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Heart failure with preserved ejection fraction (HFpEF) has currently become a major concern in the aging society owing to its substantial and growing prevalence. Recent investigations regarding sacubitril/valsartan have suggested that there is a gender difference in the efficacy of the medication in HFpEF cohort. However, information of gender difference in clinical profiles, examination, and prognosis have not been well investigated. The present study aimed to evaluate the differences in baseline characteristics and outcomes between women and men in a Japanese HFpEF cohort. We analyzed the data from our prospective, observational, and multicenter cohort study. Overall, 1036 consecutive patients hospitalized for acute decompensated heart failure were enrolled. We defined patients with an ejection fraction (EF) of ≥ 50% as HFpEF. Patients with severe valvular disease were excluded; the remaining 379 patients (women: n = 201, men: n = 178) were assessed. Women were older than men [median: 85 (79–89) years vs. 83 (75–87) years, p = 0.013]. Diabetes mellitus, hyperuricemia, and coronary artery disease were more prevalent in men than in women (34.8% vs. 23.9%, p = 0.019, 23.6% vs. 11.4%, p = 0.002, and 23.0% vs. 11.9%, p = 0.005, respectively). EF was not significantly different between women and men. The cumulative incidence of cardiovascular death or hospitalization for congestive heart failure (CHF) was significantly lower in women than in men (log-rank p = 0.040). Women with HFpEF were older and less often exhibited an ischemic etiology; further, they were associated with a lower risk for cardiovascular death or hospitalization for CHF compared with men in the Japanese population.

Helicobacter pylori eradication treatments are widely performed to improve gastric mucosal inflammation, promote ulcer healing, and reduce the incidence of gastric cancer. However, there are several issues associated with H. pylori eradication treatment. First, various treatment regimens are currently used worldwide, and the standard treatment varies with region and country. Second, the antimicrobial resistance of H. pylori is increasing due to indiscriminate antibiotic use. Finally, gut microbiota dysbiosis is potentially induced by H. pylori treatment.Based on current international guidelines and a network meta-analysis comparing the effects of various treatment regimens, nonbismuth quadruple therapies for 10-14 days and vonoprazan-based triple therapy for 7 days are the currently recommended H. pylori treatment regimens. These regimens show good eradication rates of approximately 90%, even in areas where antimicrobial-resistant strains are highly prevalent. However, these regimens still have inherent drawbacks that may promote further increases in antimicrobial resistance and induce gut microbiota dysbiosis because of the empiric use of multiple antibiotics. Key Message: The ideal concept for the present and future H. pylori eradication treatment involves "a simple, cost-effective strategy that fosters compliance without having a negative impact on the gut microbiota or contributing to future antimicrobial resistance." One interesting possibility that may fulfill this concept is a dual therapy involving vonoprazan and amoxicillin. This is the simplest treatment regimen that provides acceptable eradication rates, improves safety and tolerability, and minimizes the potential for increasing antimicrobial resistance or causing gut microbiota dysbiosis.

Treatment strategies for colonic diverticular bleeding (CDB) based on stigmata of recent hemorrhage (SRH) remain unstandardized, and no large studies have evaluated their effectiveness. We sought to identify the best strategy among combinations of SRH identification and endoscopic treatment strategies.We retrospectively analyzed 5823 CDB patients who underwent colonoscopy at 49 hospitals throughout Japan (CODE-BLUE J-Study). Three strategies were compared: find SRH (definitive CDB) and treat endoscopically, find SRH (definitive CDB) and treat conservatively, and without finding SRH (presumptive CDB) treat conservatively. In conducting pairwise comparisons of outcomes in these groups, we used propensity score-matching analysis to balance baseline characteristics between the groups being compared.Both early and late recurrent bleeding rates were significantly lower in patients with definitive CDB treated endoscopically than in those with presumptive CDB treated conservatively (30 days, 19.6% vs 26.0% [P .001]; 365 days, 33.7% vs 41.6% [P .001], respectively). In patients with definitive CDB, the early recurrent bleeding rate was significantly lower in those treated endoscopically than in those treated conservatively (17.4% vs 26.7% [P = .038] for a single test of hypothesis; however, correction for multiple testing of data removed this significance). The late recurrent bleeding rate was also lower, but not significantly, in those treated endoscopically (32.0% vs 36.1%, P = .426). Definitive CDB treated endoscopically showed significantly lower early and late recurrent bleeding rates than when treated conservatively in cases of SRH with active bleeding, nonactive bleeding, and in the right-sided colon but not left-sided colon.Treating definitive CDB endoscopically was most effective in reducing recurrent bleeding over the short and long term, compared with not treating definitive CDB or presumptive CDB. Physicians should endeavor to find and treat SRH for suspected CDB.

Endoscopic submucosal dissection (ESD) is effective for the treatment of colorectal neoplasms. We have developed a self-completion ESD (S-ESD) using Endosaber without requiring additional instruments or assistance. This prospective cohort study was conducted to investigate the feasibility of S-ESD for colorectal neoplasms. Patients with colorectal neoplasms measuring 20–40 mm in size were enrolled. A single operator, without assistance, performed ESD using only the Endosaber. The primary outcome was the success rate of S-ESD. Secondary outcomes included procedure time, the rates of en bloc, complete, and curative resection, and complication rates, including the incidence of perforation and delayed bleeding. In total, 15 patients with 15 lesions were enrolled. The median size of the resected lesions was 28 mm (interquartile range 25–29 mm). S-ESD success rate of 100% was achieved. The median procedure time was 44 min (29.5–53.5 min). We observed en bloc, complete, and curative resection rates of 100%, 93.3%, and 86.7%, respectively, and a complication rate of 6.7% (perforation: 0%, delayed bleeding: 6.7%). S-ESD for colorectal neoplasms was successfully performed with favorable treatment outcomes and low complication rates. S-ESD reduces the number of devices and extent of assistance, making S-ESD a simple and cost-effective procedure.

