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Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods

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World Journal of Gastroenterology 2016年第26期22卷 5927-5935页

作者： Yosuke Kataoka Yosuke Tsuji Yoshiki Sakaguchi Chihiro Minatsuki Itsuko Asada-Hirayama Keiko Niimi Satoshi Ono shinya kodashima Nobutake Yamamichi Mitsuhiro Fujishiro Kazuhiko Koike Department of Gastroenterology Graduate School of Medicine The University of Tokyo Center for Epidemiology and Preventive Medicine Graduate School of Medicine The University of Tokyo Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine The University of Tokyo

Endoscopic submucosal dissection(ESD) has become widely accepted as a standard method of treatment for superficial gastrointestinal neoplasms because it enables en block resection even for large lesions or fibrotic lesions with minimal invasiveness, and decreases the local recurrence rate. Moreover, specimens resected in an en block fashion enable accurate histological assessment. Taking these factors into consideration, ESD seems to be more advantageous than conventional endoscopic mucosal resection(EMR), but the associated risks of perioperative adverse events are higher than in EMR. Bleeding after ESD is the most frequent among these adverse events. Although post-ESD bleeding can be controlled by endoscopic hemostasis in most cases, it may lead to serious conditions including hemorrhagic shock. Even with preventive methods including administration of acid secretion inhibitors and preventive hemostasis, post-ESD bleeding cannot be completely prevented. In addition high-risk cases for post-ESD bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing. Although there have been many reports about associated risk factors and methods of preventing post-ESD bleeding, many issues remain unsolved. Therefore, in this review, we have overviewed risk factors and methods of preventing post-ESD bleeding from previous studies. Endoscopists should have sufficient knowledge of these risk factors and preventive methods when performing ESD.

关键词： Endoscopic submucosal dissection Risk factor Bleeding Prevention Antithrombotic agents

Curative ESD for intraepithelial esophageal carcinoma with leiomyoma mimicking submucosal invasive carcinoma

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World Journal of Gastrointestinal Endoscopy 2009年第1期1卷 68-71页

作者： Keiko Niimi shinya kodashima Satoshi Ono Osamu Goto Nobutake Yamamichi Mitsuhiro Fujishiro Department of Gastroenterology Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

This case report presents a 65-year-old man who developed early esophageal cancer with leiomyoma treated by endoscopic submucosal dissection(ESD).There have been several reports of co-existing superficial esophageal cancer and leiomyoma treated by endoscopic mucosal ***,there is no previous report describing the co-existing lesion treated by *** order to determine treatment strategies for esophageal cancer,accurate endoscopic evaluation of the cancerous depth is *** the present case,the combination of endoscopic ultrasonography and narrow-band imaging system with magnifying endoscopy was extremely useful to evaluate the superficial esophageal cancer with leiomyoma,which lead to the appropriate treatment,ESD.

关键词： Endoscopic submucosal dissection Submucosal tumor Esophageal neoplasms Narrow-band imaging magnifying endoscopy Endoscopic ultrasonography

Evaluation of preferable insertion routes for esophagogastroduodenoscopy using ultrathin endoscopes

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World Journal of Gastroenterology 2014年第17期20卷 5045-5050页

作者： Satoshi Ono Keiko Niimi Mitsuhiro Fujishiro Yu Takahashi Yoshiki Sakaguchi Chiemi Nakayama Chihiro Minatsuki Rie Matsuda Itsuko Hirayama-Asada Yosuke Tsuji Satoshi Mochizuki shinya kodashima Nobutake Yamamichi Atsuko Ozeki Lumine Matsumoto Yumiko Ohike Tsutomu Yamazaki Kazuhiko Koike Center for Epidemiology and Preventive Medicine Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan Department of Gastroenterology Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan Department of Endoscopy and Endoscopic Surgery Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

AIM: To evaluate the discomfort associated with esophagogastroduodenoscopy (EGD) using an ultrathin endoscope through different insertion routes.

关键词： Esophagogastroduodenoscopy Ultrathin endoscope Visual analog scale

Subserosal injection of hyaluronic acid may prevent perforation after endoscopic resection

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World Journal of Gastrointestinal Endoscopy 2009年第1期1卷 61-64页

作者： Keiko Niimi Mitsuhiro Fujishiro shinya kodashima Satoshi Ono Osamu Goto Nobutake Yamamichi Kazuhiko Koike Department of Gastroenterology Graduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

AIM:To investigate the protective effect of subserosal injection of hyaluronic acid(HA) after endoscopic resection(ER) using ex vivo and in vivo ***:As the first examination,technical application of subserosal injection was tested 10 times using resected porcine *** the second examination,ER was applied to make six mucosal defects per stomach in three live minipigs and thermal damage was given on the proper muscle layer by using hemostatic *** the thermocoagulation,1 mL of normal saline and HA,respectively,was injected targeting the subserosal layer in two mucosal defects each and the rest kept no injection as the *** minipigs were recovered from the anesthesia and kept fasting until euthanasia which was carried out around 24 h after the ***:Ex vivo study revealed that complete and partial subserosal injection was possible two(20%) and four(40%) times,*** vivo study revealed that no postoperative perforation occurred at any point of the *** retention of hyaluronic acid was identified at only two(33%) points where HA was ***:This study failed to show preventative effects of subserosal injection of HA on postoperative perforation due to technical ***,this concept has a possibility to change strategy of ER with further technical innovation.

