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Objective ndoscopic laryngopharyngeal surgery (ELPS) is a useful surgery for superficial cancers of the head and neck region, but it has not yet been well evaluated for synchronous multiple primary cancers (multiple primaries). The purpose of this study was to clarify the safety and usefulness of ELPS for patients with multiple superficial primary cancers in the head and neck region. Methods rom December 2009 to December 2016, 145patients with superficial head and neck cancers underwent ELPS. The patients were divided into two groups; a group consisting of patients with a single primary cancer (single primary) and another group consisting of patients with synchronous multiple primaries, and the incidences of postoperative complications and lymph node metastasis were retrospectively compared between the two groups. Results f the 145 patients, 107 had a single primary cancer and 38 had multiple primaries. There was no significant difference in the age, sex, or rate of intraepithelial cancer between the two groups. Postoperative complications included dysphagia in 6 (5.6%) patients with a single primary and 2 (5.3%) patients with multiple primaries. One patient with multiple primaries required gastrostomy because of aspiration pneumonia. In addition, the following complications were also observed. Laryngeal paralysis occurred in 2 (1.9%) patients with a single primary, and 1 (2.6%) patient with multiple primaries; tracheostomy because of postoperative bleeding in 1 (0.9%) patient with a single primary; infection occurred in 2 (5.3%) patients with multiple primaries. Postoperative lymph node metastasis was found in 7 (6.5%) patients with a single primary and 6 (15.8%) patients with multiple primaries. Lymphatic invasion of the primary cancer was noted in 3 (2.8%) patients with a single primary and 5 (13.2%) patients with multiple primaries, being significantly higher in the latter group. Conclusion ELPS is also a safe surgery for patients with multiple primaries. However, the incidence of lymphatic invasion of the primary cancer was significantly higher in patients with multiple primaries.

Objective: Involvement in the tracheostomy procedure for COVID-19 patients can lead to a feeling of fear in medical staff. To address concerns over infection, we gathered and analyzed experiences with tracheostomy in the COVID-19 patient population from all over Japan. Methods: The data for health-care workers involved in tracheostomies for COVID-19-infected patients were gathered from academic medical centers or their affiliated hospitals from all over Japan. Results: Tracheostomies have been performed in 35 COVID-19 patients with a total of 91 surgeons, 49 anesthesiologists, and 49 surgical staff members involved. Twenty-eight (80%) patients underwent surgery more than 22 days after the development of COVID-19-related symptoms (11: 22-28 days and 17: >= 29 days). Thirty (85.7%) patients underwent surgery >= 15 days after intubation (14: 15-21 days, 6: 22-28 days, and 10: >= 29 days). Among the total of 189 health-care workers involved in the tracheostomy procedures, 25 used a powered air-purifying respirator (PAPR) and 164 used a N95 mask and eye protection. As a result, no transmission to staff occurred during the 2 weeks of follow-up after surgery. Conclusion: No one involved in tracheostomy procedures were found to have been infected with COVID-19 in this Japanese study. The reason is thought to be that the timing of the surgery was quite late after the infections, and the surgery was performed using appropriate PPE and surgical procedure. The indications for and timing of tracheostomy for severe COVID-19 patients should be decided through multidisciplinary discussion. (c) 2021 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.

