Impact of an artificial intelligence-aided endoscopic diagnosis system on improving endoscopy quality for trainees in colonoscopy: Prospective, randomized, multicenter study.

OBJECTIVE: This study was performed to evaluate whether the use of CAD EYE (Fujifilm, Tokyo, Japan) for colonoscopy improves colonoscopy quality in gastroenterology trainees. METHODS: The patients in this multicenter randomized controlled trial were divided into Group A (observation using CAD EYE) and Group B (standard observation). Six trainees performed colonoscopies using a back-to-back method in pairs with gastroenterology experts. The primary end-point was the trainees' adenoma detection rate (ADR), and the secondary end-points were the trainees' adenoma miss rate (AMR) and Assessment of Competency in Endoscopy (ACE) tool scores. Each trainee's learning curve was evaluated using a cumulative sum (CUSUM) control chart. RESULTS: We analyzed data for 231 patients (Group A, n = 113; Group B, n = 118). The ADR was not significantly different between the two groups. Group A had a significantly lower AMR (25.6% vs. 38.6%, P = 0.033) and number of missed adenomas per patient (0.5 vs. 0.9, P = 0.004) than Group B. Group A also had significantly higher ACE tool scores for pathology identification (2.26 vs. 2.07, P = 0.030) and interpretation and identification of pathology location (2.18 vs. 2.00, P = 0.038). For the CUSUM learning curve, Group A showed a trend toward a lower number of cases of missed multiple adenomas by the six trainees. CONCLUSION: CAD EYE did not improve ADR but decreased the AMR and improved the ability to accurately locate and identify colorectal adenomas. CAD EYE can be assumed to be beneficial for improving colonoscopy quality in gastroenterology trainees. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN000044031).

Unusual manifestations of giant cell arteritis and granulomatosis with polyangiitis.

Giant cell arteritis (GCA) is a type of large vessel vasculitis, and it involves the aorta, large vessels and terminal branches of the external carotid artery, especially the temporal artery. Temporal artery biopsy is a simple tool for the diagnosis of vasculitis, however, the histopathological findings do not always differentiate between the small-vessel vasculitis and GCA. We report the case of 72-year-old male who initially had a clinical diagnosis of GCA, then in the course of treatment, diagnostic histopathological approach revealed the necrotizing vasculitis with bronchocentric granulomatosis in the inflammatory nodule of the lung. The manifestations of patients with systemic vasculitis represent the disorders of multiple organ systems thus are diverse and may vary through the course of the disease. Presentation of unexpected features such as insufficient response to antibiotics, sinusitis, runny nose, discomfort of frontal region or pachymeningitis which anticipates re-evaluation of systemic vasculitis that may lead us to an appropriate diagnosis and the treatment.

Suppression of Oral Sweet Taste Sensation with Gymnema sylvestre Affects Postprandial Gastrointestinal Blood Flow and Gastric Emptying in Humans.

An oral sweet taste sensation (OSTS) exaggerates digestive activation transiently, but whether it has a role after swallowing a meal is not known. Gymnema sylvestre (GS) can inhibit the OSTS in humans. We explored the effect of the OSTS of glucose intake on gastrointestinal blood flow, gastric emptying, blood-glucose, and plasma-insulin responses during the postprandial phase. Eight participants ingested 200 g (50 g × 4 times) of 15% glucose solution containing 100 mg of 13C-sodium acetate after rinsing with 25 mL of 2.5% roasted green tea (control) or 2.5% GS solution. During each protocol, gastrointestinal blood flow and gastric emptying were measured by ultrasonography and 13C-sodium acetate breath test, respectively. Decreased subjective sweet taste intensity was observed in all participants in the GS group. The time to attain a peak value of blood flow in the celiac artery and gastric emptying were delayed in the GS group compared with the control group. At the initial phase after glucose intake, blood-glucose and plasma-insulin responses were lower in the GS group than those for the control group. These results suggest that the OSTS itself has a substantial role in controlling postprandial gastrointestinal activities, which may affect subsequent glycemic metabolism.

Effect of soy protein isolate preload on postprandial glycemic control in healthy humans.

