The aim of this study was to identify factors associated with the use of a multibending scope （MBS） as a rescue instrument in gastric endoscopic submucosal dissection （ESD） for neoplasia. Between January 2015 and June 2023, 502 patients with gastric neoplasia underwent ESD at Showa University Hospital. The patients were classified into ESD with MBS （MB） and ESD with conventional scope only （C） groups. Significantly more cases in the MB group had prolonged procedural times （≥120min）（p＜0.001） and difficult ESD （p＜0.001） compared with the C group. Patients in the MB group had significantly higher rates of lesions located in the lesser curvature （p＜0.001）, larger than 20mm （p＜0.001）, located in the upper two-thirds of the stomach （p＝0.004）, and endoscopic ulceration findings （p＝0.02） compared with the C group. These factors were significant after adjustment in the multivariate analysis. Independent clinicopathological characteristics of superficial gastric neoplasms associated with MBS use as a rescue scope for gastric ESD were identified. These results indicate that using a MBS as the initial scope may be beneficial in certain cases.

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Languages share properties common among human species, and even seemingly English-specific phenomena, such as the third-person singular present-tense morpheme “s,” reveal commonalities with Japanese. Research has shown that meta-linguistic competence—the adoption of a higher perspective in observing and analyzing language—enhances proficiency in individual languages. Japanese learners of English often experience difficulties stemming from a lack of understanding of linguistic principles shared across languages rather than challenges specific to English. Meta-linguistic competence is a valuable tool in foreign-language learning. Akita et al. （2012） described how meta-linguistic competence can help abstract and identify commonalities between languages. Such an approach raises awareness among Japanese learners of English regarding their native language and directs their attention toward broader linguistic principles underlying Japanese and English. This study highlights common fundamental concepts and elements through an appropriate level of abstraction and versatility, investigating how the application of shared linguistic fundamentals can improve English language learning.

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To determine the effectiveness of vaginal saline douching in patients with a short cervix and subclinical cervical infection. Pregnant women at 16-26 gestational weeks with a cervical length of ≤25mm were randomized into the bed rest therapy without vaginal douching （BR group） and the bed rest therapy with vaginal douching （VD group）. Patients in the BR group had no asymptomatic vaginal infection, whereas those in the VD group developed an asymptomatic vaginal infection. The BR group was allowed a 2-week bed rest, and the VD group was provided bed rest and vaginal douche with 500ml saline for 32 weeks. The other treatment measures were standardized. The primary and secondary endpoints were premature birth （weeks of delivery） and transition to the “rescue arm” defined as the rate of tocolytic drug use, respectively. We analyzed 30 and 35 cases in the BR and VD groups, respectively, including those transitioning to the “rescue arm.” Patient background and delivery outcomes, including mean delivery time, weeks from allocation to delivery, birth weight, and neonatal outcomes, did not significantly differ. The VD group had a longer gestational period than the BR group （up to 32 gestational weeks）. The VD group had a significantly higher 70-day pregnancy extension effect than the BR group （p＜0.05）. Moreover, the VD group （10 cases ［28.6％］） showed a lower but nonsignificant tendency to transition to the “rescue arm” than the BR group （12 cases ［40.0％］）. In patients with a short cervix, cervicitis, or vaginitis, vaginal saline douching may prolong the gestational period and reduce preterm births, thereby improving maternal and neonatal outcomes.

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In cerebral angiography for dural arteriovenous fistula （dAVF）, three-dimensional （3D） images obtained from 3D rotational angiography （3DRA） can be especially useful. However, if the contrast injection rates used in 3DRA are inappropriate, poor vessel delineation and reduced visibility of the observed vessels due to contrast reflux are likely to occur. To address this issue, the present study investigated the relationship between the contrast injection conditions for two-dimensional digital subtraction angiography （2D-DSA） and 3DRA, aiming to identify the optimal contrast injection rate for 3DRA based on the contrast injection conditions for 2D-DSA. Cases with dAVF who had undergone both 2D-DSA and 3DRA using subtraction techniques under very similar contrast injection conditions were included. Agreement in the visual evaluation of vessel delineation between angiographies was evaluated using weighted kappa coefficients, while agreement with contrast reflux was assessed using kappa coefficients. Our results showed a good agreement in vessel delineation between 2D-DSA and 3DRA with subtraction, with a weighted kappa coefficient of 0.82. The agreement with or without contrast agent reflux was also good, with a kappa coefficient of 0.85. Our findings indicated that when excellent vessel delineation is achieved in 2D-DSA immediately before 3DRA, clinically useful images can be obtained using the same contrast agent injection rate as in 2D-DSA.

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Signet ring cell carcinoma is rarely accompanied by intramural metastases. The patient was a 76-year-old woman. A colonoscopy revealed early malignancy on the right side of the transverse colon. A depressed lesion was observed near the tumor. After laparoscopic right hemicolectomy, histopathological examination revealed a signet ring cell carcinoma with two intramural metastases arranged concentrically. The only complication was minor anastomotic leakage, on postoperative day 8. The patient was discharged and prescribed conservative therapy. In the 15 months since the laparoscopy, she has remained healthy, without recurrence. We treated a rare case of signet ring cell carcinoma of the transverse colon that was accompanied by concentric intramural metastases.

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Here, we report the case of a 65-year-old male patient with invasive thymoma who developed peritoneal dissemination after approximately 16 years despite multimodal therapy. The patient was initially diagnosed with invasive thymoma and underwent extended thymectomy with the resection of a pleural disseminated nodule; the postoperative diagnosis was type B1/B2 thymoma according to the World Health Organization classification. He received surgery, chemotherapy, and radiotherapy for the treatment of the residual disseminated nodules in the pleura. However, he developed peritoneal dissemination 16 years later, an unusual recurrence pattern occurring after a prolonged duration despite thymectomy and multimodal therapy.

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