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Recent trends for practical rehabilitation robotics, current challenges and the future

Yakub F, Md Khudzari AZ, Mori Y

Int J Rehabil Res, 2014 Mar;37(1):9-21.
PMID: 24126254 DOI: 10.1097/MRR.0000000000000035

This paper presents and studies various selected literature primarily from conference proceedings, journals and clinical tests of the robotic, mechatronics, neurology and biomedical engineering of rehabilitation robotic systems. The present paper focuses of three main categories: types of rehabilitation robots, key technologies with current issues and future challenges. Literature on fundamental research with some examples from commercialized robots and new robot development projects related to rehabilitation are introduced. Most of the commercialized robots presented in this paper are well known especially to robotics engineers and scholars in the robotic field, but are less known to humanities scholars. The field of rehabilitation robot research is expanding; in light of this, some of the current issues and future challenges in rehabilitation robot engineering are recalled, examined and clarified with future directions. This paper is concluded with some recommendations with respect to rehabilitation robots.
In vitro fertilization of follicular oocytes from the swamp buffalo (Bubalus bubalis) and Kedah-Kelantan cattle (Bos indicus) in Malaysia

Takahashi Y, Nihayah M, Jainudeen MR, Hishinuma M, Kanai Y, Mori Y, et al.

J Vet Med Sci, 1992 Aug;54(4):799-801.
PMID: 1391198
Characterization of oil-palm trunk residue degradation enzymes derived from the isolated fungus, Penicillium rolfsii c3-2(1) IBRL

Lee KC, Arai T, Ibrahim D, Deng L, Murata Y, Mori Y, et al.

Environ Technol, 2016 Jun;37(12):1550-8.
PMID: 26582429 DOI: 10.1080/09593330.2015.1120786

This study characterizes crude enzymes derived from Penicillium rolfsii c3-2(1) IBRL, a mesophilic fungus isolated from the local soil of Malaysia. Prior to enzyme activity evaluation, P. rolfsii c3-2(1) IBRL was inoculated into a broth medium containing oil-palm trunk residues for the preparation of crude enzymes. Oil-palm trunk residues were optimally hydrolysed at pH5.0 and 50°C. P. rolfsii c3-2(1) IBRL-derived crude enzymes displayed higher thermal stability compared with the commercial enzymes, Celluclast 1.5 L and Acellerase 1500. Moreover, the hydrolysing activities of the P. rolfsii c3-2(1) IBRL-derived crude enzymes (xylan, arabinan, and laminarin) were superior compared to that of Celluclast 1.5 L and Acellerase 1500, and exhibit 2- to 3-fold and 3- to 4-fold higher oil-palm trunk residues-hydrolysing specific activity, respectively. This higher hydrolysis efficiency may be attributed to the weak 'lignin-binding' ability of the P. rolfsii c3-2(1) IBRL-derived enzymes compared to the commercial enzymes.
Evaluation of Enzymatic Deinking of Non-impact Ink Laser-Printed Paper Using Crude Enzyme from Penicillium rolfsii c3-2(1) IBRL

Lee KC, Tong WY, Ibrahim D, Arai T, Murata Y, Mori Y, et al.

Appl Biochem Biotechnol, 2017 Jan;181(1):451-463.
PMID: 27596245 DOI: 10.1007/s12010-016-2223-4

Application of microbial enzymes for paper deinking is getting tremendous attention due to the rapidly increasing of waste paper every year. This study reports the deinking efficiency of laser-printed paper by the lignocellulolytic enzyme from Penicillium rolfsii c3-2(1) IBRL strain compared to other enzyme sources as well as commercial available enzymes. High enzymatic deinking efficiency of approximately 82 % on laser-printed paper was obtained by pulp treatment with crude enzyme from P. rolfsii c3-2(1) IBRL. However, this crude enzyme was found to reduce the paper strength properties of the pulp based on the results of tensile, tear and burst indices, most probably due to the cellulose degradation. This was further proven by the low viscosity of paper pulp obtained after enzymatic treatment and increasing of sugar production during the treatment. Balancing to this detrimental effect on paper pulp, high deinking efficiency was achieved within a short period of time, in which the enzymatic treatment was conducted for 30 min that enabled contribution to higher brightness index obtained, thus promoting savings of time and energy consumption, therefore environmental sustainability. Extensive research should be conducted to understand the nature and mechanism of enzymatic deinking process by the crude enzyme from P. rolfsii c3-2(1) IBRL in order to improve paper strength properties.
C-terminal splice variants of P/Q-type Ca2+ channel CaV2.1 α1 subunits are differentially regulated by Rab3-interacting molecule proteins

Hirano M, Takada Y, Wong CF, Yamaguchi K, Kotani H, Kurokawa T, et al.

