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Stage at diagnosis of colorectal cancer through diagnostic route:Who should be screened?

World Journal of Gastroenterology 2024年第10期30卷 1368-1376页

作者： Nobukazu Agatsuma Takahiro Utsumi Yoshitaka Nishikawa Takahiro Horimatsu Takeshi Seta Yukitaka Yamashita Yukari Tanaka Takahiro Inoue Yuki Nakanishi Takahiro Shimizu Mikako Ohno Akane Fukushima Takeo Nakayama Hiroshi Seno Department of Gastroenterology and Hepatology Kyoto University Graduate School of MedicineKyoto 606-8507Japan Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical CenterWakayama 640-8558Japan Department of Health Informatics Kyoto University School of Public HealthKyoto 606-8501Japan Institute for Advancement of Clinical and Translational Science(iACT) Kyoto University HospitalKyoto 606-8507Japan Medical Support Section Medical Affairs DivisionKyoto University HospitalKyoto 606-8507Japan

BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of patients remain unscreened,with>70%of cases diagnosed outside screening.Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources,the association between the diagnostic routes and identification of these subgroups has been less appreciated.In the japanese cancer registry,the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms.AIM To clarify the stage at CRC diagnosis based on diagnostic routes.METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals.The diagnostic routes were primarily classified into three groups:Cancer screening,follow-up,and symptomatic.The early-stage was defined as Stages 0 or I.Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups,referencing the follow-up group.The adjusted covariates were age,sex,and tumor location.RESULTS Of the 2083 patients,715(34.4%),1064(51.1%),and 304(14.6%)belonged to the follow-up,symptomatic,and cancer screening groups,respectively.Among the 2083 patients,CRCs diagnosed at an early stage were 57.3%(410 of 715),23.9%(254 of 1064),and 59.5%(181 of 304)in the follow-up,symptomatic,and cancer screening groups,respectively.The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group[P<0.001,adjusted odds ratio(aOR),0.23;95%confidence interval(95%CI):0.19-0.29].The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups(P=0.493,aOR for early-stage diagnosis in the

关键词： Colorectal neoplasms Cancer registry Diagnostic route Cancer screening Stage at diagnosis

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Pathophysiology of acute graft-versus-host disease from the perspective of hemodynamics determined by dielectric analysis

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World Journal of Transplantation 2023年第6期13卷 379-390页

作者： Masayuki Nagasawa Department of Pediatrics Musashino Red Cross HospitalMusashino City 180-8610TokyoJapan Department of Pediatrics and Developmental Biology Tokyo Medical and Dental UniversityTokyo 113-8519TokyoJapan

BACKGROUND Numerous reports have demonstrated that the pathophysiology of graft-versushost disease(GVHD)during hematopoietic stem cell transplantation(HSCT)is closely related to vascular endothelial disorders and coagulation abnormalities.We previously presented the discovery of a principle and the development of a novel instrument for measuring whole blood coagulation.This was achieved by assessing the variations in the dielectric properties of whole blood.AIM To investigate how GVHD affects the changes of dielectric properties of whole blood in patients with HSCT.METHODS We examined the changes of dielectric properties of whole blood and erythrocyte proteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis sequentially in patients with HSCT and compared it with clinical symptoms and inflammatory parameters of GVHD.RESULTS During severe GVHD,the dielectric relaxation strength markedly increased and expression of band3 decreased.The dielectric relaxation strength normalized with the improvement of GVHD.In vitro analysis confirmed that the increase of relaxation strength was associated with severe erythrocyte aggregates,but not with decreased expression of band3.CONCLUSION Severe erythrocyte aggregates observed in GVHD may cause coagulation abnormalities and circulatory failure,which,together with the irreversible erythrocyte dysfunction we recently reported,could lead to organ failure.

