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Background and Aim Methods Results Conclusions Colorectal endoscopic submucosal dissection is a technically demanding procedure with a steep learning curve. In Japan, the National Cancer Center Hospital allows overseas doctors to participate in hands‐on training. We aimed to assess the colorectal endoscopic submucosal dissection performance and learning curve of an endoscopist who participated in hands‐on training.In this retrospective analysis using a prospectively collected database, 100 consecutive superficial colorectal tumors from 100 patients treated with endoscopic submucosal dissection by a colorectal surgeon between January 2020 and May 2024 were included. The cases were grouped into three learning periods: phase I (the initial 30 cases under local expert supervision before training in Japan), phase II (the middle 30 cases), and phase III (the last 40 cases). The primary outcome was resection speed.The median resection speed was 5, 11.7, and 13.2 cm2/h in phases I, II, and III, respectively. In matched data, the resection speeds in phases II and III were higher than that in phase I (P = 0.02 and P < 0.001, respectively). En bloc and R0 resection rates were 99% and 95%, respectively. The en bloc resection, R0 resection, and complication rates were not different between phases. Cumulative sum analysis of the resection speed revealed that proficiency was achieved after 36 cases.An endoscopist who underwent a tutored approach and hands‐on training in Japan achieved the proficiency benchmarks for colorectal endoscopic submucosal dissection after 36 cases. However, the endoscopist's extensive experience before training may contribute to excellent outcomes. [ABSTRACT FROM AUTHOR]

A comprehensive endoscopic small and large intestinal untargeted step biopsy procedure was conducted to compare gene expression between the normal intestinal mucosa of healthy individuals and that of patients with colorectal tumors. From 78 participants (healthy individuals [n = 17], patients with colorectal conventional adenomas [n = 6], patients with Tis–T1 colorectal cancer [n = 41], patients with T2–4 colorectal cancer [n = 14]), biopsies of normal mucosa of the terminal ileum, right-sided colon (cecum and ascending colon), and left-sided colorectum (descending colon, sigmoid colon, and rectum) were obtained using a lower gastrointestinal endoscope. RNA was extracted from all samples, and total transcriptome sequencing was performed. Transcriptome data from 388 samples was analyzed. DNA was also extracted from tumor biopsy tissues and analyzed for whole-exome sequencing. In healthy individuals, gene expression differed significantly among the terminal ileum, right-sided colon, and left-sided colorectum, presumably linked to embryological factors. There were differences in gene expression in the normal mucosa in colorectal cancer patients, compared to healthy controls. Patients with tumors, especially T2–4 colorectal cancer, showed considerable variation in gene expression in non-tumor tissues, even in the terminal ileum distant from the tumor site. Based on endoscopic biopsies, the results imply cancer-predisposing conditions in seemingly normal tissues. The present study points to the importance of small intestine and cancer-predisposing conditions in the colon of colorectal cancer patients, with possible implications for developing novel immunotherapy and other therapeutic modalities. [ABSTRACT FROM AUTHOR]

Objectives: Narrow‐band imaging (NBI) contributes to real‐time optical diagnosis and classification of colorectal lesions. The Japan NBI Expert Team (JNET) was introduced in 2011. The aim of this study was to explore the diagnostic accuracy of JNET when applied by European and Japanese endoscopists not familiar with this classification. Methods: This study was conducted by 36 European Society of Gastrointestinal Endoscopy (ESGE) and 49 Japan Gastroenterological Endoscopy Society (JGES) non‐JNET endoscopists using still images of 150 lesions. For each lesion, nonmagnified white‐light, nonmagnified NBI, and magnified NBI images were presented. In the magnified NBI, the evaluation area was designated by region of interest (ROI). The endoscopists scored histological prediction for each lesion. Results: In ESGE members, the sensitivity, specificity, and accuracy were respectively 73.3%, 94.7%, and 93.0% for JNET Type 1; 53.0%, 64.9%, and 62.1% for Type 2A; 43.9%, 67.7%, and 55.1% for Type 2B; and 38.1%, 93.7%, and 85.1% for Type 3. When Type 2B and 3 were considered as one category of cancer, the sensitivity, specificity, and accuracy for differentiating high‐grade dysplasia and cancer from the others were 59.9%, 72.5%, and 63.8%, respectively. These trends were the same for JGES endoscopists. Conclusion: The diagnostic accuracy of the JNET classification was similar between ESGE and JGES and considered to be sufficient for JNET Type 1. On the other hand, the accuracy for Types 2 and 3 is not sufficient; however, JNET 2B lesions should be resected en bloc due to the risk of cancers and JNET 3 can be treated by surgery due to its high specificity. [ABSTRACT FROM AUTHOR]

Pathologic sm2 carries a moderate risk of metastases even without other unfavorable factors, but positive horizontal margins have low local recurrence risk after en bloc resection: Referring to Santos-Antunes J et al. p. 235-244 and Haasnoot K et al. p. 245-251 Careful endoscopic assessment is typically performed to select patients with noninvasive lesions or superficially invasive cancer for ESD, with the avoidance of endoscopic resection in patients with endoscopic features of deeply invasive cancer. The authors did not report specifically whether there was any difference between en bloc resection and piecemeal resection in cases with an indeterminate horizontal margin (HMX). [Extracted from the article]

Objectives: To verify the efficacy and safety of red dichromatic imaging (RDI) in hemostatic procedures during endoscopic submucosal dissection (ESD). Methods: This is a multicenter randomized controlled trial of 404 patients who underwent ESD of the esophagus, stomach, colorectum. Patients who received hemostatic treatments by RDI during ESD were defined as the RDI group (n = 204), and those who received hemostatic treatments by white light imaging (WLI) were defined as the WLI group (n = 200). The primary endpoint was a shortening of the hemostasis time. The secondary endpoints were a reduction of the psychological stress experienced by the endoscopist during the hemostatic treatment, a shortened treatment time, and a non‐inferior perforation rate, in RDI versus WLI. Results: The mean hemostasis time in RDI (n = 860) was not significantly shorter than that in WLI (n = 1049) (62.3 ± 108.1 vs. 56.2 ± 74.6 s; P = 0.921). The median hemostasis time was significantly longer in RDI than in WLI (36.0 [18.0–71.0] vs. 28.0 [14.0–66.0] s; P = 0.001) in a sensitivity analysis. The psychological stress was significantly lower in RDI than in WLI (1.71 ± 0.935 vs. 2.03 ± 1.038; P < 0.001). There was no significant difference in the ESD treatment time between RDI (n = 161) and WLI (n = 168) (58.0 [35.0–86.0] vs. 60.0 [38.0–88.5] min; P = 0.855). Four perforations were observed, but none of them took place during the hemostatic treatment. Conclusions: Hemostatic treatment using RDI does not shorten the hemostasis time. RDI, however, is safe to use for hemostatic procedures and reduces the psychological stress experienced by endoscopists when they perform hemostatic treatment during ESD. UMIN000025134. [ABSTRACT FROM AUTHOR]

