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Backgrounds: A meta-analysis of reports primarily from Western countries showed no association between Helicobacter pylori eradication and reflux esophagitis development. The risk of reflux esophagitis may differ among different populations based on H. pylori virulence factors and acid secretion ability. We evaluated the prevalence rates of reflux esophagitis in H.-pylori-positive Japanese subjects and assessed risk factors for reflux esophagitis after eradication. Methods: Among 148 H.-pylori-positive subjects who underwent H. pylori eradication from August 2015 to December 2019, we evaluated the prevalence of reflux esophagitis on endoscopy at 12 months after eradication success and the severity of reflux-related symptoms by the F-scale questionnaire at 2 months after treatment and 12 months after eradication success. Results: The prevalence of reflux esophagitis in H.-pylori-positive patients at entry was 2.0% (3/148). At 12 months after eradication success, the prevalence was 10.8% (16/148) (p &lt, 0.01). In the F scale, the median total score before treatment was 4 (range: 0–49), which significantly decreased to 2 (range: 0–22) (p &lt, 0.01) at 2 months after treatment and 3 (range: 0–23) (p &lt, 0.01) at 12 months after eradication success. Following multivariate analysis, the pretreatment total F-scale score was a risk factor for the development of reflux esophagitis (odds ratio: 1.069, 95% confidence interval: 1.003–1.139, p &lt, 0.01). Conclusions: In this H.-pylori-positive Japanese population, eradication therapy was associated with reflux esophagitis in around 10% of patients, particularly in those with severe reflux-related symptoms at baseline. Reflux-related symptoms may improve throughout the 12 months after successful eradication therapy, irrespective of the development of reflux esophagitis.

BackgroundThe value of endoscopy for acute lower GI bleeding (ALGIB) remains unclear, given few large cohort studies. We aim to provide detailed clinical data for ALGIB management and to identify patients at risk for adverse outcomes based on endoscopic diagnosis.MethodsWe conducted a multicenter, retrospective cohort study, named CODE BLUE J-Study, in 49 hospitals throughout Japan and studied 10,342 cases admitted for outpatient-onset of acute hematochezia.ResultsCases were mostly elderly, with 29.5% hemodynamic instability and 60.1% comorbidity. 69.1% and 87.7 % of cases underwent CT and colonoscopy, respectively. Diagnostic yield of colonoscopy reached 94.9%, revealing 48 etiologies, most frequently diverticular bleeding. During hospitalization, the endoscopic therapy rate was 32.7%, mostly using clipping and band ligation. IVR and surgery were infrequently performed, for 2.1% and 1.4%. In-hospital rebleeding and death occurred in 15.2% and 0.9%. Diverticular bleeding cases had higher rates of hemodynamic instability, rebleeding, endoscopic therapy, IVR, and transfusion, but lower rates of death and surgery than other etiologies. Small bowel bleeding cases had significantly higher rates of surgery, IVR, and transfusion than other etiologies. Malignancy or upper GIB cases had significantly higher rates of thromboembolism and death than other etiologies. Etiologies that have favorable outcomes were ischemic colitis, infectious colitis, and post-endoscopy bleeding.ConclusionsLarge-scale data of patients with acute hematochezia revealed high proportions of colonoscopy and CT, resulting in high endoscopic therapy rates. We highlight the importance of colonoscopy in detecting accurate bleeding etiologies that stratify patients at high or low risk of adverse outcomes.

Objectives Useful indices to determine whether to reduce the dose of 5-aminosalicylic acid (5-ASA) in patients with ulcerative colitis (UC) during remission remain unclear. We aimed to analyze the rate and risk factors of relapse after reducing the dose of oral 5-ASA used for maintenance therapy of UC. Methods UC patients whose 5-ASA dose was reduced in clinical remission (partial Mayo score of ≤ 1) at our institution from 2012 to 2017 were analyzed. Various clinical variables of patients who relapsed after reducing the dose of oral 5-ASA were compared with those of patients who maintained remission. Risk factors for relapse were assessed by univariate and multivariate logistic regression analyses. Cumulative relapse-free survival rates were calculated using the Kaplan–Meier method. Results A total of 70 UC patients were included; 52 (74.3%) patients maintained remission and 18 (25.7%) patients relapsed during the follow-up period. Multivariate analysis indicated that a history of acute severe UC (ASUC) was an independent predictive factor for clinical relapse (p = 0.024, odds ratio: 21, 95% confidence interval: 1.50–293.2). Based on Kaplan–Meier survival analysis, the cumulative relapse-free survival rate within 52 weeks was 22.2% for patients with a history of ASUC, compared with 82.0% for those without. the log-rank test showed a significant difference in a history of ASUC (p < 0.001). Conclusions Dose reduction of 5-ASA should be performed carefully in patients who have a history of ASUC.

