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Unsedated transnasal small-caliber esophagogastroduoden oscopy in elderly and bedridden patients

World Journal of Gastroenterology 2009年第44期15卷 5586-5591页

作者： Mika Yuki Yuji Amano Yoshinori Komazawa Hiroyuki Fukuhara Toshihiro Shizuku Shun Yamamoto yoshikazu kinoshita Division of Internal Medicine Izumo-City General Medical Center613 Nadabunn-choIzumo-shi Shimane 693-0003Japan Division of Endoscopy Shimane University Hospital89-1 Enya-choIzumo-shiShimane 693-8501Japan Division of Internal Medicine Unnan Municipal General Hospital96-1 Iida-choUnnan-shiShimane 699-1221Japan Second Department of Internal Medicine Shimane UniversitySchool of Medicine89-1 Enya-choIzumo-shiShimane 693-8501Japan

AIM:To evaluate the safety of unsedated transnasal small-caliber esophagogastroduodenoscopy(EGD)for elderly and critically ill bedridden patients. METHODS:One prospective randomized comparative study and one crossover comparative study between transnasal small-caliber EGD and transoral conventional EGD was done(Study 1).For the comparative study, we enrolled 240 elderly patients aged>65 years old. For the crossover analysis,we enrolled 30 bedridden patients with percutaneous endoscopic gastrostomy (PEG)(Study 2).We evaluated cardiopulmonary effects by measuring arterial oxygen saturation(SpO2)and calculating the rate-pressure product(RPP)(pulse rate×systolic blood pressure/100)at baseline,2 and 5 min after endoscopic intubation in Study 1.To assess the risk for endoscopy-related aspiration pneumoniaduring EGD,we also measured blood leukocyte counts and serum C-reactive protein(CRP)levels before and 3 d after EGD in Study 2. RESULTS:In Study 1,we observed significant decreases in SpO2 during conventional transoral EGD, but not during transnasal small-caliber EGD(0.24%vs -0.24%after 2 min,and 0.18%vs-0.29%after 5 min, P=0.034,P=0.044).Significant differences of the RPP were not found between conventional transoral and transnasal small-caliber EGD.In Study 2,crossover analysis showed statistically significant increases of the RPP at 2 min after intubation and the end of endoscopy (26.8 and 34.6 vs 3.1 and 15.2,P=0.044,P=0.046), and decreases of SpO2(-0.8%vs-0.1%,P=0.042) during EGD with transoral conventional in comparison with transnasal small-caliber endoscopy.Thus,for bedridden patients with PEG feeding,who were examined in the supine position,transoral conventional EGD more severely suppressed cardiopulmonary function than transnasal small-caliber EGD.There were also significant increases in the markers of inflammation, blood leukocyte counts and serum CRP values,in bedridden patients after transoral conventional EGD,but not after transnasal small-caliber EGD performed with the patient in the supine position.Leu

关键词：胃造口术胃疾病 PEG 治疗患者

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A dose-up of ursodeoxycholic acid decreases transaminases in hepatitis C patients

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World Journal of Gastroenterology 2009年第22期15卷 2782-2786页

作者： Shuichi Sato Tatsuya Miyake Hiroshi Tobita Naoki Oshima Junichi Ishine Takuya Hanaoka Yuji Amano yoshikazu kinoshita Department of Gastroenterology and Hepatology Shimane UniversitySchool of Medicine Division of Gastrointestinal Endoscopy Shimane University Hospital

AIM:To examine whether a dose-up to 900 mg of ursodeoxycholic acid(UDCA) decreases transaminases in hepatitis C patients.METHODS:From January to December 2007,patients with chronic hepatitis C or compensated liver cirrhosis with hepatitis C virus(HCV)(43-80 years old) showing positive serum HCV-RNA who had already taken 600 mg/d of UDCA were recruited into this study.Blood parameters were examined at 4,8 and 24 wk after increasing the dose of oral UDCA from 600 to 900 mg/d.RESULTS:Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),and gamma-glutamyl transpeptidase(GGT) levels were signifi cantly decreased following the administration of 900 mg/d as compared to 600 mg/d.The decrease in ALT from immediately before the dose-up of UDCA to 8 wk after the dose-up was 14.3 IU/L,while that for AST was 10.5 IU/L and for GGT was 9.8 IU/L.Platelet count tended to increase after the dose-up of UDCA,although it did not show a statistically signifi cant level(P=0.05).Minor adverse events were observed in 3 cases,although no drop-outs from the study occurred.CONCLUSION:Oral administration of 900 mg/d of UDCA was more effective than 600 mg/d for reducing ALT,AST,and GGT levels in patients with HCV-related chronic liver disease.

