Abstract We analyzed oral behavior from food intake until terminal swallow for mastication and swallowing under a freely eating condition with a natural food. Measurements, including movement of the ...mandible and tongue, the size of the gape, different sequences involved in the oral aspect of the swallowing action, and bolus size and movement were carried out in five “freely eating subjects” using videofluorography. During food intake, the tongue moved forwards and backwards to introduce food into the mouth, to compress the food against the hard palate, and to transport food to the occlusal surface of the molar teeth. Most of the food was swallowed in the first swallow, and any residual food was aggregated by the tongue into a bolus and then swallowed in the last swallow. These findings suggest that 1) tongue manipulation plays an important role in recognizing and evaluating the volume of bite taken, 2) the intra-oral compression of food has a role in the recognition of food texture, 3) stage I transport is closely bound to the texture recognition process, 4) humans need at least two swallows, even with one bite of food, when ingesting food freely, and 5) the duration time of the oral stage of swallowing may depend on the bolus volume and be longer for smaller volumes unlike those measured under the command swallow.
This paper presents a Bayesian method of probability forecasting for a renewal of earthquakes. When only limited records of characteristic earthquakes on a fault are available, relevant prior ...distributions for renewal model parameters are essential to computing unbiased, stable time‐dependent earthquake probabilities. We also use event slip and geological slip rate data combined with historical earthquake records to improve our forecast model. We apply the Brownian Passage Time (BPT) model and make use of the best fit prior distribution for its coefficient of variation (the shape parameter, alpha) relative to the mean recurrence time because the Earthquake Research Committee (ERC) of Japan uses the BPT model for long‐term forecasting. Currently, more than 110 active faults have been evaluated by the ERC, but most include very few paleoseismic events. We objectively select the prior distribution with the Akaike Bayesian Information Criterion using all available recurrence data including the ERC datasets. These data also include mean recurrence times estimated from slip per event divided by long‐term slip rate. By comparing the goodness of fit to the historical record and simulated data, we show that the proposed predictor provides more stable performance than plug‐in predictors, such as maximum likelihood estimates and the predictor currently adopted by the ERC.
Key Points
We proposed a Bayesian earthquake forecast model for a small sample size
Bayesian predictive distribution gives more stable and better forecast
There is significant regional variability in coefficient of variation in Japan
Background
Recent studies have indicated the potential benefit of intraoperative near-infrared fluorescence imaging (NIR-FI) with indocyanine green in reducing early anastomotic leakage in colorectal ...surgery. Nonetheless, whether NIR-FI is effective in reducing structural sequelae of anastomotic leakage (SSAL) remains unclear. The aim of the present study was to investigate the impact of NIR-FI on SSAL after laparoscopic intersphincteric resection (ISR) of malignant rectal tumors.
Methods
This study was a retrospective single-center cohort study. A total of 293 consecutive patients who underwent elective laparoscopic ISR from May 2010 to August 2017 were included. Patients were divided into 2 groups; those who underwent elective laparoscopic ISR with lymphadenectomy for malignant rectal tumors using NIR-F (NIR-FI group) and those who underwent elective laparoscopic ISR with lymphadenectomy for malignant rectal tumors without using NIR-FI (control group). Thirty were excluded from the analyses (13 died, 7 had pelvic recurrence, and 10 were lost to follow-up). The primary endpoint was the rate of SSAL within 2 years after the primary resection, whereas the secondary endpoint was the rate of natural defecation via the anus at 2 years after the primary resection. Using various statistical analyses, such as propensity score matching, the rate of SSAL was compared between groups.
Results
A total of 263 patients were analyzed 177 males and 86 females, median age 61 (27–84) years. Prior to propensity score matching (
n =
263), NIR-FI was performed in 70 patients (26.6%) The rates of SSAL were 1.4% (1/70) in the NIR-FI group and 10.4% (20/193) in the control group (
p
= 0.02). After propensity score matching (
n =
163), the rates of SSAL were 1.5% (1/66) in the NIR-FI group and 11.7% (12/103) in the control group (
p
= 0.02). Propensity score analyses, as well as simple regression analyses, revealed that NIR-FI was associated with a significantly lower risk of SSAL (OR 0.10–0.13;
p
= 0.03–0.05).
Conclusions
NIR-FI is useful in reducing the rate of SSAL after laparoscopic ISR.
Objective
To assess the effectiveness of an HPV vaccination programme in reducing the risk of cervical abnormalities identified at subsequent screening.
Design
Retrospective cohort study using ...administrative health data.
Setting
General population of Ferrara Province, Italy.
Population
Female residents born in 1986–1993 and participating in the organized cervical screening programme in 2011–2018, who were eligible for HPV vaccination in catch‐up cohorts.
Methods
Logistic regression to evaluate the potential association between abnormal cervical cytology and one, two, three or at least one dose of HPV vaccine.
Main outcome measures
Cervical abnormalities, as predicted by low‐grade or high‐grade cytology, by number of vaccine doses, stratified by age.
