Changes in the Clinical Features and Long-term Outcomes of Colonic Diverticulitis in Japanese Patients

Objective The purpose of this study was to investigate whether changes occurred in the clinical features of acute colonic diverticulitis (ACD) over a period of 10 years, to estimate the long-term probability of disease recurrence and to investigate whether it could be treated in an outpatient setting. Methods Between January 1998 and January 2009, 488 ACD patients were diagnosed and treated in Saiseikai Central Hospital, Tokyo. The diagnoses were made by ultrasonography (US) and/or CT. We investigated the time-dependent changes in the characteristics of patients with ACD, and we used the Kaplan-Meier method to estimate the cumulative probability of recurrence, based on information from a questionnaire. Results The percentage of patients who were diagnosed with left-sided ACD significantly increased over time in comparison to those with right-side disease (4% in 1998, 36% in 2009). Patients with left-sided ACD were significantly older and were diagnosed at a more advanced disease stage than those with right-sided ACD. Among the 212 ACD patients who responded to the questionnaire, the cumulative probability of recurrence in 125 patients with no history of ACD at 2.9, 5.9 and 10.1 years was 16.0%, 20.1% and 26.2%, respectively. The probability of recurrence in patients with right-sided and left-sided ACD did not differ to a statistically significant extent. In addition, outpatient treatability in patients with left-sided to right-sided ACD did not differ to a statistically significant extent (66.6% vs. 70.1%). Conclusion The ratio of left-sided to right-sided ACD was found to have increased over the past decade. Left-sided ACD patients were older and their incidence of complications was higher in comparison to right-sided patients; however, the rate of recurrence and outpatient treatability in patients with left-sided and right-sided ACD did not differ to a statistically significant extent.

Intelligent control of neurosurgical robot MM-3 using dynamic motion scaling

OBJECTIVE

Advanced and intelligent robotic control is necessary for neurosurgical robots, which require great accuracy and precision. In this article, the authors propose methods for dynamically and automatically controlling the motion-scaling ratio of a master-slave neurosurgical robotic system to reduce the task completion time.

METHODS

Three dynamic motion-scaling modes were proposed and compared with the conventional fixed motion-scaling mode. These 3 modes were defined as follows: 1) the distance between a target point and the tip of the slave manipulator, 2) the distance between the tips of the slave manipulators, and 3) the velocity of the master manipulator. Five test subjects, 2 of whom were neurosurgeons, sutured 0.3-mm artificial blood vessels using the MM-3 neurosurgical robot in each mode.

RESULTS

The task time, total path length, and helpfulness score were evaluated. Although no statistically significant differences were observed, the mode using the distance between the tips of the slave manipulators improves the suturing performance.

CONCLUSIONS

Dynamic motion scaling has great potential for the intelligent and accurate control of neurosurgical robots.

Long-Term Clinical Course after Conservative and Endoscopic Treatment of Colonic Diverticular Bleeding

BACKGROUND/AIM

What naturally happens to patients after they undergo conservative and endoscopic treatment of colonic diverticular bleeding (CDB) is largely unknown. We retrospectively track the long-term outcome of the recurrence of CDB between patients with endoscopic and conservative treatment.

METHODS

The group was divided into 2 groups: patients treated with injection and/or clipping (endoscopic group) and patients in whom such treatment could not be performed (conservative group). CDB recurrence was assessed via a questionnaire, and recurrence rates were investigated between groups using the Kaplan-Meier's method. The Cox proportional hazards model was performed to identify potential risk factors for recurrence.

RESULTS

Eighty-eight patients answered the questionnaires. The median (interquartile range) follow-up period was 42.7 (61.8) months. Twenty-four (38.7%) of 62 conservatively treated patients and 16 (61.5%) of 26 endoscopically treated patients experienced recurrence of CDB during the follow-up period. Kaplan-Meier's analysis showed that the rate of recurrence was significantly higher (p < 0.05) in cases with endoscopic treatment than in those with conservative treatment (mean time to recurrence = 55.3 months (95% CI 30.8-79.9) vs. 99.9 months (95%CI 80.7-119.1)). The Cox proportional hazards model did not identify any significant variables.

CONCLUSION

We should carefully follow-up patients to check for the recurrence of CDB, even when it could be successfully treated endoscopically. Can endoscopic treatment of CDB prevent CDB recurrence? Also, what happens to the patient's well-being after they undergo conservative and endoscopic treatment (cases diagnosed by Jensen's criteria) is largely unknown. We examined a population of patients undergoing conservative or endoscopic treatment to clarify the clinical course, particularly with regard to CDB recurrence.

