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Journal of Geriatric Cardiology 2022年第12期19卷 995-1000页

作者： Koji Takahashi Hiromasa Nakahara Eiji Arimitsu Satoshi Imamine Yoshiyasu Obata Kimio Nakanishi Yoshiyasu Taniguchi Maiko Amano chika omori Takafumi Okura Department of Community Emergency Medicine Ehime University Graduate School of MedicineEhimeJapan Department of Cardiology Yawatahama City General HospitalEhimeJapan Department of Internal Medicine Oozu City HospitalEhimeJapan Department of Clinical Laboratory Oozu City HospitalEhimeJapan

Registries and hospital discharge datasets of unselected patients with pulmonary embolism show 30-day all-cause mortality rates of approximately 10%.[1]Clinical findings from histories and physical examinations,such as age,systemic blood pressure,and respiratory rate at presentation,classify patients into risk classes of increasing risk of death and other adverse medical outcomes.

关键词： mortality patients Clinical

Unilateral branch retinal artery occlusion in association with COVID-19:a case report

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International Journal of Ophthalmology(English edition) 2024年第4期17卷 777-782页

作者： Kunihiko Hirosawa Takenori Inomata Jaemyoung Sung Yuki Morooka Tianxiang Huang Yasutsugu Akasaki Yuichi Okumura Ken Nagino Kaho omori Shintaro Nakao Department of Ophthalmology Juntendo University Graduate School of Medicine2-1-1 HongoBunkyo-kuTokyo 113-0033Japan Department of Digital Medicine Juntendo University Graduate School of Medicine2-1-1 HongoBunkyo-kuTokyo 113-0033Japan Department of Telemedicine and Mobile Health Juntendo University Graduate School of Medicine2-1-1 HongoBunkyo-kuTokyo 113-0033Japan Department of Hospital Administration Juntendo University Graduate School of Medicine2-1-1 HongoBunkyo-kuTokyo 113-0033Japan AI Incubation Farm Juntendo University Graduate School of Medicine2-1-1 HongoBunkyo-kuTokyo 113-0033Japan Department of Ophthalmology Tulane University School of MedicineNew OrleansLA 70112USA

Dear Editor,I am Kunihiko Hirosawa of the Department of Ophthalmology at Juntendo University Hospital.I am writing to present a case of concomitant Coronavirus Disease 2019(COVID-19)with branch retinal artery occlusion(BRAO).BRAO presents as a sudden,painless loss of vision on the afflicted side and is most often focal in nature[1].

关键词： branch COV occlusion

Tumor size discrepancy between endoscopic and pathological evaluations in colorectal endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2024年第3期16卷 136-147页

作者： Takeshi Onda Osamu Goto Toshiaki Otsuka Yoshiaki Hayasaka Shun Nakagome Tsugumi Habu Yumiko Ishikawa Kumiko Kirita Eriko Koizumi Hiroto Noda Kazutoshi Higuchi Jun omori Naohiko Akimoto Katsuhiko Iwakiri Department of Gastroenterology Nippon Medical SchoolGraduate School of MedicineBunkyo-ku 113-8603TokyoJapan Endoscopy Center Nippon Medical School HospitalBunkyo-ku 113-8603TokyoJapan Department of Hygiene and Public Health Nippon Medical SchoolBunkyoku 113-8603TokyoJapan Center for Medical Education Nippon Medical SchoolBunkyo-ku 113-8603TokyoJapan

