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1.
Sci Rep ; 14(1): 18058, 2024 08 05.
Article in English | MEDLINE | ID: mdl-39103366

ABSTRACT

Recent advances in AI and intelligent vehicle technology hold the promise of revolutionizing mobility and transportation through advanced driver assistance systems (ADAS). Certain cognitive factors, such as impulsivity and inhibitory control have been shown to relate to risky driving behavior and on-road risk-taking. However, existing systems fail to leverage such factors in assistive driving technologies adequately. Varying the levels of these cognitive factors could influence the effectiveness and acceptance of ADAS interfaces. We demonstrate an approach for personalizing driver interaction via driver safety interfaces that are are triggered based on the inference of the driver's latent cognitive states from their driving behavior. To accomplish this, we adopt a data-driven approach and train a recurrent neural network to infer impulsivity and inhibitory control from recent driving behavior. The network is trained on a population of human drivers to infer impulsivity and inhibitory control from recent driving behavior. Using data collected from a high-fidelity vehicle motion simulator experiment, we demonstrate the ability to deduce these factors from driver behavior. We then use these inferred factors to determine instantly whether or not to engage a driver safety interface. This approach was evaluated using leave-one-out cross validation using actual human data. Our evaluations reveal that our personalized driver safety interface that captures the cognitive profile of the driver is more effective in influencing driver behavior in yellow light zones by reducing their inclination to run through them.


Subject(s)
Automobile Driving , Cognition , Humans , Automobile Driving/psychology , Cognition/physiology , Male , Safety , Female , Adult , Risk-Taking , Impulsive Behavior , Neural Networks, Computer , Computer Simulation , Accidents, Traffic/prevention & control , Accidents, Traffic/psychology
2.
Environ Toxicol Pharmacol ; 110: 104517, 2024 Jul 19.
Article in English | MEDLINE | ID: mdl-39032581

ABSTRACT

Nuclear and radiological accidents can occur due to poor management, in transportation, radiation therapy and nuclear wards in hospitals, leading to extreme radiation exposure and serious consequences for human health. Additionally, in many of previous radiological accidents, skin damage was observed in patients and survivors due to the high radiation exposure. However, as part of a medical countermeasures in a nuclear/radiological emergency, it is critical to plan for the treatment of radiation-induced skin damage. Hence, the new, non-invasive technology of photodynamic therapy (PDT) is projected to be more effectively used for treating skin damage caused by high-dose radiation. PDT plays an important role in treating, repairing skin damage and promoting wound healing as evidenced by research. This review, highlighted and recommended potential impacts of PDT to repair and decrease radiation-induced skin tissue damage. Moreover, we have suggested some photosensitizer (PS) agent as radio-mitigator drugs to decrease radiobiological effects.

3.
J Radiat Res ; 2024 Jul 15.
Article in English | MEDLINE | ID: mdl-39007844

ABSTRACT

The Planning and Acting Network for Low Dose Radiation Research in Japan (PLANET) was established in 2017 in response to the need for an all-Japan network of experts. It serves as an academic platform to propose strategies and facilitate collaboration to improve quantitative estimation of health risks from ionizing radiation at low-doses and low-dose-rates. PLANET established Working Group 1 (Dose-Rate Effects in Animal Experiments) to consolidate findings from animal experiments on dose-rate effects in carcinogenesis. Considering international trends in this field as well as the situation in Japan, PLANET updated its priority research areas for Japanese low-dose radiation research in 2023 to include (i) characterization of low-dose and low-dose-rate radiation risk, (ii) factors to be considered for individualization of radiation risk, (iii) biological mechanisms of low-dose and low-dose-rate radiation effects and (iv) integration of epidemiology and biology. In this context, PLANET established Working Group 2 (Dose and Dose-Rate Mapping for Radiation Risk Studies) to identify the range of doses and dose rates at which observable effects on different endpoints have been reported; Working Group 3 (Species- and Organ-Specific Dose-Rate Effects) to consider the relevance of stem cell dynamics in radiation carcinogenesis of different species and organs; and Working Group 4 (Research Mapping for Radiation-Related Carcinogenesis) to sort out relevant studies, including those on non-mutagenic effects, and to identify priority research areas. These PLANET activities will be used to improve the risk assessment and to contribute to the revision of the next main recommendations of the International Commission on Radiological Protection.

