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AIM: Anastomotic leakage (AL) in left-sided colorectal cancer is a serious complication, with an incidence rate of 6-18%. We developed a novel predictive model for AL in colorectal surgery with double-stapling technique (DST) anastomosis using auto-artificial intelligence (AI). PATIENTS AND METHODS: A total of 256 patients who underwent curative surgery for left-sided colorectal cancer between 2017 and 2021 were included. In addition to conventional clinicopathological factors, we included the type of circular stapler using DST, conventional double-row circular stapler (DCS) or EEA™ circular stapler with Tri-Staple™ technology, 28 mm Medium/Thick (Covidien, New Haven, CT, USA) which had triple-row circular stapler (TCS) as a covariate. Auto-AI software Prediction One (Sony Network Communications Inc.) was used to predict AL with 5-fold cross validation. Predictive accuracy was assessed using the area under the receiver operating characteristic curve. Prediction One also evaluated the 'importance of variables' (IOV) using a method based on permutation feature importance. RESULTS: The area under the curve of the AI model was 0.766. The type of circular stapler used was the most influential factor contributing to AL (IOV=0.551). CONCLUSION: This auto-AI predictive model demonstrated an improvement in accuracy compared to the conventional model. It was suggested that use of a TCS may contribute to a reduction in the AL rate.

Background Infections caused by Prevotella bivia, a gram-negative anaerobic bacillus, are rare, with no reported cases in Japan. We present a novel case of scrotal abscess in a Japanese patient co-infected with Prevotella bivia and Streptococcus agalactiae. Case Presentation A 41-year-old uncontrolled diabetic man complained of swelling and pain in the scrotum. On examination, computed tomography revealed an abscess of 5-cm diameter in the scrotum. Then, the abscess was incised and drained. He was treated with cefazolin empirically. Prevotella bivia and Streptococcus agalactiae were identified in the pus cultures obtained from the abscess. However, the susceptibility tests for Prevotella bivia could not be submitted. Seven days following admission, the pain reduced, and the drainage slowed. The patient was discharged on day 14 when cefazolin was discontinued and oral amoxicillin (750 mg/day) was started. Amoxicillin was continued until day 42; improvement was confirmed. Conclusion To the best of our knowledge, this case is the first report of Prevotella bivia in Japan. We suggest that cephem antibiotics such as cefazolin may be effective against Prevotella bivia in Japan.

Cellulitis is an infection of the soft tissues of the skin. Some patients are hospitalized multiple times; lymphedema, chronic venous insufficiency, peripheral circulatory disturbance, and deep vein thrombosis are said to be risk factors for multiple admissions. Conversely, in Japan, elderly women and undernourished elderly have been reported to be at risk of multiple hospitalizations, suggesting a different patient background from that reported overseas. We investigated the characteristics of readmission cases for patients hospitalized for cellulitis in Japan. We retrospectively examined cases of cellulitis and erysipelas admitted between April 1, 2005 and March 31, 2018. Patients with cellulitis or erysipelas at multiple sites and those with osteomyelitis, pressure ulcer infection, and necrotizing fasciitis were excluded. In terms of recurrence, only hospitalizations for recurrence at the same site were considered. Patients with multiple hospitalizations had significantly lower blood albumin levels than those hospitalized only once. Furthermore, the rates of lymphedema, hypertension, and hyperlipidemia were significantly higher in patients hospitalized multiple times. Other laboratory and clinical factors were not statistically significant. Therefore, hypoalbuminemia with or without liver dysfunction, lymphedema, hypertension, and hyperlipidemia were suggested as risk factors for cellulitis recurrence. However, chronic venous insufficiency, peripheral circulatory disturbance, and deep vein thrombosis did not seem to be risk factors in Japanese cases. Japanese cases had a low body mass index (approximately 25 kg/m2), suggesting that the patient background may be different from that in existing reports. This suggests that the risk factors in Japanese cases may be different from those reported in other countries.

