Novel Endoscopic Findings of Lesions with a Short White Hair-like Appearance in the Lower Esophagus.

Objective The presence of a short white hair-like appearance in the lower esophagus has recently been noted during esophagogastroduodenoscopy (EGD) at our institution. Histological findings showed that this formation was a spiked protrusion of the esophageal papilla. The results regarding the prevalence of such lesions in individuals who underwent EGD examinations as part of medical checkup procedures are herein presented. Methods The EGD results of 14,338 individuals (9,225 males, 5,113 females; mean age 54.0±9.8 years) were examined. The findings related to the presence of multiple lesions with a short white hair-like appearance in the lower esophagus of patients with reflux esophagitis, esophageal squamous papilloma, or gastric mucosal atrophy (GMA), as well as the hiatal hernia width, were investigated. Results Endoscopic findings indicating short white hair-like appendages in the lower esophagus were noted in 167 patients, with a prevalence rate of 1.2%. A female sex, younger age, lower body mass index, lower percentages of habitual smoking and drinking, and the presence of esophageal squamous papilloma were characteristic features of cases with such findings. In addition, a significantly lower prevalence of reflux esophagitis and a smaller diaphragmatic hiatus size were observed. A multiple logistic regression analysis indicated that a female sex, absence of reflux esophagitis, presence of esophageal squamous papilloma, and a smaller diaphragmatic hiatus were factors significantly related to the presence of these short white hair-like appendages. An analysis of circumferential localization revealed the main location to be the left-posterior wall. Conclusion This study is the first to report the prevalence of multiple short white hair-like appendages in the lower esophagus. The occurrence of such lesions is inversely associated with the presence of reflux esophagitis.

Gastric Flat Elevated Undifferentiated Signet-ring Cell Mucosal Cancer Lesion Detected in a Case without Helicobacter pylori Infection.

Protruded signet-ring cell carcinoma (SRCC) is extremely rare. We herein report a rare case of flat elevated gastric SRCC in a patient without Helicobacter pylori infection. Esophagogastroduodenoscopy of a woman in her 50s revealed a flat, whitish lesion in the gastric body with elevation. Histological results of an endoscopically biopsied specimen led to a diagnosis of SRCC. Resection using endoscopic submucosal dissection was performed, and histology results revealed that the tumor was localized in the lamina propria. The size was 10×6 mm, and a protrusion had been formed by SRCC enlargement without destruction of the surface epithelium structure.

Prevalence of Raspberry-type Gastric Foveolar-type Tumor in Individuals Undergoing Medical Checkups.

Objective This study was performed to clarify the prevalence of raspberry-type gastric foveolar-type tumors, along with the time-course changes in the size and clinical course. Methods The subjects were 10,663 consecutive patients who underwent a medical checkup between April 2016 and March 2022, including an esophagogastroduodenoscopy (EGD) examination and determination of Helicobacter pylori infection status (uninfected, positive, post-eradication). The presence of characteristic reddish polypoid lesions in the stomach was investigated, and a diagnosis of raspberry-type gastric foveolar-type tumor was made based on histological findings. Results Thirty-eight cases had gastric polyps with a raspberry-like appearance on endoscopy, with 29 lesions in 28 cases endoscopically and histologically diagnosed as a raspberry-type gastric foveolar-type tumor. All of the affected subjects were determined to be H. pylori-uninfected. The prevalence of this type of lesion in all subjects was 0.26%, while that in the 6,635 H. pylori-uninfected subjects was 0.42%. An older age and the presence of a fundic gland polyp were found to be significant risk factors associated with the occurrence of the tumor. The mean size was 3.8±1.9 (range: 2-10) mm, and the location was in a fundic gland area in all affected subjects. Furthermore, examinations of previous EGD images revealed that two-thirds of the lesions had not changed in size, while follow-up EGD findings showed that lesions ≤5 mm in size had disappeared after a biopsy procedure. Conclusion The prevalence of raspberry-type gastric foveolar-type tumors was 0.42% in H. pylori-uninfected subjects. More than half of the lesions were too small to be removed by an endoscopic biopsy.

