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Bright endoscopic light sources improve the visibility of the intestinal mucosa. A newly launched endoscopic system developed by Olympus Corporation (Tokyo, Japan) in 2020 required modification to prevent heat-induced tissue damage, which reportedly occurs during magnifying chromoendoscopy. We investigated the mechanism of this phenomenon by evaluating the rise in temperature of stained and unstained porcine mucosa using the new and previous endoscopic systems.Surface temperatures of stained (India ink, 0.05% crystal violet, 0.5% methylene blue, or 0.2% indigo carmine) and unstained porcine mucosa were evaluated using infrared imaging after contact with the new endoscopic system before it was modified (system-EVIS X1; scope-GIF-EZ1500) and compared with a previous endoscopic system (system-EVIS EXERAIII; scope-GIF-H190). We performed histological analysis of the porcine mucosa stained with 0.05% crystal violet after contact with the new endoscope to evaluate the degree of tissue damage.Surface temperatures remained 40°C when the new endoscope was in contact with the unstained mucosa. However, the maximum surface temperature rose to 70°C when the new endoscope was in contact with the stained mucosa (stained other than indigo carmine). Histological analysis revealed cavity formation in porcine epithelium stained with crystal violet where the endoscope made contact forHeat transfer by light absorption could cause heat-induced tissue damage during magnifying chromoendoscopy using the new endoscope.

Background Talaporfin sodium photodynamic therapy (tPDT) is an effective salvage treatment for local failure after chemoradiotherapy for esophageal cancer. Repeated tPDT could also be indicated for local recurrence or residue after the first salvage tPDT. However, the safety and efficacy of repeated tPDT have not been elucidated. Methods We reviewed 52 patients with esophageal cancer who were treated with the first tPDT at Kyoto University Hospital between October 2015 and April 2020. Results Among 52 patients, repeated tPDT after the first tPDT was indicated for 13 patients (25%), of which six had residual tumor, four had local recurrence after complete response (CR) after the first tPDT at the primary site, and six had metachronous lesion. The total session of repeated tPDT was 25; 16 were for primary sites and nine were for metachronous sites. Among them, six patients (46.2%) achieved local (L)-CR and nine lesions (56.3%) achieved lesion L-CR. By session, 10 sessions (40%) achieved L-CR. There were no severe adverse events except for one patient; this patient showed grade 3 esophageal stenosis and perforation after the third tPDT on the same lesion that was previously treated with porfimer sodium photodynamic therapy four times. Conclusion Repeated tPDT could be an effective and safe treatment for local failure even after salvage tPDT for esophageal cancer.

Stenosis of the segmental bronchus is a characteristic airway complication in living-donor lobar lung transplantation Ei Miyamoto, MD, Toyofumi F. Chen-Yoshikawa, MD, PhD, Hirokazu Higuchi, MS, Akihiro Aoyama, MD, PhD, and Hiroshi Date, MD, PhD From the Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and the Department of Medical Supply Clinical Engineering, Kyoto University Hospital, Kyoto, Japan

The multidiameter balloon catheter is used widely for severe esophageal stricture dilation. However, the relationships between inflation pressure, balloon size, and radial dilation force at the stricture site have not been examined fully. We performed an experiment using phantom models to investigate the relationships between inflation pressure, balloon size, and radial dilation force. The balloon dilation procedure was performed for each stricture model using three sizes of balloon: 10–11–12, 12–13.5–15, and 15–16.5–18 mm. A positive association between inflation pressure and dilation force was observed for each balloon size. In balloons inflated by targeting the same diameter, the dilation force was higher for smaller balloons than for larger balloons. An inverse association between stricture size and dilation force was observed in the 12–13.5–15 mm balloon (3 vs 5 mm, P = .002; 5 vs 7 mm, P

