Background/Aims: The incidence of perianal lesions (PL) in children with Crohn’s disease (CD) is higher in East Asia than in Western countries. Early intervention for PL is essential to prevent sphincter dysfunction and ostomy placement. In this study, we aimed to investigate the clinical features, treatment, and consequences of pediatric CD with PL. Methods: We retrospectively reviewed a cohort of children diagnosed with CD from 2010 to 2020 at a Japanese children’s hospital. Demographics, treatments, and outcomes were evaluated and compared among subgroups. Results: Among 112 pediatric patients with CD, 36 (32.1%) had experienced PL during the observational period. The median ages at diagnosis and follow-up periods were 131 and 70 months, respectively. Six (85.7%) patients in the very early-onset (VEO) group (CD diagnosed before 6 years old) and 24 (82.8%) in the older age group had PL upon diagnosis of CD (P= 0.851). Biologics were given to 94.4% of patients: infliximab (67.7%), adalimumab (58.8%), ustekinumab (44.1%), risankizumab (11.8%), and vedolizumab (5.9%). Biologics were introduced within 1 year in 89.5% and 40.0% of patients diagnosed in 2016–2020 and 2010–2016, respectively (P= 0.002). Seton was frequently used in the older age group (87.5 vs. 42.9%, P= 0.190). Ostomy was frequently required in the VEO group (42.9% vs. 0.0%, P= 0.006). Conclusions Patients with VEO-CD and PL had a notably high risk of ostomy placement. The earlier introduction of biologics and surgical interventions reduced corticosteroids use and ostomy placement in pediatric CD patients with PL.

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disease of the gastrointestinal tract, with increasing prevalence worldwide. IBD Ahead is an international educational program that aims to explore questions commonly raised by clinicians about various areas of IBD care and to consolidate available published evidence and expert opinion into a consensus for the optimization of IBD management. Given differences in the epidemiology, clinical and genetic characteristics, management, and prognosis of IBD between patients in Japan and the rest of the world, this statement was formulated as the result of literature reviews and discussions among Japanese experts as part of the IBD Ahead program to consolidate statements of factors for disease prognosis in IBD. Evidence levels were assigned to summary statements in the following categories: disease progression in CD and UC; surgery, hospitalization, intestinal failure, and permanent stoma in CD; acute severe UC; colectomy in UC; and colorectal carcinoma and dysplasia in IBD. The goal is that this statement can aid in the optimization of the treatment strategy for Japanese patients with IBD and help identify high-risk patients that require early intervention, to provide a better long-term prognosis in these patients.
Asian Continental Ancestry Group ; Colectomy ; Colitis, Ulcerative ; Colorectal Neoplasms ; Consensus ; Crohn Disease ; Disease Management* ; Disease Progression ; Early Intervention (Education) ; Epidemiology ; Expert Testimony ; Gastrointestinal Tract ; Hospitalization ; Humans ; Inflammatory Bowel Diseases* ; Japan* ; Prevalence ; Prognosis

The human immunodeficiency virus (HIV) epidemic and dual infection of tuberculosis (TB) and HIV are now altering the role of chest radiography (CR) in TB control. The role has been gaining increasing importance, especially as HIV-associated TB and childhood TB are less likely to show positive smears. However, CR with poor image quality can cause misdiagnoses or require repeated examinations, wasting economic resources and exposing patients to unnecessary radiation. In order to improve the image quality of CR, the Tuberculosis Coalition for Technical Assistance (TBCTA) developed an assessment tool for CR categorized on the basis of six factors as “excellent,” “good,” “fair,” and “poor.” With the aim of disseminating the assessment tool, five-day international training sessions were held in Cambodia and Kenya in 2009. This field report summarizes the international training activities and documents the findings after the trainings.
A total of thirty-four participants from 14 countries were trained and assigned to conduct an assessment upon their return. The results from nine countries showed that the quality of CR ranged from 90% excellent or good in Bangladesh to over 90% fair or poor in Afghanistan. Of 69 health facilities, only 4 apply more than 120kV and above. This is one of the considerable factors behind the sub-optimal quality of CR in these countries.

A 51-year-old man, with an abnormal shadow on chest X-ray film, was found to have a right-sided aortic arch with mirror-image branching and Kommerell's diverticulum. Neither congenital heart anomalies nor vascular ring was observed. We performed descending aorta replacement with a Hemashield^TM 24-mm graft, because the trachea and esophagus were compressed by the diverticulum, and to eliminate the risks of aneurysmal change or rupture. The operation was performed through right thoracotomy, and with total CPB under deep hypothermic circulatory arrest. The patient was discharged on the 18th postoperative day. This is rare adulthood case of right aortic arch with Kommerell's diverticulum and no anomalies in the heart.

A 67-year-old man was referred to our department for surgical treatment of ischemic cardiomyopathy. Chest X-ray showed cardiomegaly with a cardiothoracic ratio of 62% and pulmonary congestion. CAG revealed multiple obstructive lesions in the left coronary artery system. LVG and UCG showed ventricular dilatation and dysfunction. ECG showed complete left bundle branch block with a QRS duration of 180ms. He underwent autologous bone marrow cell implantation and biventricular pacing concomitant with coronary artery bypass grafting. He is doing well after 15 months without any complications. Combination with therapeutic angiogenesis and cardiac resynchronization therapy may contribute to the development of new regenerative strategy for patients with severe ischemic cardiomyopathy.