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Utility of FibroScan-based scoring systems to narrow the risk group of nonalcoholic fatty liver disease with comorbidities

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World Journal of Gastrointestinal Pathophysiology 2022年第3期13卷 96-106页

作者： Kouichi Miura Hiroshi Maeda Naoki Morimoto Shunji Watanabe Mamiko Tsukui Yoshinari Takaoka Hiroaki Nomoto Rie Goka Kazuhiko Kotani hironori yamamoto Department of Medicine Division of GastroenterologyJichi Medical University School of Medicine3311-1 YakushijiShimotsuke 329-0498TochigiJapan Division of Community and Family Medicine Center for Community MedicineJichi Medical University3311-1 YakushijiShimotsuke 329-0498Japan

BACKGROUND Vibration-controlled transient elastography(VCTE)is proposed as a second step of examination to assess liver fibrosis in patients with nonalcoholic fatty liver disease(NAFLD)after triaging by the fibrosis-4(FIB-4)index.Recently,VCTEbased scoring systems,including FibroScan-AST(FAST),Agile 3+,and Agile 4,emerged to determine the status of NAFLD.However,the significance of these scoring systems remains unknown in narrowing the high-risk group of NAFLD patients with comorbidities,including hepatocellular carcinoma(HCC)and esophagogastric varices(EGV).AIM To clarify the significance of VCTE-based scoring systems to narrow the high-risk group of NAFLD patients with comorbidities.METHODS We performed a cross-sectional study to investigate the usefulness of VCTE-based scoring systems and other fibrosis markers to narrow the high-risk group of patients with NAFLD.FIB-4 index was used for the first triage.Risk groups of FAST,Agile 3+,and Agile 4 were stratified according to the published data.Among the 191 patients with NAFLD,there were 26(14%)and 25 patients(13%)with HCC and EGV,respectively.RESULTS When 1.3 was used as a cutoff value,the FIB-4 index narrowed the risk group to 120 patients,in which all patients with HCC and/or EGV were included.High risk group of Agile 3+could subsequently narrow the risk group.The prevalence of HCC and EGV at this step were 33%(26/80)and 31%(25/80),respectively.In further narrowing of EGV,Agile 4 aggregated the patients with EGV into 43 patients,of whom 23(53%)had EGV.FAST failed to narrow the risk group of patients with comorbidities.When 2.6 was used as a cutoff value of the FIB-4 index,three patients with HCC and two patients with EGV were missed at the first triage.CONCLUSION Agile 3+and Agile 4 are useful to narrow the NAFLD patient group,in which patients may have HCC and/or EGV.

关键词： Nonalcoholic fatty liver disease Vibration controlled transient elastography Non-invasive test Hepatocellular carcinoma Varix

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Clinical outcomes of enteroscopy using the double-balloon method for strictures of the small intestine

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World Journal of Gastroenterology 2005年第7期11卷 1087-1089页

作者： Keijiro Sunada hironori yamamoto Hiroto Kita Tomonori Yano Hiroyuki Sato Yoshikazu Hayashi Tomohiko Miyata Yutaka Sekine Akiko Kuno Michiko Iwamoto Hirohide Ohnishi Kenichi Ido Kentaro Sugano Department of Internal Medicine

AIM: To evaluate the clinical outcome of enteroscopy, using the double-balloon method, focusing on the involvement of neoplasms in strictures of the small intestine.METHODS: Enteroscopy, using the double-balloon method, was performed between December 1999 and December 2002 at Jichi Medical School Hospital, Japan and strictures of the small intestine were found in 17 out of 62 patients. These 17 consecutive patients were subjected to analysis.RESULTS: The double-balloon enteroscopy contributed to the diagnosis of small intestinal neoplasms found in 3out of 17 patients by direct observation of the strictures as well as biopsy sampling. Surgical procedures were chosen for these three patients, while balloon dilation was chosen for the strictures in four patients diagnosed with inflammation without involvement of neoplasm.CONCLUSION: Double-balloon enteroscopy is a useful method for the diagnosis and treatment of strictures in the small bowel.

