New Proposal Strategy of Sentinel Lymph Node Navigation Surgery for Endoscopic Curability C-2: A Retrospective Study.

BACKGROUND/AIM: The purpose of this study was to evaluate the outcomes of the sentinel node navigation surgery (SNNS) followed by limited gastrectomy for early gastric cancer (EGC) with Endoscopic Curability C-2 (eCuraC-2). PATIENTS AND METHODS: Between 2001 and 2018, 33 patients were included in this study. Following sentinel node (SN) biopsy using indocyanine green combined with an infrared ray laparoscopic system, limited gastrectomy (LG) [wedge resection (WR), or segmental gastrectomy (SG)] was performed without extended lymphadenectomy. RESULTS: SN detection rate was 97% (32/33). The mean number of SNs per case was 7.8. Three patients (9.1%) with lymph node metastasis (LNM) had a positive SN identified by intraoperative pathological examination. When intraoperative pathologic examination showed SN to be LNM negative, 11 patients underwent WR, and seven were subjected to SG. Postoperative pathological examinations showed no false negatives for LNM, and four patients (12%) had residual cancer in their resected stomachs. Overall survival and disease-specific survival five years after SNNS were 87.9% and 100%, respectively. CONCLUSION: SNNS followed by LG with lymphatic basin resection may be one of the ideal procedures for patients with eCuraC-2 due to the accurate diagnosis of LNM and favorable disease-specific prognosis.

Bio-catalytic nanoparticle shaping for preparing mesoscopic assemblies of semiconductor quantum dots and organic molecules.

We report a unique bio-catalytic nanoparticle shaping (BNS) method for preparing a variety of mesoscopic particles by a facile process. For example, the BNS method affords mesoscopic QD assembly dispersions. Large-size sedimentations (>1 µm) of QDs are first formed using oligo-L-lysine linkers. These then undergo controlled enzymatic cleavage of the linkers using trypsin, which surprisingly leads to mesoscopic particles about 84 nm in size with a narrow size distribution. A detailed mechanism of the BNS method is investigated using tetrakis(4-carboxyphenyl)porphyrin (TCPP), instead of QDs, as a probe molecule. Interestingly, the BNS method can also be applied to other combinations of enzymes and enzymatically degradable linkers, such as hyaluronidase with hyaluronan. As a potential application, the mesoscopic particles of QDs and oligo-lysine exhibit their ability to act as a drug delivery carrier originating from the features of both QDs and oligo-lysine. The BNS method demonstrates the universality and versatility of preparing mesoscopic particles and opens new doors for studying QD assemblies and molecular-based mesoscopic particles.

Investigation of the Nanoparticulation Method and Cell-Killing Effect following the Mitochondrial Delivery of Hydrophobic Porphyrin-Based Photosensitizers.

Photodynamic therapy is expected to be a less invasive treatment, and strategies for targeting mitochondria, the main sources of singlet oxygen, are attracting attention to increase the efficacy of photodynamic therapy and reduce its side effects. To date, we have succeeded in encapsulating the photosensitizer rTPA into MITO-Porter (MP), a mitochondria-targeted Drug Delivery System (DDS), aimed at mitochondrial delivery of the photosensitizer while maintaining its activity. In this study, we report the results of our studies to alleviate rTPA aggregation in an effort to improve drug efficacy and assess the usefulness of modifying the rTPA side chain to improve the mitochondrial retention of MITO-Porter, which exhibits high therapeutic efficacy. Conventional rTPA with anionic side chains and two rTPA analogs with side chains that were converted to neutral or cationic side chains were encapsulated into MITO-Porter. Low-MP (MITO-Porter with Low Drug/Lipid) exhibited high drug efficacy for all three types of rTPA, and in Low-MP, charged rTPA-encapsulated MP exhibited high drug efficacy. The cellular uptake and mitochondrial translocation capacities were similar for all particles, suggesting that differences in aggregation rates during the incorporation of rTPA into MITO-Porter resulted in differences in drug efficacy.

Proctoring System Enables Safe Induction of Robotic Gastrectomy: Short-term Outcomes of the First 10 Cases.

