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Adult T‐cell leukemia‐lymphoma (ATL) is a T‐cell malignancy that is endemic to Japan. In this latest nationwide study of ATL, we collected the data from 4 nationwide registries of patients diagnosed in 2012‐2013; the Hematology Blood Disease, the Skin Cancer Society, the Hospital‐Based Cancer Registries, and information from the hospitals that participated in the Japanese nationwide survey of ATL in 2010‐2011. In the present study, 2614 patients with ATL were diagnosed based on the registries, and 117 departments registered 1042 patients. Among these patients, 984 were eligible for analysis. The median age at diagnosis was 69 y. A larger proportion of patients with ATL older than 70 y was diagnosed with the lymphoma subtype, and more than half of the patients with ATL in the metropolitan areas were born in the human T‐cell leukemia virus type I (HTLV‐1)‐endemic areas of Kyushu/Okinawa, which are almost identical to the findings in our 2010‐2011 study. Additionally, we identified that patients with ATL migrated from the endemic areas for HTLV‐1 to the non‐endemic metropolitan areas. The present study was able to reduce the burden of searching each hospital and to update the clinico‐epidemiological characteristics of a large number of patients with ATL in Japan, suggesting the usefulness and feasibility of the novel data collection method. The establishment of a more sophisticated database management system for ATL is necessary for future continuous surveys. We identified that ATL patients shifted from areas endemic for HTLV‐1 to non‐endemic metropolitan areas. The median age at diagnosis was 69 y, which was significantly older than that in the 1980s and 1990s. We conducted a nationwide survey of ATL during 2012‐2013 by modifying data acquisition from 4 nationwide registries.

Adult T‐cell leukemia/lymphoma (ATL) is a mature T‐cell neoplasm and is classified into four subtypes (acute, lymphoma, chronic, and smoldering) according to the Shimoyama classification, established in 1991 through several nationwide surveys based on the clinical diversity of patients diagnosed in 1983‐1987 in Japan. Thereafter, no such studies have been conducted. Recently, we conducted a nationwide hospital survey using the method of the 1980s studies, collected baseline data on 996 ATL patients diagnosed in 2010‐2011 from 126 hospitals, and reported their unique epidemiological characteristics. Here, we report the follow‐up results of registered ATL patients with the goal of evaluating current prognoses and treatment modalities as of 2016‐2017. Of 770 evaluable patients, 391 (50.8%) had acute‐type, 192 (24.9%) had lymphoma‐type, 106 (13.8%) had chronic‐type, and 81 (10.5%) had smoldering‐type ATL. The initial therapy regimens used for acute/lymphoma‐type ATL were vincristine, cyclophosphamide, doxorubicin and prednisone, followed by doxorubicin, ranimustine, and prednisone and then by vindesine, etoposide, carboplatin, and prednisone (VCAP‐AMP‐VECP)‐like in 38.5/41.7% and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)‐like in 14.6/13.7% of patients. Allogeneic hematopoietic stem cell transplantation was used to treat 15.9/10.4% of acute/lymphoma‐type ATL patients. The 4‐year survival rates (the median survival time, days) for acute‐, lymphoma‐, unfavorable chronic‐, favorable chronic‐, and smoldering‐type ATL were 16.8% (252), 19.6% (305), 26.6% (572), 62.1% (1937), and 59.8% (1851), respectively. The 4‐year survival rates for acute‐ and lymphoma‐type ATL improved compared with those reported in 1991, but those for chronic‐ and smoldering‐type ATL were not. Further efforts are warranted to develop more efficient therapeutic strategies to improve the prognosis of ATL in Japan. The survival curve shows that the prognoses of patients with acute and lymphoma‐type ATL in Japan have improved modestly, but those of patients with chronic and smoldering‐type ATL have not improved.

