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Factors affecting recurrence after surgery for Crohn's disease

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World Journal of Gastroenterology 2005年第26期11卷 3971-3979页

作者： takayuki yamamoto Inflammatory Bowel Disease Center and Department of Surgery Yokkaichi Social Insurance Hospital YokkaichiMie 510-0016Japan

Although in Crohn's disease post-operative recurrence is common, the determinants of disease recurrence remain speculative. The aim of this study was to examine factors affecting post-operative recurrence of Crohn's disease. A Medline-based literature review was carried out. The following factors were investigated: age at onset of disease, sex, family history of Crohn's disease,smoking, duration of Crohn's disease before surgery,prophylactic medical treatment (corticosteroids, 5-amino salicylic acid [5-ASA] and immunosuppressants),anatomical site of involvement, indication for surgery (perforating or non-perforating disease), length of resected bowel, anast-omotic technique, presence of granuloma in the specimen, involvement of disease at the resection margin, blood transfusions and postoperative complications. Smoking significantly increases the risk of recurrence (risk is approximately twice as high), especially in women and heavy smokers. Quitting smoking reduces the post-operative recurrence rate. A number of studies have shown a higher risk when the duration of the disease before surgery was short. There were, however, different definitions of 'short' among the studies. Prophylactic cortic-osteroids therapy is not effective in reducing the post-operative recurrence. A number of randomized controlled trials offered evidence of the efficacy of 5-ASA (mesalazine) in reducing post-operative recurrence. Recently, the thera-peutic efficacy of immunosuppressive drugs (azathioprine and 6-mercaptopurine) in the prevention of post-operative recurrence has been investigated and several studies have reported that these drugs might help prevent the recurrence. Further clinical trials would be necessary to evaluate the prophylactic efficacy of *** studies showed a higher recurrence rate in patients with perforating disease than in those with non-perforating disease. However, evidence for differing recurrence rates in perforating and non-perforating dis

关键词： Crohn's disease Post-operative recurrence Predictive factors Resection Surgery

Steroid-sparing strategies in the management of ulcerative colitis:Efficacy of leukocytapheresis

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World Journal of Gastroenterology 2012年第41期18卷 5833-5838页

作者： Manabu Shiraki takayuki yamamoto Inflammatory Bowel Disease Center Yokkaichi Social Insurance Hospital Yokkaichi Mie 510-0016 Japan

Active ulcerative colitis （UC） is frequently associated with infiltration of a large number of leukocytes into the bowel mucosa. Leukocytapheresis is a novel nonphar- macologic approach for active UC, in which leukocytes are mechanically removed from the circulatory system. Current data indicate that leukocytapheresis is effica- cious in improving response and remission rates with excellent tolerability and safety in patients with UC. Corticosteroid therapy remains a mainstay in the treat- ment of active UC, however, long-term, high doses of corticosteroids usually produce predictable and po- tentially serious side effects. If leukocytapheresis can spare patients from exposure to corticosteroids, the risk of steroid-induced adverse events should be mini- mized. This may be of great benefit to patients because severe side effects of steroids seriously impair health- related quality of life. In this article, we reviewed cur- rent evidence on whether leukocytapheresis can avoid or reduce the use of corticosteroids in the manage- ment of patients with UC. Several studies have shown that leukocytapheresis was effective for steroid-nafve patients with active UC. Furthermore, both short-term and long-term studies have demonstrated the steroid- sparing effects of leukocytapheresis therapy in patients with UC. Although the evidence level is not striking, theavailable data suggest that leukocytapheresis can avoid or reduce the use of corticosteroids in the management of UC. Large, well-designed clinical trials are necessary to more accurately evaluate the steroid-sparing effects of leukocytapheresis in the management of UC.

