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A new index for non-invasive assessment of liver fibrosis

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World Journal of Gastroenterology 2010年第38期16卷 4809-4816页

作者： Naohiro Ichino Keisuke Osakabe Toru Nishikawa Hiroko Sugiyama Miho Kato Shiho Kitahara senju hashimoto Naoto Kawabe Masao Harata Yoshifumi Nitta Michihito Murao Takuji Nakano Yuko Arima Hiroaki Shimazaki Koji Suzuki Kentaro Yoshioka Faculty of Medical Technology School of Health SciencesFujita Health UniversityToyoakeAichi 470-1192Japan Department of Clinical Laboratory Fujita Health University Hospital Department of Liver Biliary Tract and Pancreas DiseasesFujita Health University

AIM:To construct and evaluate a new non-invasive fibrosis index for assessment of the stage of liver f ibrosis. METHODS:A new f ibrosis index (Fibro-Stiffness index) was developed in 165 of 285 patients with chronic hepatitis C, and was validated in the other 120 patients where liver biopsy was performed. Its usefulness was compared with liver stiffness (LS) measured by FibroScan, the aminotransferase-to-platelet ratio index, the Forns index and the FibroIndex. RESULTS: The Fibro-Stiffness index consists of LS,platelet count and prothrombin time. The values of the Fibro-Stiffness index differed signif icantly between neighboring f ibrosis stages except F0-F1. The area under the receiver operating characteristics curves of the Fibro-Stiffness index for prediction of F≥2 (0.90), F≥ 3 (0.90) and F= 4(0.92) in the estimation group and those for F≥ 3 (0.93) and F =4 (0.97) in the validation group were the highest among the 5 methods examined. The accuracy of the Fibro-Stiffness index had highest values for F≥2, F≥3 and F=4 in both the estimation and validation groups. The diagnostic performance for F= 4 was improved by a combination of the Fibro-Stiffness index with serum hyaluronic acid level. CONCLUSION: The Fibro-Stiffness index was constructed and validated. It showed superior diagnostic performance to other indices for F ≥ 2,3 and 4.

关键词： Non-invasive fi brosis index Fibro-Stiffness index Chronic hepatitis C Liver stiffness Liver fi brosis

Use of color Doppler ultrasonography in the diagnosis of anomalous connection in pancreatobiliary disease

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World Journal of Gastroenterology 2005年第7期11卷 1018-1022页

作者： Hiroki Kawashima Yoshiki Hirooka Akihiro Itoh senju hashimoto Terutomo Itoh Kazuo Hara Akira Kanamori Naoki Ohmiya Yasumasa Niwa Hidemi Goto Department of Gastroenterology Department of Endoscopy

AIM: To estimate the detectability of anomalous connection in pancreatobiliary disease (ACPBD) cases, measuring gallbladder wall blood flow (GWBF).METHODS: In the retrospective study, we enrolled 42subjects with gallbladder wall thickening. GWBF velocity was determined as an average value of the peak velocity of color signals on the gallbladder wall, three times in each case. Based on the findings on endoscopic ultrasonography (EUS) or endoscopic retrograde cholangiopancreatography (ERCP), the 42 subjects were divided into 11 cases with ACPBD and 31 cases without ACPBD. In the prospective study, the subjects were 92 cases with gallbladder wall thickening. Using the cut-off level of the flow velocity obtained in the retrospective study, the usefulness of measuring GWBF velocity in diagnosing ACPBD was evaluated.RESULTS: In the retrospective study, imaging of GWBF was obtained in 40 of the 42 subjects. The mean GWBF velocity of the ACPBD cases was 29.4±3.9 cm/s(mean±SD), which was significantly different (P＜0.0001;95% CI 5.48-13.2) from that of the without ACPBD cases(20.1±5.9 cm/s). Based on this result, we prepared a receiver operating characteristic curve, and the cut-off level appropriate for diagnosing ACPBD was estimated to be 25 cm/s. In the prospective study, GWBF was detected in 86 of the 92 subjects. Based on the EUS or ERCP findings, the 92 subjects were divided into 15 cases with ACPBD and 77 cases without ACPBD. When a cut-off level of 25 cm/s was employed, ACPBD could be diagnosed with a sensitivity of 87.0% (13/15) and a specificity of87.3% (62/71).CONCLUSION: Measurement of GWBF velocity, which is less invasive and provides objective values, is very useful for diagnosing ACPBD prior to the development of malignant tumors in cases with gallbladder wall thickening.