BACKGROUND Tumor size impacts the technical difficulty and histological curability of colorectal endoscopic submucosal dissection(ESD);however,the preoperative evaluation of tumor size is often different from histological assessment.Analyzing influential factors on failure to obtain an accurate tumor size evaluation could help prepare optimal conditions for safer and more reliable ESD.METHODS This was a retrospective study conducted at a single institution.A total of 377 lesions removed by colorectal ESD at our hospital between April 2018 and March 2022 were collected.We first assessed the difference in size with an absolute per-centage of the scaling discrepancy.Subsequently,we compared the clinicopatho-logical characteristics of the correct scaling group(>-33%and33%),which was further subdivided into the underscaling group(-33%or less of the discrepancy)and overscaling group(33%or more of the discrepancy),respectively.As secondary outcome measures,parameters on size estimation were compared between the underscaling and correct scaling groups,as well as between the overscaling and correct scaling groups.Finally,multivariate analysis was performed in terms of the following relevant parameters on size estimation:Pathological size,location,and possible influential factors(P<0.1)in the univariate analysis.RESULTS The mean of absolute percentage in the scaling discordance was 21%,and 91 lesions were considered to be incorrectly estimated in size.The incorrect scaling was significantly remarkable in larger lesions(40 mm vs 28 mm;P<0.001)and less experience(P<0.001),and these two factors were influential on the underscaling(75 lesions;P<0.001).Conversely,compared with the correct scaling group,16 lesions in the overscaling group were significantly small(20 mm vs 28 mm;P<0.001),and the small lesion size was influential on the overscaling(P=0.002).CONCLUSION Lesions indicated for colorectal ESD tended to be underestimated in large tumors,but overestimated in small one

关键词： Endoscopic submucosal dissection Colorectal tumor Tumor size Size estimation Size discrepancy

Risk factors for small intestinal adenocarcinomas that are common in the proximal small intestine

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World Journal of Gastroenterology 2022年第39期28卷 5658-5665页

作者： Shunji Fujimori Ryohei Hamakubo Aitoshi Hoshimoto Takayoshi Nishimoto Jun omori Naohiko Akimoto Shu Tanaka Atsushi Tatsuguchi Katsuhiko Iwakiri Department of Gastroenterology Chiba Hokusoh HospitalNippon Medical SchoolChiba 270-1694Japan Department of Gastroenterology Nippon Medical SchoolGraduate School of MedicineTokyo 113-8603Japan Department of Gastroenterology Tama-Nagayama HospitalNippon Medical SchoolTokyo 206-0025Japan

The frequency of primary small intestinal adenocarcinoma is increasing but is still low.Its frequency is approximately 3%of that of colorectal adenocarcinoma.Considering that the small intestine occupies 90%of the surface area of the gastrointestinal tract,small intestinal adenocarcinoma is very rare.The main site of small intestinal adenocarcinoma is the proximal small intestine.Based on this characteristic,dietary animal proteins/lipids and bile concentrations are implicated and reported to be involved in carcinogenesis.Since most nutrients are absorbed in the proximal small intestine,the effect of absorbable intestinal content is a suitable explanation for why small intestinal adenocarcinoma is more common in the proximal small intestine.The proportion of aerobic bacteria is high in the proximal small intestine,but the absolute number of bacteria is low.In addition,the length and density of villi are greater in the proximal small intestine.However,the involvement of villi is considered to be low because the number of small intestinal adenocarcinomas is much smaller than that of colorectal adenocarcinomas.On the other hand,the reason for the low incidence of small intestinal adenocarcinoma in the distal small intestine may be that immune organs reside there.Genetic and disease factors increase the likelihood of small intestinal adenocarcinoma.In carcinogenesis experiments in which the positions of the small and large intestines were exchanged,tumors still occurred in the large intestinal mucosa more often.In other words,the influence of the intestinal contents is small,and there is a large difference in epithelial properties between the small intestine and the large intestine.In conclusion,small intestinal adenocarcinoma is rare compared to large intestinal adenocarcinoma due to the nature of the epithelium.It is reasonable to assume that diet is a trigger for small intestinal adenocarcinoma.

关键词： Small intestine Large intestine Adenocarcinoma Risk factor Carcinogenesis

Protein-losing enteropathy caused by a jejunal ulcer after an internal hernia in Petersen's space: A case report

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World Journal of Clinical Cases 2022年第1期10卷 323-330页

作者： Tomohiko Yasuda Nobuyuki Sakurazawa Komei Kuge Jun omori Hiroki Arai Daisuke Kakinuma Masanori Watanabe Hideyuki Suzuki Katsuhiko Iwakiri Hiroshi Yoshida Department of Gastrointestinal Surgery Nippon Medical School Chiba Hokusoh HospitalChiba 270-1694Japan Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery Nippon Medical SchoolTokyo 113-8603Japan Department of Gastroenterology Nippon Medical SchoolTokyo 113-8603Japan