In ergonomic experiments, a small number of participants is often a problem because a sufficient amount of data is not obtained. In recent years, human state recognition is wide-spread, and estimating the human state from biological information acquired from a wearable device, is useful for improving living behavior. While it is necessary to collect a sufficient amount of data in order to perform state estimation with a certain degree of accuracy, collecting the amount of data requires a considerable cost. This study attempted to expand physiological and psychological data using deep learning. Specifically, information on physiological indicators was added to ACGAN. From the verification using the actual experimental results, it was found that the accuracy of recognizing the human state was improved by using the augmented data compared to the case of learning with a small number of original data.

BACKGROUND AND AIM Either clipping or band ligation will become the most common endoscopic treatment for colonic diverticular bleeding (CDB). Rebleeding is a significant clinical outcome of CDB, but there is no cumulative evidence comparing reduction of short-term and long-term rebleeding between them. Thus, we conducted a systematic review and meta-analysis to determine which endoscopic treatment is more effective to reduce recurrence of CDB. METHODS A comprehensive search of the databases PubMed/MEDLINE and Embase was performed through December 2019. Main outcomes were early and late rebleeding rates, defined as bleeding within 30 days and 1 year of endoscopic therapy for CDB. Initial hemostasis, need for transcatheter arterial embolization, or surgery were also assessed. Overall pooled estimates were calculated. RESULTS Sixteen studies fulfilled the eligibility criteria, and a total of 790 participants were included. The pooled prevalence of early rebleeding was significantly lower for band ligation than clipping (0.08 vs 0.19; heterogeneity test, P = 0.012). The pooled prevalence of late rebleeding was significantly lower for band ligation than clipping (0.09 vs 0.29; heterogeneity test, P = 0.024). No significant difference of initial hemostasis rate was noted between the two groups. Pooled prevalence of need for transcatheter arterial embolization or surgery was significantly lower for band ligation than clipping (0.01 vs 0.02; heterogeneity test, P = 0.031). There were two cases with colonic diverticulitis due to band ligation but none in clipping. CONCLUSION Band ligation therapy was more effective compared with clipping to reduce recurrence of colonic diverticular hemorrhage over short-term and long-term durations.

The feeling that a body part is one's own body (sense of ownership; SoO) and the feeling based on the causal relationship between one's will and action (sense of agency; SoA) have been recognized as the basis of our bodily self-consciousness. Previously, the illusory SoO over a fake body part (e.g., rubber hand) was introduced as the rubber hand illusion (RHI). Furthermore, it was determined that one could also evoke a SoA over an object with movements linked to the one's prior intention. On the other hand, the postdictivity of our spontaneity implies that it is essentially inseparable whether actions originate from self or others. In other words, our SoA or daily experiences are obtained in such as inseparable scenario. Previous research, however, has maintained the premise that self- and other-origin movements are perceptually distinguishable. Here, we implement a protocol to make these aspects ambiguous for the participants and to estimate whether they can feel SoO and/or SoA and how. To this end, we employ an experiment using virtual reality, under which participants observe virtual fingers moving very slowly (or quickly or not moving) while their own fingers do not move. For evaluation of the illusory SoO, measurements of skin conductance responses against a knife threat are adopted. Additionally, we introduce face-to-face interviews to determine whether the feelings regarding the slow movement match the conventional SoA definition. Our representative results suggest that the SoO is evoked over the hand, and various attitudes to accept its movement as the participant's own with awareness that they did not originate it are reported by the majority. As the results show, the novelty of this protocol is discovering that in such a situation, the SoO cooperates with an externally produced SoA to establish one's own bodily experience rather than the independence of the SoO and SoA.

