Efficacy of Dose Escalation of Oral 5-Aminosalicylic Acid for Ulcerative Colitis With a Mayo Endoscopic Subscore of 1: An Open Label Randomized Controlled Trial

BACKGROUND

Endoscopic healing is generally defined as Mayo endoscopic subscore (MES) ≤1 in ulcerative colitis (UC). However, patients with an MES of 1 are at higher relapse risk than those with an MES of 0. This study evaluated the therapeutic efficacy of proactive dose escalation of oral 5-aminosalicylic acid (5-ASA) in UC patients with an MES of 1.

METHODS

An open-label, randomized controlled trial was conducted in 5 hospitals between 2018 and 2022. Ulcerative colitis patients in clinical remission under oral 5-ASA therapy and diagnosed as having an MES of 1 were enrolled. Patients receiving maintenance therapy other than 5-ASA and immunomodulator were excluded. Patients were randomly assigned in a 1:1 ratio to receive either a dose-escalated (intervention) or constant dose (control) of 5-ASA. Concomitant immunomodulator was used as the stratification factor in the randomization. The primary end point was relapse within 1 year. The subgroup analysis was stratified for the use of immunomodulators.

RESULTS

The full analysis set included 79 patients (39 intervention and 40 control). Immunomodulators were used in 20 (25.3%) patients. Relapse was less in the intervention group (15.4%) than the control group (37.5%; P = .026). In the subgroup with concomitant immunomodulators, relapse was also less in the intervention group (10.0%) than the control group (70.0%; P = .020). In patients without immunomodulators, the difference was not significant between 2 groups (intervention, 17.2%; control, 26.7%; P = .53).

CONCLUSIONS

Dose escalation of 5-ASA reduced relapse within 1 year in UC patients in clinical remission with an MES of 1.

Medical treatment selection and outcomes for hospitalized patients with severe ulcerative colitis as defined by the Japanese criteria

BACKGROUND

Hospitalization for ulcerative colitis (UC) is potentially life-threatening. Severe disease in the Japanese criteria which modifies the Truelove-Witts' criteria might encompass more fulminant cases than the definition for acute severe UC. However, few studies have investigated the predictive factors for clinical remission (CR) after medical treatments for severe hospitalized patients by Japanese criteria.

METHODS

Medical treatment selection, CR rates, and factors contributing to CR on day 14 were assessed in severe patients by Japanese criteria. We also investigated whether the reduction rate in patient-reported outcome 2 (PRO2) on day 3 could predict short-term prognosis.

RESULTS

Eighty-five severe hospitalized patients were selected. Corticosteroids, tacrolimus, and infliximab were mainly selected as first-line treatments (76/85; 89.4%). The CR rates on day 14 were 26.8%, 21.4%, and 33.3% in patients receiving corticosteroids, tacrolimus, and infliximab, respectively. Extensive disease (odds ratio [OR] 0.022; 95% confidence interval [CI] 0.002-0.198), higher PRO2 (OR 0.306; 95% CI 0.144-0.821), and higher reduction rate in PRO2 on day 3 (OR 1.047; 95% CI 1.019-1.075) were independent factors predicting CR on day 14. If the cutoff value for the reduction rate in PRO2 on day 3 was 18.3%, sensitivity was 0.714 and specificity was 0.731 to predict CR on day 14. A higher reduction rate in PRO2 on day 3 (OR 0.922; 95% CI 0.853-0.995) was a negative factor to predict surgery within 28 days.

CONCLUSIONS

Tacrolimus and infliximab in addition to corticosteroids were used as first-line treatment in severe hospitalized patients. PRO2 on day 3 is a useful marker for switching to second-line therapy or colectomy.

Real-world efficacy and safety of advanced therapies in hospitalized patients with ulcerative colitis

BACKGROUND

This multicenter observational cohort study aimed to evaluate the utilization and short-term efficacy of advanced therapy (AT) in hospitalized patients with acute severe ulcerative colitis (ASUC).

METHODS

In total, 221 patients with ASUC were enrolled between August 2020 and July 2021. The primary endpoint was clinical remission (CR, defined as a patient-reported outcome score < 2 with no blood in the stool) rate on Day 7 and 14 in hospitalized patients who received corticosteroids (CS) and AT.

