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Initial management for acute lower gastrointestinal bleeding

World Journal of Gastroenterology 2019年第1期25卷 69-84页

作者： tomonori aoki Yoshihiro Hirata Atsuo Yamada Kazuhiko Koike Department of Gastroenterology Graduate School of Medicine the University of Tokyo Division of Advanced Genome Medicine the Institute of Medical Sciencethe University of Tokyo

Acute lower gastrointestinal bleeding(LGIB) is a common indication for hospital admission. Patients with LGIB often experience persistent or recurrent bleeding and require blood transfusions and interventions, such as colonoscopic,radiological, and surgical treatments. Appropriate decision-making is needed to initially manage acute LGIB, including emergency hospitalization, timing of colonoscopy, and medication use. In this literature review, we summarize the evidence for initial management of acute LGIB. Assessing various clinical factors,including comorbidities, medication use, presenting symptoms, vital signs, and laboratory data is useful for risk stratification of severe LGIB, and for discriminating upper gastrointestinal bleeding. Early timing of colonoscopy had the possibility of improving identification of the bleeding source, and the rate of endoscopic intervention, compared with elective colonoscopy. Contrast-enhanced computed tomography before colonoscopy may help identify stigmata of recent hemorrhage on colonoscopy, particularly in patients who can be examined immediately after the last hematochezia. How to deal with nonsteroidal antiinflammatory drugs(NSAIDs) and antithrombotic agents after hemostasis should be carefully considered because of the risk of rebleeding and thromboembolic events. In general, aspirin as primary prophylaxis for cardiovascular events and NSAIDs were suggested to be discontinued after LGIB. Managing acute LGIB based on this information would improve clinical outcomes. Further investigations are needed to distinguish patients with LGIB who require early colonoscopy and hemostatic intervention.

关键词： Lower gastrointestinal bleeding Predictive model Colonoscopy Computed tomography Medication

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Stresses in the Scapular Fossa Do Not Exceed the Yield Stress When Elevated up to 135 Degrees of Abduction after Reverse Shoulder Arthroplasty

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Journal of Biomedical Science and Engineering 2024年第2期17卷 35-40页

作者： Rina Sakai tomonori Kenmoku Ryo Tazawa Kazuhiro Yoshida Tomomi Mizuhashi Masanobu Ujihira Department of Medical Engineering and Technology Kitasato University School of Allied Health Sciences Sagamihara Japan Department of Orthopedic Surgery Kitasato University School of Medicine Sagamihara Japan Kitasato University Graduate School of Medical Sciences Sagamihara Japan

Reverse shoulder arthroplasty (RSA) is an effective treatment for rotator cuff tears. Despite its advantages, complications occur at a high rate. Complications requiring revision include a high rate of base plate failure, 38% of which are due to instability. The primary stability the base plate ensures is a crucial factor and, thus, is the subject of much debate in clinical studies and biomechanical research. This study is aimed to provide data that will contribute to the base plate’s pri-mary stability and glenoid longevity by clarifying the stresses at the scapular fossa and base plate interface associated with elevation after RSA. A 3D finite element model was created from the DICOM data for the scapulohumeral joint and SMR shoulder system. For loading conditions, 30 N was applied for each posi-tion with abduction angles of 0, 45, 90, and 135 degrees. A three-dimensional fi-nite element analysis was performed using the static implicit method with LS-DYNA. The von Mises stresses in the scapular fossa were found not to exceed the yield stress on the bone even after elevation to an abduction angle of 135 de-grees after RSA. It is rough to uniformly compare the yield stress and the von Mises stress, but it was inferred that the possibility of fracture is low unless a large external force is applied. A maximum von Mises stress showed 0 degrees of abduction, suggesting that the lowered position is in a more severe condition than the elevated position. If better improvement is desired, it may be necessary to devise ways to reduce the stress on the upper screw. .