4.
Sci Rep ; 14(1): 8167, 2024 Apr 08.
Article in English | MEDLINE | ID: mdl-38589610

ABSTRACT

Modeling monthly rainfall erosivity is vital to the optimization of measures to control soil erosion. Rain gauge data combined with satellite observations can aid in enhancing rainfall erosivity estimations. Here, we presented a framework which utilized Geographically Weighted Regression approach to model global monthly rainfall erosivity. The framework integrates long-term (2001-2020) mean annual rainfall erosivity estimates from IMERG (Global Precipitation Measurement (GPM) mission's Integrated Multi-satellitE Retrievals for GPM) with station data from GloREDa (Global Rainfall Erosivity Database, n = 3,286 stations). The merged mean annual rainfall erosivity was disaggregated into mean monthly values based on monthly rainfall erosivity fractions derived from the original IMERG data. Global mean monthly rainfall erosivity was distinctly seasonal; erosivity peaked at ~ 200 MJ mm ha-1 h-1 month-1 in June-August over the Northern Hemisphere and ~ 700 MJ mm ha-1 h-1 month-1 in December-February over the Southern Hemisphere, contributing to over 60% of the annual rainfall erosivity over large areas in each hemisphere. Rainfall erosivity was ~ 4 times higher during the most erosive months than the least erosive months (December-February and June-August in the Northern and Southern Hemisphere, respectively). The latitudinal distributions of monthly and seasonal rainfall erosivity were highly heterogeneous, with the tropics showing the greatest erosivity. The intra-annual variability of monthly rainfall erosivity was particularly high within 10-30° latitude in both hemispheres. The monthly rainfall erosivity maps can be used for improving spatiotemporal modeling of soil erosion and planning of soil conservation measures.

5.
Int J Clin Oncol ; 29(5): 512-534, 2024 May.
Article in English | MEDLINE | ID: mdl-38493447

ABSTRACT

In recent years, rapid advancement in gene/protein analysis technology has resulted in target molecule identification that may be useful in cancer treatment. Therefore, "Clinical Practice Guidelines for Molecular Tumor Marker, Second Edition" was published in Japan in September 2021. These guidelines were established to align the clinical usefulness of external diagnostic products with the evaluation criteria of the Pharmaceuticals and Medical Devices Agency. The guidelines were scoped for each tumor, and a clinical questionnaire was developed based on a serious clinical problem. This guideline was based on a careful review of the evidence obtained through a literature search, and recommendations were identified following the recommended grades of the Medical Information Network Distribution Services (Minds). Therefore, this guideline can be a tool for cancer treatment in clinical practice. We have already reported the review portion of "Clinical Practice Guidelines for Molecular Tumor Marker, Second Edition" as Part 1. Here, we present the English version of each part of the Clinical Practice Guidelines for Molecular Tumor Marker, Second Edition.


Subject(s)
Biomarkers, Tumor , Neoplasms , Humans , Biomarkers, Tumor/genetics , Biomarkers, Tumor/analysis , Japan , Neoplasms/therapy , Neoplasms/genetics , Neoplasms/diagnosis
6.
Curr Environ Health Rep ; 11(2): 318-328, 2024 06.
Article in English | MEDLINE | ID: mdl-38538904