Patients with head and neck cancer (HNC) have some problems such as dysfunction of breathing, eating, and/or speaking. The aim of this study was to examine efficacy of the stress management program for HNC patients (SMAP-HNC) compared with usual care (UC).We conducted a pilot study of SMAP-HNC for depressive HNC patients between January 2016 and March 2018. The program contains psychoeducation, stress coping training, and operant reinforcement. The outcome measure was the Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy (FACT), and Brief Coping Inventory (COPE).Twenty patients were randomly assigned to SMAP-HNC and UC group. Although a small sample sizes, there was no significant difference of depression score change between SMAP-HNC and UC group (Hedges'dIt was the first study to conduct stress management program for HNC patients. Unfortunately, our trial designed as a randomized controlled trial is underpowered to make conclusion as to the efficacy of SMAP-HNC. However, there are some valuable suggestions to modify the stress management program in future.Los pacientes con cáncer de cabeza y cuello (CCC) tienen algunos problemas como trastornos de la respiración, la alimentación y/o el habla. El objetivo de este estudio fue examinar la eficacia de un programa de control del estrés para pacientes con CCC (SMAP-HNC) en comparación con la atención habitual (AH).Llevamos a cabo un estudio piloto de SMAP-HNC para pacientes depresivos con CCC entre enero de 2016 y marzo de 2018. El programa contiene psicoeducación, entrenamiento para afrontar el estrés y refuerzo operante. Las medidas de los resultado fueron la Hospital Anxiety and Depression Scale (HADS), la Functional Assessment of Cancer Therapy (FACT) y el Brief Coping Inventory (COPE).Veinte pacientes fueron asignados aleatoriamente al grupo SMAP-HNC y AH. Aunque los tamaños de las muestras son pequeños, no hubo diferencias significativas en el cambio en el puntaje de depresión entre el grupo SMAP-HNC y el grupo AH (Es el primer estudio en emplera un programa de control del estrés para pacientes con CCC. Desafortunadamente, nuestro ensayo diseñado como un ensayo controlado aleatorio tiene poco poder para llegar a una conclusión sobre la eficacia de SMAP-HNC. Sin embargo, hay algunas sugerencias valiosas para modificar el programa de control del estrés en el futuro.

Lingual lymph node metastases are rarely seen in carcinoma of the tongue, and these nodes are not removed during neck dissection. Lingual lymph nodes are classified into medial and lateral groups, and metastasis to the former is extremely rare. A 55-year-old male with squamous cell carcinoma of the tongue, (stage T4aN0M0), underwent hemiglossectomy with neck dissection and free flap reconstruction. The lingual septum had a mass, 8 mm in size, which was diagnosed as medial lingual lymph node metastasis on histopathology. The patient developed multiple distant metastases and died of disease 18 months after the initial surgery. The presence of medial lymph node metastasis could result in contralateral neck metastases and worsen prognosis. Such cases may warrant more intensive therapy than recommended by current guidelines.

Objectives: The indication of transoral robotic surgery for hypopharyngeal cancer is limited because of poor accessibility. The aim of this study was to explore the efficacy of a curved laryngopharyngoscope used in combination with a next-generation flexible robotic surgical system for accessing and resecting the hypopharynx. Methods: A comparative evaluation of the curved laryngopharyngoscope versus standard straight-blade retractors using the flexible robotic surgical system was conducted on 2 cadavers. End points measured included visualization, accessibility, and ease of dissection for accessing and resecting the hypopharynx. Results: Visualization, accessibility, and dissection were superior with the curved laryngopharyngoscope in all subareas of the hypopharynx. The advantages of accessibility and visualization were much more evident in the cadaver with a high body mass index. Conclusions: These preclinical data suggest that using a curved laryngopharyngoscope in combination with a flexible robotic surgical system may lead to technical innovations concerning transoral surgery of the hypopharynx.

The impact of increasing numbers of livestock on wild ungulates has been a concern in Mongolia. We used DNA barcoding via next generation sequencing to reveal detailed food habits and assess the extent of potential resource competition among ungulates in the desert steppe of southern Mongolia. From feces of 2 wild (Mongolian gazelle [Procapra gutturosa], Asiatic wild ass [Equus hemionus]) and 4 domestic (sheep [Ovis aries], goat [Capra hircus], horse [Equus caballus], camel [Camelus bactrianus]) ungulates collected in June 2014, we identified 25 plant families (39 to genus and 18 to species). Dietary diversity was the highest for sheep (Levins' standardized index = 0.351), followed by goats (0.342), and the lowest for gazelles (0.220). Gazelles had a high dietary overlap with goats (Pianka's index = 0.654) and sheep (0.630). Wild asses had the highest dietary overlap with horses (0.847), followed by goats (0.727) and sheep (0.719). The high dietary overlaps may be explained by similar digestive systems and body sizes among gazelles, sheep, and goats and between wild asses and horses, and by the high dietary diversity of sheep and goats. The present study shows more diverse food compositions than previous studies, suggesting that because of the high dietary diversity of sheep and goats and their overlap with wild species, their increasing number is a potential risk for the survival of wild ungulates.

Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of lymphoma that commonly originates in the gastrointestinal (GI) tract, and in rare instances may also occur in the head and neck region. In this report, we present a case of early stage, primary asymptomatic MALT lymphoma of the hypopharynx as detected by esophagogastroduodenoscopy (EGD). A 73-year-old man underwent EGD for an examination of the upper GI tract. At the left pyriform sinus, a swollen irregular mucosa was detected. Biopsy specimens confirmed histologically prominent proliferation of lymphocytes in the epithelium. Immunohistochemical analysis showed that the neoplastic lymphocytes were positive for CD20 and negative for CD3. Based on the other imaging studies, we diagnosed the lesion as a localized MALT lymphoma of the hypopharynx at Stage IA. In total, 46 Gy of radiotherapy was administered to the lesion. In the subsequent 5 years after the treatment, there have been no signs of recurrence.

A 65-year-old man was admitted to our hospital following 6 months of dysphagia. At first, conventional endoscopy showed a reddish and depressed lesion in the stomach and an elevated lesion in the posterior wall of the hypopharynx. An endoscopic biopsy showed adenocarcinoma in the stomach, and squamous cell carcinoma in the hypopharynx. On the further examination, trans-nasal endoscopy with narrow band imaging (NBI) was performed. During the trumpet maneuver, a huge protruded lesion was observed and it reached to the orifice of the esophagus. Other superficial lesion located at left pyriform sinus was detected by NBI system as brownish area with brown dots. Furthermore, superficial esophageal cancer in the cervical esophagus was detected. Finally, 4 carcinomas in upper gastrointestinal tract were detected. Among them, the hypopharyngeal cancer was the most advanced (T3N0). The patient hoped to preserve his voice and swallowing function, endoscopic laryngo-pharyngeal surgery (ELPS) was performed for the hypopharyngeal cancer. Endoscopic mucosal resection (EMR) was performed for the esophageal cancer, and Endoscopic submucosal dissection (ESD) was performed for the gastric cancer. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en-bloc. The histopathological findings of hypopharyngeal cancer were squamous cell carcinoma, subeipthelial invasion, 29 × 28 × 4.2 mm. The others were diagnosed as mucosal cancers. The patient is currently alive with no recurrence at 28 months after the surgery; there is no stricture at the cervical esophagus. Endoscopic laryngopharyngeal surgery for the tumor of pharyngo-esophageal junction can provide a less invasive treatment.

For the optimal design and safety evaluation of sodium-cooled fast reactors (SFRs), the risk estimation of tube failure in the steam generator (SG) via numerical analysis is very important. This requires the understand of the droplet entrainment behavior induced by high-speed steam injection from the heat transfer tube into the liquid sodium in the shell; however, there is a lack of detailed information such as droplet diameter and velocity due to measurement difficulties. Therefore, this study aims to understand the droplet entrainment caused by high-speed gas injection into a liquid pool and to obtain experimental data for developing proper analysis models. Air was injected into a water pool at various air superficial velocities and the droplets were visualized via the frame-straddling method, obtaining clear images of the droplet generation from the gas–liquid interface. The droplet entrainment was caused by the liquid phase stretching and tearing due to the gas jet shear stress. Based on the visualization results, the droplet diameter and velocity were simultaneously measured at various locations through image processing; the number of fast droplets decreased as the diameter increased. The droplet diameter increased along with the distance from the nozzle. At the center of the jet, the droplet velocity was higher near the nozzle and lower at larger distances. The droplets tended to be larger and slower near the jet interface than near the center of the jet. When the jet interface fluctuation became larger, the droplet diameter increased, while the velocity decreased. Therefore, to develop droplet entrainment analysis models for the risk evaluation of tube failures in SFR SGs, the effect of the jet interface fluctuation on the droplet behavior must be evaluated.

