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A powerful regime for regulating trade, the Group of Seven (G-7) has increasingly negotiated its digital trade through bilateral and preferential trade agreements, including with non-member states in the Global South. Focusing on the dominant concept shaping these agreements, Japan’s “Data Free Flow with Trust” (D.F.F.T.), we trace its discursively contested emergence and meaning within a national (“Society 5.0”) vision for Japan’s digital transformation, and its subsequent transnationalization in international fora and institutionalization in global digital trade policy. Drawing on our interviews with Japanese government ministers, business elites, and legal experts who contributed to the processual development of D.F.F.T., as well as diverse additional primary sources, we find that the D.F.F.T. has become more than a trade policy, covering a wider range of social and geopolitical issues. In particular, we show that contention over “data localization measures” has restructured international relations of trust, especially across the Global North/South divide. Ultimately, this research report contributes to our understanding of how D.F.F.T. poses threats to human rights, democracy, and the global knowledge economy that may undermine its goals of enhancing innovation capacity and economic growth.

Background/Objectives: Covered self-expandable metallic stents (CSEMS) are commonly used to treat malignant distal biliary obstructions. A 10-mm CSEMS carries the risk of obstructing the pancreatic and cystic duct orifices by adhering to the bile duct; therefore, postoperative pancreatitis and cholecystitis are reported to occur at a certain frequency. We have adopted a new drainage technique for malignant distal biliary obstruction called ‘‘double-slim SEMS stenting” (DSS), where two small-diameter CSEMS are placed side-by-side. We aimed to compare the efficacy and safety of biliary drainage using DSS with those of conventional CSEMS. Methods: In total, 50 patients who underwent endoscopic biliary drainage for malignant distal biliary obstructions between April 2019 and March 2022 at Hyogo Medical University Hospital were enrolled. Patients were divided into DSS and Conventional groups, and the technical success rate, clinical success rate, adverse events, success rate for reintervention, recurrent biliary obstruction (RBO) rate, and time to RBO (TRBO) were evaluated. Results: There were no significant differences in patient characteristics between the DSS (n = 20) and Conventional groups (n = 30). The technical and clinical success rates were 100% in the DSS group. The incidence of adverse events was not significantly different between the two groups (DSS/Conventional: 10.0% [2/20]/20.0% [6/30]) (p = 0.34). No acute cholecystitis was observed in the DSS group. The incidence rates of RBO were 30% (6/20) and 43% (13/30) in the DSS and Conventional groups, respectively (p = 0.92). The median TRBO in the DSS group was 378 days, while the TRBO in the Conventional group was 195 days (p = 0.03), resulting in significantly longer TRBO in the DSS group. Conclusions: DSS emerges as a viable and safe approach for biliary drainage in malignant distal biliary obstruction, demonstrating a lower incidence of adverse events and longer TRBO compared to conventional CSEMS.

Background/Aim: Gastroesophageal varices (GEV) hemorrhage is a serious complication that can lead to unfavorable outcomes in cirrhotic patients. However, the clinical impact of HCV elimination [sustained viral response (SVR)] by direct-acting antivirals (DAAs), particularly on the long-term effects on the endoscopic findings of GEV have not been sufficiently evaluated. This study aimed to investigate whether HCV elimination with DAA treatment suppresses the progression of GEV. Patients and Methods: The clinical courses of the endoscopic findings of GEV were retrospectively compared between patients without an SVR (non-SVR group: n=71) and those who achieved an SVR with DAAs (DAA-SVR group: n=38). Results: At 1, 3, 5, and 7 years, the cumulative GEV progression rates were 8.7%, 32.8%, 45.6%, and 66.2%, respectively. At 3 years, the cumulative GEV progression rate in the DAA-SVR group was similar to that in the non-SVR group. Beyond 3 years, cases with GEV progression were found in the non-SVR group, but not in the DAA-SVR group. At 7 years, the cumulative GEV progression rate in the DAA-SVR group was significantly lower than that in the non-SVR group (p<0.05, logrank test). Variceal hemorrhage occurred in eight patients in the non-SVR group, while no bleeding events were observed in the DAA-SVR group during the observational period [8/71 (11.3%) vs. 0/38 (0.0%), p<0.05]. Conclusion: DAA treatment suppresses the progression of GEV over the long term. [ABSTRACT FROM AUTHOR]

A powerful regime for regulating trade, the Group of Seven (G-7) has increasingly negotiated its digital trade through bilateral and preferential trade agreements, including with non-member states in the Global South. Focusing on the dominant concept shaping these agreements, Japan's "Data Free Flow with Trust" (D.F.F.T.), we trace its discursively contested emergence and meaning within a national ("Society 5.0") vision for Japan's digital transformation, and its subsequent transnationalization in international fora and institutionalization in global digital trade policy. Drawing on our interviews with Japanese government ministers, business elites, and legal experts who contributed to the processual development of D.F.F.T., as well as diverse additional primary sources, we find that the D.F.F.T. has become more than a trade policy, covering a wider range of social and geopolitical issues. In particular, we show that contention over "data localization measures" has restructured international relations of trust, especially across the Global North/South divide. Ultimately, this research report contributes to our understanding of how D.F.F.T. poses threats to human rights, democracy, and the global knowledge economy that may undermine its goals of enhancing innovation capacity and economic growth. [ABSTRACT FROM AUTHOR]