Results
The sample consisted of 7785 women (mean age 27.5 years, SD 2.3). Overall, 391 (5.0%) were vaccinated with ≥1 dose and 893 (11.5%) had abnormal cytology. Women receiving at least one vaccine dose were significantly less likely to have an abnormal cytology (adjusted odds ratio 0.52; 95% confidence interval 0.34–0.79). Similar results were observed for women receiving a single dose, for both bivalent and quadrivalent vaccines, and applying buffer periods (excluding cytological outcomes within 1 month, 6 months and 1 year of the first dose).
Conclusions
In the context of an organised cervical screening programme in Italy, catch‐up HPV vaccination almost halved the risk of cytological abnormalities.
Tweetable
Among Ferrara women, vaccination against human papillomavirus halved the risk of screening cervical abnormalities.
Tweetable
Among Ferrara women, vaccination against human papillomavirus halved the risk of screening cervical abnormalities.
Backgrounds
Anastomotic leakage (AL) represents a major complication after rectal low anterior resection (LAR). Transanal drainage tube (TDT) placement offers a potential strategy for AL prevention; ...however, its efficacy and safety remain contentious.
Methods
A systematic review and meta-analysis were used to evaluate the influence of TDT subsequent to LAR as part of the revision of the surgical site infection prevention guidelines of the Japanese Society of Surgical Infectious Diseases (PROSPERO registration; CRD42023476655). We searched each database, and included randomized controlled trials (RCTs) and observational studies (OBSs) comparing TDT and non-TDT outcomes. The main outcome was AL. Data were independently extracted by three authors and random-effects models were implemented.
Results
A total of three RCTs and 18 OBSs were included. RCTs reported no significant difference in AL rate between the TDT and non-TDT groups relative risk (RR): 0.69, 95% confidence interval (CI) 0.42–1.15. OBSs reported that TDT reduced AL risk odds ratio (OR): 0.45, 95% CI 0.31–0.64. In the subgroup excluding diverting stoma (DS), TDT significantly lowered the AL rate in RCTs (RR: 0.57, 95% CI 0.33–0.99) and OBSs (OR: 0.41, 95% CI 0.27–0.62). Reoperation rates were significantly lower in the TDT without DS groups in both RCTs (RR: 0.26, 95% CI 0.07–0.94) and OBSs (OR: 0.40, 95% CI 0.24–0.66). TDT groups exhibited a higher anastomotic bleeding rate only in RCTs (RR: 4.28, 95% CI 2.14–8.54), while shorter hospital stays were observed in RCTs standard mean difference (SMD): −0.44, 95% CI −0.65 to −0.23 and OBSs (SMD: −0.54, 95% CI −0.97 to −0.11) compared with the non-TDT group.
Conclusions
A universal TDT placement cannot be recommended for all rectal LAR patients. Some patients may benefit from TDT, such as patients without DS creation. Further investigation is necessary to identify the specific beneficiaries.
Indoleamine 2,3-dioxygenase (IDO) is a tryptophan-catabolising enzyme inducing immune tolerance. The present study aimed to investigate IDO expression and its prognostic significance in endometrial ...cancer. Indoleamine 2,3-dioxygenase expression in endometrial cancer tissues (n = 80) was immunohistochemically scored as four groups (IDO-, 1+, 2+, and 3+). The high IDO expression (IDO2+ or 3+) in tumour cells was found in 37 (46.3%) of the 80 cases, and was positively correlated with surgical stage, myometrial invasion, lymph-vascular space involvement, and lymph node metastasis, but not with the histological grade. Patients with high IDO expression had significantly impaired overall survival and progression-free survival (PFS) (P = 0.002 and P = 0.001, respectively) compared to patients with no or weak expression of IDO (IDO- or 1+). The 5-year PFS for IDO-/1+, 2+, and 3+ were 97.7, 72.9, and 36.4%, respectively. Even in patients with early-stage disease (International Federation of Gynecology and Obstetrics I/II, n = 64), the PFS for IDO2+/3+ was significantly poor (P = 0.001) compared to that for IDO-/1+. On multivariate analysis, IDO expression was an independent prognostic factor for PFS (P = 0.020). These results indicated that the high IDO expression was involved in the progression of endometrial cancer and correlated with the impaired clinical outcome, suggesting that IDO is a novel and reliable prognostic indicator for endometrial cancer.
Background: Eltrombopag is an oral, non‐peptide thrombopoietin receptor agonist that has shown efficacy and safety in chronic immune thrombocytopenia (ITP). However, ethnic differences in ...eltrombopag exposure have been reported: area under the curve exposure to eltrombopag was 87% greater among ITP patients of East Asian descent than among ITP patients of non‐East Asian ITP descent.
Objectives: To evaluate the efficacy and safety of eltrombopag by using, in Japanese ITP patients, lower starting (12.5 mg) and maximum (50 mg) doses of eltrombopag than the standard starting (50 mg) and maximum (75 mg) doses approved in the USA and Europe.
