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Abstract Background Ulcerative colitis (UC) causes extensive ulceration attributable to intestinal inflammation. This study investigated the effect of past extensive ulcers (PEUs) on fecal calprotectin (FC). Methods This retrospective, single-center, observational study included patients with UC with a Mayo endoscopic subscore of 0. UC with scarring or pseudopolyposis was defined as PEU and FC and fecal immunochemical occult blood test (FIT) values were compared. The marker levels of patients in the PEU and non-PEU groups were examined to assess clinical relapse within 12 months. Results Of the 61 included patients, 27 had UC with PEUs and 34 had UC without PEUs. Albumin, hemoglobin, and FIT values between groups were not significantly different; however, the C-reactive protein and FC values of the PEU group were significantly higher than those of the non-PEU group. The FC values of the clinical relapse and remission groups within 12 months differed significantly. The cutoff values for the prediction of relapse within 12 months for all patients (area under the curve [AUC], 0.709; 95% confidence interval [CI], 0.512–0.907) and the non-PEU group (AUC, 0.893; 95% CI, 0.724–1.000) were both 118 mg/kg. Conclusions UC patients with PEUs have higher FC values than those without PEUs, even in remission. Additionally, FC values do not predict relapse in PEU patients. Therefore, FC may not be a sufficiently accurate biomarker for patients with PEUs.

Abstract Background We aimed to compare the hydrodynamic values of carbon dioxide (CO2) and iodine contrast media for bleeding detection using an in vitro model. Materials and methods We created a bleeding model with large and small wounds in simulated blood vessels. We connected a syringe to the bleeding model and the blood pressure transducer, filling the circuit with CO2 and iodine contrast media. The syringe’s piston was pressed, and the flow rate and intravascular pressure of the CO2 and iodine contrast media leaking from the bleeding model were measured. We compared each leaked contrast medium’s volume, sphere-equivalent diameter, and sphere-equivalent area. These values were analyzed to compare the visibility of the leakage objectively. Results At a constant flow rate, the intravascular pressure required for the model to leak was lower for the CO2 than that for the iodine contrast medium. The CO2 contrast medium leakage volume, equivalent circle diameter, and equivalent circle area were greater than those of the iodine one. These values indicate higher CO2 visibility during fluoroscopy. Conclusions In the bleeding model, a CO2 contrast medium may be more prone to leakage than the iodine one in large and small wounds. Regarding visibility, a CO2 contrast medium may be more likely to detect leakage than an iodine one.

Abstract Predicting the therapeutic response to biologics before administration is a key clinical challenge in ulcerative colitis (UC). We previously reported a model for predicting the efficacy of vedolizumab (VDZ) for UC using a machine-learning approach. Ustekinumab (UST) is now available for treating UC, but no model for predicting its efficacy has been developed. When applied to patients with UC treated with UST, our VDZ prediction model showed positive predictive value (PPV) of 56.3% and negative predictive value (NPV) of 62.5%. Given this limited predictive ability, we aimed to develop a UST-specific prediction model with clinical features at baseline including background factors, clinical and endoscopic activity, and blood test results, as we did for the VDZ prediction model. The top 10 features (Alb, monocytes, height, MCV, TP, Lichtiger index, white blood cell count, MCHC, partial Mayo score, and CRP) associated with steroid-free clinical remission at 6 months after starting UST were selected using random forest. The predictive ability of a model using these predictors was evaluated by fivefold cross-validation. Validation of the prediction model with an external cohort showed PPV of 68.8% and NPV of 71.4%. Our study suggested the importance of establishing a drug-specific prediction model.

High population growth, a lack of wastewater treatment plants and poor wastewater management are major challenges in wastewater management in Timor-Leste (East Timor). One of the approaches of the government of Timor-Leste is to separate wastewater into greywater and blackwater from domestic, commercial, residential, and industrial areas. Three methods were applied to obtain insight into the locations and discharge of grey- and blackwater to develop a cost-effective wastewater strategy: a field survey and data collection, interviews with over 130 participants from local authorities and communities, and the open-source mapping of locations of wastewater discharge. This research concluded that 47.7% of the grey wastewater is discharged into open sewers connected directly to the sea. Most communities discharge their wastewater directly due to the absence of wastewater management, policies and regulations, and lack of communities’ understanding of the possible health impacts of wastewater. The impact of poor wastewater management showed that most of the children in these communities have suffered from diarrhea (73.8%), and in the rainy season, there is a high possibility of infection with waterborne diseases. The literature review, field mapping, and interviews show that there is high demand for a cost-effective wastewater strategy for health improvement. Low-cost nature-based solutions such as constructed wetlands and bioswales can be implemented with local skills and materials to improve the wastewater situation and address other challenges such as biodiversity loss, heat stress, drought, and floodings. These installations are easier to rebuild than large-scale grey infrastructure given the multiple hazards that occur in Timor-Leste: landslides, earthquakes, strong wind, and pluvial and fluvial floodings, and they can serve as coastal protection.

