Background/Aims: Visualization of palisade vessels (PVs) in Barrett’s esophagus is crucial for proper assessment. This study aimed to determine whether red dichromatic imaging (RDI) improves PV visibility compared with white-light imaging (WLI) and narrow-band imaging (NBI). Methods: Five expert and trainee endoscopists evaluated the PV visibility in Barrett’s esophagus using WLI, NBI, and RDI on 66 images from 22 patients. Visibility was rated on a 4-point scale: 4, excellent; 3, good; 2, fair; and 1, poor. The color difference between the most recognizable PV spots and surrounding areas with undetectable blood vessels was also analyzed. Results: Mean visibility scores were 2.6±0.7, 2.3±0.6, and 3.4±0.4 for WLI, NBI, and RDI, respectively. The RDI scores were significantly higher than the WLI (p<0.001) and NBI (p<0.001) scores. These differences were recognized by trainees and expert endoscopists. Color differences in PVs were 7.74±4.96 (WLI), 10.43±5.09 (NBI), and 15.1±6.54 (RDI). The difference in RDI was significantly higher than that in WLI (p<0.001) and NBI (p=0.006). Conclusions RDI significantly improved PV visibility compared to WLI and NBI based on objective and subjective measures.

Objective: Of the total number of prescriptions received, the percentage of refill prescriptions in May-June 2022 was 0.053%. In order to speculate on the reasons for the low utilization rate of the refill system and future developments, we surveyed patients who have been receiving continuous drug treatment for more than 6 months to determine their attitudes toward the refill system.Methods: The survey was conducted on the Web and valid responses were obtained from 290 respondents.Results: The respondents were 44.8% male and 55.2% female, with a mean age of 45.6 ± 10.5 years. Respondents' diseases included hypertension (32.1%), dyslipidemia (15.9%), diabetes (15.2%), psychiatric diseases (10.0%), skin diseases (9.3%), and others. Of the respondents, 83.4% had no prescription change within 6 months, and 69.0% had access to treatment medications for the purpose of going to the hospital, indicating that their symptoms were stable and they could use the refill system. In addition, we found that only 17.2% were aware of the refill system. However, 73.4% of respondents indicated their intention to use the refill system in the future. Therefore, our results strongly suggest that the reason for the lack of its use is due to a lack of awareness of it.Conclusion: It is expected that the refill system will be promoted in the future through awareness-raising events and education of the public. It is thought that the use of the refill system may cause delays in the detection of adverse drug reactions and the overlooking of worsening health conditions. The issue is whether pharmacists can appropriately judge whether or not to continue refill prescriptions.

Background/Aims: Visualization of palisade vessels (PVs) in Barrett’s esophagus is crucial for proper assessment. This study aimed to determine whether red dichromatic imaging (RDI) improves PV visibility compared with white-light imaging (WLI) and narrow-band imaging (NBI). Methods: Five expert and trainee endoscopists evaluated the PV visibility in Barrett’s esophagus using WLI, NBI, and RDI on 66 images from 22 patients. Visibility was rated on a 4-point scale: 4, excellent; 3, good; 2, fair; and 1, poor. The color difference between the most recognizable PV spots and surrounding areas with undetectable blood vessels was also analyzed. Results: Mean visibility scores were 2.6±0.7, 2.3±0.6, and 3.4±0.4 for WLI, NBI, and RDI, respectively. The RDI scores were significantly higher than the WLI (p<0.001) and NBI (p<0.001) scores. These differences were recognized by trainees and expert endoscopists. Color differences in PVs were 7.74±4.96 (WLI), 10.43±5.09 (NBI), and 15.1±6.54 (RDI). The difference in RDI was significantly higher than that in WLI (p<0.001) and NBI (p=0.006). Conclusions RDI significantly improved PV visibility compared to WLI and NBI based on objective and subjective measures.

