Curriculum Vitaes
Profile Information
- Affiliation
- School of Medicine Faculty of Medicine, Fujita Health University
- Degree
- 医学博士(Mar, 2021, Fujita Health University)
- J-GLOBAL ID
- 201701005740821590
- researchmap Member ID
- 7000019895
Research History
1-
Apr, 2017 - Present
Papers
82-
Internal medicine (Tokyo, Japan), Jan 12, 2023Objective In general, surface ulceration in gastric gastrointestinal stromal tumor (GIST) is considered a malignant feature; however, the mechanism underlying its formation has not been evaluated in detail. In this study, we analyzed the factors involved in ulceration using resected specimens of gastric GIST. Methods A total of 48 samples were retrospectively analyzed. We examined the association of surface ulceration of gastric GIST with the MIB-1 labeling index, mitotic number, tumor size, endoscopic ultrasound (EUS) findings and growth pattern on computed tomography (CT). Results The proportion of men was significantly higher in the ulceration group than in the non-ulceration group (p=0.04146), whereas age was not significantly different between the groups. Tumor was significantly larger in the ulceration group than in the non-ulceration group (p=0.0048). There was no correlation between tumor size and ulcer number. The MIB-1 index was not related to ulceration, nor were EUS findings. The number of mitotic cells tended to be higher in the ulceration group than in the non-ulceration group (p=0.05988). Intraluminal growth pattern was strongly associated with ulceration (p=0.00019). After a multivariate analysis, the growth pattern was the only factor associated with ulceration of gastric GIST. Conclusion Although formation of surface ulceration in gastric GIST was partially associated with the degree of malignancy, the growth pattern was the most important factor associated with ulceration in gastric GIST.
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Journal of gastroenterology and hepatology, Aug 9, 2022BACKGROUND: The management of bleeding during endoscopic submucosal dissection (ESD) is critical and related to the procedure time. We collaborated on a new image enhancement algorithm with parameter optimization for clinical use being developed by FUJIFILM Co. and processed white light image data offline to evaluate the effectiveness of this technology. This study aims to evaluate the clinical usefulness of this technology. METHODS: Eighteen video scenes of bleeding points from 5 gastric ESDs were selected and processed by the new image enhancement algorithm. The time until a bleeding point was found, visibility of a bleeding point and color abnormality of the submucosal layer were evaluated by ESD experts, ESD trainees, and endoscopy trainees. The color differences between the bleeding point and the surroundings in CIE- L*a*b* color space were calculated in the original and enhanced images. RESULTS: The time until a bleeding point was found in the enhanced videos was significantly shorter than that in the original videos (11.10 seconds vs. 13.85 seconds) (P=0.017). On a 5-point (-2 to +2) Likert scale of visibility, the enhanced image was slightly superior to the original (+0.45), and the appearance of the submucosa was comparable between images (+0.14). The color difference among the bleeding areas on the enhanced images were significantly larger than that on the original images (10.93 vs. 8.36). CONCLUSION: This novel image enhancement algorithm emphasizes the color difference between a bleeding point and the surrounding area, which would help find bleeding points faster during ESD for the less experienced endoscopists.
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Medicine, 101(28) e29386, Jul 15, 2022Gastric endoscopic submucosal dissection (ESD) is increasingly performed in patients receiving antithrombotic therapy. Second-look endoscopy (SLE) has been performed empirically in several clinical settings. We investigated whether SLE omission was associated with an increased risk of postESD bleeding in all patients, including those administered antithrombotic agents. Between July 2016 and June 2018, 229 patients were treated with a clinical pathway for gastric ESD that involved SLE on the day after ESD (SLE group). Between September 2018 and May 2020, 215 patients were treated using a clinical pathway that did not include SLE (nonSLE group). We retrospectively compared the incidence of postESD bleeding among the propensity score-matched cohorts and determined the risk factors for postESD bleeding using multivariate analysis. The propensity score-matched cohorts showed no significant differences in the incidence of postESD bleeding between the SLE (3.2%) and nonSLE (5.1%) groups. Multivariate analysis revealed that the presence of lesions in the lower gastric body (adjusted odds ratio [OR] 2.17, 95% confidence interval [CI] 1.06-4.35, P.03) was a significant risk factor for postESD bleeding during admission, whereas resected specimen size ≥ 40 mm (adjusted OR 3.21, 95% CI 1.19-8.19, P.02) and antiplatelet therapy (adjusted OR 4.16, 95% CI 1.47-11.80, P.007) were significant risk factors after discharge. Complete omission of SLE after gastric ESD does not increase postESD bleeding in clinical practice.
