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Background and Aim Colonic diverticular bleeding is a common cause of acute lower gastrointestinal bleeding. Endoscopic hemostasis is generally selected as the first‐line treatment; however, a considerable number of patients experience early rebleeding after endoscopic treatment. We investigated the risk factors for early rebleeding after endoscopic treatment. Methods We retrospectively evaluated the data of 142 consecutive patients who underwent endoscopic treatment (endoscopic clipping or endoscopic band ligation) for colonic diverticular bleeding with stigmata of recent hemorrhage between April 2012 and April 2020. Multivariate logistic regression analysis was conducted to evaluate the statistical relationship between patient characteristics and the incidence of early rebleeding occurring within 30 days after endoscopic treatment. Results Of 142 patients, early rebleeding was detected in 34 (23.9%) patients. According to univariate analysis, platelet count of, Using endoscopic band ligation was associated with a decreased risk for early rebleeding compared with the use of endoscopic clipping, indicating that endoscopic band ligation was a preferable endoscopic modality to prevent early recurrent bleeding.

Introduction: To present our findings of the porcine ocular surface that were obtained with an ultra-compact hand-held microscope that weighs less than 500 g, we examined the corneal epithelial cells with this hand-held microscope. Methods: This device is equipped with an automatic focusing mechanism that enabled us to observe living cells in macro to micro magnifications with a series of operations. The focus is semi-automatically adjusted by the infrared and ultrasonic distance sensor. The instrument has a commercially-available microscope objective lens of 20x or 40x magnification and has a high-resolution 2K Complementary Metal-Oxide-Semiconductor (CMOS) camera. The theoretical spatial resolution is around 300 nm with a higher Numerical Aperture (high-NA) lenses. The widefield reflectance-based imaging system is equipped with three-color visible Light-Emitting Diodes (LEDs) for use in bright environments and an infrared LED for dark environments. Ten normal and two injured porcine corneas were examined with this hand-held microscope. Results: Our observations showed that the corneal and conjunctival epithelial cells could be continuously observed. The epithelial cells of the central cornea, limbus, and conjunctiva were clearly seen. The epithelial cells on the injured corneal surface were also easily and clearly observed. Conclusion: This hand-held microscopic imaging device allows medical health care workers such as ophthalmologists and endoscopists to obtain real-time in vivo optical biopsies without collecting tissues and cells. Our system enables us to observe single cells in the superficial layers without any fluorescein or other dyes.

Under hypoxic conditions, microRNA-210 is upregulated and plays multiple physiological roles including in cell growth arrest, stem cell survival, repression of mitochondrial respiration, angiogenesis, and arrest of DNA repair. In this study, we investigated the histopathological expression of microRNA-210 under hypoxic conditions using a femoral artery ligation model established in C57BL/6J mice to determine the pathological significance of microRNA-210. Following femoral artery ligation, ischemia was represented by decreased blood flow compared to the control, in which a sham operation was performed. On histopathology, degeneration/necrosis of the muscle fibers, inflammatory cell infiltration, and regeneration of the muscle fibers were sequentially observed from 3 h to 3 d after ligation of the artery. The degree of these effects was more severe in the area in which type I muscular fibers are dominant. The histological expression of hypoxia-inducible factor 1α, a well-known biomarker of hypoxia, and microRNA-210 was observed in a few necrotic muscle fibers, macrophages, and myoblasts, a distribution consistent with the histopathological lesions, and their signal increased over time. The expression of microRNA-210 in macrophages and myoblasts under ischemia might be indicative of a significant role in the recovery from ischemic lesions. In addition, the in situ hybridization of microRNA-210 could potentially be used for the detection of hypoxia as a histological marker in addition to the immunohistochemistry of hypoxia-inducible factor 1α.

Background Selective biliary cannulation (SBC) is the first challenge of endoscopic retrograde cholangiopancreatography (ERCP), especially for trainees, and a rotatable sphincterotome may be useful to guide the directional axis of the scope and SBC. Methods We performed a prospective randomized single-center trial, enrolling 200 patients with a native papilla who required therapeutic biliary ERCP. Patients were randomly assigned to the rotatable sphincterotome group (n = 100) or the conventional sphincterotome group (n = 100). The primary endpoint was successful SBC by the trainees within 10 minutes. Results The early and late cannulation success rates did not differ significantly between the groups (P = 0.46 and P > 0.99, respectively). For the patients in whom trainees failed to achieve SBC, the rotatable sphincterotome was used as a rescue cannulation technique in four patients from the conventional group; in no patients in the rotatable group was the conventional sphincterotome used for SBC. Post-ERCP pancreatitis (PEP) occurred in 11 patients (5.5 %; 6 mild, 5 moderate); the incidence did not differ significantly between the two groups (rotatable group 3 %, conventional group 8 %; P = 0.21). The two groups were thus combined for evaluation of the factors relating to cannulation difficulty for trainees, which revealed that orientation of the papilla was a significant factor (P Conclusions The type of sphincterotome used did not affect the success of SBC by trainees. However, orientation of the papilla was revealed to be a significant factor relating to cannulation difficulty for trainees overall.

