Nowadays, barriers of distance are gradually taken away by information technologies. It is likely that shopping activities in cyber-space are being substituted for that in town-space. This study aims to clarify the potentiality of the cyber-space to supplant the town-walk in near future. Questionnaire survey with experiment of cyber-walk has executed. It is clarified that, 1) destinations of cyber-walk are completely different from those of town-walk, 2) cyber-walk is truly "distance free" activity and 3) town-walk and cyber-walk are not always compete, but those have possibilities to complement.
Abstract Background and Aim Absent contractility (AC) and ineffective esophageal motility (IEM) are esophageal hypomotility disorders diagnosed using high‐resolution manometry (HRM). Patient characteristics and disease course of these conditions and differential diagnosis between AC and achalasia are yet to be elucidated. Methods A multicenter study involving 10 high‐volume hospitals was conducted. Starlet HRM findings were compared between AC and achalasia. Patient characteristics including underlying disorders and disease courses were analyzed in AC and IEM. Results Fifty‐three patients with AC and 92 with IEM were diagnosed, while achalasia was diagnosed in 1784 patients using the Chicago classification v3.0 (CCv3.0). The cut‐off integrated relaxation pressure (IRP) value at 15.7 mmHg showed maximum sensitivity (0.80) and specificity (0.87) for differential diagnosis of AC from type I achalasia. While most ACs were based on systemic disorders such as scleroderma (34%) and neuromuscular diseases (8%), 23% were sporadic cases. The symptom severity of AC was not higher than that of IEM. Regarding the diagnosis of IEM, the more stringent CCv4.0 excluded 14.1% of IEM patients than the CCv3.0, although patient characteristics did not change. In patients with the hypomotile esophagus, concomitance of reflux esophagitis was associated with low distal contractile integral and IRP values. AC and IEM transferred between each other, paralleling with the underlying disease course, although no transition to achalasia was observed. Conclusion A successful determination of the optimal cut‐off IRP value was achieved using the starlet HRM system to differentiate AC and achalasia. Follow‐up HRM is also useful for differentiating AC from achalasia. Symptom severity may depend on underlying diseases instead of hypomotility severity.
Under the growing awareness of the global environmental issues, the Japanese Government has been enacting various laws for energy saving and material recycling to promote the formation of environment-friendly society.The input-output analysis is a useful tool to examine economic structural problems concerning the economic growth, the industrial structure and the environment. Several researches have been conducted to identify the efficiency of resources and energy consumption of Japanese industries using input-output analysis. However, we have few researches on the relationship between the industrial structure and the resources and energy consumption in Japanese regions.The aim of this paper is to identify the trends in the industrial structure and the consumption of resources and energy in Japanese regions using Interregional input-output tables for the period 1975-1990. The relationships between the industrial structure and the efficiency of resources and energy consumption in Japanese regions are examined by calculating various coefficients and analytical methods on regional economic linkage; the induction coefficients for resources and energy supply sectors; the resources and energy induction coefficients; the interregional input-output analysis.The analysis of induction coefficients for resources and energy supply sectors for eight Japanese regions has revealed the efficient use of oil and coal materials had been achieved during 1975-1990. However, the other sectors, such as the mining, the electricity and the gas and water supply had not made much progress.The reduction of resources and energy induction coefficients in terms of input structure factors (i.e. technological improvements) and the structure of final demand had been proceeded throughout the study period. However, the efficiency deteriorated in a few regions and industrial sectors under the economic growth during the bubble economy period.The feedback effects for resources and energy supply sectors using interregional input-output model had been weakened in tertiary sector, whereas strengthened in the manufacturing industries in the eastern part of Japan. The regional disparities in terms of feedback effects for resources and energy supply sectors had been reduced in both manufacturing and tertiary sectors.
This study compared the safety and efficacy of peroral endoscopic myotomy for esophageal motility disorders between octogenarians and non-octogenarians.This retrospective observational study recruited 321 patients (28 octogenarians and 293 non-octogenarians) who underwent peroral endoscopic myotomy from two institutions. Clinical success (postoperative Eckardt score ≤ 3), technical success (completion of gastric and esophageal myotomy), and perioperative adverse events were compared between octogenarians and non-octogenarians. Perioperative adverse events were classified into major and minor adverse events based on the International Peroral Endoscopic Myotomy Survey criteria and were subdivided into technical and non-technical adverse events according to the presence of a direct causal relationship with the procedure.There were no significant differences in the rates of clinical success 1 year after treatment (100% vs. 97.3%, P = 0.64) and technical success (100% vs. 99.7%, P = 0.91) between octogenarians and non-octogenarians. Octogenarians had a higher incidence of perioperative adverse events (28.6% vs. 10.2%, P = 0.00097), particularly major adverse events (25.0% vs. 3.0%, P < 0.0001). There were no significant differences in the incidence of minor adverse events (7.1% vs. 7.9%, P = 0.67). Although there was no difference in the incidence of technical adverse events (10.7% vs. 9.2%, P = 0.74), octogenarians had a significantly higher incidence of non-technical adverse events (17.9% vs. 1.0%, P = 0.0002).There were no significant differences in short-term clinical success and technical success between octogenarians and non-octogenarians. However, octogenarians showed a significantly higher incidence of perioperative adverse events, particularly in major adverse events and non-technical adverse events. Peroral endoscopic myotomy for octogenarians should be carefully applied.