ABSTRACT

PURPOSE OF REVIEW: This review provides insights into resolving intergenerational issues related to the disposal of waste containing high amounts of uranium (uranium waste), from which distant future generations will have higher health risks than the current generation. RECENT FINDINGS: Uranium (half-life: 4.5 billion years) produces various progeny radionuclides through radioactive decay over the long term, and its radioactivity, as the sum of its contributions, continues to increase for more than 100,000 years. In contrast to high-level radioactive wastes, protective measures, such as attenuation of radiation and confinement of radionuclides from the disposal facility, cannot work effectively for uranium waste. Thus, additional considerations from the perspective of intergenerational ethics are needed in the strategy for uranium waste disposal. The current generation, which has benefited from the use and disposal of uranium waste, is responsible for protecting future generations from the potential risk of buried uranium beyond the lifetime of a disposal facility. Fulfilling this responsibility means making more creative efforts to convey critical information on buried materials to the distant future to ensure that future generations can properly take measures to reduce the harm by themselves in response to changing circumstances including people's values.


Subject(s)
Radioactive Waste , Uranium , Humans , Refuse Disposal
7.
Front Public Health ; 12: 1335097, 2024.
Article in English | MEDLINE | ID: mdl-38299079

ABSTRACT

Even today when nearly 80 years have passed after the atomic bomb (A-bomb) was dropped, there are still debates about the exact doses received by the A-bomb survivors. While initial airborne kerma radiation (or energy spectrum of emitted radiation) can be measured with sufficient accuracy to assess the radiation dose to A-bomb survivors, it is not easy to accurately assess the neutron dose including appropriate weighting of neutron absorbed dose. Particularly, possible post-explosion exposure due to the radioactive particles generated through neutron activation have been almost neglected so far, mainly because of a large uncertainty associated to the behavior of those particles. However, it has been supposed that contribution of such non-initial radiation exposure from the neutron-induced radioactive particles could be significant, according to the findings that the stable chromosomal aberration rates which indicate average whole-body radiation doses were found to be more than 30% higher for those exposed indoors than for those outdoors even at the same initial dose estimated for the Life Span Study. In this Mini Review article, the authors explain that such apparently controversial observations can be reasonably explained by assuming a higher production rate of neutron-induced radioactive particles in the indoor environment near the hypocenter.


Subject(s)
Atomic Bomb Survivors , Radiometry , Humans , Explosions , Chromosome Aberrations , Neutrons
8.
Sci Rep ; 14(1): 3384, 2024 Feb 09.
Article in English | MEDLINE | ID: mdl-38336983

ABSTRACT

The recently proposed method for on-site radiation dosimetry by a combination of radiochromic film and portable colorimeter was tested for six combinations of two popular Gafchromic films (EBT3 and EBT-XD) and three commercially available portable colorimeters (nix pro2, nix spectro2 and Spectro1 Pro; abbreviated to "NixP", "NixS" and "SpoP", respectively). EBT3 and EBT-XD were irradiated with X-rays (160 kV, 6.3 mA) up to 40 Gy and 80 Gy, respectively, and the radiation-induced color levels of RGB and CMYK components were measured with the three colorimeters. Angle dependence was examined by reading at 15° intervals. As a result, it was judged that all combinations would work effectively under certain irradiation conditions. NixP and NixS were applicable to a wider dose range for both films, while SpoP fit a lower dose range. On the other hand, SpoP showed an advantageous feature of no angular dependence in reading films, while NixP and NixS showed significant angle-dependent changes. These differences are considered to be attributable to the different geometries of LED light emission, which came from all directions (360°) in SpoP, 4 directions in NixP, and 8 directions in NixS. These findings are expected to expand the applicability of the novel method to various occasions of on-site dosimetry.

9.
Radiat Prot Dosimetry ; 199(14): 1557-1564, 2023 Sep 18.
Article in English | MEDLINE | ID: mdl-37721076

ABSTRACT

A total of seven Japanese laboratories participated in an intercomparison study to estimate the dose given to tooth enamel samples, using the electron spin resonance method. Each of four of the participating laboratories prepared a set of tooth enamel samples, using the electron spin resonance method. Four of the participating laboratories each prepared a set of tooth enamel samples, consisting of seven standard aliquots irradiated from 100 to 2000 mGy and three samples with an 'unknown' dose between 140 and 960 mGy, were intended to eliminate bias from sample preparation. Although not all seven laboratories measured all four sets of samples, the major finding was that systematic biases in estimating doses may be caused by differences in laboratory measurements rather than by the enamel extracting procedures. When doses were averaged by measurements made by multiple laboratories, the averaged values were close to the actual values. Scattering in the intercepts in the standard dose response would be a serious problem in actual dosimetry where no background sample is available.