INTRODUCTION: Perineural invasion (PNI) has been cited as an independent prognostic factor in colorectal cancer. We report the first case of an additional resection after ileocecal resection due to advanced lateral extension of PNI, with a review of the literature.CASE PRESENTATION: A 67-year-old woman underwent colonoscopy due to positive fecal occult blood. Biopsy revealed a 20-mm type 2 tumor in the ascending colon near the ileocecal valve, which was a poorly differentiated adenocarcinoma. She underwent laparoscopic-assisted ileocecal resection and D3 dissection, and the surgery was completed routinely in which functional end-to-end anastomosis (FEEA) was performed extracorporeally. Postoperative course was good and she was discharged one week postoperatively. The pathology showed AI, type 3, 30 × 23 mm, 40%, por2>sig>tub2, pT3a (SS), int, INFb, v2, ly3, Pn1b, PM1, DM0, pN1. There was widespread cancerous extension along the intermuscular plexus within the intrinsic muscular layer of the ileum, and although grossly separated from the tumor by about 80 mm, the tumor was R1 resected with positive oral margins. Additional anastomotic resection was performed by laparotomy. Intraoperatively, the resected section was submitted to a rapid examination, which was confirmed to be negative, and the surgery was completed. The pathological examination revealed that the resected specimen showed an adenocarcinoma on the ileum side of the anastomosis, which infiltrated and proliferated within the intermuscular plexus by about 15 mm, although the tumor was not visually recognized on the resection specimen. Both bilateral margins were negative, resulting in R0 resection. Postoperative adjuvant chemotherapy was not requested by the patient. Thereafter, periodic imaging follow-up was performed and, nine months after the initial diagnosis, there was no increase in tumor markers and no evidence of recurrence on imaging.CONCLUSIONS: Preventing R1 resection due to lateral extension of advanced PNI, which is very rare as in this case, is practically difficult given its frequency and residual bowel function. Instead, prompt additional resection and adjuvant therapy (which was not performed in this case) are essential to minimize the risk of recurrence.

Adult T‐cell leukemia–lymphoma (ATL) is a mature T‐cell malignancy associated with human T‐cell leukemia virus type 1 (HTLV‐1) infection. Japan is the most endemic country for HTLV‐1 and ATL in the world. Recent nationwide studies of Japanese blood donors reported that HTLV‐1 carriers spread from endemic areas to non‐endemic areas. Therefore, the latest information on nationwide epidemiological and clinical data for ATL is necessary to guide clinical practice. We undertook a multicenter, hospital‐based survey of newly diagnosed ATL patients from 2010 to 2011. A total of 996 patients with ATL were registered from 126 hospitals across Japan. Of those, 922 (487 men and 435 women) were included in the analysis. The median age at diagnosis was 68 years (interquartile range, 60–75 years). Overall, 67.2% of ATL was diagnosed in the Kyushu–Okinawa area. The most common subtype was acute (49.5%), followed by lymphoma (25.7%), chronic (14.2%), and smoldering (10.6%). Lymphoma type was more prevalent in men (60%), whereas chronic was more prevalent in women (60%). Half of patients with lymphoma type were aged over 70 years, whereas one‐third of patients with the chronic type were aged under 60 years. All of these characteristics were different from those of the previous nationwide surveys in the 1980s and 1990s. This survey clarified that half of current patients with ATL are aged over 68 years who were unable to receive intensive cytotoxic therapies. New less toxic agents for aged patients and further strategies to prevent the development of ATL from HTLV‐1 carrier status are needed. A multicenter, hospital‐based survey of newly diagnosed ATL patients from 2010 to 2011 was conducted.This survey clarified that half of current patients with ATL were aged over 68 years.

Atopic dermatitis (AD) is a common pruritic inflammatory skin disease characterized by impaired epidermal barrier function and dysregulation of Thelper-2 (T H 2)-biased immune responses. While the lineage of conventional dendritic cells (cDCs) are implicated to play decisive roles in T-cell immune responses, their requirement for the development of AD remains elusive. Here, we describe the impact of the constitutive loss of cDCs on the progression of AD-like inflammation by using binary transgenic (Tg) mice that constitutively lacked CD11c hi cDCs. Unexpectedly, the congenital deficiency of cDCs not only exacerbates the pathogenesis of AD-like inflammation but also elicits immune abnormalities with the increased composition and function of granulocytes and group 2 innate lymphoid cells (ILC2) as well as B cells possibly mediated through the breakdown of the Fms-related tyrosine kinase 3 ligand (Flt3L)-mediated homeostatic feedback loop. Furthermore, the constitutive loss of cDCs accelerates skin colonization of Staphylococcus aureus (S. aureus) , that associated with disease flare. Thus, cDCs maintains immune homeostasis to prevent the occurrence of immune abnormalities to maintain the functional skin barrier for mitigating AD flare.

