AIM:To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy. METHODS:We conducted a randomized,double-blind, placebo-controlled study with mosapride in addition to ...AIM:To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy. METHODS:We conducted a randomized,double-blind, placebo-controlled study with mosapride in addition to polyethylene glycol(PEG)-electrolyte solution.Of 250 patients undergoing colonoscopy,124 were randomized to receive 2 L PEG plus 15 mg of mosapride citrate (mosapride group),and 126 received 2 L PEG plus placebo(placebo group).Patients completed a questionnaire reporting the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed by colonoscopists using a 5-point scale based on Aronchick's criteria.The primary end point was optimal bowel preparation rates(scores of excellent/good/fair vs poor/inadequate). RESULTS:A total of 249 patients were included in the analysis.In the mosapride group,optimal bowel preparation rates were significantly higher in the left colon compared with the placebo group(78.2%vs 65.6%,P<0.05),but not in the right colon(76.5%vs 66.4%,P=0.08).After excluding patients with severe constipation,there was a significant difference in bowel preparation in both the left and right colon(82.4%vs 66.7%,80.8%vs 67.5%,P<0.05,P<0.01).The incidence of adverse events was similar in both groups. Among the subgroup who had previous colonoscopy experience,a significantly higher number of patients in the mosapride group felt that the current preparation was easier compared with patients in the placebo group(34/72 patients vs 24/74 patients,P<0.05). CONCLUSION:Mosapride citrate may be an effective and safe adjunct to PEG-electrolyte solution that leads to improved quality of bowel preparation,especially in patients without severe constipation.展开更多
The use of machine learning in computational molecular design has great potential to accelerate the discovery of innovative materials.However,its practical benefits still remain unproven in real-world applications,par...The use of machine learning in computational molecular design has great potential to accelerate the discovery of innovative materials.However,its practical benefits still remain unproven in real-world applications,particularly in polymer science.We demonstrate the successful discovery of new polymers with high thermal conductivity,inspired by machine-learning-assisted polymer chemistry.This discovery was made by the interplay between machine intelligence trained on a substantially limited amount of polymeric properties data,expertise from laboratory synthesis and advanced technologies for thermophysical property measurements.Using a molecular design algorithm trained to recognize quantitative structure—property relationships with respect to thermal conductivity and other targeted polymeric properties,we identified thousands of promising hypothetical polymers.From these candidates,three were selected for monomer synthesis and polymerization because of their synthetic accessibility and their potential for ease of processing in further applications.The synthesized polymers reached thermal conductivities of 0.18–0.41 W/mK,which are comparable to those of state-of-the-art polymers in non-composite thermo-plastics.展开更多
AIM： To study the mechanisms of hyporesponsiveness of HBV-specific CD4^＋ T cells by testing TH1 and TH2 commitment and regulatory T cells. METHODS： Nine patients with chronic hepatitis B were enrolled. Peripheral b...AIM： To study the mechanisms of hyporesponsiveness of HBV-specific CD4^＋ T cells by testing TH1 and TH2 commitment and regulatory T cells. METHODS： Nine patients with chronic hepatitis B were enrolled. Peripheral blood mononuclear cells were stimulated with HBcAg or HBsAg to evaluate their potential to commit to TH1 and TH2 differentiation. HBcAg-specific activity of regulatory T cells was evaluated by staining with antibodies to CD4, CD25, CTLA-4 and interleukin-10. The role of regulatory T cells was further assessed by treatment with anti-interleukin-10 antibody and depletion of CD4^＋CD25^＋ cells. RESULTS： Level of mRNAs for T-bet, IL-12R β2 and IL-4 was significantly lower in the patients than in healthy subjects with HBcAg stimulation. Although populations of CD4^＋CD25^highCTLA-4^＋ T cells were not different between the patients and healthy subjects, IL-10 secreting cells were found in CD4^＋ cells and CD4^＋CD25^＋ cells in the patients in response to HBcAg, and they were not found in cells which were stimulated with HBsAg. Addition of anti-IL-10 antibody recovered the amount of HBcAgspecific TH1 antibody compared with control antibody （P 〈 0.01, 0.34% ± 0.12% vs 0.15% ± 0.04%）. Deletion of CD4^＋CD25^＋ T cells increased the amount of HBcAgspecific TH1 antibody when compared with lymphoo/tes reconstituted using regulatory T cells （P 〈 0.01, 0.03% ± 0.02% vs 0.18% ± 0.05%）.CONCLUSION： The results indicate that the mechanism of T cell hyporesponsiveness to HBcAg includes activation of HBcAg-induced regulatory T cells in contrast to an increase in TH2-committed cells in response to HBsAg.展开更多
AIM: To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study. METHODS: We investigated the clinical outcomes and risk factors for ...AIM: To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study. METHODS: We investigated the clinical outcomes and risk factors for the development of perforation in 98 consecutive gastric neoplasms undergoing ESD regarding. Demographic and clinical parameters including patient-, tumor-, and treatment-related factors, clinical parameters, and duration of hospital stay were analyzed for risk factors for perforation. In subgroup analysis, we also compared the clinical outcomes between perforation and "silent" free air without endoscopically visible perforation detected only by computed tomography.RESULTS: Perforation was identified in 8.2% of patients. All patients were managed conservatively by the administration of antibiotics. The mean procedure time was significantly longer in patients with endoscopic perforation than in those without. According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for perforation was 115 min (87.5% sensitivity, 56.7% specificity). Prolonged procedure time (≥ 115 min) was associated with an increased risk of perforation (odds ratio 9.15; 95%CI: 1.08-77.54; P = 0.04). Following ESD, body temperature and C-reactive protein level were significantly higher in patients with perforation than in those without (P = 0.02), whereas there was no difference between these patient groups on the starting day of oral intake or of hospitalization. In subgroup analysis, the post-ESD clinical course was not different between endoscopic perforation and silent free air. CONCLUSION: Only prolonged procedure time (≥ 115 min) was significantly associated with perforation. The clinical outcomes of perforation are favorable and are comparable to those of patients with or without silent free air.展开更多