Objectives: The Japan Endoscopy Database Project was initiated to develop the world's largest endoscopy data repository. This study describes the first phase of the colonoscopy project in Japan. Methods: Data were aggregated offline by integrating information from the endoscopy database software from January 2015 through March 2017. The study population included all patients who underwent colonoscopy at eight centers. Results: A total of 31,395 patients who underwent 38,497 colonoscopy procedures were registered. The majority of procedures were performed for screening (n = 14,156), followed by fecal immunochemical test positivity (n = 3960), abdominal symptoms (n = 3864), post‐colorectal surgery surveillance (n = 3431), post‐endoscopic treatment surveillance (n = 3757), thorough pre‐treatment examination (n = 2822), and therapeutic purposes (n = 6507). In the screening group, advanced cancers, early cancers, and adenomas were diagnosed endoscopically in 2.1%, 1.3%, and 28.7% of cases, respectively, while in the fecal immunochemical test‐positive group, they were diagnosed in 2.5%, 1.9%, and 41.6% of cases, respectively. The incidence of complications was 0.177% and 0.152% in the screening and fecal immunochemical test‐positive groups, respectively. The therapeutic procedures included 1446 cold forceps polypectomy procedures, 4770 cold snare polypectomy procedures, 368 hot biopsies, 2998 hot snare polypectomy procedures, 9775 endoscopic or piecemeal endoscopic mucosal resections, and 1660 endoscopic submucosal dissections. A total of 173 procedure‐related complications (0.82%) occurred in 21,017 therapeutic procedures performed in 15,744 patients. Conclusions: The first phase of the Japan Endoscopy Database Project established the proportions of the diagnostic and therapeutic colonoscopy procedures, and complication rates in real‐world settings. [ABSTRACT FROM AUTHOR]

Accurate variant effect prediction has broad impacts on protein engineering. Recent machine learning approaches toward this end are based on representation learning, by which feature vectors are learned and generated from unlabeled sequences. However, it is unclear how to effectively learn evolutionary properties of an engineering target protein from homologous sequences, taking into account the protein's sequence-level structure called domain architecture (DA). Additionally, no optimal protocols are established for incorporating such properties into Transformer, the neural network well-known to perform the best in natural language processing research. This article proposes DA-aware evolutionary fine-tuning, or 'evotuning', protocols for Transformer-based variant effect prediction, considering various combinations of homology search, fine-tuning and sequence vectorization strategies. We exhaustively evaluated our protocols on diverse proteins with different functions and DAs. The results indicated that our protocols achieved significantly better performances than previous DA-unaware ones. The visualizations of attention maps suggested that the structural information was incorporated by evotuning without direct supervision, possibly leading to better prediction accuracy. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy and safety of oral sulfate solution administered using the same‐day dose and the split‐dose regimens with those of polyethylene glycol plus ascorbate solution, used for bowel preparation in Japanese patients undergoing colonoscopy. Methods: This multicenter (n = 13), randomized, active‐controlled, colonoscopist‐ and image evaluator‐blinded, noninferiority study with parallel‐group comparison recruited 632 patients from December 2018 to June 2019. Of these, 602 patients were divided into the oral sulfate solution same‐day dose group (n = 200); oral sulfate solution split‐dose group (n = 202); and polyethylene glycol plus ascorbate same‐day dose group (n = 200). Differences in the efficacy rates between the polyethylene glycol plus ascorbate group and each oral sulfate solution group were calculated using the asymptotic method. The safety of the oral sulfate solution was evaluated, based on the occurrence of adverse events and reactions. Results: Both oral sulfate solution protocols were confirmed as noninferior to the polyethylene glycol plus ascorbate protocol for bowel‐cleansing. The occurrence of adverse reactions was significantly lower in the oral sulfate solution same‐day dose group than in the polyethylene glycol plus ascorbate group (P = 0.010). The occurrence of adverse reactions was not significantly different between the oral sulfate solution split‐dose and the polyethylene glycol plus ascorbate group. Conclusions: Oral sulfate solution is not only safe and efficacious but also not inferior to polyethylene glycol plus ascorbate solution (active control). It could be used for bowel preparation in Japanese patients scheduled for colonoscopy (Clinical trial registration number: NCT03794310). [ABSTRACT FROM AUTHOR]

Morphological profiling is a combination of established optical microscopes and cutting-edge machine vision technologies, which stacks up successful applications in high-throughput phenotyping. One major question is how much information can be extracted from an image to identify genetic differences between cells. While fluorescent microscopy images of specific organelles have been broadly used for single-cell profiling, the potential ability of bright-field (BF) microscopy images of label-free cells remains to be tested. Here, we examine whether single-gene perturbation can be discriminated based on BF images of label-free cells using a machine learning approach. We acquired hundreds of BF images of single-gene mutant cells, quantified single-cell profiles consisting of texture features of cellular regions, and constructed a machine learning model to discriminate mutant cells from wild-type cells. Interestingly, the mutants were successfully discriminated from the wild type (area under the receiver operating characteristic curve = 0.773). The features that contributed to the discrimination were identified, and they included those related to the morphology of structures that appeared within cellular regions. Furthermore, functionally close gene pairs showed similar feature profiles of the mutant cells. Our study reveals that single-gene mutant cells can be discriminated from wild-type cells based on BF images, suggesting the potential as a useful tool for mutant cell profiling. [ABSTRACT FROM AUTHOR]

The Colonoscopy Screening and Surveillance Guidelines were developed by the Japan Gastroenterological Endoscopy Society as basic guidelines based on the scientific methods. The importance of endoscopic screening and surveillance for both detection and post‐treatment follow‐up of colorectal cancer has been recognized as essential to reduce disease mortality. There is limited high‐level evidence in this field; therefore, we had to focus on the consensus of experts. These clinical practice guidelines consist of 20 clinical questions and eight background knowledge topics that have been determined as the current guiding principles. [ABSTRACT FROM AUTHOR]

Magnifying chromoendoscopy using crystal violet staining showed a type II open pit pattern in the slightly elevated central area and the reddish nodule on the oral side of the lesion (Fig. Endocytoscopy using 1.0 % methylene blue and 0.05 % crystal violet showed oval lumens and small round nuclei in the slightly elevated area and in the reddish nodule on the anal side of the lesion (Fig. Magnifying chromoendoscopy showed suspected dysplasia in the reddish nodule on the anal side of the lesion, but endocytoscopy was correctly able to identify the dysplasia in the nodule on the oral side of the lesion from the findings of irregular lumens and swollen roundish nuclei. [Extracted from the article]