Background: Maternal lipid intake in the early postnatal period has a long-term effect on the possibility of fatty liver formation in children; besides, the importance of lipid consumption during lactation for children's health has been suggested. Green tea extract (GTE) contains abundant catechins, and it has been reported to improve lipid metabolism and prevent fatty liver. Objective: The aim of this study was to examine the effects of maternal GTE intake during lactation on hepatic lipid accumulation in adult male rats exposed to a continuous high-fat (HF) diet from the foetal period. Methods: Pregnant Wistar rats received diets containing 13% (control-fat, CON) or 45% (high-fat, HF) fat. CON-fed mothers received the same diet during lactation, whereas HF-fed mothers received either HF diet alone or HF diet supplemented with 0.24% GTE. At weaning, male offspring were divided into three groups, i.e. CON/CON/CON, HF/HF/HF (HF-offspring) or HF/HF+GTE/HF (GTE-offspring), and were fed until 51 weeks. Results: A significant hepatic triglyceride (Tg) accumulation was observed in the HF-offspring when compared with the other offspring. This is presumed to be caused by the promotion of Tg synthesis derived from exogenous fatty acid due to a significant increase in diacylglycerol O-acyltransferase 1 and a decrease in Tg -expenditure caused by decreasing microsomal triglyceride transfer protein (MTTP) and long-chain acyl-CoA dehydrogenase. On the other hand, attenuated hepatic Tg accumulation was observed in the GTE-offspring. The levels of the hepatic lipid metabolism-related enzymes were improved to the same level as the CON-offspring, and particularly, MTTP was significantly increased as compared with the HF-offspring. Conclusion: This study indicates the potential protective effects of maternal GTE intake during lactation on HF diet-induced hepatic lipid accumulation in adult male rat offspring and the possible underlying mechanisms.

Background The worldwide spread of organisms with antimicrobial resistance is of concern, especially the trend of significantly increasing carbapenemase-producing Enterobacterales (CPE). In this study, we investigated the annual trend of intestinal CPE carriage rates in inpatients and healthy adults in a primary care hospital in Tenri, Japan. Methods We collected 551 samples of feces from inpatients in our institution and 936 samples from healthy people living in Tenri city from December 2012 to April 2015. All samples were cultured on MacConkey agar plates containing 4 μg/mL ceftazidime for screening test. The colonies grown on the screening medium were detected for carbapenemase genes (blaIMP-1, blaIMP-2, blaVIM, blaKPC, blaGES, blaNDM, and blaOXA-48 groups) by multiplex PCR, and CPE were identified by MALDI-TOF MS. Plasmid replicon typing and pulsed-field gel electrophoresis (PFGE) were performed on PCR-positive strains. Results The CPE carriage rate was 1.6% (9/551) in the inpatient group and 0% (0/936) in the healthy adults group. The numbers of strains positive for the carbapenemase gene were 4 for Enterobacter cloacae, 2 for Klebsiella pneumoniae, 1 for Citrobacter freundii, 1 for Raoultella ornithinolytica and 1 for Escherichia coli. In all CPE strains, the carbapenemase gene was bla IMP-6 and the plasmid replicon type was IncN. The 4 E. cloacae strains showed a similar pattern in PFGE. Conclusion In the same city in Japan, CPE intestinal carriers were detected only in the inpatient group in this study but not in a healthy adults, suggesting that the spread of asymptomatic CPE carriers was confined to inpatients.

Background Two types of skin biopsies are routinely performed in dermatology: excisional and punch biopsies. A punch biopsy is a relatively low-risk procedure for surgical site infections (SSIs) because of the shallow wound depth and short operative time. In Japan, prophylactic antimicrobial agents are often used after skin biopsies due to lack of consensus, and there is no mention of antimicrobial use after skin biopsies in Japanese guidelines. In this study, we investigated whether prophylactic antibiotic use after punch biopsies reduces the risk of SSI development. Methods Cases of punch biopsy performed in our dermatology department during a one-year period from April 2018 to March 2019 were included retrospectively. The cases were divided into a group with and another without prophylactic antimicrobial use after biopsy. Results A total of 75 cases of punch skin biopsy were reviewed. There were no cases of wound infection after punch biopsy in any of the groups. The number of years of experience of the physicians in the group that used antimicrobials was significantly higher than that in the group that did not use antimicrobials (P < 0.0001). Conclusions Our result suggests that the incidence of SSI in punch biopsies without prophylaxis seems to be low. However, further research is needed due to the small number of cases in this study.

