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Background and aim: Covered self-expandable metal stents (EMS) were recently developed to overcome tumour ingrowth in conventional EMS. However, supporting evidence for the efficacy of covered EMS is lacking. Patients and methods: We enrolled 112 patients with unresectable distal biliary malignancies. They were randomly assigned to polyurethane covered (n = 57) or original diamond stent (n = 55). Results: Stent occlusion occurred in eight patients (14%) after a mean of 304 days in the covered group, and in 21 patients (38%) after a mean of 166 days in the uncovered group. The incidence of covered EMS occlusion was significantly lower than that of uncovered EMS (p = 0.0032). The cumulative stent patency of covered stents was significantly higher than that of uncovered stents (p = 0.0066). No tumour ingrowth occurred in the covered group while it was observed in 15 patients in the uncovered group. In subgroup analysis, the cumulative patency of the covered EMS was significantly higher in pancreatic cancer (p = 0.0363) and metastatic lymph nodes (p = 0.0354). There was no significant difference in survival between the two groups. Acute cholecystitis was observed in two of the covered group and in none of the uncovered group. Mild pancreatitis occurred in five of the covered group and in one of the uncovered group. Conclusions: Covered diamond stents successfully prevented tumour ingrowth and were significantly superior to uncovered stents for the treatment of patients with distal malignant biliary obstruction. However, careful attention must be paid to complications specific to covered self-expandable metal stents, such as acute cholecystitis and pancreatitis.

Background and aim:Helicobacter pylori infection and gastric atrophy are both risk factors for gastric cancer. We aimed to elucidate the natural history of gastric cancer development according to H pylori infection and gastric atrophy status. Subjects and methods: A total of 9293 participants in a mass health appraisal programme were candidates for inclusion in the present prospective cohort study: 6983 subjects revisited the follow up programme. Subjects were classified into four groups according to serological status at initial endoscopy. Group A (n = 3324) had “normal” pepsinogen and were negative for H pylori antibody; group B (n = 2134) had “normal” pepsinogen and were positive for H pylori antibody; group C (n = 1082) had “atrophic” pepsinogen and were positive for H pylori antibody; and group D (n = 443) had “atrophic” pepsinogen and were negative for H pylori antibody. Incidence of gastric cancer was determined by annual endoscopic examination. Results: Mean duration of follow up was 4.7 years and the average number of endoscopic examinations was 5.1. The annual incidence of gastric cancer was 0.04% (95% confidence interval (CI) 0.02–0.09), 0.06% (0.03–0.13), 0.35% (0.23–0.57), and 0.60% (0.34–1.05) in groups A, B, C, and D, respectively. Hazard ratios compared with group A were 1.1 (95% CI 0.4–3.4), 6.0 (2.4–14.5), and 8.2 (3.2–21.5) in groups B, C, and D, respectively. Age, sex, and “group” significantly served as independent valuables by multivariate analysis. Conclusions: The combination of serum pepsinogen and anti-H pylori antibody provides a good predictive marker for the development of gastric cancer.

Background:Juvenile idiopathic arthritis (JIA) may induce substantial morbidity and diminished quality of life, accompanied by a reduction in health-related quality of life and an increased susceptibility to enduring joint disability, persisting into adulthood. The contemporary proliferation of therapeutic agents, encompassing conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic/targeted synthetic DMARDs (b/tsDMARDs), has facilitated efficacious disease management for numerous patients. However, this has concurrently engendered heightened intricacy in treatment decision-making.Objectives:Systematic reviews (SRs) were conducted informing the clinical practical guidelines (CPG) for JIA with oligoarthritis or polyarthritisMethods:The SR was implemented as a project of the Ministry of Health, Labor and Welfare’s research group in collaboration with the Japan College of Rheumatology, using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) method. Seven key outcomes were selected: remission, achieving ACR ped 30 or a similar composite index, child-health assessment questionnaire disability index (C-HAQ DI), number of limited