bluuebunny/crossref_metadata_2025 huggingface dataset:
A NUMERICAL STUDY ON CORRELATION OF RIB FRACTURES WITH THORACIC INJURY CRITERIA IN OBLIQUE IMPACT
Authors: WANG FANG , WANG BINGYU , HAN YONG , HUANG XIAOQUN , YANG JIKUANG
Published: December 2017

Thoracic injury is one of the vital issues in vehicle side crashes. Experiments have been done widely to study thoracic injuries using biological subjects but less virtual tests were made by using Finite Element (FE) models. This study aimed at determining the correlation of the computationally calculated thoracic injury (Number of Rib Fractures NRF) with existing thoracic injury criteria under pure side and oblique impacts. For this purpose, a previously developed thorax FE model was validated by using Post Mortem Human Subject (PMHS) tests in pure side and oblique impacts in this study. The rib fractures were reconstructed and compared with the fractures observed in the PMHS tests. The model was then used to simulate rib fractures in human thorax impactor tests at Principal Direction of Force (PDOF) angles of 90[Formula: see text] to 35[Formula: see text] (total of 12 impacts). Furthermore, the normalized NRF were calculated and analyzed for comparing with normalized simulated injury parameters based on various human thoracic injury criteria, including contact force criterion, thorax deflection criterion, compression criterion, upper spine acceleration criterion and Thoracic Trauma Index (TTI). It is suggested that the TTI criterion has better correlation with the NRF than the other injury criteria.
INVESTIGATION OF SKIN LACERATION THRESHOLD UNDER A SPECIFIC CONDITION: BLADE PENETRATION TEST ON PORCINE SKIN
Authors: ITO MASATO , PRAMUDITA JONAS A. , WATANABE RYOJI , SHIMIZU YUSUKE , TANABE YUJI
Published: December 2017

Skin lacerations are not fatal but constitute one of the most common injuries in daily life. There is a need, therefore, for measures to prevent skin lacerations caused by accidents; however, since only a few engineering studies have been undertaken, the threshold of skin laceration is still unclear. In this study, the thresholds of skin laceration under moderate loading rate are proposed according to the results of penetration tests on porcine skin using a knife or blunt blade. In the tests, a sharp blade (knife) and blunt blade with an edge having a small radius of curvature were applied to the external surfaces of dorsal and ventral porcine skin specimens. Penetration tests using sharp blades showed that the average rupture load was 39.0[Formula: see text]N for dorsal skin and 36.0[Formula: see text]N for ventral skin. On the other hand, the results of the penetration tests using the blunt blade were statistically analyzed by ordinal logistic regression, because the rupture load could not be defined precisely based on the load sequence data. The regression curves show that the rupture loads for a 50% probability were within the range of 123.7[Formula: see text]N to 214.4[Formula: see text]N for dorsal region skin and 80.1[Formula: see text]N to 160.0[Formula: see text]N for ventral region skin.
A NOVEL PROPORTIONAL AND SIMULTANEOUS CONTROL METHOD FOR PROSTHETIC HAND
Authors: LI XIN , HUANG QIANG , ZHU JINYING , SUN WENTAO , SHE HAOTIAN
Published: December 2017

This paper proposes a novel control method of using the surface electromyogram (sEMG) signals to predict the kinematics of hand and wrist, which will be applied in the prosthetic hand control. Prediction of movement in 3 degree-of-freedoms’ (DoFs’) (wrist flexion/extension (WFE), lateral abduction/adduction (LAA), and hand open/close (HOC)) is investigated in this paper. The proposed control method contains a time-delay recurrent neural network (TDRNN), adopting the previous prediction of the joint angles and the time-delay sEMG signals as the system input. This proposed method uses a batch training based on Levenberg–Marquardt (LM) algorithm to learn the weights of the TDRNN. The trained TDRNN is aimed to achieve simultaneous and proportional regression from human movements of the 3 DoFs to those of the prosthetic hand. Three able-bodied subjects are chosen to participate in the test and demonstrate its feasibility and performance. The offline test result R2 ranges between 0.81 and 0.94. The online test results show that TDRNN reacts faster, which verifies that the method proposed in this paper will be feasible and effective in prosthetic hand control.
Vertical geochemical zonation in the Masjed Daghi porphyry copper-gold deposit, northwestern Iran: implications for exploration of blind mineral deposits
Authors: Imamalipour Ali , Mousavi Reza
Published: December 2017

The geochemical zonation method allows distinction between sub-ore and supra-ore primary halos, prediction of erosion level of mineralization, and exploration of blind mineral deposits. In this study, the geochemical zonation of the Masjed Daghi porphyry-Cu deposit, located in the NW of Iran, was investigated to estimate the level of erosion of this deposit based on the geochemical data obtained from 46 drill cores. We used vertical zonation indices (Pb.Zn/Cu.Mo) and (Pb.Zn/Cu.Ag) as geochemical indicators in exploration of blind porphyry-Cu deposits. The values of Vz
1
varied in different parts of the study area. Its values are considerably higher in the eastern and southeastern parts of the area (7-100), and lower in the northwestern parts of the area (0.03–1), indicating the least amount of erosion in the east and SE in comparison with the northwestern parts of study area. Vertical variations of the Pb.Zn/Cu.Mo index show a significant decrease with increased depth; for example, the level decreases to 0.001 at a depth of 580 metres in the NW of the area, indicating a sub-ore zone of halo. With respect to the present level of erosion, high values of Vz indices imply the presence of sub-cropping to blind porphyry-Cu deposits in this area.
Škocjan Caves, Slovenia: an integrative approach to the management of a World Heritage Site
Authors: Debevec Vanja , Peric Borut , Šturm Samo , Zorman Tomaž , Jovanovič Peter
Published: December 2017