关键词： Reverse Shoulder Arthroplasty Finite Element Analysis Yield Stress Glenoid

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Comparison of endoscopic gastritis based on Kyoto classification between diffuse and intestinal gastric cancer

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World Journal of Gastrointestinal Endoscopy 2021年第5期13卷 125-136页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida tomonori aoki Fumiko Nagura Kosuke Sakitani Yosuke Tsuji Hayato Nakagawa Hidekazu Suzuki Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Internal Medicine Chitosefunabashi Ekimae ClinicTokyo 157-0054Japan Department of Gastroenterology Sakiatani Endoscopy ClinicNarashino 275-0026Japan Department of Gastroenterology and Hepatology Tokai University School of MedicineIsehara 259-1193Japan

BACKGROUND Gastric cancers can be categorized into diffuse-and intestinal-type cancers based on the Lauren histopathological classification.These two subtypes show distinct differences in metastasis frequency,treatment application,and prognosis.Therefore,accurately assessing the Lauren classification before treatment is crucial.However,studies on the gastritis endoscopy-based Kyoto classification have recently shown that endoscopic diagnosis has improved.AIM To investigate patient characteristics including endoscopic gastritis associated with diffuse-and intestinal-type gastric cancers in Helicobacter pylori(H.pylori)-infected patients.METHODS Patients who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic were enrolled.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.The effects of age,sex,and Kyoto classification score on gastric cancer according to the Lauren classification were analyzed.We developed the Lauren predictive background score based on the coefficients of a logistic regression model using variables independently associated with the Lauren classification.Area under the receiver operative characteristic curve and diagnostic accuracy of this score were examined.RESULTS A total of 499 H.pylori-infected patients(49.6%males;average age:54.9 years)were enrolled;132 patients with gastric cancer(39 diffuse-and 93 intestinal-type cancers)and 367 cancer-free controls were eligible.Gastric cancer was independently associated with age≥65 years,high atrophy score,high intestinal metaplasia score,and low nodularity score when compared to the control.Factors independently associated with intestinal-type cancer were age≥65 years(coefficient:1.98),male sex(coefficient:1.02),high intestinal metaplasia score(coefficient:0.68),and low enlarged folds score(coefficient:-1.31)when compared to diffuse-type cancer.The Lauren predictive background score was defined as the sum of+2(age≥65 years),+1(male sex),+1(endoscopic intestinal metaplasia),a

关键词： Gastric cancer Lauren classification Endoscopy Pathology Gastritis Kyoto classification

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Pneumonia and seizures due to hypereosinophilic syndrome—organ damage and eosinophilia without synchronisation:A case report

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World Journal of Clinical Cases 2022年第18期10卷 6325-6332页

作者： Tetsuro Ishida tomonori Murayama Seiju Kobayashi Department of Psychiatry Hokujinkai Ishibashi HospitalOtaru 047-8585Japan Department of Psychiatry Kushiro Red Cross HospitalKushiro 085-8512Japan Department of Psychiatry Shinyukai Nakae HospitalSapporo 001-0022Japan

BACKGROUND Hypereosinophilic syndrome(HES)is a condition characterized by increased eosinophil proliferation in the bone marrow,as well as tissue eosinophilia,often causing organ damage.The cause of the disease is unknown.Initial symptoms include fatigue,cough,shortness of breath,myalgia,angioedema,fever,and pneumonia.In addition to the respiratory symptoms,damage to the central nervous system can lead to severe seizures.Here,we report a case with pneumonia and complex partial seizures secondary to HES.CASE SUMMARY A 94-year-old woman was admitted to our hospital for heart failure and bloody stools.After admission,she also showed symptoms of pneumonia.Non-contrast computed tomography of the chest showed pleural effusion and infiltrative shadows.Lower gastrointestinal endoscopy showed multiple ulcers in the sigmoid colon.Blood analyses showed marked eosinophilia(eosinophils 1760/mm3,total leukocytes 6850/mm3).Initial treatment with furosemide 20 mg/d and prednisolone 25 mg/d relieved these symptoms.However,the patient subsequently experienced localised epileptic seizures characterized by bilateral eyelid twitching and eyes rolling upwards,without generalized convulsions,and respiratory arrest occurred.Electroencephalography showed spikes and waves.Non-contrast magnetic resonance imaging of the brain showed extensive periventricular hyperintensity.With administration of levetiracetam 1000 mg/d the epileptic seizures disappeared.However,the patient’s consciousness remained impaired,and her pneumonia worsened again.Two weeks later,she died of pneumonia.CONCLUSION HES symptoms are variable and atypical,and the level and timing of eosinophilia and organ damage are often discordant.