The study of commonsense reasoning and robotic agents in home environments is trending considering artificial intelligence. Handling the contexts of human daily living is crucial for the system to achieve, for example, the detection of risky situations in a care facility and long-term natural dialogue with other individuals. This study aims to construct an ontology to represent daily living activities by reusing the International Classification of Functioning, Disability and Health (ICF) categories. We extracted relevant categories from the ICF, introduced new classes, and defined an “is-a” hierarchy to provide a common vocabulary for the annotation of the context of multiple sensor data obtained in home environments. As a result, the constructed ontology consists of 284 classes. The evaluation of its coverage is performed using the following two resources related to commonsense reasoning: ATlas Of MachIne Commonsense (ATOMIC) and STAIR Actions captions. We sampled 100 sentences from each resource and described the context of the samples using the constructed ontology, which resulted in 63% and 84% of each sample being covered by our ontology. This demonstrates that our ontology has the competency to describe the context in a daily living environment. In addition, we found the types of contexts that are lacking in the ontology via the evaluation.

In high-end hospitality industries such as airline lounges, high star hotels, and high-class restaurants, employee service skills play an important role as an element of the brand identity. However, it is very difficult to train an intermediate employee into an expert employee who can provide higher value services which exceed customers’ expectations. To hire and develop employees who embody the value of the brand, it is necessary to clearly communicate the value of the brand to their employees. In the video analysis domain, especially analyzing human behaviors, an important task is the understanding and representation of human activities such as conversation, physical actions and their connections on the time. This paper addresses the problem of massively annotating video contents such as multimedia training materials, which then can be processed by human-interaction training support systems (such as VR training systems) as resources for content generation. In this paper, we propose a POC (proof of concept) system of a service skill assessing platform, which is a knowledge graph (KG) of high-end service provision videos massively annotated with human interaction semantics.

In this work, we present the development of a on robot that can provide company to a person watching television (TV). To establish guidelines for developing the utterance function for the robot, we analyze the utterances of pairs of people watching TV together, which were then classified into eight categories. We observe that human-human dialogue while watching TV most often starts with “Disclosures” utterances that express one’s own feelings. In addition, we found that utterances with high response rates could be classified as “Questions “Edifications,” and “Confirmations Based on this analysis, we implemented an utterance function in the robot under development that corresponds to “Disclosures” in relation to the TV program. The utterances generated by the robot are composed automatically by combining template sentences that include emotional words prepared from previous TV closed captions with keywords abstracted from the closed caption information of the program that the person is currently watching.

A drawback of visual assessment for late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is the subjectivity and reproducibility of the results. The aim of this study was to investigate the relationship between left ventricular (LV) reverse remodeling in response to optimal pharmacotherapies and the definite or discrepant mid-wall LGE with visual assessment in patients with dilated cardiomyopathy (DCM). A total of 65 patients who had been hospitalized with newly diagnosed DCM and had undergone CMR, were enrolled. When the visual assessment of the presence or absence of mid-wall LGE was confirmed by the two observers, patients were classified into either the positive- (n = 20) or negative-LGE (n = 29) groups. If there was discordance between the diagnoses of the two observers, patients were classified into the discrepant-LGE (n = 16) group. LV reverse remodeling was defined as an increase in LV ejection fraction by at least 10% concomitant with a decrease in the LV end-diastolic dimension by at least 10%. Among the three groups, the frequency of early LV reverse remodeling within a 1-year follow-up was significantly different (p = 0.0068). The frequency of LV reverse remodeling within a 1-year follow-up was 59, 31, and 15%, and over 2 years was 83, 62, and 40%, in patients with negative-, discrepant-LGE, and positive-LGE, respectively. The survival rate for composite end-points of cardiovascular mortality, sustained ventricular tachycardia, appropriate cardioverter-defibrillator discharge, or rehospitalization for decompensated heart failure was lower in positive-LGEs than in negative-LGEs (p =0.0011), whereas, there were no significant differences between both negative- and discrepant-LGEs, and discrepant- and positive-LGEs. This study showed that the discordance for LGE visual assessment occupied an intermediate position between positive and negative for LGE in LV reverse remodeling in patients with DCM.