BACKGROUND The incidence of internal hernias has recently increased in concordance with the popularization of laparoscopic surgery.Of particular concern are internal hernias occurring in Petersen's space,a space that is surgically created after treatment for gastric cancer and obesity.These hernias cause devastating sequelae,such as massive intestinal necrosis,fatal Roux limb necrosis,and superior mesenteric vein thrombus.In addition,protein-losing enteropathy(PLE)is a rare syndrome involving gastrointestinal protein loss,although its relationship with internal Petersen’s hernias remains unknown.CASE SUMMARY A 75-year-old man with a history of laparotomy for early gastric cancer developed Petersen's hernia 1 year and 5 mo after surgery.He was successfully treated by reducing the incarcerated small intestine and closure of Petersen’s defect without resection of the small intestine.Approximately 3 mo after his surgery for Petersen’s hernia,he developed bilateral leg edema and hypoalbuminemia.He was diagnosed with PLE with an alpha-1 antitrypsin clearance of 733 mL/24 h.Double-balloon enteroscopy revealed extensive jejunal ulceration as the etiology,and it facilitated minimum bowel resection.Pathological analysis showed extensive jejunal ulceration and collagen hyperplasia with nonspecific inflammation of all layers without lymphangiectasia,lymphoma,or vascular abnormalities.His postoperative course was unremarkable,and his bilateral leg edema and hypoalbuminemia improved after 1 mo.There was no relapse over the 5-year follow-up period.CONCLUSION PLE and extensive jejunal ulceration may occur after Petersen's hernia.Doubleballoon enteroscopy helps identify and resect these lesions.

关键词： Internal hernia Ulcer Protein-losing enteropathy Double-balloon enteroscopy Ischemia-reperfusion injury Case report

Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by the tumor microenvironment

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World Journal of Gastroenterology 2023年第40期29卷 5566-5581页

作者： Aitoshi Hoshimoto Atsushi Tatsuguchi Ryohei Hamakubo Takayoshi Nishimoto Jun omori Naohiko Akimoto Shu Tanaka Shunji Fujimori Tsutomu Hatori Akira Shimizu Katsuhiko Iwakiri Department of Gastroenterology Nippon Medical SchoolTokyo 113-8603Japan Department of Analytic Human Pathology Nippon Medical SchoolTokyo 113-8603Japan Department of Pathology Nippon Medical SchoolChiba Hokusoh HospitalChiba 270-1694Japan

BACKGROUND Comprehensive genomic analysis has shown that small bowel adenocarcinoma(SBA)has different genomic profiles from gastric and colorectal cancers.Hence,it is essential to establish chemotherapeutic regimens based on SBA characteristics.The expression of programmed cell death-ligand 1(PD-L1)and programmed cell death-ligand 2(PD-L2)in SBA is not fully understood.Anti-PD-L1/PD-1 therapy uses tumor-infiltrating lymphocytes(TILs);therefore,the status of TILs in the tumor microenvironment(TME)may influence their efficacy.The ratio of FoxP3+to CD8+T cells has been reported to be useful in predicting the prognosis of digestive system cancers.AIM To investigate the clinicopathological significance of PD-L1/2 expression according to the status of TILs in SBA tissues.METHODS We performed immunohistochemical analysis for PD-L1,PD-L2,CD8,FoxP3,and DNA mismatch repair(MMR)proteins using formalin-fixed,paraffin-embedded tissues from 50 patients diagnosed with primary SBA.The immunoreactivities of PD-L1 and PD-L2 were determined separately in tumor cells and tumor-infiltrating immune cells throughout the tumor center and invasive margins,and finally evaluated using the combined positive score(CPS).We assessed CD8+and FoxP3+T cells in the intratumoral and tumor-surrounding stroma.Subsequently,we calculated and summed the ratio of FoxP3 to CD8+T cell counts.Immune-related cell densities were graded as low or high.Immunohistochemical results were compared with clinicopathological factors and patient prognosis.The distribution of cancer-specific survival(CSS)was estimated using the Kaplan–Meier method,and the log-rank test was used to test for significant differences in CSS.A Cox proportional hazard model was also used to assess the effect of tumor variables on CSS.RESULTS PD-L1 expression was positive in 34%in tumor cells(T-PD-L1)and 54%in tumor-infiltrating immune cells(I-PDL1)of the cases examined.T-PD-L2 was positive in 34%and I-PD-L2 was positive in 42%of the cases.PD-L1 CPS≥10 and PD-L2 CPS≥10 were observed in 50%and