RESULTS

Among patients with ASUC, 120 and 101 patients received CS or any AT as first-line treatment, respectively. The CR rates on Day 7 and 14 were 22.5% and 35.0%, respectively, in hospitalized patients who received CS as first-line treatment. Most patients who used ATs had CS-dependent or frequent recurrences. Eight different ATs (apheresis, tacrolimus, infliximab, golimumab, tofacitinib, vedolizumab, ustekinumab, and cyclosporine) were used as first-line treatment in patients with ASUC, and the CR rates on Day 7 and 14 were 16.8% and 29.7%, respectively. Twenty-five patients received the second ATs after hospitalizations, and the CR rates on Day 7 and 14 were 0% and 12%, respectively. The CR rates on Day 14 were significantly higher in patients who changed to AT than in those whose dose of CS increased (34.0% vs 10.7%, p = 0.020) among patients who had already used CS before hospitalization.

CONCLUSION

Most first-use ATs were effective for patients with ASUC, while second-use ATs might have had limited benefits in inducing CR. These findings may contribute to considerations for the management of hospitalized patients.

An extremely energetic cosmic ray observed by a surface detector array

Cosmic rays are energetic charged particles from extraterrestrial sources, with the highest-energy events thought to come from extragalactic sources. Their arrival is infrequent, so detection requires instruments with large collecting areas. In this work, we report the detection of an extremely energetic particle recorded by the surface detector array of the Telescope Array experiment. We calculate the particle's energy as [Formula: see text] (~40 joules). Its arrival direction points back to a void in the large-scale structure of the Universe. Possible explanations include a large deflection by the foreground magnetic field, an unidentified source in the local extragalactic neighborhood, or an incomplete knowledge of particle physics.

Augmented reality-based affective training for improving care communication skill and empathy

It is important for caregivers of people with dementia (PwD) to have good patient communication skills as it has been known to reduce the behavioral and psychological symptoms of dementia (BPSD) of PwD as well as caregiver burnout. However, acquiring such skills often requires one-on-one affective training, which can be costly. In this study, we propose affective training using augmented reality (AR) for supporting the acquisition of such skills. The system uses see-through AR glasses and a nursing training doll to train the user in both practical nursing skills and affective skills such as eye contact and patient communication. The experiment was conducted with 38 nursing students. The participants were assigned to either the Doll group, which only used a doll for training, or the AR group, which used both a doll and the AR system. The results showed that eye contact significantly increased and the face-to-face distance and angle decreased in the AR group, while the Doll group had no significant difference. In addition, the empathy score of the AR group significantly increased after the training. Upon analyzing the correlation between personality and changes of physical skills, we found a significant positive correlation between the improvement rate of eye contact and extraversion in the AR group. These results demonstrated that affective training using AR is effective for improving caregivers' physical skills and their empathy for their patients. We believe that this system will be beneficial not only for dementia caregivers but for anyone looking to improve their general communication skills.

Behavioral and neural underpinnings of empathic characteristics in a Humanitude-care expert

Background

Humanitude approaches have shown positive effects in elderly care. However, the behavioral and neural underpinnings of empathic characteristics in Humanitude-care experts remain unknown.

Methods

We investigated the empathic characteristics of a Humanitude-care expert (YG) and those of age-, sex-, and race-matched controls (n = 13). In a behavioral study, we measured subjective valence and arousal ratings and facial electromyography (EMG) of the corrugator supercilii and zygomatic major muscles while participants passively observed dynamic facial expressions associated with anger and happiness and their randomized mosaic patterns. In a functional magnetic resonance imaging (MRI) study, we measured brain activity while participants passively observed the same dynamic facial expressions and mosaics. In a structural MRI study, we acquired structural MRI data and analyzed gray matter volume.

Results

Our behavioral data showed that YG experienced higher subjective arousal and showed stronger facial EMG activity congruent with stimulus facial expressions compared with controls. The functional MRI data demonstrated that YG showed stronger activity in the ventral premotor cortex (PMv; covering the precentral gyrus and inferior frontal gyrus) and posterior middle temporal gyrus in the right hemisphere in response to dynamic facial expressions versus dynamic mosaics compared with controls. The structural MRI data revealed higher regional gray matter volume in the right PMv in YG than in controls.

Conclusion

These results suggest that Humanitude-care experts have behavioral and neural characteristics associated with empathic social interactions.