Background The purpose of this cadaveric study was to determine the efficacy of a flexible, next-generation robotic surgical system for transoral robotic hypopharyngectomy. Methods A comparative evaluation study of the flexible versus rigid robotic surgical systems for the hypopharynx was conducted using 3 cadavers. Endpoints for assessment were visualization of the hypopharynx, access to the hypopharynx, and difficulty of dissection. Hypopharyngectomy was performed on 3 other cadavers using the da Vinci Sp surgical system. Results Access to the apex of the pyriform sinus and the esophageal inlet was easier with the da Vinci Sp than with the da Vinci Si. Dissection with the da Vinci Sp was easier in all areas of the hypopharynx than with the da Vinci Si. Robotic hypopharyngectomy was successfully completed on all cadavers using the da Vinci Sp surgical system. Conclusion Preclinical testing in human cadavers suggests that flexible robotic surgery may facilitate successful transoral hypopharyngectomy.

Purpose IgG4-related disease is a systemic disease that affects various organs of the body. Aim of this study is to elucidate the clinical characteristics of IgG4-related rhinosinusitis. Material and methods Clinical features, laboratory findings, radiological and endoscopic findings, associated disease, treatment and prognosis were retrospectively examined in 10 patients with IgG4-related rhinosinusitis. Results The age was 59.1 ± 11.3 years old and male-to-female ratio was 1:1. The chief nasal complaints were hyposmia (n = 4), nasal obstruction (n = 3), and nothing (n = 3). Serum IgG4 levels were elevated in all patients and the value was 740.4 ± 472.4 mg/dl. Other IgG4-related diseases were associated in all 10 patients, including IgG4-related sialadenitis (n = 6), IgG4-related dacryoadenitis (n = 5), and autoimmune pancreatitis (n = 5). Imaging findings on CT/MRI were obstruction of the way of elimination (n = 10), thickening of the sinus mucous membrane (n = 10), and fluid in the sinus (n = 6). All of the cases had bilateral findings. Nasal endoscopic findings were chiefly deviated nasal septum (n = 5), polyps (n = 4), edema of the mucous membrane (n = 3). Histologically, abundant infiltration of IgG4 positive plasma cell and lymphocyte and an elevated IgG4+/IgG+ cell ration was detected in all 8 patients and 5 patients, respectively. Endoscopic sinus surgery was performed in 8 patients. Eight patients were treated with steroid therapy for other associated IgG4-related diseases. Symptoms improved in all 6 patients after an initial treatment (endoscopic surgery (n = 5) and steroids (n = 1)), but one patient suffered relapse. Conclusions IgG4-related rhinosinusitis is a distinct entity of IgG4-related disease, and is associated in patients with multiple IgG4-related diseases.

Background Magnifying endoscopy with narrowband imaging (ME-NBI) is useful in predicting the invasion depth by examining the microvascular status of tumor surfaces. This retrospective study aimed to determine its efficacy in pharyngeal cancer. Methods Between April 2016 and March 2018, 59 lesions from 46 patients who underwent transoral resection were retrospectively analyzed. Using ME-NBI, microvascular status was classified into B1, B2, or B3, based on the classification of the Japan Esophageal Society. Results A significant correlation was observed between microvascular status and invasion depth (P = .011). Mean thickness of lesions with B1, B2, and B3 vessels were 563, 1364, and 2825 μm, respectively (P = .006). In previously treated lesions, a significant correlation was observed between microvascular status and invasion depth (P = .012). Conclusions ME-NBI is useful in predicting the invasion depth and thickness of pharyngeal tumors, even in patients with previously treated lesions.

Amur tigers and Far Eastern leopards are sympatric in the Russian Far East. Different ecological characteristics, such as different resource use, may enable coexistence of these two large predators, as indicated in other tiger–leopard habitats in Asia. We examined the winter food habits of tigers and leopards in the sympatric range in Southwest Primorskii Krai, Russian Far East using feces collected during four winters (2000–01, 2001–02, 2002–03, and 2004–05). Fecal samples were identified as either tiger or leopard by genetic analysis, and we examined 63 and 139 samples of tiger and leopard feces, respectively. We found that leopards preyed on 13 species and tigers on 8 species. Wild boar and sika deer were the most frequently consumed prey for tigers and leopards, respectively. Three ungulates (sika deer, roe deer, and wild boar) appeared to be the essential prey because they provided a large proportion of the relative biomass consumed by tigers (92%) and leopards (87%). Tigers showed a strong preference for wild boar (Jacobs index: +0.55), whereas leopards did not show such a strong preference for any particular ungulate species. Moreover, both species consumed mid-sized carnivores and small mammals, with leopards consuming a more diverse range of prey, including squirrels, rodents, birds, and clams, none of which were identified in the tiger feces. There was a significant difference in the composition of their prey, suggesting resource partitioning between the two predators; however, Pianka's niche overlap index was high (0.77) because both species heavily relied on the three ungulates. Our study suggests that the availability of three different ungulate species, the tigers’ preference for wild boar, and the diverse prey base of leopards contribute to the coexistence of tigers and leopards in this region.