Sonazoid(Daiichi Sankyo,Tokyo,Japan),a secondgeneration of a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent,has been used clinically in patients with liver tumors and for harmonic gray...Sonazoid(Daiichi Sankyo,Tokyo,Japan),a secondgeneration of a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent,has been used clinically in patients with liver tumors and for harmonic gray-scale ultrasonography(US)in Japan since January 2007.Sonazoid-enhanced US has two phases of contrast enhancement:vascular and late.In the late phase of Sonazoid-enhanced US,we scanned the whole liver using this modality at a low mechanical index(MI)without destroying the microbubbles, and this method allows detection of small viable hepatocellular carcinoma(HCC)lesions which cannot be detected by conventional US as perfusion defects in the late phase.Re-injection of Sonazoid into an HCC lesion which previously showed a perfusion defect in the late phase is useful for confirming blood flow intothe defects.High MI intermittent imaging at 2 frames per second in the late phase is also helpful in differentiation between necrosis and viable hypervascular HCC lesions.Sonazoid-enhanced US by the coded harmonic angio mode at a high MI not only allows clear observation of tumor vessels and tumor enhancement, but also permits automatic scanning with Sonazoidenhanced three dimensional(3D)US.Fusion images combining US with contrast-enhanced CT or contrastenhanced MRI have made it easy to detect typical or atypical HCC lesions.By these methods,Sonazoidenhanced US can characterize liver tumors,grade HCC lesions histologically,recognize HCC dedifferentiation, evaluate the efficacy of ablation therapy or transcatheter arterial embolization,and guide ablation therapy for unresectable HCC.This article reviews the current developments and applications of Sonazoid-enhanced US and Sonazoid-enhanced 3D US for diagnosing and treating hepatic lesions,especially HCC.展开更多
In addition to surgical procedures, radiofrequency ablation is commonly used for the treatment of hepatocellular carcinomas(HCCs) of limited size and number. Transcatheter arterial chemoembolization(TACE), using iodiz...In addition to surgical procedures, radiofrequency ablation is commonly used for the treatment of hepatocellular carcinomas(HCCs) of limited size and number. Transcatheter arterial chemoembolization(TACE), using iodized poppy seed oil, Lipiodol and anticancer drugs, has been actively performed for the treatment of unresectable HCC, particularly in Asian countries. Recently, Sorafenib become available for advanced HCCs when the liver is still sufficiently functional. Sorafenib is an oral multikinase inhibitor with antiproliferative and antiangiogenic effects. However, the effect of sorafenib seems to be inadequate to control the progression of HCC. Radiation therapy(RT)for HCC has a potential role across all stages of HCC. However, RT is generally not considered an option in HCC consensus documents or national guidelines, primarily because of insufficient supporting evidence. However, the method of RT has much improved because of advances in technology. Moreover, combined treatment of RT plus other treatments(TACE, sorafenib and chemotherapy etc.) has become one of the alternative therapies for HCC. Therefore, we should understand the various kinds of RT available for HCC. In this review, we focus on various kinds of external beam radiation therapy.展开更多
AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical practice.METHODS: A systematic review was performed using MEDLINE,EMBASE,Cochrane,L...AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical practice.METHODS: A systematic review was performed using MEDLINE,EMBASE,Cochrane,LILACS,Scopus and CINAHL databases. Information of the selected studies was extracted on characteristics of trial participants,inclusion and exclusion criteria,interventions(mainly,mucosal resection and submucosal dissection vs surgical approach) and outcomes(adverse events,different survival rates,mortality,recurrence and complete resection rates). To ascertain the validity of eligible studies,the risk of bias was measured using the Newcastle-Ottawa Quality Assessment Scale. The analysis of the absolute risk of the outcomes was performed using the software Rev Man,by computingrisk differences(RD) of dichotomous variables. Data on RD and 95%CIs for each outcome were calculated using the Mantel-Haenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%,a subsequent assay was done and other findings were compiled.RESULTS: Eleven retrospective cohort studies were selected. The included records involved 2654 patients with early gastric cancer that filled the absolute or expanded indications for endoscopic resection. Threeyear survival data were available for six studies(n = 1197). There were no risk differences(RD) after endoscopic and surgical treatment(RD = 0.01,95%CI:-0.02-0.05,P = 0.51). Five-year survival data(n = 2310) showed no difference between the two groups(RD = 0.01,95%CI:-0.01-0.03,P = 0.46). Recurrence data were analized in five studies(1331 patients) and there was no difference between the approaches(RD = 0.01,95%CI:-0.00-0.02,P = 0.09). Adverse event data were identified in eight studies(n = 2439). A significant difference was detected(RD =-0.08,95%CI:-0.10--0.05,P < 0.05),demonstrating better results with endoscopy. Mortality data were obtained in four studies(n = 1107). There was 展开更多
AIM: To differentiate focal liver lesions based on enhancement patterns using three-dimensional ultrasonography (3D US) with perflubutane-based contrast agent.METHODS: Two hundred and eighty two patients with focal li...AIM: To differentiate focal liver lesions based on enhancement patterns using three-dimensional ultrasonography (3D US) with perflubutane-based contrast agent.METHODS: Two hundred and eighty two patients with focal liver lesions,including 168 hepatocellular carcinomas (HCCs),63 metastases,40 hemangiomas and 11 focal nodular hyperplasias (FNHs),were examined by 3D US with perflubutane-based contrast agent.Tomographic ultrasound images and sonographic angiograms were reconstructed.Among 282 lesions,enhancement patterns of 163 lesions between January 2007 and October 2007 were analyzed retrospectively.Then from November 2007 to May 2008,compared with contrast-enhanced (CE) 2D US,CE 3D US was performed on 119 lesions for prospective differential diagnosis.Sensitivity,specificity,area under receiver operating characteristic curve (Az) and inter-reader agreement were assessed.RESULTS: With the tridimensional view,dominant enhancement patterns were revealed as diffuse enhancement or peripheral ring-like enhancement,followed with washout change for HCCs or metastases,respectively,and peripheral nodular enhancement or diffuse enhancement with spoke-wheel arteries,followed by persistent enhancement for hemangiomas or FNHs,respectively.At CE 3D US,the prospective differentiation of lesions showed sensitivity 92% (mean for two readers),specificity 91% and Az value 0.95 for HCCs,84%,97%,and 0.95 for metastases,91%,98%,and 0.98 for hemangiomas and 80%,99%,and 0.99 for FNHs,respectively,while good to excellent inter-reader agreement was achieved.No significant difference exists between prospective diagnosis accuracy at CE 3D US and that at CE 2D US.CONCLUSION: CE 3D US provides a spatial perspective for liver tumor enhancement,and could help in differentiating focal liver lesions.展开更多