关键词： Subserosal injection Endoscopic submucosal dissection Endoscopic mucosal resection Animal model Thermal injury Perforation

Sessile serrated adenoma detection rate is correlated with adenoma detection rate

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World Journal of Gastrointestinal Oncology 2018年第3期10卷 82-90页

作者： Daisuke Ohki Yosuke Tsuji Tomohiro Shinozaki Yoshiki Sakaguchi Chihiro Minatsuki Hiroto Kinoshita Keiko Niimi Satoshi Ono Yoku Hayakawa Shuntaro Yoshida Atsuo Yamada shinya kodashima Nobutake Yamamichi Yoshihiro Hirata Tetsuo Ushiku Mitsuhiro Fujishiro Masashi Fukayama Kazuhiko Koike Department of Gastroenterology Graduate School of Medicinethe University of Tokyo Department of Biostatistics School of Public Healththe University of Tokyo Center for Epidemiology and Preventive Medicine Graduate School of Medicinethe University of Tokyo Department of Endoscopy and Endoscopic Surgery Graduate School of Medicinethe University of Tokyo Department of Pathology Graduate School of Medicine the University of Tokyo

AIM To investigated the association between adenoma detection rate(ADR) and sessile serrated ADR(SSADR) and significant predictors for sessile serrated adenomas(SSA) *** This study is a retrospective, single-center analysis. Total colonoscopies performed by the gastroenterologists at the University of Tokyo Hospital between January and December 2014 were retrospectively identified. Polyps were classified as low-grade or high-grade adenoma, cancer, SSA, or SSA with cytological dysplasia, and the prevalence of each type of polyp was investigated. Predictors of adenoma and SSA detection were examined using logistic generalized estimating equation models. The association between ADR and SSADR for each gastroenterologist was investigated by calculating a correlation coefficient weighted by the number of each gastroenterologist's *** A total of 3691 colonoscopies performed by 35 gastroenterologists were assessed. Overall, 978 (26.5%) low-and 84 (2.2%) high-grade adenomas, 81 (2.2%) cancers, 66 (1.8%) SSAs, and 2 (0.1%) SSAs with cytological dysplasia were detected. Overall ADR was 29.5%(men 33.2%, women 23.8%) and overall SSADR was 1.8%(men 1.7%, women 2.1%). In addition, 672 low-grade adenomas (68.8% of all the detected lowgrade adenomas), 58 (69.9%) high-grade adenomas, 29 (34.5%) cancers, 52 (78.8%) SSAs, and 2 (100%) SSAs with cytological dysplasia were found in the proximal colon. Adenoma detection was the only significant predictor of SSA detection (adjusted OR: 2.53, 95%CI: 1.53-4.20; P < 0.001). The correlation coefficient between ADR and SSADR weighted by the number of each gastroenterologist's examinations was 0.606(P < 0.001).CONCLUSION Our results demonstrated that ADR is correlated to SSADR. In addition, patients with adenomas had a higher prevalence of SSAs than those without adenomas.

关键词： Sessile serrated adenoma Sessile serrated adenoma detection rate Adenoma detection rate Colonoscopy Interval colorectal cancer

Ultrathin endoscope flexibility can predict discomfort associated with unsedated transnasal esophagogastroduodenoscopy

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World Journal of Gastrointestinal Endoscopy 2013年第7期5卷 346-351页

作者： Satoshi Ono Keiko Niimi Mitsuhiro Fujishiro Tomoko Nakao Kazushi Suzuki Yumiko Ohike shinya kodashima Nobutake Yamamichi Tsutomu Yamazaki Kazuhiko Koike Center for Epidemiology and Preventive Medicine Graduate School of Medicine the University of TokyoTokyo 113-8655 Japan Department of Gastroenterology Graduate School of Medicine the University of TokyoTokyo 113-8655 Japan Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine the University of TokyoTokyo 113-8655 Japan