Background: This study aimed to demonstrate the feasibility of endoscopic hand-suturing (EHS) and attainability of sustained closure after colorectal endoscopic submucosal dissection (ESD).Methods: EHS was defined as uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope needle holder. Following individual EHS training using an ex vivo porcine colonic model, two experienced endoscopists performed EHS. Repeat colonoscopy was performed on the third or fourth day after ESD to examine the EHS site. The primary end point was the complete EHS closure rate, and secondary end points were sustained closure and post-ESD bleeding rates.Results: 11 lesions were included. Median size of the mucosal defect was 38 mm (range 25 - 55 mm) and the lesion characteristics were as follows: lower rectum/upper rectum/ascending colon/cecum = 3/3/2/3, and 0-IIa/0-Is + IIa/others = 5/4/2. EHS was not attempted in two patients owing to difficulty in colonoscope reinsertion after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and the complete EHS closure rate was 73 %. Median procedure time for suturing was 56 minutes (range 30 - 120 minutes) and median number of stitches was 8 (range 6 - 12). Sustained closure and post-ESD bleeding rates were 64 % and 9 %, respectively.Conclusions: EHS achieved complete and sustained closure in the colorectum. However, EHS is not currently clinically applicable given the long procedure time. Further modifications of the technique and devices are desirable. [ABSTRACT FROM AUTHOR]

Yao I et al i .[1] developed the colorectal cancer invasion calculation (CICC), an artificial intelligence system for diagnosing colorectal tumor depth. If sufficient training images are available, the most intuitive machine learning model for predicting tumor depth using clinical data and endoscopic images can be a one-stage machine learning model that predicts the output using all inputs. [Extracted from the article]

In protein engineering, generation of mutagenesis libraries is a key step to study the functions of mutants. To generate mutants with a desired composition of amino acids (AAs), a codon consisting of a mixture of nucleotides is widely applied. Several computational methods have been proposed to calculate a codon nucleotide composition for generating a given amino acid profile based on mathematical optimization. However, these previous methods need to manually tune weights of amino acids in objective functions, which are time-consuming and, more importantly, lack publicly available software implementations. Here, we develop CodonAdjust, a software to adjust a codon nucleotide composition for mimicking a given amino acid profile. We propose different options of CodonAdjust, which provide various customizations in practical scenarios such as setting a guaranteeing threshold for the frequencies of amino acids without any manual tasks. We demonstrate the capability of CodonAdjust in the experiments on the complementarity-determining regions (CDRs) of antibodies and T-cell receptors (TCRs) as well as millions of amino acid profiles from Pfam. These results suggest that CodonAdjust is a productive software for codon design and may accelerate library generation. CodonAdjust is freely available at https://github.com/tiffany-nguyen/CodonAdjust. Paper edited by Dr. Jeffery Saven, Board Member for PEDS. [ABSTRACT FROM AUTHOR]

We described two new species collected from Miscanthus spp. in Thailand and Taiwan. One of the new species, Stigmaeopsis inthanonsis Saito, Kongchuensin & Sahara n. sp., was found in Thailand (Inthanon National Park). The other species from Taiwan, named Stigmaeopsis formosa Saito, Chao & Sato n. sp. was previously referred to as T-form or ML form of Stigmaeopsis miscanthi (Saito). Thus 15 species are now involved in the genus Stigmaeopsis. Because five species inhabiting Miscanthus grasses are resemble together, we call them as Stigmaeopsis miscanthi species group. An updated key to all known species of Stigmaeopsis is proposed. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested deep learning to be a highly effective approach for screening lead compounds for new drugs. Several deep learning models have been developed by addressing the use of various kinds of fingerprints and graph convolution architectures. However, these methods are either advantageous or disadvantageous depending on whether they (1) can distinguish structural differences including chirality of compounds, and (2) can automatically discover effective features. Results: We developed another deep learning model for compound classification. In this method, we constructed a distributed representation of compounds based on the SMILES notation, which linearly represents a compound structure, and applied the SMILES-based representation to a convolutional neural network (CNN). The use of SMILES allows us to process all types of compounds while incorporating a broad range of structure information, and representation learning by CNN automatically acquires a low-dimensional representation of input features. In a benchmark experiment using the TOX 21 dataset, our method outperformed conventional fingerprint methods, and performed comparably against the winning model of the TOX 21 Challenge. Multivariate analysis confirmed that the chemical space consisting of the features learned by SMILES-based representation learning adequately expressed a richer feature space that enabled the accurate discrimination of compounds. Using motif detection with the learned filters, not only important known structures (motifs) such as protein-binding sites but also structures of unknown functional groups were detected. Conclusions: The source code of our SMILES-based convolutional neural network software in the deep learning framework Chainer is available at http://www.dna.bio.keio.ac.jp/smiles/, and the dataset used for performance evaluation in this work is available at the same URL. [ABSTRACT FROM AUTHOR]

1 Endoscopic views of the multiple colorectal neoplasms, with a schematic marking where they were identified, showing a 10-mm 0-Is lesion in the cecum; a 12-mm lesion at the hepatic flexure; a 40-mm type 2 lesion in the transverse colon; a 15-mm 0-IIa lesion in the transverse colon; a 0-IIb lesion in the transverse colon; a 40-mm 0-Is + IIa lesion in the sigmoid colon; and a 35-mm 0-IIb laterally spreading tumor, non-granular type, in the descending colon. Multiple flat non-polypoid colorectal neoplasms with diverse morphologies, including a type 2 lesion, were detected by subsequent colonoscopy (Fig. We report the case of a patient with multiple flat non-polypoid colorectal neoplasms, among which a 0-IIb (LST-NG) lesion was appropriately diagnosed with image-enhanced endoscopy and treated with endoscopic submucosal dissection (ESD) [2]. [Extracted from the article]

This Editorial refers to the article by McCarty et al., p 851–860 of this issue. [ABSTRACT FROM AUTHOR]

1 Endoscopic images showing whitish nodules and elevated papillary lesions of various sizes in the anal transitional zone: a white light; b chromoendoscopy; c narrow-band imaging (NBI). The pathological findings were of low grade squamous intraepithelial lesion in the protruding lesions and high grade squamous intraepithelial lesion in the flat area (Fig. In contrast, the area of high grade squamous intraepithelial lesion is rather flat. b Immunohistochemical staining for p16 shows a block-positive pattern in the area of high grade squamous intraepithelial lesion. [Extracted from the article]

