研究者業績
基本情報
- 所属
- 藤田医科大学 医学部 医学科 先端光学診療学講座
- 学位
- 博士(医学）
- J-GLOBAL ID
- 200901011108502975
- researchmap会員ID
- 6000005568
患者さんの立場にたって、安全かつ最高の医療を提供できるよう努力します。
研究キーワード
8研究分野
1委員歴
28-
2024年2月 - 現在
-
2023年2月 - 現在
-
2022年9月 - 現在
受賞
4-
2022年10月
-
2019年10月
-
2015年10月
論文
270-
The Journal of dermatology 2024年9月30日 査読有り
-
JAMA 2024年7月22日 査読有りImportance The clinical effects of risankizumab (a monoclonal antibody that selectively targets the p19 subunit of IL-23) for the treatment of ulcerative colitis are unknown. Objective To evaluate the efficacy and safety of risankizumab when administered as an induction and a maintenance therapy for patients with ulcerative colitis. Design, Setting, and Participants Two phase 3 randomized clinical trials were conducted. The induction trial was conducted at 261 clinical centers (in 41 countries) and enrolled 977 patients from November 5, 2020, to August 4, 2022 (final follow-up on May 16, 2023). The maintenance trial was conducted at 238 clinical centers (in 37 countries) and enrolled 754 patients from August 28, 2018, to March 30, 2022 (final follow-up on April 11, 2023). Eligible patients had moderately to severely active ulcerative colitis; a history of intolerance or inadequate response to 1 or more conventional therapies, advanced therapies, or both types of therapies; and no prior exposure to risankizumab. Interventions For the induction trial, patients were randomized 2:1 to receive 1200 mg of risankizumab or placebo administered intravenously at weeks 0, 4, and 8. For the maintenance trial, patients with a clinical response (determined using the adapted Mayo score) after intravenous treatment with risankizumab were randomized 1:1:1 to receive subcutaneous treatment with 180 mg or 360 mg of risankizumab or placebo (no longer receiving risankizumab) every 8 weeks for 52 weeks. Main Outcomes and Measures The primary outcome was clinical remission (stool frequency score ≤1 and not greater than baseline, rectal bleeding score of 0, and endoscopic subscore ≤1 without friability) at week 12 for the induction trial and at week 52 for the maintenance trial. Results Among the 975 patients analyzed in the induction trial (aged 42.1 [SD, 13.8] years; 586/973 [60.1%] were male; and 677 [69.6%] were White), the clinical remission rates at week 12 were 132/650 (20.3%) for 1200 mg of risankizumab and 20/325 (6.2%) for placebo (adjusted between-group difference, 14.0% [95% CI, 10.0%-18.0%], P < .001). Among the 548 patients analyzed in the maintenance trial (aged 40.9 [SD, 14.0] years; 313 [57.1%] were male; and 407 [74.3%] were White), the clinical remission rates at week 52 were 72/179 (40.2%) for 180 mg of risankizumab, 70/186 (37.6%) for 360 mg of risankizumab, and 46/183 (25.1%) for placebo (adjusted between-group difference for 180 mg of risankizumab vs placebo, 16.3% [97.5% CI, 6.1%-26.6%], P < .001; adjusted between-group difference for 360 mg of risankizumab vs placebo, 14.2% [97.5% CI, 4.0%-24.5%], P = .002). No adverse event signals were detected in the treatment groups. Conclusion and Relevance Compared with placebo, risankizumab improved clinical remission rates in an induction trial and in a maintenance trial for patients with moderately to severely active ulcerative colitis. Further study is needed to identify benefits beyond the 52-week follow-up. Trial Registration ClinicalTrials.gov Identifiers: NCT03398148 and NCT03398135
-
