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ObjectiveTo evaluate the diagnostic accuracy of keratoconus using deep learning of the colour-coded maps measured with the swept-source anterior segment optical coherence tomography (AS-OCT).DesignA diagnostic accuracy study.SettingA single-centre study.ParticipantsA total of 304 keratoconic eyes (grade 1 (108 eyes), 2 (75 eyes), 3 (42 eyes) and 4 (79 eyes)) according to the Amsler-Krumeich classification, and 239 age-matched healthy eyes.Main outcome measuresThe diagnostic accuracy of keratoconus using deep learning of six colour-coded maps (anterior elevation, anterior curvature, posterior elevation, posterior curvature, total refractive power and pachymetry map).ResultsDeep learning of the arithmetical mean output data of these six maps showed an accuracy of 0.991 in discriminating between normal and keratoconic eyes. For single map analysis, posterior elevation map (0.993) showed the highest accuracy, followed by posterior curvature map (0.991), anterior elevation map (0.983), corneal pachymetry map (0.982), total refractive power map (0.978) and anterior curvature map (0.976), in discriminating between normal and keratoconic eyes. This deep learning also showed an accuracy of 0.874 in classifying the stage of the disease. Posterior curvature map (0.869) showed the highest accuracy, followed by corneal pachymetry map (0.845), anterior curvature map (0.836), total refractive power map (0.836), posterior elevation map (0.829) and anterior elevation map (0.820), in classifying the stage.ConclusionsDeep learning using the colour-coded maps obtained by the AS-OCT effectively discriminates keratoconus from normal corneas, and furthermore classifies the grade of the disease. It is suggested that this will become an aid for improving the diagnostic accuracy of keratoconus in daily practice.Clinical trial registration number000034587.

The present study aimed to design, develop, operate and evaluate a sightseeing spot recommendation system that can efficiently and usefully support tourists while considering their visiting frequencies. This system was developed by integrating social networking services (SNSs), Web-geographic information systems (GIS) and recommendation systems. The system recommends sightseeing spots to users with different visiting frequencies, adopting two recommendation methods (knowledge-based recommendation and collaborative recommendation methods). Additionally, the system was operated for six weeks in Kamakura City, Kanagawa Prefecture, Japan, and the total number of users was 61. Based on the results of the web questionnaire survey, the usefulness of the system when sightseeing was high, and the recommendation function of sightseeing spots, which is an original function, received mainly good ratings. From the results of the access analysis of users’ log data, the total number of sessions in this system was 329, 77% used mobile devices, and smartphones were used most frequently. Therefore, it is evident that the system was used by different types of devices just as it was designed for, and that the system was used according to the purpose of the present study, which is to support the sightseeing activities of users.

Purpose: Placido disk-based corneal topography is still most commonly used in daily practice. This study was aimed to evaluate the diagnosability of keratoconus using deep learning of a color-coded map with Placido disk-based corneal topography. Methods: We retrospectively examined 179 keratoconic eyes [Grade 1 (54 eyes), 2 (52 eyes), 3 (23 eyes), and 4 (50 eyes), according to the Amsler-Krumeich classification], and 170 age-matched healthy eyes, with good quality images of corneal topography measured with a Placido disk corneal topographer (TMS-4 TM , Tomey). Using deep learning of a color-coded map, we evaluated the diagnostic accuracy, sensitivity, and specificity, for keratoconus screening and staging tests, in these eyes. Results: Deep learning of color-coded maps exhibited an accuracy of 0.966 (sensitivity 0.988, specificity 0.944) in discriminating keratoconus from normal eyes. It also exhibited an accuracy of 0.785 (0.911 for Grade 1, 0.868 for Grade 2, 0.920 for Grade 3, and 0.905 for Grade 4) in classifying the stage. The area under the curve value was 0.997, 0.955, 0.899, 0.888, and 0.943 as Grade 0 (normal) to 4 grading tests, respectively. Conclusions: Deep learning using color-coded maps with conventional corneal topography effectively distinguishes between keratoconus and normal eyes and classifies the grade of the disease, indicating that this will become an aid for enhancing the diagnosis and staging ability of keratoconus in a clinical setting.

 Background/Objectives: This study aimed to elucidate the effect of rhythm jump training on the rhythm and motor abilities of elementary school students to provide insights into its potential benefits for their physical performance and coordination. Methods: A non-randomized controlled trial was conducted involving 101 elementary school students (grades 1–6) attending a soccer school. Participants were divided into a rhythm jump group (n = 51, age: 7.5 years, height: 126.0 cm, weight: 25.7 kg) and a control group (n = 39, age: 8.0 years, height: 128.8 cm, weight: 26.5 kg) based on their practice venue. The rhythm jump group engaged in 10 min of rhythm jump at the beginning of soccer practice once a week over 8 weeks (intervention period), while the control group continued regular soccer training. Measurements included rhythmic reproduction ability during jumps, Pro Agility Test (PAT) values, and Reactive Strength Index (RSI) scores, assessed before and after the intervention period. Rhythmic reproduction ability was measured by comparing the data of the timing of jumps to 4- and 8-beat audio tracks. These were analyzed using repeated-measures analysis of variance, with significance set at p < 0.05. Results: Significant interactions were observed between 8-beat rhythmic reproduction ability and PAT values. In 8-beat rhythm deviation, a significant decrease was observed in the rhythm jump group (0.048 s) compared to that in the control group (0.013 s) (p < 0.01). PAT time significantly decreased in the rhythm jump group (0.18 s) compared to the control group (−0.25 s) (p < 0.01). There was no observed interaction between 4-beat rhythmic reproduction ability and RSI. Conclusions: This study revealed that rhythm jump training can be effective even with short sessions and infrequent practice, emphasizing its efficiency. The short-term rhythm jump intervention improved the 8-beat rhythmic reproduction ability and agility of elementary school students.