Background: Endoscopic submucosal dissection (ESD) is a standard treatment for tumors of the gastrointestinal tract. We developed a self-completion method of ESD using Endosaber to eliminate the need for an additional device or human assistance during the procedure. The aim of this study was to evaluate the technical feasibility and outcomes of this method in an ex vivo porcine training model. Methods: This was a pilot study, and the procedures were performed by 4 experts. Mock lesions measuring 15 mm in diameter were prepared at the posterior wall in the middle or lower esophagus obtained from domestic pigs. Each operator performed ESD on the mock lesions in 3 models. The primary outcome was ESD completion rate using the self-completion method. The secondary outcomes were procedure time, en bloc resection rate, perforation rate, and number of injections during the procedure. Results: All 12 ESDs were completed using the self-completion method. The median procedure time (interquartile range) was 483.5 (399–619.3) s (median incision time: 240.4 [168.3–332.5] s; median dissection time: 222 [182.8–257] s). En bloc resection rate was 100%. No perforation was noted during any of the procedures. The median number of injections was 10.5 (9–14.3). The procedure time decreased significantly with increase in experience (p = 0.020). Conclusions: The self-completion ESD method using one Endosaber without any assistance achieved a 100% en bloc resection rate without any perforation. The need for an additional device or assistance was successfully eliminated. This method may prove to be a simple and cost-effective ESD procedure for lesions in humans.

Objective: Recently, screening for Helicobacter pylori infection has been performed among children in Japan as a prevention strategy for gastric cancer. However, the diagnostic accuracy of the serum antibody test, using the ELISA-kit, for screening in children has not been confirmed, and it is unknown whether the cutoff value used for adults is appropriate for children. The aim of this study was to evaluate the accuracy of the serum antibody test for H. pylori infection for the mass screening of junior high school students in Japan. Subjects and Methods: H. pylori infection testing and eradication therapy in junior high schools began in the 2015 fiscal year for students in Yurihonjo and Nikaho cities, located in the Akita prefecture. The data of 410 students who underwent both stool antigen tests (SATs) and serum antibody test, between 2016 and 2018, were used for analysis. Students who had positive results on the SATs test were diagnosed with H. pylori infection. Results: The rate of H. pylori infection was 3.7% (15/410). The optimal cutoff of serum antibody for children was identified to be 5.4 U/mL, with this cutoff having an area under the curve of 0.94 (95% CI 0.83–1.00), specificity of 99.5% (95% CI 98.2–99.9) and sensitivity of 93.3% (95% CI 68.1–99.8), which was wide because of the small sample size. Conclusion: The accuracy of the serum antibody test may be enough for practical use in children 13–14 years old

Background and study aims We developed an e-learning program for endoscopic diagnosis of invasion depth of early gastric cancer (EGC) using a simple diagnostic criterion called non-extension sign, and the contribution of self-study quizzes to improvement of diagnostic accuracy was evaluated. Methods We conducted a prospective randomized controlled study that recruited endoscopists throughout Japan. After completing a pretest, the participants watched video lectures and undertook post-test 1. The participants were then randomly allocated to either the self-study or non-self-study group, and participants in the first group completed the self-study program that comprised 100-case quizzes. Finally, participants in both groups undertook post-test 2. The primary endpoint was the difference in post-test 2 scores between the groups. The perfect score for the tests was set as 100 points. Results A total of 423 endoscopists completed the pretest and were enrolled. Post-test 1 was completed by 415 endoscopists and 208 were allocated to the self-study group and 207 to the non-self-study group. Two hundred and four in the self-study group and 205 in the non-self-study group were included in the analysis. Video lectures improved the mean score of post-test 1 from 72 to 77 points. Participants who completed the self-study quizzes showed significantly better post-test 2 scores compared with the non-self-study group (80 vs. 76 points, respectively, P Conclusions Our e-learning program showed that self-study quizzes consolidated knowledge of the non-extension sign and improved diagnostic ability of endoscopists for invasion depth of EGC.

Helicobacter pylori (H. pylori) antimicrobial resistance is an urgent, global issue. In 2017, the World Health Organization designated clarithromycin-resistant H. pylori as a high priority bacterium for antibiotic research and development. In addition to clarithromycin, resistance to metronidazole and fluoroquinolones has also increased worldwide. Recent international guidelines for management of H. pylori infection recommend bismuth or non-bismuth quadruple therapy for 14 d as a first-line treatment for H. pylori in areas of high clarithromycin and/or metronidazole resistance. Although these treatment regimens provide acceptable H. pylori eradication rates, the regimens used should not contribute to future resistance of H. pylori to antimicrobials. Moreover, these regimens can promote resistance, due to prolonged therapy with multiple antibiotics. A new strategy that can eradicate H. pylori as well as reduce the antibiotics used is required to prevent future antimicrobial resistance in H. pylori. Dual-therapy with vonoprazan and amoxicillin could be a breakthrough for H. pylori eradication in an era of growing antimicrobial resistance. This regimen may provide a satisfactory eradication rate of H. pylori and also minimize antimicrobial resistance due to single antibiotic use and the strong inhibitory effect of vonoprazan on gastric acid secretion.

