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Background: Bleeding is the most common complication in out-of-hospital cardiac arrest (OHCA) patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). No studies comprehensively described the incidence rate, timing of onset, risk factors, and treatment of bleeding complications in OHCA patients receiving ECPR in a multicenter setting with a large database. This study aimed to analyze the risk factors of bleeding during the first day of admission and to comprehensively describe details of bleeding during hospitalization in patients with OHCA receiving ECPR in the SAVE-J II study database. Methods: This study was a secondary analysis of the SAVE-J II study, which is a multicenter retrospective registry study from 36 participating institutions in Japan in 2013–2018. Adult OHCA patients who received ECPR were included. The primary outcome was the risk factor of bleeding complications during the first day of admission. The secondary outcomes were the details of bleeding complications and clinical outcomes. Results: A total of 1,632 patients were included. Among these, 361 patients (22.1%) had bleeding complications during hospital stay, which most commonly occurred in cannulation sites (14.3%), followed by bleeding in the retroperitoneum (2.8%), gastrointestinal tract (2.2%), upper airway (1.2%), and mediastinum (1.1%). These bleeding complications developed within two days of admission, and 21.9% of patients required interventional radiology (IVR) or/and surgical interventions for hemostasis. The survival rate at discharge of the bleeding group was 27.4%, and the rate of favorable neurological outcome at discharge was 14.1%. Multivariable logistic regression analysis showed that the platelet count (< 10 × 104/μL vs > 10 × 104/μL) was significantly associated with bleeding complications during the first day of admission (adjusted odds ratio [OR]: 1.865 [1.252–2.777], p = 0.002). Conclusions: In a large ECPR registry database in Japan, up to 22.1% of patients experienced bleeding complications requiring blood transfusion, IVR, or surgical intervention for hemostasis. The initial platelet count was a significant risk factor of early bleeding complications. It is necessary to lower the occurrence of bleeding complications from ECPR, and this study provided an additional standard value for future studies to improve its safety. [ABSTRACT FROM AUTHOR]

Anaphylaxis is a potentially fatal severe systemic hypersensitivity reaction that causes symptoms in multiple organs such as the skin, respiratory tract, and gastrointestinal tract; however, no nationwide epidemiological survey on anaphylaxis has been conducted in Japan. This survey aimed to elucidate the triggers and treatment of anaphylaxis in Japan. Between February 2015 and October 2017, we prospectively collected clinical data on the triggers and treatment of patients who developed anaphylaxis or were admitted to the emergency room with anaphylaxis in the training and teaching facilities of the Japanese Society of Allergology. This study included 79 of the 451 affiliated facilities (18%), and a total of 767 patients were enrolled; 73% of them were aged <18 years and 7% had in-hospital triggers. The most common triggers were food (68%), drugs (12%), food-dependent exercise-induced anaphylaxis (5%), insects (4%), and oral immunotherapy (3%), with drugs being the most common in-hospital trigger and food being the most common out-of-hospital trigger. Intramuscular injection of adrenaline was administered therapeutically to 38% of the patients, with 10% requiring multiple doses. Adrenaline auto-injectors were used in 12% of out-of-hospital patients. The present survey revealed the most common triggers and treatments for anaphylaxis in Japan. Self-management and adrenaline administration as first-line treatment may not be done sufficiently. Therefore, it is necessary to thoroughly educate and train patients and physicians about anaphylaxis. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) allergies are broadly associated with food allergies and divided into groups based on the degree of allergen-specific immunoglobulin E (IgE) involvement: IgEmediated, non-IgE-mediated, and mixed. Non-IgE-mediated GI food allergies are mostly observed in neonates and infants and include food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), and food protein-induced enteropathy (FPE). In addition to the classical phenotype, unique phenotypes such as vomiting and bloody stool, suspected sepsis, and overlapping eosinophilic GI disorders (EGIDs) have increased in Japan over the past 2 decades. Some of these cases were defined as having chronic FPIES. More recently, cases of hen’s-egg FPIES in Japan have increased dramatically since 2018, albeit for unknown reasons. Typical mixed-type food allergies are EGIDs, characterized by prominent eosinophil infiltration in the GI tract leading to GI symptoms. EGIDs are broadly classified into eosinophilic esophagitis (EoE) and non-EoE EGIDs that involve the GI tract with the exception of the esophagus. Of the EGIDs, EoE is the best known, as the number of cases has increased dramatically in Western countries, whereas pediatric EoE remains rare in Asia and non-EoE EGIDs may be more prevalent in Japan. A recent Japanese national survey showed that pediatric non-EoE EGIDs were persistent and severe compared to those in adults, possibly requiring further effective therapeutic options. Among the EGIDs, FPIAP is pathologically diagnosed as an infantile form of eosinophilic colitis. In addition, recent FPIES and FPE cases also involved eosinophilic inflammation. Recent cases of GI allergies may be associated with type 2 inflammation. A better understanding of the interactions between GI allergies and type 2 inflammation may clarify the pathogenesis of the recent increase in GI allergies. [ABSTRACT FROM AUTHOR]

