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Some situations may require endoscopy during the COVID‐19 (Coronavirus Disease 2019) pandemic. Here, we describe the necessary precautions in the form of clinical questions and answers (Q&A) regarding the safe deployment of gastrointestinal endoscopy in such situations while protecting endoscopy staff and patients from infection. Non‐urgent endoscopy should be postponed. The risk of infection in patients should be evaluated in advance by questionnaire and body temperature. The health of staff must be checked every day. Decisions to employ endoscopy should be based on the institutional conditions and aims of endoscopy. All endoscopic staffs need to wear appropriate personal protective equipment (PPE). The endoscope and other devices should be cleaned and disinfected after procedures in accordance with relevant guidelines. Optimal management of the endoscopy unit is required. Endoscopy for infected patients or those with suspected infection demands exceptional caution. When a patient who undergoes endoscopy is later found to have COVID‐19, the members of staff involved are considered exposed to the virus and must not work for at least 14 days if their PPE is considered insufficient. When PPE resources are limited, some equipment may be used continuously throughout a shift as long as it is not contaminated. Details of the aforementioned protective measures are described.

Additional file 1: Table S1. Key inclusion and exclusion criteria. Figure S1. SLFN11 sensitizes cancer cells to nedaplatin and carboplatin but not 5-fluorouracil. (A–C) Viability curves of the indicated cell lines after continuous treatment for 72 h with the indicated agents (carboplatin, nedaplatin, and 5-fluorouracil). ATP concentration was measured to estimate cell viability. The viability of untreated cells was defined as 100%. Error bars represent standard deviation (n = 3). Human leukemia CCRF-CEM SLFN11-proficient [parent] and -deficient [SLFN11-KO], and K562 SLFN11-deficient [K562 + vector] and -proficient [K562 + SLFN11] cell lines were established previously [18, 20, 31]. Figure S2. Inverse correlation between DNA methylation and transcripts of SLFN11. Scatter plot shows the level of SLFN11 methylation in the promoter region (y-axis) and its mRNA expression level (Log2, x-axis) in esophageal squamous cell carcinoma cell lines within the dataset Sanger/MGH GDSC ( http://discover.nci.nih.gov/cellminercdb ). Pearson’s correlation coefficient (r) and two-sided P value (p) are shown above the chart. (PPTX 326 kb)

Objective To present results of the Kyoto Global Consensus Meeting, which was convened to develop global consensus on (1) classification of chronic gastritis and duodenitis, (2) clinical distinction of dyspepsia caused by Helicobacter pylori from functional dyspepsia, (3) appropriate diagnostic assessment of gastritis and (4) when, whom and how to treat H. pylori gastritis. Design Twenty-three clinical questions addressing the above-mentioned four domains were drafted for which expert panels were asked to formulate relevant statements. A Delphi method using an anonymous electronic system was adopted to develop the consensus, the level of which was predefined as ≥80%. Final modifications of clinical questions and consensus were achieved at the face-to-face meeting in Kyoto. Results All 24 statements for 22 clinical questions after extensive modifications and omission of one clinical question were achieved with a consensus level of >80%. To better organise classification of gastritis and duodenitis based on aetiology, a new classification of gastritis and duodenitis is recommended for the 11th international classification. A new category of H. pylori -associated dyspepsia together with a diagnostic algorithm was proposed. The adoption of grading systems for gastric cancer risk stratification, and modern image-enhancing endoscopy for the diagnosis of gastritis, were recommended. Treatment to eradicate H. pylori infection before preneoplastic changes develop, if feasible, was recommended to minimise the risk of more serious complications of the infection. Conclusions A global consensus for gastritis was developed for the first time, which will be the basis for an international classification system and for further research on the subject.