Hepatic ischaemia–reperfusion (I/R) injury is a serious liver damage that critically influences the clinical outcome of liver surgery or transplantation. Since recent studies indicated the critical involvement of von Willebrand factor (VWF) in reperfusion injuries of brain and myocardium, we hypothesized that VWF-dependent thrombotic or inflammatory responses also play a role in hepatic I/R injury. Using a mouse model of hepatic I/R injury, we explored the functional relevance of the VWF–ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) axis in this pathologic condition. Time-course studies during hepatic I/R revealed significantly lower alanine aminotransferase (ALT) values, as well as greater hepatic blood flow, in VWF gene-deleted (KO) mice in comparison with wild-type (WT) mice. Histological analysis revealed a significantly lesser extent of neutrophil infiltration and hepatocellular necrosis in liver tissues of VWF-KO mice. Human recombinant ADAMTS13 significantly improved the impairment in ALT values and hepatic blood flow and decreased neutrophil infiltration within the liver tissue of WT mice. Real-time intravital imaging successfully visualized significantly reduced leukocyte–vessel wall interactions in I/R liver of VWF-KO mice. Taken together, our results indicate that VWF promotes neutrophil recruitment in ischaemic mouse liver, critically aggravating reperfusion injury, and suggest that functional regulation of VWF by ADAMTS13 represents a promising therapeutic option for hepatic I/R injury.

Background Previous pathohistological studies demonstrated that cholesterol crystals (CCs) are frequently observed in atherosclerotic plaques, and are usually present abundantly in vulnerable plaques. However, the role of CCs in plaque destabilization, as well as their origin and composition, is unknown. Optical coherence tomography (OCT) imaging system is a high-resolution imaging device, which allows the in vivo identification of CCs accumulating within atherosclerotic plaques. The aim of this study was to investigate the relationship between the presence of CCs, other plaque morphologies assessed by OCT, and patients’ clinical characteristics including acute coronary syndrome (ACS). Methods and results Preinterventional OCT images of 173 patients with either ACS or stable angina pectoris were studied. Of 173 lesions in the patients, 66 (38%) had CCs within the culprit lesion segment and 107 (62%) had non-CC lesions. Multivariate analysis revealed that low high-density lipoprotein cholesterol levels, diabetes mellitus, the presence of plaque rupture, intimal vasculature, and thrombus were independent factors associated with CCs. Moreover, the frequency of CCs increased in proportion to the accumulation of the number of components of their vulnerable plaque features within the culprit lesion segment. Compared with the plaques without thrombus, CCs were present at shallower locations in those with thrombus. Conclusions This study demonstrates the potential correlation between the clinical metabolic disorder and vulnerable morphological features of culprit lesions to the presence of CCs in patients with stable and unstable coronary syndromes. These observations of CCs by using in vivo plaque imaging could provide incremental value to OCT evaluation of atherosclerotic plaques.

Background Peripheral nerve injury causes limb muscle/bone atrophy, leading to chronic pain. However, the mechanisms underlying muscle/bone atrophy after peripheral nerve injury remain unknown. It was recently reported that M1 macrophages are the main factors responsible for neurogenic inflammation after peripheral nerve injury. We hypothesized that M1 macrophages are important in muscle/bone atrophy after nerve injury. Therefore, we investigated the influence of M1 macrophages on muscle/bone atrophy after nerve injury in mice to prevent muscle/bone atrophy by suppressing M1 macrophages. Methods Hindlimb muscle weight and total bone density were measured in a chronic constriction injury (CCI) mouse model. Immunohistochemical analysis and intravital microscopy were performed to visualize hindlimb muscles/bones, and cells were quantified using flow cytometry. We compared M1 macrophage infiltration into muscles/bones and muscle/bone atrophy between macrophage depletion and untreated groups. We also investigated muscle/bone atrophy using administration models for anti-inflammatory and neuropathic pain drugs. Results Peripheral nerve injury caused significant reduction in muscle weight and total bone density at 1 and 3 weeks after CCI, respectively, compared with that in controls. Osteoclast numbers were significantly higher at 1 week after CCI in the CCI group than in the control group. M1 macrophage infiltration into muscles was observed from 2 h after CCI via intravital microscopy and 1 week after CCI, and it was significantly higher 1 week after CCI than in the control group. In the macrophage depletion group, dexamethasone, pregabalin, and loxoprofen groups, M1 macrophage infiltration into muscles/bones was significantly lower and muscle weight and total bone density were significantly higher than in the untreated group. Conclusions M1 macrophage infiltration exacerbates muscle/bone atrophy after peripheral nerve injury. By suppressing M1 macrophages at the neural injury local site, muscle/bone atrophy could be avoided.

The paper focuses on dialogue modelling that enables communication between users and social robots, on topics that concern experience and knowledge of people in service industries, especially in elder-care services. We discuss different knowledge types and explication of knowledge using dialogues based on goal-oriented ontologies. We present an architecture and an example of a dialogue system that allows humans to communicate with a robot partner and be engaged in interactions concerning activities related to basic care-giving tasks.