Degree of Gastric Mucosal Atrophy Correlated Well with Gastric Cancer Occurrence in Patients with Helicobacter pylori-eradicated Status.

Objective This study was performed to clarify the association of the degree of gastric mucosal atrophy (GMA) with the occurrence of gastric cancer in patients with Helicobacter pylori-eradicated status. Methods The subjects were 3,058 patients (2,035 men, 1,023 women; mean age 57.9 ± 9.5 years old) with H. pylori eradication who underwent esophago-gastroduodenal endoscopy examinations as part of medical checkups conducted between April 2013 and March 2022. The gender, age at eradication, time since eradication, usage of anti-secretory drugs, degree of endoscopic GMA, and the fundic gland polyp (FGP) prevalence were compared between subjects with and without gastric cancer occurrence. Results Gastric cancer was newly detected in 26 subjects (0.85%) during the study period, with an older age at H. pylori eradication and severe grade of endoscopic GMA being significant risk factors for its occurrence. The gender, smoking history, and usage of anti-secretory drugs were not significantly different between subjects with and without gastric cancer occurrence. A Cox regression analysis showed that an older age at eradication and the degree of GMA were risk factors significantly related to occurrence. Furthermore, the degree of GMA was inversely correlated with FGP development, and gastric cancer was not detected in 467 subjects with FGP prevalence. Conclusion An older age at the time of H. pylori eradication and the degree of GMA are significant risk factors for gastric cancer occurrence in H. pylori-eradicated patients. The FGP prevalence in subjects with H. pylori eradication was inversely associated with GMA, suggesting it was negatively related with gastric cancer occurrence.

Endoscopic findings of cardiac lymphoid hyperplasia and Helicobacter pylori infection status.

Objective: Lymphoid hyperplasia is endoscopically observed as multiple small whitish round nodules or spots. This retrospective study was performed to examine the prevalence of that finding in patients with Barrett's epithelium and its relationship with the status of H. pylori infection. Methods: The study subjects were 3353 patients (males 2186, females 1167; mean age 55.2 ± 9.4 years) in whom the status of H. pylori infection had been determined. The presence of Barrett's epithelium ≥ 5 mm in length was endoscopically determined, and then endoscopic observations with blue laser imaging were used to investigate the presence of lymphoid hyperplasia in those areas. Results: Barrett's epithelium was diagnosed in 1884 (56.2%) of the subjects, and endoscopic findings of lymphoid hyperplasia were observed in 402 (21.3%) of those with Barrett's epithelium. Lymphoid hyperplasia in Barrett's epithelium was not present in any without a current or prior H. pylori infection, while the prevalence of lymphoid hyperplasia in H. pylori-positive and post-eradicated subjects was 48.4% and 30.4%, respectively (p < 0.001). Multiple logistic regression analysis revealed that female gender, younger age, and higher degree of gastric mucosal atrophy were significant factors related to lymphoid hyperplasia positivity. In addition, the duration after H. pylori eradication was negatively correlated with its prevalence. Conclusion: Endoscopic findings of cardiac lymphoid hyperplasia were well correlated with H. pylori infection, although prevalence decreased over time following bacterial eradication.

Clinical outcome of intrauterine infusion of platelet-rich plasma in patients with recurrent implantation failure.