The Škocjan Caves are included in UNESCO's World Heritage List due to their outstanding natural features. The caves include a large underground canyon containing the Reka River, collapse dolines with vegetation in rock fissures and impressive archaeological sites with a rich history of speleological and scientific research. They are also included in the Ramsar Directory of Wetlands of International Importance. Together with their broader surface area, the site is known as the UNESCO Karst Biosphere Reserve. The aim of the management of the reserve is to protect the World Heritage Site and to preserve its outstanding universal value for future generations. The protection activities are regulated by the provisions of international documents, the Škocjan Caves Regional Park Act and the park's management plan. These activities include monitoring of the water quality in the Reka River and meteorological surveys on the surface. Monitoring of the microclimate of the caves focuses on measuring the effects of tourism and monitoring the levels of radon, with the aim of the ensuring the safety of the park's employees. Ensuring a favourable status for the underground habitats and species is laid down in the Natura 2000 management programme. Particular attention is paid to ensuring high-quality, safe visits to the caves and providing educational and awareness-raising activities on the surface of the park.
Differentiation of the Follicular Neoplasm on the Gray-Scale US by Image Selection Subsampling along with the Marginal Outline Using Convolutional Neural Network
Authors: Seo Jeong-Kweon , Kim Young Jae , Kim Kwang Gi , Shin Ilah , Shin Jung Hee , Kwak Jin Young
Published: December 2017

We conducted differentiations between thyroid follicular adenoma and carcinoma for 8-bit bitmap ultrasonography (US) images utilizing a deep-learning approach. For the data sets, we gathered small-boxed selected images adjacent to the marginal outline of nodules and applied a convolutional neural network (CNN) to have differentiation, based on a statistical aggregation, that is, a decision by majority. From the implementation of the method, introducing a newly devised, scalable, parameterized normalization treatment, we observed meaningful aspects in various experiments, collecting evidence regarding the existence of features retained on the margin of thyroid nodules, such as 89.51% of the overall differentiation accuracy for the test data, with 93.19% of accuracy for benign adenoma and 71.05% for carcinoma, from 230 benign adenoma and 77 carcinoma US images, where we used only 39 benign adenomas and 39 carcinomas to train the CNN model, and, with these extremely small training data sets and their model, we tested 191 benign adenomas and 38 carcinomas. We present numerical results including area under receiver operating characteristic (AUROC).
Ischemic Retinopathies: Oxidative Stress and Inflammation
Authors: Rivera José Carlos , Dabouz Rabah , Noueihed Baraa , Omri Samy , Tahiri Houda , Chemtob Sylvain
Published: December 2017

Ischemic retinopathies (IRs), such as retinopathy of prematurity (ROP), diabetic retinopathy (DR), and (in many cases) age‐related macular degeneration (AMD), are ocular disorders characterized by an initial phase of microvascular changes that results in ischemia, followed by a second phase of abnormal neovascularization that may culminate into retinal detachment and blindness. IRs are complex retinal conditions in which several factors play a key role during the development of the different pathological stages of the disease. Increasing evidence reveals that oxidative stress and inflammatory processes are important contributors to the pathogenesis of IRs. Despite the beneficial effects of the photocoagulation and anti‐VEGF therapy during neovascularization phase, the need to identify novel targets to prevent initial phases of these ocular pathologies is still needed. In this review, we provide an update on the involvement of oxidative stress and inflammation in the progression of IRs and address some therapeutic interventions by using antioxidants and anti‐inflammatory agents.
A Randomized Crossover Trial of a Pressure Relief Technology (SensAwake™) in Continuous Positive Airway Pressure to Treat Obstructive Sleep Apnea
Authors: Bogan Richard K. , Wells Charles
Published: December 2017

Objectives/Background. Improving adherence to CPAP devices is crucial to reduce the long-term morbidity associated with OSA. SensAwake is a unique pressure relief technology that aims to promptly reduce the pressure upon sensing irregular respiration indicative of wakefulness. The purpose of this study was to compare adherence and sleep-quality outcomes in patients treated by CPAP with and without SensAwake technology.Methods. Participants with moderate-to-severe OSA were randomized to use CPAP devices with or without SensAwake (4 weeks) before crossing over.Results. Sixty-five patients completed both arms of the trial. There were no statistically significant differences in CPAP adherence with or without SensAwake over the study period (SensAwake ON272.67±17.06versus SensAwake OFF289.09±15.24;p=0.180). SensAwake reported a significantly lower system leak, 90th percentile leak, and time spent with excessive (>60 L/min) leak. Subgroup analysis suggested a trend towards improved adherence in patients with moderate-to-severe insomnia when using SensAwake.Conclusions. Using SensAwake incurred benefit in terms of reduced leaks; however, SensAwake did not improve CPAP adherence or objective sleep quality. Further studies should investigate the accuracy of observed trends towards increased adherence using SensAwake among patients with OSA and insomnia.
Methicillin-Sensitive Staphylococcus aureus Suppurative Thyroiditis with Thyrotoxicosis
Authors: Yan Sha , Patti Laryssa
Published: December 2017

Intravenous drug use (IVDU) can lead to numerous complications from skin abscesses to bacteremia to endocarditis. Here, we present a rare case of acute suppurative thyroiditis as a complication of IVDU, in which a 26-year-old female with a past medical history of IVDU presented to the emergency department for evaluation of a large right sided neck mass. On exam, she had signs of sepsis and thyrotoxicosis. Fine needle aspiration confirmed suppurative thyroiditis. Blood cultures and culture from fine needle aspiration grew Staphylococcus aureus. Patient was treated with 2 weeks of intravenous antibiotics with good resolution of her symptoms.
Administration of FTY720 during Tourniquet-Induced Limb Ischemia Reperfusion Injury Attenuates Systemic Inflammation
Authors: Foster Anthony D. , Vicente Diego , Sexton Jonathan J. , Johnston Luke , Clark Nick , Leonhardt Crystal , Elster Eric A. , Davis Thomas A. , Bradley Matthew J.
Published: December 2017

