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Outcomes of gastrointestinal defect closure with an overthe-scope clip system in a multicenter experience: An analysis of a successful suction method

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World Journal of Gastroenterology 2017年第9期23卷 1645-1656页

作者： Hideki Kobara Hirohito Mori Shintaro Fujihara Noriko Nishiyama Taiga Chiyo Takayoshi Yamada Masao Fujiwara Keiichi Okano Yasuyuki Suzuki Masayuki Murota Yoshitaka Ikeda makoto oryu Mohamed Abo Ellail Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of MedicineKagawa University Department of Gastroenterology Kochi Health Sciences Center Department of Gastroenterological Surgery Faculty of MedicineKagawa University Department of Gastroenterology Sakaide City Hospital Department of Surgery Ehime Rosai Hospital Department of Gastroenterology Kagawa Saiseikai Hospital Department of Gynecology Faculty of MedicineKagawa University

AIM To demonstrate the clinical outcomes of a multicenter experience and to suggest guidelines for choosing a suction method. METHODS This retrospective study at 5 medical centers involved 58 consecutive patients undergoing over-the-scope clips(OTSCs) placement. The overall rates of technical success (TSR), clinical success (CSR), complications, and procedure time were analyzed as major outcomes. Subsequently, 56 patients, excluding two cases that used the Anchor device, were divided into two groups: 14 cases of simple suction (SS-group) and 42 cases using the Twin Grasper (TG-group). Secondary evaluation was performed to clarify the predictors of OTSC success.RESULTS The TSR, CSR, complication rate, and median procedure time were 89.7%, 84.5%, 1.8%, and 8 (range 1-36) min, respectively, demonstrating good outcomes. However, significant differences were observed between the two groups in terms of the mean procedure time (5.9 min vs 14.1 min). The CSR of the SS- and TG-groups among cases with a maximum defect size ≤ 10 mm and immediate or acute refractory bleeding was 100%, which suggests that SS is a better method than TG in terms of time efficacy. The CSR in the SS-group (78.6%), despite the technical success of the SS method (TSR, 100%), tended to decrease due to delayed leakage compared to that in the TG-group (TSR, CSR; 88.1%), indicating that TG may be desirable for leaks and fistulae with defects of the entire layer. CONCLUSION OTSC system is a safe and effective therapeutic option for gastrointestinal defects. Individualized selection of the suction method based on particular clinical conditions may contribute to the improvement of OTSC success.

关键词： Over-the-scope 片断漏胃肠的倔强的流血管内视镜的闭合

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Accurate hemostasis with a new endoscopic overtube for emergency endoscopy

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World Journal of Gastroenterology 2013年第17期19卷 2723-2726页

作者： Hirohito Mori Hideki Kobara Shintaro Fujihara Noriko Nishiyama makoto oryu Kazi Rafiq Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa Medical University School of Medicine Departments of Pharmacology Kagawa Medical University School of Medicine

Endoscopic hemostasis performed in the emergency room is difficult due to the presence of blood clots and food residue that makes obtaining a clear view of the bleeding vessel difficult. We experienced the efficacy of a newly developed inverted overtube to shorten the hemostatic time and obtain a clear endoscopic view with upper gastrointestinal bleeding patient who were transferred by ambulance car and required emergency endoscopy. The technique improved the endoscopic views and enabled us to perform the hemostatic procedures from the conventional standing position while freely and easily changing the patient's position. The presence of blood clots and food residue in the gastric fornix or upper gastric body makes identifying a bleeding exposed vessel impossible. This set-up significantly shortened the procedure time. The inverted overtube helped us obtain a clear view in patients who were laid in the right lateral position. Rapid identification of ex-posed vessels resulted in success of hemostasis.

关键词： Emergency endoscopic hemostasis Right lateral decubitus position Identification of exposed vessel Newly developed inverted overtube Clear endoscopic view

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Cytomegalovirus-associated gastric ulcer:A side effect of steroid injections for pyloric stenosis

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World Journal of Gastroenterology 2013年第7期19卷 1143-1146页

作者： Hirohito Mori Shintaro Fujihara Noriko Nishiyama Hideki Kobara makoto oryu Kiyohito Kato Kazi Rafiq Tsutomu Masaki Departments of Gastroenterology and Neurology Kagawa Medical University School of MedicineKagawa 761-0793Japan Departments of Pharmacology Kagawa Medical University School of MedicineKagawa 761-0793Japan