Background: Neuroendocrine neoplasm (NEN) is a comparatively rare tumor that has been considered indolent. Due to these characteristics, detailed epidemiological data have not been analyzed in Japan. To elucidate the present status of NEN diagnosis and treatment in Japan, we started a registry cohort study in January 2015. Methods: Patients pathologically diagnosed with NENs of the pancreas, gastrointestinal tract, lungs, bronchi, or thymus after January 2012 were enrolled in this registry after the date of ethics review committee approval in each hospital or institute. Follow-up was continued for enrolled patients. Results: During 5 years of enrollment between January 2015 and December 2019, a total of 1526 participants from 63 departments were enrolled in this registry (mean, 305.2 participants/year), covering approximately 5.8% of the annual incidence of NENs in Japan. For pancreatic NEN, 41.9% of patients had metastasis and the dominant metastatic site was the liver, at twice the rate of lymph node metastasis in the current registry. In contrast, the frequency of lymph node metastasis from gastrointestinal (GI)-NEN was similar to that of the liver. The distribution of WHO 2019-based grades varied according to the primary site. Low-to-intermediate grade (G1–G2) was dominant for duodenal, jejunal/ileal, rectal, and pancreatic NENs, whereas high grade (G3 or NEC) was dominant for esophageal, stomach, and colon NENs. For PanNENs, G3 and NEC accounted only for 1.6% and 2.9%, respectively. Conclusions: These cohort data provide crucial information for clinical research to clarify the characteristics of NENs in Japan. [ABSTRACT FROM AUTHOR]

Objective: We examined the impact of simulated Tokyo 2020 environmental condition on exercise performance, thermoregulatory responses and thermal perception among Dutch elite athletes. Methods: 105 elite athletes from different sport disciplines performed two exercise tests in simulated control (15.9 ± 1.2 °C, relative humidity (RH) 55 ± 6%) and Tokyo (31.6 ± 1.0 °C, RH 74 ± 5%) environmental conditions. Exercise tests consisted of a 20-min warm-up (70% HRmax), followed by an incremental phase until volitional exhaustion (5% workload increase every 3 min). Gastrointestinal temperature (Tgi), heart rate, exercise performance and thermal perception were measured. Results: Time to exhaustion was 16 ± 8 min shorter in the Tokyo versus the control condition (− 26 ± 11%, whereas peak power output decreased with 0.5 ± 0.3 W/kg (16 ± 7%). Greater exercise-induced increases in Tgi (1.8 ± 0.6 °C vs. 1.5 ± 0.5 °C, p < 0.001) and higher peak Tgi (38.9 ± 0.6 °C vs. 38.7 ± 0.4 °C, p < 0.001) were found in the Tokyo versus control condition. Large interindividual variations in exercise-induced increase in Tgi (range 0.7–3.5 °C) and peak Tgi (range 37.6–40.4 °C) were found in the Tokyo condition, with greater Tgi responses in endurance versus mixed- and skill-trained athletes. Peak thermal sensation and thermal comfort scores deteriorated in the Tokyo condition, with aggravated responses for power versus endurance- and mixed-trained athletes. Conclusion: Large performance losses and Tgi increases were found among elite athletes exercising in simulated Tokyo conditions, with a substantial interindividual variation and significantly different responses across sport disciplines. These findings highlight the importance of an individual approach to optimally prepare athletes for safe and maximal exercise performance during the Tokyo Olympics. [ABSTRACT FROM AUTHOR]

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tickborne infectious disease caused by SFTS virus (SFTSV). We report 7 cases of spontaneous fatal SFTS in felines. Necropsies revealed characteristic lesions, including necrotizing lymphadenitis in 5 cases and necrotizing splenitis and SFTSV-positive blastic lymphocytes in all cases. We detected hemorrhagic lesions in the gastrointestinal tract in 6 cases and lungs in 3 cases, suggesting a more severe clinical course of SFTS in felids than in humans. We noted necrotic or ulcerative foci in the gastrointestinal tract in 3 cases, the lung in 2 cases, and the liver in 4 cases. We clarified that blastic lymphocytes are predominant targets of SFTSV and involved in induction of necrotic foci. We also found that thymic epithelial cells were additional targets of SFTSV. These results provide insights for diagnosing feline SFTS during pathological examination and demonstrate the similarity of feline and human SFTS cases. [ABSTRACT FROM AUTHOR]

Characteristics of the chronotypes of patients with gastrointestinal disease are unknown. We evaluated chronotypes of patients with upper gastrointestinal diseases with the Munich ChronoType Questionnaire (MCTQ). A total of 2027 subjects from 29 institutions in Japan who had undergone esophagogastroduodenoscopy were asked to answer the MCTQ. The subjects' chronotypes were divided into three groups (early, intermediate, and late chronotype) using the sleep-corrected mid-point of sleep on free days (MSFSC) values. According to their endoscopic diagnosis and abdominal symptoms, the subjects were divided into the reflux esophagitis (RE) group, gastroduodenal ulcer (GDU) group, upper gastrointestinal carcinoma (CA) group, functional dyspepsia (FD) group, non-FD group, and control group. In total, 1128 subjects were eligible for the analysis. The MSFSC (average ± standard deviation, clock hours, h) of each disease group was as follows: control group: 02.51 ± 1.22, non-FD group: 02.69 ± 1.14, FD group: 02.91 ± 1.19, RE group: 02.58 ± 1.05, GDU group: 02.47 ± 1.31, and CA group: 02.11 ± 1.08 h. Compared to the control group, the rate of late chronotype of the FD group significantly increased to 33.3%, whereas that of early chronotype of the CA group significantly increased to 38.3% (P =.0177 and 0.0036, respectively). In both the FD and CA groups, chronotype was the independent factor related to the diseases. The adjusted odds ratio of late chronotype to early chronotype was 3.01 [95% CI, 1.23–7.35] in the FD group and 0.44 [95% CI, 0.23–0.85] in the CA group. In conclusion, late chronotype was common in patients with FD, and early chronotype was common in patients with upper gastrointestinal carcinoma. [ABSTRACT FROM AUTHOR]