关键词： Corticosteroid Granulocyte and monocyteadsorptive apheresis Leukocytapheresis Steroid-naivepatients Steroid-sparing effect Ulcerative colitis

Surgery for luminal Crohn's disease

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World Journal of Gastroenterology 2014年第1期20卷 78-90页

作者： takayuki yamamoto Toshiaki Watanabe Inflammatory Bowel Disease Center and Department of Surgery Yokkaichi Social Insurance HospitalMie 510-0016Japan Department of Surgical Oncology The University of TokyoHongoTokyo 113-0033Japan

Many patients with Crohn’s disease (CD) require surgery. Indications for surgery include failure of medical treatment, bowel obstruction, fistula or abscess formation. The most common surgical procedure is resection. In jejunoileal CD, strictureplasty is an accepted surgical technique that relieves the obstructive symptoms, while preserving intestinal length and avoiding the development of short bowel syndrome. However, the role of strictureplasty in duodenal and colonic diseases remains controversial. In extensive colitis, after total colectomy with ileorectal anastomosis (IRA), the recurrence rates and functional outcomes are reasonable. For patients with extensive colitis and rectal involvement, total colectomy and end-ileostomy is safe and effective; however, a few patients can have subsequent IRA, and half of the patients will require proctectomy later. Proctocolectomy is associated with a high incidence of delayed perineal wound healing, but it carries a low recurrence rate. Patients undergoing proctocolectomy with ileal pouch-anal anastomosis had poor functional outcomes and high failure rates. Laparoscopic surgery has been introduced as a minimal invasive procedure. Patients who undergo laparoscopic surgery have a more rapid recovery of bowel function and a shorter hospital stay. The morbidity also is lower, and the rate of disease recurrence is similar compared with open procedures.

关键词： Crohn’ s disease, Laparoscopic surgery, Resection, Strictureplasty, Surgery

Pouchitis and pre-pouch ileitis developed after restorative proctocolectomy for ulcerative colitis:A case report

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World Journal of Gastroenterology 2007年第4期13卷 643-646页

作者： Takashi Iwata takayuki yamamoto Satoru Umegae Koichi Matsumoto Inflammatory Bowel Disease Center and Department of Surgery Yokkaichi Social Insurance Hospital 10-8 Hazuyamacho Yokkaichi Mie 510-0016 Japan

We report a case of pouchitis and pre-pouch ileitis, and inflammation in the neo-terminal ileum proximal to the pouch, developed after restorative proctocolectomy for ulcerative colitis. A 35-year old female presented with fever and abdominal pain five weeks after ileostomy closure following proctocolectomy. Computed tomography showed collection of feces in the pouch and proximal ileum. A drainage tube was placed in the pouch perianally, and purulent feces were discharged. With antibiotic treatment, her symptoms disappeared, but two weeks later, she repeatedly developed fever and abdominal pain along with anal bleeding. Pouchscopy showed mucosal inflammation in both the pouch and the pre-pouch ileum. The mucosal cytokine production was elevated in the pouch and pre-pouch ileum. With antibiotic and corticosteroid therapy, her symptoms were improved along with improvement of endoscopic inflammation and decrease of mucosal cytokine production. The fecal stasis with bacterial overgrowth is the major pathogenesis of pouchitis and pre-pouch ileitis in our case.

关键词： Mucosal cytokines Pouchitis Pre-pouchileitis Restorative proctocolectomy Ulcerative colitis

Treating inflammatory bowel disease by adsorptive leucocytapheresis:A desire to treat without drugs

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World Journal of Gastroenterology 2014年第29期20卷 9699-9715页

作者： Abbi R Saniabadi Tomotaka Tanaka Toshihide Ohmori Koji Sawada takayuki yamamoto Hiroyuki Hanai Department of Pharmacology Hamamatsu University School of Medicine Department of Gastroenterology Akitsu Prefectural Hospital Ohmori Gastrointestinal Clinic Ikoma General and Gastroenterological Clinic Inflammatory Bowel Disease Centre Yokkaichi Social Insurance Hospital Hamamatsu South Hospital