The postharvest properties of two ultra-late maturing peach cultivars, ‘Tobihaku’ (TH) and ‘Daijumitsuto’ (DJ), were investigated. Fruit were harvested at commercial maturity and held at 25°C. TH exhibited the characteristics of normal melting flesh (MF) peach, including rapid fruit softening associated with an increase in endogenous ethylene production In contrast, DJ did not soften at all during three-week experimental period even though substantial ethylene production was observed. Fruit of TH and DJ were treated with 5000 ppm of propylene, an ethylene analog, continuously for seven days. TH softened rapidly whereas DJ maintained high flesh firmness in spite of an increase in endogenous ethylene production, suggesting that DJ but not TH lacked the ability to be softened in response to endogenous and exogenous ethylene/propylene. DNA-seq analysis showed that tandem endo-polygalacturonase (endoPG) genes located atmelting flesh(M) locus,Pp-endoPGM(PGM) andPp-endoPGF(PGF), were deleted in DJ. TheendoPGgenes atMlocus are known to control flesh texture of peach fruit, and it was suggested that the non-softening property of DJ is due to the lack ofendoPGgenes. On the other hand, TH possessed an unidentifiedMhaplotype that is involved in determination of MF phenotype. Structural identification of the unknownMhaplotype, designated asM0, through comparison with previously reportedMhaplotypes revealed distinct differences betweenPGMonM0haplotype (PGM-M0) andPGMon other haplotypes (PGM-M1). PeachMhaplotypes were classified into four main haplotypes:M0withPGM-M0;M1with bothPGM-M1andPGF;M2withPGM-M1; andM3lacking bothPGMandPGF. Re-evaluation ofMlocus in association with MF/non-melting flesh (NMF) phenotypes in more than 400 accessions by using whole genome shotgun sequencing data on database and/or by PCR genotyping demonstrated thatM0haplotype was the common haplotype in MF accessions, andM0andM1haplotypes were dominant overM2andM3haplotypes and co-dominantly determined the MF trait. It was also assumed on the basis of structural comparison ofMhaplotypes amongPrunusspecies that the ancestral haplotype ofM0diverged from those of the other haplotypes before the speciation ofPrunus persica.

Backgrounds: The etiology of gastroesophageal reflux disease (GERD) including reflux esophagitis and non-erosive reflux disease is multifactorial and a recent meta-analysis showed no association between the development of GERD and Helicobacter pylori eradication in both Western and East-Asian populations. However, the problem remains that various inclusion criteria are used in these studies, which hinders meta-analysis. With a focus on reflux esophagitis with endoscopic mucosal injury, we meta-analysed to evaluate the association between eradication and reflux esophagitis and symptoms using a clearly defined set of inclusion criteria. Methods: We conducted a meta-analysis of studies published up until March 2020, which compared the incidence of reflux esophagitis and symptoms between patients undergoing H. pylori eradication therapy in a randomized placebo-controlled trial (Category A), between patients with successful and failed eradication (Category B), and between patients with successful vs. failed eradication, receipt of placebo, or no-treatment H. pylori-positives (Category C). Results: A total of 27 studies were included. Significant statistical effects were found for development of endoscopic reflux esophagitis [relative risk (RR): 1.46, 95% confidence interval (CI): 1.16&ndash, 1.84, p = 0.01] or de novo reflux esophagitis (RR: 1.42, 95% CI: 1.01&ndash, 2.00, p = 0.03) in the case group that received eradication in all studies, especially in Western populations. There was no significant difference in the incidence of symptoms after eradication between patient and control groups, regardless of category, location of population, or baseline disease. Conclusions: Eradication therapy for H pylori increases the risk of reflux esophagitis, irrespective of past history of esophagitis. In contrast, no effect was seen on reflux-related symptoms.