Acute ischemia-reperfusion injury (IRI) of the extremities leads to local and systemic inflammatory changes which can hinder limb function and can be life threatening. This study examined whether the administration of the T-cell sequestration agent, FTY720, following hind limb tourniquet-induced skeletal muscle IRI in a rat model would attenuate systemic inflammation and multiple end organ injury. Sprague-Dawley rats were subjected to 1 hr of ischemia via application of a rubber band tourniquet. Animals were randomized to receive an intravenous bolus of either vehicle control or FTY720 15 min after band placement. Rats (n=10/time point) were euthanized at 6, 24, and 72 hr post-IRI. Peripheral blood as well as lung, liver, kidney, and ischemic muscle tissue was analyzed and compared between groups. FTY720 treatment markedly decreased the number of peripheral blood T cells (p<0.05) resulting in a decreased systemic inflammatory response and lower serum creatinine levels and had a modest but significant effect in decreasing the transcription of injury-associated target genes in multiple end organs. These findings suggest that early intervention with FTY720 may benefit the treatment of IRI of the limb. Further preclinical studies are necessary to characterize the short-term and long-term beneficial effects of FTY720 following tourniquet-induced IRI.
The Role of NK Cells in Pig-to-Human Xenotransplantation
Authors: Puga Yung Gisella , Schneider Mårten K. J. , Seebach Jörg D.
Published: December 2017

Recruitment of human NK cells to porcine tissues has been demonstrated in pig organs perfused ex vivo with human blood in the early 1990s. Subsequently, the molecular mechanisms leading to adhesion and cytotoxicity in human NK cell-porcine endothelial cell (pEC) interactions have been elucidatedin vitroto identify targets for therapeutic interventions. Specific molecular strategies to overcome human anti-pig NK cell responses include (1) blocking of the molecular events leading to recruitment (chemotaxis, adhesion, and transmigration), (2) expression of human MHC class I molecules on pECs that inhibit NK cells, and (3) elimination or blocking of pig ligands for activating human NK receptors. The potential of cell-based strategies including tolerogenic dendritic cells (DC) and regulatory T cells (Treg) and the latest progress using transgenic pigs genetically modified to reduce xenogeneic NK cell responses are discussed. Finally, we present the status of phenotypic and functional characterization of nonhuman primate (NHP) NK cells, essential for studying their role in xenograft rejection using preclinical pig-to-NHP models, and summarize key advances and important perspectives for future research.
A Hybrid Constraints Handling Strategy for Multiconstrained Multiobjective Optimization Problem of Microgrid Economical/Environmental Dispatch
Authors: Li Xin , Lai Jingang , Tang Ruoli
Published: December 2017

Microgrid (MG) economical/environmental dispatch (MGEED) problem is a complex multiobjective optimization topic. Since the generators are diversified and the operation mode changes frequently, the MGEEED problem always has different types of constraints, such as the load balance constraints and the ramp rates constraints, which make it a nonlinear, nonconvex optimization problem. In this paper, the mathematical model of a typical MG system applied in northwest China is established. Then, a hybrid constraints handling strategy (HCHS) based on nondominated sorting genetic algorithm II (NSGAII) is proposed to deal with the typical constraints, by which the constraints violations can be removed in several steps during the evolutionary process. A dimensionality reduction method is introduced to simplify the optimization model. And an individual repair approach is designed for the violations of ramp rates constraints. In order to balance the weights of various types of constraints, the process of constraints handling in standard NSGAII is revised. Thereafter, HCHS-NSGAII is applied to some typical MGEED problems, considering all kinds of typical constraints. The results show that HCHS-NSGAII can obtain feasible Pareto sets with satisfactory convergence and distribution, which is efficient in handling complex practical industrial MGEED problems with the change of constraints combinations.
Study on the Oxidative Leaching of Uranium from the Lignite in the CO32-/HCO3- System
Authors: Ning Y. , Li Y. , Zhang Y. , Tang P.
Published: December 2017

Na2CO3/NaHCO3 mixtures with different oxidants were used to leach uranium in the lignite which was obtained from Lincang, Yunnan province. The experimental results showed that the optimal solid/liquid ratio and CO32-/HCO3- ratio for uranium leaching were 1 : 20 (g/mL) and 2 : 1, respectively. With the increase of carbon concentration from 0.1 mol/L to 1.1 mol/L, the leaching efficiency of uranium increased from 14.64% to 42.39% after 6 h leaching. The oxidants could significantly enhance the uranium leaching efficiency, which was up to 72.23% by injecting O2 at 1.5 L/min after 12 h leaching. The oxidative leaching process of uranium from the lignite was better fitted to the pseudo-second-order reaction model. The sequential extraction results illustrated that the oxidants could effectively enhance the leaching of organic matter bound uranium in the lignite, which was decreased from 76.86 mg/kg to 9.00 mg/kg by injecting O2. The infrared spectrum analysis demonstrated that the corresponding transmittance at about 3197 cm−1 was prominently reduced after the oxidative leaching, which intimated that the phenolic and alcoholic hydroxyl might be the main functional groups combined with uranium in the lignite.
A Case of a 34-Year-Old Female with Acute Hypoxemic Respiratory Failure and Proximal Muscle Weakness
Authors: Diaz Alex , Sharma Surit
Published: December 2017