joints, serious adverse drug reactions/adverse events, serious infections, and treatment retention rate. The search period was from January 1990 until November 2022, and only articles written in English or Japanese were included. Patient, intervention, comparison, and outcome (PICO) from the CQs were abstracted, and PubMed, the Cochrane Library, and the Japan Centra Revuo Medicina databases were searched using search terms used in each of the CQs. Randomized controlled trials (RCTs) and RCT sub-analyses were adopted for efficacy. In the analysis of RCT, we examined the risk of bias using the Revised Cochrane risk of bias tool for randomized trials (RoB 2.0). The certainty of evidence for each outcome was evaluated using the methods proposed by the GRADE working group. Recommendations were prepared based on the results of the SRs and structured abstracts of additional retrieved literature. Recommendations are agreed upon by a panel including patients, pediatric and non-pediatric rheumatologists, a nurse specialized in patient care with rheumatic diseases, guideline experts, and health economists using the Delphi method.Results:Six CQs regarding efficacy and safety of medical treatment were evaluated, with CQ1 addressing methotrexate (MTX), CQ2 non-MTX csDMARDs, CQ3 glucocorticoids (GCs), CQ4 tumor necrosis factor (TNF) inhibitors, CQ5 interleukin (IL)-6 inhibitors, and CQ6 Janus kinase (JAK) inhibitors. The total number of candidate articles was initially 3,511 in PubMed, 1,698 in Cochrane, 395 in Japan Centra Revuo Medicina, and 16 others. From these sources, two RCTs for CQ1, three RCTs for CQ2, two post-hoc analyses of RCTs for CQ3, eight RCTs for CQ4, two RCTs for CQ5, and two RCTs for CQ6 were identified. The overall quality of evidence was moderate for CQ5, low for CQ6, and very low for CQ1, 2, 3, and 4. Afterward, six recommendations were developed (three strong ones and three conditional). The CPG has also been approved by the Pediatric Rheumatology Association of Japan.Conclusion:The SRs provided the necessary evidence therapeutic agents, including b/tsDMARDs, needed to develop a CPG for managing JIA with oligoarthritis or polyarthritis. We were the inaugural entity globally to undertake a comprehensive systematic review pertaining to JAK inhibitors. The CPGs are intended for healthcare professionals not limited to pediatrics, caregivers, and patients and their family members making treatment decisions. Including non-pediatric rheumatologists as panel members substantially contributed to establishing consensual care during the transition to adulthood.REFERENCES:NIL.Acknowledgements:We extend our deepest gratitude to the patient representatives, the Systematic Review (SR) team, the SR support committee members, and the members of Cochrane Japan for their cooperation in the development of this guideline.Disclosure of Interests:Tomohiro Kawabe: None declared, Takako Miyamae Abbie Japan GK, Chugai Pharmaceutical Co., Pfizer Japan Inc., UCB Japan Co. Ltd., Nami Okamoto Abbie, Novartis Pharma, Eli Lilly, Asteras, Bristrol Myers Squib, Eli lilly as an advosory board menmber for international clinical study, Yuzaburo Inoue: None declared, Takasuke Ebato: None declared, Hitoshi Irabu: None declared, Hideto Kameda AbbVie, Asahi-Kasei, Bristol-Myers, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Pfizer, Taisho and UCB, AbbVie, Amgen, Asahi-Kasei, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, Taisho and UCB, Yuko Kaneko Pfizer, Gielad, Lilly, Eisai, Chugai, Tanabe-Mitsubishi, Asahi Kasei Pharma, Bristolo Myeres Squibb, Astellas, UCB, Abbvie, Taisho, Pfizer, Gielad, Lilly, Eisai, Chugai, Tanabe-Mitsubishi, Asahi Kasei Pharma, Hiroshi Kubo: None declared, Tomohiro Kubota: None declared, Kanako Mitsunaga: None declared, Ayako Nakajima: None declared, Kenichi Nishimura: None declared, Naoaki Ohkubo: None declared, Tomomi Sato: None declared, Yuko Sugita: None declared, Eiichi Tanaka ET has received lecture fees or consulting fees from AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Daiichi-Sankyo, Inc., Eisai Co., Ltd., Eli Lilly Japan K.K., Gilead Sciences, Inc., GlaxoSmithKline K.K., Kyowa Pharma Chemical CO., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Mochida Pharmaceutical CO., Ltd., Nippon Kayaku Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd and Viatris Japan., ET has received research funding from Pfizer Inc. and UCB Japan Co. Ltd., Takayuki Tanaka: None declared, Nobuyuki Yajima: None declared, Masato Yashiro: None