Although the clinical importance of esophagogastric junction (EGJ) cancer is being increasingly recognized, its definition and treatment strategies vary considerably across regions. Recently, new concepts such as the gastroesophageal junction zone have been proposed for classification of EGJ cancer. Moreover, EGJ adenocarcinoma has been shown to possess a heterogeneous molecular profile consisting of both esophageal- and gastric-like phenotypes, indicating the need for EGJ-specific therapeutic strategies.Although international clinical practice guidelines for EGJ cancer have been published, substantial regional differences remain. This review aimed to summarize recent updates on the biological characteristics and management of EGJ cancers. Trials such as TIME and MIRO have demonstrated that minimally invasive surgery (MIS) reduces postoperative complications and improves the early postoperative quality of life. More recently, the MONET trial showed that MIS is not inferior to open esophagectomy in terms of long-term oncological outcomes, and the REVATE trial demonstrated the advantages of robot-assisted surgery over thoracoscopic approaches. Perioperative treatment strategies also differ across regions. Western guidelines recommend 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT)-based perioperative chemotherapy, as supported by the FLOT4 and ESOPEC trials, whereas Asian studies, such as RESOLVE and PRODIGY, have demonstrated the efficacy of docetaxel, oxaliplatin, and S-1 or S-1 plus oxaliplatin regimens. The application of immune checkpoint inhibitors is also evolving; although KEYNOTE-585 did not show a survival advantage, the MATTERHORN trial demonstrated that durvalumab plus FLOT significantly improved event-free survival, establishing a new emerging global standard. Future directions include redefining EGJ classification, implementing molecular-guided treatment selection, advancing organ-preserving strategies, and optimizing perioperative immunochemotherapy.

In the 2 decades or so since full-endoscopic spine surgery (FESS) was introduced, the procedure has advanced considerably. There are 2 major approaches of FESS, transforaminal (TF) and interlaminar. In this review article, we discuss the key strengths and merits of TF-FESS based on a literature search. First, the minimal invasiveness of the procedure allows for early return to work. Second, minimal invasiveness of the back muscles enables athletes to make a faster return to their previous competitive level. Third, the ability to perform TF-FESS under local anesthesia means it is suitable even in the elderly with poor general health.

Background: In Japan, in 2016, the School Health and Safety Act was revised and examination of extremities in addition to scoliosis became mandatory. Musculoskeletal examinations were subsequently started using a mark sheet-type questionnaire. In the present study, we aimed to analyze the relationship between physical findings and musculoskeletal problems and propose a preventive strategy for musculoskeletal injuries.Methods: In 2017, a total of 4,073 elementary and middle school students underwent direct musculoskeletal examination. In a direct examination, the following elements were included: torticollis; scoliosis; stiffness of the shoulder, elbow, hip, knee, and ankle; flexion and extension in standing position; flat foot; hallux valgus; and alignment of the upper and lower extremities. Of the 4,073 students who underwent direct examination in early 2017, only 3,754 were able to complete the mark sheet-type questionnaires in early 2018. A prospective longitudinal analysis of the data gathered was performed.Results: A total of 396 (11%) students had injuries. The ankle sprain/non-ankle sprain group comprised 119 (3%)/3,635 (97%) students, while the fracture/non-fracture group comprised 105 (2.8%)/3,650 (97.2%) students, respectively. Comparing the sprain group with the non-sprain group, ankle stiffness significantly correlated with ankle sprain in the univariable and multivariable analyses. Injuries occurred more frequently among boys, older students, students with stiff bodies, and students who were involved in sports activities of longer duration.Conclusion: Ankle stiffness was assumed to be a risk factor for ankle sprain. Stretching of the ankle might be effective for preventing ankle sprain. However, further interventional studies are needed to confirm this finding.

Objective: In 2016, Japan started conducting musculoskeletal examinations that included “limb status” of students as an essential item. Our institution implemented a unified musculoskeletal examination for all public elementary and junior high schools in T-city. In this study, we aimed to report the progress in the past 4 years.Patients and Methods: The Tsukuba Childhood Locomotive-Organ Screening Sheet (T-CLOSS), which is a questionnaire that includes some nationwide-recommended questions, was prepared and distributed to students. Results of the questionnaires were analyzed, and the orthopedic surgeon conducted examinations for the extracted items. From these questionnaires, the ratio of each item, rate of advisory for screening, and content of the advisory were investigated.Results: During 2016–2019, musculoskeletal examinations were conducted in every public schools, with nearly 20,000 students in T-city. The consultation advisory rate was 6.7% in 2019. Of the 524 students who received the third screening recommendation, the actual consultation rate was 248 (40.8%). After the third screening, the proportion of students requiring treatment and outpatient visits was 46.7% (n=248), which accounted for 1.2% of all elementary and junior high school students in the city.Conclusion: We reported the results of 4-year musculoskeletal examinations in a city. In our screening, we distributed a uniform questionnaire throughout the city, and orthopedic surgeons performed secondary examinations of identified students in all schools. This appears to be an advanced effort to prevent musculoskeletal impairment in students. We hope to conduct more sophisticated musculoskeletal examinations using our results, aiming at early detection, early treatment, and improvement of musculoskeletal function in elementary and junior high school students.