Journal of gastrointestinal and liver diseases : JGLD 33(2) 164-169 2024年6月29日 査読有りBACKGROUND AND AIMS: Early gastric cancers (EGCs) after Helicobacter pylori (H. pylori) eradication often appear as reddish depressed lesions (RDLs); the same features are also appeared in benign stomachs after eradication. We compared clinic-pathological and endoscopic features of benign and neoplastic RDLs after H. pylori eradication. METHODS: 228 neoplastic RDLs after H. pylori eradication were studied. All lesions were divided into neoplastic RDLs (differentiated carcinoma or adenoma, n=114) and benign RDLs (n=114) according to the histology. Clinical and pathological characteristics were compared in neoplastic and benign groups. Endoscopic diagnostic yields using the white light (WL) endoscopy, chromoendoscopy (CE) using indigo carmine dye and the magnifying endoscopy with narrow-band imaging (ME-NBI) were also evaluated in relation to the pathological diagnosis. RESULTS: Size of neoplastic RDLs was larger than that of benign RDLs (p<0.01). Sensitivity, specificity and accuracy for predicting pathological types of RDLs was 70.1%, 52.6% and 61.4% for the WL, 65.8%, 63.1% and 65.4% for the CE, while the ME-NBI scored better with the 88.6%, 88.6%, 99.1% and 93.9% of sensitivity, specificity and accuracy. The accuracy of the ME-NBI was 99.9% (113/114) in the benign RDLs and 89.4% (101/114) for the neoplastic RDLs. Undiagnosed neoplastic RDLs using the ME-NBI were associated with more differentiated tumors such as adenoma and well-differentiated adenocarcinoma (tub1) and the presence of an unclear demarcation line. CONCLUSIONS: ME-NBI is useful to diagnose RDLs after H. pylori eradiation, while some of neoplastic lesions are difficult to diagnose using the ME-NBI.
-
Journal of gastroenterology 59(5) 376-388 2024年5月 査読有りBACKGROUND: The clinicopathological features and prognosis of primary small bowel adenocarcinoma (PSBA), excluding duodenal cancer, remain undetermined due to its rarity in Japan. METHODS: We analyzed 354 patients with 358 PSBAs, between January 2008 and December 2017, at 44 institutions affiliated with the Japanese Society for Cancer of the Colon and Rectum. RESULTS: The median age was 67 years (218 males, 61.6%). The average tumor size was 49.9 (7-100) mm. PSBA sites consisted of jejunum (66.2%) and ileum (30.4%). A total of 219 patients (61.9%) underwent diagnostic small bowel endoscopy, including single-balloon endoscopy, double-balloon endoscopy, and capsule endoscopy before treatment. Nineteen patients (5.4%) had Lynch syndrome, and 272 patients (76.8%) had symptoms at the initial diagnosis. The rates for stages 0, I, II, III, and IV were 5.4%, 2.5%, 27.1%, 26.0%, and 35.6%, respectively. The 5-year overall survival rates at each stage were 92.3%, 60.0%, 75.9%, 61.4%, and 25.5%, respectively, and the 5-year disease-specific survival (DSS) rates were 100%, 75.0%, 84.1%, 59.3%, and 25.6%, respectively. Patients with the PSBA located in the jejunum, with symptoms at the initial diagnosis or advanced clinical stage had a worse prognosis. However, multivariate analysis using Cox-hazard model revealed that clinical stage was the only significant predictor of DSS for patients with PSBA. CONCLUSIONS: Of the patients with PSBA, 76.8% had symptoms at the initial diagnosis, which were often detected at an advanced stage. Detection during the early stages of PSBA is important to ensure a good prognosis.