Safety of Daiobotampito in the Treatment of Acute Diverticulitis of the Colon: A Single-Center, Open-Label, Prospective Trial

PURPOSE

The purpose of this study was to investigate the safety of daiobotampito in the treatment of acute diverticulitis of the colon.

METHODS

We conducted a single-center, open-label, prospective study. Ten patients who suffered from diverticulitis of the colon were recruited. The patients were treated with fasting, antibacterial agents, and daiobotampito extract for 10 days in or out of hospital. The patients individually recorded their body temperature, grade of abdominal pain, number of times that analgesics were used, and number of stools daily. We checked whether the patients had adverse reactions such as abdominal pain or diarrhea.

RESULTS

No patients experienced serious adverse reactions. One patient had moderate abdominal pain and diarrhea soon after daiobotampito intake. This patient discontinued daiobotampito on day 4, and the pain and diarrhea quickly resolved. The abdominal pain of this patient was worse 6 days before treatment, and the pain was almost relieved with initial daiobotampito treatment.

CONCLUSIONS

Daiobotampito is a safe treatment option for early stage, acute diverticulitis.

Registration of eye reflection and scene images using an aspherical eye model

This paper introduces an image registration algorithm between an eye reflection and a scene image. Although there are currently a large number of image registration algorithms, this task remains difficult due to nonlinear distortions at the eye surface and large amounts of noise, such as iris texture, eyelids, eyelashes, and their shadows. To overcome this issue, we developed an image registration method combining an aspherical eye model that simulates nonlinear distortions considering eye geometry and a two-step iterative registration strategy that obtains dense correspondence of the feature points to achieve accurate image registrations for the entire image region. We obtained a database of eye reflection and scene images featuring four subjects in indoor and outdoor scenes and compared the registration performance with different asphericity conditions. Results showed that the proposed approach can perform accurate registration with an average accuracy of 1.05 deg by using the aspherical cornea model. This work is relevant for eye image analysis in general, enabling novel applications and scenarios.

Learning from Observation Paradigm: Leg Task Models for Enabling a Biped Humanoid Robot to Imitate Human Dances

This paper proposes a framework that achieves the Learning from Observation paradigm for learning dance motions. The framework enables a humanoid robot to imitate dance motions captured from human demonstrations. This study especially focuses on leg motions to achieve a novel attempt in which a biped-type robot imitates not only upper body motions but also leg motions including steps. Body differences between the robot and the original dancer make the problem difficult because the differences prevent the robot from straightforwardly following the original motions and they also change dynamic body balance. We propose leg task models, which play a key role in solving the problem. Low-level tasks in leg motion are modelled so that they clearly provide essential information required for keeping dynamic stability and important motion characteristics. The models divide the problem of adapting motions into the problem of recognizing a sequence of the tasks and the problem of executing the task sequence. We have developed a method for recognizing the tasks from captured motion data and a method for generating the motions of the tasks that can be executed by existing robots including HRP-2. HRP-2 successfully performed the generated motions, which imitated a traditional folk dance performed by human dancers.

Increased expression of perforin, granzyme B, and C5b-9 in villitis of unknown etiology

INTRODUCTION

Villitis of unknown etiology (VUE) is associated with fetal growth restriction. However, the underlying mechanisms of villous injury in placentas with VUE are still largely unknown. We aimed to verify whether apoptosis-related factors are increased in VUE placentas. Furthermore, we determined apoptosis of villous cells.

METHODS

Six placentas with VUE and 3 control placentas were stained using immunohistochemistry with antibodies for CD3, CD4, CD8, CD68, CD163, perforin, granzyme B, granzyme K, and C5b-9. TUNEL assay analysis was also performed with these placentas. The percentage of cells that stained positive, CD163/CD68 ratio, percentage of C5b-9 positive area, and apoptosis index were quantified and compared between the inflammatory lesions of the VUE placentas, non-VUE inflammatory lesions of the VUE placentas, and control placentas.