BACKGROUND/AIM: The Japan Society of Endoscopic Surgery (JSES) proctoring system was established to prevent serious pancreatic pressure injuries in Japan in 2019. To safely perform robotic gastrectomy (RG) in our hospital, which has no experience in robotic surgery, we conducted a clinical trial with the support of this proctoring system. PATIENTS AND METHODS: The present study was a single-center clinical prospective study. The primary endpoint was morbidity determined using Clavien-Dindo classification (C-D) Grade IIIa or higher. RESULTS: Ten patients, seven males and three females, were recruited in this study. RG was performed under the proctoring system of the JSES in the initial six cases and was completed independently for the remaining four patients. We successfully performed the initial ten cases without C-D classification grade IIIa or higher morbidities. CONCLUSION: This study underscores the significance of a proctoring system for introducing RG to facilities with limited experience in robotic surgery. Despite some limitations, this study demonstrated successful outcomes in the initial ten cases, emphasizing the benefits for both surgeons and patients. This study provides valuable insights into the safety of RG in small institutions and calls for further research in this area.

Dual-color photoluminescence modulation of zero-dimensional hybrid copper halide microcrystals.

Zero-dimensional hybrid copper(I) halides (HCHs) are attractive due to their interesting photoluminescence (PL) properties and the high abundance and low toxicity of copper. In this study, we report green-red dual emission from rhombic 1-butyl-1-methyl piperidinium copper bromide [(Bmpip)2Cu2Br4] microcrystals (MCs) prepared on borosilicate glass. The structure and elemental composition of the MCs are characterized by single crystal X-ray diffraction analysis, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Interestingly, MCs prepared on an ITO-coated glass plate show an intense green emission compared to the dual emission on a bare glass or plastic substrate. Furthermore, the intensity of the green emission from the MC is enormously increased by powdering using a conductive material, suggesting the deactivation of the red-emitting state by a charge transfer interaction with the conductor. These findings open a new strategy to suppress the self-trapping of excitons by longitudinal optical phonons and control the dual emitting states in HCHs.

Psychometric properties of the Japanese version of the Insomnia Catastrophizing Scale and relationship of insomnia severity with catastrophic thoughts, safety behaviors, and dysfunctional beliefs.

BACKGROUND: This study aimed to clarify the reliability and validity of the Japanese version of the Insomnia Catastrophizing Scale (ICS) and to examine the relationship between insomnia severity and insomnia-related cognitive factors. METHODS: A total of 786 participants were recruited via an online survey and classified into the insomnia group (n = 342) and healthy group (n = 444). The insomnia group comprised individuals who self-reported meeting the diagnostic criteria for chronic insomnia disorder in the third edition of the International Classification of Sleep Disorders. RESULTS: The ICS is used to independently assess nighttime (ICS-N) and daytime (ICS-D) catastrophic thoughts, and item response theory revealed that each ICS-N and ICS-D item can adequately assess catastrophic thoughts during the night and day, respectively. The internal consistency and test-retest reliability of the ICS-N and ICS-D were good. Further, the ICS-N and ICS-D had a significant positive correlation with insomnia severity, hyperarousal, sleep-related safety behaviors, dysfunctional beliefs about sleep, and anxiety symptoms. Multiple regression analyses with insomnia severity as the dependent variable in the insomnia group demonstrated that catastrophic thoughts were more strongly associated with insomnia severity than sleep-related safety behaviors and dysfunctional beliefs about sleep. The interaction between nighttime catastrophic thoughts and sleep-related safety behaviors increased insomnia severity. CONCLUSIONS: The Japanese versions of ICS-N and ICS-D were found to be superior in measuring insomnia-related catastrophic thoughts and to have high reliability and validity. Furthermore, these findings more clearly demonstrate that the catastrophic thoughts may be an important associated factor of insomnia.

Appropriate concentration setting for the intraoperative administration of indocyanine green for fluorescence imaging to identify the sentinel lymph node in early gastric cancer: a clinical pilot study.

