起点となる大腸内視鏡検査および初回サーベイランス大腸内視鏡検査の所見に基づくAdvanced neoplasia発生のリスク層別化に関する検討

熊本大

Risk stratification for advanced colorectal neoplasia based on the findings of the index and first surveillance colonoscopies.

Risk stratification by index colonoscopy is well established for first surveillance endoscopy, but whether the previous two colonoscopies affect the subsequent advanced neoplasias has not been established. Therefore, the subsequent risk based on the findings of the index and first surveillance colonoscopies were investigated. This retrospective, cohort study was conducted in two clinics and included participants who had undergone two or more colonoscopies after index colonoscopy. High-risk was defined as advanced adenoma (≥ 1 cm, or tubulovillous or villous histology, or high-grade dysplasia). Based on the findings of the index and first surveillance colonoscopies, patients were classified into four categories: category A (both colonoscopy findings were normal), category B (no high-risk findings both times), category C (one time high-risk finding), and category D (high-risk findings both times). The incidence of subsequent advanced neoplasia was examined in each category. A total of 13,426 subjects were included and surveyed during the study periods. The subjects in category D had the highest risk of advanced neoplasia (27.4%, n = 32/117). The subjects in category A had the lowest risk (4.0%, n = 225/5,583). The hazard ratio for advanced neoplasia of category D compared to category A was 9.90 (95% Confidence interval 6.82-14.35, P<0.001). Classification based on the findings of index and first surveillance colonoscopies more effectively stratifies the risk of subsequent advanced neoplasia, resulting in more proper allocation of colonoscopy resources after two consecutive colonoscopies

Additional Damping Effects of Damping Sheets Patch on a Cantilever Steel Plate

This study aims to apply the damping rubber sheet to vibration control of the member of a transmission tower. This Paper reports the basic damping properties of the rubber sheet patch which contributes to the vibration control　of a steel plate which vibrates in a low frequency range. Our experimental results indicated that the rubber sheet patch which is attached on the steel plate using only glue was not effective for vibration control. However it was　found that the rubber sheet which was attached on the plate using glue became very effective for low－frequency vibration by binding using other small steel plates. Finally, it was found that the damping rubber sheet has possibility to be useful as a damping device for the member vibration of a transmission tower

Isolation and spectral characterization of thermally generated multi-<i>Z</i>-isomers of lycopene and the theoretically preferred pathway to di-<i>Z</i>-isomers

<p>Lycopene has a large number of geometric isomers caused by <i>E</i>/<i>Z</i> isomerization at arbitrary sites within the 11 conjugated double bonds, offering varying characteristics related to features such as antioxidant capacity and bioavailability. However, the geometric structures of only a few lycopene <i>Z</i>-isomers have been thoroughly identified from natural sources. In this study, seven multi-<i>Z</i>-isomers of lycopene, (9<i>Z</i>,13′<i>Z</i>)-, (5<i>Z</i>,13<i>Z</i>,9′<i>Z</i>)-, (9<i>Z</i>,9′<i>Z</i>)-, (5<i>Z</i>,13′<i>Z</i>)-, (5<i>Z</i>,9′<i>Z</i>)-, (5<i>Z</i>,9<i>Z</i>,5′<i>Z</i>)-, and (5<i>Z</i>,9<i>Z</i>)-lycopene, were obtained from tomato samples by thermal isomerization, and then isolated by elaborate chromatography, and fully assigned using proton nuclear magnetic resonance. Moreover, the theoretically preferred pathway from (all-<i>E</i>)-lycopene to di-<i>Z</i>-isomers was examined with a computational approach using a Gaussian program. Fine-tuning of the HPLC separation conditions led to the discovery of novel multi-<i>Z</i>-isomers, and whose formation was supported by advanced theoretical calculations.</p> <p>Isolation and characterization of novel (multi-<i>Z</i>)-lycopene, and a possible potential energy diagram for the formation to the isomer.</p

A multicenter, randomized controlled trial comparing the identification rate of stigmata of recent hemorrhage and rebleeding rate between early and elective colonoscopy in outpatient-onset acute lower gastrointestinal bleeding: study protocol for a randomized controlled trial

Abstract Background The clinical benefit of early colonoscopy within 24 h of arrival in patients with severe acute lower gastrointestinal bleeding (ALGIB) remains controversial. This trial will compare early colonoscopy (performed within 24 h) versus elective colonoscopy (performed between 24 and 96 h) to examine the identification rate of stigmata of recent hemorrhage (SRH) in ALGIB patients. We hypothesize that, compared with elective colonoscopy, early colonoscopy increases the identification of SRH and subsequently improves clinical outcomes. Methods This trial is an investigator-initiated, multicenter, randomized, open-label, parallel-group trial examining the superiority of early colonoscopy over elective colonoscopy (standard therapy) in ALGIB patients. The primary outcome measure is the identification of SRH. Secondary outcomes include 30-day rebleeding, success of endoscopic treatment, need for additional endoscopic examination, need for interventional radiology, need for surgery, need for transfusion during hospitalization, length of stay, 30-day thrombotic events, 30-day mortality, preparation-related adverse events, and colonoscopy-related adverse events. The sample size will enable detection of a 9% SRH rate in elective colonoscopy patients and a SRH rate of ≥ 26% in early colonoscopy patients with a risk of type I error of 5% and a power of 80%. Discussion This trial will provide high-quality data on the benefits and risks of early colonoscopy in ALGIB patients. Trial registration UMIN-CTR Identifier, UMIN000021129. Registered on 21 February 2016; ClinicalTrials.gov Identifier, NCT03098173. Registered on 24 March 2017