OBJECTIVE: Premeal consumption of whey protein improves the postmeal glycemic profile, but little information exists on soy protein. The study aim was to examine the effect of consuming different amounts of a soy protein isolate (SPI) before a 75-g oral glucose tolerance test (OGTT) on subsequent glycemic control. METHODS: After overnight fasting, eight healthy young subjects consumed a 400-mL liquid meal containing 0 g (SP0), 20 g (SP20) or 40 g (SP40) SPI. Thirty minutes after SPI consumption, an OGTT was performed to evaluate the individual glycemic response. Blood glucose and plasma insulin concentrations were measured immediately before the SPI preload (i.e., 30 min before the start of the OGTT) and before (-10 min) and during the OGTT (15, 30, 45, 60, 90, and 120 min). RESULTS: The incremental area under the curve and peak blood glucose response were significantly less for SP40 than those for SP0 and SP20. Insulin secretion was significantly higher for SP20 and SP40 than that for SP0 before and at 15 min after oral glucose consumption. The incremental area under the curve of plasma insulin was significantly higher for SP20 and SP40 than that for SP0. CONCLUSIONS: An SPI preload of 40 g, but not 20 g, improved glycemic control in young healthy subjects. Glycemic control appears to be attributed not only to the exaggerated insulin response to SPI preload, but also to non-insulin dependent mechanism(s), such as delayed gastric emptying.

Acute effect of oral sensation of sweetness on celiac artery blood flow and gastric myoelectrical activity in humans.

Little is known about the effect of sweet taste stimulus on gastrointestinal motility and splanchnic blood flow. We examined whether gastric myoelectrical activity and/or celiac artery blood flow (CABF), which perfuses the stomach, are increased following an oral sensation of sweetness. After overnight fasting, 11 subjects rested for 5min and sipped, but not swallowed, one of four solutions for 1min. The fluid was then spat out, and subjects remained at rest for a further 10min. Fluids were approximately 15ml of three glucose solutions (4, 16, or 48%) or distilled water. Subjects completed trials with all four solutions in a randomized order. During each trial, gastric myoelectrical activity and CABF were continuously measured using electrogastrography and pulsed Doppler ultrasonography, respectively. None of the four solutions affected gastric myoelectrical activity. CABF was significantly increased after oral stimuli by all three glucose solutions, but not by water. There were no significant differences in the increments in CABF among the three glucose solutions. These results suggest that a sweet taste stimulus above a certain level of intensity acutely increases CABF during cephalic phase, without augmentation of gastric myoelectrical activity.

Multiple Intestinal Ulcers Associated with Primary Epstein-Barr Virus Infection in a Patient with Rheumatoid Arthritis Undergoing Methotrexate Therapy.

A 47-year-old woman with a 2-year history of rheumatoid arthritis (RA) undergoing methotrexate treatment developed a perforated ulcer in the ileum for which she underwent emergency surgery. A histological analysis of the extirpated specimen presented a possible Epstein-Barr virus (EBV) infection in the ulcerative lesion without a feature of lymphoproliferative disorder. Interestingly, the patient's serological tests with a paired serum diagnosed a primary EBV infection. The present case emphasizes the importance of being aware of severe enteritis as a possibility for patients with RA, for an accurate diagnosis.

Mechanism of robust circadian oscillation of KaiC phosphorylation in vitro.

By incubating the mixture of three cyanobacterial proteins, KaiA, KaiB, and KaiC, with ATP in vitro, T. Kondo and his colleagues in recent work reconstituted the robust circadian rhythm of the phosphorylation level of KaiC. This finding indicates that protein-protein interactions and the associated hydrolysis of ATP suffice to generate the circadian rhythm. Several theoretical models have been proposed to explain the rhythm generated in this "protein-only" system, but the clear criterion to discern different possible mechanisms was not known. In this article, we discuss a model based on two basic assumptions: the assumption of the allosteric transition of a KaiC hexamer and the assumption of the monomer exchange between KaiC hexamers. The model shows a stable rhythmic oscillation of the phosphorylation level of KaiC, which is robust against changes in concentration of Kai proteins. We show that this robustness gives a clue to distinguish different possible mechanisms. We also discuss the robustness of oscillation against the change in the system size. Behaviors of the system with the cellular or subcellular size should shed light on the role of the protein-protein interactions in in vivo circadian oscillation.

Monomer-shuffling and allosteric transition in KaiC circadian oscillation.

Circadian rhythms in living organisms have long been attributed solely to a transcription-translation loop comprising a negative or positive feedback. The rhythms in cyanobacteria are known to be modulated by kaiC, kaiA and kaiB genes. It was recently shown, however, that their product proteins KaiC, KaiA and KaiB are sufficient to reconstitute the circadian rhythm in the phosphorylation level of KaiC in vitro. It has since been unclear why such an oscillatory behavior can occur in the absence of the apparent transcription-translation feedback. In the meantime, it has been reported that the monomer exchange between KaiC hexamers occurs in a phosphorylation-dependent manner, which suggests that the monomer shuffling is also involved in the circadian rhythm (H. Kageyama et al., Mol. Cell, 23, 161 (2006)). To further clarify the role of the monomer shuffling, we have performed a computational modeling of interactions among Kai proteins assuming the allosteric transition of KaiC hexamer as well as the monomer shuffling. The results show that the existence of both monomer shuffling and allosteric transition can synchronize the phosphorylation level of the KaiC hexamers, and stabilizes its oscillation.