PURPOSE: Some prospective trials have demonstrated the feasibility of sentinel node (SN) biopsy in gastric cancer (GC) surgery. This study aimed to identify the appropriate concentration settings for the intraoperative injection of indocyanine green (ICG) for SN biopsy. METHODS: Before the clinical studies, porcine model experiments explored the optimal concentration of ICG injected intraoperatively. Next, nine GC patients were enrolled in the clinical research. ICG (0.5 ml) was injected intraoperatively into four quadrants of the submucosa around the tumor at various concentrations (0.5, 0.25, and 0.1 mg/ml). The lymphatic basin dissection method was applied to the ICG-positive lymphatic areas. The number and location of the lymphatic basins and positive nodes were recorded intraoperatively. RESULTS: In the porcine model, the visibility gradually became clear at an ICG concentration higher than 0.1 mg/ml. In the clinical study, the average number of detected lymphatic basins was 3.3, 1.7, and 1.7, respectively. The mean number of detected SNs was 14.7, 6.7, and 4.0, respectively. CONCLUSION: To improve the reproducibility of SN biopsy, it is essential to prepare the correct concentration setting of ICG. Under current conditions in which ICG is injected intraoperatively, a 0.1 mg/ml concentration setting of ICG may be necessary and sufficient for SN identification.

Effect of cognitive behavioral therapy for insomnia in workers: A systematic review and meta-analysis of randomized controlled trials.

Although cognitive behavioral therapy for insomnia (CBT-I) is recommended as a first-line treatment, its efficacy for workers with insomnia remains unclear. This systematic review and meta-analysis aimed to determine the effectiveness of CBT-I in the management of insomnia symptoms in workers. We searched the literature in three electronic databases, namely PubMed, PsycINFO, and Embase, and included 21 studies in the meta-analysis. Compared with the control group, CBT-I overall resulted in significant improvements in terms of severity of insomnia (g = -0.91), sleep onset latency (g = -0.62), wakefulness after sleep onset (g = -0.60), early morning awakening (g = -0.58), and sleep efficiency (g = 0.71). However, there was no improvement in the total sleep time relative to that in the control group. Furthermore, CBT-I significantly alleviated depressive (g = -0.37) and anxiety (g = -0.35) symptoms and fatigue (g = -0.47) compared with the control group. Our study findings suggest that both web-based and face-to-face CBT-I are effective interventions for managing insomnia symptoms in daytime workers, although it is important to note that only face-to-face CBT-I achieved clinically meaningful changes. The effectiveness of CBT-I for shift workers could not be determined.

Network analysis to estimate central insomnia symptoms among daytime workers at-risk for insomnia.

Although insomnia complaints are associated with mental health problems and reduced work productivity, the central insomnia symptoms in workers at-risk for insomnia remain unclear. This study aimed to identify the central insomnia symptoms among daytime workers at risk for insomnia. The participants were 881 Japanese daytime workers at-risk for insomnia with a mean age of 49.33 ± 9.92 years. At-risk for insomnia was defined as an Athens Insomnia Scale score of six or higher. The Athens Insomnia Scale was used as a screening for at-risk insomnia because it has higher sensitivity and specificity than other insomnia screening scales. The Insomnia Severity Index is recommended as a mechanism of insomnia and an outcome measure; therefore, a network analysis was conducted with the seven items of the Insomnia Severity Index. The important variables in the connections between insomnia symptoms were estimated from centrality indices, which were interpretable only for strength. The strength value results suggest that difficulty staying asleep and worry about sleep problems were the central insomnia symptoms. The connections were stronger for difficulty staying asleep and problem waking up too early, difficulty staying asleep and difficulty falling asleep, and interference with daytime functions and noticeable to others. Worry about sleep problems was strongly associated with variables other than nocturnal insomnia symptoms. Therefore, difficulty staying asleep and worry about sleep problems are important variables in daytime workers at-risk for insomnia and are key points for improvement or exacerbation of insomnia symptoms.

An antibacterial conjugate of carbon nanohorns for NIR-light mediated peri-implantitis treatment.

This study developed a novel antibacterial conjugate based on carbon nanohorns for peri-implantisis, an inflammatory disease around dental implants, which may result in failing implants by bone loss around them. The conjugate demonstrates much better photodurability than commonly used indocyanine green and a significant antibacterial effect under NIR illumination.

Long-term survival after multidisciplinary treatments for HER2-positive advanced gastric cancer with multiple liver and lung metastases.