Background: The aim of this pilot study is to investigate the diagnostic yield of probe-based confocal laser endomicroscopy (pCLE) in the evaluation of depth of invasion in colorectal lesions.Methods: Patients with colorectal lesions eligible for either endoscopic treatment or surgery were enrolled in the study. Tumor’s depth of invasion was classified as mucosal or slight submucosal (M-SM1) and deep submucosal invasion or deeper (SM2 or deeper). White light endoscopy (WLE), magnifying narrow band imaging (M-NBI), and magnifying chromoendoscopy (M-CE) were used to assess colorectal lesions, and pCLE was used to identify tumor’s features related to SM2 or deeper. The diagnostic classification of depth of invasion was obtained by correlating pCLE findings with histology results (on-site diagnosis). All colorectal lesions were stratified by a second endoscopist who was blinded to any clinical and histological information with the use of WLE, M-NBI, M-CE, and pCLE (off-line review).Results: A total of 22 colorectal lesions were analyzed: seven were adenoma, ten intramucosal cancer, and five SM2 or deeper cancer. With respect to pCLE findings, loss of crypt structure was seen in all SM2 or deeper cancers and only in one M-SM1 lesion. Sensitivity, specificity, and accuracy of WLE, M-NBI, and M-CE in off-line review were 60/94/86, 60/94/86, and 80/94/91%, respectively. Sensitivity/specificity/accuracy of pCLE in off-line review were 80/94/91%, respectively. The inter-observer agreement of pCLE between on-site diagnosis and off-line review was 0.64 (95%CI 0.27-1.0).Conclusions: pCLE may represent a useful tool to evaluate the depth of invasion in colorectal lesions. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) has become popular as an alternative to laparoscopy-assisted colectomy (LAC) for early colorectal cancer.Aim: To validate postoperative quality of life (QOL) based on subjective symptoms of patients from questionnaire survey.Methods: We prospectively enrolled patients planned to undergo ESD for adenoma or Tis/T1a cancer at our institution between December 2011 and January 2013. Controls were prospectively enrolled LAC patients diagnosed with T1b cancer. Patients answered questionnaire survey on QOL on postoperative day (POD) 1 and POD14. Questions were scored using visual analog scale (0 points = worst condition, 100 points = best condition) and were classified into six categories: health status, mental status (MeS), motor status (MoS), bodily painless, passage and anorectal function (PAF), and stress for the treatment. Total score was also calculated. We compared the median scores among categories using the Wilcoxon rank-sum test.Results: A total of 82 ESDs and 41 LACs were included. Median score for the factors in questionnaire (POD1/POD14) in ESDs versus LACs for colonic lesion (rectal lesion) was as follows: MeS, 74/83 versus 54/73 (72/85 vs. 42/62); MoS, 98/96 versus 51/75 (95/90 vs. 66/67); PAF, 90/96 versus 80/80 (90/95 vs. 70/53); total score, 83/91 versus 58/75 (81/87 vs. 51/66). These items showed statistical significant differences between ESDs and LACs.Conclusions: Postoperative QOL and symptoms are significantly better on POD1 and POD14 following ESD compared with LAC. [ABSTRACT FROM AUTHOR]

Most of the detected lesions are so-called 0-IIa depression with adenomatous histology, and de novo cancers are usually detected at the more advanced stage of submucosal deep invasive cancer with a 0-IIa + IIc morphology, which is an indication for surgery [1]. Recently, artificial intelligence (AI) has been used in clinical practice for tumor detection to improve the adenoma detection rate in superficial depressed tumors [2][3]. [Extracted from the article]

1. A type of arms race that includes predation, counterattacks and cross-counterattacks occurs between the phytophagous mite Stigmaeopsis nanjingensis ( Ma et Yuan), which lives in self-woven nests and exhibits cooperative sociality, and its specialised phytoseiid mite predator, Typhlodromus bambusae Ehara. 2. First, the efficiency of the S. nanjingensis (prey) counterattacking T. bambusae (predator) was observed. The prey females frequently locked the immature predators out of their nests using silk web, and the predators subsequently died of starvation. Furthermore, the prey males often killed immature T. bambusae mites after they invaded the nests. 3. This reversal of roles in the predator-prey system was then re-reversed (returned to a normal state) by the behaviour of T. bambusae females. Immature predators could maintain their predacious natures due to the presence of attending adult females, which are able to cope with the prey counterattack behaviours. [ABSTRACT FROM AUTHOR]

Mucosal-associated invariant T cells (MAITs) are innate-like T cells that play a pivotal role in the host defense against infectious diseases, and are also implicated in autoimmune diseases, metabolic diseases, and cancer. Recent studies have shown that induced pluripotent stem cells (iPSCs) derived from MAITs selectively redifferentiate into MAITs without altering their antigen specificity. Such a selective differentiation is a prerequisite for the use of MAITs in cell therapy and/or regenerative medicine. However, the molecular mechanisms underlying this phenomenon remain unclear. Here, we performed methylome and transcriptome analyses of MAITs during the course of differentiation from iPSCs. Our multi-omics analyses revealed that recombination-activating genes (RAG1 and RAG2) and DNA nucleotidylexotransferase (DNTT) were highly methylated with their expression being repressed throughout differentiation. Since these genes are essential for V(D)J recombination of the T cell receptor (TCR) locus, this indicates that nascent MAITs are kept from further rearrangement that may alter their antigen specificity. Importantly, we found that the repression of RAGs was assured in two layers: one by the modulation of transcription factors for RAGs, and the other by DNA methylation at the RAG loci. Together, our study provides a possible explanation for the unaltered antigen specificity in the selective differentiation of MAITs from iPSCs. [ABSTRACT FROM AUTHOR]

Hybrid argon plasma coagulation (hAPC) is an alternative ablation technique that can be used to perform margin ablation. Thermal ablation of resection margins after EMR using snare-tip soft coagulation has been shown to decrease the risk of local recurrence in a randomized trial [1]. Thermal ablation of mucosal defect margins reduces adenoma recurrence after colonic endoscopic mucosal resection. [Extracted from the article]

B Effective use of image-enhanced endoscopy and endoscopic submucosal dissection for multiple flat non-polypoid colorectal neoplasms b Uozumi T, Saito Y, Toyoshima N et al. Effective use of image-enhanced endoscopy and endoscopic submucosal dissection for multiple flat non-polypoid colorectal neoplasms. [Extracted from the article]

The article discusses a pipeline called VeloPro that integrates Ribo-seq data and AlphaFold2-predicted 3D protein structure information to analyze the association patterns between translation velocity and protein structure features in various organisms. The study reveals that these association patterns differ across organisms, partially reflecting their taxonomical relationship. The article provides insights into the relationship between translation velocity and protein features, such as secondary structure elements, proline residue, positively charged amino acids, relative accessible surface area, intrinsically disordered region scores, and local contact order. The findings contribute to a better understanding of factors that affect co-translational folding. [Extracted from the article]