Water-rock interaction and groundwater mixing are important phenomena in understanding hydrogeological systems and the stability of rock slopes especially those consisting largely of moderately watersoluble minerals l...Water-rock interaction and groundwater mixing are important phenomena in understanding hydrogeological systems and the stability of rock slopes especially those consisting largely of moderately watersoluble minerals like calcite. In this study, the hydrogeological and geochemical evolutions of groundwater in a limestone quarry composed of three strata: limestone layer(covering), interbedded layer under the covering layer, and slaty greenstone layer(basement) were investigated. Water-rock interaction in the open-pit limestone quarry was evaluated using PHREEQC, while hierarchical cluster analysis(HCA)and principal component analysis(PCA) were used to classify and identify water sources responsible for possible groundwater mixing within rock layers. In addition, Geochemist's Workbench was applied to estimate the mixing fractions to clarify sensitive zones that may affect rock slope stability. The results showed that the changes in Ca2+and HCO3àconcentrations of several groundwater samples along the interbedded layer could be attributed to mixing groundwater from the limestone layer and that from slaty greenstone layer. Based on the HCA and PCA results, groundwaters were classified into several types depending on their origin:(1) groundwater from the limestone layer(LO),(2) mixed groundwater flowing along the interbedded layer(e.g., groundwater samples L-7, L-11, S-3 and S-4), and(3) groundwater originating from the slaty greenstone layer(SO). The mixing fractions of 41% LO: 59% SO, 64% LO: 36% SO, 43%LO: 57% SOand 25% LO: 75% SOon the normal days corresponded to groundwaters L-7, L-11, S-3 and S-4,respectively, while the mixing fractions of groundwaters L-7 and L-11(61% LO: 39% SOand 93% LO: 7% SO,respectively) on rainy days became the majority of groundwater originating from the limestone layer.These indicate that groundwater along the interbedded layer significantly affected the stability of rock slopes by enlarging multi-breaking zones in the layer through calcite dissolution and inducing high water pressure, t展开更多
The outdoor thermal environment might become worse than at present. It causes health injuries through the deterioration of the outdoor thermal condition. It is necessary to study how humans stay outdoors and adjust to...The outdoor thermal environment might become worse than at present. It causes health injuries through the deterioration of the outdoor thermal condition. It is necessary to study how humans stay outdoors and adjust to thermal conditions. The purpose of this study was to clarify the influence of the outdoor tropical urban thermal environment on a subject who has been acclimatized to the environment studied using the outdoor thermal environment evaluation index ETFe. In addition, the tendency of human impacts was clarified through comparison to subjects from a temperate thermal environment region. As a result, it was found that an ETFe of up to 35°C could be recognized as a temperate thermal environment. However, when the ETFe was greater than 40°C, the subject could not tolerate the environment. There was not a significant difference of psychological reaction between Thai people, who were acclimatized to the tropical climate, and Japanese people, who were acclimatized to the temperate climate.展开更多
Cell division and differentiation of stem cells are controlled by non- cell-autonomous signals in higher organisms. The plant vascular meristem is a stem-cell tissue comprising procambial cells that produce xylem cell...Cell division and differentiation of stem cells are controlled by non- cell-autonomous signals in higher organisms. The plant vascular meristem is a stem-cell tissue comprising procambial cells that produce xylem cells on one side and phloem cells on the other side. Recent studies have revealed that TDIF （tracheary element differentiation inhibitory factor）/CLE41/CLE44 peptide signal controls the procambial cell fate in a non-cell-autonomous manner. TDIF produced in and secreted from phloem cells is perceived by TDR/PXY, a leucine-rich repeat receptor kinase located in the plasma membrane of procambial cells. This signal suppresses xylem cell differentiation of procambial cells and promotes their proliferation. In addition to TDIF, some other CLE peptides play roles in vascular development. Here, we summarize recent advances in CLE signaling governing vascular development.展开更多
AIM To clarify the diagnostic efficacy and limitations of endoscopic ultrasonography(EUS) and the characteristics of early gastric cancers(EGCs) that are indications for EUS-based assessment of cancer invasion depth.M...AIM To clarify the diagnostic efficacy and limitations of endoscopic ultrasonography(EUS) and the characteristics of early gastric cancers(EGCs) that are indications for EUS-based assessment of cancer invasion depth.METHODS We retrospectively investigated the cases of 153 EGC patients who underwent conventional endoscopy(CE) and EUS(20 MHz) before treatment.RESULTS We found that 13.7% were "inconclusive" cases with low-quality EUS images, including all nine of the cases with protruded(0-I)-type EGCs. There was no significant difference in the diagnostic accuracybetween CE and EUS. Two significant independent risk factors for misdiagnosis by EUS were identified-ulcer scarring [UL(+); odds ratio(OR) = 4.49, P = 0.003] and non-indication criteria for endoscopic resection(ER)(OR = 3.02, P = 0.03). In the subgroup analysis, 23.1% of the differentiated-type cancers exhibiting SM massive invasion(SM2) invasion(submucosal invasion ≥ 500 μm) by CE were correctly diagnosed by EUS, and 23.1% of the undifferentiated-type EGCs meeting the expanded-indication criteria for ER were correctly diagnosed by EUS.CONCLUSION There is no need to perform EUS for UL(+) EGCs or 0-I-type EGCs, but EUS may enhance the pretreatment staging of differentiated-type EGCs with SM2 invasion without UL or undifferentiated-type EGCs revealed by CE as meeting the expanded-indication criteria for ER.展开更多