Ulcerative colitis and Crohn’s disease are the major phenotypes of the idiopathic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms, impairing function and quality of life. Current medications are aimed at reducing the symptoms or suppressing exacerbations. However, patients require life-long medications, and this can lead to drug dependency, loss of response together with adverse side effects. Indeed, drug side effects become additional morbidity factor in many patients on long-term medications. Nonetheless, the efficacy of anti-tumour necrosis factors (TNF)-α biologics has validated the role of inflammatory cytokines notably TNF-α in the exacerbation of IBD. However, inflammatory cytokines are released by patients’ own cellular elements including myeloid lineage leucocytes, which in patients with IBD are elevated with activation behaviour and prolonged survival. Accordingly, these leucocytes appear logical targets of therapy and can be depleted by adsorptive granulocyte/monocyte apheresis (GMA) with an Adacolumn. Based on this background, recently GMA has been applied to treat patients with IBD in Japan and in the European Union countries. Efficacy rates have been impressive as well as disappointing. In fact the clinical response to GMA seems to define the patients’ disease course, response to medications, duration of active disease, and severity at entry. The best responders have been first episode cases (up to 100%) followed by steroid naïve and patients with a short duration of active disease prior to GMA. Patients with deep ulcers together with extensive loss of the mucosal tissue and cases with a long duration of IBD refractory to existing medications are not likely to benefit from GMA. It is clinically interesting that patients who respond to GMA have a good long-term disease course by avoiding drugs including corticosteroids in the early st

关键词： Inflammatory bowel disease Myeloid lineage leucocytes Adsorptive granulocytes/monocytes apheresis Corticosteroid sparing effect Complement activation fragments Treating inflammatory bowel disease without drugs

Impact of lipoprotein lipase gene polymorphisms on ulcerative colitis

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World Journal of Gastroenterology 2006年第39期12卷 6325-6330页

作者： Toshihito Kosaka Junji Yoshino Kazuo Inui Takao Wakabayashi Kazumu Okushima Takashi Kobayashi Hironao Miyoshi Yuta Nakamura Shigekazu Hayashi Taizou Shiraishi Masatoshi Watanabe takayuki yamamoto Ai Nakahara Takahiko Katoh Department of Internal Medicine Second Teaching Hospital Fujita Health University School of Medicine 3-6-10 Otobashi Nakagawaku Nagoya 454-8509 Japan Department of Gastroenterology Nagoya Ekisaikai Hospital 4-66 Shounencho Nakagawaku Nagoya 454-8502 Japan Department of Pathologic Oncology Mie University Graduate School of Medicine 2-174 Edobashi Tsu Mie 514-8507 Japan School of Engineering Yokohama National University 79-5 Tokiwadai Hodogaya-ku Yokohama 240-8501 Japan Inflammatory bowel disease centre and department of surgery Yokkaichi Social Insulance Hospital 10-8 Hazuyamacho Yokkaichi Mie Japan Department of Public Health Miyazaki Medical College University of Miyazaki 5200 Kihara Miyazaki 889-1692 Japan

AIM： To examine the influence of lipoprotein lipase （LPL） gene polymorphism in ulcerative colitis （UC） patients.METHODS： Peripheral blood was obtained from 131 patients with UC and 106 healthy controls for DNA extraction. We determined LPL gene polymorphisms affecting the enzyme at Ser447stop, as well as Hind Ⅲ and Pvu Ⅱ polymorphisms using PCR techniques. PCR products were characterized by PCR-RFLP and direct sequencing. Polymorphisms were examined for association with clinical features in UC patients. Genotype frequencies for LPL polymorphisms were also compared between UC patients and controls.RESULTS： In patients with onset at age 20 years or younger, C/G and G/G genotypes for Ser447stop polymorphism were more prevalent than C/C genotype （OR = 3.13, 95% CI = 0.95-10.33）. Patients with H^＋/- or H^-/- genotype for Hind Ⅲ polymorphism also were more nu merous than those with H^＋/＋ genotype （OR = 2.51, 95% CI = 0.85-7.45）. In the group with H^＋/＋ genotype for Hind Ⅲ polymorphism, more patients had serum triglyceride concentrations over 150 mg/dL than patients with H^＋/- or H^- genotype （P 〈 0.01, OR = 6.46, 95% CI = 1.39-30.12）. Hypertriglycemia was also more prevalent in patients with P^＋/＋ genotypes for Pvu Ⅱ polymorphism （P 〈 0.05, OR = 3.0, 95% CI = 1.06-8.50）. Genotype frequency for LPL polymorphism did not differ significantly between UC patients and controls.

