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Toshimi Chiba,1,* Ting Wang,1,* Satoshi Kikuchi2,* 1Division of Internal Medicine, Department of Oral Medicine, Iwate Medical University, Morioka, Iwate, Japan; 2Department of Gastroenterology, Sanai Hospital, Morioka, Iwate, Japan*These authors contributed equally to this workCorrespondence: Toshimi Chiba, Division of Internal Medicine, Department of Oral Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan, Tel +81 19 651 5111, Fax +81 19 654 3281, Email toschiba@iwate-med.ac.jpAbstract: Melanosis coli occurs with the administration of stimulant laxatives for the relief of constipation. However, the duration of macroscopic improvement of melanosis coli after discontinuation of anthracene laxatives is not well understood. We describe the case of an 81-year-old female diagnosed with melanosis coli via colonoscopy who had been taking senna laxatives for 5 years. Seven months after cessation of senna laxatives, colonoscopy showed no melanosis coli in the colon. This impressive report describes the observation of melanosis coli with colonoscopy; 7 months after the withdrawal of senna stimulant laxatives, melanosis coli resolved.Keywords: melanosis coli, colonoscopy, discontinued, senna laxative, anthraquinone

Makoto Kobayashi, Eiji Yoshida, Takuro Kyuno, Ryoko Kawagishi, Kei Sato, Tsuyoshi Kono, Takehiro Chiba, Hitoshi Yonezawa, Osamu Funato, Akinori Takagane Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City, Hokkaido, 040-8611, JapanCorrespondence: Makoto KobayashiDepartment of Surgery, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate City, Hokkaido, 040-8611, JapanTel +81-138-51-2295Fax +81-138-56-2696Email koba86gg@gmail.comPurpose: Faster surgery has been associated with better outcomes. In the present study, we aimed to determine whether surgical duration affected overall survival (OS) in patients undergoing esophagectomy. Additionally, we assessed factors that influence surgical duration.Patients and Methods: This single-center retrospective cohort study included 128 patients who underwent Ivor-Lewis esophagectomy by a single surgeon between 2005 and 2019. The Cox proportional hazard model was used to evaluate the association of OS with the following variables: surgical duration, neo-adjuvant chemotherapy, pathological grade of depth of tumor invasion, lymph node (LN) metastasis, body mass index (BMI), and cervical LN dissection. Additionally, factors associated with prolonged surgical duration were examined by logistic regression analysis.Results: Based on the multivariate analysis, surgical duration was not associated with OS [hazard ratio (HR), 1.065; 95% confidence interval (CI), 0.586– 1.937; P = 0.837]. On the other hand, tumor invasion (HR, 2.901; 95% CI, 1.483– 5.674; P = 0.002) and LN metastasis (HR, 2.338 2.403; 95% CI, 1.237– 4.420 1.257– 4.593; P = 0.009 0.008) significantly influenced OS. The assessment of variables affecting surgical duration showed that BMI had a significant effect on surgical duration (odds ratio, 2.790; 95% CI, 1.254– 6.204, P = 0.012).Conclusion: According to the analysis of patients who underwent the same surgical approach by a single surgeon, surgical duration of esophagectomy for esophageal cancer was significantly influenced by BMI; however, surgical duration had no impact on patient survival.Keywords: esophagectomy, Ivor-Lewis approach, depth of tumor invasion, lymph node metastasis, body mass index, overall survival

Tetsuhiro Chiba,1 Atsushi Hiraoka,2 Shigeru Mikami,3 Masami Shinozaki,4 Yukio Osaki,5 Masamichi Obu,6 Takamasa Ohki,7 Naoyuki Mita,8 Dianne Ledesma,8 Nariaki Yoshihara,8 Kathleen Beusterien,9 Kaitlan Amos,9 John FP Bridges,10 Osamu Yokosuka111Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan; 2Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Ehime Prefecture, Japan; 3Department of Internal Medicine, Kikkoman General Hospital, Noda-shi, Chiba Prefecture, Japan; 4Department of Gastroenterology, Numazu City Hospital, Shizuoka, Japan; 5Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan; 6Department of Gastroenterology, Kimitsu Chuo Hospital, Kisarazu City, Chiba Prefecture, Japan; 7Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan; 8Market Access, Bayer Yakuhin, Ltd., Tokyo, Japan; 9ORS Health, Washington DC, USA; 10Department of Biomedical Informatics and Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA; 11Japan Community Health care Organization Funabashi Central Hospital, Funabashi, Chiba Prefecture, JapanPurpose: This study aimed to evaluate Japanese patient preferences regarding features of intermediate or advanced (Progressed) hepatocellular carcinoma (HCC) treatments: transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), and oral anti-cancer therapy.Methods: Patients with HCC, recruited from clinical sites and a patient panel in Japan, completed a cross-sectional web-based survey. Preferences were quantified using best–worst scaling, where patients identified the best and worst among 13 treatment features. Direct elicitation was used to identify preference for TACE, HAIC, or oral therapy, including the likelihood of trying each. Additional items asked for the willingness to try an oral medication that delays progression by six months but has an 8% or 21% risk of severe hand-foot skin reaction (HFSR).Results: The sample (N=119; 29 early stage; 90 Progressed) most preferred “oral medication”, “artery branches plugged”, and “prevents formation of new blood vessels”, and least preferred “risk of liver damage” and “risk of catheter-related complications”. Overall, 51%, 40%, and 8% preferred oral therapy, TACE, and HAIC, respectively (p