Such a process is unstructured and makes the integration of lesion-specific results into an endoscopic database difficult.1,2 Although there are reports of English pathology results that are structured using natural language-processing technologies,3-5 to the best of our knowledge, no Japanese pathology reports have been reported. ACKNOWLEDGMENTS We thank Dr Yoji Takeuchi, Dr Satoki Shichijo (Osaka International Cancer Institute), Dr Yasushi Oda (Oda GI Endoscopy and Gastroenterology Clinic), Dr Kiyonori Kobayashi, Dr Miwa Sada (Kitasato University), Dr Akira Yokoyama, Dr Takahiro Utsumi (Kyoto University), Dr Takahisa Matsuda, Dr Nozomu Kobayashi, Dr Masau Sekiguchi, Dr Hiroyuki Takamaru, Dr Yasuhiko Mizuguchi (National Cancer Center Hospital), Dr Hiroaki Ikematsu (National Cancer Center Hospital East), Dr Koji Matsuda (Shizuoka Medical Center), Dr Masayuki Kato (The Jikei University Katsushika Medical Center), Dr Yosuke Tsuji, Dr Daisuke Oki (The University of Tokyo), Dr Satoshi Teramukai, and Mr Go Horiguchi (Kyoto Prefectural University of Medicine) for their cooperation. [Extracted from the article]

Background: Endoscopic submucosal dissection (ESD) has recently provided a new treatment strategy for large colorectal neoplasms, as an alternative to laparoscopy-assisted colectomy (LAC). Prospective comparative data on the perioperative course of ESD vis-à-vis LAC are scarce.Methods: We prospectively evaluated the perioperative course of colorectal ESD in 300 patients. We evaluated en bloc and curative resection, procedure duration, postoperative parameters [white blood cell count (WBC), C-reactive protein (CRP), and hemoglobin], pain, recovery duration (time to achieve full mobilization, normal diet, and length of hospitalization), and complications. We also prospectively evaluated 190 patients undergoing LAC as a control group.Results: The median size of the lesions was 30 mm for ESDs (LACs: 20 mm). The median procedure time was 90 min for ESDs (LACs: 185 min). Postoperative pyrexia was reported in 4 % of ESDs (LACs: 54 %). Only 4 % of ESDs required analgesia (LACs: 61 %). Between the preoperative period and postoperative day 1, the mean difference in WBC and CRP was +1,300/μl for ESDs (LACs: +3,100/μl), and +0.91 mg/dl for ESDs (LACs: +3.96 mg/dl), respectively. A ≥2 g/dl decrease in hemoglobin was observed in 5 % of ESDs (LACs: 30.0 %). Complications were seen in 7 % of ESDs (LACs: 15 %). The rate of delayed bleeding and perforation was 5 and 1.7 % of ESDs, respectively. Although only one of them required laparotomy for peritonitis caused by delayed perforation, others could be managed endoscopically. Additional LAC was required in 16 ESDs due to redefined risk for lymph node metastases. The median hospital stay was 5 days for ESDs (LACs: 10 days). These were consecutive patients with prospective data collection.Conclusions: Colorectal ESD is effective, minimally invasive and safe in terms of periperative clinical course. Colorectal ESD provides advantages for treatment of large adenomas and early cancers with no risk of lymph node metastasis. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) has recently provided a new treatment strategy for large colorectal neoplasms, as an alternative to laparoscopy-assisted colectomy (LAC). Prospective comparative data on the perioperative course of ESD vis-à-vis LAC are scarce. Methods: We prospectively evaluated the perioperative course of colorectal ESD in 300 patients. We evaluated en bloc and curative resection, procedure duration, postoperative parameters [white blood cell count (WBC), C-reactive protein (CRP), and hemoglobin], pain, recovery duration (time to achieve full mobilization, normal diet, and length of hospitalization), and complications. We also prospectively evaluated 190 patients undergoing LAC as a control group. Results: The median size of the lesions was 30 mm for ESDs (LACs: 20 mm). The median procedure time was 90 min for ESDs (LACs: 185 min). Postoperative pyrexia was reported in 4 % of ESDs (LACs: 54 %). Only 4 % of ESDs required analgesia (LACs: 61 %). Between the preoperative period and postoperative day 1, the mean difference in WBC and CRP was +1,300/μl for ESDs (LACs: +3,100/μl), and +0.91 mg/dl for ESDs (LACs: +3.96 mg/dl), respectively. A ≥2 g/dl decrease in hemoglobin was observed in 5 % of ESDs (LACs: 30.0 %). Complications were seen in 7 % of ESDs (LACs: 15 %). The rate of delayed bleeding and perforation was 5 and 1.7 % of ESDs, respectively. Although only one of them required laparotomy for peritonitis caused by delayed perforation, others could be managed endoscopically. Additional LAC was required in 16 ESDs due to redefined risk for lymph node metastases. The median hospital stay was 5 days for ESDs (LACs: 10 days). These were consecutive patients with prospective data collection. Conclusions: Colorectal ESD is effective, minimally invasive and safe in terms of periperative clinical course. Colorectal ESD provides advantages for treatment of large adenomas and early cancers with no risk of lymph node metastasis. [ABSTRACT FROM AUTHOR]

Background/Aims: This study aimed to analyze the endoscopic mucosal resection (EMR) with a novel uniquely shaped, double-loop snare (Dualoop, Medico's Hirata Inc., Tokyo, Japan) for colorectal polyps. Methods: This was a clinical trial conducted in two referral centers, Kyoto Prefectural University of Medicine and National Cancer Center Hospital in Japan. First, the firmness of various snares including 'Dualoop' was experimentally analyzed with a pressure gauge. Five hundred and eighty nine consecutive polyps that underwent EMR with 'Dualoop' were compared to 339 polyps with the standard round snare. Lesion characteristics, en bloc resection, and complications were analyzed. Results: 'Dualoop' had the most firmness among the various snares. The average tumor size was 9.3 mm (5-30), and en bloc resection was achieved in 95.4%. The rate of en bloc resection for middle polyps 15-19 mm in diameter was significantly higher with the 'Dualoop' than that with the round snare (97.9 vs. 80.0%, p < 0.05). The rate of en bloc resection was 64.7% for large polyps ≥20 mm in diameter using 'Dualoop'. Higher age, larger tumor size, and superficial polyps were associated with the failure of en bloc resection. Conclusion: EMR with 'Dualoop' was effective for resecting both middle and large polyps en-bloc. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In the two-spotted spider mite Tetranychus urticae (Acari: Tetranychidae), because only the first mating results in fertilisation, adult males guard quiescent deutonymph females, the stage immediately before adult emergence. Previous studies showed that T. urticae males prefer to guard older rather than younger females. However, as previous experimental designs have included uncertain factors, findings have not always been sufficiently rigorous. Therefore, we reexamined whether T. urticae males discriminate between the females closest to becoming receptive and younger females. One male was introduced onto leaf squares with two differently aged quiescent deutonymph females, with time lags between the females of 3, 6, 12 or 23 h, and whether the older or younger female was guarded was recorded. When the time lags between the females were 3, 6 or 12 h, males showed no preferences. Males preferred older females over younger ones only when the time lag was 23 h. Under non-choice conditions, fewer males guarded the 23-h younger females than other older females, suggesting that the attractiveness of the younger females is weaker than older females. Our results are not fully consistent with previous studies; T. urticae males do not obviously discriminate between females closest to becoming receptive and younger females. [ABSTRACT FROM AUTHOR]