关键词：丙氨酸转氨酶丙型肝炎病毒熊去氧胆酸加剂量患者阳性血清国际单位谷草转氨酶

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Effects of anti-hypertensive drugs on esophageal body contraction

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World Journal of Gastroenterology 2010年第8期16卷 987-991页

作者： Koichi Yoshida Kenji Furuta Kyoichi Adachi Shunji Ohara Terumi Morita Takashi Tanimura Shuji Nakata Masaharu Miki Kenji Koshino yoshikazu kinoshita Second Department of Internal Medicine Shimane University Faculty of Medicine Department of Clinical Nursing Shimane University Faculty of Medicine

AIM:To clarify the effects of anti-hypertensive drugs on esophageal contraction and determine their possi-ble relationship with gastro-esophageal reflux disease.METHODS:Thirteen healthy male volunteers were enrolled. Esophageal body peristaltic contractions and lower esophageal sphincter (LES) pressure were measured using high resolution manometry. All subjects were randomly examined on four separate occasions following administrations of nifedipine,losartan,and atenolol,as well as without any drug administration.RESULTS:Peristaltic contractions by the esophageal body were separated into three segments by two troughs. The peak peristaltic pressures in the mid and lower segments of the esophageal body under atenolol administration were signifi cantly higher than those without medication in a supine position. On the other hand,peristaltic pressures under nifedipine administration were lower than those observed without drug ad-ministration. Losartan did not change esophageal body peristalsis. Atenolol elevated LES pressure and slowed peristaltic wave transition,while the effects of nifedip-ine were the opposite. CONCLUSION:Among the anti-hypertensive drugs tested,atenolol enhanced esophageal motor activity,which was in contrast to nifedipine.

关键词： Anti-hypertensive drug High-resolution manometry Lower esophageal sphincter Esophageal body contraction Calcium-channel blocker β1 blocker

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Systematic review:Eosinophilic esophagitis in Asian countries

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World Journal of Gastroenterology 2015年第27期21卷 8433-8440页

作者： yoshikazu kinoshita Norihisa Ishimura Naoki Oshima Shunji Ishihara Department of Gastroenterology and Hepatology Shimane University School of Medicine

AIM: to investigate the prevalence and the clinical characteristics of Asian patients with eosinophilic esophagitis.METHODS: We conducted a systematic search of the Pub Med and Web of Science databases for original studies, case series, and individual case reports of eosinophilic esophagitis in Asian countries published from January 1980 to January 2015. We found 66 and 80 articles in the Pub Med and Web of Science databases, respectively; 24 duplicate articles were removed. After excluding animal studies, articles not written in English, and meeting abstracts, 25 articles containing 217 patients were selected for analysis.RESULTS: Sample size-weighted mean values were determined for all pooled prevalence data and clinical characteristics. The mean age of the adult patients with eosinophilic esophagitis was approximately 50 years, and 73% of these patients were male. They frequently presented with allergic diseases including bronchial asthma, allergic rhinitis, food allergy, and atopic dermatitis. Bronchial asthma was the most frequent comorbid allergic disease, occurring in 24% of patients with eosinophilic esophagitis. Dysphagia was the primary symptom reported; 44% of the patients complained of dysphagia. Although laboratory blood tests are not adequately sensitive for an accurate diagnosis of eosinophilic esophagitis, endoscopic examinations revealed abnormal findings typical of this disease, including longitudinal furrows and concentric rings, in 82% of the cases. One-third of the cases responded to proton pump inhibitor administration.CONCLUSION: The characteristics of eosinophilicesophagitis in Asian patients were similar to those reported in Western patients, indicating that this disease displays a similar pathogenesis between Western and Asian patients.