This paper proposes an ontology of musical performance techniques for teaching and learning support. We have attempted to support musical instrument performance from the viewpoint of knowledge-engineering. We focused on classical guitar which requires many techniques, and organized the knowledge related to guitar rendition by using a goal-oriented form of description. However, it presents several difficulties for use as a basis of knowledge-based systems such as a lack of coherence. In this study, we developed the Guitar Rendition Ontology that can serve as a guideline for classical guitar performance at learning and teaching sites. The ontology consists of 96 concepts, that describe the relationships between renditions, and 18 properties that explain the features of the concepts. We defined three properties to describe the process of action of each rendition as the core structure of guitar rendition concept: that is, action, primary-action, and conditional-action. The description form led to more appropriate expression of the action processes than the knowledge we systematized in our previous work. We significantly improved machine-readability and machine-processability by using Ontology Web Language (OWL). Moreover, we investigated some issues with the ontology in order to improve it through interviewing teachers and learners. As a result, we acquired additional information and found several problems with the domain of guitar rendition and the representation of knowledge. Furthermore, we received positive responses concerning the possibility of using the ontology on site. Finally, we described an annotation method for integrating data between the ontology and score information.

This paper reports an attempt to accurately quantify one-dimensional compressibility of stiff, cement-treated high-water-content clays by using a constant-rate-of-strain (CRS) oedometer equipped with an image-based strain measurement system. The errors in stiffness measurements due to imperfect specimen–platen bedding and apparatus compliances, significant factors when stiff soils are tested, were avoided by directly observing movements of the specimen's lateral surface over a transparent confining ring. The proposed system is meant to be practical, requiring only minimum alterations to existing CRS oedometers and a generally available mid-market digital camera. The effectiveness of the method is demonstrated by testing six cement-treated clay specimens with or without air-foam inclusions in one-dimensional compression and by comparing the obtained compression curves with those obtained by more conventional measuring systems. The image analysis always revealed significantly stiffer responses than observed by the conventional methods. Validity of the image-based stiffness determination at small strains was confirmed by generally good agreements of its derived stiffness values with those obtained from highly precise triaxial probes, which provided a full set of cross-anisotropic elastic parameters. Implications for field problems are discussed in relation to an offshore reclamation project, in which similar cement-treated high-water-content clays were extensively used for upper layers.

Despite considerable efforts to develop efficient carriers, the major target organ of short-interfering RNAs (siRNAs) remains limited to the liver. Expanding the application outside the liver is required to increase the value of siRNAs. Here we report on a novel platform targeted to muscular organs by conjugation of siRNAs with anti-CD71 Fab' fragment. This conjugate showed durable gene-silencing in the heart and skeletal muscle for one month after intravenous administration in normal mice. In particular, 1μg siRNA conjugate showed significant gene-silencing in the gastrocnemius when injected intramuscularly. In a mouse model of peripheral artery disease, the treatment with myostatin-targeting siRNA conjugate by intramuscular injection resulted in significant silencing of myostatin and hypertrophy of the gastrocnemius, which was translated into the recovery of running performance. These data demonstrate the utility of antibody conjugation for siRNA delivery and the therapeutic potential for muscular diseases.

Recently, unstable angina pectoris (UAP) and non-ST-segment-elevation myocardial infarction (NSTEMI) have been considered together because they exhibit indistinguishable clinical and electrocardiogram features, and constitute non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). However, no optical coherence tomography (OCT) studies have reported the association between vulnerable plaque morphology and clinical characteristics in NSTE-ACS patients based on assessment of clinical symptoms and myocardial necrosis. The aim of this study was to investigate the differences in clinical characteristics and plaque morphology assessed by OCT between patients with UAP and NSTEMI. Preinterventional OCT images of 84 NSTE-ACS patients were studied, 19 with NSTEMI and 65 with UAP, according to levels of high-sensitivity troponin T. The frequency of plaque rupture and thrombus in patients with NSTEMI was higher than in UAP patients with either class I or II + III (rupture: NSTEMI, 68 %; UAP classes II + III, 30 %; UAP class I, 19 %, thrombus: NSTEMI, 73 %; UAP classes II + III, 22 %; UAP class I, 14 %). In NSTEMI patients, the frequency of occurrence of both thrombus and rupture was the highest. Conversely, patients with UAP class I or those with UAP classes II + III most frequently had no thrombus and rupture, and the frequencies of the presence of thrombus were only 14 and 22 %, respectively. Multivariate analysis revealed that thrombus and plaque rupture were independently associated with NSTEMI. This study demonstrates that the morphological features of culprit lesions could be related to clinical severity in NSTE-ACS patients.

We describe four cases of the patients with ST-elevation myocardial infarction (STEMI) that were treated with interleukin-11 (IL-11), a cardioprotective cytokine. Recombinant human IL-11 (rhIL-11), was intravenously administered to two cases at low dose (6 µg/kg) and to two at high dose (25 µg/kg). The cytokine administration started just after the coronary occlusion was confirmed by coronary angiography (CAG), taking 3 h. Following CAG, percutaneous coronary intervention (PCI) was performed as a standard therapy. No serious adverse drug reactions were observed. All the cases left the hospital without the symptom of heart failure. We discuss the possibility of the clinical use of rhIL-11 as an adjunct therapy to PCI for the STEMI patients.