Background/aim We aimed to develop a novel recurrence prediction model for stage II-III colon cancer using simple auto-artificial intelligence (AI) with improved accuracy compared to conventional statistical models. Patients and methods A total of 787 patients who had undergone curative surgery for stage II-III colon cancer between 2000 and 2018 were included. Binomial logistic regression analysis was used to calculate the effect of variables on recurrence. The auto-AI software 'Prediction One' (Sony Network Communications Inc.) was used to predict recurrence with the same dataset used for the conventional statical model. Predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Results The AUC of the multivariate model was 0.719 (95%CI=0.655-0.784), whereas that of the AI model was 0.815, showing a significant improvement. Conclusion This auto-AI prediction model demonstrates improved accuracy compared to the conventional model. It could be constructed by clinical surgeons who are not familiar with AI.

Novel perfluoroalkyl gelators without hydrogen bonds–bis(2,2,3,3,4,4,5,5,6,6,7,7,8,8,8-pentadecafluorooctyl) isophthalate (1m), bis(2,2,3,3,4,4,5,5,6,6,7,7,8,8,8-pentadecafluorooctyl) terephthalate...

BackgroundThe risk of herpes zoster is increased among older and immunocompromised patients. However, it had been reported that Japanese tend to have a low BMI and that the patient characteristics of cellulitis is different from that of other countries. Due to the different characteristics of the Japanese population, we investigated for other characteristics unique to the Japanese population.MethodWe retrospectively examined cases of disseminated herpes zoster hospitalization between April 1, 2005, and March 31, 2018.ResultsThe mean patient age was 68.35 ± 15.76 years(mean ± SD). Recurrence was observed in only one patient. Hypertension was observed in 35%, hyperlipidemia in 25%, cancer in 30%, and autoimmune disease was found in 20% of patients. Based on the results of this study and previous reports, herpes zoster was more likely to occur among older immunosuppressed patients. In contrast to previous reports of hypertension occurrence in approximately 6% of Japanese patients, our findings indicated 35%. In addition, in contrast to the previously reported rate of hyperlipidemia of approximately 2% in the Japanese population, our results showed 25%. This suggested that hypertension and hyperlipidemia were also the risk factors for disseminated herpes zoster in Japanese patients.ConclusionHypertension and hyperlipidemia were the proposed risk factors for disseminated herpes zoster in Japanese patients, in addition to age and immunodeficiency.

This study was aimed at evaluating the oncologic outcomes of our preoperative treatment strategies for cStage Ⅱ/Ⅲ lower rectal cancer. At our hospital, neoadjuvant chemotherapy is administered for patients with bulky mesenteric lymph nodes on pretreatment imaging, and neoadjuvant chemoradiotherapy is administered for patients whose circumferential radial or distal margin cannot be secured because of strong local extension.Thirty patients who underwent preoperative therapy followed by total mesorectal excision for cStage Ⅱ/Ⅲ lower rectal cancer were retrospectively analyzed from October 2010 to October 2015.Twenty-five patients underwent neoadjuvant chemotherapy, and 5 patients underwent neoadjuvant chemotherapy. Tumor recurrence occurred in 10 patients at local(5 patients)and distant(5 patients)sites. The 5-year recurrence-free survival(5RFS)was 63.9%.We performed preoperative therapy in poor-risk locally advanced lower rectal cancer and obtained good results.

A 49-year-old man was preoperatively diagnosed with rectosigmoid carcinoma, c-T4a, N3, M1b, Stage Ⅳb. On CT, lymph node swelling outside that area, including lesser-curvature lymph nodes(LNS), and liver metastases were seen. Laparoscopic high anterior resection was performed with the aim of local control. Additionally, D3 dissection and LNS sampling were performed. The tumor had invaded the bladder wall, and removed LNS were positive for metastasis. The final diagnosis was f-T4b, N3, M1b, Stage Ⅳb. One month after surgery, a CV port was implanted, and chemotherapy was initiated for unresectable cancer. The regimen was capecitabine and oxaliplatin(CAPOX)plus bevacizumab(BEV). After 5 courses, the patient was hospitalized for a CV thrombus that had occurred, and his chemotherapy was withdrawn for approximately 1 month while he was receiving antithrombotic therapy. After discharge, BEV was discontinued, and he received CAPOX alone. Bleeding from a pituitary adenoma was seen after a total of 19 courses. He was hospitalized for 2 months for the treatment, including surgery. A clinical complete response was determined based on CT and PET-CT performed after chemotherapy had been withdrawn for approximately 3 months. For approximately 1 year since the chemotherapy was discontinued, progression-free survival has been maintained.