BACKGROUND: Trastuzumab-based chemotherapy is a standard treatment regimen for human epithelial growth factor 2 (HER2)-positive gastric cancer. This is a case of a patient who has survived 12 years after being diagnosed with advanced gastric cancer with multiple liver and lung metastases. CASE PRESENTATION: A woman in her 70s underwent total gastrectomy, cholecystectomy, and left hepatic lobectomy for gastric cancer with liver metastasis. One month after the surgery, multiple liver metastases appeared. After two courses of S-1 + CDDP chemotherapy, the liver metastases disappeared, and new lung metastases occurred. Because the primary tumor was HER2 positive, S-1 + CDDP + trastuzumab chemotherapy was performed. After one course of chemotherapy, the blood test showed pancytopenia, and CDDP was discontinued. S-1 + trastuzumab chemotherapy was then initiated, and as a result, the lung metastases disappeared. The patient is alive without recurrence 12 years after the surgery. CONCLUSIONS: We encountered a case of long-term survival after multidisciplinary treatments for HER2-positive advanced gastric cancer with multiple liver and lung metastases.

Development and validation of the Japanese version of the Restorative Sleep Questionnaire in community samples.

OBJECTIVE: This study aimed to validate the Japanese version of the Restorative Sleep Questionnaire Weekly version (RSQ-W-J) and estimate the RSQ-W-J cut-off score to identify the degree of non-restorative sleep (NRS) that interferes with daytime function. METHODS: An online survey was conducted, and 513 participants (241 men, 272 women; mean age, 47.88 ± 16.66 years) completed the questionnaires. The RSQ-W-J, Multidimensional Fatigue Inventory, Athens Insomnia Scale, Patient Health Questionnaire-9, Epworth Sleepiness Scale, Sleep Debt Index, NRS and the degree of daytime dysfunction, and the diagnostic criteria for chronic insomnia were used as implementation scales. RESULTS: The RSQ-W-J was confirmed to have a single-factor structure. Both the Cronbach α coefficient and test-retest reliability of RSQ-W-J were high (α = 0.91; intraclass correlation coefficient [ICC]agreement = 0.85). The RSQ-W-J was significantly negatively correlated with the scales of fatigue, insomnia, depressive symptoms, daytime sleepiness, and sleep debt. In addition, the RSQ-W-J scores of the insomnia group, in which participants met the diagnostic criteria for chronic insomnia, NRS group, in which participants had NRS only, and sleep debt group, in which participants had sleep debt, were significantly lower than those in the normal sleep group. Furthermore, the insomnia group scored significantly lower than the sleep debt group. The RSQ-W-J cut-off score, which indicates whether or not NRS interferes with daytime function, was estimated to be 45.8 points. CONCLUSIONS: The RSQ-W-J was shown to be useful for comprehensively measuring the degree of restorative sleep.

Sleep Debt Mediates the Relationship between Work-Related Social Factors, Presenteeism, and Well-Being in Japanese Workers.

Sleep debt is associated with presenteeism and mental health; however, the association of sleep debt with presenteeism and well-being in the context of work-related social factors (commuting time, workdays, and working hours) has not been fully elucidated. This study aimed to examine whether work-related social factors are associated with presenteeism and well-being via sleep debt. The participant group comprised 872 full-time and 526 part-time workers (mean age: 44.65 ± 12.37 and 48.47 ± 12.93 years, respectively). For both the full-time and part-time workers, increased sleep debt was significantly associated with presenteeism (ß = -0.171; ß = -0.160) and low well-being (ß = -0.135; ß = -0.153). Notably, commuting time was significantly associated with increased sleep debt in full-time workers (ß = 0.09). In contrast, the number of workdays was significantly associated with increased sleep debt in part-time workers (ß = -0.102). Working hours were not significantly associated with sleep debt for both full- and part-time workers. These results reveal that sleep debt might lead to various risks among workers, elucidating the work-related social factors related to sleep debt. They also highlight the importance of considering work-related social factors when addressing sleep debt.

Luminescent quantum dots: Synthesis, optical properties, bioimaging and toxicity.