本研究では、因子分析と因果モデル生成との効率的な統合を目標に、因子をランダム・サンプリングで構成し、それらの因子間の因果モデルを、因子間の固定した因果関係を与えた場合と、ベイジアン・ネットワークでデータから動的に構成した場合の2通りの方法で自動探索を試みた。対象としたデータは、2014年に群馬県内の2つの中学校で、技術の「計測と制御」単元で実施した、コンピュータと情報および問題解決に関する意識調査への回答である。因子の総数を4つとして、1,000万回のランダム・サンプリングで全探索空間の0.13％ずつを探索したところ、30～130通りの因果モデルが生成された。因果関係の終端ノードを「プログラミングが好き」とした場合、4因子の因果モデルでは1モデルの統計的妥当性が確認された。が、「IT・理工系職業への関心」を終端ノードとした場合は、妥当なモデルが生成されなかった。得られたモデルの内容は、教材研究上の有益な示唆を与えるものであった。探索空間の広さをいかに制限するかが課題である。

本研究では、電子黒板と実物投影機を使った授業を小学校６年生の算数科で実践し、「ICT活用ハンドブック」\n（コンピュータ教育開発センター 2007）で示される効果について追試した。ハンドブックにおいてICTの活用の\n効果として示された「関心・意欲」「知識・理解」「思考力・判断力」の観点別評価での効果について、児童のア\nンケート調査及び客観テストの結果から分析を行った。その結果、「関心・意欲」と「思考力・判断力」はハンド\nブックと同様、ICTの効果が認められた。しかし、「知識・理解」ではICTを用いない場合との違いは示されなかっ\nた。その原因について検討すると同時に、ICTの児童同士のコミュニケーションを促進する効用について論じる。

Mitsushige Sugimoto1, Takahisa Furuta21First Department of Medicine, 2Center for Clinical Research, Hamamatsu University School of Medicine, Shizuoka, JapanAbstract: Esomeprazole (Nexium®; AstraZeneca), the S-isomer of omeprazole, is the first proton pump inhibitor (PPI) to be developed as an optical isomer. Compared with omeprazole, esomeprazole has an improved pharmacokinetic profile with regards to CYP2C19 (S-mephenytoin 4'-hydroxylase) genotype, showing increased systemic exposure and less interindividual variability. Further, esomeprazole is a more potent acid inhibitor than other currently available PPIs and is therefore used as a first-line drug for acid-related diseases. While esomeprazole has been available in a number of countries worldwide, the compound only received authorized permission to be marketed in Japan in September 2011. The standard esomeprazole dose in Japan for the treatment of peptic ulcers and gastroesophageal reflux disease (GERD) is 20 mg. Other advised dosages are 10 mg for nonerosive reflux disease and 20 mg twice-daily dosing for eradication of Helicobacter pylori. In Japanese, the effective rate of esomeprazole 20 mg during 24 weeks for GERD patients is 92.0% (88.0%–96.0%), while the prevention of peptic ulcer development using 20 mg for 24 weeks in patients treated with nonsteroidal anti-inflammatory drugs is 96.0% (92.8%–99.1%). Although clinical data are limited, the usefulness of esomeprazole is expected in Japanese subjects given the reduced prevalence of CYP2C19 rapid metabolizers in Japan compared with Western countries.Keywords: esomeprazole, PPI, CYP2C19, peptic ulcer, GERD, H. pylori

Endoscopic submucosal dissection (ESD) is a novel endoscopic procedure first developed in the 1990s which enables en bloc resection of gastric neoplastic lesions that are difficult to resect via conventional endoscopic mucosal resection. However, given that ESD increases the risk of intra- and post-ESD delayed bleeding and that platelet aggregation and coagulation in artificial ulcers after ESD strongly depend on intragastric pH, faster and stronger acid inhibition via proton pump inhibitors (PPIs) and histamine 2-receptor antagonists (H2RAs) as well as endoscopic hemostasis by thermocoagulation during ESD have been used to prevent ESD-related bleeding. Because PPIs more potently inhibit acid secretion than H2RAs, they are often the first-line drugs employed in ESD treatment. However, acid inhibition after the initial infusion of a PPI is weaker in the early phase than that achievable with H2RAs; further, PPI effectiveness can vary depending on genetic differences in CYP2C19. Therefore, optimal acid inhibition may require tailored treatment based on CYP2C19 genotype when ESD is performed, with a concomitant infusion of PPI and H2RA possibly most effective for patients with the rapid metabolizer CYP2C19 genotype, while PPI alone may be sufficient for those with the intermediate or poor metabolizer genotypes.