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Efficient hemostatic method for endoscopic submucosal dissection of colorectal tumors

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World Journal of Gastroenterology 2010年第33期16卷 4180-4186页

作者： Naohisa Yoshida Yuji Naito Munehiro Kugai Ken Inoue Naoki Wakabayashi nobuaki yagi Akio Yanagisawa Toshikazu Yoshikawa Department of Molecular Gastroenterology and Hepatology Kyoto Prefectural University of MedicineGraduate School of Medical Science Department of Surgical Pathology Kyoto Prefectural University of MedicineGraduate School of Medical Science

AIM:To evaluate a new hemostatic method using hemostatic forceps to prevent perforation and perioperative hemorrhage during colonic endoscopic submucosal dissection(ESD).METHODS:We studied 250 cases,in which ESD for colorectal tumors was performed at the Kyoto Prefectural University of Medicine or Nara City Hospital between 2005 and 2010.We developed a new hemostatic method using hemostatic forceps in December 2008 for the efficient treatment of submucosal thick vessels.ESD was performed on 126 cases after adoption of the new method(the adopted group)and the new method was performed on 102 of these cases.ESD was performed on 124 cases before the adoption of the new method (the unadopted group).The details of the new method are as follows:firstly,a vessel was coagulated using the hemostatic forceps in the soft coagulation mode according to the standard procedure,and the coagulated vessel was removed using the forceps in the"endocut" mode without perioperative hemorrhage.Secondly,the partial surrounding submucosa was dissected using the forceps in the endocut mode.In the current study,we evaluated the efficacy of this method.RESULTS:Coagulated vessels were successfully removed using the hemostatic forceps in all 102 cases without severe perioperative hemorrhage.Moderate perioperative hemorrhage occurred in five cases(4.9%);however,it was stopped by immediately reuse of the hemostatic forceps.The partial surrounding submucosa was dissected using the forceps in all 102 cases.In the adopted group,the median operation time was 105 min.The proportion of endoscopic en bloc resection was 92.8%(P<0.01)compared to 80.6%in the unadopted group.The postoperative hemorrhage and perforation rates were 2.3%and 2.3%.The rate of perforation was significantly lower than that in the unadopted group (9.6%,P<0.01).We evaluated the ease of use of this method by allowing our three trainees to performed ESD on 46 cases,which were accomplished without any severe hemorrhage.CONCLUSION:The new method effectively treated submucosal thick vess

关键词： Endoscopic submucosal dissection Colorectal tumor Hemostatic forceps Perforation Perioperative hemorrhage

Rebamipide promotes healing of colonic ulceration through enhanced epithelial restitution

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World Journal of Gastroenterology 2011年第33期17卷 3802-3809页

作者： Tomohisa Takagi Yuji Naito Kazuhiko Uchiyama Toshimitsu Okuda Katsura Mizushima Takahiro Suzuki Osamu Handa Takeshi Ishikawa nobuaki yagi Satoshi Kokura Hiroshi Ichikawa Toshikazu Yoshikawa Department of Molecular Gastroenterology and Hepatology Graduate School of Medical ScienceKyoto Prefectural University of Medicine6028566 KyotoJapan

AIM:To investigate the efficacy of rebamipide in a rat model of colitis and restitution of intestinal epithelial cells in vitro.METHODS:Acute colitis was induced with trinitrobenzene sulfonic acid(TNBS)in male Wistar rats.Rats received intrarectal rebamipide treatment daily starting on day 7 and were sacrificed on day 14 after TNBS administration.The distal colon was removed to evaluate the various parameters of inflammation.Moreover,wound healing assays were used to determine the enhanced restitution of rat intestinal epithelial(RIE)cells treated with rebamipide.RESULTS:Intracolonic administration of rebamipide accelerated TNBSinduced ulcer healing.Increases in the wet weight of the colon after TNBS administration were significantly inhibited by rebamipide.The wound assay revealed that rebamipide enhanced the migration of RIE cells through phosphorylation of extracellular signalregulated kinase(ERK)and activation of Rho kinase.CONCLUSION:Rebamipide enema healed intestinal injury by enhancing restitution of RIE cells,via ERK activation.Rebamipide might be a novel therapeutic approach for inflammatory bowel disease.

