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In most high‐resource countries with organized screening programs, the incidence and mortality of cervical cancer is decreasing. Recent statistics have also revealed a reduction in invasive cervical cancer incidence as a result of national vaccination programs. Paradoxically, cervical cancer incidence has increased in Japan, particularly amongst women of reproductive age. This study aimed to examine the trends in cervical cancer incidence and mortality for young and middle adult women in Japan, by analyzing trends in 10‐year interval age‐groups. Cervical cancer incidence for young and middle adult women (ages 20‐59 years) was obtained from high‐quality population‐based cancer registries in three prefectures from 1985 to 2015. National cancer mortality data were obtained from published vital statistics from 1985 to 2019. Trends in crude and age‐standardized rates (ASR) were analyzed using Joinpoint regression. The cervical cancer incidence trend in 20‐59‐year‐old women combined significantly increased over the observation period. Both crude and ASR increased from 1985 to 2015 with an annual percent change (APC) of +1.6% (95% confidence interval, 1.1, 2.1) and +1.7% (1.2, 2.3), respectively. Similar increases were seen in ages 20‐29, 30‐39, and 40‐49 years with higher APCs especially in 20s and 30s. Both crude and ASR mortality significantly increased after the early 1990s in ages 20‐59 years combined. Based on the recognition that current cervical cancer control strategies in Japan have not been effective in reducing the cervical cancer burden in young and middle adults, promotion of screening and vaccination should be urgently strengthened. Trends in incidence and mortality of cervical cancer in young and middle‐aged women in Japan were analyzed by 10‐year interval age‐groups using long‐term high‐quality data. Incidence and mortality showed significant increase in young and middle adults from ages 20 to 59 years old. These results emphasize the importance of cervical cancer control in Japan.

Sternoclavicular joint dislocations account for <5 % of all dislocations of the shoulder girdle. Whereas most cases of anterior dislocation do not experience symptoms, some patients with anterior instability remain symptomatic and require reconstructive surgery to stabilize the sternoclavicular joint. We present the case of a 57-year-old male diagnosed with sternoclavicular joint anterior dislocation and unusual swallowing difficulty while bending the neck forward. The patient was treated using a new and effective surgical technique of sternoclavicular joint reconstruction named “double figure-of-eight” using the ipsilateral gracilis tendon. Surgical outcome was successful, based on the Rockwood SC joint rating scale, and the patient maintained excellent stability even after 2 years. This new surgical technique offers superior stability, without harvest site morbidity, to patients with rare, severe, and chronic sternoclavicular joint dislocation. Level of evidence IV.

Japan has the most ageing population in the world with a high population of bicycle users, and the percentage of older cyclists continues to grow as the population ages. At the same time, the proportion of bicycle-related collisions is increasing. The aim of this study is to analyse trends and risk factors for bicycle injuries and deaths in Japan in order to suggest preventive measures, using data from vital statistics and the National Police Agency to calculate incidence rate ratios (IRR), age-standardised mortality rates, and annual percent changes, by ten-year-interval age groups. Data from the Japan Trauma Data Bank was analysed for demographic information about injuries. The risk of casualties was high in the younger generation and lower in the older population. However, the risk of mortality increased rapidly with age, with people over 70 years old facing more than 10 times the risk of younger age groups (IRR = 12.62). Casualty and mortality rates were declining in all age groups until the year 2020 (range: −9.77% to −4.95%, −8.61% to −1.07%, respectively). However, lethality of bicycle collisions showed no significant reduction. Current methods have not been effective in reducing bicycle-related lethality in Japan, especially for the older population, and should be improved to ensure that bicycle transportation is safe for all road users.