The role of plasmacytoid dendritic cells (pDCs), and myeloid dendritic cells (mDCs) in women with preeclampsia has not been elucidated. We compared the frequency of peripheral pDCs, mDCs, NK cells, and T helper 17 (Th17) cells among non-pregnant/pregnant women, and women with early-/late-onset preeclampsia. We examined pDCs and mDCs using Anti-Human Lineage Cocktail 3 (CD3, CD14, CD19, and CD20), HLA-DR, CD11c, and CD123. We detected NK cells using Lineage cocktail, CD8, CD16, and CD56. We determined Th17 cells using CD3, CD4, CD8, CXCR3, and CCR6. We recruited 13 non-pregnant women, 50 normal pregnant women, 13 women with early-onset preeclampsia (onset at

Background While there has been great progress in artificial intelligence (AI) and the Internet of Things (IoT), numerous social problems remain to be addressed. Child maltreatment is the one of the largest social issues in the world. Although some research projects have been using ‘big data’, few studies have used AI to analyze these data. In order to save children suffering from maltreatment, AI and big data analysis should be effectively employed. Purpose In order to effectively respond to child maltreatment cases, we compute the future recurrent risk and deploy our AI platform in the field, such as with local child protective services. Method and deployment In order to develop an AI platform, we used 3648 cases spanning 3.5 years in a prefecture in Japan as data, including demographic factors, risk assessment, and whether child protection services were involved. In addition, we built a tablet iOS app that enables local social workers to easily input and store the data into a cloud database. The platform can predict the future recurrent risk by Bayesian models for binary output once users can check the probability of the risk. Result The results of the present study revealed that future recurrent cases are highly associated with risk assessment factors, such as existing bruises and injuries on a child’s face, neck, or abdomen, whether children and/or parents want social workers to protect the children, parents’ aggressive attitude toward social workers, and child sexual abuse (including suspected) cases. Conclusion and future research We need to continue to collect data and implement the system in other local child guidance centers in Japan. Furthermore, the system should consider what type of support plan would be effective for decreasing future recurrent risk in order to provide a personalized decision-making support system for local practitioners.

Medical and long-term care costs in Japan are increasing ahead of the rest of the world. Burdens of care worker are also increasing. Therefore, it is an urgent issue to improve the productivity and quality of care. In general, sharing workers’ knowledge supports business operation. However, constructing manuals consistently is costly. Knowledge explication methodology was developed to systematize procedural knowledge by the employees themselves. The authors have applied the methodology to several domains including elderly care.

The renin-angiotensin system (RAS), which plays an important role in the progression of heart failure, is efficiently blocked by the inhibition of renin, the rate-limiting enzyme in the RAS cascade. In the present study, we investigated the cardioprotective effects of TAK-272 (SCO-272, imarikiren), a novel, orally effective direct renin inhibitor (DRI), and compared its efficacy with that of aliskiren, a DRI that is already available in the market. TAK-272 was administered to calsequestrin transgenic (CSQ-tg) heart failure mouse model that show severe symptoms and high mortality. The CSQ-tg mice treated with 300 mg/kg, the highest dose tested, of TAK-272 showed significantly reduced plasma renin activity (PRA), cardiac hypertrophy, and lung congestion. Further, TAK-272 reduced cardiomyocyte injury accompanied by an attenuation of the increase in NADPH oxidase 4 and nitric oxide synthase 3 expressions. TAK-272 also prolonged the survival of CSQ-tg mice in a dose-dependent manner (30 mg/kg: P = 0.42, 100 mg/kg: P = 0.12, 300 mg/kg: P < 0.01). Additionally, when compared at the same dose level (300 mg/kg), TAK-272 showed strong and sustained PRA inhibition and reduced the heart weight and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration, a heart failure biomarker, while aliskiren showed a significant weaker PRA inhibition and failed to demonstrate any cardioprotective effects. Our results showed that TAK-272 is an orally active and persistent renin inhibitor, which reduced the mortality of CSQ-tg mice and conferred protection against cardiac hypertrophy and injury. Thus, TAK-272 treatment could provide a new therapeutic approach for heart failure.