AIM: To investigate the clinical efficacy of leukocytapheresis (LCAP) in patients with active ulcerative colitis (UC), and to elucidate the mechanisms by determining the changes in the cytokine levels in the periphera...AIM: To investigate the clinical efficacy of leukocytapheresis (LCAP) in patients with active ulcerative colitis (UC), and to elucidate the mechanisms by determining the changes in the cytokine levels in the peripheral blood and of the functions of the peripheral blood leukocytes in these patients. METHODS: The subjects were 19 patients with active UC, with a mean clinical activity index (CAI) of 9.2. The LCAP was conducted using Cellsorba E. In each session of LCAP, 2-3 L of blood at the flow rate of 30-50 mL/min was processed. The treatment was carried out in approximately 1-h sessions, once a week, for 5-10 wk. Blood samples for determination of the cytokine levels were collected from the inflow side of the column (site of dehematization; at the start of LCAP) and outflow side of the column (at the end of LCAP). Blood samples for the determination of reactive-oxygen-producing cells were collected from the peripheral blood before and after LCAP. RESULTS: LCAP resulted in clinical improvement in all the 19 patients of UC recruited for this study. Remission (CAI: ≤4) was noted in 15 (79%) of the 19 patients. The blood level of the pro-inflammatory cytokine IL-6 was found to be decreased following treatment by LCAP, and the level of the anti-inflammatory cytokine IL-10 at the outflow side of the LCAP column was found to be significantly elevated as compared to that at the inflow side of the column. The reactive-oxygen-producing granulocytes in the peripheral blood of UC patients was increased as compared to that in healthy persons and the increase was found to be decreased following treatment by LCAP. CONCLUSION: LCAP exerted a high therapeutic efficacy in patients with active UC. Our findings suggest that LCAP is associated with enhanced production of the inhibitory cytokine IL-10 to indirectly inhibit the functions of the inflammatory leukocytes, and that inflammation is also considerably attenuated by the direct removal of reactive-oxygen-producing neutrophils from the peripheral blood.展开更多
High-resolution modeling approach is increasingly being considered as a necessary step for improving the monitoring and predictions of regional air quality. This is especially true for highly urbanized region with com...High-resolution modeling approach is increasingly being considered as a necessary step for improving the monitoring and predictions of regional air quality. This is especially true for highly urbanized region with complex terrain and land-use. This study uses Community Multiscale Air Quality （CMAQ） model coupled with MM5 mesoscale model for a comprehensive analysis to assess the suitability of such high-resolution modeling system in predicting ozone air quality in the complex terrains of Osaka, Japan. The 1-km and 3-kin grid domains were nested inside a 9-km domain and the domain with 1-km grid covered the Osaka region. High-resolution Grid Point Value-Mesoscale Model （GPV-MSM） data were used after suitable validation. The simulated ozone concentrations were validated and evaluated using statistical metrics using performance criteria set for ozone. Daily maxima of ozone were found better simulated by the 1-krn grid domain than the coarser 9-km and 3-km domains, with the maximum improvement in the mean absolute gross error about 3 ppbv. In addition, 1-km grid results fared better than other grids at most of the observation stations that showed noticeable differences in gross error as well as correlation. These results amply justify the use of the integrated high-resolution MM5-CMAQ modeling system in the highly urbanized region, such as the Osaka region, which has complex terrain and land-use.展开更多
AIM To evaluate the effectiveness of oral esomeprazole(EPZ) vs injectable omeprazole(OPZ) therapy to prevent hemorrhage after endoscopic submucosal dissection(ESD).METHODS A case-control study was conducted using a qu...AIM To evaluate the effectiveness of oral esomeprazole(EPZ) vs injectable omeprazole(OPZ) therapy to prevent hemorrhage after endoscopic submucosal dissection(ESD).METHODS A case-control study was conducted using a quasirandomized analysis with propensity score matching. A total of 258 patients were enrolled in this study. Patients were treated with either oral EPZ or injectable OPZ. The endpoint was the incidence of hemorrhage after ESD.RESULTS Data of 71 subjects treated with oral EPZ and 172 subjects treated with injectable OPZ were analyzed. Analysis of 65 matched samples revealed no difference in the incidence of hemorrhage after ESD between the oral EPZ and injectable OPZ groups(OR = 0.89, 95%CI:0.35-2.27, P ≥ 0.99).CONCLUSION We conclude that oral EPZ therapy is a useful alternative to injectable PPI therapy for the prevention of hemorrhage after ESD.展开更多
AIM： To investigate the relationship between ulcerative colitis （UC） clinical activity index （CAI） and circulating levels of IL-1ra, IL-10, IL-6 and IL-18. METHODS： Blood levels of IL-1ra, IL-10, IL-6 and IL-18 ...AIM： To investigate the relationship between ulcerative colitis （UC） clinical activity index （CAI） and circulating levels of IL-1ra, IL-10, IL-6 and IL-18. METHODS： Blood levels of IL-1ra, IL-10, IL-6 and IL-18 were measured in 31 patients with active UC, the mean CAI was 11.1, ranging from 5-25; and 12 healthy individuals as controls. Patients were given granulocyte and monocyte adsorptive apheresis （GMA） with Adacolumn. Leucocytes which bear the FcyR and complement receptors were adsorbed to the column leucocytapheresis carriers. Each patient could receive up to 11 GMA sessions over 8 wk. RESULTS： We found strong correlations between CAI and IL-10 （r = 0.827, P 〈 0.001）, IL-6 （r = 0.785, P 〈 0.001） and IL-18 （r = 0.791, P 〈 0.001）. IL-1ra was not correlated with CAI. Following GMA therapy, 24 of the 31 patients achieved remission and the levels of all 4 cytokines fell to the levels in healthy controls. Further, blood levels of IL-1ra and IL-10 increased at the column outflow and inflow at 60 min suggesting release from leucocytes that adhered to the carriers. CONCLUSION： Elevated blood levels of IL-6 and IL-18 together with peripheral blood granulocytes and monocytes/macrophages in patients with active UC show activative behaviour and increased survival time can be proinflammatory and the targets of GMA therapy.展开更多