Patients: We examined 23 Japanese patients with previously treated chronic ITP with a platelet count of < 30 000 μL−1 in a multicenter study comprising a randomized, double‐blind, placebo‐controlled phase for 6‐week evaluation (15 eltrombopag, and eight placebo) and an open‐label phase for 6‐month evaluation (23 eltrombopag).
Results and Conclusions: The response rate (platelet count of ≥ 50 000 μL−1) at week 6 of the 6‐week double‐blind phase was 60% in eltrombopag‐treated patients and 0% in placebo‐treated patients. Ten of 23 patients (43.5%) responded for ≥ 75% of predefined assessment visits during the 6‐month open‐label phase. Notably, 22% (5/23) of patients responded to 12.5 mg of eltrombopag, which was administered within the first 3 weeks of eltrombopag treatment. Bleeding decreased with eltrombopag treatment as compared with baseline. Eltrombopag was generally well tolerated; one patient experienced a transient ischemic attack on day 9. Eltrombopag (12.5–50 mg) is effective for the management of Japanese patients with chronic ITP (NCT00540423).
Peppermint oil has been shown to relax gastrointestinal smooth muscle. In this randomized, placebo‐controlled study, an L‐menthol preparation, NPO‐11, was assessed for tolerability and ...pharmacokinetics (PK) during gastrointestinal endoscopy. Single doses of NPO‐11, as high as 320 mg, were well tolerated. NPO‐11 was rapidly absorbed, with peak concentrations reached within 1 h after administration. Approximately 70% of the administered L‐menthol and its metabolites were excreted in the urine, and this amount fluctuated with no change in the dose. The principal metabolite identified in plasma and urine was menthol glucuronide. The other metabolites include mono‐ or di‐hydroxylated menthol derivatives, most of which are excreted, in part, as glucuronic acid conjugates. The pharmacokinetic data indicated that when NPO‐11 is sprayed directly onto the gastric mucosa, it is rapidly metabolized to glucuronic acid conjugates that are excreted in urine. The findings from this study provide new data on the safety and PK of NPO‐11 and support further trials.
Clinical Pharmacology & Therapeutics (2011) 90 2, 221–228. doi:10.1038/clpt.2011.110
High-temperature superconducting magnets are generally driven by a power supply (driven mode), and temporal fluctuations of the power supply unit, such as ripple noise, directly affect the magnetic ...field stability. A method of suppressing such temporal instability by short-circuiting both ends of the coil with finite low-resistance joints, somewhat similar to a persistent current switch, has been proposed in order to form a closed loop having a large time constant, L/R. In this research, we developed two types of REBCO superconducting switches was constructed with a non-inductive winding using mainly ordinary copper-coated REBCO tapes, and type-B switch used uncoated REBCO tapes toward application to emergency shutdown. For the type-B switch, at the end of the winding, copper-coated REBCO tapes were jointed to prevent degradation by exposure to moisture. The R-T and V-I characteristics of each switch when cooled with liquid nitrogen were tested. The type-A switch was applied to a test REBCO magnet, and the temporal stability of the magnetic field was evaluated under a conduction cooling configuration in the driven mode.
Asthma-chronic obstructive pulmonary disease overlap (ACO), characterized by airway limitation, is an important condition with high incidence and mortality. Although some guidelines recommend triple ...therapy with inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β
agonists, this treatment approach is based on the extrapolation of data from studies of asthma or chronic obstructive pulmonary disease (COPD) alone.
A 12-week, randomized, open-label cross-over pilot study was conducted in 19 patients with ACO to investigate the effect of triple therapy with glycopyrrolate (GLY) 50 µg/day on budesonide/formoterol fumarate (BUD/FORM) 640/18 µg/day. The study period included a 4-week wash-out, 4-week run-in, and 4-week treatment period. Respiratory function tests, fractional exhaled nitric oxide (FeNO), a COPD assessment test (CAT) and an asthma control questionnaire (ACQ) were carried out 0, 4, and 8 weeks after randomization.
A total of 19 patients with stable ACO (19 males and no females) with a mean age of 70.7 ± 7.6 years (± standard deviation, SD; range 55-83 years) participated in this study. All patients were ex-smokers with a smoking history of 63.1 ± 41.1 pack-years (± SD). Mean values for inspiratory capacity (IC), an index of hyperinflation of the lung that causes exertional dyspnea and reduced exercise, were 1.93 L (± 0.47 L) after the run-in, 1.85 L (± 0.51 L) after the BUD/FORM dual therapy period and 2.11 L (± 0.58 L) after the BUD/GLY/FORM triple therapy period. IC values after the BUD/GLY/FORM triple therapy were significantly higher than those after the run-in (
< 0.02). FeNO values, ACQ, and CAT scores were not significantly different among the run-in, wash-out, and triple-therapy periods.
The present pilot study showed that triple therapy with BUD/GLY/FORM results in an improvement in lung function parameters including IC, indicating the potential value of triple therapy as standard treatment for ACO.
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