Wound associated botulism is an unusual presentation. Early detection of this potentially life-threatening illness can significantly shorten length of hospital stay and improve prognosis. We present a case of a 34-year-old female with a history of heroin abuse who presented to the ED with acute respiratory failure, diplopia, and proximal muscle weakness. There was early concern for wound botulism as the instigating process. After discussion with the CDC, she was given equine serum heptavalent botulism antitoxin. Laboratory analysis later confirmed our suspicion. Symptoms improved and the patient was liberated from mechanical ventilation on day 14 and discharged from the hospital on day 23.
Distributed Measurement Data Gathering about Moving Objects
Authors: Kholod Ivan , Plokhoy Nikolay , Shorov Andrey
Published: December 2017

This paper describes approaches to gathering measurement data about moving objects in networks with low bandwidth. The first approach uses Fog computing conception and suggests moving assessing the quality of the measurement data into measuring points. The second approach uses prediction of telemetry quality by mining models. In addition, the paper presents implementation of these approaches based on actor model. As a result, it became possible not only to load balancing among edge and cloud nodes, but also to significantly reduce the network traffic, which in turn brings the possibility of decreasing the requirements for communication channels bandwidth and of using wireless networks for gathering measurement data about moving objects.
Antibacterial Activity of Ethanolic Extract ofSyzygium polyanthumL.(Salam)Leaves against Foodborne Pathogens and Application as Food Sanitizer
Authors: Ramli Suzita , Radu Son , Shaari Khozirah , Rukayadi Yaya
Published: December 2017

The aim of this study was to determine antibacterial activity ofS. polyanthumL.(salam)leaves extract foodborne pathogens. All the foodborne pathogens were inhibited after treating with extract in disk diffusion test with range6.67±0.58–9.67±0.58 mm of inhibition zone. The range of MIC values was between 0.63 and 1.25 mg/mL whereas MBC values were in the range 0.63 mg/mL to 2.50 mg/mL. In time-kill curve,L. monocytogenesandP. aeruginosawere found completely killed after exposing to extract in 1 h incubation at 4x MIC. Four hours had been taken to completely killE. coli,S. aureus,V. cholerae,andV. parahaemolyticusat 4x MIC. However, the population ofK. pneumoniae,P. mirabilis,andS. typhimuriumonly reduced to 3 log CFU/mL. The treated cell showed cell rupture and leakage of the cell cytoplasm in SEM observation. The significant reduction of natural microflora in grapes fruit was started at 0.50% of extract at 5 min and this concentration also was parallel to sensory attributes acceptability where application of extract was accepted by the panellists until 5%. In conclusion,S. polyanthumextract exhibits antimicrobial activities and thus might be developed as natural sanitizer for washing raw food materials.
The Improvement of Laparoscopic Surgical Skills Obtained by Gynecologists after Ten Years of Clinical Training Can Reduce Peritoneal Adhesion Formation during Laparoscopic Myomectomy: A Retrospective Cohort Study
Authors: Mais Valerio , Peiretti Michele , Minerba Luigi
Published: December 2017

Objective. To evaluate if improvement of laparoscopic skills can reduce postoperative peritoneal adhesion formation in a clinical setting. Study Design. We retrospectively evaluated 25 women who underwent laparoscopic myomectomy from January 1993 to June 1994 and 22 women who underwent laparoscopic myomectomy from March 2002 to November 2004. Women had one to four subserous/intramural myomas and received surgery without antiadhesive agents or barriers. Women underwent second-look laparoscopy for assessment of peritoneal adhesion formation 12 to 14 weeks after myomectomy. Adhesions were graded according to the Operative Laparoscopy Study Group scoring system. The main variable to be compared between the two cohorts was the proportion that showed no adhesions at second-look laparoscopy. Results. Demographic and surgical characteristics were similar between the two cohorts. No complications were observed during surgery. No adverse events were recorded during postoperative course. At second-look laparoscopy, a higher proportion of adhesion-free patients was observed in women who underwent laparoscopic myomectomy from March 2002 to November 2004 (9 out of 22) compared with women who underwent the same surgery from January 1993 to June 1994 (3 out of 25). Conclusion. The improvement of surgeons’ skills obtained after ten years of surgery can reduce postoperative adhesion formation.
Bounded Subsets of Smirnov and Privalov Classes on the Upper Half Plane
Authors: Iida Yasuo
Published: December 2017

Some characterizations of boundedness in N⁎(D) and Np(D)  (1 < p < ∞) will be described, where N⁎(D) denote the Smirnov class and Np(D) the Privalov class on the upper half plane , respectively.
Studies on the Influence of Drying Shrinkage Test Procedure, Specimen Geometry, and Boundary Conditions on Free Shrinkage
Authors: Menu Bruce , Jolin Marc , Bissonnette Benoit
Published: December 2017

Although considerable progress has been made in enhancing the use and interpretation of free ring shrinkage test, little is known about the impact of the test procedure, the specimen geometry, the surface area-to-volume (S/V) ratio exposed to drying, and the boundary conditions (sealing configuration) on the measured shrinkage. This paper highlights recent findings illustrating the influence of the test procedure, the S/V ratio exposed to drying, the geometry of specimen, and the boundary conditions. A series of experimental results are presented from free shrinkage on ring test specimens to illustrate that the test procedure can significantly influence the measured free shrinkage. A second series of experimental results are presented from specimens with different geometries and S/V ratio exposed to drying to illustrate that drying shrinkage is dependent on both the specimen geometry and the surface exposed to drying. Test results further show that, even for the same S/V ratio exposed to drying, shrinkage is strongly dependent on the specimen’s geometry and boundary conditions.
Alternative Caries Management Options for Primary Molars: 2.5-Year Outcomes of a Randomised Clinical Trial
Authors: Santamaría Ruth M. , Innes N.P.T. , Machiulskiene Vita , Schmoeckel Julian , Alkilzy Mohammad , Splieth Christian H.
Published: December 2017