Background and Aim In recent years, the effectiveness of colorectal endoscopic submucosal dissection ( ESD) has been increasingly reported. Herein, we highlight the most recent developments and technical advantages of colorectal ESD compared to EMR and minimally invasive surgery. Methods All candidate lesions for ESD were confirmed as being intramucosal tumors by colonoscopy. Presently, the indications for colorectal ESD approved by the Japanese government's medical insurance system are early colorectal cancers with a maximum tumor size of 2-5 cm; however, many early cancers >5 cm have been treated by ESD in referral centers. Results The primary advantage of ESD compared to endoscopic mucosal resection ( EMR) is a higher en-bloc resection rate for large colonic tumors that had previously been treated by surgery. ESD has several advantages compared to other therapeutic modalities, such as being a safer technique and providing better quality of life. For rectal cancer treatment, a longer procedure time is required for laparoscopic assisted colectomy, whereas trans-anal resection and trans-anal endoscopic microsurgery are more invasive than ESD with a significantly higher recurrence rate. Accordingly, ESD is the preferred choice for early colorectal cancers when there is no risk of lymph-node metastasis. Conclusion ESD is an effective procedure for treating non-invasive non-polypoid colorectal tumors. These tumors may be difficult to resect en bloc by conventional EMR. The use of ESD results in a higher en-bloc resection rate and is less invasive than surgery. [ABSTRACT FROM AUTHOR]

To date, few reports focused primarily on detecting colorectal laterally spreading tumors (LSTs) have been published. The aim of this study was to determine the visibility of LSTs on computed tomographic colonography (CTC) compared with that on colonoscopy as a standard. We retrospectively reviewed and matched data on endoscopic and CTC reports in 157 patients (161 LSTs) who received a multidetector CT scan using contrast media immediately after total colonoscopy at the National Cancer Center Hospital in Tokyo, Japan, between December 2005 and August 2010. The results of the total colonoscopy were known at the time of the CTC procedure and reading. Of the 161 LSTs detected on colonoscopy, 138 were observed and matched by CTC (86%). Of the 91 granular type LSTs (LST-Gs), 88 (97%) were observed and matched, while of the 70 non-granular type LSTs (LST-NGs), 50 (71%) were observed and matched by CTC (p < 0.0001). CTC enabled observation of 73% (22/30) of 20-29 mm, 83% (35/42) of 30-39 mm, 88% (49/56) of 40-59 mm, and 97% (32/33) of =60 mm tumors. The rate of observed LSTs by CTC was 86% (97% of LST-G, 71% of LST-NG) of the LSTs found during total colonoscopy. [ABSTRACT FROM AUTHOR]

Background: Conventional endoscopic resection (CER) for early colorectal neoplasia (CRN) is widely accepted as a minimally invasive treatment. Endoscopic submucosal dissection (ESD) was developed in Japan to resect larger lesions, but ESD was not covered by the Japanese national health insurance until April 2012. In addition, treatment strategies vary considerably among medical facilities. To evaluate the current situation in Japan regarding endoscopic treatment of CRNs measuring ≥20 mm, we conducted a prospective multicenter study at 18 medium-volume and high-volume specialized facilities in cooperation with the Japan Society for Cancer of the Colon and Rectum (JSCCR). Methods: The JSCCR conducted a multicenter, observational study of all patients treated by CER and ESD of CRNs measuring ≥20 mm. Results: From October 2007 to December 2010, CERs and ESDs were performed on 1,845 CRNs (CERs 1,029; ESDs 816). Lesions diagnosed as protruded, flat, and depressed totaled 541, 1224, and 48, respectively. En bloc resection rates and mean procedure times for CER/ESD were 56.9 %/94.5 % ( P < 0.01) and 18 ± 23 min/96 ± 69 min, respectively. The average ESD procedure time was 129 ± 83 min in the ≥40-mm group. As lesion size increased, the CER en bloc resection rate decreased significantly (trend P < 0.01), but the ESD en bloc resection rate remained over 93 %. Perforation and delayed bleeding rates of CER/ESD were 0.8 %/1.6 % ( P < 0.05) and 2 %/2.2 % ( P = 0.3), respectively. Conclusions: The en bloc resection rate for ESD was significantly higher than for CER, although complication rates were fairly low. Despite a longer procedure time, safety of colorectal ESD has improved in various facilities in Japan. However, ESD for lesions measuring ≥40 mm must be performed by experienced endoscopists due to the longer procedure time. [ABSTRACT FROM AUTHOR]

Due to the widespread acceptance of gastric and esophageal endoscopic submucosal dissections (ESDs), the number of medical facilities that perform colorectal ESDs has grown and the effectiveness of colorectal ESD has been increasingly reported in recent years. The clinical indications for colorectal ESD at the National Cancer Center Hospital, Tokyo, Japan include laterally spreading tumor (LST) nongranular type lesions >20 mm and LST granular type lesions >30 mm. In addition, 0-IIc lesions >20 mm, intramucosal tumors with nonlifting signs and large sessile lesions, all of which are difficult to resect en bloc by conventional endoscopic mucosal resection (EMR), represent potential candidates for colorectal ESD. Rectal carcinoid tumors less than 1 cm in diameter can be treated simply, safely, and effectively by endoscopic submucosal resection using a ligation device and are therefore not indications for ESD. The en bloc resection rate was 90%, and the curative resection rate was 87% for 806 ESDs. The median procedure time was 60 minutes, and the mean size for resected specimens was 40 mm (range, 15 to 150 mm). Perforations occurred in 23 (2.8%) cases, and postoperative bleeding occurred in 15 (1.9%) cases, but only two perforation cases required emergency surgery (0.25%). ESD was an effective procedure for treating colorectal tumors that are difficult to resect en bloc by conventional EMR. ESD resulted in a higher en bloc resection rate as well as decreased invasiveness in comparison to surgery. Based on the excellent clinical results of colorectal ESDs in Japan, the Japanese healthcare insurance system has approved colorectal ESD for coverage. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic submucosal dissection (ESD) has recently been applied to treatment of colorectal neoplasia; however, its safety and efficacy in terms of follow-up outcomes in elders have not been thoroughly examined. The aim of this study is to describe the clinical outcomes of colorectal ESD in elderly patients. Methods: Two groups of patients, elderly (≥75 years of age) and non-elderly (<75 years of age), who underwent colorectal ESD at the National Cancer Center Hospital from February 1998 to December 2010 were retrospectively compared on the following measures: tumor size, procedure time, complication rates, en bloc resection rates, and curative resection rates. We also investigated the follow-up outcomes in non-curative resection cases. Results: Of 614 consecutive patients treated by colorectal ESD, 125 (20.4 %) comprised the elderly group, and 489 patients (79.6 %) comprised the non-elderly group. No significant differences were observed between the two groups in terms of tumor size, procedure time, complication rates, en bloc resection rates, and curative resection rates. Of the patients who underwent non-curative resection, 7/19 (36.8 %) and 47/63 (74.6 %) in the elderly and non-elderly group, respectively, underwent additional treatment. Among the elderly patients who were followed up without additional treatment, no case of local recurrence, residual lesions, or distant metastases was observed during the observation period. Conclusion: Treatment outcomes of colorectal ESD were equivalent in both groups. However, many of the non-curative cases in the elderly patients were followed up without additional treatment. Future studies should focus on the outcome in such patients to confirm the feasibility of colorectal ESD in elderly patients. [ABSTRACT FROM AUTHOR]