Background: The 2015 Japan Standard Population (2015 JSP) was established in response to changes in the age structure. However, the effects of major updates, especially the recategorization of older age groups, for interpreting various health metrics have not been clarified.Method: Population data were collected and estimated for older age categories (85-89, 90-94, 95 years and over). Data on the number of deaths were also collected from the Vital Statistics. We recalculated the all-cause and leading cause-specific age-standardized mortality rate (ASMR) using the 2015 JSP by the direct standardization method for data from 1950 to 2020. We compared ASMRs calculated using the 2015 JSP with those calculated using the 1985 JSP. Pearson’s correlation coefficients were used to evaluate the consistency of mortality trends between the 2015 and 1985 JSPs.Results: The absolute all-cause ASMRs calculated using the 2015 JSP were 2.22-3.00 times higher than those calculated using the 1985 JSP. The ASMR ratios increased gradually over time. While trends in all-cause and cause-specific ASMRs calculated using the 2015 JSP and 1985 JSP were generally highly correlated (Pearson’s correlation coefficient (r): 0.993 for all-cause), correlations were relatively low for malignant neoplasms (r: 0.720 for men and 0.581 for women) and pneumonia/bronchitis (r: 0.543 for men and 0.559 for women) due to non-monotonous trends over time and fluctuations in earlier time periods.Conclusions: The effect of introducing the new JSP for interpreting trends in all-cause mortality was considered minimal. However, caution is needed when interpreting trends in some cause-specific mortality rates.

Currently, over 190 species in family Vibrionaceae, including not-yet-cultured taxa, have been described and classified into over nine genera, in which the number of species has doubled compared to the previous vibrio evolutionary update (Vibrio Clade 2.0) (Sawabe et al. 2014). In this study, “Vibrio Clade 3.0,” the second update of the molecular phylogenetic analysis was performed based on nucleotide sequences of eight housekeeping genes (8-HKGs) retrieved from genome sequences, including 22 newly determined genomes. A total of 51 distinct clades were observed, of which 21 clades are newly described. We further evaluated the delineation powers of the clade classification based on nucleotide sequences of 34 single-copy genes and 11 ribosomal protein genes (11-RPGs) retrieved from core-genome sequences; however, the delineation power of 8-HKGs is still high and that gene set can be reliably used for the classification and identification of Vibrionaceae. Furthermore, the 11-RPGs set proved to be useful in identifying uncultured species among metagenome-assembled genome (MAG) and/or single-cell genome-assembled genome (SAG) pools. This study expands the awareness of the diversity and evolutionary history of the family Vibrionaceae and accelerates the taxonomic applications in classifying as not-yet-cultured taxa among MAGs and SAGs.

The aim of this study was to reveal the histological features of oxyntic gland adenomas and gastric adenocarcinoma of the fundic-gland type (GA-FG). We retrospectively examined the histological features of 126 lesions of oxyntic gland adenoma and/or GA-FG in 116 patients. The prevalence of oxyntic gland adenomas and GA-FG was approximately equal. The majority of the lesions were resected by endoscopic mucosal resection using a diathermic snare (EMR, n = 42) or endoscopic submucosal dissection (ESD, n = 72). Histologically, there were no lesions with invasion at the level of the muscularis propria or deeper, and lymphovascular invasion was present in 1.6%. Of the ESD and EMR specimens, there were no lesions that were positive for vertical margins. Among the eight GA-FG patients with deep (≥ 500 μm) submucosal invasion, six were treated with endoscopic resection alone, and no recurrence was documented. No patients died of the disease during the median follow-up period of 14.5 months. In conclusion, all lesions were confined to the mucosa or submucosa and were negative for vertical margins. Lymphovascular invasion was present in only 1.6% of the patients. Thus, we believe that endoscopic resection is a suitable initial treatment method for oxyntic gland adenoma and GA-FG.