关键词：彩色多普勒超声胰腺疾病超声诊断胆囊壁血液流动学

Vitamin E reduces liver stiffness in nonalcoholic fatty liver disease

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World Journal of Hepatology 2015年第27期7卷 2749-2756页

作者： Aiko Fukui Naoto Kawabe senju hashimoto Michihito Murao Takuji Nakano Hiroaki Shimazaki Toshiki Kan Kazunori Nakaoka Masashi Ohki Yuka Takagawa Tomoki Takamura Hiroyuki Kamei Kentaro Yoshioka Department of Liver Biliary Tract and Pancreas Diseases Fujita Health University Department of Clinical Pharmacy Practice and Health Care Management Faculty of PharmacyMeijo University

AIM: To evaluate the efficacy of vitamin E treatment on liver stiffness in nonalcoholic fatty liver disease(NAFLD).METHODS: Thirty-eight NAFLD patients were administered vitamin E for > 1 year. The doses of vitamin E were 150, 300, or 600 mg; three times per day after each meal. Responses were assessed by liver enzyme levels [aspartate aminotransferase(AST), alanine aminotranferease(ALT), and γ-glutamyl transpeptidase(γ-GTP)], noninvasive scoring systems of hepatic fibrosis-4 [FIB-4 index and aspartate aminotransferaseto-platelet index(APRI)], and liver stiffness [velocity of shear wave(Vs)] measured by acoustic radiation force impulse elastography. Vs measurements were performed at baseline and 12 mo after baseline. The patients were genotyped for the patatin-like phospholipase domain containing 3(PNPLA3) polymorphisms and then divided into either the CC/CG or GG group to examine each group's responses to vitamin E treatment. RESULTS: We found marked differences in the platelet count, serum albumin levels, alkaline phosphatase levels, FIB-4 index, APRI, and Vs at baseline depending on the PNPLA3 polymorphism. AST, ALT, and γ-GTP levels(all P < 0.001); FIB-4 index(P = 0.035); APRI(P < 0.001); and Vs(P < 0.001) significantly decreased from baseline to 12 mo in the analysis of all patients. In the subset analyses of PNPLA3 genotypes, AST levels(P = 0.011), ALT levels(P < 0.001), γ-GTP levels(P = 0.005), APRI(P = 0.036), and Vs(P = 0.029) in genotype GG patients significantly improved, and AST and ALT levels(both P < 0.001), γ-GTP levels(P = 0.003), FIB-4 index(P = 0.017), and APRI(P < 0.001) in genotype CC/CG patients. CONCLUSION: One year of vitamin E treatment improved noninvasive fibrosis scores and liver stiffness in NAFLD patients. The responses were similar between different PNPLA3 genotypes.

关键词： Vitamin E Acoustic radiation force impulse Nonalco

Factors correlating with acoustic radiation force impulse elastography in chronic hepatitis C

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World Journal of Gastroenterology 2014年第5期20卷 1289-1297页

作者： Toru Nishikawa senju hashimoto Naoto Kawabe Masao Harata Yoshifumi Nitta Michihito Murao Takuji Nakano Yuko Mizuno Hiroaki Shimazaki Toshiki Kan Kazunori Nakaoka Yuka Takagawa Masashi Ohki Naohiro Ichino Keisuke Osakabe Kentaro Yoshioka Department of Liver Biliary Tract and Pancreas Diseases Fujita Health University Faculty of Medical Technology School of Health Sciences Fujita Health University

AIM: To investigate the factors other than fibrosis stage correlating with acoustic radiation force impulse(ARFI) elastograpy in chronic hepatitis C. METHODS: ARFI elastograpy was performed in 108 consecutive patients with chronic hepatitis C who underwent a liver biopsy. The proportion of fibrosis area in the biopsy specimens was measured by computerassisted morphometric image analysis. RESULTS: ARFI correlated significantly with fibrosis stage(β = 0.1865, P < 0.0001) and hyaluronic acid levels(β = 0.0008, P = 0.0039) in all patients by multiple regression analysis. Fibrosis area correlated significantly with ARFI by Spearman's rank correlation test but not by multiple regression analysis. ARFI correlated significantly with body mass index(BMI)(β =-0.0334, P = 0.0001) in F 0 or F 1, with γ-glutamyltranspeptidase levels(β = 0.0048, P = 0.0012) in F 2, and with fibrosis stage(β = 0.2921, P = 0.0044) and hyaluronic acid levels(β = 0.0012, P = 0.0025) in F 3 or F 4. The ARFI cutoff value was 1.28 m/s for F ≥ 2, 1.44 m/s for F ≥ 3, and 1.73 m/s for F 4. CONCLUSION: ARFI correlated with fibrosis stage and hyaluronic acid but not with inflammation. ARFI was affected by BMI, γ-glutamyltranspeptidase, and hyaluronic acid in each fibrosis stage.