BACKGROUND AND AIM Acute gastrointestinal graft-versus-host disease (GI-GVHD) is a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). There are very few studies on specific endoscopic findings in pediatric acute GI-GVHD. The aim of this retrospective case-control study was to elucidate the characteristic endoscopic findings in pediatric acute GI-GVHD that improve the diagnostic accuracy of endoscopy. METHODS All consecutive patients under 18 years of age who underwent allogeneic HSCT in Kyoto University Hospital from May 2003 to October 2014 were identified retrospectively. Patients who underwent GI endoscopy as a result of sustained GI symptoms were identified. Intestinal villous patterns were evaluated by magnification endoscopy with the water-immersion technique. The patients were diagnosed with acute GI-GVHD and non-GVHD on the basis of biopsy histology. Endoscopic findings of the two groups were compared. RESULTS Of the 171 patients who underwent HSCT, 30 underwent GI endoscopy. Of these, 17 and nine were diagnosed with acute GI-GVHD and non-GVHD, respectively. Compared with non-GVHD, acute GI-GVHD was associated significantly more often with short blunt villi in the duodenum (P = 0.013), variable defect villi and short blunt villi in the ileum (P = 0.009 and 0.035, respectively), and edema, erosion, and tortoiseshell-like mucosae in the colon (P = 0.017, 0.023, and 0.017, respectively). CONCLUSION Pediatric acute GI-GVHD was associated with several characteristic features on magnifying endoscopy with the water-immersion technique. These features will be useful for endoscopic diagnosis of pediatric acute GI-GVHD.

Smallholder farmers attempt to adapt their farmland management through multiple strategies in order to secure their livelihood against external stress factors. Cultivating different species and genotypes of crops is one of the strategies implemented by smallholder farmers to maintain their livelihood. In the Kilimanjaro highlands, the Chagga people run small-scale farming. Traditionally, they cultivate diverse varieties of banana and coffee in home gardens in high-altitude areas and maize in low-altitude foothill farms. However, this type of farmland management had to be altered gradually in response to changes in external factors. This paper examines the role of cropping practice and diverse banana genotypes in the livelihood of the Chagga people, to understand how they altered their farmland management strategy to adapt to the current socio-economic circumstances, based on interviews, observations, and genetic analysis of banana. Our results showed that the Chagga people had altered their farmland management strategy by increasing banana and maize cultivation and decreasing coffee cultivation in the home garden based on the significance of each crop in their livelihood. The importance of banana cultivation for the livelihood of Chagga people has been recently recognized as an income source in addition to a staple food because of its increasing demand in neighboring big cities. Maize cultivation in home gardens has expanded because of the steady increase in the household demand of maize over the last 40 years and the decrease in size and ownership of foothill farms. Conversely, coffee cultivation as a household income has declined because of a reduction in coffee prices in the world market and increasing challenges in its cultivation. Additionally, the Chagga people accurately distinguish and use 11 types of bananas in their daily diet and cultural use. Maintaining diverse genotypes of bananas in home gardens is one of the adaptation strategies that bring stable food supply and income, and consequently enable them to maintain their livelihood under changing socio-economic circumstances.

Narrow band imaging (NBI) combined with magnifying endoscopy enables us to detect superficial laryngo-pharyngeal cancers, which are difficult to detect by standard endoscopy. Endoscopic laryngo-pharyngeal surgery (ELPS) is a technique developed to treat such lesions and the purpose of this study is to evaluate the usefulness of ELPS for superficial laryngo-pharyngeal cancer. Seventy five consecutive patients with 104 fresh superficial laryngo-pharyngeal cancers are included in this study. Under general anesthesia, a specially-designed curved laryngoscope was inserted to create a working space in the pharyngeal lumen. A magnifying endoscope was inserted transorally to visualize the field and a head & neck surgeon dissected the lesion using the combination of the orally-inserted curved grasping forceps and electrosurgical needle knife in both hands. The safely, functional outcomes, and oncologic outcomes of ELPS were evaluated retrospectively. Median operation time per lesion was 35 min. Post-operative bleeding occurred in 3 cases and temporal subcutaneous emphysema occurred in 10 cases. No vocal fold impairment occurred after surgery. The median fasting period was 2 days and all patients except one have a normal diet with no limitations. Local recurrence occurred in 1 case, and the 3-year overall survival rate and the 3-year disease specific survival rate was 90 % and 100 %, respectively. ELPS is a hybrid of head and neck surgery and gastrointestinal endoscopic treatment, and enjoys the merit of both procedures. ELPS makes it possible to perform minimally-invasive surgery, preserving both the swallowing and phonation functions.

