Role of preoperative circulating tumor DNA in predicting occult metastases in resectable and borderline resectable pancreatic ductal adenocarcinoma.

Background: Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) may have distant metastases, undetected on preoperative imaging or early recurrence, within 6 months after surgery. Occult metastases (OMs) must be accurately predicted to optimize multidisciplinary treatment.

Aim: To investigate the efficacy of circulating tumor DNA (ctDNA) in predicting OM.

Favorable Response Defined by CA19-9 Reduction After Neoadjuvant Treatment for Pancreatic Cancer.

Background: Neoadjuvant treatment (NAT) for pancreatic cancer has been shown to reduce mortality risk, with carbohydrate antigen (CA)19-9 response indicating survival outcomes. The purpose of this study is to clarify the degree of the CA19-9 response after neoadjuvant treatment (NAT) on prognosis.

Patients And Methods: In this retrospective, multicenter, observational study involving 1811 patients with pancreatic cancer scheduled for surgery, patients were stratified on the basis of pretreatment CA19-9 levels into elevated CA19-9 level and CA19-9 within the normal range groups.

Middle Pancreatectomy for Traumatic Main Pancreatic Duct Injury with Delayed Presentation: Two Case Series.

Introduction: Pancreatic trauma is an uncommon, yet potentially lethal condition, with main pancreatic duct (MPD) disruption guiding surgical management. Middle pancreatectomy (MP) with Roux-en-Y pancreatojejunostomy (PJ) offers an organ-preserving alternative to distal pancreatectomy, particularly for young patients. However, the extent of its applicability and the specific surgical techniques-including key technical tips-remain unclear in the context of traumatic pancreatic injury.

Successful Prevention of Bronchopleural Fistula in Single-Stage Esophagectomy and Right Lower Lobectomy: A Case Report.

Introduction: Bronchopleural fistulae (BPFs) following pulmonary resection are potentially fatal complications, with right lower lobectomy being the most susceptible among lobectomies. As esophagectomy also increases the risk of tracheobronchial ischemia and postoperative malnutrition, performing a single-stage esophagectomy combined with right lower lobectomy may further elevate the risk of BPFs, underscoring the need for meticulous preoperative planning.

Case Presentation: A 64-year-old male with a history of heavy smoking was referred to our hospital after an abnormal mass was detected on a chest radiograph during an annual health check.

Platelets and MMP‑9 contribute to esophageal cancer invasion via CD40‑CD154 interactions.

CD40 expression in esophageal cancer (EC) is linked to poor prognosis, although its molecular role remains unclear. The present study explored the function of CD40 in EC progression and metastasis, focusing on its interaction with CD154 and the upregulation of MMP‑9. CD40 expression was confirmed in EC cell lines using quantitative PCR, western blotting, flow cytometry and immunocytochemistry.

Delayed Hemorrhage Following Needle Aspiration for a Mediastinal Cyst: The Significance of Confronting Upside-Down Video-Assisted Thoracic Surgery Under Two-Lung Ventilation.

Introduction: Surgical resection remains the gold standard for managing mediastinal cysts, including bronchogenic cysts, whereas needle aspiration serves as an alternative option that can facilitate preoperative volume reduction or, in certain selected cases, serve as a definitive treatment. However, it may lead to rare but potentially life-threatening complications such as mediastinitis; therefore, its indication should be carefully considered. This report details a case of a delayed intracystic hemorrhage 3 days after an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), requiring emergency surgery with venoarterial extracorporeal membrane oxygenation (V-A ECMO) on standby, which was successfully managed using a confronting upside-down video-assisted thoracoscopic surgery (VATS) approach.

Surveys on the prevalence of pediatric asthma in Japan: A comparison between the 1982, 1992, 2002, 2012, and 2022 surveys conducted in the same region using the same methodology (WJSAAC PhaseⅠ∼Ⅴ).

Objectives: To investigate the trends in the prevalence of pediatric asthma in the western part of Japan over 40 years, using data from surveys conducted every 10 years from 1982 to 2022.

Design: A series of school-based epidemiological surveys conducted every 10 years.

Setting: Elementary schools in 11 prefectures in the western part of Japan.