Less invasive caries management techniques for treating cavitated carious primary teeth, which involve the concept of caries control by managing the activity of the biofilm, are becoming common. This study aimed to compare the clinical efficacy (minor/major failures) and survival rates (successful cases without any failures) of 3 carious lesion treatment approaches, the Hall Technique (HT), non-restorative caries treatment (NRCT), and conventional restorations (CR), for the management of occlusoproximal caries lesions (ICDAS 3-5) in primary molars. Results at 2.5 years are presented. A total of 169 children (3- to 8-year-olds) were enrolled in this secondary care-based, 3-arm parallel-group, randomised controlled trial. Participants were allocated to: HT (n = 52; sealing caries with stainless-steel crowns without caries removal), NRCT (n = 52; opening up the cavity and applying fluoride varnish), CR (n = 65; control arm, complete caries removal and compomer restoration). Statistical analyses were: non-parametric Kruskal-Wallis analysis of variance, Mann-Whitney U test and Kaplan-Meier survival analyses. One hundred and forty-two participants (84%; HT = 40/52; NRCT = 44/52; CR = 58/65) had follow-up data of 1-33 months (mean = 26). Overall, 25 (HT = 2, NRCT = 9, CR = 14) of 142 participants (17.6%) presented with at least 1 minor failure (reversible pulpitis, caries progression, or secondary caries; p = 0.013, CI = 0.012-0.018; Mann-Whitney U test). Ten (HT = 1, NRCT = 4, CR = 5) of 142 participants (7.04%) experienced at least 1 major failure (irreversible pulpitis, abscess, unrestorable tooth; p = 0.043, CI = 0.034-0.045). Independent comparisons between 2 samples found that NRCT-CR had no statistically significant difference in failures (p > 0.05), but for CR-HT (p = 0.037, CI = 0.030-0.040) and for NRCT-HT (p = 0.011, CI = 0.010-0.016; Kruskal-Wallis test) significant differences were observed. Cumulative survival rates were HT = 92.5%, NRCT = 70.5%, and CR = 67.2% (p = 0.012). NRCT and CR outcomes were comparable. HT performed better than NRCT and CR for all outcomes. This study was funded by the Paediatric Dentistry Department, Greifswald University, Germany (Trial registration No. NCT01797458).
Clinical Analysis of Esophageal Stricture in Patients Treated with Intralesional Triamcinolone Injection after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer
Authors: Okamoto Kazuki , Matsui Shigenaga , Watanabe Tomohiro , Asakuma Yutaka , Komeda Yoriaki , Okamoto Ayana , Rei Ishikawa , Kono Masashi , Yamada Mitsunari , Nagai Tomoyuki , Arizumi Tadaaki , Minaga Kosuke , Kamata Ken , Yamao Kentaro , Takenaka Mamoru , Sakurai Toshiharu , Nishida Naoshi , Kashida Hiroshi , Chikugo Takaaki , Kudo Masatoshi
Published: December 2017

Introduction: Endoscopic submucosal dissection (ESD) has been widely used in the resection of superficial esophageal cancers. Since its use has been extended to cases involving large esophageal tumors occupying nearly the whole or the whole circumference of the lumen, the occurrence of esophageal stricture has increased. Although endoscopic injection of triamcinolone (TA) is widely used for the prevention of postoperative stricture, a significant number of patients still develop stricture after TA injection therapy. Methods: We performed a retrospective study to identify the clinical parameters that predispose post-ESD patients to esophageal stricture after TA injection therapy. Results: A total of 207 patients who were diagnosed with superficial esophageal cancer and subsequently underwent ESD were enrolled in this study. Among these patients, 53 patients and 57 lesions bearing mucosal defects covering greater than two-thirds of the esophageal circumference after ESD were treated with TA injection therapy. The rate of esophageal stricture was found to be highest in cases involving mucosal defects that covered more than seven-eighths of the circumference. Conclusion: Endoscopic TA injection is not sufficient for preventing esophageal stricture in patients bearing mucosal defects covering more than seven-eighths of the esophageal circumference after ESD.
Prophylactic Suturing Closure Is Recommended after Endoscopic Treatment of Colorectal Tumors in Patients with Antiplatelet/Anticoagulant Therapy
Authors: Sakurai Toshiharu , Adachi Teppei , Kono Masashi , Arizumi Tadaaki , Kamata Ken , Minaga Kosuke , Yamao Kentaro , Komeda Yoriaki , Takenaka Mamoru , Hagiwara Satoru , Watanabe Tomohiro , Nishida Naoshi , Kashida Hiroshi , Kudo Masatoshi
Published: December 2017

The prophylactic closure of mucosal defects after endoscopic resection is known to prevent postoperative bleeding in colorectal lesions. However, closure of large mucosal defects is difficult with conventional clips only, and several closure techniques have been previously described; use of an Endoloop, 8-ring loop, or loop clip and a small incision around the mucosal defect. Given that the prophylactic closure requires much cost and time, the application should be limited to high-risk cases. Medication of antithrombotics or antiplatelet agents would be one of the reasonable indications for prophylactic closure of mucosal defects after endoscopic resection of colorectal tumors.
Computer-Aided Diagnosis Based on Convolutional Neural Network System for Colorectal Polyp Classification: Preliminary Experience
Authors: Komeda Yoriaki , Handa Hisashi , Watanabe Tomohiro , Nomura Takanobu , Kitahashi Misaki , Sakurai Toshiharu , Okamoto Ayana , Minami Tomohiro , Kono Masashi , Arizumi Tadaaki , Takenaka Mamoru , Hagiwara Satoru , Matsui Shigenaga , Nishida Naoshi , Kashida Hiroshi , Kudo Masatoshi
Published: December 2017