Luminescent nanomaterials such as semiconductor nanocrystals (NCs) and quantum dots (QDs) attract much attention to optical detectors, LEDs, photovoltaics, displays, biosensing, and bioimaging. These materials include metal chalcogenide QDs and metal halide perovskite NCs. Since the introduction of cadmium chalcogenide QDs to biolabeling and bioimaging, various metal nanoparticles (NPs), atomically precise metal nanoclusters, carbon QDs, graphene QDs, silicon QDs, and other chalcogenide QDs have been infiltrating the nano-bio interface as imaging and therapeutic agents. Nanobioconjugates prepared from luminescent QDs form a new class of imaging probes for cellular and in vivo imaging with single-molecule, super-resolution, and 3D resolutions. Surface modified and bioconjugated core-only and core-shell QDs of metal chalcogenides (MX; M = Cd/Pb/Hg/Ag, and X = S/Se/Te,), binary metal chalcogenides (MInX2; M = Cu/Ag, and X = S/Se/Te), indium compounds (InAs and InP), metal NPs (Ag, Au, and Pt), pure or mixed precision nanoclusters (Ag, Au, Pt), carbon nanomaterials (graphene QDs, graphene nanosheets, carbon NPs, and nanodiamond), silica NPs, silicon QDs, etc. have become prevalent in biosensing, bioimaging, and phototherapy. While heavy metal-based QDs are limited to in vitro bioanalysis or clinical testing due to their potential metal ion-induced toxicity, carbon (nanodiamond and graphene) and silicon QDs, gold and silica nanoparticles, and metal nanoclusters continue their in vivo voyage towards clinical imaging and therapeutic applications. This review summarizes the synthesis, chemical modifications, optical properties, and bioimaging applications of semiconductor QDs with particular references to metal chalcogenide QDs and bimetallic chalcogenide QDs. Also, this review highlights the toxicity and pharmacokinetics of QD bioconjugates.

Fine-tuning the encapsulation of a photosensitizer in nanoparticles reveals the relationship between internal structure and phototherapeutic effects.

Photodynamic therapy (PDT) is a cancer therapy that uses a photosensitizer (PS) in the presence of oxygen molecules. Since singlet oxygen is highly reactive, it is important to deliver it to the target site. Thus, an efficient drug delivery system (DDS) is essential for enhancing the efficacy of such a treatment and protecting against the side effects of PDT. Here, we report on attempts to increase the therapeutic effect of PDT by using a DDS, a lipid nanoparticle (LNP). We prepared a porphyrin analog, rTPA (PS) that was encapsulated in LNPs using a microfluidic device. The findings indicated that the internal structure of the prepared particles changed depending on the amount of rTPA in LNPs. The photoactivity and cell-killing effect of PS in LNPs also changed when the amount of the cargo increased. These results suggest that the internal structure of LNPs is important factors that affect drug efficacy.

Association between insomnia severity and presenteeism among Japanese daytime workers.

Presenteeism is the loss of productivity due to a worker's health problems, despite the worker being present at the workplace. Although the association between presenteeism and insomnia complaints is well known, few studies have examined the association between insomnia severity and presenteeism. This study aimed to explore the association between insomnia severity and presenteeism. This study included 1925 participants (1543 males, 379 females, and three of other genders) in total. The mean age of the participants was 49.94 ± 9.82 years. The inclusion criteria were full-time employment, working 8 hr per day and 5 days per week, and having no night shifts. The insomnia severity was classified based on the Insomnia Severity Index and Athens Insomnia Scale criteria. Logistic regression analysis showed that moderate and severe insomnia severity were associated to a greater magnitude with presenteeism than mild insomnia severity. Severe insomnia severity was associated to a greater magnitude with presenteeism than moderate insomnia severity. In summary, logistic regression analysis showed that increased insomnia severity based on Insomnia Severity Index classification was associated with increased odds of presenteeism, but increased insomnia severity based on Athens Insomnia Scale classification was not fully consistent with increased odds of presenteeism. Because increased insomnia severity is associated with worsening of presenteeism, early detection of and early intervention against insomnia complaints are important for reducing presenteeism. This study was the first to examine the associations between presenteeism and insomnia severity classification of no insomnia, mild, moderate, and severe insomnia severity.

Excitation-Wavelength-Dependent Functionalities of Temporally Controlled Sensing and Generation of Singlet Oxygen by a Photoexcited State Engineered Rhodamine 6G-Anthracene Conjugate.

The present study provides design guidance for unique multipotent molecules that sense and generate singlet oxygen (1 O2 ). A rhodamine 6G-aminomethylanthracene-linked donor-acceptor molecule (RA) is designed and synthesized for demonstrating wavelength-dependent functionalities as follows; (i) RA acts as a conventional fluorogenic 1 O2 sensor molecule like the commercially available reagent, singlet oxygen sensor green (SOSG), when it absorbs ultraviolet (UV)-visible light and reacts with 1 O2 . (ii) RA acts as a temporally controlled 1 O2 sensing reagent under the longer wavelength (∼700 nm) photosensitization. RA enters an intermediate state after capturing 1 O2 and does not become strongly fluorescent until it is exposed to UV, blue, or green light. (iii) RA acts as an efficient photosensitizer to generate 1 O2 under green light illumination. The spin-orbit charge transfer mediated intersystem crossing (SOCT-ISC) process achieves this function, and RA shows a potential cancer-killing effect on pancreatic cancer cells. The wavelength-switchable functionalities in RA offer to promise molecular tools to apply 1 O2 in a spatiotemporal manner.