Objectives: The purpose of this study was to evaluate the relationship between exercise time and musculoskeletal problems and to determine the appropriate amount of exercise for children in both lower- and higher-grade levels of elementary and junior high schools.Materials and Methods: Mark-sheet-type questionnaires were distributed to and collected from all elementary and junior high schools in two cities. We collected 22,494 questionnaires in total. The relationship between exercise time and musculoskeletal problems was analyzed. The χ2 test and multivariate logistic regression analysis were used for statistical analyses.Results: The mean exercise time in school, in addition to physical education time, was 3.1 hours per week. In 56% of the children, the exercise time was less than 2 hours per week, and in 13% of the children, the exercise time was more than 10 hours per week. Although the rate of sports injury increased with an increase in exercise time, the duration of one-leg stand (a test of balance and muscle strength) also increased with an increase in exercise time. The cut-off values for sports injuries in boys/girls were 2.9/2.9 hours, 4.0/2.9 hours, and 7.5/4.2 hours in lower grade elementary school, higher grade elementary school, and junior high school, respectively.Conclusions: Although an appropriate amount of exercise improves one’s physical health and ability, excessive exercise leads to musculoskeletal problems. Approximately 7 hours/week of exercise is recommended for junior high school students. In elementary school, the exercise time should be carefully decided as the musculoskeletal system of the students is still immature.

Background: The use of prophylactic contralateral pinning for slipped capital femoral epiphysis (SCFE) remains controversial. This study evaluated the outcome of SCFE treatment and examined the use of prophylactic pinning.Methods: The study included 44 patients (33 men, 11 women; 54 hips [right, 31; left, 23]), with mean age of 12.9 (7.3–29) years, who underwent treatment between 1986 and 2017, with follow-up for more than 6 months. Patients were divided into 3 groups: group 1 had bilateral SCFE at first presentation, group 2 developed contralateral side SCFE during follow-up, and group 3 had unilateral SCFE until final follow-up. Three patients who received prophylactic pinning were excluded. Univariate and multivariate logistic analyses were performed.Results: Overall, 93% (50/54) of hips underwent positional reduction and in situ fixation and 7.4% (4/54) underwent open reduction. Mean follow-up period was 4.8 (0.5–25) years. Groups 1, 2, and 3 had 7, 3, and 31 cases, respectively. Sex, age, and follow-up period showed no significant differences among the groups. The Rohrer index was significantly higher in group 1, the affected side posterior sloping angle (PSA) was significantly higher in group 3, and the contralateral side PSA and percentage with endocrinopathy were significantly higher in group 2. In multivariate logistic analysis, age, sex, Rohrer index, affected side PSA, and endocrinopathy were significantly correlated with bilateral SCFE.Conclusion: We recommend prophylactic contralateral side pinning in patients with risk factors of obesity, high PSA before slipping, and endocrinopathy. Careful observation until growth plate closure is required in patients without risk factors.

Objective: To compare effects of the fluoropyrimidines S-1 and capecitabine on prothrombin time international normalized ratios (PT-INR) of warfarin following coadministration and after discontinuation of each fluoropyrimidine treatment.
Methods: Medical records of patients receiving warfarin with either S-1 (6 patients) or capecitabine (7 patients) were obtained from four hospitals.
Results: Increased PT-INR was observed until peak levels of warfarin were achieved in all patients in S-1 and capecitabine treatment groups.　Moreover, PT-INR significantly changed after coadministration within each group (p＜0.05).　Specifically, ratios of peak PT-INR after coadministration of each fluoropyrimidine and those following administration of warfarin alone (PT-INR elevation ratio) were 3.31 and 3.29 in S-1 and capecitabine coadministration groups, respectively.　Moreover, numbers of days to peak PT-INR were 38.3 and 31.3 days, respectively, and did not significantly differ between the treatment groups.　Furthermore, PT-INR returned to pretreatment levels by 17.5 and 15.1 days after discontinuation of S-1 and capecitabine, respectively, and did not significantly differ between the treatment groups.
Conclusion: Coadministration of S-1 and capecitabine similarly prolongs PT-INR by approximately 3-fold compared with administration of warfarin alone; therefore, these drug-drug interactions were clinically suggested to be of high risk for episodes of bleeding and remarkable alterations in coagulation parameters.　Therefore, blood coagulation ability should be more carefully monitored with regard to PT-INRs in patients receiving warfarin with S-1 or capecitabine not only during coadministration but also after discontinuation of fluoropyrimidine treatments.