-
日本消化器病学会雑誌 121(臨増総会) A190-A190 2024年3月
MISC
1258-
GASTROINTESTINAL ENDOSCOPY 63(5) AB179-AB179 2006年4月
-
GASTROINTESTINAL ENDOSCOPY 63(5) AB167-AB167 2006年4月
-
GASTROENTEROLOGY 130(4) A421-A422 2006年4月
-
GASTROENTEROLOGY 130(4) A637-A637 2006年4月
-
Gastroenterological Endoscopy 48(Suppl.1) 626-626 2006年4月
-
Gastroenterological Endoscopy 48(Suppl.1) 657-657 2006年4月
-
Gastroenterological Endoscopy 48(Suppl.1) 722-722 2006年4月
-
Gastroenterological Endoscopy 48(Suppl.1) 781-781 2006年4月
-
Gastroenterological Endoscopy 48(Suppl.1) 781-781 2006年4月
-
Gastroenterological Endoscopy 48(Suppl.1) 835-835 2006年4月
-
Gastroenterological Endoscopy 48(Suppl.1) 873-873 2006年4月
-
日本消化器病学会雑誌 103(臨増総会) A131-A131 2006年3月
-
Journal of gastroenterology and hepatology 21(3) 545-51 2006年3月 査読有りBackground and Aims: Infection with Helicobacter pylori (Hp) has been linked to atrophic gastritis, an inflammatory precursor of non-cardia gastric carcinoma. Mutations in the p53 gene are one of the most frequent genetic alterations in gastric carcinoma. In a subgroup of atrophic gastritis, antiparietal cell antibody (APCA) has been detected. This study was aimed to clarify the role of APCA in the progression of atrophic gastritis and gastric carcinogenesis, and to determine the relationship of the severity of atrophic gastritis to gastric carcinoma and to p53 mutations. Methods: In 494 control subjects and 284 gastric carcinoma patients, serum APCA was evaluated and all subjects and patients were classified into four groups using serologic markers (anti-Hp IgG antibody and pepsinogen (PG) test: positive; PG I < 70 mu g/L and PG I/II ratio < 3.0) as follows: A, HP- PG-; B, HP+ PG-; C, HP+ PG+ and D, HP- PG+. p53 mutations were analyzed in 174 of 284 patients. Results: Antiparietal cell antibody seropositivity increased from group B to D, however, no difference in its positivity was found between controls and patients. The incidence of gastric carcinoma increased from A to D, especially the intestinal subtype. The frequency of p53 gene mutations was higher in PG+ than in PG- gastric carcinoma. Conclusions: Antiparietal cell antibody seropositivity is involved in the progression of a subgroup of atrophic gastritis, but not associated with gastric carcinogenesis. Severe atrophic gastritis is associated with susceptibility to gastric carcinoma, especially the intestinal subtype, and p53 mutations. (C) 2005 Blackwell Publishing Asia Pty Ltd.
-
The American journal of gastroenterology 101(1) 45-51 2006年1月 査読有りBACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is considered the most useful diagnostic modality for regional staging; however, it is still difficult to diagnose lymph node metastasis by EUS images only. In this study, we report the usefulness of contrast-enhanced EUS (CE-EUS) in the evaluation of benign lymph nodes (BLN) or malignant lymph nodes (MLN) based on blood flow patterns. SUBJECTS AND METHODS: In the retrospective study, CE-EUS was performed in 46 patients in whom EUS revealed lymph node in the mediastinum or abdominal cavity. The subjects consisted of 22 patients with BLN and 24 patients with MLN. The lesions were examined by EUS, and the maximal and minimal diameters of lymph nodes were measured. Thereafter, the shape and internal echoes were investigated, and the findings were morphologically classified based on Catalano's report. Enhancement effects and the diagnostic capability of CE-EUS were evaluated. In the prospective study, BLNs were differentiated from MLN using the enhancement patterns on CE-EUS based on the results of the retrospective study, and the diagnostic capability was evaluated. RESULTS: In the retrospective study, there were no significant differences in the maximal diameter and maximal/minimal diameter ratio between MLN and BLN. The morphology was classified into four types. Based on the morphological classification, the sensitivity, specificity, and accuracy rate were 88.2%, 77.3%, and 82.1%, respectively. On CE-EUS, the enhancement pattern was classified into three types. The BLN lesions showed uniform enhancement (19/22). In all patients with MLN, a defect of enhancement was observed (24/24). The sensitivity, specificity, and accuracy rate of CE-EUS were 100%, 86.4%, and 92.3%, respectively. In the prospective study, the sensitivity, specificity, and accuracy rate of CE-EUS were 100%, 81.8%, and 92.0%, respectively. CONCLUSIONS: CE-EUS is useful for differentiating BLN from MLN.