关键词： Graft-versus-host disease Dielectric relaxation Erythrocyte Stem cell transplantation Coagulation

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Late-onset severe biliary bleeding after endoscopic pigtail plastic stent insertion

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World Journal of Gastroenterology 2017年第4期23卷 735-739页

作者： Muneji Yasuda Hideki Sato Yuki Koyama Tomoki Sakakida Takumi Kawakami Takeshi Nishimura Hideki Fujii Yoshikazu Nakatsugawa Shinya Yamada Naoya Tomatsuri Yusuke Okuyama Hiroyuki Kimura Takaaki Ito Hiroyuki Morishita Norimasa Yoshida Department of Gastroenterology and Hepatology Japanese Red Cross Kyoto Daiichi Hospital Department of Radiology Japanese Red Cross Kyoto Daiichi Hospital

Here, we report our experience with a case of severe biliary bleeding due to a hepatic arterial pseudoaneurysm that had developed 1 year after endoscopic biliary plastic stent insertion. The patient, a 78-year-old woman, presented with hematemesis and obstructive jaundice. Ruptured hepatic arterial pseudoaneurysm was diagnosed, which was suspected to have been caused by long-term placement of an endoscopic retrograde biliary drainage(ERBD) stent. This episode of biliary bleeding was successfully treated by transarterial embolization(TAE). Pseudoaneurysm leading to hemobilia is a rare but potentially fatal complication in patients with long-term placement of ERBD. TAE is a minimally invasive procedure that offers effective treatment for biliary bleeding.

关键词：胆汁的 stent 塑料 stent 胆汁的流血 Pseudoaneurysm 辫子 stent

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Efficacy of adhesive strapping on umbilical hernia in children:a systematic review and meta-analysis of cohort studies

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World Journal of Pediatric Surgery 2023年第4期6卷 206-216页

作者： Takuya Sugimoto Kazunori Tahara Koshi Uchida Kazuhiko Yoshimoto Department of Pediatric Surgery Japanese Red Cross Kumamoto HospitalKumamotoJapan

Background Although adhesive strapping(AS)for pediatric umbilical hernia(UH),which was once obsolete,has been reconsidered as a common practice in Japan,its efficacy is still unclear.This study aimed to evaluate its efficacy by reviewing related articles.Methods A comprehensive literature search of PubMed,Cochrane,Google Scholar,and Igaku Chuo Zasshi via Ichushi-Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Cohort studies reporting on the UH closure rate after AS compared with observation-only management were included.Results A total of 10 cohort studies were included,and the overall UH closure rate was not statistically significant(p=0.31,risk ratio(RR)=0.76,95%confidence interval(CI)0.45 to 1.28).However,there were significant differences in the UH closure rate at the age of 6 months(predundant skin(p=0.049,RR=0.16,95%CI 0.03 to 0.99).Conclusions Although the efficacy of AS on UH compared with observation-only management did not differ in terms of the UH closure rate,the application of AS may be effective for faster UH closure and the prevention of protruding umbilici.However,due to the high heterogeneity of the study,further large-scale studies,particularly randomized controlled trials,are warranted to reach a conclusion.

关键词： hernia prevention closure

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Biomarkers of graft-vs-host disease:Understanding and applications for the future

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World Journal of Transplantation 2021年第8期11卷 335-343页

作者： Masayuki Nagasawa Department of Pediatrics Musashino Red Cross HospitalMusashino City 180-8610TokyoJapan

Hematopoietic stem cell transplantation(HSCT)is widely performed as a treatment for malignant blood disorders,such as leukemia.To achieve good clinical outcomes in HSCT,it is necessary to minimize the unfavorable effects of acute graft-vs-host disease(GVHD)and induce the more tolerable,chronic form of the disease.For better management of GVHD,sensitive and specific biomarkers that predict the severity and prognosis of the disease have been intensively investigated using proteomics,transcriptomics,genomics,cytomics,and tandem mass spectrometry methods.Here,I will briefly review the current understanding of GVHD biomarkers and future prospects.