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Anaerobe, 73 102502-102502, Feb, 2022 Peer-reviewedRecurrent Clostridioides difficile infection (rCDI) is a frustrating condition that may affect a person's quality of life for months. Microbiome-based therapy such as fecal microbiota transplantation (FMT) has been effective for the treatment of rCDI by correcting the imbalance of the gut microbiota. Appropriate antibiotic treatment is recommended for at least two recurrences before offering FMT. Here, we report the case of a 92-year-old woman who experienced five recurrences of Clostridioides difficile infection (CDI) (six episodes in total) complicated by dementia and delirium, both of which were dramatically improved by FMT, which was associated with alterations in fecal microbiota and the metabolome. Analyses of whole microbial communities and metabolomic analyses were performed on stool specimens collected from the patient on the first episode, the third episode, the day of FMT (before FMT), and 2, 8, and 23 weeks after the FMT and from the donor. The patient had various fecal dysbioses on the first and third episodes and on the day of FMT. Two weeks after FMT, diversity of the gut bacteriome as well as the virome increased dramatically and was reflected in a positive clinical outcome for this patient. Metabolomic analysis revealed that short-chain fatty acids, which have been reported to be associated with improved memory function, were increased after FMT.
Misc.
18-
胃と腸, 53(12) 1645-1652, Nov, 2018<文献概要>アミロイドーシスの十二指腸病変の特徴を明らかにする目的で,アミロイド別の臨床像,内視鏡所見,病理組織学的所見を自験例23例(AL型14例,AA型9例)で遡及的に検討した.十二指腸内視鏡所見は,AA型の全例で粘膜粗そうや微細顆粒状粘膜/びらんを呈する一方,AL型の60%は皺襞肥厚や多発する粘膜下腫瘍様隆起を呈していた.粘膜下腫瘍様隆起はAL型のみで認められた.生検病理組織学的所見はアミロイド沈着の程度と沈着範囲で評価したが,明らかな関連性は認めなかった.アミロイド別の特徴的な内視鏡像や臨床像を把握することがアミロイドーシスの診断に重要であり,その基礎疾患を理解することが早期診断につながると考えられた.
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胃と腸, 53(6) 869-872, May, 2018<文献概要>共焦点レーザー内視鏡は,生体組織を細胞レベルで観察することができる顕微内視鏡である.現在はプローブ型の共焦点レーザー内視鏡が使用可能である.筆者らはダブルバルーン小腸内視鏡下でプローブ型共焦点レーザー内視鏡を用いて小腸血管性病変に対して観察を行った.本稿ではその概要について述べる.
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胃と腸, 53(2) 221-225, Feb, 2018共焦点レーザー内視鏡は,レーザー光と光学技術を使って生体組織を細胞レベルで視覚化するために開発された顕微内視鏡であり,現在使用可能なプローブ型は内視鏡の鉗子孔から挿入して使用できる.生体内の自家蛍光,または生体に投与された蛍光造影剤をレーザー光で励起し放出された蛍光を口径の小さな共焦点絞りを通すことで,細胞レベルまで鮮明に観察できる.その利点として,リアルタイムな仮想病理診断,適切な生検部位の選択や生検個数の削減,通常のパラフィン固定HE染色像で観察できない生体組織のダイナミックな観察(例えば脈管),蛍光造影剤の生体内動態の観察や,蛍光標識物質による分子イメージングなどが挙げられる.筆者らは小腸炎症性疾患に対して,バルーン内視鏡下プローブ型共焦点レーザー内視鏡を用いて通常の内視鏡では観察できないleaky gut症候群や脈管の異常を観察してきた.本稿ではその概要を述べる.(著者抄録)
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薬局, 68(11) 3477-3480, Oct, 2017<Key Points>潰瘍性大腸炎、クローン病、Clostridioides difficile腸炎患者の32症例に糞便移植療法を施行した。クローン病、C.difficile腸炎患者には高い有効性が示され、糞便移植8週後レシピエントの腸内細菌叢の多様性はドナーに近づいていることが確認された。一方、潰瘍性大腸炎において有効性は既報と同様30%前後で、糞便移植前後においてレシピエントとドナーの腸内細菌叢の類似性に変化はみられなかった。大きな合併症はみられず、安全性は比較的高いものと思われた。今後はドナー検査の費用と時間を省くために糞便バンクの設立に取り組む予定である。(著者抄録)
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Medical Technology, 45(10) 1066-1068, Oct, 2017難治性クロストリジウム・ディフィシル感染症に対して高い有効性が報告されている糞便移植療法は近年、炎症性腸疾患に対して臨床応用がなされている。潰瘍性大腸炎に対しては有効性が低いという報告が多いが、当院でも2016年4月から自主研究として糞便移植療法を行ってきた。当院における糞便移植療法の有効性と今後の課題に関して報告する。(著者抄録)
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胃と腸, 52(11) 1441-1444, Oct, 2017非特異性多発性小腸潰瘍症は女性に好発し,若年より慢性に経過する鉄欠乏性貧血と蛋白漏出性腸症に伴う低蛋白血症を主徴とする.近年,プロスタグランジンのトランスポーター遺伝子SLCO2A1が責任遺伝子であることが判明した.ただし,SLCO2A1遺伝子変異と臨床病態に有意な相関はなく,今後のさらなる病態の解明と治療法の開発が必要とされる.(著者抄録)