The aim of this study was to investigate the prognostic significance of high-sensitivity troponin T (hs-TnT) in patients with heart failure (HF) with preserved ejection fraction (HFpEF). We enrolled consecutive patients admitted to Shinshu University Hospital for HF treatment between July 2014 and March 2017 and stratified them into HF with reduced ejection fraction and HFpEF groups (left ventricular ejection fraction

初等・中等教育は、学習指導の機能と生徒指導の機能を両輪としている。しかしながら、特別活動等を通した生徒指導が「社会的リテラシー」を始めとする資質・能力をいかに育成するのかを検証した数理定量的な研究は多くない。その予備的な考察として、本稿では22 大学の学生1826 名を対象に実施した質問紙調査の分析から、環境としての学級規律が積極的な生徒指導機能を果たしてことを示唆した。具体的には、自己主張に関わる資質・能力に関しては、校内成績の高低によっては学級規律の高低に左右される場合があり、集団の構成員としての自覚に関わる資質・能力に関しては、校内成績の高低に関係なく学級規律の高低に左右されていることを明らかにした。

Background: Clinical evidence of the effects of loop diuretics in patients with heart failure with preserved ejection fraction (HFpEF) is lacking. Thus, we compared the impact of azosemide and furosemide, long- and short-acting loop diuretics, in patients with HFpEF. Methods and Results: A prospective multicenter cohort study was conducted between July 2014 and July 2018. We enrolled 301 consecutive patients with HFpEF (median age, 84 years; IQR, 79-88 years; 54.8% female). Azosemide was used in 127 patients (azosemide group), and furosemide in 174 (furosemide group). We constructed Cox models for a composite of cardiac death, non-fatal myocardial infarction, non-fatal stroke, and HF hospitalization (primary endpoints). During a median follow-up of 317 days (IQR, 174-734 days), the primary endpoint occurred in 112 patients (37.2%). On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, the azosemide group had a significantly lower incidence of adverse events than the furosemide group (hazard ratio [HR], 0.46; 95% confidence interval [CI]: 0.27-0.80; P=0.006). Furthermore, on multivariate IPTW Cox modeling for the secondary endpoints, cardiac death (HR, 0.38; 95% CI: 0.17-0.89; P=0.025) and unplanned hospitalization for decompensated HF (HR, 0.50; 95% CI: 0.28-0.89; P=0.018) were also reduced in the azosemide group. Conclusions: Azosemide significantly reduced the risk of adverse events compared with furosemide in HFpEF patients.

BACKGROUND Chemotherapy is a standard strategy for stage IV gastric cancer patients. However, some cases cannot undergo conversion surgery because of their frailty, even if the patients had response to chemotherapy. For these patients, local tumor progression is a problem. We report here the case of a patient whose residual gastric cancer was resected through endoscopic submucosal dissection (ESD) after concomitant chemotherapy for metastatic gastric cancer. CASE SUMMARY An 85-year-old male complained of difficulty swallowing, and examination revealed gastric cancer with multiple liver metastases. Although he received concomitant chemotherapy, a residual tumor was observed in the primary lesion while the metastatic lesions disappeared completely. Conversion surgery was considered optional treatment; however, he could not undergo that because of advanced age and comorbidities. Thus, we performed ESD to treat the residual tumor. As a result, we resected the residual lesion completely. The patient has been alive for 29 mo since ESD, without recurrence. CONCLUSION We achieved local control using ESD, and these findings may provide therapeutic improvements both in local control and patient survival outcomes.

Bowel habits affect the quality of life (QOL) of patients with functional gastrointestinal disorders. This study evaluated the effects of reduced form coenzyme Q 10 (ubiquinol) intake on defecation frequency and stool form in patients with daily abdominal symptoms. This was a single-center, prospective, double-blind, randomized control study. Forty-one patients who had the daily symptom of constipation or diarrhea were randomly assigned at a 1:1 ratio to receive either ubiquinol (150 mg/day) or placebo for 12 weeks. Patients completed a daily diary to collect information regarding their numbers of defecations and stool forms according to the Bristol Stool Form (BSF) Scale for 7 days at baseline and 12 weeks. QOL was assessed using the 36-item short-form (SF-36) at baseline and 12 weeks. Twenty-one patients were assigned to the ubiquinol group, and 20 were assigned to the placebo group. At 12 weeks, the mean defecation frequency, compared to baseline, significantly decreased in the ubiquinol group (-0.1 times/day, P = .034) and increased in the placebo group (+0.3 times/day, P = .004). There was no significant change in the 12-week BSF Scale score of the ubiquinol group (+0.2, P = .123), whereas that of the placebo group was increased (+0.5, P .001). The 12-week general health perception SF-36 score was significantly increased in the ubiquinol group (+3.5, P = .045), whereas there was no significant difference in that score in the placebo group (+1.2, P = .178). In conclusion, taking ubiquinol for 12 weeks decreased defecation frequencies and increased the QOL score, suggesting that ubiquinol may change the bowel habits and improve QOL in patients with abdominal distress.

Gastric endoscopy is a common clinical practice that enables medical doctors to diagnose various lesions inside a stomach. In order to identify the location of a gastric lesion such as early cancer and a peptic ulcer within the stomach, this work addresses to reconstruct the color-textured 3D model of a whole stomach from a standard monocular endoscope video and localize any selected video frame to the 3D model. We examine how to enable structure-from-motion (SfM) to reconstruct the whole shape of a stomach from endoscope images, which is a challenging task due to the texture-less nature of the stomach surface. We specifically investigate the combined effect of chromo-endoscopy and color channel selection on SfM to increase the number of feature points. We also design a plane fitting-based algorithm for 3D point outliers removal to improve the 3D model quality. We show that whole stomach 3D reconstruction can be achieved (more than 90% of the frames can be reconstructed) by using red channel images captured under chromo-endoscopy by spreading indigo carmine (IC) dye on the stomach surface. In experimental results, we demonstrate the reconstructed 3D models for seven subjects and the application of lesion localization and reconstruction. The methodology and results presented in this paper could offer some valuable reference to other researchers and also could be an excellent tool for gastric surgeons in various computer-aided diagnosis applications., Whole Stomach 3D Reconstruction and Frame Localization from Monocular Endoscope Video.