PURPOSE: This study aimed to evaluate the effectiveness of intrauterine infusion of platelet-rich plasma (PRP) before embryo transfer (ET) in recurrent implantation failure (RIF) cases. METHODS: The authors retrospectively analyzed 54 ET cycles involving frozen and thawed high-quality blastocysts after intrauterine PRP infusion between September 2019 and November 2020. All patients had a history of at least two times of implantation failure on ET. A total of 54 patients were categorized into two groups: thin endometrium (39 patients) and unexplained implantation failure (15 patients). In the thin-endometrium group, the endometrial thickness (EMT) was <8.0 mm at cycle days 12-14 in the prior ET cycle. RESULTS: Among the 54 ET cycles after PRP infusion, 31 (57.4%) were positive for human chorionic gonadotropin (hCG) and 27 (50%) achieved clinical pregnancy, which was significantly better than that in prior ET cycles without PRP infusion (27.2% and 9.6%, respectively). The EMT was not increased at ET date on the PRP cycle compared with that in the prior ET cycle in both patient groups. Moreover, EMT was not different between the hCG-positive and hCG-negative groups. CONCLUSION: Although intrauterine PRP infusion had no superior effect on increasing the EMT than conventional therapeutic agents, it resulted in high pregnancy rates in patients experiencing RIF with or without thin endometrium.

Factors for Negative Result in Serum Anti-Helicobacter pylori IgG Antibody Test in Adult Subjects With Nodular Gastritis: A Single-center Study.

AIM: Nodular gastritis has been demonstrated to be strongly associated with Helicobacter pylori infection. The present retrospective study was performed to elucidate factors related to a negative serum antibody test result in adults with nodular gastritis. MATERIALS AND METHODS: We investigated 116 H. pylori-positive subjects endoscopically diagnosed with nodular gastritis and subjected to a serum anti-H. pylori immunoglobulin G (IgG) antibody test. The degree of gastric mucosal atrophy and the presence of spotty redness in the gastric body and fornix were carefully determined by observations of endoscopic images. RESULTS: Of the 116 investigated subjects, 108 were positive and 8 negative in serum anti-H. pylori IgG antibody test results. The degree of gastric mucosal atrophy was mild in seven among eight seronegative cases. The levels of pepsinogen II in serum in patients with negative antibody test findings were significantly lower as compared to those found positive, while the pepsinogen I/II ratio tended to be higher in subjects shown negative by the test. Only 1 of 69 with spotty redness was negative in serum anti-H. pylori IgG antibody testing, while 7 of 47 without spotty redness were negative. Multiple logistic regression analysis of subjects with a negative test result revealed that the absence of spotty redness shown by endoscopy was a significant risk factor. CONCLUSION: The absence of spotty redness, which may reflect the degree of gastric body inflammation, is a significant factor indicating increased risk for a negative serum anti-H. pylori IgG antibody test result in subjects with nodular gastritis.

Prevalence of Angiodysplasia Detected in Upper Gastrointestinal Endoscopic Examinations.

Background This study was performed to examine the prevalence of asymptomatic angiodysplasia detected in upper gastrointestinal endoscopic examinations and of hereditary hemorrhagic telangiectasia (HHT) suspected cases. Methodology The study participants were 5,034 individuals (3,206 males, 1,828 females; mean age 53.5 ± 9.8 years) who underwent an upper gastrointestinal endoscopic examination as part of a medical check-up. The presence of angiodysplasia was examined endoscopically from the pharynx to duodenal second portion. HHT suspected cases were diagnosed based on the presence of both upper gastrointestinal angiodysplasia and recurrent nasal bleeding episodes occurring in the subject as well as a first-degree relative. Results Angiodysplasia was endoscopically detected in 494 (9.8%) of the 5,061 subjects. Those with angiodysplasia lesions in the pharynx, larynx, esophagus, stomach, and duodenum numbered 44, 4, 155, 322, and 12, respectively. None had symptoms of upper gastrointestinal bleeding or severe anemia. Subjects with angiodysplasia showed significant male predominance and were significantly older than those without. A total of 11 (0.2%) were diagnosed as HHT suspected cases by the presence of upper gastrointestinal angiodysplasia and recurrent epistaxis episodes from childhood in the subject as well as a first-degree relative. Conclusions Asymptomatic angiodysplasia was detected in 9.8% of the subjects who underwent screening upper gastrointestinal endoscopic examinations.