Background Endoscopic balloon dilation is a promising procedure to improve symptoms of intestinal stricture in patients with Crohn's disease (CD). However, the long-term efficacy of endoscopic balloon dilation combined with immunomodulatory drugs remains unclear. The aim of the present study is to investigate whether prior use of immunomodulatory drugs affects the clinical outcome of endoscopic balloon dilation for intestinal stricture in CD. Patients and Methods Between January 2004 and December 2011, 83 dilations were carried out in 25 patients with CD. Median follow-up period was 46 months. Patients were categorized into two groups based on their medications at the first endoscopic balloon dilation: early immunomodulatory drug-induction group (early IM-induction group) in which patients were already treated with immunomodulatory drugs before the dilation; and post-immunomodulatory drug-induction group (post-IM-induction group) in which patients were not yet treated withimmunomodulatory drugs before dilation. We compared the long-term cumulative non-surgical rate and the mean number of dilation procedures per patient between early and post-IM-induction groups to clarify the influence of prior use of immunomodulatory drugs on the clinical outcome of endoscopic balloon dilation. Results There was a significant difference in the mean number of dilation procedures per patient between the early IM-induction and post-IM-induction groups (P = 0.04), although no significant difference in the cumulative non-surgical rate was observed between the two groups (P = 0.14). Conclusion Prior use of immunomodulatory drugs may improve the clinical outcome of endoscopic balloon dilation for intestinal stricture in CD.

ブドウサンショウ樹を切り返しせん定し，切り返し程度が翌年の発芽や着果に及ぼす影響を検討した．結果母枝長によって3段階に分け，3段階の各々に対してせん定程度を無せん定，弱せん定，中せん定および強せん定の4区を設けた．切り返しせん定処理を行った翌年の発芽率，着花穂新梢率，花数および果房当たり果粒数を比較した．その結果，弱せん定区で花数，果房当たりの果粒数および結果母枝当たりの果粒数が多くなった．結果母枝長に関しては中程度の長さで花数，果房中果粒数および結果母枝当たりの果粒数が多い傾向を示した．発芽率はせん定程度が強いほど高くなり，着花穂新梢率は中せん定区および強せん定区で高い傾向であった．

Carpophilus marginellus is a candidate pollinator of the subtropical orchard trees cherimoya and atemoya. We investigated the developmental period and adult size of this species at constant temperatures of 18, 20, 25, and 30°C as basic information for mass rearing and release in greenhouses as a pollinator. The photoperiod was 16-h light/8-h dark at all temperatures. The developmental period was shorter and the adult size was smaller at higher temperatures. Mortality was lowest at 25°C and highest at 30°C. The thermal threshold (developmental zero) ranged from 11.9 (female larvae) to 15.6°C (female pupae) among developmental stages and sexes. The thermal constant (total effective temperature) of the period from egg to adult emergence was ca. 292 degree-days.

In this paper, we propose a 3-D measurement method of objects' shapes in liquid using the light stripe projection method. When applying vision sensors to measuring objects in liquid, we meet the problem of an image distortion. It is caused by the light refraction on the boundary between the air and the liquid, and the distorted image brings errors in a triangulation for the range measurement. Our proposed method can measure the accurate 3-D coordinates of object surfaces in liquid taken for calculating the refraction effect. The effectiveness of the proposed method is shown through experiments.

