RYUZO DEGUCHI

A 72-year-old woman diagnosed as unresectable advanced gastric cancer with both of direct invasion to liver and pancreas and peritoneal dissemination, received 11 courses of S-1 and oxaliplatin (SOX) + nivolumab combination therapy according to the Japanese Gastric Cancer Treatment Guideline because the tumor showed HER2-negative, microsatellite instability (MSI)-high, and PD-L1-positive. Since post-treatment endoscopic and other imaging findings showed a prominent reduction of the main tumor, release of surrounding organ infiltration, and disappearance of disseminated metastases, we planned the conversion surgery and could perform laparoscopic distal gastrectomy with D2 lymph node dissection. Postoperative histopathological examination showed no residual tumor cells both in the primary tumor and dissected lymph nodes. Postoperatively, the patient was treated with SOX therapy for 1 year and remains alive at 16 months postoperatively without recurrence.

A 69-year-old man underwent upper and lower gastrointestinal endoscopic examinations for a detailed evaluation of diarrhea that had persisted for several months, which revealed multiple polyposis in the stomach, duodenum, colon, and terminal ileum. The histopathological findings also led to a diagnosis of Cronkhite-Canada syndrome (CCS). On admission, the patient had hypoalbuminemia and electrolyte abnormalities, including hypokalemia, and developed paroxysmal atrial fibrillation (Paf), although there were no apparent organic lesions in the heart. The patient's sinus rhythm was restored by electrical cardioversion, steroid therapy for CCS improved diarrhea symptoms and endoscopic findings, and the electrocardiogram findings were normal.

A 55-year-old woman presented to her primary care physician with facial and lower leg edema. After being referred to our hospital because of hypothyroidism and hypokalemia on blood tests, she also had elevated adrenocorticotropic hormone (ACTH) and cortisol levels, but a dexamethasone suppression test showed no cortisol suppression. Ectopic ACTH syndrome due to pancreatic neuroendocrine carcinoma (PNEC) was suspected. endoscopic ultrasound-guided fine-needle aspiration was performed, and a histopathological examination of the obtained specimen revealed multiple liver metastases of the PNEC. Imaging after etoposide and cisplatin therapy showed cystic changes in the primary lesions and shrinkage of the liver metastases, and the ACTH levels were within the normal range.

INTRODUCTION: Autonomic imbalance has been reported to correlate with clinical remission in patients with ulcerative colitis (UC). This study evaluated heart rate variability (HRV), a potential digital biomarker, in patients with active UC using a smartwatch that is easy to handle. METHODS: Patients with active UC were recruited for this prospective study. The patients' HRV was measured via the Fitbit Inspire2™ linked via Bluetooth to their smartphone. HRV during nighttime sleep was obtained from continuous data. Patients were required to input the Simple Clinical Colitis Activity Index (SCCAI) score once daily by the application on their smartphones for 3 months. RESULTS: Nine patients with UC were included. In clinically active disease, SCCAI scores showed a weak inverse relationship with parasympathetic activity, differences of successive R-R pulse intervals (RMSSD) (r = -0.44, p < 0.0001), high frequency (HF) (r = -0.42, p < 0.0001), and total autonomic nervous activity, low frequency (LF) (r = -0.43, p < 0.0001). Receiver operating characteristic analysis indicated that the RMSSD, HF, and LF were significantly higher in patients with active UC. Meanwhile, LF showed the most correlation with severity for bowel urgency scores. CONCLUSION: Longitudinal nighttime HRV recorded using a smartwatch is associated with disease activity in patients with active UC. In particular, RMSSD and HF, which are indices of the parasympathetic nervous system, have been suggested as potential digital biomarkers for UC.