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Abstract Introduction Painful idiopathic distal sensory polyneuropathy (IDSP) and fibromyalgia syndrome (FMS) are cryptogenic chronic pain syndromes. The contribution of small fibre pathology (SFP) in FMS remains controversial. This study aims to quantify small nerve pathology in participants with IDSP and FMS and identify relationships of SFP with sensory phenotypes. Methods In this study, 73 individuals (FMS: 25, IDSP: 23, healthy volunteers: 25) underwent comprehensive assessment, including neurological exams, questionnaires, sensory tests, and corneal confocal microscopy. Results IDSP participants displayed lower wind-up ratio (WUR) relative to FMS (p

Abstract A proportion of people with fibromyalgia demonstrate small fibre pathology (SFP). However, it is unclear how SFP directly relates to pain phenomenology. Thirty-three individuals with FMS and ten healthy volunteers underwent assessment of SFP and sensory phenotyping using corneal confocal microscopy, validated questionnaires and quantitative sensory testing (QST). Corneal nerve fibre length was used to stratify participants with fibromyalgia into with SFP [SFP+] and without SFP [SFP−]. SFP was detected in 50% of the fibromyalgia cohort. Current pain score and QST parameters did not differ between SFP+ and SFP−. Mechanical pain sensitivity (MPS) demonstrated a significant gain-of-function in the SFP− cohort compared to healthy-volunteers (p = 0.014, F = 4.806, η2 = 0.22). Further stratification revealed a cohort without structural SFP but with symptoms compatible with small fibre neuropathy symptoms and a significant gain in function in MPS (p = 0.020 Chi-square). Additionally, this cohort reported higher scores for both depression (p = 0.039, H = 8.483, η2 = 0.312) and anxiety (p = 0.022, F = 3.587, η2 = 0.293). This study confirms that SFP is present in a proportion of people with fibromyalgia. We also show that in a proportion of people with fibromyalgia, small fibre neuropathy symptoms are present in the absence of structural SFP. Greater mechanical pain sensitivity, depression and anxiety are seen in these individuals.

Abstract Emery–Dreifuss muscular dystrophy (EDMD), caused by mutations in genes encoding nuclear envelope proteins, is clinically characterized by muscular dystrophy, early joint contracture, and life-threatening cardiac abnormalities. To elucidate the pathophysiological mechanisms underlying striated muscle involvement in EDMD, we previously established a murine model with mutations in Emd and Lmna (Emd −/−/Lmna H222P/H222P; EH), and reported exacerbated skeletal muscle phenotypes and no notable cardiac phenotypes at 12 weeks of age. We predicted that lack of emerin in Lmna H222P/H222P mice causes an earlier onset and more pronounced cardiac dysfunction at later stages. In this study, cardiac abnormalities of EDMD mice were compared at 18 and 30 weeks of age. Contrary to our expectations, physiological and histological analyses indicated that emerin deficiency causes no prominent differences of cardiac involvement in Lmna H222P/H222P mice. These results suggest that emerin does not contribute to cardiomyopathy progression in Lmna H222P/H222P mice.

Abstract Background and Aim We aimed to evaluate endoscopic findings of Helicobacter pylori (H. pylori)‐positive children and young adults based on the Kyoto classification, and to examine if there are age‐associated changes in H. pylori‐positive gastritis. Methods H. pylori‐positive patients under 40 years old who underwent upper gastrointestinal endoscopy from 1 April 2009 to 15 February 2017 were included. Subjects were classified into the Pediatric (65% in patients over age 25. Conclusion H. pylori‐positive children had endoscopic findings besides nodularity based on the Kyoto classification. The prevalence of atrophy increased in patients over age 20.

