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Endoscopic Examination for Patients with Diarrhea after Allogeneic Stem Cell Transplantation

Open Journal of Internal Medicine 2017年第4期7卷 105-114页

作者： Junichi Kitagawa Takuro Matsumoto Yuhei Shibata Nobuhiko Nakamura Hiroshi Nakamura Soranobu Ninomiya Yasuhito Nannya Masahito Shimizu Takeshi Hara Hiroshi Araki Hisashi Tsurumi Department of Hematology Graduate School of Medicine Gifu University Gifu Japan Department of Gastroenterology Graduate School of Medicine Gifu University Gifu Japan

Objective: Intestinal graft-versus-host disease (GVHD) represents one of the most serious complications of allogeneic stem cell transplantation (allo-SCT). Endoscopic and histological proof is required due to the number of differential diagnoses manifesting as diarrhea. We investigated the safety of endoscopic biopsies, and the role of conducting biopsies and inspections of the terminalileum. Patients: Thirty two colonoscopic examinations and 29 biopsies were performed for 19 patients after allo-SCT in our institute between October 2011 and May 2015. Results: Endoscopic examinations and biopsies were performed safely under the policy of transfusing platelets for thrombocytopenia (3/μL). For biopsied cases, the diagnostic consistency rate with endoscopic findings was 60%, with a tendency toward negative correlations with early examinations after diarrhea onset (25% for 0 - 1 days;62.5% for later) or low-grade GVHD according to Freiburg criteria (41.2% for grade 1, 66.7% for grade 2, 100% for higher). The terminal ileum was inspected with colonoscopy in 13 cases. Endoscopic diagnoses of the ileum were provided in 11 cases and histological diagnoses in 9 cases. Diagnostic consistency for diagnosis of the terminal ileum between endoscopy and histology was 77.8%. Conclusion: Because endoscopic and histopathological findings do not always match, caution is required when focusing on endoscopic findings alone, as there is a risk of misdiagnosis. Extensive inspection of the terminal ileum with biopsy appears useful to identify otherwise undetected lesions. Our data thus support invasive endoscopic examinations for gastrointestinal complications, including ileac inspection and biopsies under appropriate management.

关键词： Intestinal GVHD Endoscopic Evaluation Ileoscopy Colonoscopy

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Evaluating Hazard Response Behavior of a Driver Using Physiological Signals and Car-Handling Indicators in a Simulated Driving Environment

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Journal of Transportation Technologies 2019年第4期9卷 439-449页

作者： Joseph Kamau Muguro Minoru Sasaki Kojiro Matsushita Department of Mechanical Engineering Gifu University Gifu Japan

Road traffic accidents are a major cause of casualties and costly implications to all the stakeholders. Research focusing on the driver as one of the causal agent of accidents has been studied for centuries and with the advent of modernized driver assistance technologies. This paper sought to evaluate response of a driver using active-driving performance indicators like reaction time and physiological signal response (surface electromyogram), to understand hazard response behavior. Simulation of driving scenes was done using Unity3D engine and VR Head mounted display. The driver was presented with stimulus (collision objects) of different size and distance. From the results, an event scene that the driver considered hazardous was marked with increased electromyography response distinct from non-event scenes. From the results, we noted an increase in pedal misapplication during hazard response. The proposed approach is applicable in a real time driving analysis for on-road risk level classification.

关键词： SEMG Driver Response Behavior 3D-VR Hazard Response

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Real-world efficacy and safety of tofacitinib treatment in Asian patients with ulcerative colitis

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World Journal of Gastroenterology 2024年第13期30卷 1871-1886页

作者： Kentaro Kojima Kenji Watanabe Mikio Kawai Soichi Yagi Koji Kaku Maiko Ikenouchi Toshiyuki Sato Koji Kamikozuru Yoko Yokoyama Tetsuya Takagawa Masahito Shimizu Shinichiro Shinzaki Department of Gastroenterology Hyogo Medical UniversityNishinomiya 663-8501Japan Department of Gastroenterology Gifu University Graduate School of MedicineGifu 501-1194Japan Department of Internal Medicine for Inflammatory Bowel Disease The University of ToyamaToyama 930-0194Japan Center for Clinical Research and Education Hyogo Medical UniversityNishinomiya 663-8501Japan