AIM:To evaluate the possibility of reducing the volume of polyethylene glycol(PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation. METHODS:This was a single-center,prospective, ran...AIM:To evaluate the possibility of reducing the volume of polyethylene glycol(PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation. METHODS:This was a single-center,prospective, randomized,investigator-blinded,non-inferiority study involving 252 patients of both sexes,aged from 20 to 80 years,scheduled for screening or diagnostic colonoscopy in our department.A total of 126 patients was randomized to receive 1.5 L PEG-electrolyte solution plus 15 mg of mosapride(1.5 L group),and 126 received 2 L PEG-electrolyte solution plus 15 mg of mosapride(2 L group).Patients completed a questionnaire on the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed using a 5-point scale based on the Aronchick scale.The primary end point was adequate bowel preparation rates(score of excellent/good/fair) vs(poor/inadequate).Acceptability and tolerability,as well as disease detection,were secondary end points. RESULTS:A total of 244 patients was included in the analysis.There were no significant differences between the 2 L and 1.5 L groups in age,sex,body mass index, number of previous colonoscopies,and the preparation method used previously.The adequate bowel preparation rates were 88.5%in the 2 L group and 82.8%in the 1.5 L group[95%lower confidence limit(LCL)for the difference=-14.5%,non-inferiority P=0.019]in the right colon.In the left colon,the adequate bowel preparation rates were 89.3%in the 2 L group and 81.1%in the 1.5 L group(95%LCL=-17.0%,non-inferiority P=0.066).Compliance,defined as complete (100%)intake of the PEG solution,was significantly higher in the 1.5 L group than in the 2 L group(96.8% vs 85.7%,P=0.002).The proportion of abdominal distension(none/mild/moderate/severe)was significantly lower in the 1.5 L group than in the 2 L group (36/65/22/3 vs 58/48/18/2,P=0.040).Within the subgroup who had undergone colonoscopy previously, a significantly higher number of patients in the 1.5 L group than in the 2 L group felt that t展开更多
文摘AIM:To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy. METHODS:We conducted a randomized,double-blind, placebo-controlled study with mosapride in addition to polyethylene glycol(PEG)-electrolyte solution.Of 250 patients undergoing colonoscopy,124 were randomized to receive 2 L PEG plus 15 mg of mosapride citrate (mosapride group),and 126 received 2 L PEG plus placebo(placebo group).Patients completed a questionnaire reporting the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed by colonoscopists using a 5-point scale based on Aronchick's criteria.The primary end point was optimal bowel preparation rates(scores of excellent/good/fair vs poor/inadequate). RESULTS:A total of 249 patients were included in the analysis.In the mosapride group,optimal bowel preparation rates were significantly higher in the left colon compared with the placebo group(78.2%vs 65.6%,P<0.05),but not in the right colon(76.5%vs 66.4%,P=0.08).After excluding patients with severe constipation,there was a significant difference in bowel preparation in both the left and right colon(82.4%vs 66.7%,80.8%vs 67.5%,P<0.05,P<0.01).The incidence of adverse events was similar in both groups. Among the subgroup who had previous colonoscopy experience,a significantly higher number of patients in the mosapride group felt that the current preparation was easier compared with patients in the placebo group(34/72 patients vs 24/74 patients,P<0.05). CONCLUSION:Mosapride citrate may be an effective and safe adjunct to PEG-electrolyte solution that leads to improved quality of bowel preparation,especially in patients without severe constipation.
基金This work was supported in part by the“Materials Research by Information Integration”Initiative(MI2I)project of the Support Program for Starting Up Innovation Hub from Japan Science and Technology Agency(JST)and a Grant-in-Aid for Scientific Research(B)15H02672 from the Japan Society for the Promotion of Science(JSPS)S.W.gratefully acknowledges financial support from JSPS KAKENHI Grant Number JP18K18017+3 种基金K.H.gratefully acknowledges financial support from JSPS KAKENHI Grant Number JP17K17762a Grant-in-Aid for Scientific Research on Innovative Areas(16H06439)and PRESTO(JPMJPR16NA)C.S.gratefully acknowledges financial support from the Ministry of Education and Science of the Russian Federation(Grant 14.Y26.31.0019)J.M.acknowledges partial financial support by JSPS KAKENHI Grant Number JP16K06768.
文摘The use of machine learning in computational molecular design has great potential to accelerate the discovery of innovative materials.However,its practical benefits still remain unproven in real-world applications,particularly in polymer science.We demonstrate the successful discovery of new polymers with high thermal conductivity,inspired by machine-learning-assisted polymer chemistry.This discovery was made by the interplay between machine intelligence trained on a substantially limited amount of polymeric properties data,expertise from laboratory synthesis and advanced technologies for thermophysical property measurements.Using a molecular design algorithm trained to recognize quantitative structure—property relationships with respect to thermal conductivity and other targeted polymeric properties,we identified thousands of promising hypothetical polymers.From these candidates,three were selected for monomer synthesis and polymerization because of their synthetic accessibility and their potential for ease of processing in further applications.The synthesized polymers reached thermal conductivities of 0.18–0.41 W/mK,which are comparable to those of state-of-the-art polymers in non-composite thermo-plastics.
基金Supported by Grant from Ministry of Education, Culture, Sports, Science and Technology of Japan, No. 12877084
文摘AIM： To study the mechanisms of hyporesponsiveness of HBV-specific CD4^＋ T cells by testing TH1 and TH2 commitment and regulatory T cells. METHODS： Nine patients with chronic hepatitis B were enrolled. Peripheral blood mononuclear cells were stimulated with HBcAg or HBsAg to evaluate their potential to commit to TH1 and TH2 differentiation. HBcAg-specific activity of regulatory T cells was evaluated by staining with antibodies to CD4, CD25, CTLA-4 and interleukin-10. The role of regulatory T cells was further assessed by treatment with anti-interleukin-10 antibody and depletion of CD4^＋CD25^＋ cells. RESULTS： Level of mRNAs for T-bet, IL-12R β2 and IL-4 was significantly lower in the patients than in healthy subjects with HBcAg stimulation. Although populations of CD4^＋CD25^highCTLA-4^＋ T cells were not different between the patients and healthy subjects, IL-10 secreting cells were found in CD4^＋ cells and CD4^＋CD25^＋ cells in the patients in response to HBcAg, and they were not found in cells which were stimulated with HBsAg. Addition of anti-IL-10 antibody recovered the amount of HBcAgspecific TH1 antibody compared with control antibody （P 〈 0.01, 0.34% ± 0.12% vs 0.15% ± 0.04%）. Deletion of CD4^＋CD25^＋ T cells increased the amount of HBcAgspecific TH1 antibody when compared with lymphoo/tes reconstituted using regulatory T cells （P 〈 0.01, 0.03% ± 0.02% vs 0.18% ± 0.05%）.CONCLUSION： The results indicate that the mechanism of T cell hyporesponsiveness to HBcAg includes activation of HBcAg-induced regulatory T cells in contrast to an increase in TH2-committed cells in response to HBsAg.