This study was performed to elucidate the distribution of amyloidosis subtypes based on tissue biopsy site. Samples obtained from 729 consecutive patients with amyloidosis were analyzed by immunohistochemical staining (IHC) and supplemental mass spectrometry (MS). The correlations between the type of organs from which samples were obtained and amyloidosis subtypes were investigated retrospectively. Among the patients, 95.1% were diagnosed by IHC and 4.9% were diagnosed by MS. The distribution of amyloidosis subtypes was as follows: AL, 59.1%; ATTR, 32.9%; AA, 4.0%; AH, 1.4%; Aβ2M, 0.8%; and others, 0.9%. AL was the most common subtype in most organs, including the liver, lung, kidney, lower urinary tract, bone marrow, gastrointestinal tract, and skin/subcutaneous tissue. ATTR was the most common subtype in the heart, carpal tunnel, and peripheral nerves. AH was the second most common subtype in renal biopsy. Three or more amyloidosis subtypes were detected in each organ. In conclusion, AL was the most common subtype in most biopsy sites except the heart, carpal tunnel, and peripheral nerve, in which ATTR was more common. Because several types of amyloidogenic protein were detected in each organ, amyloid typing must be pursued, no matter the site from where biopsy was obtained. [ABSTRACT FROM AUTHOR]

Highly impacted articles on functional gastrointestinal (GI) disorders research presented at the core symposium held in the Japanese Gastroenterological Association (JGA) annual meeting 2018–2020 are selected and summarized. Regarding visceral hypersensitivity and sensor in GI tracts, transient receptor potential vanilloid 4 ion channel and acid-sensitive ion channel were candidates for hypersensitivity in GI tracts. ATP release from vesicular nucleotide transporter may be a key pathway to sensitize the nerve endings. Regarding inflammation and mucosal immune responses, patients infected with H. pylori having Ser70 type single nucleotide polymorphism of NapA gene was associated with H. pylori-related dyspepsia via gastric dysmotility. Gastric histology infected with Ser70 type NapA was shown severe infiltration of neutrophils into intramuscular layer. Macrophages, mast cells, and neutrophils are infiltrated in the colon of irritable bowel syndrome (IBS) patients and the locally produced IL-1β upregulated brain-derived neurotrophic factor (BDNF) in enteric glia cells. BDNF can also stimulate nerve endings and might be linked to pain in the colon. Dysbiosis in the composition of commensal bacteria communities is associated with the pathogenesis of various diseases including IBS and gut-brain interaction. The investigation on the mucosa-associated microbiota (MAM) is essential for understanding the interactions. The α-diversity and β-diversity of MAM indices are significantly different among IBS-D, IBS-C, and controls, and the different diversity might contribute to the pathophysiology of IBS. As research works on psychosocial factors show, maternal separation animal model was used and it is early life stress. The stress had induced colonic hyper-contraction, gastric hypersensitivity, and delayed emptying. The precise molecular mechanisms are still under investigations. [ABSTRACT FROM AUTHOR]

Mutouhapu (610 hap) was a calcium polysulfide colloid preparation, which was sold as a bath salt in Japan. Herein, we report on the autopsy of a suicide case as a result of taking 610 hap orally and present histopathological findings with a focus on corrosive changes observed in upper gastrointestinal tract. The subject was a 60-year-old man who was discovered dead 200-300 m from his home. The site smelled of sulfur. Sixty parts per million hydrogen sulfide was detected in the oral cavity of the deceased. He had schizophrenia since junior high school. At autopsy, the oral and nasal cavities had a rotten-egg smell. Adipose tissues had green coloring. There was thickening and sclerosis of the gastric wall, and a green to pale yellow pseudomembrane-like substance was observed adhering to the gastric mucosa. Gastric content was 400 ml of green to pale yellow sludge. The distal portion of the stomach was highly contracted. Qualitative analysis for hydrogen sulfide was positive. Histological changes in the digestive tract were particularly notable in the stomach. Degeneration and necrosis of the mucosa and submucosa, degeneration of the submucosal fat, and dissection-like changes in the blood vessels of the submucosa were discovered. Basophilic lime granules were found on the mucosal surface. There were hypercontracture changes in the proper muscle layer of the pyloric region. The cause of death was hydrogen sulfide poisoning with associated corrosive gastritis. [ABSTRACT FROM AUTHOR]

