Effect of physical fitness on colorectal tumor development in patients with familial adenomatous polyposis.
Plain language summary
Familial adenomatous polyposis (FAP), is a rare genetic disease leading to a very high risk of developing colorectal cancer (CRC), with about half of all these patients developing cancer by the age of 40 years. Research has shown that exercise and physical fitness can reduce the risk of sporadic CRC. The aim of this cross-sectional study was to examine the relationship between physical fitness and CRC development in patients with FAP. 119 patients with FAP participated in the study and underwent an exercise stress test to determine physical fitness. The risk of CRC was significantly higher in those who were less physically fit. There was also a significant negative correlation between maximum polyp diameter and physical fitness. The authors conclude that physical fitness may play a role not only in the development of sporadic CRC, but also in cancer development in FAP. The mechanism by which physical fitness prevents the development of CRC and adenoma is largely unknown, but it is thought that improved insulin resistance and altered intestinal transit time may mediate the association.
Although accumulated epidemiological evidence indicates that a good physical fitness level may prevent the development of sporadic colorectal cancer (CRC), few studies have examined the effect of physical fitness level on familial adenomatous polyposis (FAP). This cross-sectional study aimed to examine the relationship between physical fitness and CRC development in patients with FAP.A total of 119 patients (54 male; 65 female) with FAP, aged 17 to 73 years, underwent a step test to induce exercise stress. Predicted maximal oxygen uptake (VO2max) was calculated for each patient by using heart rate as an index of physical fitness. The association of VO2max with the presence or absence of CRC and polyp diameter was examined. Patients with FAP were divided into 3 categories according to their VO2max (high, medium, and low). The association between maximum polyp size and VO2max among the patients with FAP without a history of colectomy was examined.The risk of CRC was significantly higher in the low VO2max group than in the high VO2max group (odds ratio = 4.07; 95% confidence interval, 1.02-16.26). The maximum polyp diameter was significantly negatively correlated with the VO2max among the patients with FAP without a history of colectomy (r = -.44, P = .01). In the multiple linear regression analysis, maximum polyp diameter was independently correlated with VO2max.Our results suggest a preventive association between physical fitness and CRC development or colorectal adenoma growth exists in patients with FAP.
The association between six month intra-dialytic resistance training and muscle strength or physical performance in patients with maintenance hemodialysis: a multicenter retrospective observational study.
BMC nephrology. 2019;(1):172
BACKGROUND Reduced muscle strength and physical performance are prevalent in patients of maintenance hemodialysis (MHD), and deleterious changes in these parameters are associated with increased mortality. METHODS This retrospective observational study included 306 patients, who received a 6-month resistance exercise program during hemodialysis, three times per week on an outpatient basis. The training protocol consisted of two sets of 10 repetitions of knee extension, hip abduction, and hip flexion, using an elastic band in a sitting or supine position. Primary outcome measures included muscle strength, measured by percent knee extension muscle power to dry body weight (pKEMP-dBW), and physical performance, measured by short physical performance battery (SPPB). The adjusted mean differences in these variables during the 6 months were estimated using a multivariate linear regression model. RESULTS The mean age with standard deviation was 70 ± 11 years. One hundred and sixty patients (52.3%) were men and the dry weight was 55.6 ± 11.3 kg. Sarcopenia, defined as SPPB ≤8, was present in 21.4% patients. Their hemodialysis adequacy was acceptable, with a Kt/V of 1.65 ± 0.29, and their nutritional status was good, with a normalized protein catabolism rate of 0.89 ± 0.18 g/kg/day. During the 6 months, both pKEMP-dBW and SPPB showed a slight but significant increase with an adjusted mean difference of 2.8 (95% confidence interval 1.3-4.3, p < 0.001) and 0.6 (0.4-0.9, p < 0.001), respectively. CONCLUSIONS Six-month resistance training was associated with improved muscle strength and physical performance in patients with MHD.
Comprehensive Health Literacy and Health-Related Behaviors Within a General Japanese Population: Differences by Health Domains.