关键词： Small bowel adenocarcinoma Programmed cell death-ligand 1 Programmed cell death-ligand 2 Tumor microenvironment Tumor-infiltrating lymphocytes Regulatory T-cells

Identification of Large Deletion of Ccs Responsible for Non-Red Fruit Color in Pepper (Capsicum annuum) and Development of DNA Marker to Distinguish the Deletion

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American Journal of Plant Sciences 2022年第9期13卷 1233-1246页

作者： Shiho omori Tsuneo Sasanuma Laboratory of Plant Genetics and Breeding Faculty of Agriculture Yamagata University Tsuruoka Japan

Chili pepper (Capsicum spp.) fruit color is an important agronomical trait. It has been known that a large deletion in the 5' upstream region of the Ccs gene generates non-red fruit color in pepper, but the accurate size and position of the deletion and whether all the non-red cultivars had the same large deletion or not were unclarified. In this study, to identify the Ccs upstream large deletion, we carried out diagnostic PCR using six forward primers at 300 - 900 bp intervals in the 5' untranslated region of Ccs with a fixed reverse primer for a yellow fruit pepper “Sonia Gold”. Then it was revealed that 4430 bp from -3234 bp position in upstream region to 1196 bp position in exon was deleted in Ccs of “Sonia Gold”. The allele having this deletion was named ccs-del. Probably this allele is substantially the same as ccs-p1 having 4879 bp deletion reported previously. Based on the sequence determined, we developed a PCR marker to distinguish ccs-del. Genotyping of 16 cultivars of C. annuum showed that 14 had ccs-del and the remaining two had another mutant allele ccs-3. This result indicates that ccs-del is the most common allele and widely shared in non-red fruit cultivars in C. annuum. Genotyping of 16 cultivars of C. chinense clarified that one cultivar each possessed ccs-del and ccs-3. These results indicate that major alleles responsible for non-red fruit color in C. annuum were shared across species throughout interspecific introgression.

关键词： Non-Red Fruit Pepper Ccs Identification of Large Deletion ccs-3 Development of DNA Marker

Efficacy of direct-acting antiviral treatment for chronic hepatitis C: A single hospital experience

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World Journal of Hepatology 2018年第1期10卷 88-94页

作者： Rena Kaneko Natsuko Nakazaki Risa omori Yuichiro Yano Masazumi Ogawa Yuzuru Sato Department of Gastroenterology Japan Organization of Occupational Health and Safety Kanto Rosai Hospital

AIM To evaluate the efficacy of direct-acting antivirals(DAAs) in Kanto Rosai Hospital. METHODS All patients with hepatitis C virus(HCV) who underwent DAA prescription were enrolled in this study. The present study was a single center retrospective analysis using patients infected with HCV genotype 1 or 2. Resistance analysis was performed by using direct sequencing and cycleave PCR in genotype 1 patients treated with interferon(IFN)-free DAA. The primary endpoint was sustained virologic response at 12 wk after therapy(SVR12).RESULTS A total of 117 patients participated in the study, including 135 with genotype 1 and 42 with genotype 2. Of the 135 patients with genotype 1, 16 received protease inhibitor + IFN + ribavirin and all achieved SVR. Of the 119 patients who received IFN-free DAA(in different combinations), 102 achieved SVR and 9 failed(7/9 were on daclatasvir/asunaprevir and 2/9 on ledipasvir/sofosbuvir). Efficacy analysis was done only for 43 patients who received daclatasvir/asunaprevir. From this analysis, Y93 resistance-associated substitutions were significantly correlated with SVR.CONCLUSION The SVR rate was 98% for genotype 1 and 100% for genotype 2. However, caution is needed for HCV NS5 A resistance-associated substitutions that are selected by HCV NS5 A inhibitors because cerebrovascular adverse events are induced by some DAA drugs.