AIM: To evaluate the effects of choice of insertion route and ultrathin endoscope types. METHODS: This prospective study (January-June 2012) included 882 consecutive patients who underwent annual health checkups. Transnasal esophagogastroduodenoscopy (EGD) was performed in 503 patients and transoral EGD in 235 patients using six types of ultrathin endoscopes. Patients were given a choice of insertion route, either transoral or transnasal, prior to EGD examination. For transoral insertion, the endo-scope was equipped with a thin-type mouthpiece and tongue depressor. Conscious sedation was not used for any patient. EGD-associated discomfort was assessed using a visual analog scale (VAS; no discomfort 0maximum discomfort 10). RESULTS: Rates of preference for transnasal insertion were significantly higher in male (male/female 299/204 vs 118/117) and younger patients (56.8 ± 11.2 years vs 61.3 ± 13.0 years), although no significant difference was found in VAS scores between transoral and transnasal insertion (3.9 ± 2.3 vs 4.1 ± 2.5). Multivariate analysis revealed that gender, age, operator, and endoscope were independent significant predictors of VAS for transnasal insertion, although gender, age, and endoscope were those for transoral insertion. Further analysis revealed only the endoscopic flexibility index (EFI) as an independent significant predictor of VAS for transnasal insertion. Both EFI and tip diameter were independent significant predictors of VAS for transoral insertion. CONCLUSION: Flexibility of ultrathin endoscopes can be a predictor of EGD-associated discomfort, especially in transnasal insertion.

关键词： Esophagogastroduodenoscopy Ultrathin endoscope Visual analog scale Discomfort Surveillance

Integrally Closed Ideals of Reduction Number Three

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Algebra Colloquium 2023年第2期30卷 315-324页

作者： shinya Kumashiro National Institute of Technology(KOSEN) Oyama College 771 NakakukiOyamaTochigi323-0806Japan

In a Cohen-Macaulay local ring(A,m),we study the Hilbert function of an integrally closed m-primary ideal I whose reduction number is three.,With a mild assump-tion we give an inequality ιA(A/I)≥e0(I)-e1(I)+(e2(I)+lA(I^(2)/QI)/2,where ei(I)denotes the ith Hilbert coeficient and Q denotes a minimal reduction of *** inequality is located between inequalities of Itoh and ***,this inequality be-comes an equality if and only if the depth of the associated graded ring of I is larger than or equal to dim *** also study the Cohen-Macaulayness of the associated graded rings of determinantal rings.

关键词： Hilbert function Rees algebra associated graded ring Sally module Cohen-Macaulay ring

Effects of hydraulic oil and lubricant additives on dynamic friction properties under various reciprocating sliding conditions

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Friction 2020年第2期8卷 471-480页

作者： Shinji KATO shinya SASAKI Engineering Headquarters Automotive ComponentsKYB Corporation2548DolaKani-shiGifu 509-0298Japan Department of Mechanical Engineering Faculty of Engineering Division ITokyo University of Science6-3-1NiijukuKatsushika-kuTokyo 125-8585Japan

The friction characteristics of a shock absorber are very complex because the reciprocating motion is not always *** this study,a device was developed and used to analyze the dynamic friction characteristics under various reciprocating sliding conditions to determine the sliding materials and hydraulic oils that improve the shock absorber *** study describes the influence of hydraulic oil additive on the fine reciprocating friction characteristics of steel and copper *** oils were prepared by blending a paraffinic mineral oil with zinc dithiophosphate(ZnDTP)and polyhydric alcohol ester as *** results show that the dynamic frictional characteristics vary mainly depending on the additive concentration.A specific additive formulation induces a unique amplitude-dependent friction *** addition,the influence of different additives on the lubrication mechanism is investigated based on the instrumental analysis of the friction surface.

关键词： shock absorber dynamic friction reciprocating friction additive zinc dithiophosphate(ZnDTP)

Towards a unified interpretation of the early Universe in R^(2)-corrected dark energy model of F(R)gravity

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Chinese Physics C 2022年第10期46卷 259-269页

作者： Hua Chen Taishi Katsuragawa shinya Matsuzaki Institute of Astrophysics Central China Normal UniversityWuhan 430079China Center for Theoretical Physics and College of Physics Jilin UniversityChangchun 130012China

R^(2)-corrected dark energy(DE)models in F(R)gravity have been widely investigated in recent years,which not only removes the weak singularity potentially present in DE models but also provide us with a unified picture of the cosmic history,including the inflationary and DE *** the unified interpretation of dynamical DE all over the cosmic history in the class of R^(2)-corrected DE models,we explore the universal features of the scalaron dynamics in the radiation-dominated epoch,along with the chameleon mechanism,by keeping our eyes on the inflationary and DE *** show that the scalaron evolution does not follow a surfing solution and is mostly adiabatic before big bang nucleosynthesis(BBN),even properly including the kick by the nonperturbative QCD phase transition,hence a catastrophic consequence claimed in the literature is not applied to this class of DE *** is due to the presence of the gigantic scale hierarchy between R^(2) correction and DE,so is the universal feature for the class of R^(2)-corrected DE *** prospects for the post-or onset-inflationary epoch would be pretty different from what the standard R^(2) inflationary scenario undergoes due to the presence of the chameleon mechanism.

关键词： modified gravity dark energy inflation