Endoscopic Submucosal Dissection in the Era of Proton Pump Inhibitors

Endoscopic submucosal dissection (ESD) has the advantage over endoscopic mucosa resection, permitting removal of gastrointestinal neoplasms en bloc, but is associated with relatively high risk of complications. Indications for early gastric cancer (EGC) are expanded: mucosal cancer without ulcer findings irrespective of tumor size; mucosal cancer with ulcer findings ≤3 cm in diameter; and minute submucosal invasive cancer ≤3 cm in size. The indications for early esophageal cancer (EEC) are the tumors confined to the two-third layer of the lamina propria. The EEC lesions spreading more than three-quarter of circumference of the esophagus are at frequent risk of stenosis. The procedures include marking, submucosal injection, circumferential mucosal incision and exforiation of the lesion along the submucosal layer. Complete ESD can achieve a large one-piece resection, allowing precise histological assessment to prevent recurrence. Clinical outcomes of gastric and esophageal ESD have been promising, and the prognosis of EGC patients treated by ESD is likely to be excellent, though further longer follow-up studies are warranted. Notification of perforation risk is essential in particular for esophageal ESD. Bleeding during ESD can be managed with coagulation forceps, and postoperative bleeding may be reduced with routine use of the stronger acid suppressant, proton pump inhibitors

Dynamic Mechanical Properties of Oxide Films Formed on Metallic Surfaces as Measured Using a Tribological Approach at High Temperature

The surface degradation of metals in boiler tubes and turbines in high-temperature corrosive environments causes severe problems in fuel combustion power plant systems. High-temperature resistant materials have been recently developed using a thermal barrier coating (TBC) and high-chromium alloys. Oxide films or coatings formed on metal surfaces at high temperatures can sometimes decrease the corrosion rate. However, the damage to the material is often accelerated by the mechanical removal of corrosion products from the material surface. It is therefore very important to investigate the mechanical and adhesive properties of the oxide films or coatings on metal surfaces used in high-temperature environments. This paper introduces a tribological method that uses a single spherical projectile impact at high temperature to measure the mechanical and adhesive properties of oxide films formed on various metal surfaces. Impact tests were performed on the surfaces of oxide films after their growth in a high-temperature furnace, and the deformed or fractured surfaces were observed in order to measure the mechanical and adhesive properties. The mechanical and adhesive properties of an elastic modulus, fracture, and exfoliation stresses were measured using the impact method, and the results depended on the type of metal oxide films and on the high-temperature environment

Infective Endocarditis-Associated Glomerulonephritis: A Comprehensive Review of the Clinical Presentation, Histopathology, and Management

A significant proportion of patients with infective endocarditis presents with acute renal failure related to infective endocarditis-associated glomerulonephritis (IEAGN). However, the clinical presentation of IEAGN differs from that of other infection-related glomerulonephritis (IRGN) with anti-neutrophil cytoplasmic antibody (ANCA) positivity occurring in almost onethird of cases; therefore, it may be difficult to establish a definitive diagnosis and provide appropriate treatment. This review article provides a comprehensive understanding of the clinical presentation, investigations, histopathology, and treatment/management of IEAGN so that clinicians can keep this differential in mind for patients with fever of unknown origin accompanied by signs and symptoms of acute renal failure

Successful Resolution of Fecal Impaction During Endoscopy Using a Looped Guidewire

Fecal impaction is the impaired excretion of a large fecal mass, and mild cases are treated by enema and osmotic laxatives. However, treatment-resistant cases need more invasive alternatives. A woman in her 60s presented with abdominal discomfort. Her abdomen was soft and without tenderness. Computed tomography revealed a large mass of feces in her sigmoid colon and no intestinal dilatation proximal to the mass. Endoscopy confirmed a fecal mass occupying the lumen. A glycerin enema, oral administration of polyethylene glycol, and enteral administration of amidotrizoic acid during colonoscopy were ineffective. We maneuvered a guidewire to form a loop at the tip of an endoscope, with which we subdivided the mass for successful removal. The patient’s abdominal discomfort disappeared immediately. Endoscopic disimpaction is far less invasive than surgery and should be considered when treating fecal impaction cases, without severe obstructive colitis, which are nonresponsive to conservative treatment

Improvement of the Decision-Making Ability by Matrix Bookkeeping: Focusing on Coefficients used in Input-Output Analysis <Notes>