关键词： Case report Hypereosinophilic syndrome Pneumonia Seizures Prednisolone Levetiracetam

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Integrated view of plant metabolic defense with particular focus on chewing herbivores

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Journal of Integrative Plant Biology 2022年第2期64卷 449-475页

作者： David Wari Takako Aboshi tomonori Shinya Ivan Galis Institute of Plant Science and Resources Okayama UniversityKurashiki710-0046 Japan Faculty of Agriculture Yamagata UniversityWakaba-machiTsuruoka997-8555 Japan

Success of plants largely depends on their ability to defend against herbivores.Since emergence of the first voracious consumers,plants maintained adapting their structures and chemistry to escape from extinction.The constant pressure was further accelerated by adaptation of herbivores to plant defenses,which all together sparked the rise of a chemical empire comprised of thousands of specialized metabolites currently found in plants.Metabolic diversity in the plant kingdom is truly amazing,and although many plant metabolites have already been identified,a large number of potentially useful chemicals remain unexplored in plant bioresources.Similarly,biosynthetic routes for plant metabolites involve many enzymes,some of which still wait for identification and biochemical characterization.Moreover,regulatory mechanisms that control gene expression and enzyme activities in specialized metabolism of plants are scarcely known.Finally,understanding of how plant defense chemicals exert their toxicity and/or repellency against herbivores remains limited to typical examples,such as proteinase inhibitors,cyanogenic compounds and nicotine.In this review,we attempt summarizing the current status quo in metabolic defense of plants that is predominantly based on the survey of ubiquitous examples of plant interactions with chewing herbivores.

关键词： defense herbivore mode of action plant specialized metabolism

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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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Current research of idiopathic normal pressure hydrocephalus:Pathogenesis,diagnosis and treatment

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World Journal of Clinical Cases 2023年第16期11卷 3706-3713页

作者： Tetsuro Ishida tomonori Murayama Seiju Kobayashi Department of Psychiatry Japan Health Care CollegeSapporo 062-0053HokkaidoJapan Department of Psychiatry Asahikawa Keisenkai HospitalAsahikawa 078-8208HokkaidoJapan Department of Psychiatry Shinyukai Nakae HospitalSapporo 001-0022HokkaidoJapan

Idiopathic normal pressure hydrocephalus(iNPH)is caused by impaired cerebrospinal fluid absorption in the elderly;it is a surgically treatable form of dementia.Gait disturbance,dementia,and urinary incontinence are the triad of signs for iNPH.In addition to these clinical findings,imaging studies show characteristic ventricular enlargement.High Evans Index and‘disproportionately enlarged subarachnoid hydrocephalus’are other well-known imaging findings of iNPH.If the tap test shows improved symptoms,shunt surgery is performed.The disease was first described by Hakim and Adams in 1965,followed by the publication of the first,second,and third editions of the guidelines in 2004,2012,and 2020,respectively.Recent studies signal the glymphatic system and classical cerebrospinal fluid(CSF)absorption from the dural lymphatics as aetiological mechanisms of CSF retention.Research is also underway on imaging test and biomarker developments for more precise diagnosis,shunting technique options with fewer sequelae and complications,and the influence of genetics.Particularly,the newly introduced‘suspected iNPH’in the third edition of the guidelines may be useful for earlier diagnosis.However,less well-studied areas remain,such as pharmacotherapy in non-operative indications and neurological findings other than the triadic signs.This review briefly presents previous research on these and future issues.