A sodium-cooled fast reactor (SFR) is now under development in Japan. A shell-and-tube type once-through heat exchanger is to be installed to generate steam in the design. Low-pressure hot sodium flows in the shell side and high-pressure water, which heated to become steam, flows in the tube side. It has been anticipated that a pin hole is formed on the tube wall and high-pressure steam blows out from the hole. When a high-pressure steam flows out from the tube hole, a high-speed steam jet is formed in the sodium coolant. Fine sodium droplets are torn off from the sodium surface and entrained into the steam jet. Sodium-water chemical reaction causes an increase of entrained droplet temperature. The hot and high-speed sodium entrained droplets attack the wall of a neighboring tube and cause a wastage on the tube wall, which may lead to a failure propagation. In Japan Atomic Energy Agency (JAEA), an analysis code for the sodium-water reaction phenomenon, called SERAPHIM, has already been developed. Visualization data is required to validate the liquid entrainment model in this code. Since the flow velocity at the gas leakage is a sonic speed, it is extremely difficult to visualize the inside of the gas jet. Experiments have been carried out to visualize this phenomenon in the past; however, experimental data for model validation has not been entirely obtained due to the above-mentioned difficulty. Thus, the motivation of this study is to examine the possibility of visualization method and to clarify flow structure. To this end, we first performed the preliminary experiments using simple test facilities. Two types of test sections were used in the experiments: three-dimensional one and two-dimensional one. In the experiment using the three-dimensional one, we tried to visualize a more realistic phenomenon. Through this experiment, the whole gas-jet behavior was clearly captured. However, we found that the detailed droplet-entrainment behavior in a gas jet could not be obtained in this setup, especially at high-velocity conditions. Then, we carried out the experiments using the two-dimensional one. In these experiments, the flow structure of a gas jet was simplified. However, it was difficult to distinguish the liquid film formed on the wall surface of the test section from the entrained droplets. We considered that the liquid film is formed due to the nozzle outlet shape and improved the test section. By experiments with new test section, we succeeded in visualizing entrained droplets of relatively large diameter and calculated droplet diameter distribution. Then, we discussed the mechanism of entrained droplet behavior.

The red-crowned crane in Japan was once considered extinct due to hunting and habitat destruction in late nineteenth century; however, in 1926, a small group of cranes was rediscovered in the Kushiro Mire in eastern Hokkaido. Since then, various conservation efforts, including artificial feeding during winter, hunting prohibition, and habitat conservation, have increased the population size to >1400 by 2012. Despite such a successful population recovery, the genetic characteristics of the population have not been fully explored. To ensure the long-term persistence and evolutionary potential of cranes, accurate knowledge of the spatial distribution of genetic variation and its underlying causes are necessary. We assessed their genetic structure using 12 polymorphic microsatellite loci and inferred the mechanisms shaping the observed structure. Among the three regional groups in Hokkaido, we found generally low pairwise F ST values and no significant differences in genetic diversity, probably because of the population expansion in the recent past. In contrast, spatial autocorrelation analysis revealed a significant positive kinship at the short distance (0–15 km) and negative kinship at the long distance (155–205 km), showing a pattern of isolation by distance. The presence of isolation by distance on a small spatial scale despite the species’ strong flight ability is probably explained by the recolonization process and restricted dispersal due to natal philopatry in a non-equilibrium condition. Cranes in Hokkaido do not appear to be a panmictic (random mating) population; however they can be considered a single population without genetic discontinuity (i.e. a single management unit). Our findings confirm the importance of considering natal philopatry when developing management strategies such as dispersing cranes into unoccupied areas.