Workshops on "Innovative Therapeutic Endoscopy" for upper gastrointestinal tract diseases were held four times as the Japan Gastroenterological Endoscopic Society (JGES) Core Sessions at the 93rd to 96th Biannual Meetings of the JGES. A total of 48 research presentations (including two invited lectures) were reported, and various discussions were held on these topics. When the research presentations were categorized according to the therapeutic procedure, endoscopic submucosal dissection (ESD) was the most frequent with 28 presentations (58.3%), followed by laparoscopy endoscopy cooperative surgery (LECS) with six presentations (12.5%). When the research presentations were classified by the target organ of the therapeutic procedures, the duodenum was the most frequent with 26 presentations (54.1%), followed by the stomach with 13 presentations (27.1%). The most important issue was the establishment of a safe and reliable endoscopic resection method for duodenal lesions. Issues related to gastric ESD were establishing an efficient traction method and a method to prevent post‐ESD bleeding in high‐risk patients. Other important issues were establishment of an efficient traction method and methods of preventing delayed bleeding in high‐risk patients who undergo gastric ESD, expansion of indications for minimally invasive treatment using LECS for gastric cancer, the development of endoscopic full‐thickness resection (EFTR) for gastric submucosal tumors (SMTs), and improvement of per‐oral endoscopic myotomy (POEM) for esophageal achalasia and per‐oral endoscopic tumor resection (POET) for esophageal SMTs. Through the JGES Core Sessions, it is expected that the minimally invasive treatments using endoscopes developed in Japan will be further advanced. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection (ESD) is a rigorous and technically sophisticated method for removal of lesions within the gastrointestinal tract. Despite having advantages of en‐bloc resection of lesions, regardless of size, and widespread use in Japan and Asia, ESD has not become widely adopted in the USA for a variety of reasons. Based upon Japanese education and the master‐apprentice model, modification to the education system and additional techniques designed to facilitate broader adoption are required for trainees in the USA. This article will review the current state of education and training for ESD in the USA. [ABSTRACT FROM AUTHOR]

Keywords: early cancer detection; GI endoscopy training; JFE; JICA; OMED (WEO) EN early cancer detection GI endoscopy training JFE JICA OMED (WEO) 699 705 7 07/11/20 20200701 NES 200701 INTRODUCTION Endoscopes are now an indispensable medical device in digestive pathology, and digestive endoscopy is performed all over the world. One of the first training programs for foreign doctors in Japan was an early gastric cancer diagnosis course in Japan organized in the 1960s under the auspices of the then Overseas Technical Cooperation Agency (OTCA), now called the Japan International Cooperation Agency (JICA).3 Most of these trainee doctors came from developing countries. Officially, foreign doctors were not allowed by the Japanese government to do live demonstrations or perform endoscopy but that changed gradually to allow overseas doctors to practise endoscopy.1 Prof. Fujita's training philosophy was based on the concept of letting the trainees learn by doing what they want to do on their own, while providing them with support and guidance. ENDOSCOPY TRAINING CENTER AND LIVE DEMONSTRATIONS Years of experience admitting and training foreign doctors at various facilities convinced Prof. Fujita that Japan should establish an endoscopy training center exclusively for foreign doctors. [Extracted from the article]

The clinical application of photodynamic therapy (PDT) for gastrointestinal (GI) neoplastic lesions has been developed with appreciation for the great efforts and kind support of Dr. Tom Dougherty and his followers' contributions. There are several published studies on clinical PDT in the field of GI oncology. Esophageal cancer was one of the first clinical indications for PDT that was approved as an endoscopic procedure in both the United States and Japan. PDT was initially used as a palliative local treatment for patients with obstructive esophageal cancer. PDT is also indicated for eradicative therapy for dysplastic Barret's esophagus, which is the precursor state of esophageal adenocarcinoma, with the support of level one evidence. In Japan, PDT was approved as a curative treatment for superficial esophageal carcinoma lesions, which are difficult to treat with endoscopic resection. Further, PDT using second‐generation photosensitizers is approved for early local failure after radiotherapy, for which treatment with other modalities is difficult. PDT has also been assessed in other GI cancers, including gastric cancer, biliary cancer and pancreatic cancer. In this review, we overview the history and state of PDT for GI cancer. [ABSTRACT FROM AUTHOR]