Hiromasa Yamashita,1,2 Kenkichi Tanioka,2 Goichiro Miyake,3 Ichiro Ota,3 Toru Noda,4 Kensaku Miyake,3 Toshio Chiba1,2 1Kairos Co. Ltd., Tokyo, Japan; 2Medical Imaging Consortium, Tokyo, Japan; 3Miyake Eye Hospital, Nagoya, Japan; 4Tokyo Medical Center, Tokyo, Japan Background: We have developed a new compact lightweight 8K ultra-high-definition (UHD; 7,680×4,320 pixels) camera and started medical application with an ophthalmic surgical microscope which is interchangeable with the conventional high-definition (1,920×1,080 pixels)/4K UHD (3,840×2,160 pixels) microscopic camera. Methods: We did a feasibility study to apply our 8K UHD microscope in cataract surgery, glaucoma surgery and vitreous surgery using pig cadaver eyes. The 8K UHD microscope comprises a surgical microscope, a camera adaptor with relay lenses, an 8K UHD camera and an 8K UHD LCD to share the 8K UHD images with all surgical staff in real time. Results: In ophthalmic surgeries, higher resolution images than conventional microscopic cameras were obtained with 8K UHD LCD equivalent to the observation through the microscopic eye pieces. Conclusion: Based on the results of this feasibility study, clinical trials on human ophthalmic surgery using the new 8K UHD microscopic camera should be conducted in the near future. Keywords: 8K ultra-high-definition camera, surgical microscope, cataract surgery, glaucoma surgery, vitreoretinal surgery, heads-up surgery

Kazuki Ide,1 Hiroshi Yamada,1 Yohei Kawasaki,1 Marika Noguchi,1 Mamoru Kitagawa,1 Tsuyoshi Chiba,2 Yoshiyuki Kagawa,3 Keizo Umegaki2 1Department of Drug Evaluation & Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, 2Information Center, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, 3Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan Background: Dietary supplements are used by >50% of the adult population in Japan, and adverse events related to these products have been reported with their increased use. Thus, an efficient system to gather and report data on these adverse events is essential. To date, however, reporting has been limited. The aim of this study was to address this deficiency by exploring the routine reporting practices of the medical staff employed at clinics or pharmacies in Japan.Methods: We conducted a survey of the procedures used by the medical staff to report adverse events related to dietary supplement intake to public health centers in Japan. The survey was conducted in Japan between November 2015 and January 2016. Based on a sample size calculation, questionnaires were administered to 1,700 potential respondents (850 pharmacists and 850 physicians). The questionnaire inquired about the sociodemographic characteristics and dietary supplement-related adverse event-reporting practices.Results: The response rate was 34.7%, including 286 pharmacists and 304 physicians. Although >30% of the pharmacists and physicians had prior experience dealing with such adverse events,

Toshimi Chiba, Kazunari Yamamoto, Shoko Sato, Kazuyuki Suzuki Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan Abstract: Irritable bowel syndrome (IBS) is a functional disease with persisting gastrointestinal symptoms that has been classified into four subtypes. Serotonin (5-hydroxytryptamine [5-HT]) plays important physiological roles in the contraction and relaxation of smooth muscle. Intraluminal distension of the intestine is known to stimulate the release of endogenous 5-HT from enterochromaffin cells, activating 5-HT3 receptors located on primary afferent neurons and leading to increases in intestinal secretions and peristaltic activity. Ramosetron, a potent and selective 5-HT3-receptor antagonist, has been in development for use in patients suffering from diarrhea-predominant IBS. In a double-blind, placebo-controlled, parallel-group study of 418 patients with diarrhea-predominant IBS-D, once-daily 5 µg and 10 µg doses of ramosetron increased the monthly responder rates of IBS symptoms compared to placebo. In a 12-week randomized controlled trial of 539 patients, a positive response to treatment was reported by 47% of a once-daily 5 µg dose of ramosetron-treated individuals compared to 27% of patients receiving placebo (P