Managing Interhospital Referrals During a COVID-19 Patient Surge in Japan: Creating Available Beds by Exchanging Patients

A COVID-19 patient surge in Japan from July to September 2021 caused a mismatch between patient severity and bed types because hospital beds were fully occupied and patient referrals between hospitals stagnated. Japan's predominantly private healthcare system lacks effective mechanisms to coordinate healthcare providers to address the mismatch. To address the surge, in August 2021, Tokyo Saiseikai Central Hospital started a scheme to exchange patients with other hospitals to mitigate the mismatch. In this article, we outline a retrospective observational study using medical records from a tertiary care medical center that treated severe COVID-19 cases. We describe daily patient admissions to our hospital's COVID-19 beds from July to September 2021, and compared the moving average of daily admissions before and after the exchange scheme was introduced. Bed occupancy reached nearly 100% in late July when the patient surge began and continued to exceed 100% in August when the surge peaked. However, the average daily admission did not decrease in August compared with July: the median daily admission (25th to 75th percentile) during each period was 2 (1 to 2.5) in late July and 3 (2 to 4) in August. The number of patients referred in from secondary care hospitals and the number of patients referred out was balanced in August. During the patient surge, the exchange scheme enabled the hospital to maintain and even increase the number of new admissions despite the bed shortage. Coordinating patient referrals in both directions simultaneously, rather than the usual 1-way transfer, can mitigate such mismatches.

THE EFFECT OF COMMUNICATION SKILLS TRAINING FOR NURSING STUDENTS BY AUGMENTED REALITY SIMULATION SYSTEM

Background

Educational methods for improving communication with dementia patients are lacking. Our study aimed to evaluate the efficacy of simulated communication skills training for nursing students using augmented reality (AR).

Methods

A randomized controlled study. 25 nursing students enrolled and learned standardized multimodal communication skills using textbooks. Participants were randomly assigned to AR training or conventional mannequin training group and each had one-hour training of basic nursing care. The mannequin of AR group was superimposed a computer graphic of an elderly woman's face, which reacts to participants' communication. Further, participants’ gaze and voice were evaluated by artificial intelligence (AI) and the participants received real-time feedback to their head-mounted display. The conventional group had the self-training with nursing mannequins. Participants performed basic nursing care to simulated patients before and after training, which were video-recorded by eye-tracking cameras and fixed cameras, then the videos were analyzed by AI. The primary outcome was the proportion of eye contact, verbal, and multimodal communication time during the care to simulated patients. Additionally, participants' empathy was evaluated by the Jefferson Scale.

Results

The interactive communication in AR group significantly increased than conventional group (eye contact 13.6% versus 4.4%, verbal communication 27.7% versus 20.1%, multimodal communication 9.6% versus 3.8%, P&lt; 0.05, respectively). The empathy score significantly increased in AR group, whereas it decreased in conventional group [Mean (SD): 9.1 (6.6) versus -1.3 (3.8), P&lt; 0.01].

Conclusions

The simulated communication skills training for nursing students using AR was associated with increased interactive communication skills and empathy to patients.

Non-goal driven eye movement after a visual search task

We investigated the functions and mechanisms of non-goal-driven eye movements, which are defined as eye movements induced when looking at visual stimuli on a display without engaging in a specific task or looking at a display without any visual stimuli or tasks. In our experiment, participants were asked to perform a visual search task on a display, which was followed by a rest period in which stimuli remained on the display or all stimuli were erased. During the rest period, the participants were asked to only look at the displays without engaging in any visual or cognitive tasks. We mainly analyzed the gaze-shift patterns in both task and rest periods, in which eye movements were classified in accordance with the angles of saccade directions in two consecutive saccades. The results indicate a significant difference between goal-driven eye movements, which were observed in the task period, and non-goal-driven eye movements, which were observed in the rest period. Scanning gaze-shift patterns dominated the task period, and backward and corrective-saccade-like gaze-shift patterns dominated the rest period. The gaze-shift pattern was affected by the task-difficulty during the task period. From these findings, we propose a model describing the oculomotor system in terms of goal-driven and non-goal-driven eye movements. In this model, the engagement levels of top-down and bottom-up control change along with task difficulty and are affected by the gaze-shift patterns during a visual search task. Decoupling of top-down control from the oculomotor system during a rest period induces backward saccades, resulting in fixation around the central part of a display. Therefore, we suggest that non-goal-driven eye movements play a crucial role in maintaining the readiness of the oculomotor system for the next search task.

Factors associated with SARS-CoV-2 antibody titers and prognosis of breakthrough infection in hemodialysis patients

BACKGROUND

The mortality rate of Coronavirus disease 2019 (COVID-19) is extremely high in hemodialysis patients (HDP). These patients also develop lower antibody titers after vaccination. Therefore, factors associated with antibody titers and vaccine efficacy in HDP with breakthrough infection need to be investigated.

METHODS

We measured anti-S1 antibody titers in HDP (n = 104) and controls (n = 35), evaluating the influence of background on HDP by multivariable regression analysis. We classified 26 HDP patients admitted with COVID-19 into the unvaccinated (n = 15) and breakthrough infection group (n = 11), performing between-group comparisons of laboratory findings and prognosis. Vaccinated COVID-19 patients were classified into HDP and non-HDP controls, and compared the relationship between antibody titer and severity, and the prognosis of breakthrough infection.

