Kagawa University

Objectives: In the midst of the coronavirus disease 2019 (COVID-19) infection pandemic, practitioners who perform endoscopic examinations need to prevent infections through procedures, along with routine medical care. By using continuous suction, Endo barrier is thought to be effective in preventing the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) droplets and aerosols. The study aimed to evaluate patient discomfort and satisfaction with the use of the Endo barrier during esophagogastroduodenoscopy (EGD). The study evaluated the system's effectiveness as well as the system's preparation time and the amount of burden on the medical staff. Methods: EGD was performed on 788 consecutive cases using the Endo barrier. A questionnaire was used to survey patients after the procedure on four points: discomfort (feeling of pressure, breathlessness) and good points (feeling of relief and satisfaction) using a visual analog scale. In addition, patients were divided into two groups according to sedation status: with sedation (69.7%) and without sedation (30.3%), and their scores were compared. Additionally, the preparation time of the Endo barrier was measured. Results: Patient discomfort was reported as minimal, resulting in a high level of satisfaction using this system. Although the overall results were better in the sedation group, the overall evaluation of the non-sedated group was also favorable. Furthermore, preparation time (30 s) was less burdensome for medical staff. Conclusion: The Endo barrier is an easy-to-implement tool to prevent COVID-19 infection in private clinics, and both patients and staff were highly satisfied with the device with or without the use of sedation during EGD.

While power shortages during and after a natural disaster cause severe impacts on response and recovery activities, related modeling and data collection efforts have been limited. In particular, no methodology exists to analyze long-term power shortages such as those that occurred during the Great East Japan Earthquake. To visualize a risk of supply shortage during a disaster and assist the coherent recovery of supply and demand systems, this study proposes an integrated damage and recovery estimation framework including the power generator, trunk distribution systems (over 154 kV), and power demand system. This framework is unique because it thoroughly investigates the vulnerability and resilience characteristics of power systems as well as businesses as primary power consumers observed in past disasters in Japan. These characteristics are essentially modeled by statistical functions, and a simple power supply-demand matching algorism is implemented using these functions. As a result, the proposed framework reproduces the original power supply and demand status from the 2011 Great East Japan Earthquake in a relatively consistent manner. Using stochastic components of the statistical functions, the average supply margin is estimated to be 4.1%, but the worst-case scenario is a 5.6% shortfall relative to peak demand. Thus, by applying the framework, the study improves knowledge on potential risk by examining a particular past disaster; the findings are expected to enhance risk perception and supply and demand preparedness after a future large-scale earthquake and tsunami disaster.

Objective: The Paris System for Reporting Urinary Cytology considered the nuclear-to-cytoplasmic (N:C) ratio as the most important cytomorphological feature for detecting high-grade urothelial carcinoma (HGUC) cells. Few quantitative studies have been conducted on other features although quantitative studies on the N:C ratio have been reported. Therefore, this study quantitatively analysed important cytomorphological features in distinguishing benign reactive cells from HGUC cells. Methods: We analysed 2866 cells from the urine of 52 patients. A digital image analyser was used to quantitatively measure the nuclear area, cell area, N:C ratio, and nuclear roundness for HGUC cells and benign reactive cells. Additionally, the diagnostic value of quantitative cytomorphological criteria in HGUC cells was evaluated by the receiver operating characteristic curve. Results: The area under the curve for the prediction of HGUC cells for all cells and the top five cells was in the following order: nuclear area (0.920 and 0.992, respectively), N:C ratio (0.849 and 0.977), cell area (0.781 and 0.920), and nuclear roundness (0.624 and 0.605). The best cutoff value of the N:C ratio to differentiate HGUC cells from benign reactive cells was 0.438, and using the N:C ratio of 0.702, the positive predictive value obtained was 100%. Conclusions: Our study indicated that nuclear area is a more important cytomorphological criterion than the N:C ratio for HGUC cell detection. Moreover, extracted data of the top five cells were more valuable than the data of all cells, which can be helpful in the routine practice and future criteria definition in urine cytology.

