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Long-term outcomes after endoscopic resection (ER) provide important information for the treatment of esophageal carcinoma. This study aimed to investigate the rates of survival and metastasis after ER of esophageal carcinoma. From 1995 to 2010, 570 patients with esophageal carcinoma were treated by ER. Of these, the 402 patients with squamous cell carcinoma (280 epithelial (EP) or lamina propria (LPM) cancer, 70 muscularis mucosa (MM) cancer, and 52 submucosal (SM) cancer) were included in our analysis. Seventeen patients had cancer invading into the submucosa up to 0.2 mm (SM1) and 35 patients had cancer invading into the submucosa more than 0.2 mm (SM2). The mean (range) follow-up time was 50 (4-187) months. The 5-year overall survival rates of patients with EP/LPM, MM, and SM cancer were 90.5, 71.1, and 70.8%, respectively (P=0.007). Multivariate analysis identified depth of invasion and age as independent predictors of survival, with hazard ratios of 3.6 for MM cancer and 3.2 for SM cancer compared with EP/LPM cancer, and 1.07 per year of age. The cumulative 5-year metastasis rates in patients with EP/LPM, MM, SM1, and SM2 cancer were 0.4, 8.7, 7.7, and 36.2%, respectively (P<0.001). Multivariate analysis identified depth of invasion as an independent risk factor for metastasis, with hazard ratios of 13.1 for MM, 40.2 for SM1, and 196.3 for SM2 cancer compared with EP/LPM cancer. The cumulative 5-year metastasis rates in patients with mucosal cancer with and without lymphovascular involvement were 46.7 and 0.7%, respectively (P<0.0001). The long-term risk of metastasis after ER was mainly associated with the depth of invasion. This risk should be taken into account when considering the indications for ER.

BackgroundDendritic cells (DCs), primary antigen-presenting cells, are now well known as an immunoregulator of many aspects of immune responses including inflammatory bowel diseases (IBDs) such as Crohn’s disease and ulcerative colitis. We have reported that PIR-A/Bhigh cDCs (conventional DCs) appeared in dextran sodium sulfate (DSS)-induced colitis and serve as a negative immunoregulator in an animal model of IBD. The immunoregulatory role of PIR-A/B+ cDCs was confirmed in both an in vitro culture system and an in vivo transfer experiment. Here, we have investigated the differentiation process of PIR-A/B+ cDCs in an in vitro inflammatory environment and examined their functions.MethodscDCs were isolated from the large intestinal lamina propria from C57BL/6 mice and cultured in an inflammatory environment (IL-1, IL-6, TNFα, and LPS). The appearance of PIR-A/B+ cDCs was determined after 24 h, and the in vitro-induced PIR-A/B+ cDCs were functionally and genetically examined.ResultsPIR-A/B+ cDCs were detected after a 24-h culture only in the inflammatory environment, and the cells acted as a negative immunoregulator when examined in an allogenic mixed leukocyte reaction (MLR). The message level of IL-27 was highly upregulated in PIR-A/B+ cDCs, while that of high mobility group box 1 protein (HMGB1) was downregulated in these cells. This was well in accordance with the fact that PIR-A/B+ cDCs showed a suppressive function against activated T cells. We found that PIR-A/B+ cDCs produced IL-27, as verified by an ELISA assay, and that the inhibitory effect by PIR-A/B+ cDCs was, at least partially, due to IL-27. Furthermore, CD85d+ cells, a human counterpart of mouse PIR-A/B+ cDCs, were found in the lamina propria of the colon of the patients with ulcerative colitis, but not in the similar part of the non-inflammatory area of colon specimens from patients with colon cancer.ConclusionsPIR-A/B+ cDCs induced in an in vitro inflammatory environment model showed a suppressive function against activated T cells by producing an inhibitory cytokine.

