Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) is technically challenging, not only because of the difficulty in reaching the target site but also in performing subsequent therapeutic procedures. To overcome these challenges, balloon enteroscopy-assisted ERCP has been introduced into clinical practice and has been reported to be both effective and safe. Recently, short-type balloon enteroscopes, with a working length of approximately 150 cm and a 3.2-mm working channel, have been widely adopted, making procedures more efficient. These short-type scopes facilitate the use of larger accessories in various procedures, such as stone extraction or self-expandable metallic stent placement. In addition, several new technologies and devices have recently been introduced to help manage difficult cases. Despite these advancements, multiple technical hurdles remain before procedures can be successfully completed. It is important to identify the key factors that contribute to procedural difficulty in order to improve success rates. At the same time, endoscopists must remain aware of the potential for adverse events, such as perforation, which can occur due to adhesions specific to SAA. In this review, we provide technical tips for short-type single-balloon enteroscopy-assisted ERCP in patients with SAA, aimed at improving procedural success rates and reducing adverse events, while also highlighting recent advancements in technology and devices.

Methods: This study included 62 patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries. The patients were categorized into the PSI and non-PSI groups based on their radiographic shoulder height 2 years after surgery. Radiographic parameters, lower end vertebra (LEV), lower instrumented vertebra (LIV), sagittal stable vertebra (SSV), postoperative DA and DJK, and Scoliosis Research Society 22 scores were compared between the two groups using unpaired t -tests or Pearson’s chi-square tests. Results: Twenty-eight patients in the PSI group and 34 in the non-PSI group were evaluated. Three patients had DA in the PSI group and 10 with DA and four with DJK in the non-PSI group. LIV–LEV was higher in the PSI group than in the non-PSI group. Although the LIV–SSV was not significantly different between the two groups, among the three patients with DJK, two had LIV–SSV of −3, one had −1, and one had 0. No significant differences in other examinations were noted between the two groups. Conclusions Although more proximal LIV selection might lead to stable DA and DJK, the LIV selection should not be extended distally to prevent DA and DJK because favorable shoulder balance and clinical outcome can still be achieved.

Background/Aims: Endoscopic resection of colorectal polyps reduces mortality from colorectal cancer. We report here a novel resection method, known as noninjecting resection using bipolar soft coagulation mode (NIRBS), and assess its feasibility. This study aimed to compare the resection depth achieved with NIRBS to those achieved with cold snare polypectomy (CSP) and conventional endoscopic mucosal resection (CEMR). Methods: Patients with 6 to 9 mm colorectal polyps underwent endoscopic resection at Hoshigaoka Medical Center between October 2023 and January 2024. We analyzed the thickness of resected submucosal tissue following the use of NIRBS, CSP, and CEMR. Results: We identified 95 polyps, including adenomas and serrated lesions. The proportions of specimens containing submucosal tissue were 21.4%, 100.0%, and 97.9% in CSP, CEMR, and NIRBS, respectively. The median submucosal tissue thickness for CEMR and NIRBS was 1,167 and 1,125 µm, respectively, which was significantly greater than 0 µm for CSP. For NIRBS, the median thickness was 1,140 and 1,017 µm for the expert and non-expert endoscopists, respectively. Conclusions The depth of submucosal resection with NIRBS exceeded 1,000 μm regardless of endoscopist experience. NIRBS can be a useful resection method for patients with colorectal polyps, including those with non-submucosally invasive carcinomas.

Background: The potassium voltage-gated channel subfamily Q member 1 (KCNQ1) gene has recently received much attention as a candidate susceptibility gene for type 2 diabetes mellitus, especially in Asian populations. We previously reported that Kcnq1 mutant mice exhibit reduced insulin secretion and hyperglycemia due to a decrease in pancreatic β-cell mass. Through in vivo and in vitro analyses, we ascertained that this mechanism is the result of the downregulation of the non-coding RNA ‘Kcnq1ot1,’ which is expressed in the paternal allele of the Kcnq1 gene region, causing an increase in the expression of the cell cycle inhibitor cyclin dependent kinase inhibitor 1C (Cdkn1c). It was found that decreased Kcnq1ot1 expression resulted in pancreatic β-cell failure; however, the degree of pancreatic β-cell volume reduction was not severe. Methods: We induced obesity in Kcnq1ot1 truncation mice by feeding them a high-fat diet and evaluated pancreatic β-cell mass. Results: In the present study, we reveal that CCAAT/enhancer binding protein beta (C/EBPβ), which is expressed at higher levels in pancreatic β-cells in obese individuals, further increases the expression of Cdkn1c, which is upregulated by the Kcnq1 gene mutation. We found that simultaneous Cdkn1c hypomethylation and C/EBPβ overexpression in pancreatic β-cells causes a synergistic decrease in pancreatic β-cell mass. Conclusion This finding suggests that the synergistic effect of genetic factors such as Kcnq1 gene mutations and environmental factors such as obesity and overeating, which lead to increased expression of C/EBPβ, contribute to the regulation of pancreatic β-cell mass. This study is the first to show that the Kcnq1 gene is related to pancreatic β-cell mass through genetic-environment interactions.