关键词： Acoustic radiation force impulse Body mass index C

Changes of shear-wave velocity by interferon-based therapy in chronic hepatitis C

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World Journal of Gastroenterology 2015年第35期21卷 10215-10223页

作者： Keisuke Osakabe Naohiro Ichino Toru Nishikawa Hiroko Sugiyama Miho Kato Ai Shibata Wakana Asada Naoto Kawabe senju hashimoto Michihito Murao Takuji Nakano Hiroaki Shimazaki Toshiki Kan Kazunori Nakaoka Yuka Takagawa Masashi Ohki Takamitsu Kurashita Tomoki Takamura Kentaro Yoshioka Faculty of Medical Technology School of Health SciencesFujita Health University Center of Ultrasound Diagnosis Fujita Health University Hospital Department of Liver Biliary Tract and Pancreas DiseasesFujita Health University

AIM: To evaluate the changes of shear-wave velocity(Vs) by acoustic radiation force impulse after treatment in chronic hepatitis C.METHODS: Eighty-seven patients with chronic hepatitis C were consecutively treated with combinations of interferon(IFN) plus ribavirin(RBV). Vs value(m/s) was measured with acoustic radiation force impulse before treatment, at end of treatment(EOT), 1 year after EOT, and 2 years after EOT.RESULTS: In patients with a sustained virological response(SVR)(n = 41), Vs significantly decreased at EOT [1.19(1.07-1.37), P = 0.0004], 1 year after EOT [1.10(1.00-1.22), P = 0.0001], and 2 years after EOT [1.05(0.95-1.16), P < 0.0001] compared with baseline [1.27(1.11-1.49)]. In patients with a relapse(n = 26), Vs did not significantly decrease at EOT [1.23(1.12-1.55)], 1 year after EOT [1.20(1.12-1.80)], and 2 years after EOT [1.41(1.08-2.01)] compared with baseline [1.39(1.15-1.57)]. In patients with a nonvirological response(n = 20), Vs did not significantly decrease at EOT [1.64(1.43-2.06)], 1 year after EOT [1.66(1.30-1.95)], and 2 years after EOT [1.61(1.36-2.37)] compared with baseline [1.80(1.54-2.01)]. Among genotype 1 patients, baseline Vs was significantly lower in SVR patients [1.28(1.04-1.40)] than in non-SVR patients [1.56(1.20-1.83)](P = 0.0142).CONCLUSION: Reduction of Vs values was shown in SVR patients after IFN-plus-RBV therapy by acoustic radiation force impulse.

关键词： Hepatitis C virus Fibrosis Interferon and ribaviri

Risk factors for de novo hepatitis B during solid cancer treatment

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World Journal of Clinical Cases 2020年第24期8卷 6264-6273页

作者： Rie Sugimoto Masayuki Furukawa Takeshi senju Yoshihusa Aratake Yuki Tanaka Hiroki Inada Tatsuya Noguchi Lingaku Lee Masami Miki Yuji Maruyama Risa hashimoto Terumasa Hisano Mototsugu Shimokawa Department of Hepato-Biliary-Pancreatology National Hospital Organization Kyushu Cancer CenterFukuoka City 811-1395Fukuoka PrefectureJapan National Hospital Organization Kyushu Cancer Center Clinical Research InstituteFukuoka City 811-1395Fukuoka PrefectureJapan Department of Biostatistics Yamaguchi University Graduate School of MedicineUbe City 755-8505Yamaguchi PrefectureJapan

BACKGROUND Reactivation of hepatitis B virus(HBV)during anticancer treatment is a critical issue.When treating patients with solid tumors,it is unclear whether specific cancer types or treatments affect HBV reactivation in hepatitis B surface antigen(HBsAg)-negative and hepatitis B core antibody(HBcAb)-positive patients,socalled de novo hepatitis B patients.The risk of de novo hepatitis B may vary based on different background factors.AIM To determine the frequency and risk factors for de novo hepatitis B during solid tumor treatment.METHODS This retrospective cohort study comprised 1040 patients without HBsAgs and with HBcAbs and/or hepatitis B surface antibodies(HBsAbs).The patients were treated for solid cancer from 2008 to 2018 at the National Kyushu Cancer Center and underwent HBV DNA measurements.Patient characteristics and disease and treatment information were investigated.HBV DNA measurements were performed using TaqMan polymerase chain reaction(PCR).To identify the risk factors associated with HBV DNA expression,the age,sex,original disease,pathology,treatment method,presence or absence of hepatitis C virus(HCV),and HBsAb and/or HBcAb titers of all subjects were investigated.In patients with HBV DNA,the time of appearance,presence of HBsAgs and HBsAbs at the time of appearance,and course of the subsequent fluctuations in virus levels were also investigated.RESULTS Among the 1040 patients,938 were HBcAb positive,and 102 were HBcAb negative and HBsAb positive.HBV DNA expression was observed before the onset of treatment in nine patients(0.9%)and after treatment in 35 patients(3.7%),all of whom were HBcAb positive.The HBV reactivation group showed significantly higher median HBcAb values[9.00(8.12-9.89)vs 7.22(7.02-7.43),P=0.0001]and significantly lower HBsAb values(14 vs 46,P=0.0342)than the group without reactivation.Notably,the reactivated group showed a significantly higher proportion of cancers in organs related to digestion and absorption(79.0%vs 58.7%,P=0.0051).A high HBcAb titer and cancers in orga

关键词： Hepatitis B Reactivation Solid cancer treatment Digestion and absorption organ Hepatitis B surface antibody Hepatitis B core antibody titer