Background: Helicobacter pylori eradication containing the potassium-competitive acid blocker, vonoprazan, achieves a higher eradication rate than therapy with proton pump inhibitors (PPIs). Because vonoprazan is mainly metabolized by CYP3A4/5, CYP genotype may affect the eradication rate. We investigated the influence of antibiotic susceptibility and CYP3A4/5 and CYP2C19 genotypes on the eradication rates. Methods: A total of 307 Japanese who were genotyped for CYP3A4 *1/*22, CYP3A5 *1/*3 and CYP2C19 *1/*2/*3/*17, and investigated for susceptibility to antimicrobial agents, received vonoprazan-containing regimens: (1) With amoxicillin and clarithromycin as the first-line treatment, (2) with amoxicillin and metronidazole as the second-line treatment, or (3) with amoxicillin and sitafloxacin as the third-line treatment. Results: The eradication rate was 84.5% (95% confidence interval [CI]: 78.9&ndash, 89.1%) using first-line, 92.6% (95% CI: 82.1&ndash, 97.9%) using second-line and 87.5% (95% CI: 73.1&ndash, 95.8%) using third-line treatment. Infection with clarithromycin-resistant strains was a predictive factor for failed eradication (odds ratio: 5.788, 95% CI: 1.916&ndash, 17.485, p = 0.002) in multivariate analysis. No significant differences were observed in the eradication rate of regimens among CYP3A4, CYP3A5 and CYP2C19 genotypes. Conclusions: Genotyping for CYP3A4 *1/*22, CYP3A5 *1/*3 and CYP2C19 *1/*2/*3/*17 before vonoprazan-containing eradication treatment may not be useful for predicting clinical outcomes.

Objective Endoscopic laryngopharyngeal surgery (ELPS) is an effective and minimally invasive treatment for pharyngeal cancers. However, the disadvantages of ELPS are the interference of instruments in the operative field and the difficulty in approaching certain areas. To overcome these drawbacks, we began to perform combination treatment of ELPS and endoscopic submucosal dissection (ESD). The aim of the present study was to compare the efficacies of treatment with ELPS alone and ELPS combined with ESD. Methods A total of 103 lesions in 73 patients who underwent pharyngeal ELPS for superficial pharyngeal cancer between August 2014 and January 2020 at our hospital were analyzed. Lesions were divided into the ELPS alone group and ELPS combined with ESD group. Lesion characteristics, technical results, adverse events, and long-term outcomes were analyzed. Results In the ELPS combined with ESD group, procedure speed was shorter than the ELPS alone group (20.2 ± 10.0 mm2/min vs 13.0 ± 6.6 mm2/min, p Conclusions Combination treatment of ESD and ELPS enabled more efficient resection than ELPS alone. Cooperative treatment of pharyngeal cancer patients involving gastroenterologists and head and neck surgeons is effective and beneficial, and results in favorable long-term outcomes.

Objective This study aims to elucidate the association between the clinical characteristics of post-colonoscopy colorectal cancer (PCCRC) and quality indicators (QIs) of colonoscopy. Methods Patients with PCCRC who underwent total colonoscopy (TCS) and were histologically diagnosed with adenocarcinoma within six months to five years of the last examination were included in this study. PCCRC and normally detected cancer (NDC) identified within the same period were compared in terms of their clinicopathological characteristics. Furthermore, the QIs at PCCRC detection were compared to those at the last examination. Results Patients with PCCRC had a significantly higher rate of colon surgery history than those with NDC (PCCRC: 25/76, 32.9%; NDC: 31/1,437, 2.2%; p

All gastrointestinal endoscopic procedures have a high risk of aerosol contamination of the coronavirus disease 2019 (COVID‐19) to endoscopists, nurses, and healthcare assistants. Given the current pandemic situation of COVID‐19, the Japan Gastroenterological Endoscopy Society issued the recommendation for gastrointestinal (GI) endoscopy based on the status of COVID‐19 as of April 9, 2020, in Japan: (i) indications for GI endoscopy in the pandemic of COVID‐19; (ii) practical protective equipment for medical personnel depending on the risk for COVID‐19; (iii) preprocedural management, such as pharyngeal local anesthesia using lidocaine spray which has a potential to generate the aerosols; (iv) ideal settings of the endoscopy room including the numbers of the staff and the patients; (v) postprocedural management, such as undressing and follow‐up of the patients, as well as the involved staff, were documented to fit the practical scenarios in GI endoscopy, with the available data in Japan and the world. We believe that certain measures will prevent further spread of COVID‐19.