关键词： Graft-vs-host disease Hematopoietic stem cell transplantation Biomarker Cytokine Graft-vs-host reaction Organ damage

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Ectopic gastrointestinal variceal bleeding with portal hypertension

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World Journal of Gastrointestinal Surgery 2017年第12期9卷 288-292页

作者： Keita Minowa Shuhei Komatsu Kenichiro Takashina Sachie Tanaka Tatsuya Kumano Kenichiro Imura Katsumi Shimomura Jun Ikeda Fumihiro Taniguchi Yasuo Ueshima Tecchuu Lee Eito Ikeda Eigo Otsuji Yasuhiro Shioaki Department of Surgery Japanese Red Cross Kyoto Daiichi Hospital Emergency and Critical Care Center Japanese Red Cross Kyoto Daiichi Hospital Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of Medicine

Massive gastrointestinal bleeding from gastrointestinal varices is one of the most serious complications in patients with portal hypertension. However, if no bleeding point can be detected by endoscopy in the predilection sites of gastrointestinal varices, such as the esophagus and stomach, ectopic gastrointestinal variceal bleeding should be considered as a differential diagnosis. Herein, we report a case of ectopic ileal variceal bleeding in a 57-year-old woman, which was successfully diagnosed by multi-detector row CT(MDCT) and angiography and treated by segmental ileum resection. To date, there have been no consensus for the treatment of ectopic ileal variceal bleeding. This review was designed to clarify the clinical characteristics of patients with ectopic ileal variceal and discuss possible treatment strategies. From the PubMed database and our own database, we reviewed 21 consecutive cases of ileal variceal bleeding diagnosed from 1982 to 2017. MDCT and angiography is useful for the rapid examination and surgical resection of an affected lesion and is a safe and effective treatment strategy to avoid further bleeding.

关键词： Ectopic gastrointestinal bleeding Ileal varix Portal hypertension

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Factors other than fibrosis that increase measured shear wave velocity

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World Journal of Gastroenterology 2022年第46期28卷 6512-6521页

作者： Hiroko Naganuma Hideaki Ishida Department of Gastroenterology Yokote Municipal HospitalYokote 013-8602Japan Department of Gastroenterology Akita Red Cross HospitalAkita 010-1495Japan

Shear wave elastography(SWE)is now becoming an indispensable diagnostic tool in the routine examination of liver diseases.In particular,accuracy is required for shear wave propagation velocity measurement,which is directly related to diagnostic accuracy.It is generally accepted that the liver shear wave propagation velocity reflects the degree of fibrosis,but there are still few reports on other factors that increase the shear wave propagation velocity.In this study,we reviewed such factors in the literature and examined their mechanisms.Current SWE measures propagation velocity based on the assumption that the medium has a homogeneous structure,uniform density,and is purely elastic.Otherwise,the measurement is subject to error.The other(confounding)factors that we routinely experience are primarily:(1)Conditions that appear to increase the viscous component;and(2)Conditions that appear to increase tissue density.Clinically,the former includes acute hepatitis,congested liver,biliary obstruction,etc,and the latter includes diffuse infiltration of malignant cells,various storage diseases,tissue necrosis,etc.In any case,it is important to evaluate SWE in the context of the entire clinical picture.

关键词： Liver Shear wave elastography Propagation velocity Viscoelasticity Artifact Ultrasound

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Efficacy of 1.2L polyethylene glycol plus ascorbic acid for bowel preparations

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World Journal of Clinical Cases 2019年第4期7卷 452-465页

作者： Hiroyuki Tamaki Teruyo Noda Masahiro Morita Akina Omura Atsushi Kubo Chikara Ogawa Toshihiro Matsunaka Mitsushige Shibatoge Department of Gastroenterology Takamatsu Red Cross Hospital

