior wall of the pylorus underwent upper gastrointestinal endoscopy. The tumor was 40 mm in diameter with a long stalk extending into the duodenal bulb. In addition, the long stalk had an ulcer with a blood vessel. Removal of this tumor was initially considered to be possible only by distal gastrectomy. However, endoscopic ultrasound (EUS) was subsequently proven to be a reliable investigative procedure for evaluating the lesion. The tumor was characterized by its origin in the second layer, and endoscopic submucosal dissection (ESD) was performed. En bloc resection of a 32 × 20 × 40 mm area of tissue with tumor-free lateral/vertical margins was accomplished without complication. Histopathological examination confirmed a heterotopic gastric mucosa. By immunostaining, the neoplasm was positive for MUC6 and negative for amylase and trypsin. In this case, EUS was used to investigate a heterotopic gastric mucosa that originated in the second layer, with no infiltration of the fourth layer under the tumor. Therefore, we performed successful ESD at the appropriate layer.

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