Background: Previous studies have yielded conflicting results on the adenoma detection rate with narrow band imaging (NBI) compared with white light imaging (WLI). To overcome the confounding factors of these studies, we aimed to evaluate the colonic adenoma detection rate with primary NBI versus that with primary WLI by using consistent NBI system, endoscope, and imaging settings, and experienced colonoscopists. Methods: In this multicenter prospective trial, 813 patients were randomized to undergo high-definition, tandem colonoscopy in the right colon with either NBI followed by WLI (NBI-WLI group) or WLI followed by NBI (WLI-NBI group). The NBI settings were fixed at surface structure enhancement level A-5 and adaptive index of hemoglobin color enhancement level 3. All detected polyps were resected or biopsied for histopathological analysis. The primary and secondary outcome measures were the adenoma detection rates and miss rates, respectively, with primary imaging. Results: The NBI-WLI and WLI-NBI groups comprised 389 and 393 patients, respectively, who met the inclusion criteria. The groups did not differ significantly in age, gender, institution, indication for colonoscopy, bowel preparation, or observation time. The adenoma detection rates of primary NBI and WLI were 42.3 and 42.5 %, respectively [difference not significant (NS)]. The adenoma miss rate was significantly less with primary NBI than with primary WLI (21.3 vs. 27.8 %; p = 0.03). Conclusions: NBI does not improve the adenoma detection rate during primary colonoscopy; however, it has a lower miss rate for adenoma lesions in the proximal colon than WLI. [ABSTRACT FROM AUTHOR]

Aim: The primary purpose of this questionnaire survey study was to determine the current status of colorectal endoscopic submucosal dissection (ESD) in specialized Japanese referral centers before and after introduction of a government-approved advanced medical treatment system; and, secondly, to determine the current status of colorectal ESD in other Asian specialized referral centers. Methods: A total of 1321 colorectal ESDs were performed in 11 institutions including two Asian centers outside Japan. Results: Overall en-bloc resection, curative resection, R0 resection, perforation, delayed bleeding and emergency surgery rates were 95.4%, 89.1%, 87.2%, 2.9%, 2.5% and 0.2%, respectively. Similar clinical results were reported in the two Asian centers. Conclusion: There were no significant differences with regards to clinical results between the two periods although the perforation rate decreased from 3.3% to 2.4%. In addition, colorectal ESD has become increasingly standardized technically at specialized referral centers not only in Japan, but several other Asian referral institutions as well. [ABSTRACT FROM AUTHOR]

We report the successful production of subradiant states of a two-atom system in a three-dimensional optical lattice starting from doubly occupied sites in a Mott insulator phase of a quantum gas of atomic ytterbium. We can selectively produce either a subradiant 1g state or a superradiant Ou state by choosing the excitation laser frequency. The inherent weak excitation rate for the subradiant 1g, state is overcome by the increased atomic density due to the tight confinement in a three-dimensional optical lattice. Our experimental measurements of binding energies, linewidth, and Zeeman shift confirm the observation of subradiant levels of the 1g state of the Yb2 molecule. [ABSTRACT FROM AUTHOR]

Background and Aims: The change of therapeutic strategy for large colorectal tumors after the introduction of endoscopic submucosal dissection (ESD) has not yet been clarified. The aim of this study was to estimate the impact of ESD as an initial treatment strategy. Methods: A questionnaire was administered to nine expert panelists in colorectal ESD. The questionnaire used retrospective data from consecutive case series. Forty-seven cases of early colorectal tumors (≥ 20 mm) were included. Endoscopic growth types were 25 laterally-spreading tumors (LST) of granular type (G), 15 LST of non-granular types (NG), and seven protruded types. Pathological diagnoses included 15 adenomas (Ad), 18 intramucosal cancers (M), three submucosally-shallow invasive cancers (< 1000 µm) (SMs), and 11 submucosally-deep invasive cancers (≥ 1000 µm) (SMd). The expert panelists completed questionnaires about recommended initial treatment under suppositions of before and after the introduction of ESD. Over-surgery was defined as surgery for Ad, M, and SMs. Non-curative endoscopic resection (ER) was defined as ER for SMd. Results: After the introduction of ESD, the reduction in the over-surgery rate was estimated at 10.8% for Ad, M, and SMs, and the increase in the non-curative ER rate was estimated at 27.2% for SMd. By endoscopic growth type, the reduction of over-surgery rates for LST-NG, LST-G, and protruded type was 15.5%, 10.5%, and 2.2%, respectively. Conclusions: The endoscopists changed their therapeutic strategy for large colorectal tumors to reduce over-surgery, especially in LST-NG, demonstrating the impact of ESD. [ABSTRACT FROM AUTHOR]