关键词：肠上皮细胞伤口愈合结肠炎复原溃疡 Wistar大鼠灌肠治疗大鼠模型

Image-enhanced endoscopy for diagnosis of colorectal tumors in view of endoscopic treatment

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World Journal of Gastrointestinal Endoscopy 2012年第12期4卷 545-555页

作者： Naohisa Yoshida nobuaki yagi Akio Yanagisawa Yuji Naito Department of Molecular Gastroenterology and Hepatology Kyoto Prefectural University of MedicineGraduate School of Medical Science Department of Surgical Pathology Kyoto Prefectural University of MedicineGraduate School of Medical Science

Recently,image-enhanced endoscopy(IEE) has been used to diagnose gastrointestinal tumors.This method is a change from conventional white-light(WL) endoscopy without dyeing solution,requiring only the push of a button.In IEE,there are many advantages in diagnosis of neoplastic tumors,evaluation of invasion depth for cancerous lesions,and detection of neoplastic lesions.In narrow band imaging(NBI) systems(Olympus Medical Co.,Tokyo,Japan),optical filters that allow narrow-band light to pass at wavelengths of 415 and 540 nm are used.Mucosal surface blood vessels are seen most clearly at 415 nm,which is the wavelength that corresponds to the hemoglobin absorption band,while vessels in the deep layer of the mucosa can be detected at 540 nm.Thus,NBI also can detect pit-like structures named surface pattern.The flexible spectral imaging color enhancement(FICE) system(Fujifilm Medical Co.,Tokyo,Japan) is also an IEE but different to NBI.FICE depends on the use of spectral-estimation technology to reconstruct images at different wavelengths based on WL images.FICE can enhance vascular and surface patterns.The autofluorescence imaging(AFI) video endoscope system(Olympus Medical Co.,Tokyo,Japan) is a new illumination method that uses the difference in intensity of autofluorescence between the normal area and neoplastic lesions.AFI light comprises a blue light for emitting and a green light for hemoglobin absorption.The aim of this review is to highlight the efficacy of IEE for diagnosis of colorectal tumors for endoscopic treatment.

关键词： Flexible spectral imaging color enhancement Narrow band imaging Autofluorescence imaging Colorectal polyps Image-enhanced endoscopy

Gastric carcinoma originating from the heterotopic submucosal gastric gland treated by laparoscopy and endoscopy cooperative surgery

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World Journal of Gastrointestinal Oncology 2015年第8期7卷 118-122页

作者： Taisuke Imamura Shuhei Komatsu Daisuke Ichikawa Hiroki Kobayashi Mahito Miyamae Shoji Hirajima Tsutomu Kawaguchi Takeshi Kubota Toshiyuki Kosuga Kazuma Okamoto Hirotaka Konishi Atsushi Shiozaki Hitoshi Fujiwara Kiyoshi Ogiso nobuaki yagi Akio Yanagisawa Takashi Ando Eigo Otsuji Division of Digestive Surgery Department of Digestive Surgery Kyoto Prefectural University of Medicine Kyoto 602-8566 Japan Department of Molecular Gastroenterology and Hepatology Kyoto Prefectural University of Medicine Kyoto 602-8566 Japan Department of Pathology Kyoto Prefectural University of Medicine Kyoto 602-8566 Japan Department of Gastroenterology and Hepatology Kyoto Kuramaguchi Medical Center Kyoto 603-8151 Japan

Gastric carcinoma is derived from epithelial cells in the gastric mucosa. We reported an extremely rare case of submucosal gastric carcinoma originating from the heterotopic submucosal gastric gland(HSG) that was safely diagnosed by laparoscopy and endoscopy cooperative surgery(LECS). A 66-year-old man underwent gastrointestinal endoscopy, which detected a submucosal tumor(SMT) of 1.5 cm in diameter on the lesser-anterior wall of the upper gastric body. The tumor could not be diagnosed histologically, even by endoscopic ultrasound-guided fine-needle aspiration biopsy. Local resection by LECS was performed to confirm a diagnosis. Pathologically, the tumor was an intra-submucosal well differentiated adenocarcinoma invading 5000 μm intothe submucosal layer. The resected tumor had negative lateral and vertical margins. Based on the Japanese treatment guidelines, additional laparoscopic proximal gastrectomy was curatively performed. LECS is a less invasive and safer approach for the diagnosis of SMT, even in submucosal gastric carcinoma originating from the HSG.

关键词： Heterotopic submucosal gland Laparoscopyand endoscopy cooperative surgery Gastric carcinoma Gastric submucosal tumor Less invasive treatment

在早 colorectal 癌症的内视镜的切除术的组织学的评估的重要性

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World Journal of Gastrointestinal Pathophysiology 2012年第2期3卷 51-59页

作者： Naohisa Yoshida Yuji Naito nobuaki yagi Akio Yanagisawa Department of Molecular Gastroenterology and Hepatology Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyoto 602-8566Japan Department of Surgical Pathology Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyoto 602-8566Japan

The diagnostic criteria for colonic intraepithelial tumors vary from country to country.While intramucosal adenocarcinoma is recognized in Japan,in Western countries adenocarcinoma is diagnosed only if the tumor invades to the submucosa and accesses the muscularis mucosae.However,endoscopic therapy,including endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),is used worldwide to treat adenoma and early colorectal cancer.Precise histopathological evaluation is important for the curativeness of these therapies as inappropriate endoscopic therapy causes local recurrence of the tumor that may develop into fatal metastasis.Therefore,colorectal ESD and EMR are not indicated for cancers with massive submucosal invasion.However,diagnosis of cancer with massive submucosal invasion by endoscopy is limited,even when magnifying endoscopy for pit pattern and narrow band imaging and flexible spectral imaging color of enhancement are performed.Therefore,occasional cancers with massive submucosal invasion will be treated by ESD and EMR.Precise histopathological evaluation of these lesions should be performed in order to determine the necessity of additional therapy,including surgical resection.