Subject(s)
Laboratories , Radiometry , Electron Spin Resonance Spectroscopy , Data Collection , Dental Enamel
10.
Front Public Health ; 11: 1217118, 2023.
Article in English | MEDLINE | ID: mdl-37554727

ABSTRACT

In the accident at the Fukushima Daiichi nuclear power station following the Great East Japan Earthquake and tsunami, more than 50 hospital patients died during or soon after evacuation, primarily owing to the interruption of necessary medical care. To prevent the occurrence of such losses in the future, the focus of evacuation decisions should be on the health status of individual patients and not on currently evaluated non-human aspects such as the geophysical conditions and the status of the accident facility. This brief research report provides a conceptual basis considering the principle of justification for making more appropriate decisions on the evacuation of hospitalized patients by balancing radiological risks and evacuation-induced health risks. This research report is expected to foster discussions among stakeholders on how to protect vulnerable people more appropriately in nuclear emergencies.


Subject(s)
Earthquakes , Fukushima Nuclear Accident , Humans , Japan/epidemiology
11.
Environ Res ; 236(Pt 2): 116872, 2023 Nov 01.
Article in English | MEDLINE | ID: mdl-37573022

ABSTRACT

Proper land use and management (LUM) planning is pivotal to curbing land degradation and ensuring sustainable use of limited watershed resources. Despite decades of research and development efforts, land degradation remains a serious environmental problem in many parts of the world. Issues regarding the sustainability of current LUM initiatives are due to poor linkages between the ecological and socio-economic dimensions of LUM decisions, and an integrated framework allowing LUM interventions to be properly planned and implemented is lacking. In this study, we developed an integrated framework to identify, evaluate, and propose LUM alternatives with ecological and socio-economic benefits. The framework comprises six components: (i) identification of land use problems and setting of objectives, (ii) identification of the best-performing land use-based integrated solutions, (iii) formulation of LUM alternatives and modeling of key indicators, (iv) cost-benefit analysis, (v) evaluation of the LUM alternatives with stakeholders engagement, and (vi) communication of the LUM alternatives to relevant stakeholders to obtain institutional and financial support for implementation. To demonstrate the use of this framework, we conducted a case study in the Aba Gerima watershed of the Upper Blue Nile basin in Ethiopia. This study used extensive plot- and watershed-scale observations (2015-2019) obtained under both conventional and improved sustainable land management practices. We analyzed changes in runoff, soil loss, soil organic carbon (SOC) stock, and land productivity of five LUM alternatives as compared to a baseline scenario (existing farming practices). The results showed that the LUM alternatives reduced runoff by 11-71% and soil loss by 66-95%, and SOC stock and watershed-scale land productivity were improved by 36-104% and 48-134%, respectively. Evaluation of LUM alternatives by stakeholders, including land users, policy makers, and researchers, produced divergent results. In particular, land users prioritized implementation of sustainable land management practices without altering existing land uses. The integrated framework developed in this study can serve as a valuable tool for identifying, evaluating, and proposing LUM alternatives and facilitating decision-making in planning and implementation of LUM practices in watersheds experiencing land degradation.

