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Effectiveness and safety of chemotherapy for patients with malignant gastrointestinal obstruction:A Japanese populationbased cohort study

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World Journal of Clinical Cases 2022年第16期10卷 5253-5265页

作者： Gota Fujisawa ryota niikura Takuya Kawahara Tetsuro Honda Kenkei Hasatani Naohiro Yoshida Tsutomu Nishida Tetsuya Sumiyoshi Shu Kiyotoki Takashi Ikeya Masahiro Arai Yoku Hayakawa Takashi Kawai Mitsuhiro Fujishiro Department of Gastroenterology Graduate school of MedicineThe University of TokyoTokyo 1138655Japan Gastroenterological Endoscopy Tokyo Medical UniversityTokyo 1600023Japan Clinical Research Support Center The University of Tokyo HospitalTokyo 1138655Japan Department of Gastroenterology Nagasaki Harbor Medical CenterNagasaki 8508555Japan Department of Gastroenterology Fukui Prefectural HospitalFukui 9108526Japan Department of Gastroenterology Ishikawa Prefectural Central HospitalIshikawa 9208530Japan Department of Gastroenterology Toyonaka Municipal HospitalOsaka 5608565Japan Department of Gastroenterology Tonan HospitalHokkaido 0600004Japan Department of Gastroenterology Shuto General HospitalYamaguchi 7420032Japan Department of Gastroenterology St.Luke's International HospitalTokyo 1048560Japan Department of Gastroenterology Nerima Hikarigaoka HospitalTokyo 1790072Japan

BACKGROUND The impacts of chemotherapy on patients with malignant gastrointestinal obstructions remain unclear,and multicenter evidence is lacking.AIM To evaluate the effectiveness and safety of chemotherapy in patients with unresectable malignant gastrointestinal obstructions.METHODS We conducted a multicenter retrospective cohort study that compared the chemotherapy group who received any chemotherapeutics after interventions,including palliative surgery or selfexpandable metal stent placement,for unresectable malignant gastrointestinal obstruction vs the best supportive care(BSC)group between 2014 and 2019 in nine hospitals.The primary outcome was overall survival,and the secondary outcomes were patency duration and adverse events,including gastrointestinal perforation and gastrointestinal bleeding.RESULTS In total,470 patients in the chemotherapy group and 652 patients in the BSC group were analyzed.During the follow-up period of 54.1 mo,the median overall survival durations were 19.3 mo in the chemotherapy group and 5.4 mo in the BSC group(log-rank test,P<0.01).The median patency durations were 9.7 mo[95% confidence interval(CI):7.7-11.5 mo]in the chemotherapy group and 2.5 mo(95%CI:2.0-2.9 mo)in the BSC group(log-rank test,P<0.01).The perforation rate was 1.3%(6/470)in the chemotherapy group and 0.9%(6/652)in the BSC group(P=0.567).The gastrointestinal bleeding rate was 1.5%(7/470)in the chemotherapy group and 0.5%(3/652)in the BSC group(P=0.105).CONCLUSION Chemotherapy after interventions for unresectable malignant gastrointestinal obstruction was associated with increased overall survival and patency duration.

关键词： Gastrointestinal cancer Chemotherapy Malignant gastrointestinal obstruction Self-expandable metal stent Palliative surgery

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Colonoscopy can miss diverticula of the left colon identified by barium enema

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World Journal of Gastroenterology 2013年第15期19卷 2362-2367页

作者： ryota niikura Naoyoshi Nagata Takuro Shimbo Junichi Akiyama Naomi Uemura Department of Gastroenterology and Hepatology National Center for Global Health and MedicineShinjukuTokyo 162-8655Japan Department of Clinical Research and Informatics National Center for Global Health and MedicineShinjukuTokyo 162-8655Japan Department of Gastroenterology and Hepatology Kohnodai HospitalNational Center for Global Health and MedicineIchikawaChiba 272-8516Japan

AIM: To identify the diagnostic value of colonoscopy for diverticulosis as determined by barium enema. METHODS: A total of 65 patients with hematochezia who underwent colonoscopy and barium enema were analyzed, and the diagnostic value of colonoscopy for diverticula was assessed. The receiver operating characteristic area under the curve was compared in relation to age (< 70 or ≥ 70 years), sex, and colon location. The number of diverticula was counted, and the detection ratio was calculated. RESULTS: Colonic diverticula were observed in 46 patients with barium enema. Colonoscopy had a sensitivity of 91% and specificity of 90%. No significant differences were found in the receiver operating characteristic area under the curve (ROC-AUC) for age group or sex. The ROC-AUC of the left colon was significantly lower than that of the right colon (0.81 vs 0.96, P=0.02). Colonoscopy identified 486 colonic diverticula, while barium enema identified 1186. The detection ratio for the entire colon was therefore 0.41 (486/1186). The detection ratio in the left colon (0.32, 189/588) was significantly lower than that of the right colon (0.50, 297/598) (P < 0.01). CONCLUSION: Compared with barium enema, only half the number of colonic diverticula can be detected by colonoscopy in the entire colon and even less in the left colon.