Acute gastrointestinal graft-versus-host disease (GI-GVHD) is a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). There are very few studies on specific endoscopic findings in pediatric acute GI-GVHD. The aim of this retrospective case-control study was to elucidate the characteristic endoscopic findings in pediatric acute GI-GVHD that improve the diagnostic accuracy of endoscopy.All consecutive patients under 18 years of age who underwent allogeneic HSCT in Kyoto University Hospital from May 2003 to October 2014 were identified retrospectively. Patients who underwent GI endoscopy as a result of sustained GI symptoms were identified. Intestinal villous patterns were evaluated by magnification endoscopy with the water-immersion technique. The patients were diagnosed with acute GI-GVHD and non-GVHD on the basis of biopsy histology. Endoscopic findings of the two groups were compared.Of the 171 patients who underwent HSCT, 30 underwent GI endoscopy. Of these, 17 and nine were diagnosed with acute GI-GVHD and non-GVHD, respectively. Compared with non-GVHD, acute GI-GVHD was associated significantly more often with short blunt villi in the duodenum (P = 0.013), variable defect villi and short blunt villi in the ileum (P = 0.009 and 0.035, respectively), and edema, erosion, and tortoiseshell-like mucosae in the colon (P = 0.017, 0.023, and 0.017, respectively).Pediatric acute GI-GVHD was associated with several characteristic features on magnifying endoscopy with the water-immersion technique. These features will be useful for endoscopic diagnosis of pediatric acute GI-GVHD.

Novel scheme of polydimethylsiloxane-based optical system was proposed, and its measurement system combined with tablet type terminal has been demonstrated. Effective stray light reduction was observed in this scheme, and its mechanism have been studied. Scattering properties at the border between PDMS and carbon-doped PDMS was investigated, and discussed.

A polydimethylsiloxane (PDMS)-based optical system has been demonstrated. To suppress intense background radiation due to multiple internal scatting in a transparent material, a composite structure of a carbon–PDMS compound and PDMS was proposed. The index matching of the real part of the refractive index can suppress internal scattering, and an absorption of 99–99.7% was attained by using carbon micro particles and carbon nano tubes. The black-PDMS light channel functions as a light filter for straight pass, and an optical density of 5 was obtained by bending the filter.

The cherimoya is an orchard tree that is not pollinated by bees. To identify likely pollinators, and to describe community diversity, we surveyed flower visitors at four sites in Wakayama and Mie prefectures, and found 569 individuals from 31 species of arthropods. Two of these species were arachnid and the others were insects. The most abundant species in terms of per capita density was Mimemodes monstrosus (Rhizophagidae), followed by species in the genus Phloeonomus (Staphylinidae) and Cortinicara gibbosa (Lathridiidae). Two nitidulid species, Carpophilus marginellus and Haptoncus ocularis, were also common. Among them, M. monstrosus, C. marginellus and H. ocularis, especially the former two, were regarded as good candidates for pollinators. All of the dominant species were beetles. C. gibbosa was most abundant early in the flowering season, whereas Phloeonomus sp. showed two peaks, in late May and late July. Species richness, S′ (45), ranged from 5.4 to 9.0, while heterogeneity measures, 1-D and exp H′, ranged from 0.59 to 0.78 and from 3.5 to 5.9, respectively. The index of similarity, Cλ, varied from 0.04 to 0.76, whereas the rank correlation coefficient, τ, between each site varied from −0.32 to 0.23. The contents and diversities of flower visitor communities appeared to be affected by the surrounding environment and management strategy of the orchards.

The transpired mass flow of water from the inflorescence was monitored continuously and compared with the flow in the whole shoot attached to the inflorescence by the stem heat balance method. The transpiration was compared with the chamber method. The stem heat balance method is able to continuously measure the intact sap flow of water. Modified sap flow gauges were adapted to obtain precise measurements of minute fluctuations in the flow. The stem sap flow fluctuated with the solar radiation, reaching a maximum at midday. The flow was also affected by the saturation deficit. At midday, a sap flow rate was 60 g · h−1 at the shoot base (11.5 mm in diam.); the shoot subtended 55 leaves between the shoot base and the terminal inflorescence. At the peduncle of the inflorescence, the maximum sap flow rate occurred during the morning. Subsequently, the flow tended to decrease gradually and steadily, hardly affected by the solar radiation and the saturation deficit. An entire inflorescence with a peduncle diameter of 11.2 mm exhibited a maximum transpiration rate of 15 g · h−1 during late morning. The daily water consumption of the inflorescence was estimated to be 130 g, representing 22% of the water consumption by the entire shoot. The chamber method indicated similar results as the stem heat balance method.