Background: Blunt traumatic vertebral artery injury is commonly associated with head and cervical spinal trauma. However, those associated with chest or upper extremity injuries without cervical spine-related trauma are rare. Case presentation: A 94-year-old woman was injured in a motor vehicle crash. She was diagnosed with traumatic subarachnoid hemorrhage, bilateral subdural hematomas, right vertebral artery injury, and right clavicle fracture. No cervical spine injuries were observed. It was possible that the fracture fragment of the right clavicle may have directly injured the right vertebral artery. Coil embolization was performed for the vertebral artery injury. The patient had a good postoperative course and was transferred to the hospital for rehabilitation on day 65. Conclusion: Regarding the high-risk injury mechanism, blunt traumatic vertebral artery injuries in the V1–2 segment may occur in cases with clavicle fractures.

Abstract Background Biomarkers such as fecal calprotectin (FC) and fecal immunochemical occult blood tests (FIT) for ulcerative colitis (UC) are used in clinical practice. In this study, the effect of UC disease duration on FC was investigated and compared to that on FIT. Methods One hundred twenty-eight colonoscopic examinations and two fecal biomarkers measurements were performed. The cases of UC were divided into short- and long-term disease-duration groups or categorized into three groups with disease durations of 0–5, 6–13, and 14–38 years. We analyzed correlations between biomarker levels and endoscopic scores, including the Mayo endoscopic subscore (MES), ulcerative colitis endoscopic index of severity, and the sum of MES. Results In the analysis of short- and long-term disease durations, the three endoscopic scores and biomarker levels showed significant correlations in both long-term and short-term groups. Most of the correlation coefficients for the individual long-term group were lower than the corresponding values for all cases, while most of the correlation coefficients for the individual short-term groups were higher than the corresponding values for all cases. In the three-group analysis (disease durations of 0–5, 6–13, and 14–38 years), the two biomarkers and three endoscopic scores showed significant correlations, and most of the correlation coefficients between biomarkers and endoscopic scores tended to be lower in the long-term follow-up group. In the receiver operating characteristic analysis for predicting mucosal healing in the three groups, the area under the curve for FC and FIT concentrations in the 0–5 year disease-duration group showed particularly higher values than those for the other two groups. Conclusions Similar to FIT, FC is affected by the duration of UC, indicating that FC may be a highly useful biomarker, especially in short-term disease.

Abstract Tacrolimus therapy for ulcerative colitis is ineffective in certain patients; these patients require biologics or colectomy. We examined the ability of serum albumin levels and leukocyte subtypes to predict the therapeutic efficacy of tacrolimus. Patients with ulcerative colitis treated with tacrolimus were divided into non-failure and failure (required colectomy or switch to biologics or systemic steroids) groups. Serum albumin levels and leukocyte subtypes at induction, week 1, and week 2 after reaching high trough levels were retrospectively examined. Tacrolimus therapy failed in 18/45 patients within 3 months. The week 2/week 1 albumin ratio was significantly different between the failure and non-failure groups (P

Abstract In 2012, Japan approved the use of a tag-less patency capsule (PC), which evaluates gastrointestinal patency before small-bowel capsule endoscopy (SBCE). This study aimed to evaluate the validity of our modification on the passage criteria for this PC in clinical practice. We retrospectively enrolled 326 consecutive patients who underwent PC examination before SBCE. If X-ray could not reveal the PC in the body during the judgement time (30–33 h after ingestion), we defined it as ‘estimated patency’ and performed SBCE. We employed plain computed tomography (CT) for the second judgement, as needed. The overall patency rate was 95.1%. By X-ray, 41 (12.6%) patients were judged to have ‘estimated patency’, and SBCE could be safely performed. Plain CT judgement was necessary in 106 patients (32.5%). One PC case had a residual coating film associated with stenosis in a patient with Crohn’s disease (CD), and one (0.3%) SBCE case had capsule retention resulting from false CT judgement. Multivariate analysis revealed that established CD and inpatient were factors related to no-patency. In conclusion, PC is useful for examining gastrointestinal patency, keeping in mind CT misjudgement. If PC was not found in the body via X-ray, performing SBCE as ‘estimated patency’ seemed appropriate.

BackgroundPost-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most serious complications of ERCP. Various procedures can reduce the incidence of PEP, such as wire-guided cannulation, prophylactic pancreatic stent placement, and pretreatment anal insertion of NSAIDs. Recently, iso-osmolar contrast media (IOCM) have been used for ERCP in several hospitals to reduce the risk of PEP in Japan. However, the effect of IOCM is uncertain because few reports have examined IOCM in relation to PEP.AimThis study aimed to investigate the relationship between contrast media used and the incidence of PEP.MethodsThis retrospective study included all qualifying patients who had undergone ERCP at Hamamatsu University Hospital between January 2012 and January 2020. This study examined whether there was a difference in the onset of PEP between patients administered IOCM and high osmolar contrast medium (HOCM). Propensity score matching was used to analyze patient characteristics and ERCP procedures. Amidotrizoic acid was used as HOCM and iodixanol as IOCM.ResultsERCP was performed on 458 patients, and 830 procedures were conducted. After propensity score matching, 162 patients from the amidotrizoic acid group and 162 patients from the iodixanol group were selected. The incidence of PEP was 10.5% (17) in the amidotrizoic acid group and 9.3% (15) in the iodixanol group (P = 0.71). Changes in serum amylase levels post- and pre-ERCP were 240.6 ± 573.8 U/L and 142.7 ± 382.1 U/L in the amidotrizoic acid and iodixanol groups, respectively (P = 0.072).ConclusionIodixanol had no prophylactic effect on PEP and clinical outcomes.