To achieve carbon-neutrality, internal combustion engines need to further improve their thermal efficiency to reduce CO2 emissions. To accomplish this, it is necessary to quantify and enhance five factors that control indicated thermal efficiency: compression ratio, specific heat ratio, combustion duration, combustion timing, and heat transfer to wall. In this work, quantitative targets for each factor were defined, which were derived from a simulation that considered the influence of heterogeneity of diesel combustion on thermal efficiency. The simulation utilized a two-zone combustion model. In particular, the targets for the combustion duration, combustion timing and heat transfer to wall were increased significantly compared to those for a conventional engine, in anticipation of an expansion of the load range of premixed charge compression ignition (PCI) combustion to higher loads. To expand the applicable load for PCI combustion, it was necessary to achieve a high degree of constant volume, low combustion noise, and clean emissions by suppressing the interference between the burned gas of the prior spray and the subsequent spray in the multi-stage injections near TDC. For this purpose, Distribution Controlled partially Premixed Compression Ignition (DCPCI) with the Dual Zone Egg-shape Combustion Chamber was proposed as a new combustion concept, and it was validated through CFD analysis that the DCPCI concept achieved high degree of constant volume and lean mixture formation. In addition, experiments were conducted on a new generation engine that applied the DCPCI combustion and other technologies such as slightly increased compression ratio, decreased intake temperature and increased wall temperature with a steel piston to improve the five control factors. The two-zone combustion model was utilized to analyze the result of the experiments, and improvements against the targets for the control factors was verified quantitatively. Furthermore, compared to a previous generation engine, a significant improvement in fuel consumption was confirmed without any adverse effects on emissions or combustion noise.

ObjectivesTo compare CT findings of early (within 3 weeks post-onset)- and later (within 1 month before or after diagnostic criteria were satisfied, and later than 3 weeks post-onset) stage thrombocytopenia, anasarca, fever, reticulin fibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome.MethodsBetween 2014 and 2019, 13 patients with TAFRO syndrome (8 men and 5 women; mean age, 54.9 years) from nine hospitals were enrolled. The number of the following CT findings (CT factors) was recorded: the presence of anasarca, organomegaly, adrenal ischaemia, anterior mediastinal lesion, bony lesion, and lymphadenopathy. Records of adrenal disorders (adrenomegaly, ischaemia, and haemorrhage) throughout the disease course were also collected. Differences in CT factors at each stage were statistically compared between remission and deceased groups.ResultsPara-aortic oedema and mild lymphadenopathy were observed in all patients, whereas pleural effusion, ascites, and subcutaneous oedema were found in 5/13, 7/13, and 7/13 cases, respectively, at the early stage. CT factors at the early stage were significantly higher in the deceased than in the remission group (mean, 11 vs 6.5; p = 0.04), while they were nonsignificant at the later stage. Adrenal disorders were present in 7/13 cases throughout the course including 6 of adrenomegaly and 4 of ischaemia at the early stage.ConclusionsPara-aortic oedema and mild lymphadenopathy are most common at the early stage. Anasarca, organomegaly, lymphadenopathy, and adrenal disorders on early-stage CT are useful for unfavourable prognosis prediction. Moreover, adrenal disorders are frequent even at the early stage and are useful for early diagnosis of TAFRO syndrome.Key Points• CT findings facilitate early diagnosis and prognosis prediction in TAFRO syndrome.• Adrenal disorders are frequently observed in TAFRO syndrome.• Adrenal disorders are useful for differential diagnosis of TAFRO syndrome.

Four new tricyclic macrolides, named shikinefragalides A (1), B (2), C (3) and D (4), were isolated by physicochemical (PC) screening from a static culture material of Stachybotryaceae sp. FKI-9632. Their structures were elucidated as new analogs of colletofragarones by MS and NMR analyses. Compounds 1 and 2 showed weak antimalarial activity and cytotoxicity.

Background: Stress coping strategies are related to health outcomes. However, there is no clear evidence for sex differences between stress-coping strategies and mortality. We investigated the relationship between all-cause mortality and stress-coping strategies, focusing on sex differences among Japanese adults.Methods: A total of 79,580 individuals aged 35–69 years participated in the Japan Multi-Institutional Collaborative Cohort Study between 2004 and 2014 and were followed up for mortality. The frequency of use of the five coping strategies was assessed using a questionnaire. Sex-specific, multivariable-adjusted hazard ratios (HRs) for using each coping strategy (“sometimes,” and “often/very often” use versus “very few” use) were computed for all-cause mortality. Furthermore, relationships were analyzed in specific follow-up periods when the proportion assumption was violated.Results: During the follow-up (median: 8.5 years), 1,861 mortalities were recorded. In women, three coping strategies were related to lower total mortality. The HRs for “sometimes” were 0.81 (95% confidence interval [CI], 0.67–0.97) for emotional expression, 0.79 (95% CI, 0.66–0.95) for emotional support-seeking, and 0.80 (95% CI, 0.66–0.98) for disengagement. Men who “sometimes” used emotional expression and sometimes or often used problem-solving and positive reappraisal had a 15–41% lower HRs for all-cause mortality. However, those relationships were dependent on the follow-up period. There was evidence that sex modified the relationships between emotional support-seeking and all-cause mortality (P for interaction = 0.03).Conclusion: In a large Japanese sample, selected coping strategies were associated with all-cause mortality. The relationship of emotional support-seeking was different between men and women.