关键词：肠镜检查小肠狭窄检查方法临床应用

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Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy

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World Journal of Gastroenterology 2005年第31期11卷 4861-4864页

作者： Yoshikazu Hayashi hironori yamamoto Hiroto Kita Keijiro Sunada Hiroyuki Sato Tomonori Yano Michiko Iwamoto Yutaka Sekine Tomohiko Miyata Akiko Kuno Takaaki Iwaki Yoshiyuki Kawamura Hironari Ajibe Kenichi Ido Kentaro Sugano Department of Internal Medicine

AIM: To clarify clinical features of the NSAID-induced small bowel lesions using a new method of endoscopy.METHODS: This is a retrospective study and we analyzed seven patients with small bowel lesions while taking NSAIDs among 61 patients who had undergone doubleballoon endoscopy because of gastro-intestinal bleeding or anemia between September 2000 and March 2004, at Jichi Medical School Hospital in Japan. Neither conventional EGD nor colonoscopy revealed any lesions of potential bleeding sources including ulcerations. Double-balloon endoscopy was carried out from oral approach in three patients, from anal approach in three patients, and from both approaches in one patient.RESULTS: Ulcers or erosions were observed in the ileum in six patients and in the jejunum in one patient, respectively.The ulcers were multiple in all the patients with different features from tiny punched out ulcers to deep ulcerations with oozing hemorrhage or scar. All the patients recovered uneventfully and had full resolution of symptoms after suspension of the drug.CONCLUSION: NSAIDs can induce injuries in the small bowel even in patients without any lesions in both the stomach and colon.

关键词：抗炎症药小肠损伤双球内窥镜检查方法

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Diagnosis of a submucosal mass at the staple line after sigmoid colon cancer resection by endoscopic cuttingmucosa biopsy

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World Journal of Gastrointestinal Endoscopy 2016年第8期8卷 374-377页

作者： Mitsuaki Morimoto Koji Koinuma Alan K Lefor Hisanaga Horie Homare Ito Naohiro Sata Yoshikazu Hayashi Keijiro Sunada hironori yamamoto Department of Surgery Jichi Medical University Department of Gastroenterology Jichi Medical University

A 48-year-old man underwent laparoscopic sigmoid colon resection for cancer and surveillance colonoscopy was performed annually thereafter. Five years after the resection, a submucosal mass was found at the anastomotic staple line, 15 cm from the anal verge. Computed tomography scan and endoscopic ultrasound were not consistent with tumor recurrence. Endoscopic mucosa biopsy was performed to obtain a definitive diagnosis. Mucosal incision over the lesion with the cutting needle knife technique revealed a creamy white material, which was completely removed. Histologic examination showed fibrotic tissue without caseous necrosis or tumor cells. No bacteria, including mycobacterium, were found on culture. The patient remains free of recurrence at five years since the resection. Endoscopic biopsy with a cutting mucosal incision is an important technique for evaluation of submucosal lesions after rectal resection.

关键词： Submucosal tumor Staple line Endoscopic cutting-mucosa biopsy

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早胃的癌症用的程度的诊断灵活光谱成像颜色改进

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World Journal of Gastrointestinal Endoscopy 2012年第8期4卷 356-361页

作者： Hiroyuki Osawa hironori yamamoto Yoshimasa Miura Mitsuyo Yoshizawa Keijiro Sunada Kiichi Satoh Kentaro Sugano Department of Internal Medicine Division of Gastroen- terology Jichi Medical University Tochigi 329-0498 Japan