Abstract Autonomous robots are expected to replace dangerous, dirty, and demanding (3D) jobs. At a theme park, surveillance, cleaning, and guiding tasks can be regarded as 3D jobs. The present paper attempts to develop an autonomous tour guide robot system and co-experience system at a large theme park. For realizing such autonomous service robots used in our daily environment, localization is one of the most important and fundamental functions. A number of localization techniques, including simultaneous localization and mapping, have been proposed. Although a global navigation satellite system (GNSS) is most commonly used in outdoor environments, its accuracy is approximately 10 m, which is inadequate for navigation of an autonomous service robot. Therefore, a GNSS is usually used together with other localization techniques, such as map matching or camera-based localization. In the present study, we adopt the quasi-zenith satellite system (QZSS), which became available in and around Japan in November 2018, for the localization of an autonomous service robot. The QZSS provides high-accuracy position information using quasi-zenith satellites (QZSs) and has a localization error of less than 10 centimeters. In the present paper, we compare the positioning performance of the QZSS and the real-time kinematic GPS and verify the stability and the accuracy of the QZSS in an outdoor environment. In addition, we introduce a tour guide robot system using the QZSS and present the results of a guided tour experiment in a theme park. On the other hand, based on the tour guide system, we also develop a co-experience robot system in a theme park, which realizes the sharing of experiences using an immersive VR display and the 5th-generation mobile communication system (5G). The robot is equipped with a 360-degree video camera and real-time 4K video is transmitted to a remote operator using the large communication capacity of the 5G network. The experimental results at a theme park showed that the guided tour experiment was successful and that the co-experience system allowed sharing of the experience with high immersion by a remote operator.

Abstract Background With more prevalent gastroesophageal reflux disease comes increased cases of Barrett's esophagus and esophageal adenocarcinoma. Image-enhanced endoscopy using linked-color imaging (LCI) differentiates between mucosal colors. We compared LCI, white light imaging (WLI), and blue LASER imaging (BLI) in diagnosing reflux esophagitis (RE). Methods Consecutive RE patients (modified Los Angeles [LA] classification system) who underwent esophagogastroduodenoscopy using WLI, LCI, and BLI between April 2017 and March 2019 were selected retrospectively. Ten endoscopists compared WLI with LCI or BLI using 142 images from 142 patients. Visibility changes were scored by endoscopists as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. For total scores, 40 points was considered improved visibility, 21–39 points was comparable to white light, and

Abstract Spatial change detection is a fundamental technique for finding the differences between two or more pieces of geometrical information. This technique is critical in some robotic applications, such as search and rescue, security, and surveillance. In these applications, it is desirable to find the differences quickly and robustly. The present paper proposes a fast and robust spatial change detection technique for a mobile robot using an on-board range sensors and a highly precise 3D map created by a 3D laser scanner. This technique first converts point clouds in a map and measured data to grid data (ND voxels) using normal distributions transform. The voxels in the map and the measured data are then compared according to the features of the ND voxels. Three techniques are introduced to make the proposed system robust for noise, that is, classification of point distribution, overlapping of voxels, and voting using consecutive sensing. The present paper shows the results of indoor and outdoor experiments using an RGB-D camera and an omni-directional laser scanner mounted on a mobile robot to confirm the performance of the proposed technique.

Abstract This paper proposes a navigation system of a personal mobility robot in informationally structured and unstructured environments. First, we introduce a group of robots named Portable Go, which are equipped with laser range finders, gyros, and omni-directional wheels. The Portable Go robots expand the informationally structured environment by deploying in the informationally unstructured environment in advance. Then, a personal mobility robot based on an electric wheelchair is guided by eleven Portable Go robots in the new informationally structured environment which is just created by the Portable Go robots. Through navigation experiments, we verify that the proposed system navigates the personal mobility robot from the informationally structured environment to the informationally unstructured environment smoothly by using the Portable Go robots.

The endoscopic features of gastric epithelial neoplasms of fundic gland mucosa lineage (GEN-FGML) have not been well investigated. We aimed to clarify the endoscopic features of GEN-FGML and differences between gastric adenocarcinoma of the fundic gland type (GA-FG) and fundic gland mucosa type (GA-FGM). A total of 62 GEN-FGML lesions, including 52 GA-FG and 10 GA-FGM, were retrospectively analyzed using endoscopic and clinicopathological findings to provide information of diagnostic value using white light imaging (WLI) and magnifying endoscopy with narrow-band imaging (M-NBI). GA-FG frequently presented with a whitish, submucosal tumor (SMT) shape with dilated vessels with branching architecture and background mucosa without atrophic change in WLI, an indistinct demarcation line (DL), dilatation of the crypt opening and intervening part (IP), and microvessels without distinct irregularity in M-NBI. GA-FGM frequently presented as a reddish, elevated lesion in WLI, with a distinct DL, dilatation of the IP, and an irregular microvascular pattern in M-NBI. As for an M-NBI diagnosis, five GA-FGM lesions met the diagnostic criteria for cancer, whereas none of the GA-FG lesions met the same criteria. We highlight the endoscopic features of GEN-FGML, and the differentiation between GA-FG and GA-FGM might be possible by combination of lesion color and morphology in WLI and M-NBI diagnoses.

