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Objectives: Endoscopic submucosal dissection (ESD) is a widely used treatment for early gastrointestinal cancer. However, colon ESD remains challenging. Previous studies on colon ESD using the traction method used a small sample, single‐center design, providing insufficient evidence of this procedure's efficacy. We thus aimed to investigate the efficacy and safety of the traction method in colon ESD in this multicenter randomized trial. Methods: We conducted a prospective, multicenter, randomized, two‐arm controlled trial at 10 facilities in Japan. A 1:1 allocation was conducted for the conventional ESD (C‐ESD) and traction ESD (T‐ESD) groups. The primary end‐point was ESD procedure time. Results: We included 128 C‐ESD and 123 T‐ESD cases from April 2020 to August 2021. The median procedure times for C‐ESD and T‐ESD were 61 (40–100) and 53 (40–76) min (P = 0.18), respectively, and no significant differences were observed between the groups. Subgroup analysis showed that the median procedure times for patients with a lesion diameter of ≥30 mm in the C‐ESD and T‐ESD groups were 89 (57−80) and 69 (50−104) min (P = 0.05), respectively, and for nonexpert operators were 81 (62−120) and 64 (52−109) min (P = 0.07), respectively. Conclusions: The traction method did not contribute to a significantly shortened ESD procedure time. However, this method may be useful when the tumor diameter is large or if the procedure is conducted by nonexpert endoscopists. [ABSTRACT FROM AUTHOR]

The Obiro deposit is located in the Tagawa Acidic Rocks (AR), Uetsu region, NE Japan. The Tagawa AR is composed of a volcanic phase of dacitic welded tuff and a plutonic phase of porphyritic granodiorite. Drill core and ore samples were collected from the deposit and examined by XRD, EPMA, and microthermometry. The drill core samples have suffered pervasively from sericite (illite) alteration, whereas pinkish K‐feldspar alteration halo occur close to veins. The results of EPMA and microthermometry is interpreted as that the magnatic‐hydrothermal fluids has changed as follows; the granodioritic magma intruded at about 1.0 kb and 700°C near the water‐saturated granite solidus; after cooling to about 500°C the fluids boiled according to a change in the pressure regime from lithostatic to hydrostatic; mixing with meteoric water led to sulfide mineralization at around 400°C or less. The main reasons for the mineralization in the Obiro deposit are as follows; the oxidized magma intruded at a shallower level, and thereafter hydrothermal fluids were boiled, resulting in a saline fluid. The saline fluid then dissolved metals such as Pb, Zn, Cu, and Bi, and these metals precipitated during cooling accompanied by dilution of the meteoric water and increasing pH, resulting in decreasing solubility. [ABSTRACT FROM AUTHOR]

Objectives: To determine the outcomes and prognostic factors associated with pulmonary resection of pulmonary pleomorphic carcinoma (PPC)., Methods: During 2008-2017, 17 patients underwent pulmonary resection for primary PPC at the Saitama Cancer Center, Japan. We investigated clinicopathological characteristics and outcomes of these cases. Overall survival (OS) and disease-free survival (DFS) rates were determined using Kaplan-Meier method and compared using log-rank test. Univariate analysis was performed to identify prognostic factors., Results: The 5-year OS and DFS rates were 27.2% and 51.0%, respectively. The median follow-up period was 30.8±24.9 (3.6-92.8) months after pulmonary resections. Patients with disease-free interval (DFI) <1 year of resection had poorer prognosis than those without (p = 0.001). Patients with N2 status and adenocarcinoma components had significantly poorer disease-free prognosis than their counterparts (p = 0.021 and p = 0.019, respectively). Univariate analysis revealed that DFI <1 year was an unfavorable prognostic factor for OS (p = 0.005); N2 pathological status and presence of adenocarcinoma components were unfavorable prognostic factors for DFS (p = 0.038 and p = 0.036, respectively)., Conclusion: PPC patients with an adenocarcinoma component and N2 pathological status may have an earlier relapse and poorer prognosis than their counterparts. Further assessment of cases may help clarify the predictors of PPC.

To prospectively validate the incidence, manifestations, and outcomes of graft-versus-host disease (GVHD) by National Institutes of Health criteria, we recruited 406 hematopoietic stem cell transplantation recipients at 16 transplant centers in Japan from May 2012 to June 2014. The 2-year cumulative incidence of late acute and chronic GVHD was 3.2% (n = 13) and 35.4% (n = 145), with a median onset of 3.6 and 4.7 months after transplant, respectively. The global severity at onset was mild in 30.3%, moderate in 43.5%, and severe in 26.2%. Eighty-two patients were followed up for 2 years, with 79.3% still manifesting GVHD symptoms, and 80.6% (n = 117) of the patients received systemic immunosuppressive treatment (IST), with a 2-year cumulative incidence of IST termination of 33.1%. Severe patients showed a significantly lower rate of IST termination than those with mild and moderate severities (mild, 38.5%; moderate, 40.9%; and severe, 17.2%). The 2-year incidence of nonrelapse mortality (NRM) and relapse was not significantly different according to the severity at onset (NRM: mild [16.6%] versus moderate [8.7%] versus severe [16.1%]; relapse: mild [14.9%] versus moderate [14.7%] versus severe [5.3%]). As a result, 2-year overall survival (OS) and GVHD-specific survival (GSS) were equivalent according to the severity at onset (mild: OS = 81.0%, GSS = 85.7%; moderate: OS = 84.2%, GSS = 92.5%; severe: OS = 83.9%, GSS = 89.2%). Our study helped identify the characteristics of late acute and chronic GVHD in Japanese patients. Further investigation is needed to identify an optimal endpoint for survival prediction., (Copyright © 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

A 65-year-old man was diagnosed with polycythemia vera (PV) and treated with hydroxyurea. Three years later, he was admitted to our institution for severe hypoxia. Right heart catheterization revealed that the patient had pulmonary hypertension (PH). In addition, radiographic findings and resistance to pulmonary vasodilators led to the diagnosis of PH associated with pulmonary veno-occlusive disease. The administration of ruxolitinib improved his hematopoiesis and respiratory failure. While the disease is relatively common in Europe and the United States, limited data exist regarding myeloproliferative neoplasm complicated with PH in Japan. PH should be considered a potential complication and screened during the clinical care of patients with myeloproliferative neoplasms.

Unlabelled: Postoperative acute exacerbation of interstitial pneumonia (IP) is known to be a serious complication in the surgical treatment for primary lung cancer combined with IP. This retrospective study was conducted to investigate the influence of three different approaches to the thorax on postoperative acute exacerbation of IP in lung cancer patients. Forty-seven lung cancer patients who developed it underwent pulmonary resection between 1982 and 2003. Among them, approaches to the thorax consisted of posterolateral thoracotomy (PLT) (n=15), muscle-sparing thoracotomy (MST) (n=15), and video-assisted thoracic surgery (VATS) (n=17). Seven of 47 suffered from acute exacerbation of IP. Single variable analysis suggested that exertion dyspnea (Hugh-Jones classification), serum C-reactive protein, serum lactate dehydrogenase and total lung capacity were considered to be preoperative risk factors of acute exacerbation. As for the VATS patient, there was little frequency of postoperative complication in comparison with the other two approaches. However no significant difference was shown in the incidence of acute exacerbation between the three approaches., Conclusion: The use of VATS did not prevent acute exacerbation of IP. However, the incidence of postoperative complications in VATS seemed to be low, therefore further trials are required.