declared, Shingo Yamanishi: None declared, Ryo Yanai: None declared, Masaaki Mori AbbVie Japan, Asahikasei Pharmaceutical, Ayumi Pharmaceutical, Chugai Pharmaceutical, and UCB Japan, AbbVie Japan, Asahikasei Pharmaceutical, Ayumi Pharmaceutical, CSL Behring, Chugai Pharmaceutical, Japan Blood Products Organization, Nippon Kayaku, and UCB Japan, Yutaka Kawahito YK (Yutaka Kawahito) has received speaker’s fee from AbbVie GK, Asahi Kasei Pharma Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Corp., Bristol Myers Squibb Co., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Gilead Sciences, Inc., and Pfizer Japan Inc.., YK (Yutaka Kawahito) has received research grants from Asahi Kasei Pharma Corp., Ayumi Pharmaceutical Corp., AbbVie GK, ChugaiPharmaceutical Co. Ltd., Inc., Eisai Co., Ltd., Gilead Sciences, Inc., and Pfizer Japan Inc., Masayoshi Harigai Abbie Japan GK, Asahi Kasei Corp., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Eisai Co., Ltd., Eli Lilly Japan K.K., Gilead Sciences Inc., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Mochida Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Pfizer Japan Inc., Taisho Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., AbbVie Japan GK, Asahi Kasei Corp., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Eisai Co., Ltd., Eli Lilly Japan K.K., Mitsubishi Tanabe Pharma Co., Mochida Pharmaceutical Co., Ltd., Pfizer Japan Inc., Taisho Pharmaceutical Co., Ltd., Teijin Pharma Ltd., UCB Japan Co., Ltd., and Viatris Japan.

A catheter sensor system composed of a tube flow sensor with a medical basket forceps and an optical fiberscope was systemized for in-situ measurements in the airway in the lung system. The tube flow sensor was produced by assembling the sensor film containing two heaters onto the tube surface, and the basket forceps was installed into the inside space of the tube sensor. The assembled tube flow sensor with the basket forceps was inserted into the tube and was fixed at the center of the tube by expanding the basket. The flow detection characteristics of the tube flow sensor were experimentally evaluated. A calibration equation based on King’s law was derived from the sensor output vs. flow velocity curve, and a sufficiently short response time of 60 ms was obtained for the breathing measurements in a rabbit and a person. Finally, the tube flow sensor with the basket forceps and the optical fiberscope was systemized into a single tube with the diameter of 5.0 mm for in-situ measurements in the airway. The developed system successfully detected both a breathing airflow waveform and an optical image inside the airway in the rabbit.

BackgroundTocilizumab (TCZ) was approved for systemic juvenile idiopathic arthritis (sJIA) as an intravenous formulation in 2008 after its effectiveness and safety were shown in a world-leading clinical trial performed in Japan in 2002–2008.ObjectivesThis study aimed to understand the long-term prognosis of patients participating in phases II (Study MRA011JP), III (Study MRA316JP), and III/IV (Study MRA324JP). There were 149 participants in the clinical trial.MethodsInformation on eligible patients was obtained from 12 cooperating institutions approved by the Ethics Committee of Tokyo Women’s Medical University and each institution. Patients who could be followed-up were referred and transferred to other hospitals or departments. The following long-term prognoses were assessed: treatment status, including the continuation of TCZ administration during the long-term course of sJIA, disease status (remission rate and clinical phenotype), complications, social adjustment, employment status, and health-related quality of life (HRQOL) scale.ResultsResults were collected for 132 cases from ten centers by December 2022. We examined 125 patients (58 males and 67 females) whose medical records were still available and whose final diagnosis was sJIA. The age of the study participants was 18.6 years at the time of the study, 4.3 years at onset, 8.8 years at first TCZ administration, 3.8 years from onset to the first TCZ administration, and 9.1 years from TCZ initiation (all median values). Of the 125 patients, 28 (22.4%) were in medication-free remission and were either under or completely followed-up. Of the 93 patients (74.4%) who continued therapy, 10 (10.8%) were moved to a subcutaneous version of TCZ, which is not yet licensed for the treatment of sJIA in Japan. Ten patients (10.8%) were switched to canakinumab (CAN) due to TCZ primary failure (5 patients), secondary