关键词： Resistance-associated substitutions Directacting antivirals Sustained viral response Hepatitis C

Presence of columnar-lined esophagus is negatively associated with the presence of esophageal varices in Japanese alcoholic men

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World Journal of Gastroenterology 2017年第39期23卷 7150-7159页

作者： Akira Yokoyama Kenro Hirata Rieko Nakamura Tai omori Takeshi Mizukami Junko Aida Katsuya Maruyama Tetsuji Yokoyama National Hospital Organization Kurihama Medical and Addiction Center Division of Gastroenterology and Hepatology Department of Internal Medicine School of Medicine Keio University Department of Health Promotion National Institute of Public HealthSaitama Endoscopy Center Kawasaki Municipal Ida Hospital Research Team for Geriatric Pathology Tokyo Metropolitan Institute of Gerontology

AIM To determine whether the presence of columnar-lined esophagus(CLE) is associated with the presence of esophageal varices(EVs) in male Japanese alcoholics. METHODS The subjects were 1614 Japanese alcohol-dependent men(≥ 40 years of age) who had undergone upper gastrointestinal endoscopic screening. Digitalized records of high-quality endoscopic images that included the squamocolumnar junction and esophagogastric junction were retrospectively jointly reviewed by four expert endoscopists for the purpose of diagnosing CLE. The authors investigated whether and to what extent there were associations between the presence of CLE and the presence of EVs, especially in the group with liver cirrhosis(LC).RESULTS CLE ≥ 5 mm in length was found in 355 subjects(≥ 30 mm in 6 of them), LC without EVs in 152 subjects, LC with EVs in 174 subjects, and EVs without LC in 6 subjects. Advanced EVs, i.e., nodular, large or coiled forms, red color sign, or post-treatment, were found in 88 subjects. The incidence of CLE ≥ 5 mm decreased in the following order(P < 0.0001): 23.3% in the group without EVs, 17.4% in the group with small and straight EVs, and 5.7% in the group with advanced EVs. The multivariate ORs(95%CI) for EVs and advanced EVs in the group with LC were lower when CLE ≥ 5 mm was present [0.46(0.23-0.93) and 0.24(0.08-0.74), respectively, vs 0-4 mm CLE]. CONCLUSION The presence of CLE in male Japanese alcoholics was negatively associated with the presence of EVs.

关键词：酒精圆柱线的食管 Hiatal 脱肠肝肝硬化门高血压食道的静脉曲张

Evaluation Method of the Gait Motion Based on Self-organizing Map Using the Gravity Center Fluctuation on the Sole

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International Journal of Automation and computing 2017年第5期14卷 603-614页

作者： Koji Makino Masahiro Nakamura Hidenori omori Yoshinobu Hanagata Shohei Ueda Kyosuke Nakagawa Kazuyoshi Ishida Hidetsugu Terada Graduate School of Engineering University of YamanashiKofuYamanashi 400-8511Japan Kofu Municipal Hospital KofuYamanashi 400-0832Japan

This paper describes the evaluation method of the gait motion in walk rehabilitation. We assume that the evaluation consists of the classification of the measured data and the prediction of the feature of the gait motion. The method may enable a doctor and a physical therapist to recognize the condition of the patients more easily, and increase the motivation of patient further for rehabilitation. However, it is difficult to divide the gait motion into discrete categories, since the gait motion continuously changes and does not have the clear boundaries. Therefore, the self-organizing map （SOM） that is able to arrange the continuous data on the almost continuous map is employed in order to classify them. And, the feature of the gait motion is predicted by the classification. In this study, we adopt the gravity-center fluctuation （GCF） on the sole as the measured data. First, it is shown that the pattern of the CCF that is obtained by our developed measurement system includes the feature of the gait motion. Secondly, the relation between the pattern of the GCF and the feature of the gait motion that the doctor and the physical therapist evaluate by visual inspection is considered using the SOM. Next, we describe the prediction of following features measured by numerical values： the length of stride, the velocity of walk and the difference of steps that are important for the doctor and the physical therapist to make a diagnosis of the condition of the gait motion in walk rehabilitation. Finally, it is investigated that the position of a new test data that is arranged on the map accords with the prediction. As a consequence, we confirm that the method using the SOM is often useful to classify and predict the condition of the patient.

关键词： Gait motion self-organizing map （SOM） rehabilitation evaluation method gravity center fluctuation （GCF）.