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The Los Angeles classification system is the most widely employed criteria associated with the greatest interobserver agreement among endoscopists. In Japan, the Los Angeles classification system has been modified (modified LA system) to include minimal changes as a distinct grade of reflux esophagitis, rather than as auxiliary findings. This adds a further grading M defined as minimal changes to the mucosa, such as erythema and/or whitish turbidity. The modified LA system has come to be used widely in Japan. However, there have been few reports to date that have evaluated the interobserver agreement in diagnosis when using the modified LA classification system incorporating these minimal changes as an additional grade. A total of 100 endoscopists from university hospitals and community hospitals, as well as private practices in the Osaka-Kobe area participated in the study. A total of 30 video clips of 30-40 seconds duration, mostly showing the esophagocardiac junction, were created and shown to 100 endoscopists using a video projector. The participating endoscopists completed a questionnaire regarding their clinical experience and rated the reflux esophagitis as shown in the video clips using the modified LA classification system. Agreement was assessed employing kappa (kappa) statistics for multiple raters. The kappa-value for all 91 endoscopists was 0.094, with a standard error of 0.002, indicating poor interobserver agreement. The endoscopists showed the best agreement on diagnosing grade A esophagitis (0.167), and the poorest agreement when diagnosing grade M esophagitis (0.033). The kappa-values for the diagnoses of grades N, M, and A esophagitis on identical video pairs were 0.275-0.315, with a standard error of 0.083-0.091, indicating fair intraobserver reproducibility among the endoscopists. The study results consistently indicate poor agreement regarding diagnoses as well as fair reproducibility of these diagnoses by endoscopists using the modified LA classification system, regardless of age, type of practice, past endoscopic experience, or current workload. However, grade M reflux esophagitis may not necessarily be irrelevant, as it may suggest an early form of reflux disease or an entirely new form of reflux esophagitis. Further research is required to elucidate the pathophysiological basis of minimal change esophagitis.

症例は53歳の男性で, 便秘を主訴に来院. 大腸内視鏡検査で直腸に2型の腫瘍を認め生検にて低分化腺癌と診断され, 低位前方切除術 (D2郭清) を施行された. 組織学的に悪性度の高いカルチノイド腫瘍で, INFb, ss, ly2, v0, n1 (+), stage IIIaであった. 2年5カ月後に局所再発のため, 腫瘤切除術を施行された. 再発組織には核分裂像が多数認められ, Ki-67陽性細胞率68%であり, 内分泌細胞癌と診断された. 化学療法 (CDDP+UFT) を施行するも腫瘍は骨盤内にて増大し, 再手術1年5カ月後に, 再々手術が施行されたが, その5カ月後, 局所再発, リンパ節転移, 脳転移にて原癌死した. 内分泌細胞腫瘍は, 腫瘍細胞の異型度により臨床像に違いが見られるが, 脳転移をきたした内分泌細胞癌を経験したので考察を加え報告する.

One of the critical problems in the study of physiotherapy of Oriental medicine is not being able to use the same reproducible stimulation, especially in Ayurvedic oil treatments. To address this problem, we developed a healing robot which conducts shirodhara (an oil treatment) in a computerized reproducible manner. The physio-psychological changes during taila dhara conducted by the healing robot and an estimated psychological experiences during taila dhara by psychometric studies of anxiety and altered states of consciousness (ASC) were studied. The physiological changes of the practitioners themselves were checked. Sixteen healthy adult females (ages 21-56, 33 /spl plusmn/ 9 years) signed informed consent and participated in this study. During shirodhara the monitoring items for the subjects were: blood pressure and intermittent blood pressure, electrocardiogram (ECG) R-R intervals, expired gas analysis, impedance cardiography and electroencephalogram (EEG). The single EEG (C3 lead) of the technician was recorded at the same time, and respiratory movement of the chests of both subject and technician were also recorded. In the active studies, shirodhara was performed by a machine with a pumping and heating system. The subject's feelings during shirodhara showed deep restfulness with less anxiety - as if the subjects were between the sleep and awake states. Shirodhara induced bradycardia and the relative suppression of LF/HF power spectrum density, which indicated lowered sympathetic tone. Expired gas analysis showed a decreased tidal volume and CO/sub 2/ excretion. The EEG showed the slowing of the /spl alpha/ wave, an increase in /spl alpha/ and /spl theta/ activity and an increase in right-left coherence. These metabolic, ECG, and EEG findings support the reported experiences of relaxed and low metabolic states during shirodhara. Physiological changes during shirodhara were similar to those of meditation, including /spl alpha/-wave dominance in the frontal area and a decrease in heart rate and CO/sub 2/ excretion. These findings indicated a change in the function of the frontal lobe, limbic system, brain stem, and autonomic nervous system. On the other hand, the EEGs of the technicians of the manual shirodhara showed an increase in their stressful condition, which may also justify the utility of the healing robot as an assistant for the technicians.