Abstract The composite films of polydimethylsiloxane (PDMS) and cyanoethylsucrose (CR‐U) were prepared and investigated as an electroactive silicone actuator in the air. CR‐U is highly viscose and soluble in tetrahydrofuran (THF) and acetone (ACT). The composites showed a phase‐separation structure, in which the spherical CR‐U dispersed in the PDMS domain. The films from THF had an asymmetric cross‐sectional view, in which CR‐U large sphere dispersed with a thin skin layer of PDMS on one side. On the other hand, the films from ACT had a symmetric cross‐sectional structure, in which CR‐U small sphere dispersed uniformly without a PDMS thin skin layer. By applying DC electric field, the films from THF deformed by expanding the thin skin layer regardless of the electric field polarity. The films from ACT showed almost no deformation. The space‐charge distribution explained deformation behavior.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been accepted as a useful bridging tool to definitive hemostasis in refractory hemorrhagic shock. Although there is insufficient evidence of the target blood pressure under the utilization of REBOA, it may be reasonable to avoid excessive blood pressure elevation. Invasive blood pressure monitoring proximal to the aortic occlusion is desirable during REBOA. The zone of the aorta is selected and changed according to the location of injuries and the physiological conditions. The key to successful REBOA management is to set up an independent REBOA coordinator for systemic management. This review article aims to explain the procedures of proper REBOA management, so as to fill the knowledge gap between educational courses, which highlight the indications and safe procedures of the device, and the critical settings faced in clinical practice.

Objective Transcatheter arterial embolization (TAE) of bilateral internal iliac arteries (IIAs) in patients with a hemodynamically unstable pelvic fracture is associated with a low mortality rate. The persistence of unstable hemodynamics after IIA embolization indicates the involvement of other arteries, such as the median sacral artery (MSA). This study aimed to evaluate the efficacy of MSA embolization. Methods In this single-center, retrospective, observational study, medical records of patients who underwent MSA angiography or embolization for pelvic fractures (n = 21) between January 2007 and August 2019 were reviewed. The percentage of patients achieving hemodynamic stabilization by MSA embolization was calculated. Results Fifteen patients underwent MSA embolization, and the remaining six underwent MSA angiography. The shock index value was significantly higher after MSA embolization than that before MSA embolization in hemodynamically unstable patients who underwent this procedure. The success rate of MSA selection was 100%. One patient presented with urinary retention because of bladder and rectal disorders after MSA embolization. The 30-day survival rate was 85.7%. Conclusions Severe pelvic fractures, such as a Dennis Zone III fracture and suicidal jumper’s fracture due to trauma from a fall, may require MSA embolization.

The mixing water used for cement concrete has a significant effect on the physical properties of the material after hardening; however, other than the upper limit for the mixed impurities, not enough consideration has been given to the functions and characteristics of water at the molecular level. In this study, we investigated the effect of four different types of water (two spring-, mineral waters, tap water and distilled water) on the drying shrinkage of the hardened cement by comparing the material properties of the concrete specimens and analyzing the molecular structure of the water and cement mortar using aquaphotomics. The near infrared (NIR) spectra of waters used for mixing were acquired in the transmittance mode using a high-precision, high-accuracy benchtop spectrometer in the range of 400–2500 nm, with the 0.5 nm step. The NIR spectra of cement paste and mortar were measured in 6.2 nm increments in the wavelength range of 950 nm to 1650 nm using a portable spectrometer. The measurements of cement paste and mortar were performed on Day 0 (immediately after mixing, cement paste), 1 day, 3 days, 7 days, and 28 days after mixing (cement mortar). The spectral data were analyzed according to the aquaphotomics’ multivariate analysis protocol, which involved exploration of raw and preprocessed spectra, exploratory analysis, discriminating analysis and aquagrams. The results of the aquaphotomics’ analysis were interpreted together with the results of thermal and drying shrinkage measurements. Together, the findings clearly demonstrated that the thermal and drying shrinkage properties of the hardened cement material differed depending on the water used. Better mechanical properties were found to be a result of using mineral waters for cement mixing despite minute differences in the chemical content. In addition, the aquaphotomic characterization of the molecular structure of waters and cement mortar during the initial hydration reaction demonstrated the possibility to predict the characteristics of hardened cement at a very early stage. This provided the rationale to propose a novel evaluation method based on aquaphotomics for non-invasive evaluation and monitoring of cement mortar.