Background and Aim: Computer-aided diagnosis (CAD) is becoming a next-generation tool for the diagnosis of human disease. CAD for colon polyps has been suggested as a particularly useful tool for trainee colonoscopists, as the use of a CAD system avoids the complications associated with endoscopic resections. In addition to conventional CAD, a convolutional neural network (CNN) system utilizing artificial intelligence (AI) has been developing rapidly over the past 5 years. We attempted to generate a unique CNN-CAD system with an AI function that studied endoscopic images extracted from movies obtained with colonoscopes used in routine examinations. Here, we report our preliminary results of this novel CNN-CAD system for the diagnosis of colon polyps. Methods: A total of 1,200 images from cases of colonoscopy performed between January 2010 and December 2016 at Kindai University Hospital were used. These images were extracted from the video of actual endoscopic examinations. Additional video images from 10 cases of unlearned processes were retrospectively assessed in a pilot study. They were simply diagnosed as either an adenomatous or nonadenomatous polyp. Results: The number of images used by AI to learn to distinguish adenomatous from nonadenomatous was 1,200:600. These images were extracted from the videos of actual endoscopic examinations. The size of each image was adjusted to 256 × 256 pixels. A 10-hold cross-validation was carried out. The accuracy of the 10-hold cross-validation is 0.751, where the accuracy is the ratio of the number of correct answers over the number of all the answers produced by the CNN. The decisions by the CNN were correct in 7 of 10 cases. Conclusion: A CNN-CAD system using routine colonoscopy might be useful for the rapid diagnosis of colorectal polyp classification. Further prospective studies in an in vivo setting are required to confirm the effectiveness of a CNN-CAD system in routine colonoscopy.
The Feasibility of 18-mm-Diameter Colonic Stents for Obstructive Colorectal Cancers
Authors: Ogawa Satoshi , Ishii Tatsuya , Minaga Kosuke , Nakatani Yasuki , Hatamaru Keiichi , Akamatsu Takuji , Seta Takeshi , Urai Shunji , Uenoyama Yoshito , Yamashita Yukitaka , Kudo Masatoshi
Published: December 2017

Objectives: This study aimed to evaluate the characteristics and the feasibility of 18-mm-diameter stents for obstructive colorectal cancer, comparing the clinical courses with 22- mm-diameter stents. Methods: We retrospectively compared 33 consecutive cases treated with 18-mm-diameter stents (bridge to surgery [BTS] in 25, palliative therapy [PAL] in 8) with 27 consecutive cases treated with 22-mm-diameter stents (BTS in 21, PAL in 6) for obstructive colorectal cancer between May 2013 and November 2015 in our institution. Results: There were no significant differences between the 18-mm and 22-mm groups in technical success rates (97 and 96%, respectively) and clinical success rates (100 and 100%, respectively). As a BTS, the rates of complications and stoma formation were not significantly different between groups. For PAL, although the rates of complications and stent patency were similar, stent occlusion occurred in 1 patient (12.5%) in the 18-mm group. Conclusions: The 18-mm-diameter stents were similarly effective when compared with 22-mm-diameter stents. Because 18-mm-diameter stents are easy to handle and produce less mechanical stress, they have the potential to decrease the perforation rate and mitigate the stent's impact on the tumors. 18-mm-diameter stents can be useful and safe, especially as a BTS.
Characterization of Pancreatic Tumors with Quantitative Perfusion Analysis in Contrast-Enhanced Harmonic Endoscopic Ultrasonography
Authors: Omoto Shunsuke , Takenaka Mamoru , Kitano Masayuki , Miyata Takeshi , Kamata Ken , Minaga Kosuke , Arizumi Tadaaki , Yamao Kentaro , Imai Hajime , Sakamoto Hiroki , Harwani Yogesh , Sakurai Toshiharu , Watanabe Tomohiro , Nishida Naoshi , Takeyama Yoshifumi , Chiba Yasutaka , Kudo Masatoshi
Published: December 2017

Objectives: This study evaluated whether quantitative perfusion analysis with contrast-enhanced harmonic (CH) endoscopic ultrasonography (EUS) characterizes pancreatic tumors, and compared the hemodynamic parameters used to diagnose pancreatic carcinoma. Methods: CH-EUS data from pancreatic tumors of 76 patients were retrospectively analyzed. Time-intensity curves (TIC) were generated to depict changes in signal intensity over time, and 6 parameters were assessed: baseline intensity, peak intensity, time to peak, intensity gain, intensity at 60 s (I60), and reduction rate. These parameters were compared between pancreatic carcinomas (n = 41), inflammatory pseudotumors (n = 14), pancreatic neuroendocrine tumors (n = 14), and other tumors (n = 7). All 6 TIC parameters and subjective analysis for diagnosing pancreatic carcinoma were compared. Results: Values of peak intensity and I60 were significantly lower and time to peak was significantly longer in the groups with pancreatic carcinomas than in the other 3 tumor groups (p < 0.05). Reduction rate was significantly higher in pancreatic carcinomas than in pancreatic neuroendocrine tumors (p < 0.05). Areas under the receiver-operating characteristic curves for the diagnosis of pancreatic carcinoma using subjective analysis, baseline intensity, peak intensity, intensity gain, I60, time to peak, and reduction rate, were 0.817, 0.664, 0.810, 0.751, 0.845, 0.777, and 0.725, respectively. I60 was the most accurate parameter for differentiating pancreatic carcinomas from the other groups, giving values of sensitivity/specificity of 92.7/68.6% when optimal cutoffs were chosen. Conclusions: In pancreatic carcinomas, TIC patterns were markedly different from the other tumor types, with I60 being the most accurate diagnostic parameter. Quantitative perfusion analysis is useful for differentiating pancreatic carcinomas from other pancreatic tumors.
Chronic Pancreatitis Finding by Endoscopic Ultrasonography in the Pancreatic Parenchyma of Intraductal Papillary Mucinous Neoplasms Is Associated with Invasive Intraductal Papillary Mucinous Carcinoma
Authors: Takenaka Mamoru , Masuda Atsuhiro , Shiomi Hideyuki , Yagi Yosuke , Zen Yoh , Sakai Arata , Kobayashi Takashi , Arisaka Yoshifumi , Okabe Yoshihiro , Kutsumi Hiromu , Toyama Hirochika , Fukumoto Takumi , Ku Yonson , Kudo Masatoshi , Azuma Takeshi
Published: December 2017