Virtual reality (VR) training is an increasingly popular topic in sports science [1]. We introduce a VR application for martial arts training, which utilizes physics-based full-body interaction that extends our previous work on the subject [2]. Our use of full-body tracking and user-worn VR equipment without external tethering enables training of techniques that employ lower body: e.g. kicking, grappling, and leg sweeps. Hence a wide variety of martial art styles – from stand-up fighting to ground fighting – can be trained.The training application features virtual opponents and a motion tracked user avatar, which is implemented using RUIS toolkit [3]. The avatar’s and the virtual opponents’ body segments are part of physics simulation that determine their final motion. This enables dynamic hand-to-hand combat, where the user’s punches, takedowns, holds, and other techniques affect the opponents in a convincing manner. The user can engage any number of virtual opponents at full power in no-holds-barred matches without risk of injury to fellow practitioners.In addition to partner training, sparring, and virtual target mitts, the application also includes novel VR training features: performance playback, rhythm game, and controls for adjusting virtual opponent speed, strength, and knockout resistance. User performed techniques can be recorded and then replayed dynamically by the virtual opponent using the physics simulation. Thus, the user can be their own training partner, and even fight himself in the virtual arena.

Background and Aims The effectiveness of vonoprazan relative to that of proton pump inhibitors (PPIs) after gastric endoscopic submucosal dissection (ESD) is unclear. Although previous studies used post-ESD ulcer healing as the outcome measure, post-ESD bleeding rate is the most objective and appropriate outcome measure because it has less ascertainment bias. We aimed to compare the post-ESD bleeding rates between vonoprazan and PPIs. Methods This nationwide population-based retrospective cohort study was conducted between 2014 and 2018 and involved 9 hospitals. After 2 days of intravenous PPI administration, either vonoprazan or PPI was administrated from postoperative day 2 to 30. Results Overall, data of 1715 patients (627 patient pairs) were analyzed through propensity score matching. The vonoprazan group had significantly lower post-ESD bleeding rates than the PPI group (overall, 11.9% vs 17.2%, P = .008; bleeding between days 2 and 30, 7.8% vs 11.8%, P = .015). The readmission rate because of post-ESD bleeding was lower in the vonoprazan group (2.4% vs 4.1%, P = .081). Blood transfusion (2.1% vs 3.0%, P = .15) and additional surgery because of delayed perforation (.5% vs 1.0%, P = .32) were not significantly different between the 2 groups. No deaths within 30 days occurred in both groups. On Cox regression analysis, vonoprazan use, lesion location (antrum), aspirin use, direct oral anticoagulant use, and Charlson Comorbidity Index (≥2) were associated with an increased risk of post-ESD bleeding within 30 days. Conclusions Vonoprazan has a lower post-ESD bleeding rate than PPIs. Further prospective studies are required to confirm these results.

The purpose of the study was to clarify the exothermic chemical reaction mechanisms in Ti/Si multilayered nanofilms under mechanical loading. We conducted in situ compression experiments of truncated-cone specimens of polycrystalline-Ti/amorphous-Si multilayered nanofilms (bilayer thickness of ~ 34 nm) deposited by electron beam evaporation within a scanning electron microscope. The true stress increased almost linearly with increasing true strain and the tangent modulus began to decrease at ~ 3 GPa. Transmission electron microscopy of the deformed specimens confirmed that each layer was plastically compressed in the stacking direction and expanded in the in-plane direction, resulting in an increase in the Ti/Si interface area. Selected-area electron diffraction analysis revealed that a new crystal structure, proposed to be Ti5Si4 and/or TiSi, was generated on the Ti/Si interface and within the Ti layer. In addition, the volume of the specimens decreased with increasing strain, supporting the hypothesis of a chemical reaction occurring. The chemical reaction was induced at the new reactive Ti/Si interface by the partial fracture of preexisting compound layers due to tensile stresses in the in-plane direction, and/or induced by diffusion-induced mixing through the thinned compound layers. These findings present the possibility of controlling the chemical reaction by local mechanical loading. The observed exothermic reaction can be used for various applications, such as local heating in large-scale micro- and nanodevices.