关键词： Colonoscopic diagnosis Colonic diverticulosis Colonic diverticular bleeding Barium enema Receiver operating characteristic area under the curve

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Risk factors for small bowel angioectasia:The impact of visceral fat accumulation

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World Journal of Gastroenterology 2015年第23期21卷 7242-7247页

作者： Atsuo Yamada ryota niikura Yuka Kobayashi Hirobumi Suzuki Shuntaro Yoshida Hirotsugu Watabe Yutaka Yamaji Yoshihiro Hirata Kazuhiko Koike Department of Gastroenterology Graduate School of Medicine The University of Tokyo Department of Endoscopy and Endoscopic Surgery The University of Tokyo Hospital

AIM: To investigate visceral fat accumulation in association with the risk of small bowel angioectasia.METHODS: We retrospectively investigated 198 consecutive patients who underwent both capsule endoscopy and CT for investigation of obscure gastrointestinal bleeding(OGIB) from January 2009 to September 2013. The visceral fat area(VFA) and subcutaneous fat area were measured by CT, and information on comorbidities, body mass index, and medications was obtained from their medical records.Logistic regression analysis was used to evaluate associations.RESULTS: Capsule endoscopy revealed small bowel angioectasia in 18/198(9.1%) patients with OGIB.Compared to patients without small bowel angioectasia,those with small bowel angioectasia had a significantly higher VFA(96 ± 76.0 cm2 vs 63.4 ±51.5 cm2, P = 0.016) and a higher prevalence of liver cirrhosis(61% vs 22%, P < 0.001). The proportion of patients with chronic renal failure was higher in patients with small bowel angioectasia(22% vs 9%,P = 0.11). There were no significant differences in subcutaneous fat area or waist circumference. The prevalence of small bowel angioectasia progressively increased according to the VFA. Multivariate analysis showed that the VFA [odd ratio(OR) for each 10-cm2 increment = 1.1; [95% confidence interval(CI):1.02-1.19; P = 0.021] and liver cirrhosis(OR = 6.1,95%CI: 2.2-18.5; P < 0.001) were significant risk factors for small bowel angioectasia.CONCLUSION: VFA is positively associated with theprevalence of small bowel angioectasia, for which VFA and liver cirrhosis are independent risk factors in patients with OGIB.

关键词： Capsule endoscopy Obscure gastrointestinalbleeding Small bowel angioectasia Visceral fataccumulation

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Current state of practice for colonic diverticular bleeding in 37 hospitals in Japan: A multicenter questionnaire study

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World Journal of Gastrointestinal Endoscopy 2016年第20期8卷 785-794页

作者： ryota niikura Naoyoshi Nagata Hisashi Doyama Ryosuke Ota Naoki Ishii Katsuhiro Mabe Tsutomu Nishida Takuto Hikichi Kazuki Sumiyama Jun Nishikawa Toshio Uraoka Shu Kiyotoki Mitsuhiro Fujishiro Kazuhiko Koike Department of Gastroenterology Graduate School of Medicinethe University of Tokyo Bunkyo-ku Tokyo 113-8655 Japan Department of Gastroenterology and Hepatology National Center for Global Health and MedicineShinjuku-ku Tokyo 162-8655 Japan Department of Gastroenterology Ishikawa Prefectural Central Hospital Kanazawa-shiIshikawa 920-8201 Japan Department of Gastroenterology St. Luke’s International Hospital Chuo-ku Tokyo 104-8560 Japan Division of Endoscopy Hokkaido University Hospital Kita-ku Sapporo 060-0808 Hokkaido Japan Department of Gastroenterology National Hospital Organization Hakodate Hospital KawaharachouHakodate-shi 041-0844 Hokkaido Japan Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka-shi Osaka 560-0055 Japan Department of Endoscopy Fukushima Medical University Hospital Fukushima-shi Fukushima 960-1295 Japan Department of Endoscopy the Jikei University School of Medicine Minato-ku Tokyo 105-8471Japan Department of Clinical Laboratory Science Yamaguchi University Graduate School of Medicine Ube-shiYamaguchi 755-0046 Japan Department of Gastroenterology National Hospital Organization Tokyo Medical Center Meguro-ku Tokyo 150-0021 Japan Department of Gastroenterology Shuto General Hospital Yanai-shi Yamaguchi 742-0032 Japan Endoscopy and Endoscopic Surgery the University of Tokyo Hospital Bunkyo-ku Tokyo 113-8655 Japan