Reflective teaching has become dominant paradigm in second language teacher education, as critical reflection helps teachers achieve a better understanding of teaching and learning processes. Critical reflection begins from classroom investigation. Several methods such as questionnaire, lesson report, teaching journal and audio/video recordings are widely used for classroom investigation. However, these methods are either susceptible to memory bias or are hard to be continued on a day-to-day basis. In this study, we proposed an approach for effective classroom investigation in second language education using activity coding in combination with data visualization technology. The proposed method consists of three stages. In the first stage, a smartphone application was used to record the activities that happen in a class following a slightly modified experience sampling method. In the second stage, the activities were quantified using our proposed 2-level activity coding scheme, and each activity was assigned a colour code. In the third stage, a data visualization tool D3.js was used to create heat maps of the classroom activities. We applied the proposed method to investigating the classroom activities in five English conversation lessons given by native-speaking teachers. The visual feedback led to the answering of some key questions that critical reflection aims to address, including teachers’ time management, lesson structure, and the characteristics of teacher-student interaction. Based on the results obtained, we highlighted the potential of the proposed approach for involving different sectors in second language education and pointed out the directions for future research.

Objective: We compared the frequency of peripheral blood Treg cells in women with pre-eclampsia (PE) and in those without, and investigated whether the frequency of Treg cells in women with high-risk factor for PE changed during pregnancy. Methods: We examined the frequency of CD4+FoxP3+ Treg cells in the peripheral blood using flow cytometry. Eleven women with PE and 10 women without PE (controls) were included. Every control had any risk factors for PE, such as high blood pressure, bilateral notching or a past history of PE or gestational hypertension. Blood sampling was conducted 1–3 times in the controls. Results: No significant differences were observed in the frequency of Treg cells between women with PE and the controls [mean ± SE (%): 5.74 ± 0.91 versus 5.48 ± 0.94, p = 0.843]. In five controls with serial sampling, the frequency of Treg cells significantly decreased from 5.83 ± 1.20 to 2.99 ± 0.54 (p = 0.046) (week of the first sampling to that of the last sampling [mean ± SD]: 21.5 ± 1.6 weeks t...

Nurses' daily practices are performed according to nursing guidelines of hospitals. Novice nurses learn by consulting the bulky files of the guidelines for their practices. The nurses' actions in practice are usually transmitted from experienced nurses to the novices through the daily practices. It is difficult to represent complex and intertwined actions with their goals by the paper guidelines. The goal of the actions is often implicit knowledge accumulated through the nurses' daily practices. To cope with this problem, we have previously proposed a goal realization model called “CHARM” (an abbreviation for “Convincing Human Action Rationalized Model”). Unlike in the printed guidelines, CHARM can represent the goal of actions. We have described nursing actions and their goals as CHARM trees constructed from real nursing guidelines used in a hospital through consultation with experienced nurses. On the other hand, the novices need to learn sequence of the actions. Therefore we developed a tablet computer, which is called CHARM Pad, for browsing CHARM trees with two modes corresponding to the both viewpoints. The novices are able to learn nursing actions with their goals by both goal-oriented viewpoint and sequence-oriented viewpoint. The CHARM Pad has been used for training of the novice nurses at ICU unit. After the training, we received positive comments from the chief nurse in the ICU unit and the chief nurse in the Nursing Department. Questionnaires completed by the novice nurses also showed that the two modes of the CHARM Pad helped them to understand the goals and the sequence of the actions.

From a “traditional” narratological point of view, such texts as chapter one of Thomas Hardy’s The return of the Native and part two of Virginia Woolf ’s to the Lighthouse would be categorized as narratives that frequently deploy extradiegetic-heterodiegetic narration with zero focalization, since in each case an omniscient narrator often recounts what happened in the absence of any other witnesses. The adequacy of that categorization, however, becomes questionable once we consider passages such as the following

A 16-years old man with severe ulcerative colitis (UC) was admitted to our hospital. After initiating treatment with corticosteroid for UC, chicken pox appeared. At the same time of appearance of chicken pox, the disease activity of UC was exacerbated. After initiating the treatment with acyclovir, both chicken pox and UC improved. Because colonoscopic findings revealed the remaining of moderately active UC, initiating the treatment with infliximab could induce clinical remission of UC without relapse of varicella-zoster virus (VZV) infection. This is a very rare case of UC with concomitant VZV infection. According to our report, the vaccination for VZV prior to immunosuppressive treatments would be necessary for VZV naïve patients with UC.

Evaluating motion quality has many applications in health promotion and exercise coaching. This study aimed to develop an approach for automatic and cost-efficient evaluation on motion quality using the Nintendo Wii Balance Board (WBB) and machine learning techniques. We conducted a pilot study with twelve participants to collect data of chest rotation and hip joint rotation. We used support vector machine for automatic classification of good and poor motions. The preliminary results suggested that using WBB for motion quality evaluation is feasible. Future studies are needed to improve the accuracy of the classification model and to investigate the health impact of the proposed approach.

The paper focuses on issues related to dialogue modelling that enables interaction between users and service systems, on topics that concern the experience and knowledge of people in the service industry. We discuss dialogue design that is based on the crowd-sourced data structured according to goal-directed ontological requirements, as well as architectural aspects and the human-centered companion view of IoT communication. Our ultimate aim is to create a framework for improving and reconstructing operations for service industries such as nursing, caregiving, and education, and for activities that promote health and create community through hobbies such as dance and music.