Background: Real-time ultrasound-guided catheterization of the internal jugular vein (IJV) is widely used for its safety and high success rate. However, it becomes difficult when the IJV’s cross-sectional area (CSA) is reduced. A reported technique applies manual pressure (with fingers) to the supraclavicular IJV to impede venous return and enlarge the distal CSA. While effective in previous studies, its clinical utility remains unclear, as those studies involved only healthy volunteers and used blind technique. Therefore, this study aimed to evaluate the efficacy of our novel ultrasound-guided compression of the proximal IJV. Methods: In this prospective observational study, 25 hospitalized patients were included. Two ultrasound machines were used: one to visualize the CSA of the distal IJV, and the other to apply and guide compression of the supraclavicular IJV, ensuring real-time confirmation of venous occlusion. Patients were asked about pain during the compression procedure. The primary outcome was the degree of dilation at the puncture site of the IJV. Results: All 25 patients (mean Sequential Organ Failure Assessment score: 5.2±3.6) completed the study. Supraclavicular IJV compression resulted in a significant increase in the CSA of the distal IJV by approximately 150%, from 0.4±0.3 cm² to 1.0±0.3 cm² (P<0.001). No patient reported any pain during the procedure. Conclusions Ultrasound-guided supraclavicular IJV compression significantly increased the CSA of the distal IJV in hospitalized patients. This method enhances vein visibility by increasing IJV volume, potentially improving the success and safety of central venous catheterization.

Background  The Kenya Medical Research Institute (KEMRI) is a national institution (state corporation of the Kenyan government) that conducts human health research in Kenya. The institute is important in the East African region. During the COVID-19 pandemic, KEMRI played a major role in conducting half of the PCR testing in Kenya.  In response to the excessive burden on researchers during the COVID-19 pandemic, to improve support to researchers, KEMRI decided to conduct internal training to develop skills in research management and administration (RMA) for mainly administrative staff, to strengthen collaboration between researchers and administrative staff.Planning, implementation, and evaluation of the RMA Training  From July 2023 to January 2024, in cooperation with Kyoto University and Japan International Cooperation Agency (JICA), a series of internal RMA training courses on the basic knowledge required for RMA staff was planned and conducted for the first time at KEMRI. As part of the training, Kyoto University’s practices were learned, and the “KEMRI RMA Process Mapping” workshop was held to make these processes easier to visualize for researchers by having the training participants compile the organization’s rules and regulations of KEMRI that were difficult to understand for researchers.   This paper describes KEMRI’s first internal RMA training in planning, implementation, and evaluation through group discussions.Conclusion  KEMRI conducted its first internal RMA training, which incorporated a combination of lectures and workshops. The training evaluation revealed that participants developed a more comprehensive understanding of the RMA-related work and enhanced their comprehension of the researchers’ work. The training participants began to utilize the learning of RMA-related specialized knowledge and organizational management related to the work for research support. The communication between RMA-related departments and between RMA staff and researchers was enhanced, and behavioral changes towards cross-departmental collaboration were observed. KEMRI is planning to revise its personnel and organizational regulations and strengthen internal training, including the RMA training.

Tokito is not only used to treat chest and abdominal pain caused by cold, but also acts as a qi-tonifying formula. In this report, we describe three cases of painless abdominal distention treated with tokito. Case 1 was a 53-year-old woman who complained of abdominal coldness and abdominal distension. Case 2 was a 48-year-old woman who complained of abdominal distention that had been bothering her for many years. Case 3 was a 57-year-old woman who complained of a stuffy chest and abdominal distention. All three patients experienced abdominal distention as well as coldness and easy fatigability. Therefore, we thought that the patients were suffering from abdominal distention due to depression unaccompanied by pain, and administered tokito to them. After one month of treatment with tokito, the abdominal distention was alleviated, and with continuous treatment, it improved in all cases. In addition to abdominal distention, the patients’ complaints of coldness and fatigability were also alleviated. Therefore, tokito may be effective in treating abdominal distention due to qi depression unaccompanied by pain.

This study aimed to explore, identify, and classify the strengths of elderly individuals living in rural areas from their own perspectives, using an asset-based approach. A qualitative analysis was conducted through group interviews. The study included two groups of four elderly individuals who resided in District D of Area C, City B, Prefecture A, and three groups of five to six elderly individuals from District E in the same city. As a result, 133 key items related to the strengths of elderly individuals were identified. These items were further classified into 39 subcategories, which were grouped into three major categories: individuals (personal strengths), associations (organizations/groups), and institutions (environments/resources that support strengths). Specifically, 18 subcategories were classified into the individuals category, 11 into the associations category, and 10 into the institutions category. These findings revealed that elderly individuals in rural areas actively take on various roles within their communities, utilizing their rural environment both as individuals and as part of a group. The rural setting itself was found to significantly influence their engagement, while intergenerational support and assistance from public institutions also played a crucial role. In the future, we aim to utilize these “strengths of elderly individuals” to develop strategies that empower community residents to lead vibrant, active, and secure lives in their familiar environments.