The demarcation line between the cancerous lesion and the surrounding area could be easily recognized with flexible spectral imaging color enhancement (FICE) system compared with conventional white light images. The characteristic f inding of depressed-type early gastric cancer (EGC) in most cases was revealed as reddish lesions distinct from the surrounding yellowish non-cancerous area without magnification. Conventional endoscopic images provide little information regarding depressed lesions located in the tangential line, but FICE produces higher color contrast of such cancers. Histological f indings in depressed area with reddish col- or changes show a high density of glandular structure and an apparently irregular microvessel in intervening parts between crypts, resulting in the higher color con- trast of FICE image between cancer and surrounding area. Some depressed cancers are shown as whitish lesion by conventional endoscopy. FICE also can pro- duce higher color contrast between whitish cancerous lesions and surrounding atrophic mucosa. For nearly flat cancer, FICE can produce an irregular structuralpattern of cancer distinct from that of the surrounding mucosa, leading to a clear demarcation. Most elevated-type EGCs are detected easily as yellowish lesions with clearly contrasting demarcation. In some cases, a partially reddish change is accompanied on the tumor surface similar to depressed type cancer. In addition, the FICE system is quite useful for the detection of minute gastric cancer, even without magnif ication. These new contrasting images with the FICE system may have the potential to increase the rate of detection of gastric cancers and screen for them more effectively as well as to determine the extent of EGC.

关键词： Early gastric cancer Flexible spectral imag- ing color enhancement Nonmagnified image Magnified image Endoscopic submucosal dissection

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Photo-Induced Reduction Reaction of Methylene Blue in an Ionic Liquid

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International Journal of Organic Chemistry 2011年第4期1卷 158-161页

作者： Jun-ichi Kadokawa hironori Izawa Tomoya Ohta Satoshi Wakizono Kazuya yamamoto 不详

Reduction of methylene blue (MB) occurred by photo irradiation at 280 - 370 nm wavelengths to a solution of MB in an ionic liquid, 1-butyl-3-methylimidazolium chloride (BMIMCl), which was confirmed by color change and UV-Vis measurement of the solution. Furthermore, the reduced MB was oxidized again by standing the solution under the conditions of light shielding at 50?C. The fluorescence spectra of the solution excited at 350 nm suggested that the photo-induced reduction probably took place via electron-transfer from BMIMCl to MB.

关键词： Methylene Blue Ionic Liquid Reduction Photo Irradiation

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Implementation of an educational program for pancreaticoduodenectomy in a university hospital: a retrospective observational study

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Journal of Pancreatology 2021年第2期4卷 99-105页

作者： Sohei Satoi Tomohisa yamamoto So Yamaki Satoshi Hirooka Daisuke Hashimoto Tatsuma Sakaguchi hironori Ryota Rintaro Yui Kazuto Sakuramoto Hideyuki Matsushima Hiroaki Yanagimoto Hideyoshi Toyokawa Taku Michiura Kentaro Inoue Mitsugu Sekimoto Department of Surgery Kansai Medical UniversityOsakaJapan

Objective:No ideal training system exists for pancreaticoduodenectomy(PD).We developed an educational system that uses an objective structured assessment of technical skills.Methods:This retrospective observational study was conducted using the data of consecutive trainees and patients who underwent PD from 2007 to 2013 in Kansai Medical University Hospital.The total score on the task checklist(21 parameters)for measuring technical performance during PD by self assessment and instructor assessment was compared between junior(JN)and hepatobiliary pancreatic(HBP)trainees at a university hospital.Surgical outcomes of 303 PDs(2007-2013)were also compared among JN trainees,HBP trainees,and instructors,and the present position of the trainees was investigated.This study was approved by the institutional review board of Kansai Medical University on May 26,2020.Results:The self-assessment score on the task checklist was significantly higher for the HBP trainees than for the JN trainees on all parts of PD(P<.001).The discrepancy between self-assessment and instructor assessment improved in 3 JN trainees after experience with the first 5 PDs.Although total score curves rose to the right in the JN group,scores in the HBP group were stable,at 70 or higher,which correlated with the instructor assessment.The 90-day and 30-day mortality rates were 1.6%and 0.3%,respectively.Mortality and morbidity after PD did not differ between the JN and HBP trainees or between the instructors and the trainees.Four of 10 trainees became board-certified expert surgeons of the Japanese Society of Hepatobiliary Pancreatic Surgery.Conclusion:These results indicated good construct validity of the task checklist system.This program was safely and effectively implemented in terms of surgical outcomes and final outcomes of trainees becoming board-certified expert surgeons.