12.
Phys Med Biol ; 68(15)2023 07 26.
Article in English | MEDLINE | ID: mdl-37429310

ABSTRACT

Objective.FLASH radiation therapy with ultrahigh dose rates (UHDR) has the potential to reduce damage to normal tissue while maintaining anti-tumor efficacy. However, rapid and precise dose distribution measurements remain difficult for FLASH radiation therapy with proton beams. To solve this problem, we performed luminescence imaging of water following irradiation by a UHDR proton beam captured using a charge-coupled device camera.Approach. We used 60 MeV proton beams with dose rates of 0.03-837 Gy s-1from a cyclotron. Therapeutic 139.3 MeV proton beams with dose rates of 0.45-4320 Gy s-1delivered by a synchrotron-based proton therapy system were also tested. The luminescent light intensity induced by the UHDR beams was compared with that produced by conventional beams to compare the dose rate dependency of the light intensity and its profile.Main results. Luminescence images of water were clearly visualized under UHDR conditions, with significantly shorter exposure times than those with conventional beams. The light intensity was linearly proportional to the delivered dose, which is similar to that of conventional beams. No significant dose-rate dependency was observed for 0.03-837 Gy s-1. The light-intensity profiles of the UHDR beams agreed with those of conventional beams. The results did not differ between accelerators (synchrotron or cyclotron) and beam energies.Significance. Luminescence imaging of water is achievable with UHDR proton beams as well as with conventional beams. The proposed method should be suitable for rapid and easy quality assurance investigations for proton FLASH therapy, because it facilitates real-time, filmless measurements of dose distributions, and is useful for rapid feedback.


Subject(s)
Proton Therapy , Radiation Injuries , Humans , Protons , Luminescence , Water , Proton Therapy/methods , Light , Radiotherapy Dosage
13.
J UOEH ; 44(4): 331-339, 2022.
Article in English | MEDLINE | ID: mdl-36464307

ABSTRACT

The selection of appropriate recipient vessels is important for the success of head and neck reconstruction. Vessels located outside of previously-dissected neck regions tend to be more frequently selected due to relative ease of preparation. However, some advantages are offered regarding dead space filling and formation by using vascular anastomoses within regions previously dissected, or reusing former free flap pedicle due to their proximity to the defect. We analyzed microsurgical anastomoses in patients requiring oral reconstruction who had previously undergone neck dissection. Contralateral vascular anastomoses were preoperatively planned in 10 cases of which 9 could be successfully performed (achievement rate, 90%). Ipsilateral side anastomoses were planned in 28 cases, with 26 anastomosed as planned (achievement rate, 92.9%). There was no statistically significant difference between the two groups. Vascular anastomosis within the scar region can be performed safely, based on preoperative planning and intraoperative judgment.


Subject(s)
Neck , Humans , Feasibility Studies , Neck/surgery , Anastomosis, Surgical
14.
JGH Open ; 6(10): 685-691, 2022 Oct.
Article in English | MEDLINE | ID: mdl-36262540

ABSTRACT

Background and Aim: The aim of this study was to identify the factors associated with liver-related and non-liver-related mortality of patients with hepatitis C virus (HCV) after sustained virologic response (SVR) to direct-acting antiviral agents (DAAs). Methods: We conducted a retrospective, single-center cohort study of HCV patients cured by DAAs. Results: A total of 330 patients with SVR to DAAs were eligible. The median follow-up period was 3.38 years (inter-quartile range: 2.03-4.58). The cumulative liver-related or non-liver-related mortality rates at 1, 3, and 5 years were 0.00 or 1.29%, 2.87 or 3.60%, and 5.10 or 9.46, respectively. Among the liver-related deaths, 9 of the 10 were from liver cancer. Among the non-liver-related deaths, the most common cause was malignancy. Through multivariate analysis using the Cox proportional hazard model, diabetes mellitus (DM, hazard ratio 13.1, 95% confidence interval 2.81-61.3) and a history of hepatocellular carcinoma (HCC, 12.8, 2.76-59.2), independently predicted liver-related death. No variables were associated with non-liver-related death. Conclusion: Our findings suggest that DM and a history of HCC are risk factors for liver-related mortality of HCV patients cured by DAAs. These results indicate that early management of HCV and HCC surveillance of diabetic patients after SVR are important to increase the chance of survival. Further studies are needed to confirm the association of DM and HCC history with survival.