A 73-year-old woman was admitted for closer investigation into an abdominal tumor. Abdominal ultra-sonography, CT, and magnetic resonance imaging showed a discrete abdominal tumor. Especially on MRI, the tumor appeared as a relatively ill-defined whorled soft-tissue thickening within the mesenteric fat, causing angulation or speculation of adjacent bowel mesentery. Surgery was performed under a presumptive diagnosis of a mesojejunum desmoid. The tumor was invading the transverse mesocolon and mesojejunum as well as the third portion of the duodenum and the middle colic artery, and it was close to but apart from the superior mesenteric artery. The tumor was resected, including removal of part of the duodenum and transverse colon. The specimen contained a white solid tumor measuring 14×12×8cm. Pathologic examination showed differentiated fibroblasts and copious collagen fibers. The tumor was negative for CD34, c-kit, S-100, and α-SMA, but positive for β-catenin. On the basis of these findings, we established a diagnosis of mesenteric desmoid tumor of the small intestine. The patient has been followed postoperatively for 2 years, no sign of recurrence, to date.

// Yoshiko Mori 1, 2 , Akihiro Nyuya 3 , Kazuya Yasui 1 , Toshiaki Toshima 1 , Takashi Kawai 1 , Fumitaka Taniguchi 1 , Keisuke Kimura 1 , Ryo Inada 1 , Masahiko Nishizaki 1 , Junko Haraga 4 , Keiichiro Nakamura 4 , Yuzo Umeda 1 , Hiroyuki Kishimoto 1 , Toshiyoshi Fujiwara 1 , Yosuke Katata 3 , Yoshiyuki Yamaguchi 3 and Takeshi Nagasaka 3 1 Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan 2 Clinical Genomic Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan 3 Department of Clinical Oncology, Kawasaki Medical School, Kurashiki City, Japan 4 Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan Correspondence to: Takeshi Nagasaka, email: takeshin@med.kawasaki-m.ac.jp Keywords: ovarian metastases; colorectal cancer; ovarian metastatectomy; BRAF; RAS Received: August 15, 2017 Accepted: February 21, 2018 Published: March 27, 2018 ABSTRACT We clarified the clinical prevalence of ovarian metastases from colorectal cancers (CRCs) in 296 female patients with CRC and evaluated clinical outcomes with relation to their mutational profiles, such as BRAF/KRAS mutation and microsatellite instability (MSI) status. The female CRCs were categorised into three subsets: CRCs with ovarian metastases [6.4% ( n = 19), 5-year overall survival (OS) = 24.7%], CRCs with extra-ovarian metastases only [32.4% ( n = 96), 5-year OS = 34.5%] and CRCs without any recurrence or metastasis [61.2% ( n = 181), 5-year OS = 91.3%]. All patients with ovarian metastases underwent oophorectomy; of these, 9 who received preoperative chemotherapy had measurable metastases to extra-ovarian sites and the ovaries. Although 5 of 9 (56%) achieved partial response or complete response at extra-ovarian sites, no patient archived objective response at ovarian sites. Regarding the mutation profiles, in CRCs with extra-ovarian metastases only, the median survival time (MST) after initial treatments to progression to stage IV or recurrence was 13 [95% confidence interval (CI): 7–16 months] in BRAF-mutant and 34 months (95% CI: 22–58 months) in BRAF wild-type ( P = 0.0033). Although ovarian metastases demonstrated poor response to systemic chemotherapy in CRCs with ovarian metastases, the MST after initial treatments to progression to stage IV or recurrence was 22 (95% CI: 21–25 months) in BRAF-mutant and 38 months (95% CI: 24–42 months) in BRAF wild-type ( P = 0.0398). The outcomes of patients with ovarian metastases could be improved by oophorectomy regardless of their mutation profiles.