Survival after neoadjuvant and induction FOLFIRINOX versus gemcitabine-nab-paclitaxel in patients with resected localised pancreatic adenocarcinoma: an international multicentre study.

Background: It remains unclear whether there is a difference in overall survival (OS) benefit between (m)FOLFIRINOX and gemcitabine-nab-paclitaxel as preoperative regimens for localised pancreatic adenocarcinoma. This study aimed to investigate the outcome of patients with resected localised pancreatic adenocarcinoma following (m)FOLFIRINOX versus gemcitabine-nab-paclitaxel.

Methods: International multicentre retrospective study (16 centres, 8 countries, 3 continents), including consecutive patients after pancreatic resection for localised pancreatic adenocarcinoma following 2-6 months preoperative (m)FOLFIRINOX or gemcitabine-nab-paclitaxel (2010-2018).

Pathogenic Mechanisms of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-Associated Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer deaths worldwide. The etiology of HCC has now dramatically changed from viral hepatitis to metabolic dysfunction-associated steatotic liver disease (MASLD). The main pathogenesis of MASLD-related HCC is the hepatic lipid accumulation of hepatocytes, which causes chronic inflammation and the subsequent progression of hepatic fibrosis.

Postoperative Cholangitis After Biliary Reconstruction: Risk Factors, Timing of Occurrence, and Validity of Tokyo Guidelines.

Background: Postoperative cholangitis (POC) is a major late complication of biliary reconstruction. This study aimed to investigate the risk factors and timing of POC occurrence and the validity of the Tokyo Guidelines 18 (TG18) for POC diagnosis in patients who underwent biliary reconstruction.

Methods: A retrospective review was conducted on 635 patients who underwent biliary reconstruction between January 2010 and December 2020.

Projection of future demand for non-cancerous gastrointestinal surgery in Japan: challenges and workforce planning in an aging society.

Purpose: Japan's aging population poses challenges for balancing healthcare demands and workforce supply. The aim of this study was to project the future demand for major non-cancerous gastrointestinal surgeries such as cholecystectomy, inguinal hernia repair, and appendectomy up until 2050 and examine the impact of a shrinking working-age population on surgical workforce needs.

Methods: We used data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data (2018-2022) and population projections to calculate age- and sex-specific procedure rates.

Confronting Upside-Down Video-Assisted Thoracic Surgery Approach for Hemorrhagic Bronchogenic Cyst Manifested by Sudden Back Pain.

Introduction: Bronchogenic cysts, arising from an aberrant bronchial primordium inclusion during the fetal period, are typically located in the mediastinum but can develop in ectopic regions. While generally asymptomatic, these cysts may become symptomatic due to infection or, rarely, hemorrhage. This report details a case of a hemorrhagic bronchogenic cyst in the supradiaphragmatic region, successfully resected using video-assisted thoracic surgery (VATS) with a confronting upside-down monitor setting.

Short- and Long-term Surgical Results of Extended Surgery for Widespread Gallbladder Carcinoma.

Background/aim: Hepatectomy with extrahepatic bile duct resection (Hx+EBDR), pancreaticoduodenectomy (PD), and occasionally hepatopancreaticoduodenectomy (HPD) are required for the treatment of advanced gallbladder cancer (GBC). This study aimed to clarify the clinical value of these extended surgeries for GBC.

Patients And Methods: We retrospectively reviewed the medical records of patients who underwent curative resection (Surg-G, n=59), and their survival rates were compared with those of patients with unresectable GBC who underwent chemotherapy (CTx-G, n=63).

The Global Burden of Cirrhosis and Other Chronic Liver Diseases in 2021.

Background And Aim: The burden of cirrhosis and other chronic liver diseases has changed in recent years due to shifts in the contributing aetiologies. We estimated the burden of cirrhosis and other chronic liver diseases, including etiological and regional differences, across 204 countries and territories from 2010 to 2021.

Approach And Results: We analysed temporal trends in the burden of cirrhosis and other chronic liver diseases utilising data from the Global Burden of Disease Study 2021.

Regional Difference of Liver Cancer in Japan: A Real-world Evidence Using the National Database of Health Insurance Claims.