15.
Metallomics ; 14(9)2022 09 27.
Article in English | MEDLINE | ID: mdl-36087072

ABSTRACT

The children today are in the midst of the epidemic of neurodevelopmental disorders. In this metallomics study for the scalp hair samples of total 2550 children with autistic disorders (2108 males and 442 females aged 0-15 years), it was demonstrated that near one-half of the infantile individuals aged 0-3 years are suffering from zinc deficiency and toxic metal burdens. Zinc level correlated closely to the index of zinc/iron ratio more than zinc/copper ratio. Furthermore, there were significant relationships between zinc deficiency and toxic metal burdens such as lead and aluminum, which were inversely associated with not only zinc level but also zinc/iron ratio with higher regression coefficients of r = -0.486 and -0.551 (P < 0.00001), respectively. High-significant inverse association was detected between zinc and molybdenum concentration (r = -0.509) and also between zinc/iron ratio and molybdenum (r = -0.548). These findings suggest that infantile zinc deficiency relates to the high burdens of not only toxic but also some essential metals such as molybdenum, iron, and manganese and that these various mineral imbalances play principal roles in the etiology of neurodevelopmental disorders. We expect that the early assessment and intervention of the mineral imbalances (or dis-homeostasis) in individual child open an avenue for evidence-based individualized treatment of neurodevelopmental disorders and also of the comorbid immune disorders, in near future.


Subject(s)
Copper , Neurodevelopmental Disorders , Aluminum , Child , Copper/analysis , Female , Humans , Iron/analysis , Male , Manganese/analysis , Minerals , Molybdenum , Neurodevelopmental Disorders/diagnosis , Zinc/analysis
16.
J Radiat Res ; 63(Supplement_1): i45-i53, 2022 Aug 13.
Article in English | MEDLINE | ID: mdl-35968990

ABSTRACT

There are two types of exposure to atomic bomb (A-bomb) radiation: exposure to initial radiation released at the time of the detonation of the bomb, and exposure to residual radiation, which remains afterwards. Health hazards caused by exposure from residual radiation have not yet been clarified. The purpose of our study was to reveal the relationships between mortality risk from solid cancer and residual radiation based on data from the early entrants to Hiroshima. It is hard to identify the individual residual radiation doses. However, these are assumed to depend on the date of entry and the entrants' behavior. Individual behavior is thought to be closely related to gender and age at exposure. We investigated a cohort of 45 809 individuals who were living in Hiroshima Prefecture on 1 January 1970 and were registered on the Database of Atomic Bomb Survivors as entrants after the bombing. Poisson regression methods were used to estimate excess relative risks (ERR) with data cross-classified by sex, age at entry, and date of entry. In males in their 20s, 30s, and 40s at entry and in females less than 10 years old and in their 40s at entry, solid cancer mortality risks were significantly higher among persons who entered the city on the day of the bombing than those who entered three or more days later. With adjustments for the age-dependent sensitivities to radiation exposure, it was extrapolated that middle-aged people who entered the city on the day of the bombing were exposed to higher levels of residual radiation than younger people.


Subject(s)
Neoplasms , Nuclear Warfare , Nuclear Weapons , Child , Cohort Studies , Female , Humans , Male , Middle Aged , Risk
18.
Nanomaterials (Basel) ; 12(5)2022 Feb 25.
Article in English | MEDLINE | ID: mdl-35269259