A 600-MHz single-chip multiprocessor, which includes two M32R 32-bit CPU cores , a 512-kB shared SRAM and an internal shared pipelined bus, was fabricated using a 0.15-/spl mu/m CMOS process for embedded systems. This multiprocessor is based on symmetric multiprocessing (SMP), and supports modified-exclusive-shared-invalid (MESI) cache coherency protocol. The multiprocessor inherits the advantages of previously reported single-chip multiprocessors, while its multiprocessor architecture is optimized for use as an embedded processor. The internal shared pipelined bus has a low latency and large bandwidth (4.8 GB/s). These features enhance the performance of the multiprocessor. In addition, the multiprocessor employs various low-power techniques. The multiprocessor dissipates 800 mW in a 1.5-V 600-MHz multiprocessor mode. Standby power dissipation is less than 1.5 mW at 1.5 V. Hence, the multiprocessor achieves higher performance and lower power consumption. This paper presents a single-chip multiprocessor architecture optimized for use as an embedded processor and its various low-power techniques.

Ubiquitous computing is very expected to improve safety and offer more services in Japan. This involves managing large amounts of personal data, which is currently done by private companies. The paper describes how to use these data to watch children to keep safety on road to go to school. We use an agent-based recognition of relations among people using GPS data to show context information to parent who watch over his child. The recognition functions consisted of autonomous intelligent agents. An agent in lower layer of hierarchy finds the child drop off the way from school to home, then it makes alarm in system. The current application system such as a support system for watching over child on the school community road will send alarm-mail to the parent. Frequently, the child only go to a park with his friends to play, it is safe case, but the ordinary system makes an alarm-mail therefore the parent doesn't watch the alarm-mail at last. The system which is proposed in this paper tries to reduce unneeded alarm-mail to use recognition of relation among people.

The amputee cannot operate a mouse freely when they use a personal computer. Also there are few old people who think it easy to use computers. We have developed a new type of man-machine interface using the electromyogram (EMG). The two advantages of using the EMG are the following: The first is that we can control EMG freely. The second is that, what is necessary is just to put electrodes on the skin surface. In this study, the operation of a mouse cursor is reproduced (up, down, left, right, right click, left click). We used EMG for the input and the output of the system for mouse cursor operation. Six EMG signals are converted to the mouse cursor movement by the electric circuit or computer software. The usability of this system is conformed by Fitts's law.

In an effort to continuously improving business productivity, companies are adopting new practices towards a continuous optimization of the total enterprise in the areas of business processes, supply chain and plant life cycle. This trend is supported with the enabling technology for integrated enterprise systems, such as enterprise resource planning (ERP) and supply chain management (SCM) systems. With an ERP system, various types of information can be accessed in one system which allows us to do work flow reengineering more effectively. The accessibility of information from the lower layer (process automation/control) system such as process data to the upper layer (enterprise) system such as business data is critical for establishing an effective SCM system. This system plays a critical role for linking the enterprise and the control systems in optimizing the enterprise performance. In a chemical industry, the range of feasible operation regions that is set for the SCM system to find the best operation policy will indirectly depend on the ability of the process control system to perform in the range of operation regions. One of the requirements for an efficient production network is the ability to adopt changes in production operations with greater flexibility. This requirement will put a challenge on the process control technology. Meeting this requirement will allow for greater feasible operation regions set in the SCM study. Here, we discuss the potential impacts of a new trend in enterprise wide SCM practices on process control system in a chemical plant operation.

This paper reports the current situation and future directions of control theory and control technology which have been practically applied to Japanese industries. The control technology committee of the Japanese Society of Instrument and Control Engineering (SICE) have carried out the investigation on the activities and control technology of Japanese industry. The committee sent 300 questionnaire letters to Japanese manufacturing companies and got 110 effective answers which include 150 application examples in the practical industries. After the inquiry, the committee visited the potential companies' plants and interviewed the process and control engineers to confirm and get their views and comments on the subject studied.