Settings for endoscopic submucosal dissection (ESD) of esophageal cancer have not been standardized, and no studies have directly compared ESD devices in humans. We conducted a randomized study to compare the performances of two different endo-knives, the Flush knife and Mucosectom, for esophageal ESD in 48 lesions. All procedures were initiated by two endoscopists, who were assisted by senior endoscopists with verbal advice. In the Flush-knife group, mucosal incision with a 2-mm Flush knife was followed by submucosal dissection using a 1-mm Flush knife. In the Mucosectom group, mucosal incision with a 2-mm Flush knife was followed by submucosal dissection with a Mucosectom. The primary outcome variable was the procedure time required for submucosal dissection. The secondary outcome variables were total procedure time, self-completion rates, and adverse events. Total procedure time in the Mucosectom group was significantly shorter than in the Flush-knife group (57±21 vs. 83±27 min, respectively; P<0.001). The submucosal-dissection time in the Mucosectom group was significantly shorter than in the Flush-knife group (40±18 vs. 61±23 min, respectively; P<0.001). The self-completion rate in the Mucosectom group was slightly higher than in the Flush-knife group, but the difference was not significant (91.7% vs. 75%, respectively; P=0.25). One perforation and one postoperative bleeding occurred in the Flush-knife group, both of which were treated successfully by endoscopic treatment. The Mucosectom reduced the procedure and submucosal-dissection times of esophageal ESD, without increasing adverse events.

Background Liver resection is the standard operative procedure for patients with T2 and T3 gallbladder cancers (GBC). However, the optimal extent of hepatectomy remains unclear. Methods We conducted a systematic literature search and meta-analysis to assess the safety and long-term outcomes of wedge resection (WR) vs. segment 4b + 5 resection (SR) in patients with T2 and T3 GBC. We reviewed surgical outcomes (i.e., postoperative complications and bile leak) and oncological outcomes (i.e., liver metastasis, disease-free survival (DFS), and overall survival (OS)). Results The initial search yielded 1178 records. Seven studies reported assessments of the above-mentioned outcomes in 1795 patients. WR had significantly fewer postoperative complications than SR, with an odds ratio of 0.40 (95% confidence interval, 0.26 − 0.60; p  < 0.001), although there were no significant differences in bile leak between WR and SR. There were no significant differences in oncological outcomes such as liver metastases, 5-year DFS, and OS. Conclusions For patients with both T2 and T3 GBC, WR was superior to SR in terms of surgical outcome and comparable to SR in terms of oncological outcomes. WR that achieves margin-negative resection may be a suitable procedure for patients with both T2 and T3 GBC.

This study aimed to determine the prevalence and risk factors of poor subjective sleep quality in elite judo athletes. A subjective cross-sectional questionnaire survey was conducted with 106 elite judo athletes who participated in the training camp of the Japanese national team. Eighty-six respondents (men: 52.3%; average age: 22.9 ± 3.1 years) with complete responses were included in the analysis (valid response rate: 81.1%). Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The prevalence of poor sleep quality (PSQI score ≥ 5.5), the mean PSQI score, and subscale scores were investigated. Relationships between poor sleep quality and attributes, lifestyle habits, competition-based activities, and psychological distress were explored using Fisher’s exact tests and multivariate logistic regression analysis. Thirty-five respondents (40.7%) reported poor sleep quality. The percentage and subscale scores of the respondents for sleep latency, sleep duration, and daytime dysfunction were higher than those of the population of Japanese national-level athletes. The mean PSQI score of the respondents was similar to that of some elite athlete populations but higher than those of others. Multivariate logistic regression analysis revealed that psychological distress was associated with poor sleep quality. In conclusion, the prevalence of poor subjective sleep quality in elite judo athletes was suggested to be similar or higher among elite athlete population. Sleep latency, sleep duration, and daytime dysfunction status were worse in elite judo athletes than in Japanese national-level athletes. Psychological distress was a risk factor for poor subjective sleep quality in elite judo athletes.

Early B-cell factor 3 (EBF3)-related syndrome, also known as hypotonia, ataxia, and delayed development syndrome (HADDS), is a recently recognized neurodevelopmental disorder frequently associated with bladder dysfunction. Despite bladder dysfunction possibly caused by detrusor sphincter dyssynergia, previous studies reported relatively accepted bladder compliance in patients with HADDS. We present the first case of bladder augmentation, in the English literature, in a girl with EBF3-related syndrome due to poor bladder compliance with clean intermittent catheterization and anticholinergic medication.