Haptoncus ocularis is a candidate pollinator of the subtropical orchard tree cherimoya (Annona cherimola). To collect basic information for the use of this species as a pollinator by mass rearing and releasing in greenhouses, the developmental period and attained adult size at constant temperatures of 15, 20, 25 and 30°C were investigated. The photoperiod was 16-h light/8-h dark at all temperatures. The developmental period was shorter at higher temperatures, except at 30°C, which lengthened pupation. Mortality from last instar larva to adult eclosion was higher at 15 and 30°C than at 20 and 25°C. The thermal threshold (developmental zero) ranged from 8.2 to 12.2°C for different developmental stages and sexes. The thermal constant (total effective temperature) of the period from egg to the next oviposition was ca. 284 degree-days. Both head width and right forewing length of the adults raised were largest at 20°C and second largest at 25°C. The maximum number of generations in a year was estimated to be nine in Wakayama, Japan.

This study was performed to examine seasonal changes in evapotranspiration (ET), soil water content, and crop coefficients (Kc) for sugarcane, cassava, and maize fields in Northeast Thailand. ET rates during the rainy season varied between 2 and 6 mm per day but remained around 1 mm per day in the dry season. The normal dry season ET was much greater than the water loss from the top 0.5 m of soil, suggesting that capillary rise from deeper soil layers provides significant amounts of water to the upper soil layer. The Kc for sugarcane and cassava reached growing season peaks of approximately 1.10 and 1.20, respectively, in June. The maximum Kc for the maize field was approximately 1.20. Although the ET estimated by the Hargreaves equation exceeded the FAO reference ET value for this region, the values had a high correlation when the Hargreaves ET was calculated using solar radiation measurements.

We describe a split-root system for examining the effects of hydraulic lift by trees on crop growth. In this system, upper lateral tree roots were grown in a container set on the ground through which the taproot of the tree could penetrate into the moist soil below. The container, with a radius of 0.5 m and a height of 0.20 m, consisted of two compartments divided by a waterproof barrier. A markhamia tree (Markhamia lutea (Benth.) Schumann) and upland rice (Oryza sativa (L.)) plants were planted in one compartment, with only rice plants planted in the other compartment. Irrigation of the container was ceased at the start of the experiment. The stomatal conductance of the rice plants in the associated side, in which both trees and rice plants were grown, declined more rapidly during the first drying period than in the rice-only compartment, suggesting that there was competition for water between the tree and the crop plants. However, during the later drying period, the rice plants in the associated side were green and viable, while those in the rice-only side became desiccated. Rice roots were seen intermingling with tree roots, and the soil water content in the associated site tended to be higher than in the rice-only side. It is likely that hydraulic lift occurred in the associated side and that water that had been transferred to the surface roots was released into the soil, enabling the rice plants in this compartment to remain viable. This novel system is useful for examination of the effects of hydraulic lift by trees on the growth of neighbouring crops.