Background: Patients taking low-dose aspirin have a higher incidence of gastroduodenal ulcers and higher risk of upper gastrointestinal bleeding than patients who do not. Thienopyridine antiplatelet agents may similarly cause bleeding gastroduodenal erosions and ulcers. The incidence of gastrointestinal bleeding is reported to be higher when these antithrombotic drugs are used in combination. Until now, most studies have focused on bleeding, and no study has compared the degree of gastric mucosal injury between patients receiving dual antiplatelet therapy (DAPT) and those receiving single antiplatelet therapy (SAPT) in real-world clinical practice. Aim: Our objective was to compare the degree of gastric mucosal injury in patients taking low-dose aspirin in combination with clopidogrel (one of the thienopyridine antiplatelet agents) with that of patients who were taking aspirin or clopidogrel as a single agent. Methods: Patients who were taking aspirin and/or clopidogrel and who underwent scheduled esophagogastroduodenoscopy between April 2015 and March 2020 were enrolled in this study. Endoscopic images were reviewed retrospectively, and the degree of gastric mucosal injury was assessed with the modified Lanza score (m-Lanza score). The m-Lanza score was compared between DAPT patients taking aspirin and clopidogrel and SAPT patients taking either aspirin alone or clopidogrel alone. Results: The m-Lanza scores of the DAPT group, the aspirin group, and the clopidogrel group were 1.67 ± 1.81 (mean ± standard deviation), 0.95 ± 1.61, and 0.72 ± 1.29, respectively. The m-Lanza score of the DAPT group tended to be higher than that of the aspirin group (p = 0.06) and was significantly higher than that of the clopidogrel group (p = 0.03). Conclusion: The degree of gastric mucosal injury in DAPT patients was significantly higher than that in patients using clopidogrel alone and tended to be higher than that in patients using aspirin alone in real-world clinical practice.

Background and Aim: Inhibition of gastric acid secretion is important for eradicating Helicobacter pylori . Vonoprazan (VPZ) is a strong, long-lasting inhibitor of gastric acid secretion. Studies that examined the effectiveness of VPZ-based triple therapy in second-line treatment have been performed. However, there have been no randomized controlled studies to compare the effect between VPZ-based triple therapy and proton pump inhibitor (PPI)-based triple therapy in second-line treatment, and it is not known which is more effective between VPZ-based and PPI-based therapies. This study aimed to compare the effectiveness of second-line triple therapies including VPZ or rabeprazole (RPZ) as the PPI. Methods: Eligible patients with H. pylori infection who failed first-line triple therapy were assigned randomly to the VPZ [VPZ40 mg/day, amoxicillin (AMPC) 1500 mg/day, metronidazole (MNZ) 500 mg/day] or RPZ (RPZ20 mg/day, AMPC1500 mg/day, MNZ500 mg/day) group. A 13 C-urea breath test result of less than 2.5% was considered as successful eradication. Results: In total, 46 and 41 patients were analyzed as intention to treat (ITT) and per protocol (PP), respectively. Eradication rates in the VPZ and RPZ groups were 73.9% [95% confidence interval (CI) 51.6–89.8%] and 82.6% (95% CI 61.2–95.0%) based on ITT analysis, respectively ( p = 0.72). Based on PP analysis, the eradication rates in the VPZ and RPZ groups were 89.5% (95% CI 66.9–98.7%) and 86.4% (95% CI 65.1–97.1%), respectively ( p = 1.00). Two patients in the VPZ group and one in the RPZ group discontinued treatment due to side effects ( p = 1.00). Conclusion: There were no significant differences in efficacy and safety between second-line therapies including VPZ or RPZ.