Staphylococcus lugdunensis produces a tannase with activity that may be associated with the onset of colon carcinoma. To clarify this feature of colon carcinoma-associated S. lugdunensis, we obtained isolates from healthy subjects and patients with colon adenomas and carcinomas and analyzed their genetic backgrounds. In total, 40 S. lugdunensis isolates from 288 rectal swabs collected between 2002 and 2008 were used. These isolates were classified into four groups according to the diseases of the subjects: healthy (n = 13), colon carcinoma (n = 13), colon adenoma (n = 9), and unknown (n = 5). The isolates were also classified by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing. In addition, an antimicrobial susceptibility test and detection of resistance genes were performed for all isolates. According to the PFGE analysis, 40 isolates could be classified into five groups. Among the groups, carcinoma and colon adenoma patients were significantly more frequently (40.9%) classified into group D (p

Introduction:As the aging of people in a society advances, the number of elderly patients older than 80 years in Japan with gastric cancer continues to increase. Although delayed ulcer bleeding is a major adverse event after endoscopic submucosal dissection (ESD), little is known about characteristic risk factors for bleeding in elderly patients undergoing ESD. This study aimed to evaluate risk factors for delayed bleeding after ESD for gastric cancer in elderly patients older than 80 years., Methods:We retrospectively evaluated the incidence of delayed bleeding after ESD in 10,320 patients with early-stage gastric cancer resected by ESD between November 2013 and January 2016 at 33 Japanese institutions and investigated risk factors for delayed bleeding in elderly patients older than 80 years., Results:The incidence of delayed bleeding in elderly patients older than 80 years was 5.7% (95% confidence interval [CI]: 4.6%-6.9%, 95/1,675), which was significantly higher than that in nonelderly (older than 20 years and younger than 80 years) patients (4.5%, 4.1%-5.0%, 393/8,645). Predictive factors for ESD-associated bleeding differed between nonelderly and elderly patients. On multivariate analysis of predictive factors at the time of treatment, risk factors in elderly patients were hemodialysis (odds ratio: 4.591, 95% CI: 2.056-10.248, P < 0.001) and warfarin use (odds ratio: 4.783, 95% CI: 1.689-13.540, P = 0.003)., Discussion:This multicenter study found that the incidence of delayed bleeding after ESD in Japanese patients older than 80 years was high, especially in patients receiving hemodialysis and taking warfarin. Management of ESD to prevent delayed bleeding requires particular care in patients older than 80 years.

ObjectiveTo assess the non-inferiority of vonoprazan to lansoprazole for secondary prevention of non-steroidal anti-inflammatory drug (NSAID)-induced peptic ulcer (PU) and the safety of vonoprazan during extended use.DesignA phase 3, 24-week, multicenter, randomised, double-blind (DB), active-controlled study, followed by a phase 3, ≥28 week, multicenter, single-blind, parallel-group extension study (EXT) in outpatients (n=642) receiving long-term NSAID therapy who are at risk of PU recurrence. The patients received vonoprazan (10 mg or 20 mg) or lansoprazole 15 mg once daily. For DB, non-inferiority of the proportion of patients with recurrent PU within 24 weeks was analysed by Farrington and Manning test (significance level 2.5%, non-inferiority margin 8.3%; primary endpoint), recurrent PU within 12 weeks, bleeding and time-to-event of PU (secondary endpoint) and treatment-emergent adverse events (TEAEs). For EXT, TEAEs (primary endpoint), recurrent PU and safety (secondary) were assessed up to 104 weeks for patients in the extension study.ResultsThe non-inferiority of vonoprazan 10 mg and 20 mg to lansoprazole 15 mg was verified (percentage difference –2.2%,95% CI –6.2% to 1.8%, pConclusionThe non-inferiority of vonoprazan (10 and 20 mg) was verified in patients receiving long-term NSAIDs in DB; it was effective and well tolerated in EXT for longer than 1 year, with a safety profile similar to lansoprazole (15 mg).Trial registration numbersNCT01452750, NCT01456260; Results.

A solid pseudo-papillary tumor of the pancreas is a rare neoplasm which mainly occurs in young women. Here, we report two cases of solid-pseudopapillary neoplasm of the pancreas (SPN) with contrasting imaging findings. One was a 59-year-old woman having no symptomatic complaint with a pancreatic cystic tumor in the tail. The tumor was 60 mm in diameter with a cyst composed of a calcified wall and low-density content which was poorly perfused on contrast-enhanced computed tomography (CT). We diagnosed SPN based on imaging findings and performed distal pancreatectomy. Histology revealed SPN, and the patient had two years of recurrence -free survival (RFS). The other case was a 34-year-old man with an asymptomatic solid tumor in the pancreatic tail. Contrast-enhanced CT showed low peripheral attenuation of a 25-mm solid tumor, with the main duct dilated distal from tumor. We diagnosed him with pancreatic cancer with atypical image findings. Pathological findings revealed SPN, and the patient had five years of RFS. Small-sized SPN is being increasingly recognized because of the recent advances in CT and MRI. We should consider SPN even if it occurs in a male, and endoscopic ultrasound -guided fine-needle aspiration has recently been reported to be useful in diagnosing SPN.