J Biol Chem, 2017 06 02;292(22):9365-9381.
PMID: 28377503 DOI: 10.1074/jbc.M117.778829

Voltage-dependent Ca2+ channels (VDCCs) mediate neurotransmitter release controlled by presynaptic proteins such as the scaffolding proteins Rab3-interacting molecules (RIMs). RIMs confer sustained activity and anchoring of synaptic vesicles to the VDCCs. Multiple sites on the VDCC α1 and β subunits have been reported to mediate the RIMs-VDCC interaction, but their significance is unclear. Because alternative splicing of exons 44 and 47 in the P/Q-type VDCC α1 subunit CaV2.1 gene generates major variants of the CaV2.1 C-terminal region, known for associating with presynaptic proteins, we focused here on the protein regions encoded by these two exons. Co-immunoprecipitation experiments indicated that the C-terminal domain (CTD) encoded by CaV2.1 exons 40-47 interacts with the α-RIMs, RIM1α and RIM2α, and this interaction was abolished by alternative splicing that deletes the protein regions encoded by exons 44 and 47. Electrophysiological characterization of VDCC currents revealed that the suppressive effect of RIM2α on voltage-dependent inactivation (VDI) was stronger than that of RIM1α for the CaV2.1 variant containing the region encoded by exons 44 and 47. Importantly, in the CaV2.1 variant in which exons 44 and 47 were deleted, strong RIM2α-mediated VDI suppression was attenuated to a level comparable with that of RIM1α-mediated VDI suppression, which was unaffected by the exclusion of exons 44 and 47. Studies of deletion mutants of the exon 47 region identified 17 amino acid residues on the C-terminal side of a polyglutamine stretch as being essential for the potentiated VDI suppression characteristic of RIM2α. These results suggest that the interactions of the CaV2.1 CTD with RIMs enable CaV2.1 proteins to distinguish α-RIM isoforms in VDI suppression of P/Q-type VDCC currents.
Endoscopic management of colorectal tumors less than 10 mm in size: Current status and future perspectives in Japan from a questionnaire survey

Uraoka T, Oka S, Ichihara S, Iwatate M, Tamai N, Kawamura T, et al.

Dig Endosc, 2018 04;30 Suppl 1:36-40.
PMID: 29658642 DOI: 10.1111/den.13060
Ethanol and lactic acid production using sap squeezed from old oil palm trunks felled for replanting

Kosugi A, Tanaka R, Magara K, Murata Y, Arai T, Sulaiman O, et al.

J Biosci Bioeng, 2010 Sep;110(3):322-5.
PMID: 20547348 DOI: 10.1016/j.jbiosc.2010.03.001

Old oil palm trunks that had been felled for replanting were found to contain large quantities of high glucose content sap. Notably, the sap in the inner part of the trunk accounted for more than 80% of the whole trunk weight. The glucose concentration of the sap from the inner part was 85.2g/L and decreased towards the outer part. Other sugars found in relatively low concentrations were sucrose, fructose, galactose, xylose, and rhamnose. In addition, oil palm sap was found to be rich in various kinds of amino acids, organic acids, minerals and vitamins. Based on these findings, we fermented the sap to produce ethanol using the sake brewing yeast strain, Saccharomyces cerevisiae Kyokai no.7. Ethanol was produced from the sap without the addition of nutrients, at a comparable rate and yield to the reference fermentation on YPD medium with glucose as a carbon source. Likewise, we produced lactic acid, a promising material for bio-plastics, poly-lactate, from the sap using the homolactic acid bacterium Lactobacillus lactis ATCC19435. We confirmed that sugars contained in the sap were readily converted to lactic acid with almost the same efficiency as the reference fermentation on MSR medium with glucose as a substrate. These results indicate that oil palm trunks felled for replanting are a significant resource for the production of fuel ethanol and lactic acid in palm oil-producing countries such as Malaysia and Indonesia.
Fulltext Contribution of Coiled-Coil Assembly to Ca2+/Calmodulin-Dependent Inactivation of TRPC6 Channel and its Impacts on FSGS-Associated Phenotypes

Polat OK, Uno M, Maruyama T, Tran HN, Imamura K, Wong CF, et al.

J Am Soc Nephrol, 2019 09;30(9):1587-1603.
PMID: 31266820 DOI: 10.1681/ASN.2018070756

BACKGROUND: TRPC6 is a nonselective cation channel, and mutations of this gene are associated with FSGS. These mutations are associated with TRPC6 current amplitude amplification and/or delay of the channel inactivation (gain-of-function phenotype). However, the mechanism of the gain-of-function in TRPC6 activity has not yet been clearly solved.
METHODS: We performed electrophysiologic, biochemical, and biophysical experiments to elucidate the molecular mechanism underlying calmodulin (CaM)-mediated Ca2+-dependent inactivation (CDI) of TRPC6. To address the pathophysiologic contribution of CDI, we assessed the actin filament organization in cultured mouse podocytes.
RESULTS: Both lobes of CaM helped induce CDI. Moreover, CaM binding to the TRPC6 CaM-binding domain (CBD) was Ca2+-dependent and exhibited a 1:2 (CaM/CBD) stoichiometry. The TRPC6 coiled-coil assembly, which brought two CBDs into adequate proximity, was essential for CDI. Deletion of the coiled-coil slowed CDI of TRPC6, indicating that the coiled-coil assembly configures both lobes of CaM binding on two CBDs to induce normal CDI. The FSGS-associated TRPC6 mutations within the coiled-coil severely delayed CDI and often increased TRPC6 current amplitudes. In cultured mouse podocytes, FSGS-associated channels and CaM mutations led to sustained Ca2+ elevations and a disorganized cytoskeleton.
CONCLUSIONS: The gain-of-function mechanism found in FSGS-causing mutations in TRPC6 can be explained by impairments of the CDI, caused by disruptions of TRPC's coiled-coil assembly which is essential for CaM binding. The resulting excess Ca2+ may contribute to structural damage in the podocytes.
Artificial intelligence in gastroenterology: Where are we heading?