BACKGROUND Real-world data on tofacitinib(TOF)covering a period of more than 1 year for a sufficient number of Asian patients with ulcerative colitis(UC)are *** To investigate the long-term efficacy and safety of TOF treatment for UC,including clinical *** We performed a retrospective single-center observational analysis of 111 UC patients administered TOF at Hyogo Medical university as a tertiary inflammatory bowel disease *** consecutive UC patients who received TOF between May 2018 and February 2020 were *** were followed up until August *** primary outcome was the clinical response rate at week *** outcomes included clinical remission at week 8,cumulative persistence rate of TOF administration,colectomy-free survival,relapse after tapering of TOF and predictors of clinical response at week 8 and week *** The clinical response and remission rates were 66.3%and 50.5%at week 8,and 47.1%and 43.5%at week 48,*** overall cumulative clinical remission rate was 61.7%at week 48 and history of anti-tumor necrosis factor-alpha(TNF-α)agents use had no influence(P=0.25).The cumulative TOF persistence rate at week 48 was significantly lower in patients without clinical remission than in those with remission at week 8(30.9%vs 88.1%;P<0.001).Baseline partial Mayo Score was significantly lower in responders vs non-responders at week 8(odds ratio:0.61,95%confidence interval:0.45-0.82,P=0.001).Relapse occurred in 45.7%of patients after TOF tapering,and 85.7%of patients responded within 4 wk after *** 6 patients with herpes zoster(HZ)developed the infection after achieving remission by *** TOF was more effective in UC patients with mild activity at baseline and its efficacy was not affected by previous treatment with anti-TNF-α*** relapsed patients responded again after re-increase of TOF and nearly half relapsed after tapering off *** attention is needed for tapering and H

关键词： Ulcerative colitis Tofacitinib Janus kinase inhibitor Real-world Biologics

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Preparation of bromfenac-loaded liposomes modified with chitosan for ophthalmic drug delivery and evaluation of physicochemical properties and drug release profile

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Asian Journal of Pharmaceutical Sciences 2013年第2期8卷 104-109页

作者： Toshimasa Tsukamoto Kohei Hironaka Takuya Fujisawa Daiki Yamaguchi Kohei Tahara Yuichi Tozuka Hirofumi Takeuchi Laboratory of Pharmaceutical Engineering Gifu Pharmaceutical University1-25-4 Daigaku-nishiGifu 501-1196Japan Laboratory of Formulation Design and Pharmaceutical Technology Osaka University of Pharmaceutical SciencesOsakaJapan

The purpose of this study was to design a submicron-sized liposomal non-steroidal antiinflammatory drug(NSAID)preparation that targets the retina via topical instillation of eye ***(BRF)-loaded liposomes were prepared using the calcium acetate gradient *** sizes and encapsulation efficiencies were optimized by screening several liposome formulations of lipid,drug concentration,and buffer *** entrapment efficiency was greater than 90%using this method,and was low using conventional hydration *** initial BRF loading using the pH gradient method caused aggregation of *** circumvent aggregation,the negatively charged lipid dicetylphosphate was incorporated into liposomes,which formed anion layer preventing *** of BRF from liposomes was sustained for several hours depending on lipid concentration,inner water phase,initial drug amounts,and surface *** modification with chitosan(CS),a mucoadhesive cationic polymer,was achieved using electrostatic interactions of negatively charged *** optimal concentration of CS for evasion of liposome aggregation was 0.15%.

关键词： NSAIDs pH Gradient method Surface modification Chitosan Eye drop

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Development of pectin nanoparticles through mechanical homogenization for dissolution enhancement of itraconazole

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Asian Journal of Pharmaceutical Sciences 2016年第3期11卷 365-375页

作者： Kanokporn Burapapadh Hirofumi Takeuchi Pornsak Sriamornsak Department of Pharmaceutical Technology Faculty of Pharmacy Silpakorn University Pharmaceutical Biopolymer Group (PBiG) Faculty of Pharmacy Silpakorn University Laboratory of Pharmaceutical Engineering Gifu Pharmaceutical University

A simple method to fabricate itraconazole(ITZ)-loaded pectin nanoparticles prepared from nanoemulsion templates is described in this study. Nanoemulsions containing ITZ were prepared by a mechanical homogenization using pectin as emulsifier. After freeze-drying, the morphology, crystallinity state, thermal properties, drug dissolution and stability of the obtained pectin nanoparticles were characterized. The results demonstrated that the morphology of freeze-dried products was different, depending on the type of internal phase; the nanoparticles prepared from chloroform-based nanoemulsions were completely dried and provided a fragile characteristic. The pectin nanoparticles also demonstrated good properties in terms of redispersibility, thermal properties, drug crystallinity and dissolution. The ITZ-loaded pectin nanoparticles showed high percentage of drug dissolved(about 60–80%within 2 h), and maintained their good dissolution properties even after 1-year storage. The results suggested that freeze-dried pectin nanoparticles prepared from nanoemulsions could be used as an effective carrier for enhancement of ITZ dissolution.