im: Submucosal elevation solution is an essential element used in endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for colorectal lesions. Therefore, it is important to select a suitable solution for the endoscopic procedure. The aim of the present study was to examine the real time vertical-to-horizontal (V-H) ratio physical effect of submucosal elevation solution during colorectal EMR. Methods: This was a prospective randomized study carried out at an endoscopy centre in a Hong Kong hospital. A total of 10 patients with 15 colorectal adenoma requiring EMR were recruited. The studied submucosal elevation solutions included normal saline, glycerol and hyaluronic acid. Before EMR, 3 mL of these solutions were injected in the submucosal space, one solution at a time. The vertical and horizontal length of the elevated submucosal space was measured by miniprobe ultrasound. V-H ratios of different solutions were calculated and compared. Vertical distance, horizontal distance and V-H ratio of the submucosal space after injection of the submucosal elevation agents were measured. Results: The mean size of lesions was 14 mm (range 10-20). Glycerol and hyaluronic acid had a significant higher V-H ratio than normal saline; the V-H ratio of normal saline, glycerol and hyaluronic Acid were 0.29, 0.53 and 0.50, respectively. Limitations: The exact volume of the injection was not certain, and the time between the injection and endoscopic ultrasound assessment was variable. These limitations were overcome by calculating the V-H ratio. Conclusion: Glycerol and hyaluronic acid have a higher V-H ratio, which makes them good submucosal elevation solutions. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection (ESD) is an alternative to transanal resection (TAR) in treating rectal adenomas, intramucosal cancers, and superficial submucosal cancers. The purpose of this study is to compare the clinical efficacy between ESD and TAR for non-invasive rectal tumors. Between January 1998 and December 2006, 85 patients with preoperative diagnosis of non-invasive rectal tumors were treated by ESD or TAR. En-bloc resection, local recurrence, complication, procedure time, and hospital stay were evaluated retrospectively using a prospectively-completed database. Mean resection sizes were 40 mm and 39 mm in diameter for the ESD and TAR groups, respectively. En-bloc resections with a negative resection margin were achieved in 67% (35/52) of the ESD group, which was significantly higher than the 42% (14/33) in the TAR group. Sixty-three lesions were diagnosed as curative resection, histopathologically. There was no local recurrence in the ESD group, but five local recurrences developed in the TAR group. Two rectal perforations, one minor delayed bleeding, and one subcutaneous emphysema in the ESD group were successfully managed conservatively. There were one minor delayed bleeding and two anesthesia-related complications in the TAR group. The ESD group had a shorter hospital stay than the TAR group (4.9 days vs 7 days), but a longer procedure time (131 min vs 63 min). ESD was more effective than TAR in treating non-invasive rectal tumors, with a lower recurrence rate and shorter hospital stay. [ABSTRACT FROM AUTHOR]

In Japan, Stigmaeopsis miscanthi (Saito) occurs in two forms that are differentiated by the intensity of male-to-male aggression, i.e. there is a low aggression and a high aggression group (known as the LW and HG forms, respectively). The effects of counterattack behavior against predators were experimentally compared between the two forms. Parental males and females of both forms could achieve significant counterattack success against Typhlodromus bambusae, a specific predator, and counterattack efficiency increased significantly with parental density. Furthermore, the HG form showed a stronger tendency than the LW form to kill predator larvae. Thus, variation in counterattack success may exist between these two forms, and there is some correspondence between male-to-male belligerence and counterattack effectiveness against predators. [ABSTRACT FROM AUTHOR]

Narrow-band imaging (NBI) diagnosis of colorectal lesions requires further consideration and standardized classification for attaining consensus among endoscopists. Compare vascular findings and diagnosis of colorectal lesions using various endoscopic images to assess effectiveness of NBI with magnification. Three endoscopic factors (vascular findings; diagnosis from NBI with magnification images; and total diagnosis from all available colonoscopic images including white light endoscopy, chromoendoscopy, NBI with magnification and magnifying chromoendoscopy) for 15 colorectal lesions were evaluated by 12 expert colonoscopists (Group A), 36 endoscopists not expert in colonoscopy (Group B) and 55 individuals not medical doctors, but familiar with gastrointestinal endoscopy or other medical products (Group C). We calculated accuracy percentages for all three endoscopic factors based on responses from each group. Highest percentage for vascular finding, NBI with magnification diagnosis and total diagnosis for each lesion assumed to be opinion of each group. We compared incidence of agreement among three groups and calculated invasion depth diagnostic accuracy rate for each group. For vascular findings from NBI with magnification images, incidence of complete agreement among three groups was 46.7%, incidence of disagreement among three groups was 46.7% and incidence of complete disagreement among three groups was 6.7%. For diagnosis from NBI with magnification images and total diagnosis from all available endoscopic images, incidence of complete agreement, disagreement and complete disagreement were 40.0%, 60.0% and 0.0%, respectively, and 60.0%, 40.0% and 0.0%, respectively. Invasion depth diagnostic accuracy from NBI with magnification images and all available endoscopic images were 60.0% and 73.3%, respectively, in Group A; 46.7% and 66.7%, respectively, in Group B; and 46.6% and 60.0%, respectively, in Group C. Results suggest some level of educational training is required for effective application of NBI with magnification for precise diagnosis of colorectal lesions. [ABSTRACT FROM AUTHOR]

The colonoscopic insertion technique is still one of the most difficult endoscopic procedures to master and development of a new colonoscope that is easier to insert is much awaited especially into the cecum without patient discomfort. We focused on reducing patient pain and boosting the success rate of colonoscope insertion into the cecum in complicated cases. As a result, we have successfully developed two mechanisms: 'Passive Bending' and use of a 'High Force Transmission insertion tube.' We believe these two mechanisms when combined together will contribute to a reduction in patient discomfort and an increase in the cecal intubation rate during many difficult colonoscopies, but further evaluation is required with respect to therapeutic endoscopy effectiveness and insertion for patients with long colons. [ABSTRACT FROM AUTHOR]

Narrow-band imaging enhances visualization of the mucosal surface structure and vascular network and helps to increase the visibility of neoplasia by improving contrast. Sano and his colleagues first reported its efficacy for endoscopic use in the gastrointestinal tract and later proposed a sequential classification of the mucosal vascular network patterns according to histopathological categories. Sano's 'capillary pattern classification' was established to facilitate diagnosis of early colorectal lesions on a step-by-step basis. This review focuses on the utility and effectiveness of Sano's capillary pattern classification when examining early colorectal lesions using narrow-band imaging. [ABSTRACT FROM AUTHOR]

Several previous studies have identified narrow-band imaging (NBI) with magnification as being useful in evaluating early colorectal cancer invasion depth, but comparative diagnostic accuracy of invasion depth between pit pattern analysis using magnifying chromoendoscopy and NBI remains unclear. The aim of this retrospective study was to compare NBI and pit pattern analysis using magnifying chromoendoscopy in estimating early colorectal cancer invasion depth and to assess interobserver agreement. We analyzed a total of 72 early colorectal cancers in 72 patients fulfilling the inclusion criteria. Each lesion image was subsequently reviewed by two experienced colonoscopists (A, B) and then classified clinically based on invasive/non-invasive pattern and Sano's capillary pattern classification with a five-point scale of confidence. In terms of diagnostic accuracy with confidence for A and B, the areas under the receiver operating characteristics curve were 0.84 and 0.81 for pit pattern analysis and 0.82 and 0.79 for NBI, respectively. Interobserver agreement for the diagnosis of submucosal deep (>1000 µm) invasion was evaluated for both modalities and indicated substantial agreement with pit pattern analysis (κ = 0.63) and moderate agreement with NBI (κ = 0.44). Estimating invasion depth of early colorectal cancer using NBI appeared to have been comparable to pit pattern analysis, but there was greater interobserver variability using NBI. [ABSTRACT FROM AUTHOR]