Background and study aims Magnifying endoscopy with narrow band imaging (M-NBI) has made a huge contribution to endoscopic diagnosis of early gastric cancer (EGC). However, we sometimes encountered false-negative cases with M-NBI diagnosis (i. e., M-NBI diagnostic limitation lesion: M-NBI-DLL). However, clinicopathological features of M-NBI-DLLs have not been well elucidated. We aimed to clarify the clinicopathological features and histological reasons of M-NBI-DLLs. Patients and methods In this single-center retrospective study, M-NBI-DLLs were extracted from 456 EGCs resected endoscopically at our hospital. We defined histological types of M-NBI-DLLs and analyzed clinicopathologically to clarify histological reasons of M-NBI-DLLs. Results Of 456 EGCs, 48 lesions (10.5 %) of M-NBI-DLLs were enrolled. M-NBI-DLLs was classified into four histological types as follows: gastric adenocarcinoma of fundic-gland type (GA-FG, n = 25), gastric adenocarcinoma of fundic-gland mucosal type (GA-FGM, n = 1), differentiated adenocarcinoma (n = 14), and undifferentiated adenocarcinoma (n = 8). Thirty-nine lesions of M-NBI-DLLs were H. pylori-negative gastric cancers (39/47, 82.9 %). Histological reasons for M-NBI-DLLs were as follows: 1) completely covered with non-neoplastic mucosa (25/25 GA-FG, 8/8 undifferentiated adenocarcinoma); 2) well-differentiated adenocarcinoma with low-grade atypia (1/1 GA-FGM, 14/14 differentiated adenocarcinoma); 3) similarity of surface structure (10/14 differentiated adenocarcinoma); and 4) partially covered and/or mixed with a non-neoplastic mucosa (1/1 GA-FGM, 6/14 differentiated adenocarcinoma). Conclusions Diagnostic limitations of M-NBI depend on four distinct histological characteristics. For accurate diagnosis of M-NBI-DLLs, it may be necessary to fully understand endoscopic features of these lesions using white light imaging and M-NBI based on these histological characteristics and to take a precise biopsy.

Abstract An informationally structured environment (ISE) is a key technology for realizing service robots in daily life in the near future. In ISE, the information of the service robot and its surroundings is structured and provided to the robot on time and on demand. We started the development of a management system for ISE named TMS (Town Management System) in Robot Town Project in 2005. Since then we are continuing our efforts for the improvement of the performance and the enhancement of the functions of TMS. In this paper, we propose the latest system of TMS named ROS-TMS 5.0, which adopts ROS to utilize high scalability and rich resources of ROS. Next, we introduce the hardware platform of ISE called Big Sensor Box which incorporates various sensors under ROS-TMS management and operates service robots based on structured information. Robot service experiments including watching service of a care receiver, voice control of a communication robot and a robotic bed, and ing information by voice are also conducted in Big Sensor Box.

This paper describes the novel on-machine measurement method of tool edge shape by using fluorescence emitted from cutting fluid. Tool wear and chipping are a major factor of decreasing machining accuracy. Therefore, on-machine measurement methods of tool edge shape with high accuracy are the subject of intensive study. Especially, considering the machining process, a robust measurement method with water-soluble cutting fluid is required for precise machining. For these reasons, the purpose of this research is to develop the technique that enables to measure tool edge shape precisely by using a confocal microscope. In order to achieve it, we have proposed the measurement method of tool edge shape by detecting fluorescence of cutting fluid adhering to the tool edge. Previous research has shown that it is possible to measure tool edge shape precisely by using oily cutting fluid. However, the applicability to water soluble cutting fluid is still remained. In particular, since water-soluble cutting fluid is used with dilution, it is worried that its fluorescence emission efficiency is lower than oily cutting fluid and the fluorescence detection is difficult. In this paper, it is shown that fluorescence could be detected from water-soluble cutting fluid. Then, the cutting tool edge shape adhering water-soluble cutting fluid is measured. These results show that the proposed method has high applicability to an on-machine measurement.

Background/Aims Vonoprazan is a new a potassium-competitive acid blocker (P-CAB) that was recently developed in Japan. However, vonoprazan’s efficacy in healing gastric ulcers after endoscopic submucosal dissection (ESD) remains controversial. This study aimed to compare the efficacy of P-CABs and proton pump inhibitors (PPIs) in healing post-ESD ulcers. Materials and Methods This prospective randomized controlled trial (UMIN000017386) enrolled 40 patients with gastric neoplasia, who underwent ESD at our hospital from April 2015 to January 2016. Before ESD, patients were randomly divided into the following two groups: group V, vonoprazan 20 mg/day; or group R, rabeprazole 10 mg/day. Medications were taken 1 day before to 4 weeks after ESD. The ESD-induced artificial ulcer size was measured just after ESD and 4 weeks after ESD to calculate the reduction rate as follows: (ulcer area 4 weeks after ESD)/(ulcer area just after ESD) × 100. Results Eighteen patients in group V and 15 patients in group R were analyzed. The mean reduction rate was significantly different in groups V and R (93.3% vs 96.6%, respectively). Post-ESD bleeding was observed in two patients in group R and drug-induced hepatic injury in one patient in group R. Conclusion Rabeprazole facilitated the healing process post-ESD.