failure (2 patients), side effects (1 patient developed anaphylaxis), or other reasons. Of the 124 patients, 44 (35.5%) changed from acute febrile sJIA to chronic arthritic sJIA, in which chronic arthritis was the primary pathology without systemic inflammation, and 17 of these patients still had active arthritis at the last observation. Corticosteroids were prescribed in 54 of 93 patients (58.1%). Except in one case of sudden death, the causes of death in the four cases that resulted in fatalities were macrophage activation syndrome, sJIA-related interstitial pneumonia, and disseminated aspergillosis. The most commonly observed complications were osteoporosis in 68 (54.4%), infection requiring hospitalization in 32 (25.6%), and hypertension in 25 (20%). The EQ-5D-5L score was 0.91 (mean). The final mean height of the patients whose information was available after the age of 18 years (n = 62) was 157.7 cm for males (mean 170.4 cm in Japanese) and 144.3 cm for females (mean 156.7 cm in Japanese), showing a significant short stature. The college/university enrollment rate was as high as 68.4% (Japanese statistical data: 58.9%), and all but five students were employed.ConclusionSeventy-four percent of the patients continued treatment with TCZ or CAN, and conversion to chronic arthritic sJIA was observed in 35.5%. Despite issues such as growth retardation, social adjustment and employment status were promising, suggesting a contribution of treatment.Reference[1]Yokota S, et al. Efficacy and safety of tocilizumab in patients with systemic-onset juvenile idiopathic arthritis: a randomized, double-blind, placebo-controlled, withdrawal phase III trial. Lancet. 2008 Mar 22;371(9617):998-1006.Acknowledgements:NIL.Disclosure of InterestsTakako Miyamae Speakers bureau: TM has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Novartis Japan, Pfizer Japan Inc. , Tomohiro Kawabe: None declared, Kenichi Nishimura Speakers bureau: Novaritis Pharma, Grant/research support from: Chugai Pharma, Seira Hattori Grant/research support from: Chugai Pharma, Tomoyuki Imagawa: None declared, Tomonori Ishii Speakers bureau: Paid as speaker, chugai, Shuichi Ito Paid instructor for: Novaritis Pharma, Chugai Pharma, Grant/research support from: Chugai Pharma, Naomi Iwata: None declared, Yasuyuki Kamata: None declared, Yuji Kamiyama Grant/research support from: Chugai Pharma, Mao Mizuta Speakers bureau: Novartis Pharma K.K., Masaaki Mori Speakers bureau: I have received lecture fees from MSD, Chugai, UCB Japan, Abbvie Japan, Japan Blood Products Organization, AYUMI, and Asahi-Kasei., Grant/research support from: I belong to the department that is financially supported by Chugai, UCB Japan, CSL Behring, Abbvie Japan, Japan Blood Products Organization, AYUMI, Nippon Kayaku, and Asahi-Kasei., Ayako Murase Grant/research support from: Chugai Pharma, Yasuo Nakagishi Speakers bureau: CHUGAI PHARMACEUTICAL CO.,LTD. Novartis Pharma K.K. AstraZeneca plc, Taiji Nakano Grant/research support from: Maruho Co., Ltd 500,000 yen, Torii Pharmaceutical Co., Ltd 300,000 yen, Shingo Nakayamada Speakers bureau: S Nakayamada has received consulting fees, lecture fees, and/or honoraria from Bristol-Myers, AstraZeneca, Pfizer, GlaxoSmithKline, AbbVie, Astellas, Asahi-kasei, Sanofi, Chugai, Eisai, Gilead Sciences, Boehringer Ingelheim., Grant/research support from: S. Nakayamada has received research grants from Mitsubishi-Tanabe, Tomo Nozawa Grant/research support from: Chugai Pharma, Takashi Ohya Grant/research support from: Chugai Pharma, Nami Okamoto Speakers bureau: N.O. has received honoraria or lecture fees from AbbVie Inc.; Amgen Inc.; Asahi Kasei Pharma Corporation; Astellas Pharma Inc.; AstraZeneca PLC; AYUMI Pharmaceutical Co., Ltd.; Bristol Myers Squibb; Chugai Pharmaceutical Co., Ltd.; Eisai Co., Ltd.; Eli Lilly Japan K.K.; GlaxoSmithKline PLC; Mitsubishi Tanabe Pharma Corporation; Novartis Pharma K.K.; Pfizer Inc.; and Teijin Pharma Limited;., Paid instructor for: N.O. has has received consulting fees from Daiichi Sankyo Company Limited; Eli Lilly Japan K.K.; and Swedish Orphan Biovitrum AB, Kojiro Sato Speakers bureau: Chugai Pharmaceutical Co., Ltd, One time, 100,000 yen, Grant/research support from: Chugai Pharmaceutical Co., Ltd, Four times, average 1,800,000 yen, Yuko Sugita: None declared, Shuji Takei Speakers bureau: Glaxo Smith Klein Pharmaceuticals Ltd, Novartis Pharma K.K., AbbVie, Mitsubishi Tanabe Pharma Corporation, Ayumimi Pharmaceutical Co, Bristol-Myers Squibb, Eli-Lilly,K.K., Asahi