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Remnant neuromuscular junctions in denervated muscles contribute to functional recovery in delayed peripheral nerve repair

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Neural Regeneration Research 2020年第4期15卷 731-738页

作者： Leyang Li Hiroyuki Yokoyama Hidetoshi Kaburagi Takashi Hirai Kunikazu Tsuji mitsuhiro enomoto Yoshiaki Wakabayashi Atsushi Okawa Department of Orthopedic and Spinal Surgery Graduate SchoolTokyo Medical and Dental UniversityTokyoJapan Department of Cartilage Regeneration Tokyo Medical and Dental UniversityTokyoJapan

Schwann cell proliferation in peripheral nerve injury(PNI)enhances axonal regeneration compared to central nerve ***,even in PNI,long-term nerve damage without repair induces degeneration of neuromuscular junctions(NMJs),and muscle atrophy results in irreversible *** peripheral regeneration of motor axons depends on the duration of skeletal muscle *** overcome this difficulty in nerve regeneration,detailed mechanisms should be determined for not only Schwann cells but also NMJ degeneration after PNI and regeneration after nerve ***,we examined motor axon denervation in the tibialis anterior muscle after peroneal nerve transection in thy1-YFP mice and regeneration with nerve reconstruction using *** number of NMJs in the tibialis anterior muscle was maintained up to 4 weeks and then decreased at 6 weeks after *** contrast,the number of Schwann cells showed a stepwise decline and then reached a plateau at 6 weeks after *** regeneration,we reconstructed the degenerated nerve with an allograft at 4 and 6 weeks after injury,and evaluated functional and histological outcomes for 10 to 12 weeks after grafting.A higher number of pretzel-shaped NMJs in the tibialis anterior muscle and better functional recovery were observed in mice with a 4-week delay in surgery than in those with a 6-week *** repair within 4 weeks after PNI is necessary for successful recovery in *** of synaptic acetylcholine receptor degeneration may play a key role in peripheral nerve *** animal experiments were approved by the Institutional Animal Care and Use Committee of Tokyo Medical and Dental University on 5 July 2017,30 March 2018,and 15 May 2019(A2017-311C,A2018-297A,and A2019-248A),respectively.

关键词： axon nerve allograft nerve regeneration neurodegeneration neuromuscular junction peripheral nerve injury Schwann cell skeletal muscle

Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2012年第1期4卷 1-8页

作者： Yosuke Muraki Shotaro enomoto Mikitaka Iguchi mitsuhiro Fujishiro Naohisa Yahagi Masao Ichinose Second Department of Internal Medicine Wakayama Medical University Department of Endoscopy and Endoscopic Surgery Faculty of Medicine University of Tokyo Division of Research and Development for Minimally Invasive Treatment Cancer Center Keio University School of Medicine

Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharma-cotherapy during the healing process are essential.

关键词： Artificial ulcer Endoscopic hemostasis Endoscopic submucosal dissection Gastric epithelial neoplasia Hemostatic forceps

Transnasal and standard transoral endoscopies in the screening of gastric mucosal neoplasias

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World Journal of Gastrointestinal Endoscopy 2011年第8期3卷 162-170页

作者： Hiroya Nakata Shotaro enomoto Takao Maekita Izumi Inoue Kazuki Ueda Hisanobu Deguchi Naoki Shingaki Kosaku Moribata Yoshimasa Maeda Yoshiyuki Mori Mikitaka Iguchi Hideyuki Tamai Hiroya Nakata Nobutake Yamamichi mitsuhiro Fujishiro Jun Kato Masao Ichinose Department of Gastroenterology School of Medicine Wakayama Medical University Wakayama City Wakayama 641-0012 Japan Nakata Medical Clinic Wakayama 641-0006 Japan Department of Gastroenterology Graduate School of Medicine The University of Tokyo Tokyo 113-8655 Japan

AIM: To compare the diagnostic performances of transnasal and standard transoral esophagogastroduodenoscopy (EGD) in gastric cancer screening of asymptomatic healthy subjects. METHODS: Between January 2006 and March 2010, a total of 3324 subjects underwent examination of the upper gastrointestinal tract by EGD for cancer screening, with 1382 subjects (41.6%) screened by transnasal EGD and the remaining 1942 subjects (58.4%) by standard transoral EGD. Clinical profiles of the screened subjects, detection rates of gastric neoplasia and histopathology of the detected neoplasias were compared between groups according to the stage of Helicobacter pylori (H. pylori)-related chronic gastritis. RESULTS: Clinical profiles of subjects did not differ significantly between the two EGD groups, except that there were significantly more men in the transnasal EGD group. During the study period, 55 cases of gastric mucosal neoplasias were detected. Of these, 23 cases were detected by transnasal EGD and 32 cases by standard transoral EGD. The detection rate for gastric mucosal neoplasia in the transnasal EGD group was thus 1.66%, compared to 1.65% in the standard transoral EGD group, with no significant difference between the two groups. Detection rates using the two endoscopies were likewise comparable, regardless of H. pylori infection. However, detection rates when screening subjects without extensive chronic atrophic gastritis (CAG) were significantly higher with standard transoral EGD (0.70%) than with transnasal EGD (0.12%, P < 0.05). In particular, standard transoral EGD was far better for detecting neoplasia in subjects with H. pylori-related non-atrophic gastritis, with a detection rate of 3.11% compared to 0.53% using transnasal EGD (P < 0.05). In the screening of subjects with extensive CAG, no significant differences in detection of neoplasia were evident between the two endoscopies, although the mean size of detected cancers was significantly smaller and the percentage o