Background We reported that the presence of anti-Ro/SS-A antibody (anti-Ro) in rheumatoid arthritis (RA) patients might be related to the inefficacy and the discontinuation of infliximab (IFX) compared to the other TNF inhibitors (etanercept and adalimumab). In addition, anti-Ro-positive patients who did not respond to IFX or adalimumab improved clinically when they switched to etanercept or tocilizmab (TCZ) as the second biologics. Objectives To study the difference in clinical response between anti-Ro-positive and -negative RA patients treated with golimumab (GLM) that is one of the TNF inhibitors and TCZ that is IL-6 inhibitor. Methods Thirty-six patients with GLM treatment (naive: 15, switch: 21) and 38 patients with TCZ treatment (naive: 7, switch: 31) were studied the efficacy and the continuation rate. The baseline characteristics were compared between responders and non-responders. Clinical response according to the disease activity score in 28 joints (DAS28) EULAR response criteria at 24 and 48 weeks was compared between anti-Ro-positive and -negative patients with RA. Results The EULAR response of a moderate or good response at 24 weeks based on DAS28 score in GLM and TCZ treatment was 29/36 (80.6%) and 35/38 (85.7%), respectively. There was revealed similar pattern at 48 weeks both GLM and TCZ treatment (82.1% and 94.7%, respectively). The following variables at baseline that were sex, age, disease duration, methotrexate dose, steroid dose, CRP levels, ESR levels, and DAS28 were not different between responders and non-responders in both GLM and TCZ treatment. When the clinical efficacy was compared between naive and switch patients, the number of responders to TCZ treatment was not different between naive and switch (85.7% to 93.5%, respectively), while the response to GLM in naive was significantly higher than that in switch (100% to 65%; respectively, p=0.013). Anti-Ro was detected in 7 of 36 (19.4%) patients with GLM treatment, and detected in 10 of 38 (26.3%) patients with TCZ treatment. When we focused on the presence of anti-Ro, the EULAR response of a moderate or good response was not different between anti-Ro-positive and -negative patients treated with both GLM and TCZ at 24 and 48 weeks (24 weeks: GLM; 85. 7% vs. 70.4%; respectively, p=1.000, TCZ; 100% vs. 89.3%, respectively, p=0.552, 48 weeks: GLM; 71.4% vs. 70.4%; respectively, p=1.000, TCZ; 100% vs. 92.9%; respectively, p=1.000). The continuation rate to GLM and TCZ in anti-Ro-positive patients were 74.4% and 90.0%, respectively. Conclusions There was no difference efficacy between anti-Ro-positive and -negative RA patients with both treatments. The efficacy and the continuation rate of TCZ were better than that of GLM, in RA patients with both switched bio and anti-Ro. On the other hand, GLM was effective in RA patients with anti-Ro and it was suggested that the results might be related to the different immunogenicity between GLM and IFX. References Matsudaira R,et al. Anti-Ro/SS-A antibodies are an independent factor associated with an insufficient response to tumor necrosis factor inhibitors in patients with rheumatoid arthritis. J Rheumatol 2011; 38: 2346-54 Van Schouwenburg PA, et al. Immunogenicity of anti-TNF biologic therapies for rheumatoid arthritis. Nat Rev Rheumatol 2013; 9: 164-72 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3587

We treated an infant with congenital central hypoventilation syndrome ("Ondine's curse"). She was cyanotic and given ventilatory support at the first hour after birth. An investigation of sleep state and respiration performed at the age of 3 months led to this diagnosis. Hypoventilation persisted in all sleep stages, with the most severely reduced tidal volumes occurring during delta-wave sleep (stages 3 and 4). In addition, severe secondary reduction in tidal volumes occurred in sleep-onset REM sleep. This phenomenon was absent in non sleep-onset REM sleep. At 4 months of age, her respiratory treatment was successfully converted to positive-pressure ventilation via a nasal mask, thus avoiding tracheotomy. This transition to noninvasive ventilatory support dramatically improved her quality of life during wakefulness. This report may be a clue to discuss the function of sleep-onset REM sleep seen in the early stage of life and suggests that nasal mask ventilation is a viable option in selected cases with congenital central hypoventilation syndrome (CCHS).

The switching time and the arc-firing probability of a self-sustaining discharge in UV-laser triggered vacuum gap (ULTVG) were measured. The third harmonic beam of a Nd:YAG pulse laser (wavelength 355 nm, energy 5 mJ/pulse, power density 4/spl times/10/sup 7/ W/cm/sup 2/) was used as a trigger for ULTVG. The UV-laser pulse injected perpendicularly onto the grounded cathode. The electrode materials were oxygen-free copper and aluminum. The electrodes were 85 mm in diameter. The gap length was 1.6, 1.9, 2.2 mm. The experimental chamber was evacuated to about 1.3/spl times/10/sup -4/ Pa by a turbo molecular pump. The range of the firing voltage in copper electrodes was higher than in aluminum. The jitter of the switching time in copper electrodes was smaller than in aluminum. The arc-firing probability decreased as the circuit inductance increased.

N822 mutation of KIT gene was frequent in pediatric acute myeloid leukemia patients with t(8;21) in Japan: a study of the Japanese childhood AML cooperative study group