Reducing greenhouse gas emissions from deforestation and forest degradation (REDD+) schemes, considered a key means of mitigating climate change, is being comprehensively implemented in a few countries. However, the issue of social equity requires serious consideration to ensure their sustainability. We assessed performances in implementing a REDD+ project during its demonstration phase (2013–2018) in five villages in the northern mountainous region of Lao People’s Democratic Republic, inhabited by people of the predominant Khmu and Hmong ethnicities. The evaluation covered actual land-cover changes (revealed through satellite imagery) and social changes and income generation assessed through a questionnaire-based survey. Prior to the implementation of the REDD+ demonstration project, natural resources varied across the five villages, whose social characteristics were closely linked to these resources. After the project’s implementation, income generation varied significantly among the ethnic groups and across village types according to determined land allocation and each ethnic group’s characteristics relating to the adoption of new and alternative livelihoods. The results of a canonical discriminant analysis using explanatory variables indicated that 77.3% of the initially categorized respondents were correctly classified for the ethnic group variable, and 70.1% were correctly classified for the village types variable within the village cluster targeted in the project. The results showed that rural people who depend on natural resources vary in their capabilities to transition to alternative livelihoods. Traditional livelihoods and social conditions, entailing capabilities and functions for implementing alternative livelihoods were closely linked to land and forest management outcomes. Levels of performance in implementing activities aimed at reducing deforestation and forest degradation evidently differed among rural groups and villages. Moreover, our findings indicated that to avoid implementation difficulties and to keep equity, the village-level REDD+ should be informed by the specific features and capabilities of rural people within each village, thereby reducing the risk of unsustainable REDD+.

We report an 81-year-old man with multiple liver metastases after tumorectomy for primary mediastinal malignant melanoma, who experienced limb weakness and sensory disturbance after nivolumab monotherapy. He was diagnosed with nivolumab-induced mononeuropathy multiplex and rhabdomyolysis based on serologic examination, muscle biopsy, magnetic resonance imaging of the limbs, and a nerve conduction study. A course of intravenous methylprednisolone (mPSL) was initiated at 1 g/day for 3 days. After that, oral prednisolone (PSL) was started at 1 mg/kg/day and gradually tapered. Limb muscle strength improved, but when PSL was reduced to 0.3 mg/kg/day, the weakness recurred, and a nerve conduction study showed exacerbation of mononeuropathy multiplex. The patient was again administered intravenous mPSL (0.5 g/day for 3 days) followed by oral PSL at 0.5 mg/kg/day, and his neurological symptoms improved. Nivolumab, an immune checkpoint inhibitor, is used for the treatment of advanced melanoma and other cancers and causes various immune-related adverse events (irAEs). However, neurological irAEs related to nivolumab are rare. Furthermore, there are no reports of simultaneous nerve and muscle impairment. Unexpected irAEs affecting various organs should be recognized and treated appropriately.

It has been recognized that the involvement of local community is essential to ensure the sustainability of A/R CDM (afforestation/reforestation clean development mechanism) project. This study verifies if the risks of non-permanence and leakage are addressed in a registered small scale A/R CDM project in Vietnam. Workshops, interviews, and a questionnaire survey of local villagers revealed that the project has caused a shortage of land for conventional activities such as grazing, fuel wood collection and shifting cultivation, and consequently posed the risks of project non-permanence and leakage. It is suggested that participation of all stakeholders in the community to the A/R CDM project beyond existing land tenure and adequate carbon benefit sharing according to the level of contribution to the project are required to reduce the risk of non permanence. To ensure the participation, the community should have capability such as consensus building and collective action. Leakage would be minimized if the community has alternative measures to the conventional activities before starting the project. We argue that it is necessary to first develop a community’s capabilities in the readiness phase of any A/R CDM project in order to reduce the risks for the project sustainability, and that new sources of funding are needed for this purpose.

Background Data availability in developing countries is known to be extremely varied and is one of the constraints for setting the national reference levels (RLs) for the REDD-plus (i.e. 'Policy approaches and positive incentives on issues relating to reducing emissions from deforestation and forest degradation in developing countries; and the role of conservation, sustainable management of forests and enhancement of forest carbon stocks in developing countries') under the UNFCCC. Taking Thailand as a case study country, this paper compares three types of RLs, which require different levels of datasets, including a simple historic RL, a projected forest-trend RL, and a business-as-usual (BAU) RL. Results Other than the finding that different RLs yielded different estimations on future deforestation areas, the analysis also identified the characteristics of each RL. The historical RL demanded simple data, but can be varied in accordance with a reference year or period. The forest-trend RL can be more reliable than the historical RL, if the country's deforestation trend curve is formed smoothly. The complicated BAU RL is useful as it can demonstrate the additionality of REDD-plus activities and distinguish the country's unintentional efforts. Conclusions With the REDD-plus that involves widespread participation, there should be steps from which countries choose the appropriate RL; ranging from simpler to more complex measures, in accordance with data availability in each country. Once registered with REDD-plus, the countries with weak capacity and capability should be supported to enhance the data collection system in that country.