Natural warning signs and self-evacuation are essential to save lives in the event of a tsunami caused by an earthquake, especially if there are no clear early signs for example ground shaking. This paper explores the participants’ experiences focusing on how participants’ perceptions and responses to what they felt, saw or heard before seeing the first wave of 2006 tsunami in Cilacap, Indonesia. Using a phenomenological approach, this paper analyzes the stories of ten participants in three sub-districts, namely Cilacap Selatan, covering islands of Nusakambangan, Adipala, and Binangun. The tsunami was caused by a slow-motion earthquake, so people did not feel the ground shaking. The participants did not recognise natural signs of a tsunami, so they ignored them. Before seeing the first wave, the witness heard sound of explosions, extreme low tide, unusual animal behavior around, the appearance of a large number of marine products – lobsters (Crustacea) and sea shells (Mytilus spp.), and unusual color and shape of the waves. These signs should be socialised to the community in tsunami-prone areas, thereby increasing community’s disaster mitigation capacity. This study presents some natural warning signs that have not been reported by previous studies.

Trewia nudiflora Linn. is a woody plant of the Euphorbiaceae family. It is well known for its use as a folk remedy, but its potential for phytotoxicity has not been explored. Therefore, this study investigated the allelopathic potential and the allelopathic substances in T. nudiflora leaves. The aqueous methanol extract of T. nudiflora was found to have a toxic effect on the plants used in the experiment. The shoot and root development of lettuce (Lactuca sativa L.) and foxtail fescue (Vulpia myuros L.) were significantly (p ≤ 0.05) reduced by the T. nudiflora extracts. The growth inhibition by the T. nudiflora extracts was proportional to the extract concentration and varied with the test plant species. The chromatographic separation of the extracts resulted in the isolation of two substances, identified as loliolide and 6,7,8-trimethoxycoumarin based on their respective spectral analyses. Both substances significantly inhibited lettuce growth at a concentration of 0.01 mM. To inhibit 50% of the growth of the lettuce, the required concentration of loliolide was 0.043 to 0.128 mM, while that of 6,7,8-trimethoxycoumarin was 0.028 to 0.032 mM. Comparing these values, the lettuce growth was more sensitive to 6,7,8-trimethoxycoumarin than loliolide, suggesting that 6,7,8-trimethoxycoumarin was more effective than loliolide. Therefore, the inhibition of the growth of the lettuce and foxtail fescue suggests that loliolide and 6,7,8-trimethoxycoumarin are responsible for the phytotoxicity of the T. nudiflora leaf extracts. Thus, the growth-inhibitory effectiveness of the T. nudiflora extracts and the identified loliolide and 6,7,8-trimethoxycoumarin may be used to develop bioherbicides that restrict the growth of weeds.

Sarcopenia-related factors, including the skeletal muscle index (SMI), are reportedly associated with prognosis in patients with hepatocellular carcinoma (HCC) receiving various treatments. However, there is no evidence relating to hepatic arterial infusion chemotherapy (HAIC). In this study, we investigated whether a low SMI was associated with worse clinical outcomes of HAIC. Seventy patients with advanced HCC were included. Clinical outcomes were compared between the decreased SMI (n = 27) and non-decreased SMI (n = 43) groups, which were classified according to changes in the SMI after 3 weeks of treatment. In the prognostic analysis, patients in the decreased SMI group had significantly shorter progression-free and overall survival (OS) than those in the non-decreased SMI group. In addition, poor nutritional status and liver function were associated with an immediate decrease in the SMI after HAIC. The therapeutic effect was worse in the decreased SMI group than in the non-decreased SMI group, although the incidence of adverse events did not significantly differ. In multivariate analysis, a decreased SMI at 3 weeks after HAIC was identified as a significant independent factor associated with OS. A decreased SMI in patients with advanced HCC undergoing HAIC was associated with poor prognosis. It is effective to monitor the SMI to evaluate general conditions and predict clinical outcomes.