Asia-Pacific journal of public health. 2018;(8):717-726
The present study aimed to explore how different health-related domains of health literacy, as measured by the European Health Literacy Survey Questionnaire, were associated with health-related behaviors among a general population in Japan. We conducted a cross-sectional observational study of 1002 Japanese residents. Our questionnaire addressed socioeconomic status, health status, health-related behaviors, and health literacy. Among the 3 health-related domains of health literacy (health care, disease prevention, and health promotion), a multivariate model revealed that the disease prevention domain was associated with exercise behavior and alcohol consumption. The health promotion domain was associated with dietary behavior and exercise behavior. There were strong correlations among all health-related domains of health literacy; however, there were different associations between health literacy and health-related behaviors depending on those domains. Additional research is needed to determine how and to what extent each domain of health literacy is related to what health behaviors and outcomes.
A randomized, double-blind, placebo-controlled study on long-term efficacy and safety of ipragliflozin treatment in patients with type 2 diabetes mellitus and renal impairment: results of the long-term ASP1941 safety evaluation in patients with type 2 diabetes with renal impairment (LANTERN) study.
Diabetes, obesity & metabolism. 2015;(2):152-60
AIMS: To assess the effects of renal impairment (RI) on the efficacy and safety of ipragliflozin in patients with type 2 diabetes mellitus (T2DM). METHODS A cohort of Japanese patients with T2DM and mild to moderate RI and poor glycaemic control, despite diet/exercise therapy alone or diet/exercise therapy in combination with an oral hypoglycaemic agent (an α-glucosidase inhibitor, a sulfonylurea, or pioglitazone), were randomized in a double-blind manner to 50 mg ipragliflozin or placebo once daily for 24 weeks. The patients continued open-label ipragliflozin for a 28-week extension period (total treatment duration: 52 weeks). RESULTS Ipragliflozin significantly decreased glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) levels and body weight from baseline to week 24 (last observation carried forward) compared with placebo in all patients with RI. The decreases in HbA1c and FPG levels were statistically significant in patients with mild RI, but not in patients with moderate RI. Ipragliflozin significantly reduced body weight in both RI groups. The improvements in glycaemic control were maintained in the 28-week extension period. Ipragliflozin was associated with no clinically significant safety concerns, and its safety profiles were not influenced by the severity of RI. CONCLUSIONS Ipragliflozin significantly improved glycaemic control and body weight in patients with T2DM with mild RI, but did not improve glycaemic control in patients with moderate RI. Ipragliflozin is a valid treatment option for patients with mild RI but not those with moderate RI.
[Minilaparotomy in Pancreas-Preserving Total Duodenectomy for Familial Adenomatous Polyposis Associated with Spigelman Stage Ⅳ Duodenal Polyposis].
Gan to kagaku ryoho. Cancer & chemotherapy. 2015;(12):1761-3
INTRODUCTION Reports on pancreas-preserving total duodenectomy (PPTD) for duodenal polyposis (DP) in familial adenomatous polyposis (FAP) patients are rare. We herein report a case of PPTD performed by minilaparotomy for DP in an FAP patient. CASE A 27-year-old female FAP patient was diagnosed with Spigelman classification (SC) stage Ⅳ DP on gastroduodenoscopy. She underwent PPTD through a 7 cm upper abdominal incision. All polyps were confirmed as adenomas histopathologically. After 6 months of follow-up, complications related to total duodenectomy, such as weight loss, diabetes mellitus, and fatty liver have not been observed. DISCUSSION SC stage Ⅳ refers to non-advanced cancers, and PPTD is basically prophylactic surgery. Therefore, pancreatoduodenectomy seems too aggressive for SC stage Ⅳ patients. PPTD by minilaparotomy is suitable for young female patients for its curability, esthetic outcome, and safety.
Beneficial effects of probiotic bifidobacterium and galacto-oligosaccharide in patients with ulcerative colitis: a randomized controlled study.