关键词： Itraconazole Nanoparticles Pectin Poorly water-soluble drug Stability

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Quantification of the Hysteresis of Macroscopic Fundamental Diagrams and Its Relationship with the Congestion Heterogeneity and Performance of a Multimodal Network

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Journal of Transportation Technologies 2018年第1期8卷 44-64页

作者： Seham Hemdan Amr M. Wahaballa Fumitaka Kurauchi Graduate School of Engineering Gifu University Gifu Japan Department of Civil Engineering Aswan University Aswan Egypt Department of Civil Engineering Gifu University Gifu Japan

Recent studies have observed hysteresis loops in the macroscopic fundamental diagram (MFD). In particular, for the same network density, higher network flows occur during congestion onset than during congestion offset. To evaluate management strategies using the MFD, investigating the relationship between the size of these loops and network performance is needed. The existing literature has mainly discussed correlating loop width (difference in density) and height (capacity drop) with congestion heterogeneity, but has failed to prove a relationship between the capacity drop and traffic conditions. Moreover, quantification of the MFD loop in complex multimodal networks has not been investigated. The objective of this paper covers these aspects. We simulated the Sioux Falls network with different mode-share ratios (car and bus users) based on a multi-agent simulation, MATSim. We investigated the relationships between MFD loop size and congestion heterogeneity (standard deviation of density) and network performance (average passenger travel time), and found that both were directly correlated with loop width, while weakly correlated with loop height. Moreover, we divided the MFD loop into two parts according to congestion onset and offset periods and found that the heights of the two parts had opposite effects. Accordingly, we show why the relationship between capacity drop and congestion heterogeneity is not found in the literature. We also found that network performance inversely affected the height of part of the loop while the height of its other part increased with an increase in congestion heterogeneity. These results help to evaluate network performance in the presence of MFD hysteresis, leading to elaborated management decisions.

关键词： Macroscopic Fundamental Diagram Hysteresis Loop Congestion Heterogeneity Multimodal Network Performance

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Inflammatory bowel disease of primary sclerosing cholangitis:A distinct entity?

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World Journal of Gastroenterology 2014年第12期20卷 3245-3254页

作者： Takahiro Nakazawa Itaru Naitoh Kazuki Hayashi Hitoshi Sano Katsuyuki Miyabe Shuya Shimizu Takashi Joh Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Department of Gastroenterology Gifu Prefectual Tajimi Hospital

This is a review of the characteristic findings of inflammatory bowel disease(IBD)associated with primary sclerosing cholangitis(PSC)and their usefulness in the diagnosis of sclerosing *** is a chronic inflammatory disease characterized by idiopathic fibrous obstruction and is frequently associated with *** with PSC(PSC-IBD)shows an increased incidence of pancolitis,mild symptoms,and colorectal *** an increased incidence of pancolitis is a characteristic finding,some cases are endoscopically diagnosed as right-sided ulcerative *** studies have revealed that inflammation occurs more frequently in the right colon than the left *** frequency of rectal sparing and backwash ileitis should be investigated in a future study based on the same *** cholangiographic findings of immunoglobulin G4-related sclerosing cholangitis(IgG4-SC)are similar to those of *** rare association between IBD and IgG4-SC and the unique characteristics of PSC-IBD are useful findings for distinguishing PSC from IgG4-SC.

关键词： Primary sclerosing cholangitis Primary sclerosing cholangitis Inflammatory bowel disease Inflammatory bowel disease-associated with primary sclerosing cholangitis Immunoglobulin G4-related sclerosing cholangitis

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Inhibitory effects of carbon dioxide insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy

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World Journal of Gastroenterology 2012年第27期18卷 3565-3570页

作者： Shinji Nishiwaki Hiroshi Araki Motoshi Hayashi Jun Takada Masahide Iwashita Atsushi Tagami Hiroo Hatakeyama Takao Hayashi Teruo Maeda Koshiro Saito Department of Internal Medicine Nishimino Kosei HospitalGifu 503-1394Japan Department of Gastroenterology Graduate School of MedicineGifu UniversityGifu 501-1194Japan