关键词： Eosinophilic esophagitis Allergy Prevalence Symptom Endoscopy Asia Treatment

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Esophageal epithelial surface in patients with gastroesophageal reflux disease:An electron microscopic study

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World Journal of Gastroenterology 2008年第37期14卷 5712-5716页

作者： Takane Azumi Kyoichi Adachi Kenji Furuta Shuji Nakata Shunji Ohara Kenji Koshino Masaharu Miki Terumi Morita Takashi Tanimura Nobuo Ashizawa yoshikazu kinoshita Second Department of Internal Medicine Shimane University School of MedicineShimane 693-8501 Japan

AIM: To investigate the intercellular spaces between the most superficially located esophageal epithelial cells in patients with gastroesophageal reflux disease (GERD). METHODS: Eighteen patients with erosive esophagitis, 10 patients with non-erosive reflux disease (NERD), and 18 normal asymptomatic volunteers were enrolled. Biopsy specimens were obtained from the lower esophageal mucosa without ulcer or erosion. Scanning electron microscopy was employed to investigate the tightness of the superficial cellular attachment. RESULTS: The intercellular space between the most superficially located epithelial cells in patients with erosive esophagitis or NERD was not different from that in asymptomatic healthy individuals. CONCLUSION: Widened luminal intercellular spaces of esophageal superficial epithelium are not responsible for the induction of reflux symptoms in patients with GERD.

关键词：食道上皮面胃食管反流疾病电子显微镜研究

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Randomized study of lafutidine vs lansoprazole in patients with mild gastroesophageal reflux disease

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World Journal of Gastroenterology 2016年第23期22卷 5430-5435页

作者： Ryuta Takenaka Hiroyuki Okada Seiji Kawano Yoshinori Komazawa Fumiya Yoshinaga Shinji Nagata Masafumi Inoue Hirohisa Komatsu Seiji Onogawa Yoshinori Kushiyama Shinichi Mukai Hiroko Todo Hideharu Okanobu Noriaki Manabe Shinji Tanaka Ken Haruma yoshikazu kinoshita Department of Gastroenterology Tsuyama Chuo Hospital Tsuyama 708-0841 Japan Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama 708-0841 Japan Division of Internal Medicine Izumo City General Medical Center Izumo 691-0003 Japan Department of Gastroenterology Mihara Red Cross Hospital Mihara 723-0011 Japan Department of Endoscopy Hiroshima City Asa Citizens Hospital Hiroshima 731-0293 Japan Department of Gastroenterology Okayama Red Cross Hospital Okayama 700-0941 Japan Department of Gastroenterology Hiroshima General Hospital Hiroshima 734-8551 Japan Department of Gastroenterology Onomichi General Hospital Onomichi 722-8508 Japan Department of Gastroenterology Matsue Red Cross Hospital Matsue 690-8506 Japan Department of Gastroenterology Miyoshi Central Hospital Miyoshi 728-0023 Japan Department of Gastroenterology Hiroshima-Nishi Medical Center Hiroshima 739-0651 Japan Department of Gastroenterology Chugoku Rosai Hospital Kure 737-0134 Japan Department of Gastroenterology Kawasaki Medical School Hospital Kurashiki 701-0192 Japan Department of Endoscopy Hiroshima University Hospital Hiroshima 734-8551 Japan Department of General Internal Medicine 2 Kawasaki Hospital Kawasaki Medical School Okayama 708-0841 Japan Department of Gastroenterology and Hepatology Shimane University Hospital Izumo 693-0021 Japan

AIM: To compare the clinical efficacy of the secondgeneration H2 RA lafutidine with that of lansoprazole in Japanese patients with mild gastroesophageal reflux disease(GERD). METHODS: Patients with symptoms of GERD and a diagnosis of grade A reflux esophagitis(according to the Los Angeles classification) were randomized to receive lafutidine(10 mg, twice daily) or lansoprazole(30 mg, once daily) for an initial 8 wk, followed by maintenance treatment comprising half-doses of the assigned drug for 24 wk. The primary endpoint was the frequency and severity of heartburn during initial and maintenance treatment. The secondary endpoints were the sum score of questions 2 and 3 in the Gastrointestinal Symptom Rating Scale(GSRS), and the satisfaction score.RESULTS: Between April 2012 and March 2013, a total of 53 patients were enrolled, of whom 24 and 29 received lafutidine and lansoprazole, respectively. After 8 wk, the frequency and severity of heartburn was significantly reduced in both groups. However, lafutidine was significantly inferior to lansoprazole with regard to the severity of heartburn during initial and maintenance treatment(P = 0.016). The sum score of questions 2 and 3 in the GSRS, and satisfaction scores were also significantly worse in the lafutidine group than the lansoprazole group(P = 0.0068 and P = 0.0048, respectively).CONCLUSION: The clinical efficacy of lafutidine was inferior to that of lansoprazole, even in Japanese patients with mild GERD.