Prevalence of Barrett's Epithelium Shown by Endoscopic Observations with Linked Color Imaging in Subjects with Different H. pylori Infection Statuses.

Objective This study was conducted to clarify the prevalence of short segment Barrett's esophagus (SSBE) using endoscopic observations with linked color imaging (LCI). In addition, the relationship between the presence of Barrett's epithelium (BE) and the status of H. pylori infection was investigated. Methods The study subjects were 3,353 individuals (2,186 men, 1,167 women; mean age 55.2±9.4 years old) whose status of H. pylori infection had been determined. An endoscopic observation using LCI was performed to examine the distal margin of palisade vessels and confirm the area of BE. The prevalence of BE ≥5 mm in length was investigated. Results BE was diagnosed in 1,884 (56.2%) subjects, with lengths of <10, 10-19, 20-29, and ≥30 mm found in 1,005, 851, 27, and 1, respectively. Its prevalence in H. pylori-negative, H. pylori-positive, and post-eradicated subjects was 41.7%, 64.4%, and 69.9%, respectively (p<0.001). The duration since successful eradication of H. pylori did not affect the prevalence of BE. The degree of gastric mucosal atrophy was higher in cases with BE (p<0.001), although negativity for H. pylori infection and mild gastric mucosal atrophy were significant factors for the development of longer BE. Conclusion A high prevalence of SSBE was noted when LCI was used to determine the area of BE, as the distal end of the palisade vessels was easily visualized. Negativity for H. pylori infection and mild gastric mucosal atrophy were not correlated with SSBE prevalence.

Serum Anti-Helicobacter pylori IgG Antibody Titer in H. pylori-negative Cases with a Different Gastric Mucosal Atrophy Status.

Objective This retrospective study was performed to investigate the anti-Helicobacter pylori IgG antibody serum titers in H. pylori-negative subjects with different degrees of gastric mucosal atrophy including C0 grade atrophy. Methods The absence of H. pylori infection was determined based on both negative serum anti-H. pylori IgG antibody test findings and no endoscopic evidence of that infection. Cases negative for the antibody and with positive endoscopic findings of H. pylori infection were defined as H. pylori-positive. The serum anti-H. pylori IgG antibody titers were analyzed in H. pylori-negative (n=1,087), -positive (n=69), and post-eradicated (n=278) subjects. Results The serum antibody titer in subjects with H. pylori-positive endoscopy findings was significantly higher than that in H. pylori-negative subjects, even when the serum titer indicated a negative result. In addition, the anti-H. pylori IgG antibody serum titer was higher in H. pylori-negative subjects with a greater degree of gastric mucosal atrophy. In a comparison between H. pylori-negative C0 and C1 gastric mucosal atrophy cases, the antibody serum titer in those classified as C0 was significantly lower. An analysis of H. pylori post-eradicated cases showed that the serum antibody titer decreased over time after successful eradication. Conclusion The disappearance of H. pylori infection in H. pylori-negative individuals may occur later in those with a greater degree of gastric mucosal atrophy. The serum antibody titer difference between the H. pylori-negative C0 and C1 groups might have been caused by the differences in distribution between H. pylori-uninfected subjects and those in whom the infection had disappeared, thus additional investigation is needed to clarify the significance of gastric mucosal classification including the C0 grade.

Mid-esophageal Diverticular Bleeding in a Patient with Kyphosis.

Mid-esophageal diverticulum is a rare disease, formed by the traction caused by inflamed bronchial lymph nodes or by pulsion induced by motility disorder. We herein report a case of mid-esophageal diverticular bleeding in a patient with kyphosis who was taking an anti-platelet drug. She was successfully treated with endoscopic hemostasis. An 80-year-old woman presented to our emergency department with hematemesis. She had kyphosis and was taking dipyridamole for her chest pain. Emergent upper endoscopy revealed bleeding from a mid-esophageal diverticulum; hemostasis was achieved via clipping. Mid-esophageal diverticula can cause upper gastrointestinal bleeding. An endoscopic examination and hemostasis are effective treatments.