Objective:Many patients with head and neck cancer (HNC) suffer from psychological distress associated with dysfunction and/or disfigurement. Our aim was to evaluate the ratio of patients with persistence of psychological distress during hospitalization and identify the predictors of persistence or change in psychological distress among HNC patients.Method:We conducted a single-center longitudinal study with self-completed questionnaires. We evaluated psychological distress (the Hospital Anxiety and Depression Scale; HADS) and functional level (the Functional Assessment of Cancer Therapy–Head and Neck Scale; FACT–H&N) among patients during hospitalization at the Medical Hospital of Tokyo Medical and Dental University.Results:Of 160 patients, 117 (73.1%) completed the questionnaire at both admission and discharge. Some 42 (52.5%) patients reported persistent psychological distress. The physical well-being of patients with continued distress was significantly lower than that of other patients (21.7 ± 4.7, 19.4 ± 6.1, 19.5 ± 5.4;p< 0.01), and the emotional well-being of patients with continued distress was significantly lower than that in patients with no distress and reduced distress (22.3 ± 3.5, 20.5 ± 2.5; p < 0.01).Significant of results:Impaired physical and emotional function appears to be associated with persistent psychological distress among HNC patients. Psychological interventions focused on relaxation, cognition, or behavior may be efficacious in preventing such persistent distress.

Aims: In order to observe the pharyngoesophageal junction, the trumpet maneuver with trans-nasal endoscopy was used. Its efficacy is reported here. Material and Methods: A 71-year-old man who underwent esophagectomy in esophageal cancer 2 years ago was admitted to our hospital with primary pharyngeal cancer. The type of upper endoscope used was EG-580NW (FUJI Film, Tokyo, Japan). The endoscope is a trans-nasal endoscope that can provide high quality endoscopic images. The pharyngeal cancer located at right lateral wall which was previously detected could be observed easily. We asked the patient to blow hard and puff his cheeks with his mouth closed. When inspecting the hypopharynx and the orifice of the esophagus, we told the patient that we would start the trumpet maneuver. Results: After the trumpet maneuver, the pharyngeal mucosa was stretched out. Another primary lesion was observed at the posterior wall of the hypopharynx near the pharyngoesophageal junction. This technique provided a much better view of the lesion than had been possible with trans-oral endoscopy，allowing us to remove the biopsy specimen without sedation. Conclusion: In conclusion, the trumpet maneuver using trans-nasal endoscopy is a useful technique for precise inspection before treatments for patients who have already detected the lesions.

The White-tailed Eagle breeds and winters on Hokkaido, the northern island of Japan. It is not known whether wintering eagles occasionally observed in southern Japan migrate there from the Hokkaido population or arrive from an Asian continental population. To further our understanding of their migration, we examined a nucleotide sequence of mitochondrial DNA and a multilocus genotype from the nuclear DNA of an eagle found wintering on Tsushima Island, southern Japan. Our results revealed that the eagle had originated from a continental population.

Background Recently an increase in the incidence of oropharyngeal squamous cell carcinoma has been noted in the United States Squamous cell carcinoma of the base of the tongue is often diagnosed at an advanced stage with a dismal prognosis With advances in endoscopy more cases of superficial cancer are now being found However observing the base of the tongue using trans oral endoscopy is difficult Aim Starting in April we introduced a new technique for observing the base of the tongue using trans nasal esophagogastroduodenoscopy known as the intra oropharyngeal U turn method Its efficacy is reported here Results Eleven cases of superficial squamous cell carcinoma of the base of the tongue were detected using trans nasal endoscopy between April and March Five lesions were flat type four were elevated and two were depressed Regarding the tumor size eight were T and three were T No lymph node metastasis was detected in any case Seven were resected and three were treated with chemo radiotherapy while one was followed because of esophageal cancer For the seven resected specimens the median tumor thickness was mu m range mu m and the median tumor diameter was mm range mm Histologically of these lesions were squamous cell carcinoma in situ and five showed microinvasion of the subepithelial tissue During a median follow up period of months range months patient developed lymph node metastasis which was treated by neck lymphadenectomy and chemo radiotherapy Three of the patients died of another disease and were alive as of drafting this manuscript Conclusion The intra oropharyngeal U turn method with trans nasal endoscopy is useful for detecting superficial squamous cell carcinoma of the base of the tongue