AIM:To evaluate the inhibitory effects of carbon dioxide (CO2) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).METHODS:A total of 73 consecutive patients who were undergoing PEG were enrolled in our *** eliminating 13 patients who fitted our exclusion criteria,60 patients were randomly assigned to either CO2 (30 patients) or air insufflation (30 patients) *** was performed by pull-through technique after threepoint fixation of the gastric wall to the abdominal wall using a gastropexy *** blood gas analysis was performed immediately before and after the *** X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel *** computed tomography was performed at 24 h after the procedure to detect the presence of *** outcomes of PEG for 7 d postprocedure were also ***:Among 30 patients each for the air and the CO2 groups,PEG could not be conducted in 2 patients of the CO2 group,thus they were *** of the remaining 58 patients showed that the patients' backgrounds were not significantly different between the two *** elevation values of arterial partial pressure of CO2 in the air group and the CO2 group were 2.67 mmHg and 3.32 mmHg,respectively (P = 0.408).The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO2 group compared to the air group (P < 0.001) at 10 min and 24 h after PEG,whereas there was no significant difference in large bowel distension between the two *** was observed only in the air group but not in the CO2 group (P = 0.003).There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two ***:There was no adverse event associated with CO2 ***2 insufflation is considered to be safer and more comfortable for PEG patients bec

关键词： Percutaneous endoscopic gastrostomy Car-bon dioxide insufflation Pneumoperitoneum Abdomi-nal distension Randomized control study

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A case study of seismic response of earth embankment foundation on liquefiable soils

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Journal of Central South university 2009年第6期16卷 994-1000页

作者：黄雨 YASHIMA A SAWADA K 张锋 Department of Geotechnical Engineering Tongji University Key Laboratory of Geotechnical and Underground Engineering Ministry of EducationTongji University Department of Civil Engineering Gifu University Department of Civil Engineering Nagoya Institute of Technology

A case study of seismic response of an earth embankment foundation on liquefiable soils in Kansai area,western Japan was presented. Based on a calibrated cyclic elasto-plastic constitutive model for liquefiable sand and Biot dynamic coupled theory,the seismic analysis was carried out by using a dynamic effective stress finite element method under plane strain condition. A recent design study was illustrated in detail for a river earth embankment subjected to seismic excitation on the saturated deposits with liquefiable sands. Simulated results of the embankment foundation during liquefaction were obtained for acceleration,displacement,and excess pore water pressures,which were considered to yield useful results for earthquake geotechnical design. The results show that the foundation soil reaches a fully liquefied state with high excess pore pressure ratios approaching to 1.0 due to the earthquake shaking. At the end of the earthquake,the extensive liquefaction causes about 1.0 m lateral spreading at the toe and 60 cm settlement at the crest of the earth embankment.

关键词： earth embankment earthquake liquefaction cyclic plasticity finite element method case study

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Stereotactic Radiotherapy Planning Using Modified Dynamic Conformal Arcs under Considering the Possibility for Amended Visual Organ Displacement Resulting from Early Tumor Shrinkage during Treatment for Perioptic Involvement of Myeloma

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2014年第3期3卷 183-192页

作者： Kazuhiro Ohtakara Hiroaki Hoshi Department of Radiation Oncology Murakami Memorial Hospital Asahi University Gifu Japan Department of Radiology Gifu University Graduate School of Medicine Gifu Japan Department of Radiology Gifu University Graduate School of Medicine Gifu Japan

Treatment planning of radiotherapy for skull base involvement of multiple myeloma presenting with visual impairment should be optimized to alleviate symptoms immediately and sufficiently while minimizing toxicities. Two such patients were treated with fractionated stereotactic radiotherapy by using Dynamic Conformal Arcs (DCA) under image guidance based on bony anatomy alignment. DCA planning was optimized after considering the possibility for amendment of visual organ displacement resulting from early tumor shrinkage during treatment through 1) the use of a target volume with modified geometry as a surrogate for leaf adaptation in order to improve target coverage, and 2) manual adjustment of a subset of leaf positions to reduce the dose gradient immediately inside the target boundary facing the visual organs and to eliminate an undesirable dose hotspot. In both cases, anticipated geometric changes in the target volume associated with improvement of visual organ displacement toward the target centroid were observed before the completion of treatment. Favorable visual functional outcomes as well as local tumor control were achieved during 14 months and 4 months follow-up periods. Notably, inexorable visual loss in one patient was fully reversed within one month after radiotherapy. We described the modification techniques for DCA planning in detail.

关键词： Multiple Myeloma Interfractional Anatomical Change Dynamic Conformal Arcs Image-Guided Radiotherapy Stereotactic Radiotherapy

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