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Usefulness of a novel slim type Flush Knife-BT over conventional Flush Knife-BT in esophageal endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第9期23卷 1657-1665页

作者： Yoshiko Ohara Takashi Toyonaga Namiko Hoshi Shinwa Tanaka Shinichi Baba Hiroshi Takihara fumiaki kawara Tsukasa Ishida Yoshinori Morita Eiji Umegaki Takeshi Azuma Division of Gastroenterology Department of Internal MedicineGraduate School of MedicineKobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

To investigated the usefulness of a novel slim type ball-tipped FlushKnife (FlushKnife-BTS) over ball-tipped FlushKnife (FlushKnife-BT) in functional experiments and clinical *** order to evaluate the functionality of FlushKnife-BTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between FlushKnife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using FlushKnife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were *** experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with FlushKnife-BTS was 7.7-fold faster than that with conventional FlushKnife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushKnife-BTS. The waterjet flushing speed was faster with the use of FlushKnife-BT. In clinical practice, a comparison of 6 and 7 ESD using FlushKnife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min (range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with FlushKnife-BTS when the resection size was larger than 1000 m2 (n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15) (P = 0.0065).CONCLUSIONOur results indicate that FlushKnife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspirat

关键词： Endoscopic submucosal dissection Novel slim type ball-tipped FlushKnife Ball-tipped FlushKnife Resistance to knife insertion Water aspiration speed

Gastric plexiform fibromyxoma resected by endoscopic submucosal dissection after observation of chronological changes:A case report

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World Journal of Gastrointestinal Oncology 2017年第6期9卷 263-267页

作者： fumiaki kawara Shinwa Tanaka Takashi Yamasaki Yoshinori Morita Yoshiko Ohara Yoshihiro Okabe Namiko Hoshi Takashi Toyonaga Eiji Umegaki Hiroshi Yokozaki Takanori Hirose Takeshi Azuma Division of Gastroenterology Department of Internal MedicineKobe University Graduate School of Medicine Division of Pathology Department of PathologyKobe University Graduate School of Medicine Department of Diagnostic Pathology Hyogo Cancer Center

A 66-year-old man was diagnosed with a gastric submucosal tumor. Endoscopic ultrasound(EUS) revealed an iso/hypoechoic mass in the third layer. No malignant cells were detected in a histological examination. Yearly follow-up endoscopy and EUS showed the slow growth of the tumor. Endoscopic submucosal dissection(ESD) was performed and a glistening tumor was resected. The lesion showed a multinodular plexiform growth pattern consisting of spindle cells with an abundant fibromyxoid stroma that was rich in small vessels. The tumor was diagnosed as plexiform fibromyxoma(PF) by immunohistochemistry. Although difficulties are associated with reaching a diagnosis preoperatively, chronological changes on EUS may contribute to the diagnosis of PF. ESD may also be useful in the diagnosis and treatment of PF.

关键词： Plexiform fibromyxoma Plexiform angiomyxoid myofibroblastic tumor Endoscopic ultrasound Endoscopic submucosal dissection Gastrointestinal stromal tumor

Efficacy of forced coagulation with low high-frequency power setting during endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第29期23卷 5422-5430页

作者： Tsukasa Ishida Takashi Toyonaga Yoshiko Ohara Tadao Nakashige Yasuaki Kitamura Ryusuke Ariyoshi Hiroshi Takihara Shinichi Baba Tetsuya Yoshizaki fumiaki kawara Shinwa Tanaka Yoshinori Morita Eiji Umegaki Namiko Hoshi Takeshi Azuma Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

To investigated the hemostatic ability of the S and F1-10 methods in clinical and ex vivo studies. METHODSThe hemostatic abilities of the two methods were analyzed retrospectively in all six gastric endoscopic submucosal dissection cases. The treated vessel diameter, compressed vessel frequency, and bleeding frequency after cutting the vessels were noted by the recorded videos. The coagulation mechanism of the two power settings was evaluated using the data recording program and histological examination on macro- and microscopic levels in the ex vivo experiments using porcine tissues. RESULTSF1-10 method showed a significantly better hemostatic ability for vessels ≥ 2 mm in diameter and a trend of overall better coagulation effect, evaluated by the bleeding rate after cutting the vessels. F1-10 method could sustain electrical current longer and effectively coagulate the tissue wider and deeper than the S method in the porcine model. CONCLUSIONF1-10 method is suggested to achieve a stronger hemostatic effect than the S method in clinical procedures and ex vivo models.