The presence of underlying vulnerable plaques, especially thrombus, has the potential to influence arterial healing and possibly long-term outcomes in patients with angina pectoris after percutaneous coronary intervention (PCI) [(1)][1]. T1-weighted imaging (T1WI) with noncontrast magnetic resonance

Effective exercise coaching is critical for helping people master the correct forms of movements in order to gain the benefit of exercise. However, the potential ambiguity of verbal instructions in exercise coaching may become a hindrance to effective coaching. This study proposes a framework to support explicit and objective exercise coaching. We first present the two components of the proposed framework: (1) quantifying the differences between the correct and the wrong forms of a movement using bio-mechanics, and (2) modelling the sequence of muscle and joint activation in the correct form using ontology engineering. We then provide two examples of applying the proposed framework to exercise coaching on two basic movements. The ultimate aim of the study is to reduce unnecessary injury and to improve the quality of coaching services in the context of health promotion.

Hand-over notes are extremely important to share information about irregular incidents at elderly care facilities and provide high-quality services. However, taking notes is a time-consuming task. Moreover, handwritten hand-over notes make it difficult to pass on experience and related know-how to other workers. To curate that field community intelligence, a handover support system for elderly care facilities was installed into a facility and evaluated. The system is now in actual operation at the care facility. The authors aim to use handover support system as a communication tool that sense the feelings of the care workers and supports them to maintain motivation and cultivate self-directedness. To realize this aim, this paper reports the results of hand-over data analysis and comparison with traditional paper-based hand-over notes. Furthermore, the authors explored the possibility of applying sentiment analysis technology to hand-over messages to sense the atmosphere of their working environment.

Although central giant cell granulomas (CGCGs) appear to be benign, their radiographic findings are active. These tumors become severely invasive with the stimulus of surgery, resembling malignant tumors. Achieving the correct diagnosis is reportedly difficult because CGCGs are very similar to odontogenic jaw tumors. We herein describe an intriguing case of a 21-year-old male patient who was referred to our outpatient clinic with persistent swelling of the left buccal region. After making a provisional diagnosis of ameloblastoma from panoramic and computed tomography images, a biopsy was performed. Nine days after this operation, the intraoral lesion started to enlarge, causing facial disfigurement. Soon afterward, this lesion was examined by computed tomography, magnetic resonance imaging, and by both bone and tumor scintigraphy. Segmental resection of the mandible was conducted in the hospital, and the histopathological appearance was consistent with CGCG. Although CGCG tends to be indolent, the present case suggests that the stimulus of surgery can trigger clinically invasive behavior more characteristic of malignancy. CGCG exhibits variable features, but with the stimulus of surgery, its clinical behavior becomes extremely invasive, resembling a malignant tumor. The CGCG in the present case showed unusual development and intriguing radiographic and histopathological findings. It is important to be aware of the findings that can help to achieve a correct diagnosis.

Inflammation plays a crucial role in the pathophysiological characteristics of chronic kidney disease; however, the inflammatory mechanisms underlying the chronic kidney disease process remain unclear. Recent evidence indicates that sterile inflammation triggered by tissue injury is mediated through a multiprotein complex called the inflammasome. Therefore, we investigated the role of the inflammasome in the development of chronic kidney disease using a murine unilateral ureteral obstruction (UUO) model. Inflammasome-related molecules were up-regulated in the kidney after UUO. Apoptosis-associated speck-like protein containing a caspase recruitment domain deficiency significantly reduced inflammatory responses, such as inflammatory cell infiltration and cytokine expression, and improved subsequent renal injury and fibrosis. Furthermore, apoptosis-associated speck-like protein containing a caspase recruitment domain was specifically up-regulated in collecting duct (CD) epithelial cells of the UUO-treated kidney. In vitro experiments showed that extracellular adenosine triphosphate (ATP) induced inflammasome activation in CD epithelial cells through P2X 7 -potassium efflux and reactive oxygen species–dependent pathways. These results demonstrate the molecular basis for the inflammatory response in the process of chronic kidney disease and suggest the CD inflammasome as a potential therapeutic target for preventing chronic kidney disease progression.

Background Neuroendocrine tumors (NETs) are rare especially in the gallbladder. They have not been elucidated in the pathogenesis, clinicopathological characteristics, and treatment options. Case presentation We present a 76-year-old woman with a gallbladder tumor and hepatic hilar lymph node swelling. The lymph node biopsy demonstrated neuroendocrine carcinoma (NEC). We performed cholecystectomy, hepatic hilar lymphadenectomy, extrahepatic biliary duct resection, and hepaticojejunostomy prior to chemotherapy. Pathological examination revealed the gallbladder mass was an adenocarcinoma invading to the muscular layer without any NEC components, whereas the hepatic hilar lymph nodes were filled with high-grade NEC cells with negligible area of adenocarcinoma. The patient received general chemotherapy consisting of carboplatin and etoposide, but a recurrence in the para-aortic lymph nodes occurred 4 months after surgery. Conclusions We report a rare case of NEC of the hepatic hilar lymph nodes that were concomitant with an adenocarcinoma of the gallbladder. High-grade NEC generally has an aggressive behavior and an optimal treatment strategy should be chosen for each patient.