Eosinophilic gastrointestinal diseases (EGIDs) are divided into eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE), depending on the involved gastrointestinal tract, though both are considered to be chronic Th2-type allergic diseases caused by food or environmental allergens. In development of EoE, refluxed gastric acid may also have an important role. For diagnosis of EGIDs, the presence of symptoms possibly originating from the involved gastrointestinal tract and dense eosinophil infiltration are important factors. Imaging studies, including endoscopy and computed tomography, along with histopathological examinations of biopsy specimens are useful for diagnosis, whereas laboratory testing of blood, urine, and stool samples has limited value. Three useful options for treating EoE patients are acid inhibitors, swallowed topical corticosteroids, and an elimination diet, while systemic administration of glucocorticoids is the standard treatment of EGE, though information is limited. Since the prevalence of EGIDs is increasing in Western countries as well as Japan, development of effective treatments based on sufficient evidence is becoming an urgent need. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal system (GIS) malignancy with pregnancy is a very rare condition and is not common outside Japan. The incidence is between 0.025-0.1% for each pregnancy. GIS malignancies are diagnosed late in pregnancy and detected at an advanced stage. The most common cause of this condition is that the symptoms such as vomiting, nausea, loss of appetite and abdominal growth are mistaken with pregnancy and malignancy is overlooked. Especially in the second trimester, symptoms such as nausea and vomiting, weight loss, melena, hematemesis and deep anemia should suggest malignancy. Upper GIS endoscopy and colonoscopy are the recommended screening methods in these patients, especially in the third trimester.Case Presentation: We present a rare case presenting to our emergency room with the complaint of bloody vomiting, at the 36th week of gestation with a live singleton pregnancy, and receiving the diagnosis of undifferentiated gastric carcinoma from the biopsy taken from the ulcerated lesion on the stomach cardia, with upper GIS endoscopy performed due to deep anemia, who underwent simultaneous cesarean section and subtotal gastrectomy.Conclusion: Gastrointestinal system (GIS) malignancy with pregnancy is a very rare condition, but it should be considered when symptoms such as nausea and vomiting, weight loss, melena, hematemesis and deep anemia occur, especially in the second trimester, and endoscopic screening should be recommended. Because of the delay in diagnosis of malignancy and the detection in advanced stages, patients should be referred for treatment without delay. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Artemisia asiatica Nakai (Compositae) has a long history as a traditional remedy. Preparation from various parts of the plant (aerial parts and leaves) are used to treat a wide range of diseases including gastric trouble, liver dysfunction, and skin inflammation. Aims of this review The aims of this review were: 1) to provide an overview of recent studies and progress on A. asiatica -derived ethnopharmacological compounds and their pharmacological activities; and 2) to summarize existing evidence and provide insight for future studies. Materials and methods This investigation was carried out by analyzing published books and research papers via scientific databases, namely Science Direct, PubMed ACS Publication, Wiley Online Library, CNKI and information obtained online. The keywords “ Artemisia asiatica traditional uses,” “Compounds isolated and studied in Artemisia asiatica, ” and “Pharmacological advances in Artemisia asiatica ” were used and articles published between 1995 and 2017 were considered. In total, 500 works related to biological activities of A. asiatica were identified, and only materials published in English were included in the review. Results Comparative analysis of literature searched through sources available confirmed that the ethnopharmacological use of A. asiatica was recorded in Korea, China, and Japan. Phytochemical studies revealed the presence of flavonoids, sesquiterpene lactones, monoterpenes, and steroids in A. asiatica . Of these, flavonoids have been shown to exhibit significant pharmacological effects such as gastroprotective, anti-inflammatory, anti-tumor, and anti-microbial actions. Conclusions Phytochemical and pharmacological studies of Artemisia asiatica have proven that this plant is one of valuable medicinal sources with neuroprotective, gastroprotective, anti-oxidative, anti-inflammatory, and anti-cancer effects. Although ethanol extract of this plant is now being prescribed as gastroprotective and anti-ulcerative medicine, it is now time to expand its application to other human inflammatory diseases such as pancreatitis and hepatitis and further extensive study on toxicity in human. Therefore, the present review will encourage further studies of A. asiatica in the pursuit of wide range of therapeutic remedy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to identify the current clinical features of neonatal gastrointestinal perforation in Japan.Methods: A questionnaire about cases of neonatal gastrointestinal perforation treated in recent 5 years was sent to participating institutions of the Japanese Society of Pediatric Surgeons (JSPS).Results: Five hundred and thirty-six neonates with gastrointestinal perforation were treated. They consisted of 42 patients with gastric rupture/perforation (GR), 33 patients with intestinal atresia/stenosis (IA), 3 patients with malrotation (ML), 118 patients with necrotizing enterocolitis (NEC), 160 patients with focal intestinal perforation (FIP), 46 patients with meconium-related ileus (MRI), 77 patients with meconium peritonitis (MP), and 57 patients with other conditions. The total mortality rate was 20.5 %. The mortality rates of the patients with GR, IA, ML, NEC, FIP, MRI, and MP were 9.5, 9.1, 0, 33.1, 20.6, 28.2, and 9.1 %, respectively. In 263 cases involving extremely low-birth-weight neonates (ELBW), 108 died (mortality rate 41.1 %). The mortality rates for ELBW with GR, NEC, FIP, MRI, MP, and other conditions were 27.3 % (3/11), 58.5 % (48/82), 21.6 % (24/111), 70.6 % (24/34), 57.1 % (4/7), and 27.8 % (5/18), respectively.Conclusions: The mortality rates for ELBW decreased from 62.8 % in the previous survey to 41.1 % by the time of this survey. [ABSTRACT FROM AUTHOR]

Background: Despite the high prevalence of gastroesophageal reflux disease (GERD), its risk factors are still a subject of controversy. This is probably due to inadequate distinction between reflux esophagitis (RE) and non-erosive reflux disease (NERD), and is also due to inadequate evaluation of adjacent stomach. Our aim is therefore to define background factors of RE and NERD independently, based on the evaluation of Helicobacter pylori infection and gastric atrophy. Methods: We analyzed 10,837 healthy Japanese subjects (6,332 men and 4,505 women, aged 20–87 years) who underwent upper gastrointestinal endoscopy. RE was diagnosed as the presence of mucosal break, and NERD was diagnosed as the presence of heartburn and/or acid regurgitation in RE-free subjects. Using GERD-free subjects as control, background factors for RE and NERD were separately analyzed using logistic regression to evaluate standardized coefficients (SC), odds ratio (OR), and p-value. Results: Of the 10,837 study subjects, we diagnosed 733 (6.8%) as RE and 1,722 (15.9%) as NERD. For RE, male gender (SC = 0.557, OR = 1.75), HP non-infection (SC = 0.552, OR = 1.74), higher pepsinogen I/II ratio (SC = 0.496, OR = 1.64), higher BMI (SC = 0.464, OR = 1.60), alcohol drinking (SC = 0.161, OR = 1.17), older age (SC = 0.148, OR = 1.16), and smoking (SC = 0.129, OR = 1.14) are positively correlated factors. For NERD, HP infection (SC = 0.106, OR = 1.11), female gender (SC = 0.099, OR = 1.10), younger age (SC = 0.099, OR = 1.10), higher pepsinogen I/II ratio (SC = 0.099, OR = 1.10), smoking (SC = 0.080, OR = 1.08), higher BMI (SC = 0.078, OR = 1.08), and alcohol drinking (SC = 0.076, OR = 1.08) are positively correlated factors. Prevalence of RE in subjects with chronic HP infection and successful HP eradication denotes significant difference (2.3% and 8.8%; p<0.0001), whereas that of NERD shows no difference (18.2% and 20.8%; p = 0.064). Conclusions: Significantly associated factors of NERD are considerably different from those of RE, indicating that these two disorders are pathophysiologically distinct. Eradication of Helicobacter pylori may have disadvantageous effects on RE but not on NERD. [ABSTRACT FROM AUTHOR]