OBJECTIVES Colonic spasm can interfere with colonoscopy, but antispasmodic agents can cause complications. This study aimed to assess the inhibitory effect of topical lidocaine compared with a placebo control. METHODS In five tertiary-care hospitals in Japan, 128 patients requiring endoscopic resection of a colorectal lesion were enrolled and randomly and double-blindly allocated to colonoscopy with topical administration of 2% lidocaine solution 20mL (LID, n = 64) or normal saline 20mL (control, n = 64). During colonoscopy, the assigned solution was applied with a spray catheter near the lesion and the area was observed for three minutes. primary endpoint was the inhibitory effect at three time-points (1, 2 and 3 minutes after dispersion), using a three-point scale (excellent, fair, poor). Secondary endpoints were rebound spasm and adverse events. All endpoints were scored in real time. Serum lidocaine levels were measured in 32 patients (LID 16, control 16). RESULTS There were no significant differences between groups in patient demographics. At all time-points, the proportion of patients with "excellent" scores was greater in LID group than control group, with significant differences observed at 2 minutes (p = 0.02) and 3 minutes (p = 0.02). In LID group, the rate of "excellent" scores increased by 12.5% at 2 minutes and was maintained at 3 minutes. Rebound spasm did not occur in LID group, compared with 15.6% of control group (p = 0.001). There were no adverse events in LID group. All serum lidocaine levels were below detectable levels. CONCLUSIONS Topical lidocaine is an effective and safe method for suppressing colorectal spasm during colonoscopy (UMIN000024733).

Eradication of Helicobacter pylori (Hp) is necessary for preventing peptic ulcers and stomach cancer. The potassium-competitive acid blocker vonoprazan is a gastric acid secretion inhibitor that improves the success rate of Hp eradication through its immediate and persistent inhibition of acid excretion. In Japan, first-line treatment involves a regimen in which vonoprazan is combined with amoxicillin and clarithromycin, while second-line treatment involves vonoprazan combined with amoxicillin and metronidazole. However, in contrast to the vonoprazan-based first-line therapy, no studies have investigated the factors influencing the success of vonoprazan-based second-line therapy. In this study, we therefore aimed to investigate factors related to the success of vonoprazan-based second-line therapy. We analyzed the association between the success of Hp eradication and patient factors including metronidazole/amoxicillin minimal inhibitory concentrations (MICs). MICs were measured using the Hp isolated from each patient. A receiver operating characteristic (ROC) analysis was conducted to examine continuous variables and eradication success. We reviewed the records of 33 patients (age: 34-79 years, male/female: 22/11, and body mass index (BMI): 16.1-28.8 kg/m

Although systolic blood pressure (SBP) is routinely considered when treating acute heart failure (HF), diastolic blood pressure (DBP) is hardly been assessed in the situation. There are no previous studies regarding the predictive value of DBP in elderly patients with HF with preserved ejection fraction (HFpEF) in Japan. This study aimed to investigate the prognostic significance of DBP in patients with acute decompensated HFpEF. We analyzed data of all HFpEF patients admitted to Shinonoi General Hospital for HF treatment between July 2016 and December 2018. We excluded patients with acute coronary syndrome and severe valvular disease. Patients were divided into two groups according to their median DBP; the low DBP group (DBP ≤ 77 mmHg, n = 106) and the high DBP group (DBP > 77 mmHg, n = 100). The primary outcome was HF readmission. In 206 enrolled patients (median 86 years), during a median follow-up of 302 days, the primary outcome occurred in 48 patients. The incidence of HF readmission was significantly higher in the low DBP group (33.0% vs 18.5%, p = 0.024). In Kaplan–Meier analysis, low DBP predicted HF readmission (Log-rank test, p = 0.013). In Cox proportional hazard analysis, low DBP was an independent predictor of HF readmission after adjustment for age, sex, SBP, hemoglobin, serum albumin, serum creatinine, B-type natriuretic peptide, renin-angiotensin system inhibitors, calcium channel blockers, left ventricular ejection fraction, coronary artery disease, and whether they live alone (hazard ratio, 2.229; 95% confidence interval, 1.021–4.867; p = 0.044). Low DBP predicted HF readmission in patients with HFpEF.

Gastric endoscopy is a golden standard in the clinical process that enables medical practitioners to diagnose various lesions inside a patient’s stomach. If a lesion is found, a success in identifying the location of the found lesion relative to the global view of the stomach will lead to better decision making for the next clinical treatment. Our previous research showed that the lesion localization could be achieved by reconstructing the whole stomach shape from chromoendoscopic indigo carmine (IC) dye-sprayed images using a structure-from-motion (SfM) pipeline. However, spraying the IC dye to the whole stomach requires additional time, which is not desirable for both patients and practitioners. Our objective is to propose an alternative way to achieve whole stomach 3D reconstruction without the need of the IC dye. We generate virtual IC-sprayed (VIC) images based on image-to-image style translation trained on unpaired real no-IC and IC-sprayed images, where we have investigated the effect of input and output color channel selection for generating the VIC images. We validate our reconstruction results by comparing them with the results using real IC-sprayed images and confirm that the obtained stomach 3D structures are comparable to each other. We also propose a local reconstruction technique to obtain a more detailed surface and texture around an interesting region. The proposed method achieves the whole stomach reconstruction without the need of real IC dye using SfM. We have found that translating no-IC green-channel images to IC-sprayed red-channel images gives the best SfM reconstruction result. Clinical impact We offer a method of the frame localization and local 3D reconstruction of a found gastric lesion using standard endoscopy images, leading to better clinical decision.