Kasei Medical Co., Sanofi, K.K., Grant/research support from: Chugai Pharcaceutical Co.Ltd., Eisai Co.Ltd., Yoshiya Tanaka Speakers bureau: Y. Tanaka has received speaking fees and/or honoraria from Behringer-Ingelheim, Eli Lilly, Abbvie, Gilead, AstraZeneca, Bristol-Myers, Chugai, Daiichi-Sankyo, Eisai, Pfizer, Mitsubishi-Tanabe, GlaxoSmithKline, Grant/research support from: Y. Tanaka has received research grants from Asahi-Kasei, Abbvie, Chugai, Eisai, Takeda, Daiichi-Sankyo, Behringer-Ingelheim., Minako Tomiita: None declared, Hiroaki Umebayashi Speakers bureau: Novartis, Yuichi Yamasaki: None declared, Norihiro Nishimoto Speakers bureau: I have been paid as a speaker for Chugai Pharmaceutical Co. Ltd.,the product company of tocilizumab., Paid instructor for: I have been a paid instructor for Chugai Pharmaceutical Co. Ltd.,the product company of tocilizumab., Consultant of: I have been work as a paid consultant for Chugai Pharmaceutical Co. Ltd.,the product company of tocilizumab., Grant/research support from: I have received financial grants from Chugai Pharmaceutical Co. Ltd.,the product company of tocilizumab., Shumpei Yokota: None declared.

We preivously developed a catheter type flow sensor for measuring breathing and heartbeat information from breathing at the mouth [Hasegawa et al. J Micromech Microeng 27(12): 125016, (2017); Kawaoka et al. Tech. Dig. IEEE Micro Electro Mechanical Systems Conference 2016, pp 359–362]. In this study, we redesigned and developed the new sensor configuraiton for the catheter flow sensor to downsize and improve the sensor characteristics. The previous flow sensor consists of two pairs of a heater and a temperature compensation sensor for flow rate detection. The two heaters also functioned not only for flow rate detection but also for flow direction detection. The two temperature compensation sensors had a large footprint and corresponded to each heater. Therefore, the sensor occupied a large area, and it was necessary to match the heater characteristics for flow rate detection. The newly designed sensor is composed of a set of a heater and a temperature compensation sensor and two flow direction sensors. By providing the new flow direction sensors, the number of temperature compensation sensors with a large footprint was reduced to one. Thus, the area of the new sensor design was 15.0 mm 2 , which was reduced to 54.5% of the 27.0 mm 2 of the previous sensor area by providing the flow direction sensors. Then, the new catheter type flow sensor was fabricated, and the flow characteristics for measuring breathing funciton were evaluated. Finally, we applied the catheter type flow sensor to an animal experiment using a rat, and it could evaluate the flow rate characteristics of the rat’s breathing as a reciprocating flow including flow direction. Moreover, the obtained breathing characteristics were within the range of the physiological values of rats.

Background and Aim:Visceral fat accumulation reportedly increases the risk of hepatocellular carcinoma (HCC) development in patients with chronic liver disease. However, it has not beeen fully elucidated whether visceral fat accumulation increases the risk of HCC recurrence after curative treatment in patients with suspected non-alcoholic steatohepatitis (NASH). Therefore this was investigated in the current study.Methods:62 patients with naïve HCC with suspected NASH were enrolled. All were curatively treated with percutaneous radiofrequency ablation between 1999 and 2006. The visceral fat area (VFA) was determined in each patient from CT images, taken at the time of HCC diagnosis. Patients were divided into two groups based on VFA: the high VFA group (>130 cm2 in males, >90 cm2 in females, n = 27) and the others (n = 35). The effects of VFA on HCC recurrence were analysed together with other factors including patients’ background, tumour-related factors and liver function-related factors.Results:The cumulative recurrence rates differed significantly between the two groups; 15.9, 56.5 and 75.1% at 1, 2 and 3 years, respectively, in the high VFA group, and 9.7, 31.1 and 43.1%, respectively, in the controls (p = 0.018). Multivariate analysis indicated visceral fat accumulation (risk ratio 1.08, per 10 cm2, p = 0.046) and older age (risk ratio 1.06 per 1 year, p = 0.04) as independent risk factors of HCC recurrence.Conclusions:Visceral fat accumulation is an independent risk factor of HCC recurrence after curative treatment in patients with suspected NASH.