Background: In Japan, treatment guidelines are lacking for patients with upper gastrointestinal symptoms. We aimed to compare the efficacy of different drugs for the treatment of uninvestigated upper gastrointestinal symptoms. Methods: This was a randomized, open-label, parallel-group multicenter study. Helicobacter pylori-negative, endoscopically uninvestigated patients ≥20 years of age with upper gastrointestinal symptoms of at least moderate severity (Global Overall Symptom score [GOS] ≥4 on a 7-point Likert scale) were randomized to treatment with omeprazole (10 mg once daily), famotidine (10 mg twice daily), mosapride (5 mg three times daily) or teprenone (50 mg three times daily). The primary endpoint was sufficient relief of upper gastrointestinal symptoms after 4 weeks of treatment (GOS≤2). UMIN clinical trial registration number: UMIN000005399. Results: Of 471 randomized patients, 454 were included in the full analysis set. After 4 weeks of treatment, sufficient symptom relief was achieved by 66.9% of patients in the omeprazole group, compared with 41.0%, 36.3% and 32.3% in the famotidine, mosapride and teprenone groups, respectively (all, p<0.001 vs omeprazole). There were no treatment-related adverse events. Conclusions: The favorable efficacy and safety profiles of omeprazole in relieving uninvestigated upper gastrointestinal symptoms support its use as first-line treatment in this patient group in Japan. Patients who show no improvement in symptoms despite PPI use, and those with alarm symptoms (such as vomiting, GI bleeding or acute weight loss) should receive further investigation, including prompt referral for endoscopy. Trial registration: UMIN000005399. [ABSTRACT FROM AUTHOR]

The article offers information on the 4th International Gastrointestinal Consensus Symposium (IGICS) to be held in Kyoto, Japan on February 18-192011.

Objectives: Laryngopharyngeal reflux disease (LPRD) is an important cause of throat discomfort in the elderly. Our objective was to investigate the usefulness of barium swallow studies for the diagnosis of LPRD. Methods: The subjects were 59 patients at least 60 years of age with LPRD suspected on laryngoscopic findings. We evaluated esophageal clearance using a barium swallow study and the upper gastrointestinal tract endoscopic findings of gastroesophageal reflux disease according to the revised Los Angeles classification, and correlated these findings with the effect of rabeprazole, a proton pump inhibitor. Results: Among subjects with positive reflux findings in the esophageal phase of the barium swallow, rabeprazole was significantly effective (p = 0.0025). To identify nonerosive reflux disease, we analyzed the 50 cases with a negative Los Angeles classification of upper gastrointestinal tract endoscopic findings. Rabeprazole was again significantly effective in patients with positive findings for esophageal reflux (p = 0.0025). Conclusions: Among elderly patients with suspected LPRD, there was a positive correlation between impaired esophageal clearance on the barium swallow study and the effectiveness of rabeprazole. The barium swallow study could be a screening test for LPRD in elderly patients with throat discomfort. [ABSTRACT FROM AUTHOR]

The article offers information on the 3rd International Gastrointestinal Consensus Symposium (IGICS) to be held on February 20, 2010 in Fukuoka, Japan.

Abstract: Ten wild masked palm civets infected with canine distemper virus (CDV), captured in Japan from 2005 to 2007, were histopathologically and phylogenetically analyzed. Phylogenetic analysis based on the amino acid sequences of the H protein of two CDV isolates from masked palm civets revealed that the two isolates were classified into the clade of recent isolates in Japan. Histopathologically marked lesions of virus encephalitis were present in the brain, whereas gastrointestinal lesions were absent or at a mild degree. The distribution of the lesions resembles that of recent CDV cases in dogs. Therefore, recent CDV infections in masked palm civets could be caused by recently prevalent CDV in dogs. The possibility of the masked palm civet as a spreader of CDV among wildlife is also discussed. [Copyright &y& Elsevier]