BackgroundThe value of endoscopy for acute lower GI bleeding (ALGIB) remains unclear, given few large cohort studies. We aim to provide detailed clinical data for ALGIB management and to identify patients at risk for adverse outcomes based on endoscopic diagnosis.MethodsWe conducted a multicenter, retrospective cohort study, named CODE BLUE J-Study, in 49 hospitals throughout Japan and studied 10,342 cases admitted for outpatient-onset of acute hematochezia.ResultsCases were mostly elderly, with 29.5% hemodynamic instability and 60.1% comorbidity. 69.1% and 87.7 % of cases underwent CT and colonoscopy, respectively. Diagnostic yield of colonoscopy reached 94.9%, revealing 48 etiologies, most frequently diverticular bleeding. During hospitalization, the endoscopic therapy rate was 32.7%, mostly using clipping and band ligation. IVR and surgery were infrequently performed, for 2.1% and 1.4%. In-hospital rebleeding and death occurred in 15.2% and 0.9%. Diverticular bleeding cases had higher rates of hemodynamic instability, rebleeding, endoscopic therapy, IVR, and transfusion, but lower rates of death and surgery than other etiologies. Small bowel bleeding cases had significantly higher rates of surgery, IVR, and transfusion than other etiologies. Malignancy or upper GIB cases had significantly higher rates of thromboembolism and death than other etiologies. Etiologies that have favorable outcomes were ischemic colitis, infectious colitis, and post-endoscopy bleeding.ConclusionsLarge-scale data of patients with acute hematochezia revealed high proportions of colonoscopy and CT, resulting in high endoscopic therapy rates. We highlight the importance of colonoscopy in detecting accurate bleeding etiologies that stratify patients at high or low risk of adverse outcomes.

Background: Optimal timing of colonoscopy for acute lower gastrointestinal bleeding is controversial, and it is unclear which patients benefit from early colonoscopy. The reported proportion of hemodynamically unstable patients is lower in randomized controlled trials than in observational studies. Methods: We studied 6,311 patients admitted for acute hematochezia in 49 Japanese hospitals, named the CODE-BLUE J Study. One propensity score-matched cohort comprised patients who underwent early (

BACKGROUND As a first-line therapy for Helicobacter pylori, dual therapy with vonoprazan and amoxicillin (VA-dual) provides an eradication rate similar to that of vonoprazan-based triple therapy. As the factors associated with the eradication rate of H. pylori with VA-dual are unknown,we investigated them in this study. MATERIALS AND METHODS Overall, 163 patients diagnosed with H. pylori infection received VA-dual (vonoprazan 20 mg twice daily and amoxicillin 750 mg twice daily for 7 d). The association between successful H. pylori eradication and the following patient clinical factors was analyzed: sex, age, height, weight, body surface area (BSA), body mass index (BMI), history of early gastric carcinoma and peptic ulcer, comorbidity of cirrhosis, alcohol consumption habit, smoking habit, common use of proton pump inhibitors, and concomitant use of drugs that are substratesof cytochrome P450 (CYP) 3A4. The association between post-eradication adverse events and clinical factors was analyzed retrospectively. RESULTS Successful H. pylori eradication was associated with a lower BSA (eradication rate: 90.8% in patients with BSA

Background The current virtual chromoendoscopy equipment cannot completely detect superficial squamous cell carcinoma (SCC) in the esophagus, despite its development in the recent years. Thus, in this study, we aimed to elucidate the appropriate air volume during endoscopic observation to improve the visibility of esophageal SCC. Methods This retrospective study included a total of 101 flat type esophageal SCCs identified between April 2017 and January 2019 at the Department of Gastrointestinal Oncology, Osaka International Cancer Institute. Video images of narrow band imaging (NBI) under both less-air and standard-air conditions were recorded digitally. Videos were evaluated by five endoscopists. Relative visibility between less-air and standard-air conditions of the brownish area, brownish color change of the epithelium, and dilated intrapapillary capillary loop (IPCL) were graded as 5 (definitely better under less-air condition) to 1 (definitely worse under less-air condition), with 3 indicating average visibility (equivalent to standard-air observation). Results The mean (standard deviation) visibility score of the brownish area, brownish color change of the epithelium, and dilated IPCLs under less-air condition were 3.94 (0.58), 3.73 (0.57), and 4.13 (0.60), respectively, which were significantly better than that under standard-air condition (p Conclusions The present results suggested that NBI with less air might improve the visibility of flat type esophageal SCC compared with NBI with standard air. Less-air NBI observation may facilitate the detection of flat type esophageal SCC. Trial registration The present study is a non-intervention trial.

Background Endoscopy is a common clinical practice to evaluate gastrointestinal diseases. Although endoscopy assesses gastrointestinal mucosal surface, it cannot evaluate the shape and volume of gastrointestinal organs and localization of the lesion. The accurate localization of a malignant lesion within the global view of the stomach is crucial for gastric surgeons to make a clinical decision of the operative procedure. Further, the shape of gastrointestinal organs possibly associates with some abdominal symptoms or disorders. Structure from Motion (SfM) is a method to recover 3D scene structure and camera motion from multiple images. SfM may be applied to endoscopy in order to reconstruct the shape of gastrointestinal organs. We aimed to reconstruct the 3D model of the whole stomach from standard endoscopic video image using SfM. Methods Seven participants underwent gastroscopy under sedation for screening upper gastrointestinal diseases. The endoscope video was captured using a standard endoscope system. The video data was saved as an AVI format in 30 frames per second with full HD resolution. All endoscopic video was converted to RGB frames. The red channel of the extracted RGB frames were put to the SfM, where feature extraction, matching, pose estimation, and feature points triangulation were performed to generate a sparse 3D point cloud. Poisson surface reconstructed was performed to construct a 3D mesh model of the stomach. Finally, the texture of the endoscopic images was applied to the generated 3D mesh model to add more visual detail. Results Most 3D point clouds were extracted from the red channel of the endoscopic images with the indigo carmine dye (figure 1). 3D meshes and texture representation resembling the whole shape of a stomach were generated from the cloud model (figure 2). Gastric ulcer lesion was clearly localized and reconstructed in one subject. Conclusions Our study found that 3D reconstruction of the whole stomach can be achieved from a standard endoscopic video image using SfM. Furthermore, gastric ulcer lesion was also localized and reconstructed in 3D reconstruction model. Our future work will be focused on the clinical significance of our proposed method. We will try to evaluate the clinical usefulness of this method for the patients undergone surgery for early gastric cancers.