Objective To evaluate the prevention and development of cervical cancer in SLE patients in Japan and its background based on a questionnaire survey. Methods The questionnaire was handed to 460 adult female SLE patients at 12 medical institutions. The participants were grouped by age, and data related to their HPV vaccination status, age at first coitus, cervical cancer screening, and diagnosis of cervical cancer were analyzed. Results A total of 320 responses were received. Patients aged 35–54 years included a higher proportion of patients whose age at first coitus was <20 years. This group also showed a higher rate of cervical cancer/dysplasia. Only 9 patients had a HPV vaccination history. Adequate frequency of cervical cancer screening was slightly higher (52.1%) among SLE patients than in the Japanese general population. However, 23% of the patients had never undergone examination, primarily because of a feeling of troublesome. The incidence of cervical cancer was significantly higher among SLE patients. One reason for this may be associated with the use of immunosuppressants, although the difference was not significant. Conclusion SLE patients are at a higher risk of cervical cancer and dysplasia. Rheumatologists should proactively recommend vaccination and screening examinations for SLE female patients.

Wisdom tooth extraction is one of the most commonly performed procedures by oral maxillofacial surgeons. Delayed-onset infection (DOI) is a rare complication of wisdom tooth extraction, and it occurs ~1–4 weeks after the extraction. In the present study, risk factors for DOI were investigated by retrospectively analyzing the cases of 1400 mandibular wisdom tooth extractions performed at Kagawa University Hospital from April 2015 to June 2022. Inclusion criteria were patients aged >15 years with a wisdom tooth extraction per our procedure. The exclusion criteria were patients with insufficient medical records, a >30-mm lesion around the wisdom tooth shown via X-ray, colonectomy, radiotherapy treatment of the mandible, the lack of panoramic images, and lesions other than a follicular cyst. The DOI incidence was 1.1% (16 cases), and univariate analyses revealed that the development of DOI was significantly associated with the Winter classification (p = 0.003), position (p = 0.003), hypertension (p = 0.011), and hemostatic agent use (p = 0.004). A multivariate logistic regression analysis demonstrated that position (OR = B for A, 7.75; p = 0.0163), hypertension (OR = 7.60, p = 0.013), and hemostatic agent use (OR = 6.87, p = 0.0022) were significantly associated with DOI development. Hypertension, hemostatic use, and position were found to be key factors for DOI; long-term observation may thus be necessary for patients with these risk factors.

Background and aim: To evaluate the efficacy and safety of a grasping-type knife, called Clutch Cutter (CC), for colorectal endoscopic submucosal dissection (C-ESD). Methods: This was a randomized prospective study. Patients who underwent C-ESD for colorectal neoplasms >20 mm and <50 mm in size were enrolled, dividing into two groups: ESD using needle type of dual knife alone (D-group) and circumferential incision using dual knife followed by submucosal dissection using CC (CC-group). The primary outcome was the self-completion rate. The secondary outcomes were intraoperative complication rate, procedure time, and en bloc resection rate. Results: A total of 45 patients were allocated to the D-group and 43 to the CC-group were allocated. The self-completion rate was higher in the CC-group (87% [39/45] vs. 98% [42/43]). All of the six patients with an incomplete procedure in the D-group were completely resected with CC use. The intraoperative complication rate was not significant in either group (D vs. CC: 2% vs. 0%). The mean procedure time was significantly shorter in the D-group than that in the CC-group (62.0 vs. 81.1 min; p = 0.0036). The en bloc resection rate was 100% in the D-group and 98% in the CC-group. Conclusions: While dual knife use is superior to CC in terms of time efficiency, the use of CC may be a safe and efficacious option for achieving complete C-ESD.