关键词： Endoscopic submucosal dissection Electrosurgery Endoknife Hemostatic effect The forced coagulation mode

Factors associated with residual gastroesophageal reflux disease symptoms in patients receiving proton pump inhibitor maintenance therapy

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World Journal of Gastroenterology 2017年第11期23卷 2060-2067页

作者： fumiaki kawara Tsuyoshi Fujita Yoshinori Morita Atsushi Uda Atsuhiro Masuda Masaya Saito Makoto Ooi Tsukasa Ishida Yasuyuki Kondo Shiei Yoshida Tatsuya Okuno Yoshihiko Yano Masaru Yoshida Hiromu Kutsumi Takanobu Hayakumo Kazuhiko Yamashita Takeshi Hirano Midori Hirai Takeshi Azuma Division of Gastroenterology Department of Internal MedicineKobe University Graduate School of Medicine Department of Pharmacy Kobe University Hospital

AIM To elucidate the factors associated with residual gastroesophageal reflux disease(GERD) symptoms in patients receiving proton pump inhibitor(PPI) maintenance therapy in clinical *** The study included 39 GERD patients receiving maintenance PPI therapy. Residual symptoms were assessed using the Frequency Scale for Symptoms of GERD(FSSG) questionnaire and the Gastrointestinal Symptom Rating Scale(GSRS). The relationships between the FSSG score and patient background factors, including the CYP2C19 genotype, were *** The FSSG scores ranged from 1 to 28 points(median score: 7.5 points), and 19 patients(48.7%) had a score of 8 points or more. The patients' GSRS scores were significantly correlated with their FSSG scores(correlation coefficient = 0.47, P < 0.005). In erosive esophagitis patients, the FSSG scores of the CYP2C19 rapid metabolizers(RMs) were significantly higher than the scores of the poor metabolizers and intermediate metabolizers(total scores: 16.7 ± 8.6 vs 7.8 ± 5.4, P < 0.05; acid reflux-related symptom scores: 12 ± 1.9 vs 2.5 ± 0.8, P < 0.005). In contrast, the FSSG scores of the CYP2C19 RMs in the non-erosive reflux disease patients were significantly lower than those of the other patients(total scores: 5.5 ± 1.0 vs 11.8 ± 6.3, P < 0.05; dysmotility symptom-related scores: 1.0 ± 0.4 vs 6.0 ± 0.8, P < 0.01). CONCLUSION Approximately half of the GERD patients receiving maintenance PPI therapy had residual symptoms associated with a lower quality of life, and the CYP2C19 genotype appeared to be associated with these residual symptoms.

关键词： Gastroesophageal reflux disease CYP2C19 FSSG Residual symptoms Proton pump inhibitor

Esophageal diverticulum exposed during endoscopic submucosal dissection of superficial cancer

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World Journal of Gastroenterology 2015年第10期21卷 3121-3126页

作者： Shinwa Tanaka Takashi Toyonaga Yoshiko Ohara Tetsuya Yoshizaki fumiaki kawara Tsukasa Ishida Namiko Hoshi Yoshinori Morita Takeshi Azuma Department of Endoscopy Kobe University Division of Gastroenterology Department of Internal MedicineGraduate School of MedicineKobe University

Endoscopic submucosal dissection(ESD) is now widely accepted as a strategy to treat superficial esophageal *** rate of adverse events,such as perforation,has been decreasing with the improvement of devices and *** this paper,we report a case of esophageal cancer that had a diverticulum under cancerous *** diverticulum was not detected during preoperative examination,and led to perforation during the ESD *** case shows that,although rare,some diverticula can exist underneath the mucosal surface without obvious *** there is any sign of hidden diverticula during ESD,surgeons should proceed with caution or,depending on the case,the procedure should be discontinued to avoid adverse events.

关键词： Endoscopic submucosal dissection Eso-phageal cance

Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids

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World Journal of Gastroenterology 2016年第27期22卷 6268-6275页

作者： Shinwa Tanaka Takashi Toyonaga Yoshinori Morita Namiko Hoshi Tsukasa Ishida Yoshiko Ohara Tetsuya Yoshizaki fumiaki kawara Eiji Umegaki Takeshi Azuma Department of Endoscopy Kobe University Hospital Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University

AIM: To evaluate the feasibility and safety of endoscopic submucosal dissection(ESD) for lower rectal lesions with ***: The outcome of ESD for 23 lesions with hemorrhoids(hemorrhoid group) was compared with that of 48 lesions without hemorrhoids extending to the dentate line(non-hemorrhoid group) during the same study period. RESULTS: Median operation times(ranges) in the hemorrhoid and non-hemorrhoid groups were 121(51-390) and 130(28-540) min. The en bloc resection rate and the curative resection rate in the hemorrhoid group were 96% and 83%, and they were 100% and 90% in the non-hemorrhoid group, respectively. In terms of adverse events, perforation and postoperative bleeding did not occur in both groups. In terms of the clinical course of hemorrhoids after ESD, the rate of complete recovery of hemorrhoids after ESD in lesions with resection of more than 90% was significantly higher than that in lesions with resection of less than 90%.CONCLUSION: ESD on lower rectal lesions with hemorrhoids could be performed safely, similarly to that on rectal lesions extending to the dentate line without hemorrhoids. In addition, all hemorrhoids after ESD improved to various degrees, depending on the resection range.