The local injection of triamcinolone acetonide(TA) is effective in preventing pyloric stenosis and deformity following large endoscopic submucosal dissection(ESD).However,because of its long-acting nature,TA can induce long-term local immunosuppression and subsequent adverse events.We report a case of a cytomegalovirus(CMV) ulcer that formed only at the TA local injection site.A 68-year-old man underwent ESD to treat early gastric cancer that formed over the pylorus.The lesion extended to the duodenum,and an artificial ulcer covered more than two-thirds of the circumference of the pylorus.To prevent pyloric stenosis,TA was locally injected into the ulcer floor.On day 12,a deeper ulcer 10 mm in diameter was discovered in the center of the post-ESD ulcer.Biopsies revealed large cells with intranuclear inclusion bodies,which stained positive for the anti-CMV antibody.Local TA injections are useful,however,CMV ulcer might occur as adverse events.

关键词： Pyloric stenosis Local triamcinolone acetonide injection Local immunosuppression Cytomegalovirus-associated ulcer Adverse events

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Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection

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World Journal of Gastroenterology 2013年第18期19卷 2752-2760页

作者： Noriko Nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintarou Fujihara Mitsuyoshi Kobayashi makoto oryu Tsutomu Masaki Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan Department of Pharmacology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan

AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases

关键词： Over-the-scope clip Gastrointestinal bleed-ing Endoscopic submucosal dissection complications Gastrointestinal fistulae Gastrointestinal perforation

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Novel method to prevent gastric antral strictures after endoscopic submucosal dissection: Using triamcinolone

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World Journal of Gastroenterology 2014年第33期20卷 11910-11915页

作者： Noriko Nishiyama Hirohito Mori Hideki Kobara Kazi Rafiq Shintaro Fujihara Tae Matsunaga Maki Ayaki Tatsuo Yachida makoto oryu Tsutomu Masaki Departments of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan Departments ofPharmacology Faculty of Medicine Kagawa University Kagawa 761-0796 Japan

Endoscopic submucosal dissection(ESD) of large gastric lesions often leads to severe gastric strictures, especially in cases of large ESD in the antrum of the stomach. It has recently been reported that balloon dilation, mucosal incision, and local steroid injections can successfully treat gastric strictures. However, there are some complications with existing methods and decreasing the quality of life. We have developed a novel method to prevent severe gastric strictures that does not involve balloon dilation, mucosal incision, or steroid injections after circumferential ESD. Our original method involves the submucosal injection of a mixed solution composed of triamcinolone acetonide and a general solution of glycerol, hyaluronic acid, and a small amount of indigo carmine and epinephrine dur-ing the ESD procedure; this mixture is called a mixed solution of triamcinolone(MST). According to standard ESD procedures, several milliliters of MST are injected into the submucosal layer for the purpose of elevating the submucosa during ESD resulting in prevention of severe strictures. Our method using MST take several advantages such as MST method suppress inflammation in ulcer from initial phase, prevention of stricture without obstructive symptoms, and does not require several ballooning. Therefore, MST method is safe and gentle, shorten the hospitalization duration. Here, we described two cases in which we prevented severe strictures of the gastric antrum after completing a circumferential ESD using MST without any complications.

关键词： Early gastric cancer Endoscopic submuco-sal dissec

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Deciphering the enigmatic spikelet traits:Resolving trade-offs for enhancing rice yield

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Molecular Plant 2024年第5期17卷 694-695页

作者： Hideki Yoshida makoto Matsuoka Institute of Fermentation Sciences Fukushima UniversityFukushima 960-1248Japan

Increasing the yield is one of the most important goals of crop improvement.Since the beginning of rice cultivation thousands of years ago,many efforts have been made to increase rice yield.One of the successes in this history was the Green Revolution.This tremendous improvement in the 1960s was achieved by increasing rice and wheat production through the development and widespread adoption of semi-dwarf varieties with the extensive use of fertilizers(Hedden,2003).Dwarfism in crops lowers the center of gravity of the plant body,reducing the risk of lodging and enabling farmers to use more fertilizer to increase yields.Semi-dwarf mutations in both rice and wheat created during the Green Revolution are related to the plant growth hormone gibberellin(GA).Although other mechanisms cause dwarf mutants,only GA-related semi-dwarf mutants were selected during the Green Revolution(Wang et al.,2021).While GA-related abnormalities only make plants shorter,most cases caused by other mechanisms involve not only dwarfism but also other morphological abnormalities.