关键词： Transnasal endoscopy Gastric cancer Gastric adenoma Atrophic gastritis Helicobacter pylori Cancer screening

Diazepam during endoscopic submucosal dissection of gastric epithelial neoplasias

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World Journal of Gastrointestinal Endoscopy 2012年第3期4卷 80-86页

作者： Yosuke Muraki Shotaro enomoto Mikitaka Iguchi Toru Niwa Takao Maekita Takeichi Yoshida Kosaku Moribata Naoki Shingaki Hisanobu Deguchi Kazuki Ueda Izumi Inoue Hideyuki Tamai Jun Kato mitsuhiro Fujishiro Masao Ichinose Second Department of Internal Medicine Wakayama Medical University Department of Endoscopy and Endoscopic Surgery Faculty of MedicineUniversity of Tokyo

AIM:To investigate risk factors and adverse events related to high-dose diazepam administration during endoscopic submucosal dissection for gastric ***:Between February 2002 and December 2009,a total of 286 patients with gastric epithelial neoplasia underwent endoscopic submucosal dissection in our *** achieve moderate sedation,5-7.5 mg of diazepam was administered intravenously by *** additional administration of 2.5-5 mg diazepam was performed if uncontrollable body movement of the patient was *** patients were classified into groups based on the required diazepam dose:low-dose (≤ 17.5 mg,n=252) and high-dose (> 17.5 mg,n=79).RESULTS:Differences between the low-and highdose diazepam groups were observed in lifetime alcohol consumption (0.30 ± 0.48 vs 0.44 ± 0.52 tons,P=0.032),body weight (58.4 ± 10.3 vs 62.0 ± 9.9 kg,P=0.006),tumor size (15 ± 10 vs 23 ± 18 mm,P < 0.001),lesion location (P < 0.001) and the presence of ulcerative findings (14/238 vs 18/61,P < 0.001).Multivariate analysis identified all five variables as independently related to required diazepam *** terms of adverse reactions to diazepam administration,paradoxical excitement was significantly more frequent in the high-dose diazepam group (P < 0.001).CONCLUSION:Intermittent administration of diazepam enabled safe completion of gastric endoscopic submucosal dissection except in patients who were alcohol abusers or obese,or who showed complicated lesions.

关键词： Diazepam Endoscopic submucosal dissection Gastric epithelial neoplasias Moderate sedation Non-anesthesiologists

Assessment of gastroesophageal reflux disease by serodiagnosis of Helicobacter pylori-related chronic gastritis stage

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World Journal of Gastrointestinal Endoscopy 2011年第4期3卷 71-77页

作者： Shotaro enomoto Masashi Oka Hiroshi Ohata Chizu Mukoubayashi Mika Watanabe Kosaku Moribata Yosuke Muraki Naoki Shingaki Hisanobu Deguchi Kazuki Ueda Izumi Inoue Takao Maekita Mikitaka Iguchi Kimihiko Yanaoka Hideyuki Tamai mitsuhiro Fujishiro Osamu Mohara Masao Ichinose Second Department of Internal Medicine Wakayama Medical UniversityWakayama641-0012Japan Wakayama Wellness Foundation Wakayama640-8404Japan Department of Endoscopy and Endoscopic Surgery Faculty of MedicineUniversity of TokyoTokyo113-8655Japan

AIM:To evaluate the association of Helicobacter pylori(***)-related chronic gastritis stage with upper gastro-intestinal symptoms and gastro-eso-phageal reflux disease(GERD).METHODS:Subjects underwent upper gastrointestinal endoscopy,a questionnaire using a frequency scale for symptoms of GERD(FSSG),and measurements of serum ***-antibody and pepsinogen(PG)*** were classified into the following 4 groups in terms of ***-related chronic gastritis stage:Group A(n = 219),***(-)PG(-);Group B(n = 310),***(+)PG(-);Group C(n = 279),***(+)PG(+);and Group D(n = 17),***(-)PG(+).RESULTS:Reflux esophagitis occurred in 30.6% of Group A,14.5% of Group B,6.8% of Group C,and 0% of Group D(P < 0.001).Scores for acid reflux sympto-ms decreased significantly with chro-nic gastritis stage(from Group A to D)(P < 0.05),while scores for dysmotility symptoms did no-t differ *** prevalence of nonerosive reflux disease(NERD)did not differ amo-ng ***,in subjects with GERD,the prevalence of NERD tended to increase with chronic gastritis stage(P = 0.081).CONCLUSION:Acid reflux sympto-ms and the prevalen-ce of reflux esophagitis can be assessed by measuring both serum ***-antibody and PG levels.

关键词： Gastro-eso-phageal reflux disease Helicobacter pylori Pepsinogen Screening and diagnosis