Effectiveness of high-dose transvaginal progesterone supplementation for women who are undergoing a frozen-thawed embryo transfer.

PURPOSE: To evaluate the effectiveness of high-dose progesterone supplementation for women who are undergoing a frozen-thawed embryo transfer (FET). METHODS: Among the 2010 FET cycles that were included in the present study, 1188 were 1200 mg/d of vaginal progesterone, while 822 were 900 mg/d. The dose of progesterone that was used was decided by the treatment period and additional progesterone supplementation was used when the serum progesterone levels were <9 ng/mL on luteal day 5. RESULTS: The clinical pregnancy rate was higher in the 1200 mg group than in the 900 mg group. The mean serum progesterone level on luteal day 5 in the 1200 mg and 900 mg groups was 12.6 ng/mL and 13.4 ng/mL, respectively. The rate of additional progesterone supplementation was higher in the 1200 mg group. A logistic regression analysis identified a younger age (≤37 years) and the use of 1200 mg progesterone as independent predictive factors for the clinical pregnancy outcome. The analysis of the infant outcomes revealed no significant difference in the distribution of birth ages and weights. CONCLUSION: High-dose transvaginal progesterone of 1200 mg/d as luteal support contributed to good pregnancy outcomes.

Frequency of Sperm DNA Fragmentation According to Selection Method: Comparison and Relevance of a Microfluidic Device and a Swim-up Procedure.

INTRODUCTION: Multiple rounds of centrifugation or washing spermatozoa can cause sperm DNA fragmentation (SDF); however, a microfluidic approach to select spermatozoa does not require centrifugation. Reports have suggested that sperm sorting using a microfluidic device is an effective method to select good quality spermatozoa, however, it is not known whether it reduces sperm DNA damage. We investigated whether the frequency of SDF was affected by selection method during sperm processing. MATERIALS AND METHODS: Semen samples from ten men with normal, oligozoospermia and asthenozoospermia were split into two groups and sorted using a microfluidic device or by a swim-up method. Subsequently, semen parameters and SDF were measured and analyzed using paired or non-paired Student's t-tests. RESULTS: For samples sorted by the microfluidic device (Sperm Sorter Qualis(®); Menicon, Kasugai, Japan) or the swim-up method, both showed a decrease in SDF. However, the decrease was more significant when the microfluidic device was used. CONCLUSION: Sorting using the microfluidic device resulted in less SDF than did the swim-up method.

[The effect of a semi-dry processing system on the thermal environment in school lunch kitchens].

The thermal conditions of elementary school lunch kitchens applying dry, semi-dry and wet processing systems were studied. We focused especially on the improvement of the microclimate of a kitchen applying a semi-dry processing system. The survey was conducted in two individual school kitchens with a semi-dry system (School A) and a dry system (School B). Air temperature, relative humidity and air velocity were measured at 8 to 13 points every hour in September, 2006 in School A and B, and in February, 2007 in School A. Since a similar survey had been conducted in the kitchen of School A when the cooking work had been going on in a wet manner in February and September, 1990, it was possible to compare the measurement data from this study and those from the former study. The difference between indoor and outdoor absolute humidity was used as an index of the humidification of the cooking work in the kitchen. By comparing the microclimate of School A in 2006/2007 and 1990, it was found that the differences in absolute humidity in the semi-dry systems were significantly lower than those in the wet systems during the working hours in the summer mornings and in the winter afternoons, and the floor was maintained in drier conditions. It is suggested that a reduction of humidity in the kitchen by introducing a semi-dry or a dry processing system would contribute to not only an improvement in the working environment, such as the reduction of foot chill in winter and food sanitation, but also to a reduction in the workloads of cooking workers.