关键词： Endoscopic submucosal dissection Endoscopic mucosal resection Early colorectal cancer Histopathology

Dynamic ultrasonography for optimizing treatment position in superior mesenteric artery syndrome:Two case reports and review of literature

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World Journal of Gastroenterology 2024年第5期30卷 499-508页

作者： nobuaki Hasegawa Akihiko Oka Muyiwa Awoniyi Yuri Yoshida Hiroshi Tobita Norihisa Ishimura Shunji Ishihara Department of Internal Medicine II Shimane University Faculty of MedicineIzumo 693-8501ShimaneJapan Department of Gastroenterology Hepatology and NutritionDigestive Disease and Surgery InstituteHepatology SectionCleveland ClinicClevelandOH 44195United States Clinical Laboratory Division Shimane University HospitalIzumo 693-8501ShimaneJapan Division of Hepatology Shimane University HospitalIzumo 693-8501Japan

BACKGROUND Superior mesenteric artery(SMA)syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta(SMA-Ao).Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome,individual variations in the optimal patient position have been noted.In this report,we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient.CASE SUMMARY Case 1:A 90-year-old man with nausea and vomiting.Following diagnosis of SMA syndrome by computed tomography(CT),ultrasonography(US)revealed the SMA-Ao distance in the supine position(4 mm),which slightly improved in the lateral position(5.7–7.0 mm)without the passage of duodenal contents.However,in the sitting position,the SMA-Ao distance was increased to 15 mm accompanied by improved content passage.Additionally,US indicated enhanced passage upon abdominal massage on the right side.By day 2,the patient could eat comfortably with the optimal position and massage.Case 2:An 87-year-old woman with vomiting.After the diagnosis of SMA syndrome and aspiration pneumonia by CT,dynamic US confirmed the optimal position(SMA-Ao distance was improved to 7 mm in forward-bent position,whereas it remained at 5 mm in the supine position).By day 7 when her pneumonia recovered,she could eat with the optimal position.CONCLUSION The optimal position for SMA syndrome varies among individuals.Dynamic US appears to be a valuable tool in improving patient outcomes.

关键词： Superior mesenteric artery syndrome Wilkie’s syndrome Cast syndrome Aorto-mesenteric compass syndrome Ultrasonography Case report

Real-world efficacy and safety of tofacitinib treatment in Asian patients with ulcerative colitis

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World Journal of Gastroenterology 2024年第13期30卷 1871-1886页

作者： Kentaro Kojima Kenji Watanabe Mikio Kawai Soichi yagi Koji Kaku Maiko Ikenouchi Toshiyuki Sato Koji Kamikozuru Yoko Yokoyama Tetsuya Takagawa Masahito Shimizu Shinichiro Shinzaki Department of Gastroenterology Hyogo Medical UniversityNishinomiya 663-8501Japan Department of Gastroenterology Gifu University Graduate School of MedicineGifu 501-1194Japan Department of Internal Medicine for Inflammatory Bowel Disease The University of ToyamaToyama 930-0194Japan Center for Clinical Research and Education Hyogo Medical UniversityNishinomiya 663-8501Japan

BACKGROUND Real-world data on tofacitinib(TOF)covering a period of more than 1 year for a sufficient number of Asian patients with ulcerative colitis(UC)are scarce.AIM To investigate the long-term efficacy and safety of TOF treatment for UC,including clinical issues.METHODS We performed a retrospective single-center observational analysis of 111 UC patients administered TOF at Hyogo Medical University as a tertiary inflammatory bowel disease center.All consecutive UC patients who received TOF between May 2018 and February 2020 were enrolled.Patients were followed up until August 2020.The primary outcome was the clinical response rate at week 8.Secondary outcomes included clinical remission at week 8,cumulative persistence rate of TOF administration,colectomy-free survival,relapse after tapering of TOF and predictors of clinical response at week 8 and week 48.RESULTS The clinical response and remission rates were 66.3%and 50.5%at week 8,and 47.1%and 43.5%at week 48,respectively.The overall cumulative clinical remission rate was 61.7%at week 48 and history of anti-tumor necrosis factor-alpha(TNF-α)agents use had no influence(P=0.25).The cumulative TOF persistence rate at week 48 was significantly lower in patients without clinical remission than in those with remission at week 8(30.9%vs 88.1%;P<0.001).Baseline partial Mayo Score was significantly lower in responders vs non-responders at week 8(odds ratio:0.61,95%confidence interval:0.45-0.82,P=0.001).Relapse occurred in 45.7%of patients after TOF tapering,and 85.7%of patients responded within 4 wk after re-increase.All 6 patients with herpes zoster(HZ)developed the infection after achieving remission by TOF.CONCLUSION TOF was more effective in UC patients with mild activity at baseline and its efficacy was not affected by previous treatment with anti-TNF-αagents.Most relapsed patients responded again after re-increase of TOF and nearly half relapsed after tapering off TOF.Special attention is needed for tapering and HZ.