Objective The etiology of liver cancer is changing to metabolic dysfunction-associated steatotic liver disease, and ultrasound elastography is useful for identifying high-risk patients. However, these regional differences remain unclear. We aimed to investigate regional differences in the prevalence of liver cancer and the use of ultrasound elastography in Japan using the National Database of Health Insurance Claims (NDB).

Multidisciplinary surgical strategy for an invasive thymoma in an immunocompromised patient: a case of a successful resection and postoperative troubleshooting.

Background: Robot-assisted thoracoscopic surgery has become prevalent as a feasible approach for anterior mediastinal tumor resections, while conventional open surgery, such as a median sternotomy, remains preferred for a combined resection of adjacent organs. However, an additional thoracotomy may be necessary when tumors extend into one hemithorax. This complex approach can cause significant damage to the osseous thoracic cage, increasing the risk of surgical morbidity especially in immunocompromised patients.

Normal tissue complication probability model for severe radiation-induced lymphopenia in patients with pancreatic cancer treated with concurrent chemoradiotherapy.

Background And Purpose: Radiation-induced lymphopenia (RIL) may be associated with a worse prognosis in pancreatic cancer. This study aimed to develop a normal tissue complication probability (NTCP) model to predict severe RIL in patients with pancreatic cancer undergoing concurrent chemoradiotherapy (CCRT).

Materials And Methods: We reviewed pancreatic cancer patients treated at our facility for model training and internal validation.

A noninvasive urinary microRNA-based assay for the detection of pancreatic cancer from early to late stages: a case control study.

Background: Pancreatic cancer is highly aggressive and has a low survival rate primarily due to late-stage diagnosis and the lack of effective early detection methods. We introduce here a novel, noninvasive urinary extracellular vesicle miRNA-based assay for the detection of pancreatic cancer from early to late stages.

Methods: From September 2019 to July 2023, Urine samples were collected from patients with pancreatic cancer (n = 153) from five distinct sites (Hokuto Hospital, Kawasaki Medical School Hospital, National Cancer Center Hospital, Kagoshima University Hospital, and Kumagaya General Hospital) and non-cancer participants (n = 309) from two separate sites (Hokuto Hospital and Omiya City Clinic).

Survivin as a Therapeutic Target for Neuroendocrine Neoplasms.

Introduction: Although neuroendocrine neoplasms (NENs) have a good prognosis, distant metastasis remains a crucial prognostic factor. Survivin, a tumor-associated antigen, is overexpressed in several solid tumors, indicating poor prognosis. We aimed to evaluate the clinical significance and role of survivin as a therapeutic target for NEN.

Artificial Intelligence and Machine Learning Predicting Transarterial Chemoembolization Outcomes: A Systematic Review.

Background: Major society guidelines recommend transarterial chemoembolization (TACE) as the standard of care for intermediate-stage hepatocellular carcinoma (HCC) patients. However, predicting treatment response remains challenging.

Aims: As artificial intelligence (AI) may predict therapeutic responses, this systematic review aims to assess the performance and effectiveness of radiomics and AI-based models in predicting TACE outcomes in patients with HCC.

Improvement of Hypoalbuminemia and Hepatic Reserve after Stent Placement for Postsurgical Portal Vein Stenosis.

Purpose: To investigate the change in serum albumin (Alb) levels and hepatic reserve scores before and after portal vein stent placement (PVS) for postsurgical portal vein (PV) stenosis.

Materials And Methods: A retrospective cohort of patients who underwent PVS after abdominal surgery between 2007 and 2021 was analyzed. Patients' age, sex, and PVS technical success (defined by PV patency at final portography) were evaluated.

Empowering Mental Health Monitoring Using a Macro-Micro Personalization Framework for Multimodal-Multitask Learning: Descriptive Study.

Background: The field of mental health technology presently has significant gaps that need addressing, particularly in the domain of daily monitoring and personalized assessments. Current noninvasive devices such as wristbands and smartphones are capable of collecting a wide range of data, which has not yet been fully used for mental health monitoring.

Objective: This study aims to introduce a novel dataset for personalized daily mental health monitoring and a new macro-micro framework.