Background: Atezolizumab plus bevacizumab has recently been approved as a new first-line standard of care for patients with unresectable hepatocellular carcinoma (HCC). Objective: We performed a real-world study to evaluate the impact of the IMbrave150 trial inclusion criteria on the safety and efficacy of treatment outside of clinical trials. Methods: We analyzed patients treated with atezolizumab plus bevacizumab for unresectable HCC from four different countries. No specific inclusion and exclusion criteria were applied, except for the absence of previous systemic therapies for HCC. The entire population was split into two groups according to concordance with the inclusion criteria as reported in the IMbrave150 trial in 'IMbrave150-in' and 'IMbrave150-out' patients, and safety and efficacy in the two groups of patients were evaluated. Results: Overall, 766 patients were included in the analysis: 561/766 (73%) in the 'IMbrave150-in' group and 205/766 (27%) in the 'IMbrave150-out' group. Median overall survival (OS) and median progression-free survival (PFS) were 16.3 versus 14.3 months (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.35-0.65; p < 0.0001] and 8.3 versus 6.0 months (HR 0.79, 95% CI 0.63-0.99; p = 0.0431) in 'IMbrave150-in' and 'IMbrave150-out' patients, respectively. Multivariate analysis confirmed that patients included in the 'IMbrave150-in' group had significantly longer OS compared with patients included in the 'IMbrave150-out' group (HR 0.76, 95% CI 0.47-0.97; p = 0.0195). In 'IMbrave150-in' patients, the albumin-bilirubin (ALBI) grade was not associated with OS, whereas in 'IMbrave150-out' patients, those with ALBI grade 1 reported a significant benefit in terms of OS compared with those with ALBI grade 2 (16.7 vs. 5.9 months; HR 4.40, 95% CI 2.40-8.08; p > 0.0001). No statistically significant differences were reported in the 'IMbrave150-in' and 'IMbrave150-out' groups in terms of safety profile. Conclusion: Adherence to the IMbrave150 trial inclusion criteria favorably impacts the prognosis of patients receiving atezolizumab plus bevacizumab. Among patients who did not meet the IMbrave150 inclusion criteria, those with ALBI grade 1 could benefit from the treatment.

Rotating bending fatigue tests were performed to investigate the effect of induction hardening (HQI) on the very high cycle fatigue (VHCF) properties of the axle steel. In addition, finite element analyses (FEA) and scanning electron microscope (SEM) observations were conducted to elucidate the fundamental behavior. The results obtained are summarized as follows; (1) It was found that the fatigue strength of the axle steel was improved by almost 300 MPa in VHCF region by HQI, (2) A lot of specimens of the HQI had fractured in VHCF region, therefore, the consideration of VHCF properties should be taken into account in the design of railway axles, (3) Crack initiation sites can be classified into three forms; the surface of the HQI layer in the minimum section, the base metal beyond the HQI layer in the axial direction, and the internal base material in the minimum section. These can be reconfirmed through the comparison between the local fatigue strength distribution and the bending stress distribution obtained by FEA.

The phenol-sulfuric acid (PSA) method is a widely used colorimetric method for determining the total saccharides, which is simple and rapid. Microplate-based PSA methods have been developed to handle a large number of samples and reduce the use of hazardous chemicals. However, the optimal procedures and measurement conditions for this method have not yet been fully established. To address this gap, we investigated the optimal procedure for microplate-based PSA. In addition to glucose (Glc), two types of cellulose nanofibers (CNFs) were also evaluated as they are a new type of nanomaterial, and a technique to quantify the concentration of CNFs is required in their safety assessment. The results showed that the thermal reaction with sulfuric acid before the addition of phenol resulted in a higher coloration than was shown after the addition of phenol. Furthermore, the longer the resting time after shaking with phenol, the greater the coloration and the smaller the variation, with a resting time of 60 min or longer being optimal. Overall, this study demonstrated that the optimized microplate-based PSA method can be used for the multi-sample measurements of CNFs and Glc, with a detection limit of < 8 mg/L. This research provides valuable insights into improving the reliability and efficiency of the PSA method, which can facilitate the analysis of saccharides and other substances in a range of applications.

Let X be a simple normal crossing (SNC) compact complex surface with trivial canonical bundle which includes triple intersections. We prove that if X is d -semistable, then there exists a family of smoothings in a differential geometric sense. This can be interpreted as a differential geometric analogue of the smoothability results due to Friedman, Kawamata-Namikawa, Felten-Filip-Ruddat, Chan-Leung-Ma, and others in algebraic geometry. The proof is based on an explicit construction of local smoothings around the singular locus of X , and the first author’s existence result of holomorphic volume forms on global smoothings of X . In particular, these volume forms are given as solutions of a nonlinear elliptic partial differential equation. As an application, we provide several examples of d -semistable SNC complex surfaces with trivial canonical bundle including double curves, which are smoothable to complex tori, primary Kodaira surfaces, and K 3 surfaces. We also provide several examples of such complex surfaces including triple points, which are smoothable to K 3 surfaces.