关键词： Ulcerative colitis Tofacitinib Janus kinase inhibitor Real-world Biologics

Side-Chain Type Ferrocene Macrocycles

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Precision Chemistry

Precision Chemistry 2024年第4期2卷 143-150页

作者： Bin Lan Jindong Xu Lingyun Zhu Xinyu Chen Hideya Kono Peihan Wang Xin Zuo Jianfeng Yan Akiko yagi Yongshen Zheng Songhua Chen Yaofeng Yuan Kenichiro Itami Yuanming Li Key Laboratory of Molecule Synthesis and Function Discovery(Fujian Province University) College of ChemistryFuzhou UniversityFuzhou 350108China Institute of Transformative Bio-Molecules(WPI-ITbM) Nagoya UniversityNagoya 464-8602Japan School of Materials Science and Engineering National Institute for Advanced MaterialsNankai UniversityTianjin 300350China Institute of Transformative Bio-Molecules(WPIITbM) Nagoya UniversityNagoya 464-8602Japan College of Chemistry and Material Science Longyan UniversityLongyan 364012China

A class of side-chain type ferrocene macrocycles with a radially conjugated system is introduced in this study.The stereo configurations of these ferrocene rings were determined through single-crystal X-ray diffraction analysis.Notably,in the solid state,the ferrocene rings exhibit a distinctive herringbone stacking pattern imposed by a ferrocene-to-ring host−guest interaction.Through UV−vis absorption spectroscopy,electrochemical measurements,and theoretical calculations,valuable insights into the electronic properties of these rings were obtained.In addition,the single crystal of macrocycle A_(2)B demonstrates a second-order nonlinear optical response.As a class of organometallic nanorings,this work holds great potential for further exploration in the fields of organometallic chemistry,molecular electronics,and host−guest chemistry.

关键词： Ferrocene Conjugated Macrocycles Organometallic Macrocycles Second-Order Nonlinear Optical Nanoring

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敦煌莫高窟隋至初唐洞窟西壁所绘图像的功能

敦煌研究 2024年第2期 38-50页

作者：八木春生牛源(译) 筑波大学艺术学系日本筑波305-0006 敦煌研究院美术研究所甘肃敦煌736200

敦煌莫高窟第57窟是唐前期第一期的代表洞窟。外层龛正面左右下部绘有树下两脚合并坐式菩萨像和树下坐于藤座上呈半跏思惟姿势的菩萨像。这种菩萨坐像的组合以及与其类似的组合,在隋代第二期洞窟中就已出现,它们与弥勒像密切相关。但在... 详细信息

敦煌莫高窟第57窟是唐前期第一期的代表洞窟。外层龛正面左右下部绘有树下两脚合并坐式菩萨像和树下坐于藤座上呈半跏思惟姿势的菩萨像。这种菩萨坐像的组合以及与其类似的组合,在隋代第二期洞窟中就已出现,它们与弥勒像密切相关。但在第57窟中,与隋代第二期洞窟有所不同的是人们憧憬的往生净土画在窟顶。阿弥陀如来作为过去佛,由阿弥陀、释迦、弥勒构成的新三世佛在唐前期第一期完成了转变。重要的是南北壁所表现的树下说法图不仅仅表现了三世佛,还表现了当时人们所憧憬的往生世界的情景。另外,唐前期第一期出现了将弥勒以如来表现且坐于宝池中。但是,初唐第一期末期的第322窟仅北壁阿弥陀如来坐在宝池中,南壁的弥勒如来未见宝池,这是因为弥勒净土本来就没有宝池。这种阿弥陀如来和弥勒如来都拥有配备宝池的净土的模糊印象,也显示了净土之间的不同。第57窟与第322窟一样,北壁如来坐像坐于宝池中伸出的莲花座上、南壁如来坐像周围未见表现其坐于宝池中的莲花和荷叶,那么第57窟南壁主尊虽然不是如来倚坐像,但下意识地作为弥勒如来而绘制的可能性很高。

关键词：第57窟第322窟两脚合并菩萨坐像半跏思惟菩萨像净土往生思想