Background/Aims: Visualization of palisade vessels (PVs) in Barrett’s esophagus is crucial for proper assessment. This study aimed to determine whether red dichromatic imaging (RDI) improves PV visibility compared with white-light imaging (WLI) and narrow-band imaging (NBI). Methods: Five expert and trainee endoscopists evaluated the PV visibility in Barrett’s esophagus using WLI, NBI, and RDI on 66 images from 22 patients. Visibility was rated on a 4-point scale: 4, excellent; 3, good; 2, fair; and 1, poor. The color difference between the most recognizable PV spots and surrounding areas with undetectable blood vessels was also analyzed. Results: Mean visibility scores were 2.6±0.7, 2.3±0.6, and 3.4±0.4 for WLI, NBI, and RDI, respectively. The RDI scores were significantly higher than the WLI (p<0.001) and NBI (p<0.001) scores. These differences were recognized by trainees and expert endoscopists. Color differences in PVs were 7.74±4.96 (WLI), 10.43±5.09 (NBI), and 15.1±6.54 (RDI). The difference in RDI was significantly higher than that in WLI (p<0.001) and NBI (p=0.006). Conclusions RDI significantly improved PV visibility compared to WLI and NBI based on objective and subjective measures.

Background: In recent years, dexmedetomidine (DEX) has been proposed as a useful vasoconstrictor for local anesthesia because it is less effective in circulation than clonidine of antihypertensive drugs. In addition, DEX is expected to act as a vasoconstrictor during local anesthesia. However, histomorphometric studies demonstrating that DEX exerts vasoconstrictive effects are lacking. This study aimed to clarify whether DEX exerts a histomorphologically vasoconstrictive effect on blood vessels in the mandible of rats. Methods: A total of 12 male Wistar rats were used. General anesthesia was induced and maintained using sevoflurane. Normal saline (0.2 ml) was injected on the left side of the jaw (DEX (-) effect site) and 0.2 ml normal saline containing 12.5 µg/ml DEX was injected on the right side of the jaw (DEX (+) effect site).The puncture point was located on the mesial side of the first molar, 1 mm away from the gingival sulcus.Following decalcification, the specimens were paraffinized and sagittally sliced into 20 μm-thick sections, followed by staining with anti-α smooth muscle actin antibody. The intravascular lumen area was measured in the oral mucosa, periodontal ligament, mandibular bone above the root apex, mandibular bone below the root apex, and dental pulp. The unpaired t-test was used for statistical analysis, and a P value < 0.05 was considered statistically significant. Results: Compared to the DEX (-) effect site, the intravascular lumen area in the oral mucosa and periodontal ligament of the DEX (+) effect site was significantly decreased. No significant difference was observed in the intravascular lumen area between the DEX (-) and DEX (-) effect sites in the mandibular bone above and below the root apex and dental pulp. Conclusion A direct vasoconstrictive effect of DEX was not observed in the intravascular lumen of the mandibular bone above and below the root apex and dental pulp; however, it was observed in the oral mucosa and periodontal ligament.

Background: In recent years, dexmedetomidine (DEX) has been proposed as a useful vasoconstrictor for local anesthesia because it is less effective in circulation than clonidine of antihypertensive drugs. In addition, DEX is expected to act as a vasoconstrictor during local anesthesia. However, histomorphometric studies demonstrating that DEX exerts vasoconstrictive effects are lacking. This study aimed to clarify whether DEX exerts a histomorphologically vasoconstrictive effect on blood vessels in the mandible of rats. Methods: A total of 12 male Wistar rats were used. General anesthesia was induced and maintained using sevoflurane. Normal saline (0.2 ml) was injected on the left side of the jaw (DEX (-) effect site) and 0.2 ml normal saline containing 12.5 µg/ml DEX was injected on the right side of the jaw (DEX (+) effect site).The puncture point was located on the mesial side of the first molar, 1 mm away from the gingival sulcus.Following decalcification, the specimens were paraffinized and sagittally sliced into 20 μm-thick sections, followed by staining with anti-α smooth muscle actin antibody. The intravascular lumen area was measured in the oral mucosa, periodontal ligament, mandibular bone above the root apex, mandibular bone below the root apex, and dental pulp. The unpaired t-test was used for statistical analysis, and a P value < 0.05 was considered statistically significant. Results: Compared to the DEX (-) effect site, the intravascular lumen area in the oral mucosa and periodontal ligament of the DEX (+) effect site was significantly decreased. No significant difference was observed in the intravascular lumen area between the DEX (-) and DEX (-) effect sites in the mandibular bone above and below the root apex and dental pulp. Conclusion A direct vasoconstrictive effect of DEX was not observed in the intravascular lumen of the mandibular bone above and below the root apex and dental pulp; however, it was observed in the oral mucosa and periodontal ligament.