关键词： Educational program Morbidity Mortality OSATS Pancreaticoduodenectomy

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MicroRNA-31 expression in colorectal serrated pathway progression

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World Journal of Gastroenterology 2014年第34期20卷 12346-12349页

作者： hironori Aoki Katsuhiko Nosho Hisayoshi Igarashi Miki Ito Kei Mitsuhashi Takafumi Naito Eiichiro yamamoto Tokuma Tanuma Masafumi Nomura Hiroyuki Maguchi Toshiya Shinohara Hiromu Suzuki Hiroyuki yamamoto Yasuhisa Shinomura Center for Gastroenterology Teine-Keijinkai HospitalSapporo 006-0811Japan Department of Gastroenterology Rheumatology and Clinical ImmunologySapporo Medical University School of MedicineSapporo 060-8543Japan Department of Gastroenterology Rheumatology andClinical ImmunologySapporo Medical University School of MedicineSapporo 060-8543Japan Department of Pathology Teine-KeijinkaiHospitalSapporo 006-0811Japan Department of Molecular Biology SapporoMedical University School of MedicineSapporo 060-8543Japan Division of Gastroenterology and Hepatology Department of Internal MedicineSt. Marianna University School of MedicineKawasaki 216-8511Japan

MicroRNAs have been increasingly recognized as useful biomarkers for colorectal cancers(CRC).We have recently observed that microRNA-31(miR-31)expression is associated with BRAF mutation and prognosis in CRC.Moreover,high miR-31 expression is frequently detected in sessile serrated adenomas compared with hyperplastic polyps(HPs).These results suggest that miR-31 may contribute to the progression of serrated lesions.At a follow-up colonoscopy,we observed the case of a 75-year-old man with a 7-mm flat-elevated lesion in the cecum and diagnosed the lesion as an early invasive carcinoma with serrated features.Tissue specimens were obtained from the representative areas to compare the molecular alterations in the carcinoma component with those in the HP component.Higher miR-31 expression was observed in the carcinoma component(57-fold increase)and the HP component(8-fold increase)compared with the paired normal mucosa,suggesting that miR-31 may be one of the key molecules in serrated pathway progression.

关键词： BRAF Colorectal carcinoma MicroRNA-31 MLH1 Microsa

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IGF2 differentially methylated region hypomethylation in relation to pathological and molecular features of serrated lesions

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World Journal of Gastroenterology 2014年第29期20卷 10050-10061页

作者： Takafumi Naito Katsuhiko Nosho Miki Ito Hisayoshi Igarashi Kei Mitsuhashi Shinji Yoshii hironori Aoki Masafumi Nomura Yasutaka Sukawa Eiichiro yamamoto Yasushi Adachi Hiroaki Takahashi Masao Hosokawa Masahiro Fujita Toshinao Takenouchi Reo Maruyama Hiromu Suzuki Yoshifumi Baba Kohzoh Imai Hiroyuki yamamoto Shuji Ogino Yasuhisa Shinomura Department of Gastroenterology Rheumatology and Clinical ImmunologySapporo Medical University School of Medicine Department of Gastroenterology Keiyukai Sapporo Hospital Center for Gastroenterology Teine-Keijinkai Hospital Department of Medical Oncolo-gy Dana-Farber Cancer InstituteBostonMA 02115United States Department of Surgery Keiyukai SapporoHospital Department of Pathology Keiyukai Sapporo Hospital Department of Molecular Biology Sapporo Medical University School of Medicine Department of Gastroenterological Surgery Graduate School of Medical ScienceKumamoto University Division of Cancer Research The Institute of Medical ScienceThe University of Tokyo Division of Gastroenterology and Hepatology Department of Internal MedicineSt.Marianna University School of Medicine