BACKGROUND A low-volume polyethylene glycol(PEG) solution that combines ascorbic acid with PEG-based electrolyte solution(PEG-ASC) is gaining mainstream acceptance for bowel preparation due to reduced volume and improved taste.Although several reports showed that bowel preparation with PEG-ASC volume lower than 2.0 L with laxative agents could be an alternative to traditional preparation regimen, the cleansing protocols have not been fully investigated.AIM To evaluate the cleansing efficacy of 1.2 L PEG-ASC solution comparing with 2.0 L PEG electrolyte(PEG-ELS) for bowel preparations.METHODS A randomized, single-blinded, open-label, single-center, non-inferiority study was conducted. In total, 312 japanese adult patients(aged > 18 years) who underwent colonoscopy were enrolled. Patients were randomly allocated to bowel lavage with either 1.2 L of PEG-ASC solution with at least 0.6 L of an additional clear fluid(1.2 L PEG-ASC group) or 2.0 L of PEG-ELS(PEG-ELS group). Then, 48 mg of sennoside was administered at bedtime on the day before colonoscopy, and the designated drug solution was administered at the hospital on the day of colonoscopy. Bowel cleansing was evaluated using the Boston Bowel Preparation Scale(BBPS). The volume of fluid intake and required time for bowel preparation were evaluated. Furthermore, compliance, patient tolerance,and overall acceptability were evaluated using a patient questionnaire, which was assessed using a visual analog scale.RESULTS In total, 291 patients(1.2 L PEG-ASC group, 148; PEG-ELS group, 143) completed the study. There was no significant difference in successful cleansing, defined as a BBPS score ≥ 2 in each segment, between the two groups(1.2 L PEG-ASC group, 91.9%; PEG-ELS group, 90.2%; 95%CI:-0.03-0.09). The required time for bowel preparation was significantly shorter(164.95 min ± 68.95 min vs 202.16 min± 68.69 min, P < 0.001) and the total fluid intake volume was significantly lower(2.23 L ± 0.55 L vs 2.47 L ± 0.56 L, P < 0.001) in the 1.2 L PEG-ASC group than in the

关键词： Ascorbic acid Bowel preparation Colonoscopy Efficacy Polyethylene glycol Tolerability

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Acute kidney injury and the compensation of kidney function after nephrectomy in living donation

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World Journal of Transplantation 2022年第8期12卷 223-230页

作者： Kenji Okumura Holly Grace Hiroshi Sogawa Shigeyoshi Yamanaga Department of Surgery Westchester Medical Center/New York Medical CollegeValhallaNY 10595United States Department of Surgery New York Medical CollegeValhallaNY 10595United States Department of Surgery Japanese Red Cross Kumamoto HospitalKumamoto 861-8520Japan

Acute kidney injury(AKI)incidence is growing rapidly,and AKI is one of the predictors of inpatient mortality.After nephrectomy,all the patients have decreased kidney function with AKI and recover from AKI.However,the characteristic and behavior of AKI is different from usual AKI and compensatory kidney function has been well known in the postoperative setting,especially in living donors.In this review,we have focused on the compensation of kidney function after nephrectomy in living donors.We discuss factors that have been identified as being associated with kidney recovery in donors including age,sex,body mass index,remnant kidney volume,estimated glomerular filtration rate,and various comorbidities.

关键词： Acute kidney injury Kidney transplant donor Compensation Kidney function

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Mucosal necrosis of the small intestine in myopathy,encephalopathy,lactic acidosis,and stroke-like episodes syndrome

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World Journal of Gastroenterology 2012年第41期18卷 5986-5989页

作者： Keita Fukuyama Yasuhide Ishikawa Tetsuro Ogino Hidenobu Inoue Ryoya Yamaoka Tetsuro Hirose Tomohiko Nishihira Department of Gastroenterological Surgery Takamatsu Red Cross HospitalTakamatsu 760-0017Japan Department of Pathology Takamatsu Red Cross HospitalTakamatsu 760-0017Japan

This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes(MELAS),which particularly affects the brain,nervous system and muscles.A 45-year-old japanese female,with an established diagnosis of MELAS,presented with vomiting.Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis.She underwent a resection of the small intestine.A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall.Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa.The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.

关键词：小肠黏膜坏死性酸中毒肌病脑病酸性综合征乳

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