BackgroundEndoscopic submucosal dissection (ESD) for gastrointestinal neoplasms can be technically difficult for trainee endoscopists. Presently, there is no consensus for trainees to select the endo-knife type in ESD. Therefore, we conducted a comparison study of treatment outcomes between scissors-type and needle-type knives in ESD performed by trainees in an ex vivo porcine model.MethodsThis study was conducted on trainee endoscopists who participated in ESD hands-on seminars held in August 2018 and September 2019. A total of 22 trainees from 13 institutions were divided into two groups according to their endoscopic experience. Under expert supervision, each trainee performed two ESDs in porcine models, namely, scissor-type knife (ESD-S) and needle-type knife (ESD-N). The efficacy and safety, including the procedure time and rates of self-completion, en bloc resection, and complications, were compared between ESD-S and ESD-N. In subgroup analysis, we also investigated the predictors associated with the difficulty of ESD for trainees using multivariate logistic regression analysis.ResultsEight trainees had an experience of over 1000 endoscopies (senior trainee: S-Trainee), whereas the others had an experience of less than 1000 endoscopies (junior trainee: J-Trainee). Among the S-Trainees, no significant differences were observed in any treatment outcome between ESD-S and ESD-N. Among the J-Trainees, the total procedure and mucosal incision times were significantly shorter in ESD-S than in ESD-N [total procedure time: 16.5 min (range 10.0–31.0) vs. 22.3 min (range 10.0–38.0), P = 0.018; circumferential incision time: 10.0 min (range 6–16) vs. 17.0 min (range 5.0–31.5); P = 0.019]. Regarding complications, muscular injury occurred in two patients during ESD-N performed by J-Trainees; however, no muscular injury occurred during ESD-S. In subgroup analysis, ESD-N was an independent predictive factor of difficult ESD (odds ratio 5.28, 95% confidence interval 1.25–22.30;P = 0.024).ConclusionsThis study revealed that trainees, particularly those who have experienced less than 1000 endoscopies, should opt for the scissor-type knife to perform ESD.

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Background: Gastrointestinal decompression through ileus tube is useful for the treatment of adhesive small bowel obstruction (ASBO). Gastrografin administration through the ileus tube is performed if decompression therapy fails to relieve obstruction. However, the efficacy and appropriate timing of gastrografin administration are unclear. This study aimed to evaluate the efficacy of gastrografin administration within 48 h after admission. Methods: This retrospective study used the data of patients with ASBO admitted to our hospital between January 2014 and August 2018 and included those who underwent ileus tube intubation but did not achieve obstruction relief for over 24 h after admission. The patients were classified into the following two groups: those treated with gastrografin administration within 48 h after admission (EGA group) and those treated without gastrografin administration within 48 h after admission (non-EGA [NEGA] group). Propensity-score matching was performed to compensate for confounding differences between the groups. The short-term outcomes including the rate of successful conservative management without surgery, the period until the first stool, the period of ileus tube intubation, the total period of hospital admission, and adverse events due to gastrografin administration were evaluated and compared between the two groups. Results: This study included 152 patients: 67 in the EGA group and 85 in the NEGA group. Fifty-five pairs were matched with similar background characteristics. After matching, the rates of successful conservative management were 89.1% (49/55) and 94.5% (52/55) in the matched EGA and NEGA groups, respectively (P=0.49). Although the median insertion days of ileus tube in the NEGA group were significantly lesser than those in the EGA group (7 [5–9] vs. 5 [4.5–7], P=0.017), other therapeutic outcomes did not differ significantly. In the NEGA group, 5.5% (3/55) achieved obstruction relief without gastrografin administration. Aspiration pneumonia occurred in one patients of EGA group. Conclusions: Gastrografin administration with ileus tube achieved a high rate of successful conservative management. Follow-up by decompression with ileus tube for at least 48 h after admission is required in patients with ASBO, which may avoid unnecessary gastrografin administration and consequently reduce the total cost of treatment.

Background Endoscopic submucosal dissection (ESD) of the postoperative stomach (ESD-P) for early gastric cancer (EGC) is considered a technically difficult procedure. However, it is difficult to compare the outcomes of ESD-P and ESD of the non-operative stomach (ESD-N) because their baseline characteristics are different. Therefore, we aimed to compare the technical outcomes of ESD-P with those of ESD-N using a propensity score-matching analysis to compensate for the differences. Methods The chart records of 1046 patients with EGC who were treated with ESD between January 2004 and July 2016 at Kitakyushu Municipal Medical Center in Japan were reviewed in this retrospective study. Multivariate analyses and propensity score-matching were performed for age, sex, lesion location, lesion size, tumor invasion, tumor size, ulcer (scar), and operator skill. The primary outcome was procedure time. Secondary outcomes were percentages of en bloc, complete, and curative resections, and percentages of adverse events, which were evaluated between the two groups. Results Forty-one patients were in the ESD-P group and 1005 patients were in the ESD-N group. Propensity score-matching created 41 matched pairs. According to the adjusted comparisons, ESD-P required a significantly longer procedure time (85 min vs 51 min, p