关键词： Gastroesophageal reflux disease Proton pump inhibitors Histamine receptor-2 antagonists Los Angeles

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A short climatology of black and brown carbon and their sources at a suburban site impacted by smoke in Brazil

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Journal of Environmental Sciences 2024年第2期136卷 498-511页

作者： Admir Creso Targino Patricia Krecl Gabriel yoshikazu Oukawa Eva Maria Mollinedo Graduate Program in Environmental Engineering Federal University of TechnologyAv.Pioneiros 3131LondrinaPR 86036-370Brazil Department of Environmental Engineering Federal University of TechnologyAv.Pioneiros 3131LondrinaPR 86036-370Brazil

Emissions from biomass burning challenge efforts to curb air pollution in cities downwind of fire-prone regions,as they contribute large amounts of brown carbon(Br C)and black carbon(BC)particles.We investigated the patterns of Br C and BC concentrations using Aethalometer data(atλ=370 and 880 nm,respectively)spanning four years at a site impacted by the outflow of smoke.The data required to be post processed for the shadowing effect since,without correction,concentrations would be between 29%and 35%underestimated.The Br C concentrations were consistently higher than the BC concentrations,indicating the prevalence of aerosols from biomass burning.The results were supported by the Angstrom coefficient(A_(370/880)),with values predominantly larger than 1(mean±standard deviation:1.25±0.31).A_(370/880)values below 1 were more prevalent during the wet season,which suggests a contribution from fossil fuel combustion.We observed sharp Br C and BC seasonal signals,with mean minimum concentrations of 0.40μg/m^(3)and 0.36μg/m^(3),respectively,in the wet season,and mean maximum concentrations of 2.05μg/m^(3)and 1.53μg/m^(3)in the dry season.The largest concentrations were observed when northerly air masses moved over regions with a high density of fire spots.Local burning of residential solid waste and industrial combustion caused extreme Br C and BC concentrations under favourable wind directions.Although neither pollutant is included in any ambient air quality standards,our results suggest that transboundary smoke may hamper efforts to meet the World Health Organization guidelines for fine particles.

关键词： Light-absorbing carbonaceous matter Black carbon Wildfires Biomass burning Aethalometer

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Co-infection with Neisseria mucosa in a patient with tuberculous otitis media

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Journal of Otology 2024年第1期19卷 1-4页

作者： Tatsuya Hioki Kazuaki Soejima Yuki Goto Makoto Sugiura Takumi Umemura Yoshimi Ishihara yoshikazu Mutoh Daisuke Sakanashi Hiroshige Mikamo Department of Clinical Laboratory Tosei General Hospital160 Nishioiwake-choSetoAichi489-8642Japan Department of Respiratory Medicine and Allergy Tosei General Hospital160 Nishioiwake-choSetoAichi489-8642Japan Department of Otolaryngology Tosei General Hospital160 Nishioiwake-choSetoAichi489-8642Japan Department of Infection Control Team Tosei General Hospital160 Nishioiwake-choSetoAichi489-8642Japan Department of Infectious Diseases Tosei General Hospital160 Nishioiwake-choSetoAichi489-8642Japan Department of Infection Prevention and Control Aichi Medical University Hospital1-1 YazakokarimataNagakuteAichi480-1195Japan Department of Clinical Infectious Diseases Aichi Medical University1-1 YazakokarimataNagakuteAichi480-1195Japan

Tuberculous otitis media(TOM) is a rare manifestation caused by Mycobacterium tuberculosis with low incidence rates among extrapulmonary tuberculosis cases. Diagnosis is often delayed because of the presence of several clinical manifestations and the high prevalence of secondary bacterial infections. Few reports have attributed secondary bacterial infections in patients with TOM to commensal Neisseria. Thus, understanding the pathogenic mechanisms and clinical features of commensal Neisseria is important, considering its recent presentation as an infection-causing pathogen. Neisseria mucosa is a commensal inhabitant in humans and is generally considered non-pathogenic but can cause infection in rare cases. Here, we report an atypical secondary infection caused by Neisseria mucosa in an 81-year-old woman with TOM being treated for pulmonary tuberculosis. Direct purulent otorrhea smear microscopy revealed no acid-fast bacilli using Ziehl-Neelsen staining, whereas the phagocytosis of gram-negative cocci by white blood cells was confirmed using Gram staining. Otorrhea culture revealed the growth of N. mucosa. Subsequently, M. tuberculosis infection in the otorrhea was identified using a culture-based method. Vigilance is critical for the early detection of TOM to prevent further complications. This report raises awareness regarding TOM and provides insight into the pathogenicity of N. mucosa in otitis media.