Objective Patients with head and neck cancer (HNC) experience many stressful problems with breathing, eating, swallowing, and/or speaking. The aim of this study was to (1) identify the clusters of HNC patients based on their stress coping strategies, and (2) evaluate the differences in clinical data and depression between the identified HNC patients' coping clusters. Methods We conducted a single-center, cross-sectional study with self-completed questionnaires for patients with HNC between April and August 2013. We measured stress coping (an abbreviated version of the COPE Inventory: Brief COPE) and depression (the Japanese version of the Beck Depression Inventory-II: BDI-II). Results Of the 116 patients who completed all the questionnaires, 81 (69.8%) participants were 60-79 years old and 105 (90.5%) were men. Cluster analysis based on the standardized z score of Brief COPE showed that patients were classified into three clusters, labeled "dependent coping," "problem-focused coping," and "resigned coping." The ANOVA revealed that depression (BDI score) was significantly higher in the dependent-coping cluster compared to the problem-focused coping. Conclusions This study indicates that patients with a dependent-coping pattern may account for the largest HNC population, and are likely to suffer from depression. Dependent-coping includes smoking, drinking, seeking support, or engaging self-distraction. In the future, we should develop psychological intervention programs focused on coping strategies and enhancement of the support system for patients with HNC.

Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here.Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection.Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection.Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.

Introduction: We started endoscopic treatment for superficial pharyngeal cancer in 1996, and thus far, 97 lesions of 77 cases of superficial head and neck cancer have been detected using trans-oral endoscopy. However, some areas are difficult to observe with trans-oral endoscopy because of the gag reflex. We have therefore applied transnasal endoscopy for observing of the pharynx to the cervical esophagus. Methods: To avoid overlooking cancers located at the floor of the mouth, soft palate and uvula, we first observe the oral cavity. After administering local anesthesia to the nose without sedation, the endoscope is inserted through the nose. When the tip of the endoscope reaches caudal to the uvula, the patient opens his or her mouth wide, sticks the tongue forward as far as possible and makes a makes a vocalization like “ayyy”. The endoscopist then makes the endoscope take a U-turn and observes the oropharynx, particularly radix linguae. To examine the hypopharynx and the orifice of the esophagus, the patient is asked to blow hard and puff their cheeks while the mouth remains closed. This approach provides a much better view of the orifice of the esophagus than is possible with trans-oral endoscopy with deep sedation. Results: In this study, we detected 22 superficial cancers of the oral cavity. Previous efforts to detect such cancers using trans-oral endoscopy have failed. In addition, we were never able to detect early cancers located at base of tongue in the past, but since implementing the intra-oropharyngeal U-turn method, we have detected more than 10 cases. We were also never able to detect early cancers located at the pharyngoesophageal junction in the past, but since implementing the modified Valsalva maneuver, we have detected more than 20 cases. Between 2008 and 2016, a total of 164 cases of 227 lesions of superficial head and neck cancer were detected by trans-nasal endoscopy, which is more than twice as many as were detected with conventional screening. Mucosal redness, white deposits or loss of a normal vascular pattern and proliferation of vascular pattern such as small dots or salmon roe with a close-up view of it are important characteristics to diagnose superficial pharyngeal cancer. Moreover, a brownish area using image-enhanced endoscopy is useful for early diagnosis. With adequate extension of the pharyngeal mucosa using the Valsalva maneuver, observing the protruded areas should prove useful for diagnosing the depth of invasion. Conclusions: Observing the pharynx to the cervical esophagus using trans-nasal endoscopy with imageenhanced endoscopy is useful for early detection of head and neck cancers.

Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is considered to be a distinct entity in Japan. The combination of both HPV-DNA sequencing analysis and immunohistochemistry (IHC) for p16(INK4A) is useful to discriminate the OPSCC patients with a better prognosis from other cases, especially in the advanced stage. Surgical treatment is recommended for HPV-negative advanced cancer.The number of HPV-related OPSCCs has been increasing worldwide. However, the incidence and prognostic significance of this cancer in Japan have not yet been fully elucidated.Seventy-seven Japanese patients with OPSCC were enrolled in this study. The prevalence of HPV-DNA was assessed by PCR and sequencing. The expression of p16(INK4A) and p53 was examined by IHC. The clinicopathological parameters and disease-specific survival were analyzed for HPV-positive and -negative patients.HPV-DNA was detected in 32 patients. Thirty-four patients were p16(INK4A)-positive by IHC. The patients who were positive for HPV infection were significantly younger. Furthermore, in the stage III or IV cases, the 3-year disease-specific survival of the HPV infection-positive group was significantly better than that of the HPV-negative group. Surgical treatment was demonstrated to lead to a good prognosis for the patients with HPV-negative advanced cancer.

Understanding and monitoring the population status of endangered species is vital for developing appropriate management interventions. We used noninvasive genetic analyses to obtain ecological and genetic data on the last remaining Far Eastern leopard population in the world. During seven winters from 2000–2001 to 2007–2008, we collected feces, hair, and saliva from most of the leopard habitat. Of the 239 leopard samples collected during the study period, 155 were successfully genotyped at 13 microsatellite loci and 37 individuals (18 males and 19 females) were identified. Population size estimates based on the Capwire model were 28 (95 % CI 19–38) in 2002–03 and 26 (95 % CI 13–33) in 2007–2008. The leopard population had a low level of genetic diversity (expected and observed heterozygosity = 0.43; average number of alleles per locus = 2.62), and effective population size was estimated to be low (N e = 7–16) by two genetic-based methods. We observed little improvement in the genetic diversity during the study period and did find an indication of allele loss compared with individuals from the mid-1990s, suggesting that the remaining population will continue to suffer loss of genetic diversity. Given the small population size and the low genetic diversity, with little expectation of replenishment of the genetic variation by natural immigration, successful expansion of available habitat and development of a second population based on captive individuals may be crucial for persistence of this leopard subspecies in the wild.

The Amur tiger, Panthera tigris altaica, is currently distributed across the southern part of the Russian Far East and parts of northeastern China. Most Amur tigers are found in Russia, where their range is fragmented into at least 3 populations (a large population centered in the Sikhote-Alin Mountains and 2 smaller populations in northwest and southwest Primorye Krai). Traditionally, track-based techniques have been used for surveys of tigers in Russia. However, such techniques involve problems such as misinterpretation of track sizes due to snow degradation, and thus, other survey protocols have been needed. This study aimed to identify individuals and estimate population size using noninvasive genetic samples, such as feces, hairs, and saliva, collected from southwest Primorye Krai during 4 winters (2000–2001, 2001–2002, 2002–2003, and 2004–2005). During these winters, we identified 12 tigers (5 males and 7 females) using 10 microsatellite markers. Population size estimated from the 2002–2003 samples was 12 (95% confidence interval 5 9–19), which was comparable to the estimate from the track count survey. Of the 3 types of noninvasive genetic samples we collected, feces were the most useful in terms of genotyping success rate and sampling efficiency. The noninvasive genetic methods developed in this study can contribute to population monitoring and management assessment of tiger conservation in the Russian Far East.

本邦におけるHPV関連中咽頭癌の発生率やタイピング，臨床上の特徴などを明らかにするため，多施設による前向き研究を行った。2009年5月から症例の登録が開始され，倫理委員会の承認が得られた21の施設によって，中咽頭癌148例，コントロールの正常口蓋扁桃53例が登録された。PCRによるHPV検出は，中咽頭癌症例では76例（51.4%）に認められ，タイピングの結果はHPV16が69例（90.8%），HPV18：2例（2.6%），HPV58：2例（2.6%），その他HPV31，HPV35，HPV56が各1例（1.3%）であった。HPV陽性中咽頭癌は側壁に多く発生し，非喫煙者，非飲酒者に多い傾向が認められた。正常口蓋扁桃ではHPVの感染は認められなかった。ハイブリッドキャプチャー2法を用いたブラッシングによるHPVの検出はPCRと比較すると，感度90.7%，特異度97.1%であった。