Background: Endoscopic submucosal dissection (ESD) for early gastric neoplasms is still a technically difficult and time-consuming procedure. Hybrid ESD (H-ESD) involves circumferential incision with partial submucosal dissection combined with subsequent mucosal resection by snaring, wherein the newly developed device allows us to perform H-ESD using a single device. This study aimed to determine the clinical outcomes of H-ESD compared with conventional ESD (C-ESD) for early gastric neoplasms. Methods: In this multi-center, retrospective study, using propensity score-matched analysis, we reviewed the charts of patients with early gastric neoplasms smaller than 20 mm treated with H-ESD or C-ESD at three hospitals between January 2017 and October 2018. The primary outcome was the procedure time, and the secondary outcomes were other factors, including the en bloc resection rate, complete resection rate, curative resection rate, and rate of adverse events. Results: Among 215 patients, 29 underwent H-ESD and 186 underwent C-ESD; 29 pairs were created by propensity score matching. In the H-ESD group, 82.8% of lesions met the absolute indication [mucosal lesions limited to 20-mm diameter, dominated by differentiated adenocarcinoma without ulcer (scar)] for endoscopic resection (ER). As a result, the procedure time of H-ESD was significantly shorter than that of C-ESD [20 (interquartile range, 12–27) min versus 40 (30–50) min; p Conclusion: H-ESD contributed to reduced procedure time. Therefore, H-ESD could be an alternative endoscopic treatment for gastric neoplasms when the lesion fulfils the absolute indication for ER.

Background Gastrointestinal decompression through ileus tube is useful for the treatment of adhesive small bowel obstruction (ASBO). Gastrografin administration through the ileus tube is performed if decompression therapy fails to relieve obstruction. However, the appropriate timing of gastrografin administration is unclear. The present study aimed to evaluate the efficacy of gastrografin administration within 48 h after admission.Methods This retrospective study used the data of patients with ASBO admitted to our hospital between January 2014 and August 2018. The study included those who underwent ileus tube intubation but did not achieve obstruction relief for over 24 h after admission. The patients were classified into the following two groups: those treated with gastrografin administration within 48 h after admission (EGA group) and those treated without gastrografin administration within 48 h after admission (non-EGA [NEGA] group). Propensity-score matching was performed to compensate for confounding differences between the groups. The short-term outcomes of therapeutic effectiveness such as the rate of surgery avoidance, the period until the first stool, period of ileus tube intubation, and total period of hospital admission were evaluated and compared between the two groups.Results This study included 152 patients: 67 in the EGA group and 85 in the NEGA group. Fifty-five pairs were matched with similar background characteristics. After matching, the rates of surgery avoidance were 89.1% (49/55) and 94.5% (52/55) in the matched EGA and NEGA groups, respectively (P = 0.49). Although the median insertion days of ileus tube in the NEGI group were significantly lesser than those in the EGA group (7 [5–9] vs. 5 [4.5–7], P = 0.017), other therapeutic outcomes were not significantly different between the two groups. In the non-EGA group, 5.5% (3/55) achieved obstruction relief without gastrografin administration.Conclusions Early gastrografin administration might not be superior to non-early gastrografin administration in clinical outcomes of patients with ASBO. Follow-up by decompression with ileus tube for at least 48 h after admission is required in patients with ASBO, which may avoid unnecessary gastrografin administration and consequently reduce the total cost of treatment.

Introduction Long-acting loop diuretics have a possibility of better prognosis compared to short-acting loop diuretics in patients with heart failure with preserved ejection fraction (HFpEF). Purpose To investigate the effect of long- and short-acting loop diuretics in patients with HFpEF. Methods From the Clue of Risk Stratification in Patients With Heart Failure Registry (CURE-HF Registry), we enrolled 301 consecutive patients with HFpEF (median age, 84 years; 55% female). Long-acting loop diuretics (azosemide) were administrated in 127 patients, and short-acting loop diuretics (furosemide) in 174 patients. We constructed Cox models for MACE (defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure [HF] hospitalization). Results During a median follow-up of 317 [174–734] days, the primary endpoint occurred in 129 patients (42.8%). On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, patients treated with long-acting loop diuretics had a significantly lower incidence of adverse events than those treated with short-acting loop diuretics (hazard ratio [HR], 0.39; 95% confidence interval [CI] 0.23–0.67; P=0.001). Furthermore, on multivariate IPTW Cox modeling for the secondary endpoints, all-cause mortality (HR, 0.50; 95% CI, 0.20–0.80; P=0.01) and unplanned hospitalization for decompensated HF (HR, 0.50; 95% CI, 0.28–0.89; P=0.018) were also reduced in patients treated with long-acting loop diuretics. Conclusions Long-acting loop diuretics reduced the risk of MACE compared to short-acting diuretics in patients with HFpEF.

Vonoprazan, potassium-competitive acid blocker, is expected to reduce incidence of delayed bleeding after gastric endoscopic submucosal dissection (ESD); however, preliminary data to design a large-scale comparative study are lacking. This study aimed to assess the efficacy of vonoprazan in preventing delayed bleeding after gastric ESD. In this single-center randomized phase II trial, a modified screened selection design was used with a threshold non-bleeding rate of 89% and an expected rate of 97%. In this design, Simon’s optimal two-stage design was first applied for each parallel group, and efficacy was evaluated in comparison with the threshold rate using binomial testing. Patients were randomly assigned in a 1:1 ratio to receive either vonoprazan 20 mg (VPZ group) or lansoprazole 30 mg (PPI group) for 8 weeks from the day before gastric ESD. The primary endpoint was the incidence of delayed bleeding, defined as endoscopically confirmed bleeding accompanied by hematemesis, melena, or a decrease in hemoglobin of ≥ 2 g/dl. Delayed bleeding occurred in three of 69 patients (4.3%, 95% CI 0.9–12.2%, p = 0.047) in the VPZ group, and four of 70 (5.7%, 95% CI 1.6–14.0%, p = 0.104) in the PPI group. As only vonoprazan showed significant reduction in delayed bleeding compared with the threshold rate, it was determined to be efficacious treatment. Vonoprazan efficaciously reduced the delayed bleeding rate in patients with an ESD-induced gastric ulcer. A large-scale, randomized, phase III study is warranted to definitively test the effectiveness of vonoprazan compared with proton pump inhibitors.