Based on area P lesion experiments, we hypothesized that tongue protrusion adapted for licking might be regulated by the lateral wall of the presylvian sulcus (bilateral areas P) of the cerebral cortex (Hiraba H, Sato T, Nakakawa K, Ueda K. 2009. Cortical control of appropriate tongue protrusion during licking in cats--Increase in regional cerebral blood flow (rCBF) of the contralateral area P and in tongue protrusion after the unilateral area P lesion. Somatosens Mot Res 26:82-89). We propose that the right and left lingual muscles are dominated by the right and left hypoglossal nucleus, respectively, and that right and left pyramidal cells projecting to the right and left hypoglossal nucleus, respectively, exist in unilateral area P. These cells project via an inhibitory interneuron relay to the lateral branches toward the left or right pyramidal cells in contralateral area P. In this study, we aimed to demonstrate the existence of inhibitory interneurons using injections of a gamma-aminobutyric acid (GABA) agonist (muscimol), a GABA antagonist (bicuculline), and kainic acid into unilateral area P, followed by examination of tongue protrusion and lateral movements during trained licking and changes in regional cerebral blood flow (rCBF) values in the contralateral area P. We found disordered protrusion toward both sides and a marked decrease in rCBF values in the contralateral area P after bicuculline injection. We also found abnormal tongue protrusion toward the front and a marked increase in rCBF values after muscimol and kainic acid injections. These results suggest that cortical networks between the bilateral areas P are relayed by inhibitory interneurons.

Japan is no exception among developed countries facing healthcare system problems due to aging and low birthrate as the number of possible patients increases and health care worker numbers shrink. The introduction of high tech medicine has increased the amount of knowledge to be learned by novice nurses. Although vast amounts of implicit knowledge have accumulated among nursing practitioners, this knowledge needs to be communicated when hospitals train younger generations of nurses and integrate nursing guidelines among multiple hospitals. In this paper, the authors have proposed an activity model called CHARM – the Convincing Human Action Rationalized Model. CHARM was developed to resolve the diverse needs of hospitals. CHARM explicates multidimensional purpose-oriented procedure relations often existing as implicit knowledge. For this reason, CHARM supports the training and education of novice nurses. CHARM also is used as a tool to integrate different knowledge and work procedures tacitly existing among different organizations. We developed CHARM models according to nursing guidelines of hospitals and applied them to the integration of nursing procedures at two hospitals. Based on these CHARMmodels, 12 differences were found among the two guidelines covering the same procedure for different hospitals. CHARM is being evaluated at these hospitals and positive responses are coming from nurses.

In the magnetic resonance T1-weighted imaging, some investigators have shown that coronary artery high-intensity signals (HISs) are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although previous studies used different PMR (the ratio between the signal intensities of coronary plaque and cardiac muscle) cutoff values to detect HIS, the association between PMR itself and plaque morphology has not been fully investigated.We prospectively investigated the association between PMR values and plaque morphology detected by optical coherence tomography in consecutive 106 patients with angina pectoris. The lesions with almost all of the vulnerable features such as lipid-rich, thin-cap fibroatheroma, plaque rupture, thrombus, macrophage infiltrations, intimal vasculature, and absence of calcification had significantly higher PMR; the only exception was the presence of cholesterol crystals. PMR increases linearly with the number of vulnerable features (p0.0001, Rho=0.504). Stepwise multiple linear regression analysis revealed that the absence of calcification (p=0.0027), and the presence of thrombus (p=0.0071) and intimal vasculature (p=0.019) were independently associated with higher log-transformed PMR. There was a stepwise increase in PMR of the culprit lesions in proportion to the accumulation of the number of adverse plaque characteristics defined as non-calcified plaque, thrombus, and/or intimal vasculature.These results suggest that not only the presence of HIS, but also the elevated PMR itself may be used as a quantitative marker of plaque vulnerability in clinical evaluation.

Realistic image synthesis is an important research goal in computer graphics. One important factor to achieve this goal is a bidirectional reflectance distribution function (BRDF) that mainly governs an appearance of an object. Many BRDF models have therefore been developed. A physically-based BRDF based on microfacet theory [Cook and Torrance 1982] is widely used in many applications since it can produce highly realistic images. The microfacetbased BRDF consists of three terms; a Fresnel, a normal distribution, and a geometric functions. There are many analytical and approximate models for each of these terms.