We identified the optimal location for releasing hatchery-produced juveniles of ocellate puffer (Takifugu rubripes) for stock enhancement by tag and release experiments. The fish were released at four areas, Suruga Bay, Enshu Nada, Ise Bay, and Kumano Nada, along the central coast of Honshu Island in Japan from 2001 to 2005. Approximately 10,000-40,000 cultured puffer fish were released in these areas in 23 groups. Tagged fish were mainly recaptured at age 0 by small-scale trawl net fishing in Ise Bay, and by longline fishing at age one or older in Suruga Bay, Enshu Nada, and Kumano Nada. Overall average recapture rate yielded 13.0% for the Ise Bay release group compared with 2.0%, 2.9%, and 0.7% for the Suruga Bay, Enshu Nada, and Kumano Nada release groups, respectively. Even in the Ise Bay area, significant differences in recapture rates were observed among three release locations. Lower recapture rates were presumably caused by predation, because tagged fish were found in the intestines of Japanese sea bass (Lateolabrax japonicus). It is suggested that release locations should be carefully evaluated and chosen to reduce initial mortality even if cultured ocellate puffer are released in Ise Bay. One of the optimal release locations is specified in shallow areas, such as off Tokoname, which are inhabited by wild juvenile ocellate puffer. [ABSTRACT FROM AUTHOR]

This review is regarding the narrow-band imaging (NBI) system which has been developed at National Cancer Center Hospital East, Japan. The technology of the NBI system is based on modifying the spectral features by narrowing the bandwidth of spectral transmittance using various optical filters. The NBI system consists of three filters, 415–30 nm, 445–30 nm, and 500–30 nm, which are used as observing the fine capillaries in the superficial mucosa is essential to identify gastrointestinal neoplasms. The NBI system has been in development since 1999 and the first report of it's efficacy for gastrointestinal tract use was reported in 2001. In our pilot study, the NBI system may be sufficient to differentiate hyperplastic polyp from adenomatous polyp, and to visualize neoplasia with image processing in real-time during colonoscopy without the need for dye spraying. Herein, we propose the term ‘optical/digital chromoendoscopy’ using the NBI system and hope that this instrument will become standard endoscopy for in the 21st century. To estimate the feasibility and efficacy of using the NBI system for surveillance or screening examination, randomized control trials should be conducted in the future. [ABSTRACT FROM AUTHOR]

Although clinical trials using magnifying optical endoscopy have been reported, magnifying endoscopies have been remarkably developed in the period of electronic endoscopy. Magnifying electronic endoscopies with 80 or 100-fold magnification are used for routine endoscopic examination of upper gastrointestinal tract in Japan. Magnifying endoscopy is used to visualize the microstructure and microvascular architecture of gastrointestinal surface mucosa. Microsurface structure of the mucosa includes normal structure, changed structure by inflammation and biological response, and tumor-specific structure. Microvascular architecture includes normal vascular system and tumor microvessels. Magnifying endoscopy is starting to play an important role in diagnosis of any upper gastrointestinal diseases by assessment of magnified observation. Magnifying endoscopy holds a great deal of promise in the near future because magnifying endoscopic observation is approaching optical biopsy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the necessity of morphological images (MI) in reading somatostatin receptor scintigraphy (SRS) in patients with suspected neuroendocrine gastroenteropancreatic (GEP) tumors.Material and Methods: A Japanese multicenter clinical trial of SRS was conducted in 40 patients with suspected GEP tumors. Three experienced radiologists interpreted the images in three separate sessions in a blinded manner (1: SRS images alone, 2: MI alone, 3: SRS and MI analyzed simultaneously), and the reading results of each session were compared. In addition, the diagnostic abilities of SRS, MI and SRS alone and simultaneous SRS and MI readings were compared for patients where final diagnosis was obtained.Results: SRS detected more suspected lesions (positive or inconclusive uptake) than morphological images did (51 vs 27 lesions), but included many physiological uptakes detected as positive or inconclusive uptakes. Combined reading of SRS and morphological images helped to correctly recognize these physiological uptakes, and also helped in determining the anatomical localization of the abnormal uptakes. Combined reading of SRS and morphological images gave the highest diagnostic impact.Conclusion: The sensitivity of SRS with regard to GEP is high. However the specificity is very low. Morphologic imaging is necessary for the exclusion of physiological uptake and correct anatomic location of an abnormal tracer uptake. The combined reading of SRS and morphologic imaging studies gives the highest diagnostic impact. [ABSTRACT FROM AUTHOR]

Kaposi’s sarcoma is an uncommon neoplasm that occasionally involves the gastrointestinal tract in immunosuppressed individuals. Infection with human herpes virus 8 is known to be necessary for developing all forms of Kaposi’s sarcoma. We report a renal transplant recipient who developed visceral Kaposi’s sarcoma 18 months after the transplantation. In Oriental countries, the incidence of Kaposi’s sarcoma is extremely low, and this is the first case of Kaposi’s sarcoma arising from a transplant recipient in Japan. Standard forceps biopsies of the gastric lesions failed to make the correct diagnosis. However, endoscopic resection successfully led to the correct diagnosis of Kaposi’s sarcoma and herpes simplex virus 8 infection as well. This is the first report of a patient with visceral Kaposi’s sarcoma who underwent endoscopic resection that reliably confirmed histological diagnosis and the viral genome at the same time. [ABSTRACT FROM AUTHOR]