文摘AIM: To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study. METHODS: We investigated the clinical outcomes and risk factors for the development of perforation in 98 consecutive gastric neoplasms undergoing ESD regarding. Demographic and clinical parameters including patient-, tumor-, and treatment-related factors, clinical parameters, and duration of hospital stay were analyzed for risk factors for perforation. In subgroup analysis, we also compared the clinical outcomes between perforation and "silent" free air without endoscopically visible perforation detected only by computed tomography.RESULTS: Perforation was identified in 8.2% of patients. All patients were managed conservatively by the administration of antibiotics. The mean procedure time was significantly longer in patients with endoscopic perforation than in those without. According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for perforation was 115 min (87.5% sensitivity, 56.7% specificity). Prolonged procedure time (≥ 115 min) was associated with an increased risk of perforation (odds ratio 9.15; 95%CI: 1.08-77.54; P = 0.04). Following ESD, body temperature and C-reactive protein level were significantly higher in patients with perforation than in those without (P = 0.02), whereas there was no difference between these patient groups on the starting day of oral intake or of hospitalization. In subgroup analysis, the post-ESD clinical course was not different between endoscopic perforation and silent free air. CONCLUSION: Only prolonged procedure time (≥ 115 min) was significantly associated with perforation. The clinical outcomes of perforation are favorable and are comparable to those of patients with or without silent free air.
文摘Sonazoid(Daiichi Sankyo,Tokyo,Japan),a secondgeneration of a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent,has been used clinically in patients with liver tumors and for harmonic gray-scale ultrasonography(US)in Japan since January 2007.Sonazoid-enhanced US has two phases of contrast enhancement:vascular and late.In the late phase of Sonazoid-enhanced US,we scanned the whole liver using this modality at a low mechanical index(MI)without destroying the microbubbles, and this method allows detection of small viable hepatocellular carcinoma(HCC)lesions which cannot be detected by conventional US as perfusion defects in the late phase.Re-injection of Sonazoid into an HCC lesion which previously showed a perfusion defect in the late phase is useful for confirming blood flow intothe defects.High MI intermittent imaging at 2 frames per second in the late phase is also helpful in differentiation between necrosis and viable hypervascular HCC lesions.Sonazoid-enhanced US by the coded harmonic angio mode at a high MI not only allows clear observation of tumor vessels and tumor enhancement, but also permits automatic scanning with Sonazoidenhanced three dimensional(3D)US.Fusion images combining US with contrast-enhanced CT or contrastenhanced MRI have made it easy to detect typical or atypical HCC lesions.By these methods,Sonazoidenhanced US can characterize liver tumors,grade HCC lesions histologically,recognize HCC dedifferentiation, evaluate the efficacy of ablation therapy or transcatheter arterial embolization,and guide ablation therapy for unresectable HCC.This article reviews the current developments and applications of Sonazoid-enhanced US and Sonazoid-enhanced 3D US for diagnosing and treating hepatic lesions,especially HCC.
文摘In addition to surgical procedures, radiofrequency ablation is commonly used for the treatment of hepatocellular carcinomas(HCCs) of limited size and number. Transcatheter arterial chemoembolization(TACE), using iodized poppy seed oil, Lipiodol and anticancer drugs, has been actively performed for the treatment of unresectable HCC, particularly in Asian countries. Recently, Sorafenib become available for advanced HCCs when the liver is still sufficiently functional. Sorafenib is an oral multikinase inhibitor with antiproliferative and antiangiogenic effects. However, the effect of sorafenib seems to be inadequate to control the progression of HCC. Radiation therapy(RT)for HCC has a potential role across all stages of HCC. However, RT is generally not considered an option in HCC consensus documents or national guidelines, primarily because of insufficient supporting evidence. However, the method of RT has much improved because of advances in technology. Moreover, combined treatment of RT plus other treatments(TACE, sorafenib and chemotherapy etc.) has become one of the alternative therapies for HCC. Therefore, we should understand the various kinds of RT available for HCC. In this review, we focus on various kinds of external beam radiation therapy.
文摘AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical practice.METHODS: A systematic review was performed using MEDLINE,EMBASE,Cochrane,LILACS,Scopus and CINAHL databases. Information of the selected studies was extracted on characteristics of trial participants,inclusion and exclusion criteria,interventions(mainly,mucosal resection and submucosal dissection vs surgical approach) and outcomes(adverse events,different survival rates,mortality,recurrence and complete resection rates). To ascertain the validity of eligible studies,the risk of bias was measured using the Newcastle-Ottawa Quality Assessment Scale. The analysis of the absolute risk of the outcomes was performed using the software Rev Man,by computingrisk differences(RD) of dichotomous variables. Data on RD and 95%CIs for each outcome were calculated using the Mantel-Haenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%,a subsequent assay was done and other findings were compiled.RESULTS: Eleven retrospective cohort studies were selected. The included records involved 2654 patients with early gastric cancer that filled the absolute or expanded indications for endoscopic resection. Threeyear survival data were available for six studies(n = 1197). There were no risk differences(RD) after endoscopic and surgical treatment(RD = 0.01,95%CI:-0.02-0.05,P = 0.51). Five-year survival data(n = 2310) showed no difference between the two groups(RD = 0.01,95%CI:-0.01-0.03,P = 0.46). Recurrence data were analized in five studies(1331 patients) and there was no difference between the approaches(RD = 0.01,95%CI:-0.00-0.02,P = 0.09). Adverse event data were identified in eight studies(n = 2439). A significant difference was detected(RD =-0.08,95%CI:-0.10--0.05,P < 0.05),demonstrating better results with endoscopy. Mortality data were obtained in four studies(n = 1107). There was
文摘AIM: To differentiate focal liver lesions based on enhancement patterns using three-dimensional ultrasonography (3D US) with perflubutane-based contrast agent.METHODS: Two hundred and eighty two patients with focal liver lesions,including 168 hepatocellular carcinomas (HCCs),63 metastases,40 hemangiomas and 11 focal nodular hyperplasias (FNHs),were examined by 3D US with perflubutane-based contrast agent.Tomographic ultrasound images and sonographic angiograms were reconstructed.Among 282 lesions,enhancement patterns of 163 lesions between January 2007 and October 2007 were analyzed retrospectively.Then from November 2007 to May 2008,compared with contrast-enhanced (CE) 2D US,CE 3D US was performed on 119 lesions for prospective differential diagnosis.Sensitivity,specificity,area under receiver operating characteristic curve (Az) and inter-reader agreement were assessed.RESULTS: With the tridimensional view,dominant enhancement patterns were revealed as diffuse enhancement or peripheral ring-like enhancement,followed with washout change for HCCs or metastases,respectively,and peripheral nodular enhancement or diffuse enhancement with spoke-wheel arteries,followed by persistent enhancement for hemangiomas or FNHs,respectively.At CE 3D US,the prospective differentiation of lesions showed sensitivity 92% (mean for two readers),specificity 91% and Az value 0.95 for HCCs,84%,97%,and 0.95 for metastases,91%,98%,and 0.98 for hemangiomas and 80%,99%,and 0.99 for FNHs,respectively,while good to excellent inter-reader agreement was achieved.No significant difference exists between prospective diagnosis accuracy at CE 3D US and that at CE 2D US.CONCLUSION: CE 3D US provides a spatial perspective for liver tumor enhancement,and could help in differentiating focal liver lesions.