In the current study, we sought to investigate the pathogenesis of amiodarone (AMD)-induced steatohepatitis, focusing on the pathological changes in the small intestine and liver. The association between patients taking AMD and metabolic dysfunction-associated steatohepatitis (MASH) was analyzed using the Japanese Adverse Drug Event Report (JADER) database. Barrier functions, such as crypt-villus architecture, mucosal permeability, and intestinal microbiota composition, were analyzed in a mouse model of AMD-induced steatohepatitis. The JADER database revealed positive signals for MASH in patients taking AMD. AMD induced lipid accumulation and inflammation, Tnf mRNA expression, and F4/80 + CD14 + cell infiltration in the mouse liver. Villus shortening, changes in the localization of tight junction proteins, increased mucosal permeability, and altered intestinal microbiota were observed in the small intestines of AMD-treated mice. Moreover, the localization of leucine-rich repeat-containing G-protein coupled receptor (Lgr) 5 + and the Wnt/β-catenin signaling pathway was impaired in the small intestines of these mice. Lgr 5 + crypt base columnar stem cells, which are regulated by the Wnt/β-catenin signaling pathway, play an important role in intestinal mucosal homeostasis. Our data suggest that intestinal homeostasis is disrupted in AMD-induced MASH, which provides important insights into the development of therapeutic approaches for difficult-to-treat drug-induced MASH.

INTRODUCTION:One-piece endoscopic mucosal resection (EMR) for lesions >15 mm is still unsatisfactory, and attempted 1-piece EMR for lesions >25 mm can increase perforation risk. Therefore, modifications to ensure 1-piece EMR of 15- to 25-mm lesions would be beneficial. The aim of this study was to investigate whether Tip-in EMR, which anchors the snare tip within the submucosal layer, increases en bloc resection for 15- to 25-mm colorectal lesions compared with EMR.METHODS:In this prospective randomized controlled trial, patients with nonpolypoid colorectal neoplasms of 15–25 mm in size were recruited and randomly assigned in a 1:1 ratio to undergo Tip-in EMR or standard EMR, stratified by age, sex, tumor size category, and tumor location. The primary endpoint was the odds ratio of en bloc resection adjusted by location and size category. Adverse events and procedure time were also evaluated.RESULTS:We analyzed 41 lesions in the Tip-in EMR group and 41 lesions in the EMR group. En bloc resection was achieved in 37 (90.2%) patients undergoing Tip-in EMR and 30 (73.1%) who had EMR. The adjusted odds ratio of en bloc resection in Tip-in EMR vs EMR was 3.46 (95% confidence interval: 1.06–13.6, P = 0.040). The Tip-in EMR and EMR groups did not differ significantly in adverse event rates (0% vs 4.8%) or median procedure times (7 vs 5 minutes).DISCUSSION:In this single-center randomized controlled trial, we found that Tip-in EMR significantly improved the en bloc resection rate for nonpolypoid lesions 15–25 mm in size, with no increase in adverse events or procedure time.

BackgroundA novel method for the prevention of bleeding after gastric endoscopic submucosal dissection (ESD) is necessary, as the numbers of patients taking antithrombotic agents have increased. This study aimed to assess the efficacy and safety of the covering method using polyglycolic acid (PGA) sheets and fibrin glue for ESD-induced ulcer in preventing post-ESD bleeding in patients under continued antithrombotic agents.MethodsOne hundred five consecutive gastric tumors among 84 patients who were treated by ESD under continued antithrombotic agents between April 2014 and September 2015 were enrolled in this study. The patients were classified into two groups, the covering group (52 lesions among 38 patients; those with ESD in whom PGA sheets and fibrin glue were used as the covering method) and the control group (53 lesions among 46 patients; ESD only), and their post-ESD bleeding rates were compared.ResultsNo significant differences were seen in the number and type of antithrombotic agents, lesion location, median procedure time, and median resected specimen size between the groups. ESD was completed in all cases, with no cases of uncontrollable bleeding during the procedure. Post-ESD bleeding occurred in 5.8% (3/52) and 20.8% (11/53) in the covering and control groups, respectively. The post-ESD bleeding rate significantly differed between the groups (P = 0.04; odds ratio, 0.23; 95% confidential interval, 0.06–0.89). No adverse events were associated with the use of PGA sheets and fibrin glue.ConclusionsThe covering method using PGA sheets and fibrin glue has the potential to reduce post-ESD bleeding in patients receiving continued antithrombotic agents.