Background: Sarcoidosis is a relatively rare, systemic granulomatous disease that occurs in approximately 1–40 per 100,000 individuals but affects Japanese people disproportionately. While sarcoidosis may affect any organ, morbidity and mortality is worst for cases of cardiac sarcoidosis, which is also difficult to diagnose. In this study, we investigated whether cutaneous sarcoidosis, particularly cutaneous sarcoidosis of the face, which is visible and more easily diagnosable, can be a predictor for the development of cardiac sarcoidosis. Method: We retrospectively examined patients with cutaneous sarcoidosis seen at the Department of Dermatology at the JR Tokyo General Hospital and the Department of Dermatology at the University of Tokyo Hospital between April 1, 2005 and March 31, 2019. Results: Our study found that sarcoid lesions on the face increased the risk for cardiac sarcoidosis (p = 0.0090, odds ratio 20), whereas, sarcoid lesions on the extremities decreased the risk for cardiac sarcoidosis (p = 0.0387, odds ratio 0.0961). Conclusion: Cutaneous sarcoidosis of the face is a strong predictor of cardiac sarcoidosis.

Background Tuberous sclerosis complex (TSC) is a rare autosomal dominant disorder forming hamartomas throughout the body. Facial angiofibromas (FAs) occur in 75% of TSC patients, which are often enlarged, impairing the appearance of the face, and reducing the patient’s quality of life (QOL). The aim of this study was to characterize the impact of topical sirolimus treatment on the health-related QOL in patients with FA associated with TSC. Methods We investigated a total of 33 patients who received sirolimus gel treatment for FA associated with TSC and assessed the changes in the health-related QOL using the Medical Outcomes Study 36-Item Short Form (SF-36) Health Survey. SF-36 surveys were performed before and after 3 months of treatment. The conditions of the patients after using the sirolimus gel were categorized into the following three categories: “improved,” “unchanged,” and “aggravated.” Adverse events were investigated using the CTCAE v5.0-JCOG. Results The median age of the patients was 25 (range 14–55) years. After 3 months of sirolimus gel treatment, three scale scores of the SF-36, vitality (VT), social function (SF), and mental health (MH), were significantly improved compared to before the treatment. The VT and SF in patients who had improved FA were significantly better than those in the other patients. There were no significant differences in any scale scores between patients with and without adverse events at 3 months after the initiation of sirolimus gel treatment. Conclusions This is the first report regarding improved health-related quality of life in patients treated with sirolimus gel for FA associated with TSC by using the SF-36. The three scale scores associated with mental health were significantly improved compared to before the treatment. The health-related QOL in patients receiving sirolimus gel treatment is more strongly affected by the treatment efficacy than adverse events. Mini-abstract Sirolimus gel treatment improves the health-related QOL in patients with FA associated with TSC.

Purpose Multidrug-resistant Enterobacteriaceae in urinary tract infection (UTI) has spread worldwide; one cause is overuse of broad-spectrum antimicrobial agents such as fluoroquinolone antibacterials. To improve antimicrobial agent administration, this study aimed to calculate a probability prediction formula to predict the organism strain causing UTI in real time from dip-stick testing and flow cytometry. Methodology We examined 372 outpatient spot urine samples with observed pyuria and bacteriuria using dip-stick testing and flow cytometry. We performed multiple logistic-regression analysis on the basis of 11 measurement items and BACT scattergram analysis with age and sex as explanatory variables and each strain as the response variable and calculated a probability prediction formula. Results The best prediction formula for discrimination of the bacilli group and cocci or polymicrobial group was a model with 5 explanatory variables that included percentage of scattergram dots in an angular area of 0–25° (P