文摘Water-rock interaction and groundwater mixing are important phenomena in understanding hydrogeological systems and the stability of rock slopes especially those consisting largely of moderately watersoluble minerals like calcite. In this study, the hydrogeological and geochemical evolutions of groundwater in a limestone quarry composed of three strata: limestone layer(covering), interbedded layer under the covering layer, and slaty greenstone layer(basement) were investigated. Water-rock interaction in the open-pit limestone quarry was evaluated using PHREEQC, while hierarchical cluster analysis(HCA)and principal component analysis(PCA) were used to classify and identify water sources responsible for possible groundwater mixing within rock layers. In addition, Geochemist's Workbench was applied to estimate the mixing fractions to clarify sensitive zones that may affect rock slope stability. The results showed that the changes in Ca2+and HCO3àconcentrations of several groundwater samples along the interbedded layer could be attributed to mixing groundwater from the limestone layer and that from slaty greenstone layer. Based on the HCA and PCA results, groundwaters were classified into several types depending on their origin:(1) groundwater from the limestone layer(LO),(2) mixed groundwater flowing along the interbedded layer(e.g., groundwater samples L-7, L-11, S-3 and S-4), and(3) groundwater originating from the slaty greenstone layer(SO). The mixing fractions of 41% LO: 59% SO, 64% LO: 36% SO, 43%LO: 57% SOand 25% LO: 75% SOon the normal days corresponded to groundwaters L-7, L-11, S-3 and S-4,respectively, while the mixing fractions of groundwaters L-7 and L-11(61% LO: 39% SOand 93% LO: 7% SO,respectively) on rainy days became the majority of groundwater originating from the limestone layer.These indicate that groundwater along the interbedded layer significantly affected the stability of rock slopes by enlarging multi-breaking zones in the layer through calcite dissolution and inducing high water pressure, t
文摘The outdoor thermal environment might become worse than at present. It causes health injuries through the deterioration of the outdoor thermal condition. It is necessary to study how humans stay outdoors and adjust to thermal conditions. The purpose of this study was to clarify the influence of the outdoor tropical urban thermal environment on a subject who has been acclimatized to the environment studied using the outdoor thermal environment evaluation index ETFe. In addition, the tendency of human impacts was clarified through comparison to subjects from a temperate thermal environment region. As a result, it was found that an ETFe of up to 35°C could be recognized as a temperate thermal environment. However, when the ETFe was greater than 40°C, the subject could not tolerate the environment. There was not a significant difference of psychological reaction between Thai people, who were acclimatized to the tropical climate, and Japanese people, who were acclimatized to the temperate climate.
基金supported in part by Grants-in-Aid from theMinistry of Education, Science, Sports and Culture of Japan(19060009) to HFsupported in part by Grants-in-Aid from the Japan Society for the Promotionof Science (20247003 to HF, JSPS Research Fellowships forYoung Scientists to YH)
文摘Cell division and differentiation of stem cells are controlled by non- cell-autonomous signals in higher organisms. The plant vascular meristem is a stem-cell tissue comprising procambial cells that produce xylem cells on one side and phloem cells on the other side. Recent studies have revealed that TDIF （tracheary element differentiation inhibitory factor）/CLE41/CLE44 peptide signal controls the procambial cell fate in a non-cell-autonomous manner. TDIF produced in and secreted from phloem cells is perceived by TDR/PXY, a leucine-rich repeat receptor kinase located in the plasma membrane of procambial cells. This signal suppresses xylem cell differentiation of procambial cells and promotes their proliferation. In addition to TDIF, some other CLE peptides play roles in vascular development. Here, we summarize recent advances in CLE signaling governing vascular development.
文摘AIM To clarify the diagnostic efficacy and limitations of endoscopic ultrasonography(EUS) and the characteristics of early gastric cancers(EGCs) that are indications for EUS-based assessment of cancer invasion depth.METHODS We retrospectively investigated the cases of 153 EGC patients who underwent conventional endoscopy(CE) and EUS(20 MHz) before treatment.RESULTS We found that 13.7% were "inconclusive" cases with low-quality EUS images, including all nine of the cases with protruded(0-I)-type EGCs. There was no significant difference in the diagnostic accuracybetween CE and EUS. Two significant independent risk factors for misdiagnosis by EUS were identified-ulcer scarring [UL(+); odds ratio(OR) = 4.49, P = 0.003] and non-indication criteria for endoscopic resection(ER)(OR = 3.02, P = 0.03). In the subgroup analysis, 23.1% of the differentiated-type cancers exhibiting SM massive invasion(SM2) invasion(submucosal invasion ≥ 500 μm) by CE were correctly diagnosed by EUS, and 23.1% of the undifferentiated-type EGCs meeting the expanded-indication criteria for ER were correctly diagnosed by EUS.CONCLUSION There is no need to perform EUS for UL(+) EGCs or 0-I-type EGCs, but EUS may enhance the pretreatment staging of differentiated-type EGCs with SM2 invasion without UL or undifferentiated-type EGCs revealed by CE as meeting the expanded-indication criteria for ER.