RESULTS

The antibody titer was significantly lower in the HDP group than in the control group. Among HDP, age and smoking history were significantly independent factors associated with antibody titer. The breakthrough infection group had significantly better laboratory findings (KL-6 and LDH), severity, and hospitalization period than the unvaccinated group even if antibody titers were lower than the known threshold for neutralization (p < 0.05). There was no significant difference in prognosis between the HDP and non-HDP with breakthrough infection. Severity of COVID-19 tended to be higher with lower antibody titer in non-HDP, but not in HDP.

CONCLUSION

Vaccines improved the severity of COVID-19 and hospitalization period of breakthrough infection in HDP, although HDP, especially in elderly smokers had lower antibody titers than control. There was no significant association between antibody titer and severity in HDP.

[A Case of Fournier's Gangrene during Second-Line IRIS plus Bevacizumab Chemotherapy for Rectal and Anal Canal Cancer]

A 52-year-old man diagnosed with Stage ⅢA rectal and anal canal cancer underwent abdominal perineal resection using Miles's method. Two years later, local recurrence and lung metastases were detected using contrasted CT imaging. First-line chemotherapy of XELOX was administered for 4 months until the disease progressed and lung metastases developed. After 4 courses of second-line IRIS plus bevacizumab chemotherapy, fever and swelling of the right buttock appeared; he visited and was admitted to our hospital. A CT scan revealed a pelvic abscess which resulted in septic shock. Swelling and pain extended to the right scrotum, and acute necrotizing fasciitis was suspected, and emergency surgery was performed. An incision was made from the right buttock to the right scrotum, bloody purulent drainage with a foul odor was observed, and a diagnosis of Fournier's gangrene was made. Although typical CT findings such as emphysema due to gas-producing bacteria were not observed in this case, early diagnosis and intervention of systemic management including early surgical drainage and operation were effective. For pelvic infections occurring during bevacizumab chemotherapy, Fournier's gangrene should considered for differential diagnosis, even if CT findings are atypical.

Identification of diverticular bleeding needs early colonoscopy rather than preparation

Background and study aims  When patients present with acute colonic diverticulum bleeding (CDB), a colonoscopy is performed to identify stigmata of recent hemorrhage (SRH), but valuable time can be lost in bowel preparation. This study retrospectively examined groups of patients who either had a standard pre-colonoscopy regimen or no preparation. Patients and methods  This study compared data from 433 patients who either followed a lengthy regimen of bowel preparation (prepared group, 266 patients) or had no preparation (unprepared group, 60 patients). We compared the association between time (hours) between admission before starting a colonoscopy (TMS) and identification of SRH using a chi-square test. Results  In 48 of 60 cases (80.0 %) in the unprepared group, a total colonoscopy was performed and the time to identify SRH was decreased. The respective rates of SRH identification in the unprepared and prepared groups were 55.2 % (16/29) vs. 46.7 % (7/15) if the TMS was < 3 hours; 47.1 % (8/7) vs. 36.8 % (35/95) in 3 to 12 hours; 0 % (0/3) vs. 22.0% (13/59) in 12 to 18 hours; and 21.8 % (3/11) vs. 20.6% (42/204) in > 18 hours. There were no significant differences between the two groups. However, the SRH identification rates before and after 12 hours were 42.3 % (66/156) and 20.9 % (58/277) ( P  < 0.001). Conclusions  Our data suggest that the bowel preparation method before colonoscopy is an independent variable predicting success in identifying SRH among patients with CDB. Decreasing the time before colonoscopy to no more than 12 hours after admission played an important role in identifying SRH.

Development of educational system for paramedics specializing to dementia elderlies analyzed by artificial intelligence and its learning effects

BACKGROUND

While the number of emergency transfer of dementia elderlies to acute care hospitals has being increasing, paramedics are facing challenges to perform their duties promptly due to difficult communication with patients.

OBJECTIVES

To develop the standardized educational system for paramedics specializing to dementia elderlies with the use of artificial intelligence.

DESIGN

Single arm, pre-post study. Participants are paramedics in a metropolitan area of Japan.