关键词： Commensal neisseria Miliary tuberculosis Mycobacterium tuberculosis Neisseria mucosa Tuberculous otitis media

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Predictive factors for efficacy of testosterone replacement therapy for late-onset hypogonadism in Japanese men:a preliminary report

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Asian Journal of Andrology 2023年第5期25卷 587-590页

作者： Nobuyuki Kondoh Yohei Kaizuka Seiji Nagasawa yoshikazu Togo Shingo Yamamoto Department of Urology Kawanishi City Medical CenterKawanishiHyogo 6660017Japan Department of Urology Hyogo Medical UniversityNishinomiyaHyog 6638501Japan

Although testosterone replacement therapy(TRT)is the first-choice method used worldwide for late-onset hypogonadism(LOH),clinical benefits are not seen in all cases.This study was conducted to determine the predictors of TRT efficacy for LOH.Fifty-six patients who visited our Men’s Health Clinic(Kawanishi City Medical Center,Kawanishi and Hyogo Medical University,Nishinomiya,Hyogo,Japan)between November 2003 and June 2021 with data available before and after TRT were enrolled.They were divided into responders(Group 1;n=45,accounting for 80.4%)and nonresponders(Group 2;n=11,accounting for 19.6%)based on the clinical response to TRT,including patient satisfaction.Factors noted before TRT included age,body mass index,aging males’symptoms score,sexual health inventory for men,luteinizing hormone,follicular-stimulating hormone,testosterone,free testosterone,prolactin(PRL),estradiol(E2),and testosterone/estradiol(T/E2)ratio in serum.For statistical analysis,a multivariable logistic regression model was used.Univariate analysis revealed PRL(odds ratio TORI:0.9624;95%confidence interval[Cl]:0.9316-0.9943,P<0.05),E2(OR:0.8692;95%Cl:0.7745-0.9754,P<0.05),and T/E2 ratio(OR:1.1312;95%Cl:1.0106-1.2661,P<0.05)to be predictive factors.Multivariate analyses showed that T/E2 ratio was an independent predictive factor(OR:1.1593;95%Cl:1.0438-1.2875,P<0.01).The present results suggest that a low value for T/E2 ratio may predict a reduced response to TRT.The T/E2 ratio threshold to predict nonresponders based on receiver-operating characteristics(ROC)curve analysis was shown to be 17.3.Although additional studies with larger number of patients are necessary,we propose the determination of serum E2 level and testosterone level prior to performing TRT.

关键词： estradiol late-onset hypogonadism predictive factor testosterone treatment

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A Contribution to Guy's Conjecture

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Acta Mathematica Sinica,English Series 2022年第10期38卷 1856-1886页

作者： Yukio MATSUMOTO yoshikazu MATSUTANI Angel MONTESINOS-AMILIBIA Masami ODA Shuichi OHKI Tsuyoshi SAKAI Department of Mathematics Gakushuin UniversityMejiroToshima-kuTokyo 171-8588Japan 3-21-1-901 Minamimachi KokubunjiTokyo 185-0021Japan Calle Rio Alberche 8.05260 CebrerosSpain Tsuda University 2-1-1Tsuda-choKodairaTokyo 187-8577Japan Tokyo Japanese Language Educational Center 3-22-7Kita ShinjukuShinjuku-kuTokyo 169-0074Japan Department of Mathematics College of Humanities and SciencesNihon UniversitySetagaya-kuTokyo 156-0045Japan

Let Kdenote the complete graph consisting of n vertices,every pair of which forms an edge.We want to know the least possible number of the intersections,when we draw the graph Kon the plane or on the sphere using continuous arcs for edges.In a paper published in 1960,Richard K.Guy conjectured that the least possible number of the intersections is 1/64(n-1)^(2)(n-3)^(2) if n is odd,or 1/64 n(n-2)^(2)(n-4)if n is even.A virgin road V_(n)is a drawing of a Hamiltonian cycle in Kconsisting of n vertices and n edges such that no other edge-representing arcs cross V.A drawing of Kis called virginal if it contains a virgin road.All drawings considered in this paper will be virginal with respect to a fixed virgin road V.We will present a certain drawing of a subgraph of K,for each n(≥5),which is"characteristic"in the sense that any minimal virginal drawing of Kcontaining this subdrawing satisfies Guy’s conjecture.

关键词： Complete graph virginal drawing Guy’s conjecture

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