AIM To clarify the current state of practice for colonic diverticular bleeding(CDB) in Japan.METHODS We conducted multicenter questionnaire surveys of the practice for CDB including clinical settings(8 questions),diagnoses(8 questions),treatments(7 questions),and outcomes(4 questions) in 37 hospitals across Japan.The answers were compared between hospitals with high and low number of inpatient beds to investigate which factor influenced the answers.RESULTS Endoscopists at all 37 hospitals answered the questions,and the mean number of endoscopists at these hospitals was 12.7.Of all the hospitals,computed tomography was performed before colonoscopy in 67% of the hospitals.The rate of bowel preparation was 46.0%.Early colonoscopy was performed within 24 h in 43.2% of the hospitals.Of the hospitals,83.8% performed clipping as first-line endoscopic therapy.More than half of the hospitals experienced less than 20% rebleeding events after endoscopic hemostasis.No significant difference was observed in the annual number of patients hospitalized for CDB between high-(≥700 beds) and low-volume hospitals.More emergency visits(P=0.012) and endoscopists(P=0.015),and less frequent participation of nursing staff in early colonoscopy(P=0.045) were observed in the high-volume hospitals.CONCLUSION Some practices unique to Japan were found,such as performing computed tomography before colonoscopy,no bowel preparation,and clipping as first-line therapy.Although,the number of staff differed,the practices for CDB were common irrespective of hospital size.

关键词： colonic diverticular hemorrhage lower gastrointestinal bleeding computed tomography endoscopy bowel preparation

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Predictive findings forHelicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: Validation study

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World Journal of Gastroenterology 2013年第27期19卷 4374-4379页

作者： Kazuhiro Watanabe Naoyoshi Nagata Ryo Nakashima Etsuko Furuhata Takuro Shimbo Masao Kobayakawa Toshiyuki Sakurai Koh Imbe ryota niikura Chizu Yokoi Junichi Akiyama Naomi Uemura Department of Gastroenterology and Hepatology National Center for Global Health and Medicine Department of Clinical Research and Informatics National Center for Global Health and Medicine Department of Gastroenterology and Hepatology National Center for Global Health and MedicineKohnodai Hospital

AIM:To validate the usefulness of screening endoscopy findings for predictingHelicobacter pylori (H. pylori) infection status. METHODS:H. pylori infection status was determined by histology, serology, and the urea breast test in 77 consecutive patients who underwent upper endoscopy. Based on the findings, patients were categorized as H. pylori -uninfected, -infected, or -eradicated cases. Using six photos of certain sites in the stomach per case, we determined the presence or absence of the following endoscopic findings:regular arrangement of collecting venules (RAC), linear erythema, hemorrhage, fundic gland polyp (FGP), atrophic change, rugal hyperplasia, edema, spotty erythema, exudate, xanthoma, and mottled patchy erythema (MPE). The diagnostic odds ratio (DOR) and inter-observer agreement (Kappa value) for these 11 endoscopic findings used in the determination of H. pylori infection status were calculated. RESULTS:Of the 77 patients [32 men and 45 women; mean age (SD), 39.7 (13.4) years] assessed, 28 were H. pylori uninfected, 28 were infected, and 21 were eradicated. DOR values were significantly high (< 0.05) for the following H. pylori cases:uninfected cases with RAC (11.5), linear erythema (24.5), hemorrhage (4.1), and FGP (34.5); for infected cases with atrophic change (8.67), rugal hyperplasia (15.8), edema (14.2), spotty erythema (11.5), and exudate (3.52); and for eradicated cases with atrophic change (32.4) and MPE (103.0). Kappa values were excellent for FGP (0.93), good for RAC (0.63), hemorrhage (0.79), atrophic change (0.74), and MPE (0.75), moderate for linear erythema (0.51), rugal hyperplasia (0.49), edema (0.58), spotty erythema (0.47), and exudate (0.46), and poor for xanthoma (0.19). CONCLUSION:The endoscopic findings of RAC, hemorrhage, FGP, atrophic change, and MPE will be useful for predicting H. pylori infection status.