Caging and photo-triggered uncaging of singlet oxygen by excited state engineering of electron donor-acceptor-linked molecular sensors.

Singlet oxygen (1O2), one of the most sought-after species in oxidative chemical reactions and photodynamic cancer therapy, is activated and neutralized in the atmosphere and living cells. It is essential to see "when" and "where" 1O2 is produced and delivered to understand and utilize it. There is an increasing demand for molecular sensor tools to capture, store, and supply 1O2, controlled by light and engineered singlet and triplet states, indicating the 1O2-capturing-releasing state. Here, we demonstrate the outstanding potential of an aminocoumarin-methylanthracene-based electron donor-acceptor molecule (1). Spectroscopic measurements confirm the formation of an endoperoxide (1-O2) which is not strongly fluorescent and remarkably different from previously reported 1O2 sensor molecules. Moreover, the photoexcitation on the dye in 1-O2 triggers fluorescence enhancement by the oxidative rearrangement and a competing 1O2 release. The unique ability of 1 will pave the way for the spatially and temporally controlled utilization of 1O2 in various areas such as chemical reactions and phototherapies.

Impact of sleep debt, social jetlag, and insomnia symptoms on presenteeism and psychological distress of workers in Japan: a cross-sectional study.

BACKGROUND: Presenteeism is an indicator of productivity loss and the risk of absence from work due to mental health problems. The purpose of this study was to determine the impact of sleep debt, social jetlag, and insomnia symptoms on presenteeism and psychological distress. METHODS: The participants were 351 Japanese workers (271 males, 79 females, and one of other gender, with a mean age of 49 ± 9.49 years). The eligibility criteria for this study were full-time employment, working eight hours per day, five days per week, and no night shifts. The participants answered questionnaires measuring sleep debt, social jetlag, insomnia symptoms, presenteeism, and psychological distress. RESULTS: Insomnia symptoms had the greatest impact on presenteeism and psychological distress when compared with sleep debt and social jetlag (adjusted odds ratio (OR) = 5.61, 95% confidence interval (CI) = 2.88-10.91; adjusted OR = 7.29, 95%CI = 3.06-17.35). Sleep debt had a greater impact on presenteeism and psychological distress than did social jetlag (adjusted OR = 1.61, 95%CI = 1.14-2.27; adjusted OR = 1.68, 95%CI = 1.11-2.54), which had no impact on these variables (adjusted OR = 1.04, 95%CI = 0.91-1.20; adjusted OR = 0.96, 95%CI = 0.76-1.22). CONCLUSIONS: The findings of this study indicated that insomnia symptoms had a more significant impact on presenteeism and psychological distress than social jetlag and sleep debt. Although sleep debt might have an independent impact on presenteeism and psychological distress, social jetlag did not.

Multiple large cell neuroendocrine carcinomas in the rectum and descending colon presented with liver metastasis: A case report.

Colorectal large cell neuroendocrine carcinoma (LCNEC) is rare and multiple LCNECs have not been previously reported. We encountered a case of multiple LCNECs in the rectum and the descending colon. A 66-year-old man presented with anal pain. Colonoscopy showed an ulcerated infiltrating tumor in the rectum, and 0.5 cm of erosion in the descending colon. A biopsy revealed LCNEC in both regions. Abdominal computed tomography revealed irregularly enhanced wall thickening at the rectum and hepatic metastases. Due to the diagnosis of LCNEC, laparoscopic abdominoperineal resection of the rectum was performed. Histopathological examination showed a poorly differentiated, LCNEC in both regions. Immunohistochemical examination demonstrated that the tumor cells were positive for chromogranin and synaptophysin. LCNEC was confirmed, and systemic chemotherapy with cisplatin/irinotecan was initiated. To our knowledge, this is the first case report that describes multiple LCNECs in the rectum and descending colon.