Rationale: Tricho-hepato-enteric syndrome (THES) is a rare disorder caused by mutations in the TTC37 or SKIV2L genes and characterized by chronic diarrhea, liver disease, hair abnormalities, and high mortality in early childhood due to severe infection or liver cirrhosis. Patient concerns: The patient is the second child of three siblings born to non-consanguineous healthy Japanese parents. She had intrauterine growth retardation and was delivered at 33 weeks of gestation due to placental abruption. She presented with watery diarrhea, elevated levels of liver enzymes, multiple episodes of recurrent bacterial infection, and mild mental retardation. She had facial dysmorphism, including prominent forehead and hypertelorism, and had woolly hair without trichorrhexis nodosa. Diagnosis: Clinical features led to consideration of THES. Novel compound heterozygous nonsense mutations, c.1420G>T (p.Q474∗) and c.3262G>T (p.E1088∗), in the SKIV2L gene were identified in the patient, and decreased levels of SKIV2L protein expression were revealed by flow cytometry and confirmed by western blot analysis using patient peripheral blood mononuclear cells (PBMCs). Interventions: Total parenteral nutrition was required from day 30 to day 100. Trimethoprim-sulfamethoxazole prophylaxis was started at the age of 7 years after multiple episodes of bacterial pneumonia and otitis media. Outcomes: Chronic diarrhea persisted for more than 10 years, but the symptoms gradually improved with age. At the age of 13 years, she started a normal diet in combination with oral nutritional supplementation and her height and weight were just below the 3rd percentile for healthy individuals. She developed secondary sex characteristics, and menarche occurred at the age of 12 years. Facial dysmorphism, including prominent forehead and hypertelorism, and woolly hair without trichorrhexis nodosa became noticeable as she matured. Lessons: Physicians must be aware of THES when they encounter a patient with infantile diarrhea, hair abnormalities, immune deficiency, mental retardation, and liver disease. Moreover, flow cytometric detection of SKIV2L protein in PBMCs may facilitate early diagnosis.

Shoot growth, leaf morphology, leaf chlorophyll content, and leaf gas exchange were investigated for cherimoya trees grown in a sunlit glass-house where day/night temperatures were kept at 30/25°C (warm) and 20/15°C (cool). The shoot growth at warm temperatures was greater than that at cool temperatures until 2 months after sprouting. After that, it became less at cooler temperatures. Both leaf number and area decreased at warm temperatures within 3 months of sprouting. The leaf palisade and spongy layers were thinner at warm temperatures. Specific leaf area at warm temperatures was significantly larger. The chlorophyll content of leaves at warm temperatures also decreased 6 weeks after the full expansion. Warm temperatures reduced leaf CO2 assimilation rate (AC) because of both stomatal and non-stomatal limitations. AC and stomatal conductance were suppressed during the midday hours at warm temperatures, suggesting that stomatal closure reduced AC. The ratio of 1 − Ci (intercellular CO2 partial pressure)/Ca (ambient CO2 partial pressure) at warm to that at cool temperatures indicated that CO2 fixation ability of leaves grown at warm temperatures was 59% of that at cool temperatures, irrespective of stomatal effect. The initial slope of the AC/Ci curve, which indicates ribulose bisphosphate carboxylase-oxygenase (Rubisco) activity of leaves developed at warm temperatures was 67% of those at cool temperatures.

To clarify the floral inhibition in cherimoya in warm environments, the number of flowers, floral morphology, nodal position, days to flowering, and flowering period were determined under 20/15°C and 30/25°C day/night temperature conditions throughout two years. Floral differentiation of cherimoya was more favorable at 20/15°C than at 30/25°C. More flowers were produced at 20/15°C and the flowering period was longer. Flowers were also larger at 20/15°C, however, the growth rate of floral organs was faster at 30/25°C. The temperature effects were more pronounced in the second year. The floral responses to temperature were different depending on the nodal positions, because of the different developmental processes. The number of the floral buds at the basal part of new shoot (at the 1st-3rd nodes) at 30/25°C was similar to that at 20/15°C in the first year, but it became smaller than that at 20/15°C in the second year. On the other hand, no distal buds of new shoot (at the 4th-more distal nodes) were produced at 30/25°C throughout the experiment period. The floral buds at the basal nodes differentiated almost a year previous to their anthesis, whereas the distal buds differentiated in synchronization with the shoot extension, about 5 weeks before anthesis. The axillary buds for basal flowers of the next season had already differentiated even in one-week-old leaf axils. Cherimoya produced an axillary multiple bud complex for the subsequent bloom and flush. In a 4-week-old leaf axil, a few floral buds with one or two vegetative buds usually developed at 20/15°C, while none or one floral bud with several vegetative buds developed at 30/25°C. The bud differentiation period was found to be the most temperature sensitive stage to influence flower number and morphology. Thus, exposure of cherimoya trees to a warm environment a year previous to the flowering and during shoot extension, respectively, was suggested to inhibit flowering at the basal and distal nodes.