ABSTRACT

Gold nanoparticles (AuNPs) can be used with megavolt (MV) X-rays to exert radiosensitization effects, as demonstrated in cell survival assays and mouse experiments. However, the detailed mechanisms are not clear; besides physical dose enhancement, several chemical and biological processes have been proposed. Reducing the AuNP concentration while achieving sufficient enhancement is necessary for the clinical application of AuNPs. Here, we used positively charged (+) AuNPs to determine the radiosensitization effects of AuNPs combined with MV X-rays on DNA damage in vitro. We examined the effect of low concentrations of AuNPs on DNA damage and reactive oxygen species (ROS) generation. DNA damage was promoted by 1.4 nm +AuNP with dose enhancement factors of 1.4 ± 0.2 for single-strand breaks and 1.2 ± 0.1 for double-strand breaks. +AuNPs combined with MV X-rays induced radiosensitization at the DNA level, indicating that the effects were physical and/or chemical. Although -AuNPs induced similar ROS levels, they did not cause considerable DNA damage. Thus, dose enhancement by low concentrations of +AuNPs may have occurred with the increase in the local +AuNP concentration around DNA or via DNA binding. +AuNPs showed stronger radiosensitization effects than -AuNPs. Combining +AuNPs with MV X-rays in radiation therapy may improve clinical outcomes.

19.
Life (Basel) ; 13(1)2022 Dec 30.
Article in English | MEDLINE | ID: mdl-36676053

ABSTRACT

Submucosal endoscopy (third-space endoscopy) can be defined as an endoscopic procedure performed in the submucosal space. This procedure is novel and has been utilized for delivery to the submucosal space in a variety of gastrointestinal diseases, such as a tumor, achalasia, gastroparesis, and subepithelial tumors. The main submucosal endoscopy includes peroral endoscopic myotomy, gastric peroral endoscopic myotomy, Zenker peroral endoscopic myotomy, submucosal tunneling for endoscopic resection, and endoscopic submucosal tunnel dissection. Submucosal endoscopy has been used as a viable alternative to surgical techniques because it is minimally invasive in the treatment and diagnosis of gastrointestinal diseases and disorders. However, there is limited evidence to prove this. This article reviews the current applications and evidence regarding submucosal endoscopy while exploring the possible future clinical applications in this field. As our understanding of these procedures improves, the future of submucosal endoscopy could be promising in the fields of diagnostic and therapeutic endoscopy.

20.
Dig Endosc ; 34(2): 379-390, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34775648

ABSTRACT

OBJECTIVES: To verify the efficacy and safety of red dichromatic imaging (RDI) in hemostatic procedures during endoscopic submucosal dissection (ESD). METHODS: This is a multicenter randomized controlled trial of 404 patients who underwent ESD of the esophagus, stomach, colorectum. Patients who received hemostatic treatments by RDI during ESD were defined as the RDI group (n = 204), and those who received hemostatic treatments by white light imaging (WLI) were defined as the WLI group (n = 200). The primary endpoint was a shortening of the hemostasis time. The secondary endpoints were a reduction of the psychological stress experienced by the endoscopist during the hemostatic treatment, a shortened treatment time, and a non-inferior perforation rate, in RDI versus WLI. RESULTS: The mean hemostasis time in RDI (n = 860) was not significantly shorter than that in WLI (n = 1049) (62.3 ± 108.1 vs. 56.2 ± 74.6 s; P = 0.921). The median hemostasis time was significantly longer in RDI than in WLI (36.0 [18.0-71.0] vs. 28.0 [14.0-66.0] s; P = 0.001) in a sensitivity analysis. The psychological stress was significantly lower in RDI than in WLI (1.71 ± 0.935 vs. 2.03 ± 1.038; P < 0.001). There was no significant difference in the ESD treatment time between RDI (n = 161) and WLI (n = 168) (58.0 [35.0-86.0] vs. 60.0 [38.0-88.5] min; P = 0.855). Four perforations were observed, but none of them took place during the hemostatic treatment. CONCLUSIONS: Hemostatic treatment using RDI does not shorten the hemostasis time. RDI, however, is safe to use for hemostatic procedures and reduces the psychological stress experienced by endoscopists when they perform hemostatic treatment during ESD. UMIN000025134.


Subject(s)
Endoscopic Mucosal Resection , Hemostatics , Endoscopic Mucosal Resection/adverse effects , Hemostasis , Humans , Treatment Outcome
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