关键词： Review Idiopathic normal pressure hydrocephalus Treatable dementia Shunt surgery Drug therapy

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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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Biological methane production coupled with sulfur oxidation in a microbial electrosynthesis system without organic substrates

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Journal of Environmental Sciences 2022年第6期34卷 68-78页

作者： Ha T.T.Dinh Hiromi Kambara Shuji Matsushita Yoshiteru Aoi tomonori Kindaichi Noriatsu Ozaki Akiyoshi Ohashi Department of Civil and Environmental Engineering Graduate School of Advanced Science and EngineeringHiroshima University1-4-1KagamiyamaHigashihiroshimaHiroshima 739-8527Japan Faculty of Environment Ho Chi Minh City University of Natural Resources and Environment236 Le Van Sy1 WardTan Binh DistrictHo Chi Minh CityViet Nam Agricultural Technology Research Center Hiroshima Prefectural Technology Research Institute6869HaraHachihonmatsuHigashihiroshimaHiroshima 739-0151Japan Program of Biotechnology Graduate School of Integrated Sciences for LifeHiroshima University1-3-1KagamiyamaHigashihiroshimaHiroshima 739-8530Japan

Methane is produced in a microbial electrosynthesis system(MES) without organic substrates. However, a relatively high applied voltage is required for the bioelectrical reactions.In this study, we demonstrated that electrotrophic methane production at the biocathode was achieved even at a very low voltage of 0.1 V in an MES, in which abiotic HS-oxidized to SO_(4)^(2-) at the anodic carbon-cloth surface coated with platinum powder. In addition, microbial community analysis revealed the most probable pathway for methane production from electrons. First, electrotrophic H_(2) was produced by syntrophic bacteria, such as Syntrophorhabdus, Syntrophobacter, Syntrophus, Leptolinea, and Aminicenantales, with the direct acceptance of electrons at the biocathode. Subsequently, most of the produced H_(2) was converted to acetate by homoacetogens, such as Clostridium and Spirochaeta 2. In conclusion,the majority of the methane was indirectly produced by a large population of acetoclastic methanogens, namely Methanosaeta, via acetate. Further, hydrogenotrophic methanogens,including Methanobacterium and Methanolinea, produced methane via H_(2).

关键词： Bioelectricity Homoacetogens Methane production Microbial electrosynthesis system Sulfur oxidation

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Phylogenetic placement and diet of homalopsid snake Miralia alternans (Ruess,1833)

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Zoological Research 2022年第5期43卷 734-737页

作者： Ibuki Fukuyama tomonori Kodama Koshiro Eto Masafumi Matsui Mohamad Yazid Hossman Kanto Nishikawa Graduate School of Human and Environmental Studies Kyoto UniversityYoshida-NihonmatsuSakyoKyoto 606-8501Japan Graduate School of Science Kyoto UniversityKitashirakawa-OiwakeSakyoKyoto 606-8502Japan Kitakyushu Museum of Natural History&Human History Higashida 2-4-1YahatahigashiKitakyushuFukuoka 805-0071Japan Research Developmentand Innovation DivisionForest Department SarawakKuchingSarawak 93250Malaysia Graduate School of Global Environmental Studies Kyoto UniversityYoshida-HonmachiSakyoKyoto 606-8501Japan

DEAR EDITOR,Miralia alternans(Ruess,1833)is distributed in Borneo,Sumatra,and Java in Southeast Asia.The species is morphologically similar to Raclitia indica,a monotypic genus known from Peninsular Malaysia.Here,we collected a juvenile specimen of M.alternans from Borneo,and report on its coloration in life and first prey item recovered from the species.We also explored the phylogenetic position of the genus using molecular phylogenetic analysis of mitochondrial DNA(mtDNA)gene cytochrome b(cyt b)and nuclear gene prolactin receptor(PRLR),confirming M.alternans as sister to R.indica,with the two genera exhibiting relatively high genetic divergence in cyt b(13.0%-13.1%).

关键词： EDIT fir Java

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