RESULTS

The percentages of CD3, CD4, CD8 CD68, CD163, perforin, and granzyme B positive cells were significantly higher in the inflammatory lesions of the VUE placentas (p < 0.05). The intravillous CD163/CD68 ratio was higher in the inflammatory lesions compared with the non-inflammatory lesion of the VUE placentas (p < 0.05). The percentage of granzyme K-positive cells was not significantly different between the groups. C5b-9 deposition was higher in the inflammatory lesions of the VUE placentas (p < 0.05). TUNEL-positive cells were significantly higher in the inflammatory lesions of the VUE placentas (p < 0.05).

DISCUSSION

To the best of our knowledge, this is the first report to assess villous injury, especially from a viewpoint of villous apoptosis in VUE placentas. An activated perforin/granzyme pathway and C5b-9 are suggested as possible mechanisms of apoptosis.

Clinical outcomes and evaluation of the quality of life of living donors for pediatric liver transplantation: a single-center analysis of 100 donors

There are few reports about the quality of life (QOL) and morbidities of pediatric living donor liver transplantation (LDLT) donors. We evaluated the potential morbidities and identified the predictive factors regarding the QOL of living donors after pediatric LDLT. This cross-sectional study was a single-center analysis of 100 donors for pediatric LDLT. The severity of morbidities was assessed with the Clavien classification, the QOL was investigated with the short form-36 (SF-36), and the decision-making process regarding donation was analyzed with questionnaires. The median follow-up period was 3.8 years (range, 2.2-6.0 years). A total of 13% of the donors developed postoperative complications of Clavien grades I (7%), II (3%), and IIIA (3%). There was no grade IV morbidity or mortality. Eighty-one donors responded to the questionnaire and SF-36. The analysis of the questionnaires revealed that the donors had difficulty in the decision-making process, and suggested that it may be necessary to administer multistep informed consent. We identified unique predictive risk factors for lower SF-36 scores in the donors, which were the time to donation (more than 4 weeks) and the predonation self-oriented perception. The donors who have risk factors require enhanced pre- and post-donation psychological care.

[Timely colonoscopy leads to faster identification of bleeding diverticulum]

We conducted a retrospective study of the efficacy of a polyethylene glycol purge before colonoscopic examination in 110 patients with colonic diverticular bleeding. The patients' data were assessed for the timing of colonoscopy and the methods used to stop bleeding. The rate at which bleeding diverticula were identified was markedly higher when a purge was used than when it was not (28.2% vs. 12.0%, p=0.11). In addition, the identification rate was significantly higher when colonoscopic examination was performed within 18 hours of the final hematochezia than when it was performed after 18 hours (40.5% vs. 10.5%, p<0.01). These findings suggest that patients with diverticular bleeding should undergo colonoscopy following an orally administered colonic purge, providing their condition permits. Furthermore, colonoscopy should be performed within 18 hours of the final hematochezia in order to improve identification of the bleeding diverticulum.

[Adult Gianotti-Crosti syndrome caused by hepatitis B]

A 42-year-old man was admitted to our hospital with a lower extremity rash, general fatigue, and abdominal discomfort. Laboratory findings revealed elevated serum transaminases as well as positivity for the hepatitis B surface antigen and the immunoglobulin M type anti-hepatitis B core antibody. He was diagnosed with a rash typical of Gianotti-Crosti syndrome due to acute infection with hepatitis B virus, genotype A. After admission, the rash gradually decreased; however, serum transaminases and jaundice increased. Entecavir therapy was initiated on day 11 of admission, and his liver function subsequently improved over two weeks. Gianotti-Crosti syndrome is rarely seen in adult patients. It may be important to pay attention to the typical rash of Gianotti-Crosti syndrome because it may provide an important clue to an otherwise asymptomatic acute hepatitis B infection.

Amidic and acetonic cryoprotectants improve cryopreservation of volvocine green algae

A number of volvocalean green algae species were subjected to a two-step cryopreservation protocol with various cryoprotectants. Potential cryoprotectants were methanol (DMSO), N,N-dimethylformamide (DMF), N,N-dimethylacetamide, N-methylformamide, and hydroxyacetone (HA). We confirmed prior reports that MeOH was effective for cryopreserving Chlamydomonas, but did not work well for larger volvocaleans such as Volvox. In contrast, DMF and HA were effective for both unicellular and multicellular representatives. When we used a cold-inducible transposon to probe Southern blots of Volvox DNA samples taken before and after storage for one month in LN, we could detect no differences, indicating that the genome had remained relatively stable and that the transposon had not been induced by the cryopreservation procedure. We believe these methods will facilitate long-term storage of several volvocine algal species, including Volvox strains harboring transposon-induced mutations of developmental interest.