BACKGROUND/AIM: In previous studies, we described the beneficial effects of bifidobacteria-fermented milk in patients with ulcerative colitis (UC). Here, we examined the effects of a live Bifidobacterium breve strain Yakult, a probiotic contained in bifidobacteria-fermented milk, and galacto-oligosaccharide (GOS) as synbiotics in UC patients. METHODS Forty-one patients with mild to moderate UC were assigned to two groups; one group was treated with the synbiotics and the other was not (control). The treatment group ingested 1 g of the probiotic powder (10(9) CFU/g) three times a day, and 5.5 g of GOS once a day for one year. At the start and the end of this study, colonoscopic index and the amount of myeloperoxidase in a lavage solution were used as disease activity indices. Bacterial counts in the feces at the start and the end of this study were also examined. RESULTS After a one-year treatment with the synbiotics, the clinical status of the UC patients as assessed by colonoscopy, significantly improved. Furthermore, the amount of myeloperoxidase in the lavage also decreased in these patients after the synbiotic treatment. The synbiotics significantly reduced the fecal counts of Bacteroidaceae and fecal pH. CONCLUSION Administration of live B. breve strain Yakult and GOS can improve the clinical condition of patients with UC. These results encouraged us to perform a large-scale randomized, placebo-controlled trial.
Laparoscopic resection of an epidermoid cyst originating from an intrapancreatic accessory spleen: report of a case.
Surgery today. 2010;(1):72-5
A 67-year-old man underwent an investigation of epigastric pain and weight loss. Preoperative imaging findings suggested the presence of a tumor, which developed as an epidermoid cyst and originated from an intrapancreatic accessory spleen; however, the possibility of malignancy could not be ruled out. We therefore performed a laparoscopic-assisted distal pancreatectomy with a splenectomy for both diagnostic and treatment purposes. Five laparoscopic ports were created. After the spleen and pancreatic tail were dissected from the retroperitoneum laparoscopically, they were pulled out through a 7-cm left subcostal incision and resected with an endoscopic linear stapler. The operative time was 227 min and the blood loss was 400 ml. The postoperative course was uneventful. The final pathological diagnosis was in agreement with the preoperative diagnosis. This case demonstrates that the minimally invasive approach of laparoscopic surgery can be used safely and successfully for difficult-to-diagnose pancreatic tumors. This is the first report describing a laparoscopic resection of an epidermoid cyst originating from an intrapancreatic accessory spleen.
Thoracic radiotherapy for mediastinal nodal recurrence.
Acta medica (Hradec Kralove). 2009;(1):23-5
Radiotherapy has been used to treat loco-regional recurrences located at various intra-thoracic sites, but long-term survival of these patients has been rarely observed. We report herein a lung adenocarcinoma patient with locoregional recurrence, who was successfully treated with high-dose radiotherapy. The patient could survive with no evidence of recurrence 5 years after thoracic irradiation. It is probably safe to administrate high-dose radiotherapy for some loco-regional recurrent patients with favorable prognostic factors such as good PS, no body weight loss. Further studies will be required to define a favorable subset of patients most likely to benefit from an aggressive approach.
Nonalcoholic steatohepatitis with improved hepatic fibrosis after weight reduction.
Internal medicine (Tokyo, Japan). 2004;(4):289-94
A 65-year-old woman was admitted to our hospital for an investigation of liver dysfunction. She had mild obesity with hyperlipidemia, but no history of alcohol abuse. Other known causes of liver dysfunction, such as viruses, autoimmunity and drug effects, were excluded. The liver histology was consistent with nonalcoholic steatohepatitis (NASH). After diagnosis of NASH, the patient started diet and exercise therapy and, in parallel with weight reduction, her liver function improved. One year after the therapy, a liver biopsy showed that steatosis, necroinflammation and even fibrosis were improved. Hence, here we report a case of NASH in which weight reduction was effective in improving both biochemical and histological findings.
[Cancer prevention in familial cancer].
Gan to kagaku ryoho. Cancer & chemotherapy. 2002;(4):545-9
We established a protocol for and will conduct an interventional randomized controlled trial for the prevention of colorectal cancer. The subjects will be 100 patients with hereditary non-polyposis colorectal cancer. Two regimens were formulated for the prevention of colorectal cancer. Regimen A is dietary guidance and ingestion of aged garlic extract (AGE) capsules, and regimen B is dietary guidance and non-function capsules. The main end point of the trial is number and size of colorectal adenomas after 2 years. Subject recruiting was started in March, 2002. The trial will be completed in September, 2005.