关键词： dwarf crops traits

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Microglial response to aging and neuroinflammation in the development of neurodegenerative diseases

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Neural Regeneration Research 2024年第6期19卷 1241-1248页

作者： Tingting Han Yuxiang Xu Lin Sun makoto Hashimoto Jianshe Wei Institute for Brain Sciences Research School of Life Sciences Henan University College of Chemistry and Molecular Sciences Henan University Department of Basic Technology Tokyo Metropolitan Institute of Medical Science

Cellular senescence and chronic inflammation in response to aging are considered to be indicators of brain aging; they have a great impact on the aging process and are the main risk factors for neurodegeneration. Reviewing the microglial response to aging and neuroinflammation in neurodegenerative diseases will help understand the importance of microglia in neurodegenerative diseases. This review describes the origin and function of microglia and focuses on the role of different states of the microglial response to aging and chronic inflammation on the occurrence and development of neurodegenerative diseases, including Alzheimer’s disease, Huntington’s chorea, and Parkinson’s disease. This review also describes the potential benefits of treating neurodegenerative diseases by modulating changes in microglial states. Therefore, inducing a shift from the neurotoxic to neuroprotective microglial state in neurodegenerative diseases induced by aging and chronic inflammation holds promise for the treatment of neurodegenerative diseases in the future.

关键词： aging Alzheimer's disease cytokines Huntington's disease microglia neurodegenerative diseases neuroinflammation neuroprotection neurotoxicity Parkinson's disease

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The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance

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Asian Journal of Urology 2024年第2期11卷 311-315页

作者： makoto Taguchi Kaneki Yasuda Hidefumi Kinoshita Department of Urology Osaka Saiseikai Izuo Hospital Based on Social Welfare Organization“Saiseikai”Imperial Gift Foundation Inc.OsakaJapan Department of Urology and Andrology Kansai Medical UniversityHirakataOsakaJapan

Objective: To examine factors to predict the optimal stent pusher position when inserting ureteral stents under fluoroscopy.Methods: We retrospectively reviewed 327 patients who underwent ureteral stent insertion. We considered the pubic bone as a useful anatomical landmark to insert ureteral stents under fluoroscopic guidance. Thus, we categorized patients into three groups (proximal, middle, and distal groups) according to the position of the radiopaque tip of the push catheter when inserting the ureteral stent. Success was defined as a completely curled ureteral stent tail. We compared stent insertion success rates among the three groups. A multivariate analysis was performed to identify the factors affecting stent insertion success.Results: In men, 36 (63.2%) cases were deemed successful in the proximal group compared with 40 (80.0%) cases in the middle group and 12 (20.7%) cases in the distal group (p<0.001). In women, 26 (45.6%) cases were deemed successful in the proximal group compared with 54 (98.2%) cases in the middle group and 38 (76.0%) cases in the distal group (p<0.001). With the multivariate analysis, the stent pusher position was the most significant factor influencing successful stent insertion (men: odds ratio 6.00, 95% confidence interval 2.66-13.51, p<0.001;women: odds ratio 37.80, 95% confidence interval 4.94-289.22, p<0.001).Conclusion: The position of the stent pusher affects stent insertion success. The middle of the pubic symphysis is the optimal position for the radiopaque tip of the pusher when inserting ureteral stents under fluoroscopic guidance.

关键词： Stent Cystoscopy Fluoroscopy Ureter

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Impact of sleep on gastrointestinal cancer

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World Journal of Clinical Oncology 2024年第6期15卷 677-683页

作者： Joshua Lo Pahnwat T Taweesedt makoto Kawai Department of Internal Medicine Santa Clara Valley Medical CenterSan JoseCA 95128United States Department of Psychiatry and Behavioral Sciences Stanford UniversityStanfordCA 94305United States Sierra Pacific Mental Illness Research Educationand Clinical Center(MIRECC)VA Palo Alto Health Care SystemPalo AltoCA 94304United States Department of Psychiatry and Behavioral Sciences School of MedicineStanford UniversityRedwood CityCA 94063United States

Sleep problems have become a significant public health concern,affecting a large portion of the global population and have been linked to increased morbidity and mortality.The incidence of gastrointestinal(GI)cancers continues to rise,posing a substantial burden on healthcare systems worldwide.This editorial aims to delve into the impact of sleep on GI cancers,including esophageal,gastric,colorectal,hepatobiliary,and pancreatic cancer.Recent literature investigating the potential connections between GI cancers and sleep was reviewed.We considered aspects such as sleep duration,sleep disorders,and circadian rhythmicity,in order to explore the underlying mechanisms that can contribute to the development of GI cancers and propose avenues for future research.

关键词： Sleep Cancer Gastrointestinal cancer Esophagus Stomach Colon Liver

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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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