AIM:To investigate insulin-like growth factor 2(IGF2)differentially methylated region(DMR)0 hypomethylation in relation to clinicopathological and molecular features in colorectal serrated lesions.METHODS:To accurately analyze the association between the histological types and molecular features of each type of serrated lesion,we consecutively collected1386 formalin-fixed paraffin-embedded tissue specimens that comprised all histological types[hyperplastic polyps(HPs,n=121),sessile serrated adenomas(SSAs,n=132),traditional serrated adenomas(TSAs,n=111),non-serrated adenomas(n=195),and colorectal cancers(n=827)].We evaluated the methylation levels of IGF2 DMR0 and long interspersed nucleotide element-1(LINE-1)in HPs(n=115),SSAs(n=120),SSAs with cytological dysplasia(n=10),TSAs(n=91),TSAs with high-grade dysplasia(HGD)(n=15),non-serrated adenomas(n=80),non-serrated adenomas with HGD(n=105),and CRCs(n=794).For the accurate quantification of the relative methylation levels(scale 0%-100%)of IGF2 DMR0 and LINE-1,we used bisulfite pyrosequencing method.Tumor specimens were analyzed for microsatellite instability,KRAS(codons 12 and 13),BRAF(V600E),and PIK3CA(exons 9and 20)mutations;MLH1 and MGMT methylation;and IGF2 expression by immunohistochemistry.RESULTS:The distribution of the IGF2 DMR0 methylation level in 351 serrated lesions and 185 non-serrated adenomas(with or without HGD)was as follows:mean61.7,median 62.5,SD 18.0,range 5.0-99.0,interquartile range 49.5-74.4.The IGF2 DMR0 methylation level was divided into quartiles(Q1≥74.5,Q2 62.6-74.4,Q3 49.6-62.5,Q4≤49.5)for further analysis.With regard to the histological type,the IGF2 DMR0 methylation levels of SSAs(mean±SD,73.1±12.3)were significantly higher than those of HPs(61.9±20.5),TSAs(61.6±19.6),and non-serrated adenomas(59.0±15.8)(P<0.0001).The IGF2 DMR0 methylation level was inversely correlated with the IGF2 expression level(r=-0.21,P=0.0051).IGF2 DMR0 hypomethylation was less frequently detected in SSAs compared with HPs,TSAs,and non-serrated adenomas(P<0.0001

关键词： BRAF Colon polyp Colorectal neoplasia Colorectum G

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Pneumatosis intestinalis with obstructing intussusception:A case report and literature review

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World Journal of Gastrointestinal Surgery 2016年第2期8卷 173-178页

作者： Yujiro Itazaki hironori Tsujimoto Nozomi Ito Hiroyuki Horiguchi Shinsuke Nomura Kyohei Kanematsu Shuichi Hiraki Suefumi Aosasa Junji yamamoto Kazuo Hase Department of Surgery National Defense Medical College

Pneumatosis intestinalis(PI) often represents a benign condition that should not be considered as an argument for surgery. We report a patient with PI and obstructing intussusception who underwent urgent colectomy and review the literatures regarding PI with intussusception. A 20-year-old man presented at our hospital with a 3-d intermittent lower abdominal pain history. He underwent steroid therapy for membranoproliferative glomerulonephritis for 4 years. Computed tomography revealed ascending colon intussusception with air within the wall. Intraoperative colonoscopy revealed numerous soft polypoid masses with normal overlying mucosa and right hemicolectomy was performed. Histological examination of colonic wall sections revealed large cysts in the submucosal layer. The pathological diagnosis was PI. Nine cases of intussusception associated with primary PI have been reported. Although primary PI often represents a benign condition that should not be considered as an argument for surgery,if the case involves intussusception and obstruction,emergent laparotomy should be considered.

关键词： Pneumatosis intestinalis Intussusception Urgent surgery Immunosuppressive drug Ischemia of the intestine

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