Background. Endoscopic submucosal dissection (ESD) of esophageal tumors can cause stenosis, yet the effect of esophageal ESD on motility remains unclarified. This study aimed to compare esophageal motility and symptoms, before and after ESD, using high-resolution manometry (HRM) and symptom scoring. Methods. Twenty-eight patients with 35 cT1a cancers were prospectively enrolled between December 2014 and February 2016. Pre- and post-ESD symptom score and HRM were recorded. Based on circumferential resection (CR), patients were divided into group A (n=17,

Background. Previous assessments of technical difficulty and procedure time for endoscopic submucosal dissection (ESD) of gastric neoplasms did not take into account several critical determinants of these parameters. However, two key phases of ESD determine the total procedure time: the mucosal circumference incision speed (CIS) and submucosal dissection speed (SDS). Methods. We included 302 cases of en bloc and R0 resection of gastric neoplasms performed by 10 operators who had completed the training program at our hospital. Twelve locations were classified based on multiple criteria, such as condition of surrounding mucosa, lesion vascularity, presence of submucosal fat, ulcers, scars, fibrosis, and scope and device maneuverability. Lesions in different locations were classified into three groups based on the length of the procedure: fast, moderate, or late. Results. A significant difference was found in CIS and SDS for each location (p

Background/Aims. This study aimed to establish optimal propofol anesthesia for therapeutic endoscopy, which has not been established. Methodology. We retrospectively investigated data on 89 patients who underwent upper-GI endoscopic submucosal dissection or endoscopic mucosal resection under anesthesia with propofol. Examined doses of propofol were changed according to efficacy and/or adverse events and classified into 5 periods. A bispectral index (BIS) monitor was used at Period 5 to decrease the incidence of adverse events caused by oversedation. The initial dose of propofol was administered after bolus injection of pethidine hydrochloride (0.5 mg/kg), and 1.0 mL of propofol was added every minute until the patients fell asleep. Continuous and bolus infusion were performed to maintain sedation. When the patient moved or an adverse event occurred, the maintenance dose examined was increased or decreased by 5 mL/h regardless of body weight. Results. Dose combinations (introduction : maintenance) and patient numbers for each period were as follows: Period 1 (n=27), 0.5 mg/kg : 5 mg/kg/h; Period 2 (n=11), 0.33 mg/kg : 3.3 mg/kg/h; Period 3 (n=7), 0.5 mg/kg : 3.3 mg/kg/h; Period 4 (n=14), 0.5 mg/kg : 2.5 mg/kg/h; Period 5 (n=30), 0.5 mg/kg : 2.5 mg/kg/h, using BIS monitor. During Period 5, an adverse event occurred in 10.0% of patients, which was lower than that for Periods 1–4. Conclusions. Period 5 propofol anesthesia with BIS protocol could be safe and useful for therapeutic endoscopy under deep sedation with spontaneous respiration.

Inside of fuel cells, heat exchanger, chemical reactors, and other industrial devices, the fluid flow comes into the inlet chamber and streams into many branch passages. A uniform flow distribution requirement is a common issue in those devices. In this study, the flow rate in branch channels and the pressure loss of multiple passage are investigated experimentally. As the first step, four kinds of multiple-passage channels are investigated from the view point of flow uniformity and pressure loss. Experiments are performed for the Reynolds number based on the bulk velocity and channel width at the main channel from 6.0×102 to 2.0×103. The wall static pressure is measured, and the pressure loss and flow rate are evaluated. It becomes clear that the characteristic of a reverse flow passage has the highest performance for the flow rate distribution. In the second step, the dielectric barrier discharge plasma actuator (DBD-PA) is used for the reverse flow passage. The wave form with voltage of 5 kV and frequency of 2.5 kHz is applied to the electrode of actuator, and the position in which the actuator is installed is changed in four positions of the outside wall at inlet manifold. The velocity profiles are measured by a PIV system to clarify change of the velocity field with and without PA actuation. The results show that the pressure loss decreases and the flow rate in each branch passage improves by the effect of induced flow with PA. The effect becomes remarkable when PA is installed near the first branch channel. The flow uniformity and low pressure loss are related to the reduction of the recirculation region which exists at the inlet manifold.