The serological risk prediction system combines the pepsinogen test and anti-Helicobacter pylori (H. pylori) antibody determination. In this system, chronic atrophic gastritis (CAG) is diagnosed using the pepsinogen test. Patients who are H. pylori negative and pepsinogen negative are classified into group A, are assumed to be H. pylori uninfected, and are at an extremely low risk for gastric cancer. However, gastric cancers are detected in this group. The aim of this study is to clarify the clinicopathological status of group A patients with gastric cancer. A total of 109 gastric cancer patients classified as group A were enrolled in a multicenter study. Group A patients were divided into two subgroups: group AN (H. pylori uninfected) and group AP (H. pylori infected). They were compared to 183 H. pylori-infected gastric cancer patients who were not in group A. Of the 109 patients, only 7 were classified as group AN; the other 102 were classified as group AP. The clinicopathological features of group AP included older age, predominantly differentiated type cancer, endoscopically visualized CAG, and pepsinogen (PG) I/II ratio lower than that of group AN. In group AN, the depressed type was dominant, and the PG I/II ratio was higher than in those gastric cancer patients who were infected with H. pylori. Patients in group AP had CAG, and their gastric cancers were similar to those of H. pylori-eradicated patients. Concerning the recent ABC classification system, advanced decision criteria should be proposed to decrease the false-negative evaluation of gastric cancer risk.

The sexuality of crops is an important trait affecting production and breeding efficiencies. Recently, a Y-chromosome-encoded gene, designated Oppressor of MeGI ( OGI ), has been shown to play a central role in dioecious sex determination in diploid persimmons ( Diospyros spp.). However, little is known about the relationship between OGI and the irregular sexuality in polyploid persimmon ( D. kaki ). D. kaki , which is mostly hexaploid with some nonaploid individuals, is mainly constituted of monoecious and female individuals. In this study, we attempted to investigate the association of sexuality with OGI allele diversities/dosages in a wide range of D. kaki cultivars. The results indicated that OGI is indispensable for the monoecious phenotype producing male flowers, which suggested a conserved role for OGI as a key to expressing maleness in D. kaki , as in dioecious diploid Diospyros . However, the existence of OGI alleles did not always lead to production of male flowers in D. kaki . The dosage or composition of OGI alleles had no substantial effect on the sexuality of the cultivars tested. We discuss the potential use of the obtained information on OGI allele diversities/dosages for breeding of D. kaki cultivars.

Epigenetic regulation can add a flexible layer to genetic variation, potentially enabling long-term but reversible cis-regulatory changes to an allele while maintaining its DNA sequence. Here, we present a case in which alternative epigenetic states lead to reversible sex determination in the hexaploid persimmon Diospyros kaki. Previously, we elucidated the molecular mechanism of sex determination in diploid persimmon and demonstrated the action of a Y-encoded sex determinant pseudogene called OGI, which produces small RNAs targeting the autosomal gene MeGI, resulting in separate male and female individuals (dioecy). We contrast these findings with the discovery, in hexaploid persimmon, of an additional layer of regulation in the form of DNA methylation of the MeGI promoter associated with the production of both male and female flowers in genetically male trees. Consistent with this model, developing male buds exhibited higher methylation levels across the MeGI promoter than developing female flowers from either monoecious or female trees. Additionally, a DNA methylation inhibitor induced developing male buds to form feminized flowers. Concurrently, in Y-chromosome-carrying trees, the expression of OGI is silenced by the presence of a SINE (short interspersed nuclear element)-like insertion in the OGI promoter. Our findings provide an example of an adaptive scenario involving epigenetic plasticity.