Aim: To evaluate number and quality of publications in gastroenterology, hepatology and digestive endoscopy from Western Europe (Belgium, Denmark, France, Germany, Great Britain, Italy, the Netherlands, Spain, Sweden, Switzerland), Japan and USA over a recent 5-year period. Methods: We screened by computer for full liver/gastrointestinal-related articles and reviews the top 40% of journals (according to the annual rating of the SCI Journal Citation Reports; Institute for Scientific Information database) in most clinical and basic science disciplines in the years 1992–1996. To be credited with an article, a given country had to be the site of the first institution where the work was conducted. Papers were rated according to the impact factor of the Institute for Scientific Information and to the ratio impact factor/mean European impact factor. Data were also normalized for nondefense research and development expenditure. Results and Conclusions: As randomly tested, the computer search had an error of ± 5–10%. In Europe, Great Britain achieved the highest total impact factor and the highest number of papers. Most of the British impact factor came from publications in British journals. The total USA impact factor exceeded that of Europe by 20%. The average impact factor for a single paper was highest for the USA and, in Europe, for Germany. The temporal trend of total impact factor showed Spain improving by 9% per year, with Germany and Italy also displaying a substantial growth. Expressed per funds allocated in nondefense research and development, Great Britain and the USA had the highest cumulative impact factor.Copyright © 2000 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: There is a paucity of information for predicting patient outcomes other than the American Association for the Surgery of Trauma (AAST) renal injury scale. The aim of this study was to evaluate the association between the patient characteristics and outcomes of patients with blunt renal trauma using a nationwide database in Japan. Methods: We performed a retrospective analysis of the Japan Trauma Data Bank (JTDB) from 2004 to 2018. We identified patients with blunt renal trauma by AIS codes converted to AAST grades. We evaluated trends in patient characteristics and management and assessed factors associated with mortality and nephrectomy using a multivariable logistic regression analysis. Results: We identified 3550 patients with blunt renal trauma. Their median age was 43 years and 74.2% were male. Nephrectomy was performed in 3.8%, and the overall mortality rate was 9.5%. We found increasing trends in age and emergency abdominal angiography and decreasing trends in nephrectomy and mortality over the 15-year period. The following factors were associated with mortality: age ≥ 65 years (adjusted OR 3.36); pedestrian accident (adjusted OR 1.94); fall from height (adjusted OR 1.91); shock on arrival (adjusted OR 4.02); concomitant injuries to the head/neck (adjusted OR 3.14), pelvis/lower-extremity (adjusted OR 1.59), liver (adjusted OR 1.68), spleen (adjusted OR 1.45), and gastrointestinal tract (adjusted OR 1.90); AAST grades III–V (adjusted ORs 1.42, 2.16, and 5.55); and emergency abdominal angiography (adjusted OR 0.70). The following factors were associated with nephrectomy: shock on arrival (adjusted OR 1.98), concomitant injuries to the thorax (adjusted OR 0.46) and spleen (adjusted OR 2.07), AAST grades III, IV, and V (adjusted ORs 18.40, 113.89, and 468.17), and emergency abdominal angiography (adjusted OR 0.28). Conclusions: We demonstrated that the AAST grade and emergency angiography were associated with mortality and nephrectomy in blunt renal trauma in the Japanese population. [ABSTRACT FROM AUTHOR]

Examines the applications of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in the gastrointestinal tract. Types of echo-endoscope for EUS FNA; Diagnostic purpose of EUS; Contraindications of endoscopy.

Background: The layered structure of the hollow organ visualized during endoscopic ultrasonography (EUS) has been interpreted in various ways and any consensus of opinion about how to interpret a layered structure is not yet established. This has caused confusion among physicians during discussions at academic forums or meetings. Therefore, it is necessary to establish a standard of interpretation as a basis for research and for such discussions. Purpose: To clarify a relationship between the layered structure in EUS and the histologic structure of the gastrointestinal wall. Method: To hold a meeting with participation from members eligible to pursue the purpose described. [ABSTRACT FROM AUTHOR]

The article presents information about the conference titled "Fifth Japan-Korea Joint Symposium on Gastrointestinal Endoscopy," which was held on May 16, 2006 in Tokyo, Japan. The event was a prominent one for the endoscopists in Japan and Korea. During the event professor Teruo Kouzu delivered the lecture on esophagus cancer. Professor Kyu Yong Choi presented a paper on colorectal cancer.

Endoscopic mucosal resection (EMR) is one of the endoscopic procedures for treatment of intramucosal cancer of the gastrointestinal tract. This method enables complete resection of a lesion, however, the size of lesions which can be resected en bloc has a limit. For lesions which can not be resected en bloc, endoscopic piecemeal mucosal resection (EPMR) are employed. However, it is often difficult to determine cancer invasion at holizontal and vertical cut end on pathological examination of resected specimens. Therefore, for the purpose of en bloc resection submucosal dissecting method of endoscopic mucosal resection (SDEMR) that is a method by which mucosa is dissected using some special devices after circumferential mucosal incision around the lesion was proposed. It enables us to resect large lesions which cannot be removed en bloc by EMR. Therefore, it is possible that this procedure is able to prevent residual cancer. Furthermore, sufficient pathological examination of resected specimens is possible, and it helps to determine a therapeutic plan after resection. It is now widely accepted as one of the endoscopic procedures for treatment of early gastric cancer, however, there have been few reports on its experience in the colorectum. Then, in order to consider the perspectives of SDEMR in the colorectum, the present status of it in Japan in August 2003 was analyzed and reviewed in this paper. [ABSTRACT FROM AUTHOR]