In this paper, it was investigated that the effect of crack propagation mode and the fracture life of the solder joint on a chip component, which is the most severe component of read-free solder joint reliability in automotive electronic components when changing the solder fillet shape. In addition, the effect on the fracture life of the solder joints when the dispersion due to solder nonuniformity was taken into account was also investigated. The fatigue life of the solder joint was evaluated by reproducing the temperature cycle test using the finite element method and analyzing the crack propagation of the solder. In order to investigate the effect on the fatigue life of different fillet shapes, three models with different fillet shape were created. In addition, in order to reproduce the nonuniformity of the microstructure, a model considering the anisotropy of the solder crystal and a model with voids inside the solder were created. In order to investigate the effect on fracture life, the simulation results were compared. As a result, the fillet shape of the solder joint has a significant effect on the crack propagation path, and the fracture life of the solder joint was greatly reduced when it propagates in the diagonal direction of the fillet. Furthermore, it was confirmed that when voids exist inside the solder, the fatigue life of the solder joint decreases, and the effect increases as the void ratio increases.

The divergent synthesis of penaresidin B and its straight side chain analogue was accomplished by constructing an azetidine ring via SN2 type cyclization of protected 2,3-syn-3,4-syn-4-amino-1,3-dihydroxyhept-6-en-2-yl mesylate and late-stage introduction of an alkyl side chain via olefin cross-metathesis of 4-allylazetidine with readily available terminal alkenes. This synthetic route would be useful to synthesize penaresidin side chain analogues.

The identification of widespread tephras is important, not only for understanding volcanic processes but also for age estimation and establishing stratigraphic relationships. Many widespread tephras have been erupted from six active and buried caldera volcanoes in the SW Japan-Ryukyu volcanic arcs. To reconstruct high-resolution tephrostratigraphy, we analyzed core UT from the Uwa basin on western Shikoku Island and correlated the tephras in the core with the proximal source deposits that we sampled. This 120 m-long core composed of fluvio-lacustrine deposits, spanning the middle Pleistocene to Holocene. We recognized and characterized 52 visible tephra and tephric sediment layers in the core on the basis of their stratigraphy, the petrographic features and the major-element composition of glass shards. We successfully correlated 15 tephras with the following previously identified widespread tephras, mainly from volcanoes on Kyushu: Kikai-Akahoya (7.3 ka), Aira-Tn (29 ka), Aso-4 (87 ka), Kikai-Tozurahara (95 ka), Aso-ABCD (100 ka), Ata (105-110 ka), Aso-3 (112.7 ka, calculated in this study), Aso-2 (140 ka), Ata-Toihama (240 ka), Aso-1 (250-270 ka), Tky-Ng1 (290-300 ka), Kakuto (330-340 ka), Oda (420-450 ka), Hiwaki (570-580 ka), and Yufugawa (600 ka). Above 50 m depth, all known widespread tephras from Kyushu younger than 350 ky were included in the sequence that has a fairly constant sedimentation rate of about 0.14 mm/yr. This high-resolution tephrostratigraphy was correlated with those of regional long-core records from the Lake Biwa in the central Japan and offshore of Shikoku that contributes to establish onshore-onshore and onshore-offshore correlations in southwest Japan. In the sediments, each of the following tephras from caldera-forming eruptions, Aso-4, Aso-ABCD, Ata, Aso-3, Aso-2 and Aso-1 occurred above multiple, compositionally similar tephra layers erupted from the same volcano over a long time period. This high-resolution record is therefore an important contribution to the correlation of regional stratigraphy and reconstruction of both the long-term eruptive history and the magma evolution of volcanoes in the SW Japan and -Ryukyu volcanic arcs.

Phlorotannins isolated from brown algae, such as Eisena bicyclis, have positive physiological effects, including anti-cancer, anti-inflammatory, and anti-Alzheimer’s disease. Although phlorotannins have been shown to inhibit tyrosinase, an enzyme essential for melanogenesis, their effect on melanogenesis remains unexplored. Thus, we isolated phlorotannins from E. bicyclis and examined their effects on α-melanocyte-stimulating hormone (α-MSH)-induced melanogenesis in murine B16 melanoma cells. Both fucofuroeckol-A (FF-A) and phlorofucofuroeckol-A (PFF-A) suppressed α-MSH-induced melanogenesis. Neither inhibited human tyrosinase (TYR) activity, but both inhibited tyrosinase-related protein-2 activity. FF-A downregulated the expression of microphthalmia-associated transcription factor and TYR, which subsequently suppressed melanin production. These results suggest that phlorotannins could be beneficial as melanin control drugs for hyperpigmentation disorders.