Background/Objectives: The recent guideline for intraductal papillary mucinous neoplasms (IPMNs) focuses on morphological features of the lesion as signs of malignant transformation, but ignores the background pancreatic parenchyma, including features of chronic pancreatitis (CP), which is a risk factor for pancreatic malignancies. Endoscopic ultrasonography frequently reveals evidence of CP (EUS-CP findings) in the background pancreatic parenchyma of patients with IPMNs. Therefore, we investigated whether background EUS-CP findings were associated with malignant IPMN. Methods: The clinical data of 69 consecutive patients with IPMNs who underwent preoperative EUS and surgical resection between April 2010 and October 2014 were collected prospectively. The association of EUS-CP findings (total number of EUS-CP findings; 0 vs. ≥1) with invasive IPMN was examined. The association of EUS-CP findings with pathological changes of the background pancreatic parenchyma (atrophy/inflammation/fibrosis) was also examined. Results: Among patients with EUS-CP findings, invasive intraductal papillary mucinous carcinoma (IPMC) was significantly more frequent than among patients without EUS-CP findings (42.5% [17/40] vs. 3.4% [1/29], p = 0.0002). In addition, patients with EUS-CP findings had higher grades of pancreatic atrophy and inflammation than patients without EUS-CP findings (atrophy: 72.5% [29/40] vs. 34.5% [10/29], p = 0.003; inflammation: 45.0% [18/40] vs. 20.7% [6/29], p = 0.04). Conclusions: In IPMN patients, detection of EUS-CP findings in the background pancreatic parenchyma was associated with a higher prevalence of invasive IPMC. Accordingly, EUS examination should not only assess the morphological features of the lesion itself, but also EUS-CP findings in the background parenchyma.
Primary Hepatic Adenosquamous Carcinoma Associated with Primary Sclerosing Cholangitis
Authors: Yamao Kentaro , Takenaka Mamoru , Imai Hajime , Nakai Atsushi , Omoto Shunske , Kamata Ken , Minaga Kosuke , Miyata Takeshi , Sakurai Toshiharu , Watanabe Tomohiro , Nishida Naoshi , Matsumoto Ippei , Takeyama Yosihumi , Chikugo Takaaki , Kudo Masatoshi
Published: December 2017

Introduction: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disorder characterized by multiple fibrotic strictures of the bile duct. More than 40% of deaths in PSC patients are related to malignant tumors, including cholangiocarcinoma. Primary hepatic adenosquamous carcinoma (ASC) is a rare subtype of cholangiocarcinoma containing adenocarcinoma (AC) and squamous cell carcinoma (SCC) components, with a poorer prognosis than other cholangiocarcinomas. We report the first case of a hepatic ASC in a patient with PSC. Case Report: A 28-year-old man was referred for diagnosis and treatment of a liver abscess suspected by contrast-enhanced computed tomography (CE-CT). He had a history of ulcerative colitis and PSC. Abdominal CE-CT revealed a 60-mm-diameter ring-shaped mass with central necrosis in the left lobe. Magnetic resonance imaging demonstrated a poorly circumscribed low-signal-intensity mass in T1-weighted imaging and a high-signal-intensity mass with a scattered low-signal-intensity area in T2-weighted imaging. Abdominal ultrasonography showed a hypoechoic component with a diffuse hyperechoic area in the tumor. Ultrasound-guided biopsy and histological examination showed tumor cells with both squamous and glandular differentiation. Left lobectomy was performed. Microscopic examination revealed 2 components, including moderately differentiated AC and well-differentiated SCC. The final diagnosis was hepatic ASC. Conclusion: This is the first reported case of hepatic ASC in a patient with PSC. Patients with PSC should be recognized as being at a risk of not only general cholangiocarcinoma, hepatocellular carcinoma, and metastatic liver tumor, but also ASC.
EUS-Guided Pancreatic Duct Drainage for Repeat Pancreatitis in a Patient with Pancreatic Cancer
Authors: Kamata Ken , Takenaka Mamoru , Minaga Kosuke , Sakurai Toshiharu , Watanabe Tomohiro , Nishida Naoshi , Kudo Masatoshi
Published: December 2017

Endoscopic ultrasound-guided pancreatic drainage (EUS-PD) was performed in a patient with unresectable pancreatic cancer who developed pancreatitis. In this case, EUS-PD was useful as salvage therapy for pancreatitis as the transpapillary approach was difficult.
A Case of Pancreatic Carcinoma in situ Diagnosed by Repeated Pancreatic Juice Cytology
Authors: Miyata Takeshi , Takenaka Mamoru , Omoto Shunsuke , Kamata Ken , Minaga Kosuke , Yamao Kentaro , Imai Hajime , Kudo Masatoshi
Published: December 2017

Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage (ENPD) has a high diagnostic yield and might be useful for the diagnosis of early-stage pancreatic cancer. A 67-year-old man presented with a pancreatic cyst occasionally detectable in the body of the pancreas by ultrasonography (US). No obvious pancreatic tumor was detected by US, computed tomography (CT), magnetic resonance cholangiopancreatography, and endoscopic ultrasound (EUS) (although the latter did reveal a weak, low echoic area). Endoscopic retrograde pancreatography showed irregular narrowing of the main pancreatic duct (MPD) at the pancreatic body. Pancreatic juice cytology was also performed, but did not give evidence of a malignancy. Therefore, the patient was followed up. CT and EUS performed after 3 months showed the same findings as did endoscopic retrograde pancreatography; however, the results of repeated pancreatic juice cytology performed via ENPD tube revealed a suspected malignancy on 2 of 6 occasions. Therefore, we performed a central pancreatectomy. Histopathological examination of a resected specimen revealed carcinoma in situ in the narrow MPD at the body of the pancreas. In the current case, repeated pancreatic juice cytology via ENPD was effective. A weak low echoic area around the MPD stricture on EUS might be related to the inflammatory change accompanying carcinoma in situ of the pancreas.
Hand-Foot Syndrome and Post-Progression Treatment Are the Good Predictors of Better Survival in Advanced Hepatocellular Carcinoma Treated with Sorafenib: A Multicenter Study
Authors: Ogawa Chikara , Morita Masahiro , Omura Akina , Noda Teruyo , Kubo Atsushi , Matsunaka Toshihiro , Tamaki Hiroyuki , Shibatoge Mitsushige , Tsutsui Akemi , Senoh Tomonori , Nagano Takuya , Takaguchi Kouichi , Tani Joji , Morishita Asahiro , Yoneyama Hirohito , Masaki Tsutomu , Moriya Akio , Ando Masaharu , Deguchi Akihiro , Kokudo Yasutaka , Minami Yasunori , Ueshima Kazuomi , Sakurai Toshiharu , Nishida Naoshi , Kudo Masatoshi
Published: December 2017

Objective: To determine the relationship between treatment outcomes and hand-foot syndrome (HFS), and the relationship between survival rate and post-progression treatment after sorafenib therapy. Methods: The study assessed 314 patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib at 5 general hospitals in Kagawa Prefecture, Japan. Results: At the start of sorafenib therapy, 23.6% of the patients had HCC of a Child-Pugh class other than A. The initial sorafenib dose was 800 mg in 9.2% of the patients and 400 mg in 64.3%. Time to progression was 129 days (95% CI: 87.3-170.7) and the median overall survival (OS) was 392 days (95% CI: 316.0-468.0). The OS of the patients with Child-Pugh class A HCC was significantly better than that of the patients with Child-Pugh class B HCC (p < 0.0001). The survival curves for Child-Pugh class A-5 points and class A-6 points were significantly different, with that for class A-5 points being better (p < 0.0001). A significant difference was observed between the patients who exhibited HFS and those who did not, with the former exhibiting a better survival rate (p < 0.001). In addition, the survival rate of the patients who received post-progression treatment after sorafenib therapy was significantly better than that of the patients who did not (p < 0.001). Conclusion: In sorafenib therapy, patients with HFS and those who received post-progression treatment exhibited good OS.
Validation of Newly Proposed Time to Transarterial Chemoembolization Progression in Intermediate-Stage Hepatocellular Carcinoma Cases
Authors: Izumoto Hirofumi , Hiraoka Atsushi , Ishimaru Yoshihiro , Murakami Tadashi , Kitahata Shogo , Ueki Hidetaro , Aibiki Toshihiko , Okudaira Tomonari , Miyamoto Yuji , Yamago Hiroka , Iwasaki Ryuichiro , Tomida Hideomi , Mori Kenichiro , Kishida Masato , Tsubouchi Eiji , Miyata Hideki , Ninomiya Tomoyuki , Kawasaki Hideki , Hirooka Masashi , Matsuura Bunzo , Abe Masanori , Hiasa Yoichi , Michitaka Kojiro , Kudo Masatoshi
Published: December 2017

Background/Aim: Determination of failure of transarterial chemoembolization (TACE) for treatment of Barcelona Clinic Liver Cancer stage B (BCLC-B) hepatocellular carcinoma (HCC) has become important because of the development of tyrosine kinase inhibitor (TKI) treatment. We evaluated the usefulness and efficacy of the newly proposed time to TACE progression (TTTP). Patients and Methods: From 2006 to 2016, 192 BCLC-B HCC patients [median age 72 years, male/female ratio = 149/43, Child-Pugh score 5/6/7 = 106/56/30, albumin-bilirubin (ALBI) grade 1/2 = 64/128, Kinki criteria B1/B2 = 64/128] were enrolled. TTTP was defined based on a previous report and first imaging performed 3 months after initial TACE had been used to obtain baseline images. The patients were divided into three groups according to TTTP (<5, 5-10, and ≥10 months; group I, II, and III, respectively). We evaluated the relationship between TTTP and overall survival (OS) as well as the prognostic factors for death. Results: The median number of TACE procedures was 4 (interquartile range 3-7). There was a moderate correlation between TTTP and OS (r = 0.527, 95% CI 0.416-0.622, p < 0.001). The median survival for group I (n = 78), II (n = 49), and III (n = 65) was 24.6, 34.7, and 49.5 months, respectively (group I vs. group II, p = 0.023; group I vs. group III, p < 0.001; group II vs. group III, p = 0.037; Holm's method). ALBI grade 2 (HR 1.548, 95% CI 1.004-2.388, p = 0.048), alpha-fetoprotein (>100 ng/mL) (HR 1.540, 95% CI 1.035-2.291, p = 0.033), and TTTP (<5 months) (HR 2.157, 95% CI 1.447-3.215, p < 0.001) were significant prognostic factors for death in multivariate Cox hazard analysis. Conclusion: In patients with reduced TTTP, especially <5 months, it might be difficult to improve prognosis with a repeated TACE procedures. In such cases, reconsideration of the therapeutic strategy might be needed when possible.