EXPOSURE

The two sessions of standardized multimodal communication training program which contains lecture and workshop were provided twice, 1 month apart. The training consists three parts. 1: Mechanism and clinical manifestations of dementia, 2: Communication skills: face-to-face interaction; mutual gaze, geometric characteristics and duration of eye contact, verbal communication with phonetic elements, and touch interactions. 3: Interaction strategies with dementia elderlies in emergency situation. All participants performed the rescue simulation training before the training and 1 month after the completion of the training, which were video-recorded and analyzed by artificial intelligence (AI). The video was taken by wearable camera with eye-trackers (1^st person camera) and fixed camera (3^rd person camera). The satisfaction survey of effectiveness on their work and the Jefferson Scale of Empathy for healthcare professionals were also taken.

MAIN OUTCOMES

The primary outcome is the change of communication skills in physical position, distance, eye contact with patients, phonetic elements and touch. The system to analyze face-to-face communication; mutual gaze, geometric characteristics and duration of eye contact by AI was developed by our team. Other elements of communications were evaluated manually. Secondary outcome were satisfaction and the empathy to patients.

RESULT

31 paramedics enrolled the study. Prior to the training, 88% had experienced any difficult condition taking care of dementia patients. The video analysis showed significant change of the interactive communication in the direction of approach, eye contacts and duration of mutual gaze. 96.7% considered the training was effective for their daily work and 97.5% of participants recommended this training to a colleague. The score of empathy scale showed no significant change.

CONCLUSION

The educational system for paramedics specializing to dementia with the use of artificial intelligence is effective for their work.

Technical Challenges for Smooth Interaction With Seniors With Dementia: Lessons From Humanitude™

Due to cognitive and socio-emotional decline and mental diseases, senior citizens, especially people with dementia (PwD), struggle to interact smoothly with their caregivers. Therefore, various care techniques have been proposed to develop good relationships with seniors. Among them, Humanitude is one promising technique that provides caregivers with useful interaction skills to improve their relationships with PwD, from four perspectives: face-to-face interaction, verbal communication, touch interaction, and helping care receivers stand up (physical interaction). Regardless of advances in elderly care techniques, since current social robots interact with seniors in the same manner as they do with younger adults, they lack several important functions. For example, Humanitude emphasizes the importance of interaction at a relatively intimate distance to facilitate communication with seniors. Unfortunately, few studies have developed an interaction model for clinical care communication. In this paper, we discuss the current challenges to develop a social robot that can smoothly interact with PwDs and overview the interaction skills used in Humanitude as well as the existing technologies.

[Incidence of Secondary Malignancy of Chronic Myeloid Leukemia during Treatment of Breast Cancer with Hormone Therapy]

It is expected that the number of long-term breast cancer survivors will increase owing to the improvements in chemotherapy and irradiation, while the risk of double cancers, including secondary malignancy, may become an issue. There are many unclear points in the treatment policy with regard to when a secondary malignancy occurs or the primary cancer relapses during the management of a secondary malignancy. A 54-year-old woman who was diagnosed with ER/PgR-positive HER2 negative breast cancer Stage ⅢB received neoadjuvant chemotherapy FEC and docetaxel followed by breast surgery, adjuvant hormone therapy, and radiation therapy. Chronic myeloid leukemia diagnosed by the abnormal findings of leukocytosis and bone marrow aspiration emerged after 3 years of the diagnosis of the first breast cancer. After 3 years of imatinib therapy that achieved a major molecular response(MMR)of CML, a recurrence of sacral metastasis of breast cancer was revealed by MRI. The combination of imatinib and hormone or S-1 chemotherapy could be maintained without serious adverse events after the relapse of the primary cancer.

[A Case of Recurrent Premenopausal Hormone Receptor Positive Breast Cancer with Liver, Lung and Bone Metastasis Successfully Treated with Endocrine Therapy]

Here we report a 48-year-old female with recurrent breast cancer. She had received chest muscle-conserving mastectomy and lymph node dissection at another hospital, diagnosed as pStage ⅡB, T2N1M0 premenopausal left endocrine positive/ HER2 negative breast cancer at the age of 45. Although postoperative adjuvant therapy was started with LH-RH agonist plus tamoxifen, and chest radiation, tamoxifen therapy was intolerantly discontinued due to severe adverse events of hot flash after 1 year later. Three years later, she presented with back pain and was referred to our hospital. As PET-CT revealed recurrence of multiple bone and lung metastases and solitary liver metastasis which did not seem to be life-threatening, palliative radiation therapy and endocrine therapy with leuprorelin and anastrozole(LA)were started. Eighteen months later, PET-CT showed complete disappearance of liver and lung metastases and remarkable regression of bone metastases except for the right sciatic bone. LA therapy could be maintained for a total of 30 months until metastatic recurrence on liver and bone emerged. LA endocrine therapy may be effective for patients with premenopausal hormone-positive breast cancer even if the difficult situation such as tamoxifen intolerance.

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.