关键词： Ulcerative colitis Lipoprotein lipase Lipid metabolism Triglyceride

Immunotherapy for esophageal cancer:Where are we now and where can we go

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World Journal of Gastroenterology 2024年第19期30卷 2496-2501页

作者： Yoshiaki Shoji Kazuo Koyanagi Kohei Kanamori Kohei Tajima Mika Ogimi Yamato Ninomiya Miho yamamoto Akihito Kazuno Kazuhito Nabeshima takayuki Nishi Masaki Mori Department of Gastroenterological Surgery Tokai University School of MedicineKanagawa 259-1193Japan

Immune checkpoint inhibitor therapy has dramatically improved patient prognosis,and thereby transformed the treatment in various cancer types including esophageal squamous cell carcinoma(ESCC)in the past *** antibodies that selectively inhibit programmed cell death-1(PD-1)activity has now become standard of care in the treatment of ESCC in metastatic settings,and has a high expectation to provide clinical benefit during perioperative ***,anti-cytotoxic T-lymphocyte–associated protein 4(CTLA-4)monoclonal antibody has also been approved in the treatment of recurrent/metastatic ESCC in combination with anti-PD-1 *** understanding of the existing evidence of immune-based treatments for ESCC,as well as recent clinical trials on various combinations with chemotherapy for different clinical settings including neoadjuvant,adjuvant,and metastatic diseases,may provide future prospects of ESCC treatment for better patient outcomes.

关键词： Esophageal cancer Immunotherapy Immune checkpoint inhibitor Programmed cell death-1 Anti-cytotoxic T-lymphocyte-associated protein 4 Neoadjuvant therapy Adjuvant therapy Clinical trials Combination therapy

Higher levels of the lipophilic antioxidants coenzyme Q_(10) and vitamin E in long-lived termite queens than in short-lived workers

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Insect Science 2024年第1期31卷 201-210页

作者： Eisuke Tasaki Yorihiro yamamoto Yoshihito Iuchi Department of Biological Chemistry Graduate School of Sciences and Technology for InnovationYamaguchi UniversityYamaguchiJapan School of Bioscience and Biotechnology Tokyo University of TechnologyHachiojiTokyoJapan

Termite queens and kings live longer than nonreproductive *** molecular mechanisms contributing to their long lifespan have been investigated;however,the underlying biochemical explanation remains *** Q(CoQ),a component of the mitochondrial electron transport chain,plays an essential role in the lipophilic antioxidant defense *** beneficial effects on health and longevity have been well studied in several ***,we demonstrated that long-lived termite queens have significantly higher levels of the lipophilic antioxidant CoQ_(10) than *** chromatography analysis revealed that the levels of the reduced form of CoQ_(10) were 4 fold higher in the queen's body than in the worker's *** addition,queens showed 7 fold higher levels of vitamin E,which plays a role in antilipid peroxidation along with CoQ,than ***,the oral administration of CoQ_(10) to termites increased the CoQ_(10) redox state in the body and their survival rate under oxidative *** findings suggest that CoQ_(10) acts as an efficient lipophilic antioxidant along with vitamin E in long-lived termite *** study provides essential biochemical and evolutionary insights into the relationship between CoQ_(10) concentrations and termite lifespan extension.

关键词： antioxidant defense system coenzyme Q termite queens vitamin E

Mission of the National Cancer Center Hospital in Japan to promote clinical trials for precision medicine

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Cancer Biology & Medicine 2024年第1期21卷 1-3页

作者： Kazuaki Shimada Kenichi Nakamura Noboru yamamoto Department of Hepatobiliary and Pancreatic Surgery National Cancer Center HospitalTokyo 104-0045Japan Clinical Research Support Offce National Cancer Center HospitalTokyo 104-0045Japan Department of Experimental Therapeutics National Cancer Center HospitalTokyo 104-0045Japan

Precision medicine is a growing field *** its potential benefit to many patients,several major obstacles must be overcome before precision medicine can be more widely used in clinical *** main obstacles are associated... 详细信息

关键词： clinical Cancer overcome