Background: In recent years, dexmedetomidine (DEX) has been proposed as a useful vasoconstrictor for local anesthesia because it is less effective in circulation than clonidine of antihypertensive drugs. In addition, DEX is expected to act as a vasoconstrictor during local anesthesia. However, histomorphometric studies demonstrating that DEX exerts vasoconstrictive effects are lacking. This study aimed to clarify whether DEX exerts a histomorphologically vasoconstrictive effect on blood vessels in the mandible of rats. Methods: A total of 12 male Wistar rats were used. General anesthesia was induced and maintained using sevoflurane. Normal saline (0.2 ml) was injected on the left side of the jaw (DEX (-) effect site) and 0.2 ml normal saline containing 12.5 µg/ml DEX was injected on the right side of the jaw (DEX (+) effect site).The puncture point was located on the mesial side of the first molar, 1 mm away from the gingival sulcus.Following decalcification, the specimens were paraffinized and sagittally sliced into 20 μm-thick sections, followed by staining with anti-α smooth muscle actin antibody. The intravascular lumen area was measured in the oral mucosa, periodontal ligament, mandibular bone above the root apex, mandibular bone below the root apex, and dental pulp. The unpaired t-test was used for statistical analysis, and a P value < 0.05 was considered statistically significant. Results: Compared to the DEX (-) effect site, the intravascular lumen area in the oral mucosa and periodontal ligament of the DEX (+) effect site was significantly decreased. No significant difference was observed in the intravascular lumen area between the DEX (-) and DEX (-) effect sites in the mandibular bone above and below the root apex and dental pulp. Conclusion A direct vasoconstrictive effect of DEX was not observed in the intravascular lumen of the mandibular bone above and below the root apex and dental pulp; however, it was observed in the oral mucosa and periodontal ligament.

Adenocarcinoma is a common histological type of ulcerative colitis-associated cancer (UCAC), whereas neuroendocrine carcinoma (NEC) is extremely rare. UCAC is generally diagnosed at an advanced stage, even with regular surveillance colonoscopy. A 41-year-old man with a 17-year history of UC began receiving surveillance colonoscopy at the age of 37 years; 2 years later, dysplasia was detected in the sigmoid colon, and he underwent colonoscopy every 3 to 6 months. Approximately 1.5 years thereafter, a flat adenocarcinoma lesion occurred in the rectum. Flat lesions with high-grade dysplasia were found in the sigmoid colon and surrounding area. The patient underwent laparoscopic total proctocolectomy and ileal pouch-anal anastomosis with ileostomy. Adenocarcinoma was diagnosed in the sigmoid colon and NEC in the rectum. One year postoperation, recurrence or metastasis was not evident. Regular surveillance colonoscopy is important in patients with long-term UC. A histological examination of UCAC might demonstrate NEC.

Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

In Western countries, the gold-standard therapeutic strategy for rectal cancer is preoperative chemoradiotherapy (CRT) following total mesorectal excision (TME), without lateral lymph node dissection (LLND). However, preoperative CRT has recently been reported to be insufficient to control lateral lymph node recurrence in cases of enlarged lateral lymph nodes before CRT, and LLND is considered necessary in such cases. We performed a literature review on aspects of pelvic anatomy associated with rectal surgery and LLND, and then combined this information with our experience and knowledge of pelvic anatomy. In this review, drawing upon research using a 3-dimensional anatomical model and actual operative views, we aimed to clarify the essential anatomy for LLND. The LLND procedure was developed in Asian countries and can now be safely performed in terms of functional preservation. Nonetheless, the longer operative time, hemorrhage, and higher complication rates with TME accompanied by LLND than with TME alone indicate that LLND is still a challenging procedure. Laparoscopic or robotic LLND has been shown to be useful and is widely performed; however, without a sufficient understanding of anatomical landmarks, misrecognition of vessels and nerves often occurs. To perform safe and accurate LLND, understanding the landmarks of LLND is essential.