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Fluoroscopy‐guided endoscopic procedures (FGEPs) are rapidly gaining popularity in the field of gastroenterology. Radiation is a well‐known health hazard. Gastroenterologists who perform FGEPs are required to protect themselves, patients, as well as nurses and radiologists engaged in examinations from radiation exposure. To achieve this, all gastroenterologists must first understand and adhere to the International Commission on Radiological Protection Publication. In particular, it is necessary to understand the three principles of radiation protection (Justification, Optimization, and Dose Limits), the As Low As Reasonably Achievable principle, and the Diagnostic Reference Levels (DRLs) according to them. This review will mainly explain the three principles of radiation exposure protection, DRLs, and occupational radiological protection in interventional procedures while introducing related findings. Gastroenterologists must gain knowledge of radiation exposure protection and keep it updated. [ABSTRACT FROM AUTHOR]

Background: The present prospective phase 1/2 study aimed to elucidate the efficacy and safety of 177Lu‐DOTATATE (four cycles of 7.4 GBq) in Japanese patients with unresectable, progressive neuroendocrine tumors (NETs). Methods: From April 2018 to October 2020, 15 patients with advanced NETs (five midgut, eight pancreatic, and two lung NETs) were enrolled. Objective response rate (ORR), progression‐free survival (PFS), and adverse events (AEs) were evaluated. Pharmacokinetics and dosimetry were also evaluated in three midgut patients. Results: The mean absorbed doses of 177Lu‐DOTATATE to the kidneys (20.7 Gy/29.6 GBq) and the bone marrow (0.631 Gy/29.6 GBq) were within the radiation tolerance doses. The ORR of the whole population was 53% (90% CI, 30%‐76%). ORRs of the midgut and non‐midgut NETs were 60% (90% CI, 19%‐92%) and 50% (90% CI, 22%‐78%), respectively. There was no difference in the maximum reduction rate of the sum of the target lesion diameters between patients with midgut and non‐midgut NET. The median PFS was not reached; the PFS rate at 52 weeks was 80% (90% CI, 56.1%‐91.7%). AEs of Grade 3 or higher were lymphopenia (47%) and leukopenia (7%). Conclusion: 177Lu‐DOTATATE demonstrated remarkable tumor shrinkage and tolerability in Japanese patients with advanced NETs. [ABSTRACT FROM AUTHOR]

Objectives: The transpapillary drainage by endoscopic retrograde cholangiopancreatography (ERCP‐D) cannot be performed without fluoroscopy, and there are many situations in which fluoroscopy is required even in endoscopic ultrasound‐guided drainage (EUS‐D). Previous studies have compared the efficacy, but not the radiation exposure of EUS‐D and ERCP‐D. While radiation exposure in ERCP‐D has been previously evaluated, there is a paucity of information regarding radiation doses in EUS‐D. This study aimed to assess radiation exposure in EUS‐D compared with that in ERCP‐D. Methods: This retrospective single‐center cohort study included consecutive patients who underwent EUS‐D and ERCP‐D between October 2017 and March 2019. The air kerma (AK, mGy), kerma‐area product (KAP, Gycm2), fluoroscopy time (FT, min), and procedure time (PT, min) were assessed. The invasive probability weighting method was used to qualify the comparisons. Results: We enrolled 372 and 105 patients who underwent ERCP‐D and EUS‐D, respectively. The mean AK, KAP, and FT in the EUS‐D group were higher by 53%, 28%, and 27%, respectively, than those in the ERCP‐D group, whereas PT was shorter by approximately 11% (AK, 135.0 vs. 88.4; KAP, 28.1 vs. 21.9; FT, 20.4 vs. 16.0; PT, 38.7 vs. 43.5). The sub‐analysis limited to biliary drainage cases showed the same trend (AK, 128.3 vs. 90.9; KAP, 27.0 vs. 22.2; FT, 16.4 vs. 16.1; PT, 32.5 vs. 44.4). Conclusions: This is the first study to assess radiation exposure in EUS‐D compared with that in ERCP‐D. Radiation exposure was significantly higher in EUS‐D than in ERCP‐D, despite the shorter procedure time. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to evaluate the prognostic factors in human papillomavirus (HPV)‐positive and HPV‐negative oropharyngeal cancer (OPC) treated with definitive radiotherapy. Methods: We retrospectively evaluated 101 patients with OPC who underwent definitive radiotherapy between 2008 and 2018. Results: The median follow‐up period of the surviving patients was 68 months (range, 8–164 months). The 5‐year overall survival rate was 69.8%. Univariate analyses revealed that poor survival was associated with male sex, smoking ≥30 pack‐years, Eastern Cooperative Oncology Group performance status ≥1, tumor‐node‐metastasis (TNM) stage III‐IV (8th edition), HPV‐negativity, serum lactate dehydrogenase (LDH) ≥202, C‐reactive protein/albumin ratio ≥0.15, and lymphocyte‐to‐monocyte ratio <2.90. In multivariate analyses, poor survival was independently correlated with smoking ≥30 pack‐years (p < 0.01) and LDH ≥202 (p = 0.02). Conclusions: The present study suggested that high LDH levels predicted poor survival after definitive radiotherapy for patients with both HPV‐positive and HPV‐negative OPC. [ABSTRACT FROM AUTHOR]

The lipolytic and proteolytic activity of Penicillium camemberti PC TT033 and Penicillium roqueforti PR G3, cultured on the whey solids or simulated cheese media, were compared under several pH reaction conditions. Lipolytic activity was higher when both strains had been cultured on the whey medium than on the simulated cheese medium, whereas proteolytic activity was less influenced by the culture medium. The relationship between the reaction pH and these enzyme activities was dependent on the culture medium, which suggested that the expression level and balance of isozyme rely on the culture substrate. [ABSTRACT FROM AUTHOR]