Colorectal cancer (CRC) is one of the most common causes of cancer-related death worldwide. And the incidence rates of CRC have been increasing in Japan. Screening colonoscopy is effective to decrease the incidence and mortality of CRC. Colonoscopy can be used to detect and remove precancerous polyps and early stage cancers. Although snare polypectomy and endoscopic mucosal resection (EMR) is a simple technic, sometimes it is difficult to remove the lesions 20 mm or more in diameter. Endoscopic submucosal dissection (ESD) was developed as a method for resection of large superficial gastrointestinal tumors. However, technical difficulties associated with ESD in the colorectum make it less widely applied in the treatment of tumors. To address this difficulty, we designed a new traction device, called the S-O clip and reported previously. By using this device, visibility of the submucosal layer becomes clear which makes the procedure easy and safe. Mean procedure time of ESD is significantly shorter, and it is easy to use at any location. ESD using traction device has been widely used in Japan, and it might become a worldwide standard method for removing of large superficial gastrointestinal tumors in the near future.

　Image-guided tumor ablation is a well-established hallmark of local cancer therapy. Ablation is potentially curative, minimally invasive, and easily repeatable for recurrence. There are mainly two categories of ablation: chemical ablation and thermal ablation. Thermal ablation, which includes radiofrequency ablation, microwave ablation, and others, is now the standard. In the treatment of hepatocellular carcinoma, various nonsurgical therapies have developed. Among them, ablation is regarded as best for the early-stage cancer. Ablation has achieved good long-term results and now regarded as a satisfactory alternative to resection for small HCC. Ablation is also a potentially curative treatment for metastatic liver tumors. In Japan, ablation will be reimbursed and more widely performed in other fields than the liver in the near future. In other countries, they use ablations for tumors in the liver, the lung, the bones, the thyroid and others. Between the United States and Japan, there are some different practices in ablation while many practices are similar. Asia has the largest number of ablation procedures and the largest market scale in the world. Asia is the area where percutaneous ethanol injection and microwave ablation started. Various innovations and sophisticated instruments, such as a dedicated ultrasound transducer for puncture, a dedicated procedure bed, contrast-enhanced ultrasound, multimodality fusion imaging and others, would further improve outcome in ablation. Training programs may be useful to understand basic concepts and learn cardinal skills. Ablation with the use of sophisticated techniques would be superior to conventional surgery in the treatment of liver tumors.

　Pharmacotherapy for advanced lung cancer, especially for non-small cell lung cancer (NSCLC) has progressed dramatically in past 10 years. The prognosis of patients with advanced NSCLC has improved immensely due to treatment with molecular target drugs and immune checkpoint inhibitors. Numerous clinical trials have shown that immunotherapy using immune checkpoint inhibitors is highly effective in the treatment of patients with advanced NSCLC. The 5-year survival rate is dismal in patients with advanced NSCLC treated with conventional cytotoxic chemotherapy. Alternatively, advanced NSCLC patients treated with nivolumab, an immune checkpoint inhibitor, have exhibited a 20% chance of survival for 5 years. However, immune checkpoint inhibitors are ineffective in many patients. Therefore, efforts have been taken to develop methods predicting the effects of immune checkpoint inhibitors and to explore new combination therapies using immune checkpoint inhibitors. Moreover, since immune checkpoint inhibitors may cause serious immune-related adverse events (e.g., pneumonitis, enterocolitis, encephalitis), it is important to develop methods that control these adverse events. More patients with lung cancer are expected to benefit from immunotherapies.

Objective: To investigate to investigate significance of C-reactive protein (CRP) in patients with trauma on arrival.

Materials: From September 2017 to February 2018, a medical chart review was retrospectively performed for all patients with trauma who were admitted to our department.

Methods: The subjects were divided into two groups: a CRP-negative group (initial CRP level ≤0.3 mg/dl) and a CRP-positive group (>0.3 mg/dl). For the CRP-positive group, we additionally investigated the cause of the increased level of CRP.

Results: There were 33 cases in the CRP-positive group and 168 in the CRP-negative group. The age and ratio of lymphocytes in the CRP-positive group was significantly higher than those in the CRP-negative group. Twenty-two to twenty-eight of the 33 cases (67-85%) had an infection, 3 of 33 (9%) had a delayed visit (over 24 h from the onset of the trauma) to the emergency department, and 2 cases (6%) had malignancy in the CRP-positive group. All subjects with an increased CRP level on arrival potentially had underlying diseases that might have caused their trauma.

Conclusion: Some traumatized patients may have elevated CRP levels on arrival due to underlying diseases capable of causing trauma. An increased initial level of CRP did not significantly affect the clinical outcome; however, physicians should pay attention to the cause of the increased CRP level, which may affect the patient’s outcome. Exploring increased CRP levels may be useful for identifying the mechanism underlying the occurrence of trauma.

Purpose: We retrospectively investigated the clinical significance of measuring the level of C-reactive protein (CRP) level in patients with mamushi (Gloydius blomhoffii) bites to differentiate it from bacterial cellulitis.