行列簿記はレオンチェフの産業連関表に着想をえて1957年にマテシッチが考案したものとされているが世間一般で広く知られているとはいいがたい。行列簿記の発展性を研究していくうえで，その出自に立ち戻って研究することは重要である。そこで，広島県の産業連関表に使用されている係数が行列簿記にどのように転用されているのかを論じるとともに，行列簿記の中小企業等での実務適用可能性を論じるものである。また中小企業等での経営判断を念頭におき，収益構造概略図についても論究した。本稿で展開する手法とその成果の一部は，いわばミクロレベルでの議論である行列簿記を産業連関表というマクロレベルの問題に対して発展的に適用できる可能性を模索し，その汎用性と応用可能性についての議論を深め，その経済社会的な有用性の端緒になることを意図しているものである。そうした意味において，行列簿記には，会計情報や会計システムにおける「連結環」としての意義と機能が内包されているのである

行列簿記の現代的意義とその展開可能性 : 歴史的経緯と構造の視点から <平成28年度博士論文要旨>

広島大学大学院社会科学研究科マネジメント専攻 平成28年度博士論文要旨〈学会員の論文要旨のみ掲載

行列簿記の現代的意義とその展開可能性 : 歴史的経緯と構造の視点から

広島大学(Hiroshima University)博士(マネジメント)Doctor of Philosophydoctora

3次元再構成を用いた非骨性距踵骨癒合症の形態学的分析

Background: Resection of talocalcaneal coalitions has generally involved osseous coalitions. We attempted to evaluate the morphology of nonosseous talocalcaneal coalitions. This study aimed to investigate if the calcaneal articular surface area of feet with talocalcaneal coalitions is different than that of normal feet. Methods: Twenty nonosseous talocalcaneal coalition cases with analyzable computed tomography (CT) scans were compared to 20 control cases. Three-dimensional models of the talus and calcaneus were constructed, and the surface areas of the posterior facet (SPF), whole talocalcaneal joint of the calcaneus (SWJ), and coalition site (SCS) of each 3D-CT model were measured. "Calibrated" values of the 2 groups were created to adjust for relative size of the tali and then compared. The preoperative and postoperative AOFAS Ankle-Hindfoot scale was calculated for 9 cases that had undergone single coalition resection. Results: The calibrated SPF and SWJ were significantly greater in the coalition group than in the control group (40% and 12%, respectively). No significant difference was detected between the calibrated (SWJ - SCS) value of the coalition group and the calibrated SWJ value of the control group. The AOFAS scale was improved postoperatively in all 9 cases analyzed. Conclusion: The calcaneal articular surface of nonosseous talocalcaneal coalition feet in our series was larger than that of the normal feet. This study indicates that the total calcaneal articular surface after coalition resection may be comparable to the calcaneal articular surface of normal feet. We suggest that the indication for coalition resection be reconsidered for nonosseous coalition. Level of evidence: Level III, retrospective comparative study.博士（医学）・甲第815号・令和4年3月15日© The Author(s) 2021. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/ open-access-at-sage)

Identification of a Novel Deactivating Small-Molecule Compound for Fibrogenic Hepatic Stellate Cells

Background: Liver fibrosis progresses to decompensated liver cirrhosis, for which medical needs remain unmet. We recently developed IC-2, a small-molecule compound that suppresses Wnt/β-catenin signaling, and found that IC-2 also suppresses liver fibrosis. In this study, we performed three-step screening of newly synthesized IC-2 derivatives to identify other small-molecule compounds that suppress liver fibrosis. Methods: The screening system consisted of three steps: a cell viability assay, a transcription factor 4 (TCF4) reporter assay, and induction of α-smooth muscle actin (α-SMA) and collagen 1α1 (Col1A1) expression in response to each compound. Screening using human LX-2 hepatic stellate cells (HSCs) was performed to target HSCs, which are the driver cells of liver fibrosis. Results: In the first step, since 9b and 9b-CONH2 at 100 μM did not have any effects on cell viability, they were omitted in the next screening. Additionally, the conditions that led to > 40% inhibition of the controls were also excluded in subsequent screening. The second step was performed under 31 conditions for 19 small-molecule compounds. Sixteen small-molecule compounds caused significant reduction of TCF4 activity relative to that of 0.1% DMSO. Of the 16 compounds, the 10 showing the greatest suppression of TCF4 activity were selected for the third step. Expressions of mRNA for α-SMA and Col1A1 were significantly reduced by seven and three small-molecule compounds, respectively. The greatest reductions in the α-SMA and Col1A1 mRNA expressions were observed in the cells treated with IC-2-F. Protein expressions of α-SMA and Col1A1 caused by IC-2-F were also comparable to those caused by IC-2. Conclusion: IC-2-F was identified as a novel deactivating small-molecule compound for HSCs in vitro. These data suggest that IC-2-F is a promising medicine for liver fibrosis