Background: CD44 and CD44 variant isoforms have been reported as contributing factors to cancer progression. In this study, we aimed to assess whether CD44 and its variant isoforms were correlated with the prognostic factors for distant metastasis in stage I lung adenocarcinomas using tissue microarray and immunohistochemistry. Methods: In this single-center retrospective study, we analyzed the data of 490 patients with stage I lung adenocarcinoma resected between 1999 and 2016. We constructed tissue microarrays and performed immunohistochemistry for CD44s, CD44v6, and CD44v9. The risk of disease recurrence and its associations with clinicopathological risk factors were assessed. Results: CD44v6 expression was significantly associated with recurrence. Patients with CD44v6-negative tumors had a significantly increased risk of developing distant recurrence than patients with CD44v6-positive tumors (5-year cumulative incidence of recurrence (CIR), 10.7% vs. 4.6%; P = 0.009). However, CD44v6-negative tumors were not associated with an increased risk of locoregional recurrence compared to CD44v6-positive tumors (5-year CIR, 6.0% vs. 4.0%; P = 0.39). The overall survival (OS) of patients with CD44v6-negative tumors was significantly lower than that of patients with CD44v6-positive tumors (5-year OS: 87% vs. 94%, P = 0.016). CD44v6-negative tumors were also associated with invasive tumor size and lymphovascular invasion. Conclusion: Even in stage I disease, tumors with negative-CD44v6 expression had more distant recurrences than those with positive-CD44v6 expression and were associated with poor prognosis in resected stage I lung adenocarcinomas. Thus, CD44v6 downregulation may be a prognostic factor for distant metastasis in stage I lung adenocarcinomas.

Background: Eating alone has been significantly associated with psychological distress. However, there is no research that evaluates the effects or relation of eating together online to autonomic nervous system functions. Methods: This is a randomized, open-label, controlled, pilot study conducted among healthy volunteers. Participants were randomized into either an eating together online group or an eating-alone group. The effect of eating together on autonomic nervous functions was evaluated and compared with that of the control (eating alone). The primary endpoint was the change in the standard deviation of the normal-to-normal interval (SDNN) scores among heart rate variabilities (HRV) before and after eating. Physiological synchrony was investigated based on changes in the SDNN scores. Results: A total of 31 women and 25 men (mean age, 36.6 [SD = 9.9] years) were included in the study. In the comparison between the aforementioned groups, two-way analysis of variance revealed interactions between time and group on SDNN scores. SDNN scores in the eating together online group increased in the first and second halves of eating time (F[1,216], P < 0.001 and F[1,216], P = 0.022). Moreover, high correlations were observed in the changes in each pair before and during the first half of eating time as well as before and during the second half of eating time (r = 0.642, P = 0.013 and r = 0.579, P = 0.030). These were statistically significantly higher than those in the eating-alone group (P = 0.005 and P = 0.040). Conclusions: The experience of eating together online increased HRV during eating. Variations in pairs were correlated and may have induced physiological synchrony. Trial registration: The University Hospital Medical Information Network Clinical Trials Registry, UMIN000045161. Registered September 1, 2021. https://center6.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000051592 .

The data acquired in civil engineering tasks often involve high acquisition costs, and the available datasets tend to have a limited number of samples and are highly biased. To estimate the performance of machine learning models, k‐fold cross‐validation (k‐CV) is widely used. However, if only limited data are available and the data distribution is biased, k‐CV tends to overestimate the performance for practical applications. This study proposed a new estimator, leave one reference out and k‐CV (LORO‐k‐CV), to determine the practical performance of machine learning models, that is, the generalization performance for population data in the target task, in case data are collected by multiple references resulting in biased data. LORO‐k‐CV is a combination of a new concept, LORO‐CV, that estimates the performance in the extrapolation region of the training data without human intervention and k‐CV, considering the ratio of the interpolation and extrapolation regions. The efficacy of LORO‐k‐CV was validated with its application to the regression task for the chloride‐ion concentration of concrete structures. To more specifically demonstrate the advantages of LORO‐k‐CV in model construction, the feature selections were conducted using both k‐CV and LORO‐k‐CV methods. These results revealed that LORO‐k‐CV can effectively construct a model with improved generalization performance even from the same data in cases where data are collected by multiple references, resulting in biased data.