SUMMARY This paper proposes a novel variable flux reluctance motor without dc-field coils. The stator of this motor has only armature coils. The proposed motor can control the torque-speed characteristics by increasing or decreasing the field voltage that is superimposed on the armature currents. In this paper, the operational principle of the motor is described, and the N–T characteristics are computed by finite element analysis under vector control. In addition, the N–T characteristics are compared with a conventional variable flux reluctance machine with armature and dc-field coils.

Recently, carbapenemase-producing Enterobacteriaceae (CPE) have been spreading worldwide and have become a threat in healthcare systems. We investigated the isolation frequency and molecular epidemiological characteristics of CPE isolated from clinical samples collected at a primary care hospital over the four years of 2010–2013 in Japan. CPE were detected in 17 (0.34%) of 4875 isolates by the broth microdilution method, sodium mercaptoacetate inhibition test, and modified Hodge test using meropenem disks. The frequency of CPE isolates was 0.09% in 2010, 0.17% in 2011, 0.16% in 2012 and 0.82% in 2013. Isolates positive for carbapenemase included Klebsiella pneumoniae (0.92%), Escherichia coli (0.12%), Enterobacter cloacae (0.80%), Klebsiella oxytoca (0.55%), Enterobacter aerogenes (0.81%) and Proteus mirabilis (0.08%). Antimicrobial susceptibility testing showed low MICs for piperacillin-tazobactam, amikacin, ciprofloxacin and levofloxacin, and only one multidrug-resistant strain. The carbapenemase genotype of all strains was IMP-6, and 94% of the strains were simultaneous CTX-M-2 producers. Two K. pneumoniae and 3 E. coli isolates showed the same pulsed-field gel electrophoresis group. Multilocus sequence typing detected no international high-risk clone types. Plasmid replicon typing detected IncN from all CPE strains, and IncF and IncFIB were simultaneously detected in 24% and 18%, respectively. All patients with detected CPE were inpatients, and many were elderly long-term hospitalized patients or had a history of prior vancomycin or levofloxacin antibiotic administration. The rapid spread of CPE is a concern in Japan. Preventive measures must be implemented against the spread of CPE after considering the epidemiological trend of CPE detection, antibiograms, and risk factors.

The global pandemic of ESBL-producing Escherichia coli is associated with sequence type 131 (ST131). However, mechanisms of ST131 spread remain unclear. This study searched for proteins with amino acid substitutions specific for ST131 and used proteomics analysis to clarify ST131 characteristics. Five proteins had ST131-specific amino acid substitutions: uncharacterized protein YahO with E34A (m/z 7655); UPF0337 protein YjbJ with V59D, D60S and T63K (m/z 8351); uncharacterized protein YnfD with S106T (m/z 8448); and acid stress chaperone HdeA with Q92K and N94S (m/z 9714). Soluble cytochrome b562 (m/z 11783) showed seven amino acid substitutions, and the sequence differed between clade C of the pandemic clade and non-C. In silico analysis showed YahO protein-protein interaction with YjbJ, possibly related to biofilm formation. Although the function of soluble cytochrome b562 is electron transport of unknown function, its involvement in biofilm formation was predicted. HdeA was a gastric acid resistance-related protein. The function of YnfD was completely unclear. In conclusion, ST131-specific protein amino acid substitutions consisted mainly of a gastric acid resistance protein and proteins of unknown function (possibly involved in biofilm formation), which might be mechanisms for long-term colonization in the human intestinal tract.

We have proposed a current superimposition variable flux reluctance machine that can control its torque constant. This machine can be operated by using a six-phase superimposition current composed of ac-armature and dc-field currents. In this paper, we propose a current superimposition variable flux machine using permanent magnets. The permanent magnets increase the dc magnetic flux. First, the structure and operational principle of this machine are described. Next, the torque characteristics are computed under vector control. Finally, the computed characteristics are verified by carrying out measurements on a prototype.