关键词： Diagnostic odds ratio Endoscopic finding Eradication therapy Helicobacter pylori Inter-observer agreement

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Impact of discontinuing non-steroidal antiinflammatory drugs on long-term recurrence in colonic diverticular bleeding

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World Journal of Gastroenterology 2015年第4期21卷 1292-1298页

作者： Naoyoshi Nagata ryota niikura Tomonori Aoki Takuro Shimbo Katsunori Sekine Hidetaka Okubo Kazuhiro Watanabe Toshiyuki Sakurai Chizu Yokoi Junichi Akiyama Mikio Yanase Masashi Mizokami Naomi Uemura Department of Gastroenterology and Hepatology National Center for Global Health and MedicineTokyo 162-8655Japan Department of Clinical Research and Informatics National Center for Global Health and MedicineTokyo 162-8655Japan Department of Gastroenterology and Hepatology National Center for Global Health and MedicineKohnodai HospitalChiba 272-8516Japan

AIM: To determine the effect of discontinuing nonsteroidal antiinflammatory drugs(NSAIDs) on recurrence in long-term follow-up patients with colonic diverticular bleeding(CDB).METHODS: A cohort of 132 patients hospitalized for CDB examined by colonoscopy was prospectively enrolled. Comorbidities, lifestyle, and medications(NSAIDs, low-dose aspirin, antiplatelet agents, anticoagulants, acetaminophen, and corticosteroids) were assessed. After discharge, patients were requested to visit the hospital on scheduled days during the followup period. The Kaplan-Meier method was used to estimate recurrence.RESULTS: Median follow-up was 15 mo. The probability of recurrence at 1, 6, 12, and 24 mo was 3.1%, 19%, 27%, and 38%, respectively. Of the 41 NSAID users on admission, 26(63%) discontinued NSAID use at discharge. Many of the patients who could discontinue NSAIDs were intermittent users, and could be switched to alternative therapies, such as acetaminophen or an antiinflammatory analgesic plaster. The probability of recurrence at 12 mo was 9.4% in discontinuing NSAID users compared with 77% in continuing users(P 70 years, right-sided diverticula, history of hypertension, and hemodialysis. No patients developed cerebrocardiovascular events during follow-up.CONCLUSION: There is a substantial recurrence rate after discharge among patients hospitalized for diverticular bleeding. Discontinuation of NSAIDs is an effective preventive measure against recurrence. This study provides new information on risk reduction strategies for diverticular bleeding.

关键词： Non-steroidal anti-inflammatories Drug withdrawal

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Risk factors for adverse in-hospital outcomes in acute colonic diverticular hemorrhage

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World Journal of Gastroenterology 2015年第37期21卷 10697-10703页

作者： Naoyoshi Nagata ryota niikura Tomonori Aoki Shiori Moriyasu Toshiyuki Sakurai Takuro Shimbo Katsunori Sekine Hidetaka Okubo Kazuhiro Watanabe Chizu Yokoi Junichi Akiyama Mikio Yanase Masashi Mizokami Kazuma Fujimoto Naomi Uemura Department of Gastroenterology and Hepatology National Center for Global Health and Medicine Department of Clinical Research and Informatics National Center for Global Health and Medicine Department of Gastroenterology and Hepatology National Center for Global Health and Medicine Kohnodai Hospital Kohnodai Department of Internal Medicine and Gastrointestinal Endoscopy Saga Medical School

AIM: To investigate the factors associated with transfusion, further bleeding, and prolonged length of stay.METHODS: In total, 153 patients emergently hospitalized for diverticular bleeding who were examined by colonoscopy were prospectively enrolled. Patients in whom the bleeding source was identified received endoscopic treatment such as clipping or endoscopic ligation. After spontaneous cessation of bleeding withconservative treatment or hemostasis with endoscopic treatment, all patients were started on a liquid food diet and gradually progressed to a solid diet over 3d, and were discharged. At enrollment, we assessed smoking, alcohol, medications [non-steroidal antiinflammatory drugs(NSAIDs)], low-dose aspirin, and other antiplatelets, warfarin, acetaminophen, and oral corticosteroids), and co-morbidities [hypertension,diabetes mellitus, dyslipidemia, cerebro-cardiovascular disease, chronic liver disease, and chronic kidney disease(CKD)]. The in-hospital outcomes were need for transfusion, further bleeding after spontaneous cessation of hemorrhage, and length of hospital stay.The odds ratio(OR) for transfusion need, further bleeding, and prolonged length of stay were estimated by logistic regression analysis.RESULTS: No patients required angiographic embolization or surgery. Stigmata of bleeding occurred in 18% of patients(27/153) and was treated by endoscopic procedures. During hospitalization, 40patients(26%) received a median of 6 units of packed red blood cells. Multivariate analysis revealed that female sex(OR = 2.5, P = 0.02), warfarin use(OR= 9.3, P 70years(OR = 2.1, P = 0.04) and NSAID use(OR = 2.7,P = 0.03) were independent risk factors for prolonged hospital