Background Cold snare polypectomy (CSP) to remove multiple duodenal adenomas (MDAs) in patients with familial adenomatous polyposis (FAP) could be an effective and less invasive method than more extensive surgery. The aim of the present study was to determine the safety of this procedure. Methods This prospective exploratory study included 10 consecutive patients with FAP and MDAs who underwent CSP for as many as 50 duodenal adenomas. The primary outcome was the incidence of severe adverse events. Results 10 patients were enrolled and underwent 332 CSPs from June 2016 to January 2017. The median procedure time was 33 minutes (range 25 – 53), and the median number of polyps removed during a single session was 35 (range 10 – 50). Most of the removed polyps were ≤ 10 mm. None of the 10 patients experienced a severe adverse event. One patient developed arterial bleeding during the procedure, but it was easily managed using hemoclips. Conclusions CSP for MDAs in patients with FAP was safe. The long-term efficacy of this procedure should be investigated.

Ir cocatalyst-loaded SrTiO3:Ir has arisen as a promising photocatalyst for H2 evolution with a response to the whole range of visible light up to 800 nm. The key factor for the high activity lies in H2-reduction after loading of an Ir cocatalyst to obtain metallic and adhesive Ir-cocatalysts.

Background/Aims: Serologic tests are commonly used for screening Helicobacter pylori infection because they not only provide quick results but also are inexpensive. A new latex agglutination serum antibody assay (LZ test) has been developed and it is expected to be as effective as conventional assays. This study aimed to calculate a reliable cutoff value for the LZ test and to estimate the sensitivity and specificity of the cutoff value in screening adolescents for H. pylori infection in Japan. Methods: We screened junior high school students in Akita Prefecture, Japan, for H. pylori infection. We used the data of 213 such students who underwent H. pylori stool antigen (HpSA) tests in 2016. The students who had positive results with HpSA tests were diagnosed with H. pylori infection. Of the 213 students, 209 underwent the LZ test. Results: The prevalence rate of H. pylori infection was 3.8% (8/209). The area under the curve for the LZ test was 0.88. The cutoff value of the LZ test was determined to be 3.1 U/mL. At this value, the sensitivity and specificity were 87.5 and 91.5%, respectively. Conclusion: The accuracy of the LZ test in adolescents was well balanced for sensitivity and specificity as well as for tolerable results.

The perfluorosulfonic acid membranes used in membrane dehumidifiers show high water vapor permeance that is dependent on both the operating temperature and the relative humidity (RH). For this study, water vapor permeation was examined using the water vapor solubility and diffusion coefficients, which are based on a solution-diffusion model that is well established for dense polymer membranes. It was found that the dependence of the water vapor permeance on operating temperature and RH was mainly ascribed to the water vapor solubility and the water vapor diffusivity, respectively. Furthermore, the water vapor solubility and diffusion coefficients were used to formulate the water vapor permeance, which was then used to predict the performance of a membrane dehumidifier. A simulation was performed over a wide range of operating temperatures, feed-air RHs, and flow rates under different sweep-flow processes, and the experimental and calculated RH values at each outlet showed good agreement with an error of no more than 3%.

Helicobacter pylori infection is a risk factor for gastric cancer, and it has been reported that eradication of H. pylori is effective for preventing such cancer. Recently, H. pylori eradication has been performed in children as first-line therapy against gastric cancer. Here, we report use of triple therapy with a potassium-competitive acid blocker (P-CAB) for H. pylori eradication in children. H. pylori infection testing and eradication therapy began in fiscal year 2015 in junior high school students located in Yurihonjo city and Nikaho city, Akita prefecture, Japan. Urine-based immunochromatography, stool antigen enzyme-linked immunosorbent assay tests, and serum antibody tests were performed as the initial screening examination. Those who tested positive on one of the three examinations then underwent a urea breath test (13C-UBT). Those who tested positive on 13C-UBT and expressed the desire to undergo H. pylori eradication then received eradication therapy comprising 20 mg P-CAB, 750 mg amoxicillin, and 200 mg clarithromycin twice a day for 7 days. At least 8 weeks after treatment, eradication success was evaluated using 13C-UBT. A total of 118 students received eradication therapy. Eradication rates were 81.3% (95% confidence interval: 74.3–88.4, 96/118) in ITT analysis and 85.7% (95% confidence interval: 79.1–92.9 96/112) in PP analysis. Adverse effects associated with eradication therapy were observed in 25 of 118 subjects (21.1%), seven of whom required hospital treatment (rash in five, vomiting in two). All seven subjects either discontinued therapy or were administered anti-allergy drugs, which resulted in swift alleviation of symptoms. First-line triple therapy with a P-CAB for H. pylori eradication in children was found to be safe.

A curve is considered fair if it consists of continuous and few monotonic curvature segments. Polynomial curves such as Bezier and B-spline curves have complex curvature function, hence the curvature profile may oscillate easily with a little tweak of control points. Thus, bending energy and shear deformation energy are common fairness metrics used to produce curves with monotonic curvature profiles. The fairness metrics are used not just to evaluate the quality of curves, but it also aids in reaching to the final design. In this paper, we propose two types of fairness metric functionals to fair plane curves defined by the similarity geometry invariants, i.e. similarity curvature and its reciprocal to extend a variety of aesthetic fairing metrics. We illustrate numerical examples to show how log-aesthetic curves change depending on and G1 constraints. We extend LAC by modifying the integrand of the functionals and obtain quasi aesthetic curves. We also propose -curve to introduce symmetry concept ...