Background Pygopagus is a type of conjoined twin binding at the buttocks. Some cases of pygopagus involve the fusion of the gastrointestinal tract, urinary tract, and spinal cord. Few cases of male pygopagus have been reported; however, the prognosis after separation is unclear. Herein, we report a case of male pygopagus in which successful separation was performed with the reconstruction of the anal canal. Case presentation Twins with male pygopagus were born at 35 weeks by cesarean section. They shared a common anus, penis, and scrotum with four testes. The infants had normal defecation and urination after birth. The separation surgery was scheduled when they were 5 months. Two distinct anesthesia teams and four surgical teams (neurosurgery, pediatric urology, plastic surgery, and pediatric surgery) were involved in the multidisciplinary approach. After separating the spinal cord, we found that the anal canal and sphincter muscle complex were fused near the anal aperture, and we separated them. The fused penis and testis were separated and reconstructed using the same incisional line as the other separation, and the reconstructions of the anal canals with the sphincter muscle complex were completed. Both patients had an uneventful postoperative course. At 2 years of age, they could walk and defecate independently. In addition, they voided spontaneously without urinary incontinence at the time of 3 years and 11 months. Conclusions Separation of the spinal cord with anal canal and urethral reconstruction is important for male pygopagus patients as it allows them to preserve their independent function.

Background In the evolving landscape of electronic sports (esports), where economic and social expectations are soaring, a critical concern has emerged in physical complaints among esports players. However, empirical insights into these complaints' prevalence and influencing factors are scarce. This study aimed to determine the prevalence of physical complaints and their association with esports activities among Japanese esports players. Methodology A web-based, cross-sectional survey encompassing 175 esports players from both professional and amateur teams in Japan was conducted. The analysis focused on 79 male participants (average age: 21.6 ± 5.6 years) with complete responses. The survey items included the esports factors about the esports title mainly play (device, career duration, playing time per day on weekdays and holidays, and the distance between the screen and the face) and physical complaints (headache, neck pain, stiff or sore shoulders, wrist pain, finger pain, lower back pain, and eye fatigue). Results A total of 49.4% reported stiff or sore shoulders, 48.1% faced eye fatigue, and 30.4% had headaches. Professionals exhibited a significantly higher likelihood of neck, wrist, and lower back pain and eye fatigue than amateurs. Age-adjusted univariate logistic regression analysis uncovered that using mainly mobile devices and being closer to the screen and face were significantly associated with neck pain, stiff or sore shoulders, lower back pain, and eye fatigue. Conclusions These results suggest that poor posture caused by using mobile devices and being closer to the screen was related to various physical complaints.

Background Traumatic esophageal injury leads to severe complications such as mediastinitis, pyothorax, and tracheoesophageal fistula. Although prompt diagnosis and treatment are required, there are no established protocols to guide diagnosis or treatment. In particular, thoracic esophageal injury tends to be diagnosed later than cervical esophageal injury because it has few specific symptoms. We report a case of thoracic esophageal injury caused by a cervical stab wound; the patient was stabbed with a sharp blade. Case presentation A 74-year-old woman was attacked with a knife while sleeping at home. The patient was taken to the emergency room with an injury localized to the left section of her neck. She was suspected of a left jugular vein and recurrent laryngeal nerve injury from cervical hematoma and hoarseness. On the day following the injury, computed tomography revealed a thoracic esophageal injury. Emergency surgery was performed for an esophageal perforation and mediastinal abscesses. Although delayed diagnosis resulted in suture failure, the patient was able to resume oral intake of food a month later following enteral feeding with a gastrostomy. Esophageal injuries due to sharp trauma are rare, and most are cervical esophageal injuries. There are very few reports on thoracic esophageal injuries. Conclusions The possibility of thoracic esophageal injury should always be considered when dealing with neck stab wounds, particularly those caused by an attack.

Despite the popularity of Christian schools in Japan, Christians account for only 1.6% of the nation’s population. In the attempt to explore this inconsistency, we conducted an online survey in January 2020 to those between the ages of 15 and 29 living in Tokyo and Kanagawa. Our subjects include those who have enrolled in Christian schools, those who have some sort of affiliation, and those who do not have affiliation. We attempted to measure the difference in attitude by the degree of their affiliation. We focused on the notion of 'triple faith' which was proposed by Inoue and others. Many people in Japan believe in both Buddhism and Shintoism because neither requires a rite such as baptism. Christianity requires baptism, but that aside, in practice, many Japanese have triple faith including Christianity. Prosperity of Christian schools, preferences towards Christmas, and popularity of Christian-style weddings, all testify to this. This argument by Inoue and others conflicts with the common belief that Christianity never got a foothold in Japan. The results of cross tabulation of key questions and affiliation with Christian schools, combined with our interview results, show that those who have enrolled in Christian schools are more likely to have what may be referred to as triple faith. We have also provided a discussion on the possible reasons behind this finding.