关键词： In-hospital adverse clinical outcomes Antithrombot

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Amount of TNF-αreleased from macrophagesreacting with polyethylene particles showeddose-dependent relationship to the totalsurface area of added particles

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Biosurface and Biotribology 2018年第4期4卷 122-127页

作者： Weiqi Shen Naohide Tomita Miho niikura Takuma Sugino Department of MechanicalEngineering and Science Kyoto UniversityKyotoJapan

The immune response to ultra-high molecular weight polyethylene wear debris is thought to beone of the majorcauses of osteolysis and aseptic loosening.An in-vitro methodfor the measurement of the response is necessary in orderto priori estimate the lifespan of the implants.lt is of importance to distinguish the bioactivity of various polyethylenebiomaterials.The current research focused on the inverse culturing process,which was shown to be effective toevaluate the biological reaction of mouse macrophages and wear particles by estimating the amount of inflammatorycytokines.In this study,several improvements were carried out through trial quantification.Silicon sheet wasintroduced instead of PVC seal to remove air bubbles and to eliminate the influence of potentially-attached endotoxin.Calculations along with experiments according to Stokes'law were also performed to determine the reaction time andthe minimum particle size that can be phagocytosed by macrophages in the improved method.The authorsco-incubated mouse macrophages and polyethylene particles in different sizes,densities and molecular weights usingthe new method.The result suggests that the amount of tumour necrosis factor-α(TNF-α)generated is dosagedependent on the total surface area of particles added regardless of particle size,density and molecular weight ofpolyethylene.

关键词： wear surface dosage

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Identification of tick vectors of zoonotic Babesia parasites in Japan

Identification of tick vectors of zoonotic Babesia parasites...

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第十届中国实验动物科学年会

作者： Aya Zamoto-niikura National Institute of Infectious Diseases

Human babesiosis has been reported mainly in U.S.and Europe caused by Babesia microti and B.divergens,respectively. While recently human babesiosis is recognized as emergent disease,because genetically closely related species and newly Babesia spp.have been identified.The species B.microti,commonly found in rodents,demonstrates a high degree of genetic and antigeneticdiversity as well.Three lineages,U.S.,Kobe and Hobetsu are known to have zoonotic potential present in rodents in Japan.By using thenested-PCR system,we identifiedspecific tick vector(s)for U.S.and Hobetsu parasites by field investigation at co-infected areas where up to two of the three lineages occur with similar frequency in reservoirs. Transmission experiments using laboratory animals were successfully performed.Interestingly,we found thatJapanese ticks also carried parasites closely related to B.divergens and B.venatorum,a new species found in Europe,both of which had been believed to be absent in Japan.In the conference,I will present these findings,which are of importance in the assessment of the regional risk for babesiosis in humans.

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Segmented HPGe平面型位置灵敏探测器阵列的γ成像分析

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中国科学：物理学、力学、天文学 2010年第6期40卷 748-752页

作者：郑勇周小红马飞陈亮张玉虎雷祥国 S.SHIMOURA E.IDEGUCHI S.OTA M.niikura 中国科学院近代物理研究所兰州730000 中国科学院研究生院北京100190 Center for Nuclear Study University of Tokyo

探测器位置分辨能力的高低是实现γ成像的一个重要指标.Segmented HPGe平面型位置灵敏探测器能够很好地给出γ射线与探测器晶体相互作用的作用点位置信息.利用由这种探测器组成的探测器阵列对^(22)Na标准源进行了γ成像实验.结果能够区... 详细信息

探测器位置分辨能力的高低是实现γ成像的一个重要指标.Segmented HPGe平面型位置灵敏探测器能够很好地给出γ射线与探测器晶体相互作用的作用点位置信息.利用由这种探测器组成的探测器阵列对^(22)Na标准源进行了γ成像实验.结果能够区分出标准源两个不同的摆放位置的细微差别,并与实际情况符合得很好.从而检验了Segmented HPGe平面型位置灵敏探测器的位置分辨能力.

关键词： Segmented HPGe 探测器阵列位置分辨能力 γ成像标准源

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