Methods: We retrospectively conducted a medical chart review of all patients with mamushi bites who were treated in our department between July 2013 and August 2017. The patients were divided into two groups: the CRP-negative group included patients whose CRP levels were within the normal limit (<0.3 mg/dl) during hospitalization, while the CRP-positive group included patients whose CRP levels were over the normal limit (≥0.3 mg/dl) during hospitalization.

Results: Thirty-five cases were examined in this study. Seventeen patients were classified into the CRP-negative group and 18 were classified into the CRP-positive group. Only 2 of the patients (5%) had a positive CRP level on arrival. There were no significant differences in sex, ratio of delayed arrival, anti-venom administration, antibiotic administration, grade of mamushi bite on arrival and maximum grade of mamushi bite, ratio of increase in CRP over the normal limit, duration of hospitalization, or mortality rate between the two groups. However, the CRP-negative group tended to be younger than the CRP-positive group.

Conclusion: This is the first report to show that 5% of mamushi bite cases had a positive CRP level on arrival, and that half had a positive CRP level during hospitalization. Future prospective studies involving a greater number of patients are needed in order to determine whether or not a lack of an increase in the CRP level on arrival is a useful biomarker for differentiating between mamushi bites and cellulitis.

Objective: Gadolinium-157 (¹⁵⁷Gd) has attracted interest for its use in the preparation containing metal elements of the neutron capture therapy (NCT), one of the radiation therapies. The study, however, has not developed because of the difficulty to quantify the concentration of ¹⁵⁷Gd in the tissue. Therefore, we established a quantitative imaging technique for ¹⁵⁷Gd in bio-tissue employing laser-ablation inductively coupled mass spectrometry (LA-ICP-MS).

Materials and Methods: 4 female New Zealand white rabbits, which were inoculated with rabbit VX-2 cells participated in this study. ¹⁵⁷Gd in water-in-oil-in-water (WOW) emulsion was injected via the proper hepatic artery into the rabbits and, after 24 or 72 hours, the rabbits were killed, and the liver tissues were harvested. We also prepared 7 standard tissues which were mixed with gadoteridol solutions, the final amount of ¹⁵⁷Gd was 0, 4.4, 22, 44, 220, 440 and 660 μg/g, respectively. The harvested livers and standards were sectioned on a cryostat at 5 μm intervals and they were analyzed by LA-ICP-MS.

Result: In an experiment on animal cancer tissue, ¹⁵⁷Gd was observed to accumulate around the cancer.

Conclusion: The ¹⁵⁷Gd concentration in bio tissue can be quantitatively assessed through LA-ICP-MS imaging and it was expected to contribute the progress of NCT study.

　Atherosclerotic cardiovascular disease is the leading cause of death worldwide. Among the most promising results of the preventing approach against progression of atherosclerosis derived from lipid lowering therapy especially by statins. Recent clinical trials with statins indicated that aggressive lipid lowering therapy could inhibit the progression of atherosclerosis or even induce the regression of atherosclerotic plaque. It also stabilizes the unstable plaque to stable form and reduces clinical CV events.

　Several trials using intravascular ultrasound demonstrated that lowering LDL-C to 70-80 mg/dl by aggressive lipid-lowering treatment with moderately high-dose statins significantly reduced coronary plaque volume, but these studies are vastly underpowered to determine the effects of such lipid-lowering treatment on clinical outcomes. Accordingly, the value of reducing LDL-C levels substantially below 100 mg/dl in patients with CAD, particularly Asian patients, had not been clearly demonstrated, and Japanese guidelines recommended reducing LDL-C only to immediately below 100 mg/dl until recently. HIJ-PROPER and REAL-CAD provided pivotal evidence for the aggressive lipid-lowering in Japanese patients at secondary prevention. The lipid management strategy for secondary prevention is still changing in clinical practice from recent Japanese evidence.

　In this article, we will review the history and current understanding of the efficacy of aggressive lipid lowering therapy which inhibits the atherosclerosis progression and induces the regression, and we also will review the recent clinical evidence especially from Japan.

Objective: Minimally invasive gastrectomy is performed worldwide because it confers less stress and pain for patients with gastric cancer. Recently, other types of minimally invasive gastrectomy, which include robotic gastrectomy, have also been developed. In this paper, we will review the history, current status, and future prospects of minimally invasive gastrectomy.

Methods: We overviewed gastric cancer and reviewed the outcomes of previous clinical trials. In addition, we present our newly developed technique of minimally invasive gastrectomy, especially for anastomosis.

Results: Previous clinical trials showed that minimally invasive gastrectomy was similar or superior to open gastrectomy in terms of short-term results, while minimally invasive gastrectomy was not superior to open gastrectomy in terms of long-term survival. Many studies have reported that postoperative complications could induce cancer recurrence; hence, we hypothesize that the survival of patients who underwent minimally invasive gastrectomy will be better than that of patients who underwent open gastrectomy. An intracorporeal anastomosis might help decrease the incidence of postoperative complication because it can shorten the length of surgical incisions. However, this procedure requires experienced skilled surgeons.

Conclusion: The surgical system of minimally invasive gastrectomy, including robotic gastrectomy, has dramatically improved. Although there are challenges that need to be addressed, we believe that using more advanced technology or equipment will make minimally invasive gastrectomy the standard treatment for gastric cancer in the future.