关键词： Endoscopic submucosal dissection Rectum Hemorrhoid Outcome Bleeding

Effects of Serum from a Fibrodysplasia Ossificans Progressiva Patient on Osteoblastic Cells

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Open Journal of Endocrine and Metabolic Diseases 2012年第1期2卷 1-6页

作者： Itoko Hisa Akira kawara Takenobu Katagiri Toshitsugu Sugimoto Hiroshi Kaji Division of Diabetes and Endocrinology Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan Division of Pathophysiology Research Center for Genomic Medicine Saitama Medical University Japan Internal Medicine 1 Shimane University Faculty of Medicine Izumo Japan kawara Clinic Kobe Japan

Introduction: Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder of skeletal malformations and progressive extraskeletal ossification. Patients and Methods: In the present study, we present a case of FOP with marked progressive ossification of extraskeletal tissues. We investigated whether soluble factors in serum would affect the osteoblast phenotype by examining the effects of serum from this patient and control subjects on mouse osteoblastic MC3T3-E1 cells. Results: The clinical findings of this patient were compatible with FOP, and direct sequence analysis of genomic DNA demonstrated the presence of a heterozygous 617G> A (R206H) mutation of activin type 1 receptor (ACVR1). Serum from the FOP patient enhanced the level of alkaline phosphatase (ALP) in Western blotting, compared with serum from the control, in MC3T3-E1 cells. Moreover, serum from the FOP patient enhanced the levels of ALP, osteocalcin and bone morphogenetic protein-2 mRNA in these cells. Conclusion: We presented a case of FOP with progressive ossification in extra-skeletal tissues with ACVR1 mutation. The present data suggest that the serum from this patient includes some soluble factors, which might enhance the osteoblast differentiation and BMP-2 expression in mouse osteoblastic cells.

关键词： Fibrodysplasia Ossificans Progressiva Osteoblast Bone Morphogenetic Protein

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用于液晶盒偶氮染料光致取向层的合成和性质

现代显示 2003年第4期 26-32页

作者：郭海成 Vladimir Chigrinov Elena Prudnikova Vladimir Kozenkov Hidenari Akiyama Tatsuo kawara Hirokazu Takada Haruyoshi Takatsu 香港科技大学大日本油墨化学工业公司

我们研究了可用于光致取向液晶(LCs)偶氮染料的合成和性质,提出了偶氮染料的结构与合成过程。偶氮染料光致取向完全是因为分子吸收振子垂直于UV光偏振方向的再取向。讨论了在偏振光场中,偶氮染料分子旋转扩散现象的定性模型。测量了波长... 详细信息

我们研究了可用于光致取向液晶(LCs)偶氮染料的合成和性质,提出了偶氮染料的结构与合成过程。偶氮染料光致取向完全是因为分子吸收振子垂直于UV光偏振方向的再取向。讨论了在偏振光场中,偶氮染料分子旋转扩散现象的定性模型。测量了波长为372nm时,偏振吸收光谱的有序参数S=-0.4(80%的最大绝对值Sm=-0.5)。对一个偶氮染料膜,利用在正常的正入射偏振光之后,紧跟一个斜入射的非偏振光两步曝光,可以获得温度稳定的5.3°预倾角。光致取向基片的方位角锚定能为Aφ≈10-4Jm-2,这与摩擦聚酰亚胺(PI)层的锚定能相同。我们发现,光致取向液晶盒的电压保持率甚至比摩擦PI层取向的还高,因此,偶氮染料完全可以用作有源矩阵液晶显示器的取向层。光致取向偶氮染料层的热稳定性很高,但UV稳定性需通过诸如聚合等来改良。于是,我们设想了一种新的基于聚合偶氮染料层的LCD取向技术。

关键词：光致取向液晶盒偶氮染料光致取向偏振光场聚合偶氦染料层

Effects of Serum from a Fibrodysplasia Ossificans Progressiva Patient on Osteoblastic Cells

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