Koleth G, Emmanue J, Spadaccini M, Mascagni P, Khalaf K, Mori Y, et al.

Endosc Int Open, 2022 Nov;10(11):E1474-E1480.
PMID: 36397868 DOI: 10.1055/a-1907-6569

Background and study aims Artificial intelligence (AI) is set to impact several fields within gastroenterology. In gastrointestinal endoscopy, AI-based tools have translated into clinical practice faster than expected. We aimed to evaluate the status of research for AI in gastroenterology while predicting its future applications. Methods All studies registered on Clinicaltrials.gov up to November 2021 were analyzed. The studies included used AI in gastrointestinal endoscopy, inflammatory bowel disease (IBD), hepatology, and pancreatobiliary diseases. Data regarding the study field, methodology, endpoints, and publication status were retrieved, pooled, and analyzed to observe underlying temporal and geographical trends. Results Of the 103 study entries retrieved according to our inclusion/exclusion criteria, 76 (74 %) were based on AI application to gastrointestinal endoscopy, mainly for detection and characterization of colorectal neoplasia (52/103, 50 %). Image analysis was also more frequently reported than data analysis for pancreaticobiliary (six of 10 [60 %]), liver diseases (eight of nine [89 %]), and IBD (six of eight [75 %]). Overall, 48 of 103 study entries (47 %) were interventional and 55 (53 %) observational. In 2018, one of eight studies (12.5 %) were interventional, while in 2021, 21 of 34 (61.8 %) were interventional, with an inverse ratio between observational and interventional studies during the study period. The majority of the studies were planned as single-center (74 of 103 [72 %]) and more were in Asia (45 of 103 [44 %]) and Europe (44 of 103 [43 %]). Conclusions AI implementation in gastroenterology is dominated by computer-aided detection and characterization of colorectal neoplasia. The timeframe for translational research is characterized by a swift conversion of observational into interventional studies.
Comparing Number and relevance Of false activations between two Artificial Intelligence CADe SystEms: the NOISE study

Spadaccini M, Hassan C, Alfarone L, Da Rio L, Maselli R, Carrara S, et al.

Gastrointest Endosc, 2022 Jan 04.
PMID: 34995639 DOI: 10.1016/j.gie.2021.12.031

BACKGROUND AND AIMS: Artificial Intelligence (AI) has been shown to be effective in polyp detection, and multiple computer-aided detection (CADe) system have been developed. False positive (FP) activation emerged as a possible way to benchmark CADe performances in clinical practice. The aim of this study is to validate a previously developed classification of FP comparing the performances of different brands of approved CADe systems.
METHODS: We compared 2 different consecutive video libraries (40 video per arm) collected at Humanitas Research Hospital with 2 different CADe system brands (CADe A and CADe B). For each video, the number of CADe false activations, the cause and the time spent by the endoscopist to examine the area erroneously highlighted were reported. The FP activations were classified according to the previously developed classification of false positives (the NOISE classification) according to their cause and relevance.
RESULTS: A total of 1021 FP activations were registered across the 40 videos of the Group A (25.5±12.2 FPs per colonoscopy). A comparable number of FPs were identified in the Group B (n=1028, mean:25.7±13.2 FPs per colonoscopy) (p 0.53). Among them, 22.9±9.9 (89.8%, Group A), and 22.1±10.0 (86.0%, Group B) were due to artifacts from bowel wall. Conversely, 2.6±1.9 (10.2%) and 3.5±2.1 (14%) were caused by bowel content (p 0.45). Within the Group A each false activation required 0.2±0.9 seconds, with 1.6±1.0 (6.3%) FPs requiring additional time for endoscopic assessment. Comparable results were reported within the Group B with 0.2±0.8 seconds spent per false activation and 1.8±1.2 FPs per colonoscopy requiring additional inspection.
CONCLUSION: The use of a standardized nomenclature permitted to provide comparable results with either of the 2 recently approved CADe systems.
Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis

Mayumi T, Okamoto K, Takada T, Strasberg SM, Solomkin JS, Schlossberg D, et al.

J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):96-100.
PMID: 29090868 DOI: 10.1002/jhbp.519

Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 (TG18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)

Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al.

J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):41-54.
PMID: 29032636 DOI: 10.1002/jhbp.515

The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, et al.

J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):87-95.
PMID: 28888080 DOI: 10.1002/jhbp.504

Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, et al.

J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):31-40.
PMID: 28941329 DOI: 10.1002/jhbp.509

The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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