Background: Whereas high recurrence rates of colorectal adenomas after polypectomy are widely recognised, little is known of the natural incidence in those with no neoplastic lesions initially. It is also known that single colonoscopy has a significant miss rate. Aims: To elucidate the incidence and recurrence rates of colorectal neoplasms from a large cohort of asymptomatic Japanese patients on the basis of annually repeated colonoscopies. Methods: A total of 6225 subjects (4659 men and 1566 women) participating in an annual colonoscopic screening programme and completing three or more colonoscopies were analysed during the 14 year period between 1988 and 2002. Patients were divided into three groups according to the findings of the initial two colonoscopies: 4084 subjects with no neoplasm, 1818 with small adenomas <10 mm, and 323 with advanced lesions, including carcinoma in situ, severe dysplasia, or large adenomas ⩾10 mm. Mean age at the second colonoscopy was 48.8 years. Results: For all types of colorectal neoplasms, the incidence rate in those with no initial neoplasm was 7.2%/year whereas recurrence rates in those with small adenomas and advanced lesions were 19.3% and 22.9%/year, respectively. For advanced colorectal lesions, the incidence rate was 0.21%/year whereas recurrence rates in those with small adenomas and advanced lesions were 0.64% and 1.88%/year, respectively. Colorectal neoplasms were in general more likely to develop in males and older subjects. Conclusions: Although recurrence rates after polypectomy were elevated, the incidence rates in subjects with no neoplastic lesions initially were quite high.

This study presents a novel concept of an ecological driver assistance system (EDAS) that may play an important role in intelligent transportation systems (ITS) in the near future. The proposed EDAS is designed to measure relevant information of instant vehicle-road-traffic utilising advanced sensing and communication technologies. By using the models of vehicle dynamics and traffic flow, it anticipates future situations of the vehicle-road-traffic network, estimates fuel consumption, and generates optimal control input necessary for ecological driving. Once the optimal control input becomes available, it could be used to assist the driver through a suitable human interface. The vehicle control method is developed using model predictive control algorithm with a suitable performance index to ensure safe and fuel-efficient driving. The performance of EDAS in terms of speed behaviour and fuel consumption is evaluated on the microscopic transport simulator AIMSUN NG. Comparative results are graphically illustrated and analysed to signify the prospect of the proposed EDAS in building environmentally friendly ITS.

Personalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD. We previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: hypoxemia, sympathetic overactivity, and respiratory acidosis. We aimed to verify whether mortality in patients with advanced COPD could be reduced by a personalized pulmonary rehabilitation (PPR) program in hospital, which determines individual safe ranges and includes occupational therapy (PPR-OT), to prevent desaturation and sympathetic nerve activation during daily activities. The novel PPR-OT program was evaluated in a retrospective study of patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Grade D) who underwent cardiopulmonary exercise testing (CPET) between April 1990 and December 1999. They received regular treatment without the proposed therapy (control group: n=61; male-to-female ratio [M:F] =57:4; mean age: 68.5±6.7 years) or with the proposed therapy (PPR-OT group: n=46; M:F =44:2; mean age: 68.7±7.1 years). A prospective observational study included patients with COPD receiving home oxygen therapy (HOT) between April 1995 and March 2007 to compare the survival rates of the control group (n=47; M:F ratio =34:13; mean age: 71.3±10.0 years) and the PPR-OT group (n=85; M:F =78:7; mean age: 70.7±6.1 years) who completed the proposed therapy. Survival after CPET or HOT was analyzed using Cox proportional-hazards regression and Kaplan-Meier analyses. In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172-0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296-0.933]; P=0.0291; log-rank test, P=0.0232]. At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively). Survival of patients with life-threatening pathophysiological conditions also greatly improved. The PPR-OT program improved the survival of patients with advanced COPD probably because it modified life-threatening conditions.