Endoscopic submucosal dissection for esophageal granular cell tumor using the clutch cutter

Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate.The shortcomings of this method are the deficiencies of fixing the knife to the target lesion,and of compressing it.These shortcomings can lead to major complications such as perforation and bleeding.To reduce the risk of complications related to ESD,we developed a new grasping type scissors forceps (Clutch Cutter,Fujifilm,Japan) which can grasp and incise the targeted tissue using an electrosurgical current.Esophagogastroduodenoscopy on a 59-year-old Japanese man revealed a 16mm esophageal submucosal nodule with central depression.Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement.The histologic diagnosis of the specimen obtained by biopsy was granular cell tumor.It was safely and accurately resected without unexpected incision by ESD using the CC.No delayed hemorrhage or perforation occurred.Histological examination confirmed that the granular cell tumor was completely excised with negative resection margin.We report herein a case of esophageal granular cell tumor successfully treated by an ESD technique using the CC.

Analysis software for upper atmospheric data developed by the IUGONET project and its application to polar science

To comprehensively understand the Arctic and Antarctic upper atmosphere, it is often crucial to analyze various data that are obtained from many regions. Infrastructure that promotes such interdisciplinary studies on the upper atmosphere has been developed by a Japanese inter-university project called the Inter-university Upper atmosphere Global Observation Network （1UGONET）. The objective of this paper is to describe the infrastructure and tools developed by IUGONET. We focus on the data analysis software. It is written in Interactive Data Language （IDL） and is a plug-in for the THEMIS Data Analysis Software suite （TDAS）, which is a set of IDL libraries used to visualize and analyze satellite- and ground-based data. We present plots of upper atmospheric data provided by IUGONET as examples of applications, and verify the usefulness of the software in the study of polar science. We discuss IUGONET＇s new and unique developments, i.e., an executable file of TDAS that can run on the IDL Virtual Machine, IDL routines to retrieve metadata from the IUGONET database, and an archive of 3-D simulation data that uses the Common Data Format so that it can easily be used with TDAS.

Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography

AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth Ⅱ gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing,selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth Ⅱ reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth Ⅱ reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting knife using a guidewire. The mean total duration of the procedure was 93.6 ± 6.8 min and the mean time required to reach the papilla was 30.5 ± 3.7 min. The mean time required to reach the papilla tended to be shorter in Billroth Ⅱ reconstruction (20.9 ± 5.8 min) than that in Roux-en-Y total gastrectomy (37.1 ± 4.9 min) but there was no significant difference (P = 0.09). A major complication occurred in one patient (3.5%); perforation of the long limb in a patient with Billroth Ⅱ anastomosis.CONCLUSION: Short-type DBE combined with several technical innovations enabled us to perform ERCP in most patients with altered gastrointestinal anatomy.

Clutch Cutter knife efficacy in endoscopic submucosal dissection for early gastric neoplasms

AIM To compare the outcomes of endoscopic submucosal dissection(ESD) for gastric neoplasms using Clutch Cutter(ESD-C) or other knives(ESD-O).METHODS This was a single-center retrospective study. Gastric neoplasms treated by ESD between April 2016 and October 2017 at Kitakyushu Municipal Medical Center were reviewed. Multivariate analyses and propensity score matching were used to reduce biases. Covariates included factors that might affect outcomes of ESD, including age, sex, underlying disease, anti-thrombotic drugs use, tumor location, tumor position, tumor size, tumor depth, tumor morphology, tumor histology, ulcer(scar), and operator skill. The treatment outcomes were compared among two groups. The primary outcome was ESD procedure time. Secondary outcomes were en bloc, complete, and curative resection rates, and adverse events rates including perforation and delayed bleeding.RESULTS A total of 155 patients were included in this study; 44 pairs were created by propensity score matching. Background characteristics were quite similar among two groups after matching. Procedure time was significantly shorter for ESD-C(median; 49 min) than for ESD-O(median; 88.5 min)(P < 0.01). However, there was no significant difference in treatment outcomes between ESD-C and ESD-O including en bloc resection rate(100% in both groups), complete resection rate(100% in both groups), curative resection rate(86.4% vs 88.6%, P = 0.730), delayed bleeding(2.3% vs 6.8%, P = 0.62) and perforation(0% in both groups).CONCLUSION ESD-C achieved shorter procedure time without an increase in complication risk. Therefore, ESD-C could become an effective ESD option for gastric neoplasms.

Global distributions of storm-time ionospheric currents as seen in geomagnetic field variations

To investigate temporal and spatial evolution of global geomagnetic field variations from high-latitude to the equator during geomagnetic storms, we analyzed ground geomagnetic field disturbances from high latitudes to the magnetic equator. The daytime ionospheric equivalent current during the storm main phase showed that twin-vortex ionospheric currents driven by the Region 1 field-aligned currents （R1 FACs） are intensified significantly and expand to the low-latitude region of-30~ magnetic latitude. Centers of the currents were located around 70~ and 65~ in the morning and afternoon, respectively. Corresponding to intensification of the R1 FACs, an enhancement of the eastward/westward equatorial electrojet occurred at the daytime/nighttime dip equator. This signature suggests that the enhanced convection electric field penetrates to both the daytime and nighttime equa- tor. During the recovery phase, the daytime equivalent current showed that two new pairs of twin vortices, which are different from two-cell ionospheric currents driven by the R1 FACs, appear in the polar cap and mid latitude. The former led to enhanced north- ward Bz （NBZ） FACs driven by lobe reconnection tailward of the cusps, owing to the northward interplanetary magnetic field （IMF）. The latter was generated by enhanced Region 2 field-aligned currents （R2 FACs）. Associated with these magnetic field variations in the mid-latitudes and polar cap, the equatorial magnetic field variation showed a strongly negative signature, produced by the westward equatorial electrojet current caused by the dusk-to-dawn electric field.

An integrated analysis platform merging SuperDARN data within the THEMIS tool developed by ERG-Science Center (ERG-SC)

The Energization and Radiation in Geospace （ERG） mission seeks to explore the dynamics of the radiation belts in the Earth＇s inner magnetosphere with a space-borne probe （ERG satellite） in coordination with related ground observations and simulations/modeling studies. For this mission, the Science Center of the ERG project （ERG-SC） will provide a useful data analysis platform based on the THEMIS Data Analysis software Suite （TDAS）, which has been widely used by researchers in many conjunction studies of the Time History of Events and Macroscale Interactions during Substorms （THEMIS） spacecraft and ground data. To import SuperDARN data to this highly useful platform, ERG-SC, in close collaboration with SuperDARN groups, developed the Common Data Format （CDF） design suitable for fitacf data and has prepared an open database of SuperDARN data archived in CDE ERG-SC has also been developing programs written in Interactive Data Language （IDL） to load fltacf CDF files and to generate various kinds of plots-not only range-time-intensity-type plots but also two-dimensional map plots that can be superposed with other data, such as all-sky images of THEMIS-GBO and orbital footprints of various satellites. The CDF-TDAS scheme developed by ERG-SC will make it easier for researchers who are not familiar with SuperDARN data to access and analyze SuperDARN data and thereby facilitate collaborative studies with satellite data, such as the inner magnetosphere data pro- vided by the ERG （Japan）-RBSP （USA）-THEMIS （USA） fleet.

Omicron variant:a booster depending on infection histories

Recently,Reynold et al.published a study in Science1 showing that immune imprinting patterns might differentially influence immune responses against variants of concern(VOCs)of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).They also demonstrated that infection with B.1.1.529(Omicron variant)of SARS-CoV-2 confers only partial and transient protection against itself,resulting in frequent reinfections with Omicron in short time intervals.