文摘AIM: To investigate the clinical efficacy of leukocytapheresis (LCAP) in patients with active ulcerative colitis (UC), and to elucidate the mechanisms by determining the changes in the cytokine levels in the peripheral blood and of the functions of the peripheral blood leukocytes in these patients. METHODS: The subjects were 19 patients with active UC, with a mean clinical activity index (CAI) of 9.2. The LCAP was conducted using Cellsorba E. In each session of LCAP, 2-3 L of blood at the flow rate of 30-50 mL/min was processed. The treatment was carried out in approximately 1-h sessions, once a week, for 5-10 wk. Blood samples for determination of the cytokine levels were collected from the inflow side of the column (site of dehematization; at the start of LCAP) and outflow side of the column (at the end of LCAP). Blood samples for the determination of reactive-oxygen-producing cells were collected from the peripheral blood before and after LCAP. RESULTS: LCAP resulted in clinical improvement in all the 19 patients of UC recruited for this study. Remission (CAI: ≤4) was noted in 15 (79%) of the 19 patients. The blood level of the pro-inflammatory cytokine IL-6 was found to be decreased following treatment by LCAP, and the level of the anti-inflammatory cytokine IL-10 at the outflow side of the LCAP column was found to be significantly elevated as compared to that at the inflow side of the column. The reactive-oxygen-producing granulocytes in the peripheral blood of UC patients was increased as compared to that in healthy persons and the increase was found to be decreased following treatment by LCAP. CONCLUSION: LCAP exerted a high therapeutic efficacy in patients with active UC. Our findings suggest that LCAP is associated with enhanced production of the inhibitory cytokine IL-10 to indirectly inhibit the functions of the inflammatory leukocytes, and that inflammation is also considerably attenuated by the direct removal of reactive-oxygen-producing neutrophils from the peripheral blood.
文摘High-resolution modeling approach is increasingly being considered as a necessary step for improving the monitoring and predictions of regional air quality. This is especially true for highly urbanized region with complex terrain and land-use. This study uses Community Multiscale Air Quality （CMAQ） model coupled with MM5 mesoscale model for a comprehensive analysis to assess the suitability of such high-resolution modeling system in predicting ozone air quality in the complex terrains of Osaka, Japan. The 1-km and 3-kin grid domains were nested inside a 9-km domain and the domain with 1-km grid covered the Osaka region. High-resolution Grid Point Value-Mesoscale Model （GPV-MSM） data were used after suitable validation. The simulated ozone concentrations were validated and evaluated using statistical metrics using performance criteria set for ozone. Daily maxima of ozone were found better simulated by the 1-krn grid domain than the coarser 9-km and 3-km domains, with the maximum improvement in the mean absolute gross error about 3 ppbv. In addition, 1-km grid results fared better than other grids at most of the observation stations that showed noticeable differences in gross error as well as correlation. These results amply justify the use of the integrated high-resolution MM5-CMAQ modeling system in the highly urbanized region, such as the Osaka region, which has complex terrain and land-use.
文摘AIM To evaluate the effectiveness of oral esomeprazole(EPZ) vs injectable omeprazole(OPZ) therapy to prevent hemorrhage after endoscopic submucosal dissection(ESD).METHODS A case-control study was conducted using a quasirandomized analysis with propensity score matching. A total of 258 patients were enrolled in this study. Patients were treated with either oral EPZ or injectable OPZ. The endpoint was the incidence of hemorrhage after ESD.RESULTS Data of 71 subjects treated with oral EPZ and 172 subjects treated with injectable OPZ were analyzed. Analysis of 65 matched samples revealed no difference in the incidence of hemorrhage after ESD between the oral EPZ and injectable OPZ groups(OR = 0.89, 95%CI:0.35-2.27, P ≥ 0.99).CONCLUSION We conclude that oral EPZ therapy is a useful alternative to injectable PPI therapy for the prevention of hemorrhage after ESD.
文摘AIM： To investigate the relationship between ulcerative colitis （UC） clinical activity index （CAI） and circulating levels of IL-1ra, IL-10, IL-6 and IL-18. METHODS： Blood levels of IL-1ra, IL-10, IL-6 and IL-18 were measured in 31 patients with active UC, the mean CAI was 11.1, ranging from 5-25; and 12 healthy individuals as controls. Patients were given granulocyte and monocyte adsorptive apheresis （GMA） with Adacolumn. Leucocytes which bear the FcyR and complement receptors were adsorbed to the column leucocytapheresis carriers. Each patient could receive up to 11 GMA sessions over 8 wk. RESULTS： We found strong correlations between CAI and IL-10 （r = 0.827, P 〈 0.001）, IL-6 （r = 0.785, P 〈 0.001） and IL-18 （r = 0.791, P 〈 0.001）. IL-1ra was not correlated with CAI. Following GMA therapy, 24 of the 31 patients achieved remission and the levels of all 4 cytokines fell to the levels in healthy controls. Further, blood levels of IL-1ra and IL-10 increased at the column outflow and inflow at 60 min suggesting release from leucocytes that adhered to the carriers. CONCLUSION： Elevated blood levels of IL-6 and IL-18 together with peripheral blood granulocytes and monocytes/macrophages in patients with active UC show activative behaviour and increased survival time can be proinflammatory and the targets of GMA therapy.
文摘AIM:To evaluate the possibility of reducing the volume of polyethylene glycol(PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation. METHODS:This was a single-center,prospective, randomized,investigator-blinded,non-inferiority study involving 252 patients of both sexes,aged from 20 to 80 years,scheduled for screening or diagnostic colonoscopy in our department.A total of 126 patients was randomized to receive 1.5 L PEG-electrolyte solution plus 15 mg of mosapride(1.5 L group),and 126 received 2 L PEG-electrolyte solution plus 15 mg of mosapride(2 L group).Patients completed a questionnaire on the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed using a 5-point scale based on the Aronchick scale.The primary end point was adequate bowel preparation rates(score of excellent/good/fair) vs(poor/inadequate).Acceptability and tolerability,as well as disease detection,were secondary end points. RESULTS:A total of 244 patients was included in the analysis.There were no significant differences between the 2 L and 1.5 L groups in age,sex,body mass index, number of previous colonoscopies,and the preparation method used previously.The adequate bowel preparation rates were 88.5%in the 2 L group and 82.8%in the 1.5 L group[95%lower confidence limit(LCL)for the difference=-14.5%,non-inferiority P=0.019]in the right colon.In the left colon,the adequate bowel preparation rates were 89.3%in the 2 L group and 81.1%in the 1.5 L group(95%LCL=-17.0%,non-inferiority P=0.066).Compliance,defined as complete (100%)intake of the PEG solution,was significantly higher in the 1.5 L group than in the 2 L group(96.8% vs 85.7%,P=0.002).The proportion of abdominal distension(none/mild/moderate/severe)was significantly lower in the 1.5 L group than in the 2 L group (36/65/22/3 vs 58/48/18/2,P=0.040).Within the subgroup who had undergone colonoscopy previously, a significantly higher number of patients in the 1.5 L group than in the 2 L group felt that t