-
ENDOSCOPY 38(1) 59-66 2006年1月 査読有りBackground and Study Aims: Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) have been introduced as modalities for examining the entire small bowel. The aim of the present study was to assess the clinical effects of CE and DBE to consider the roles of CE and DBE and the indications for the procedures in patients with suspected small-bowel bleeding. Patients and Methods: Between June 2004 and January 2005, 32 patients in whom a site of bleeding in the gastrointestinal tract had not been identified were enrolled in the study. Twenty-eight patients were examined with both methods. Bleeding sources were categorized as either A] lesions (immediate hemostatic procedures required) or A2 lesions (close observation required). CE and DBE were evaluated with regard to whether or not they were capable of accessing the entire small bowel and provided a diagnosis, and the access and diagnostic rates were calculated. Results: On CE, 13 patients were diagnosed with A1 lesions and six with A2 lesions; on DBE, 11 had A1 lesions and one had an A2 lesion. The access rate for the entire small intestine on CE was 90.6% (29 of 32), significantly higher than with DBE at 62.5% (10 of 16; P < 0.05). The diagnostic rate on CE was 59.4% (19 of 32), higher than with DBE at 42.9% (12 of 28; P = 0.30), but not significantly different. Among patients with A1 lesions who were diagnosed with DBE, histological diagnoses were obtained in six of the 11, and three patients were treated. Conclusions: In many suspected small-bowel bleeding cases, CE should be selected for the initial diagnosis and DBE for treatment or histopathological diagnosis after detection of the bleeding site on CE.
-
胆と膵 27(2) 81-85 2006年著者らは1993年以降早期乳頭部癌に対するIDUSによる診断体系の確立とともに,内視鏡的治療の確立をめざして取り組んできた.本稿では自験例67例(男女比45:22,平均年齢66.8歳)の切除成績を示して,十二指腸乳頭部癌の早期診断における内視鏡的乳頭切除術の意義について言及する.まず早期合併症および後期合併症の検討から安全な術式であることを確認し,診断的意義を論じるに値する術式であることを評価した.次に術前の生検病理診断と内視鏡的切除術後の最終病理診断の比較検討から,その一致率は86.6%(58/67)で,13.4%(9/67)の例で診断が異なっていた.特に術前の過小評価例9.0%(6/67)において本術式の診断的意義は大きく評価されると考えられた.内視鏡的乳頭切除術は前癌病変や早期癌の治療法として位置づけるべきであるが,そこには当然,診断的意義も有しているものと考えられる(著者抄録)
-
臨床雑誌外科 68(10) 1137-1143 2006年筆者らは、基本的に胆膵管内進展を伴わない腺腫または早期癌を適応として78例に内視鏡的十二指腸乳頭切除術を施行した。おもな早期合併症は、出血26.9%、膵炎7.7%、胆管炎3.8%で、後期合併症は、胆管炎3.9%、総胆管結石2.6%と、重篤な合併症は認めなかった。腫瘍性病変74例中50例(67.6%)で完全切除しえ、完全切除不能例(術前に胆膵管内進展陽性と診断)を除く実質の完全切除率は83.3%(50/60)であった。内視鏡的乳頭切除術は安全な治療法であり、手技の工夫によりさらに治療成績は向上する。(著者抄録)
-
臨床消化器内科 21(10) 1409-1414 2006年小腸カルチノイド腫瘍は粘膜下腫瘍様の形態をもつ腫瘍であり,欧米に比し本邦では比較的まれな疾患とされている.全消化管カルチノイド腫瘍のなかでも小腸原発は発生頻度が少ない.小腸という臓器の特性から早期診断が困難であったため,症状が出現した際に発見されたり,手術標本にて初めて診断されるケースも多かった.2000年以降,小腸をターゲットとした新しい内視鏡として,カプセル内視鏡とダブルバルーン内視鏡が登場し,小腸疾患に対する診断能は飛躍的に進歩した.小腸カルチノイド腫瘍についても早期,術前診断が可能となり新たな診療の展開が期待できる.本稿では小腸カルチノイド腫瘍,虫垂カルチノイド腫瘍の新しい診断法を中心に概説する(著者抄録)
-
ENDOSCOPY 37(12) 1215-1219 2005年12月 査読有りBackground and Study Aims: Gastric cancer remains a common malignant tumor in Japan. The aim of this study was to attempt a quantitative evaluation of the microvascular architecture observed by magnification endoscopy using image analysis, and to investigate whether this method is able to distinguish between gastric cancers and benign lesions. Patients and Methods: A total of 132 patients were studied using magnification endoscopy, and image analysis was performed in 71 patients (32 patients with early gastric cancer, 39 patients with benign lesions). Analysis was not possible in the other 61 patients because the quality of the image was not good enough. A square region of interest was selected from the magnified images of the gastric mucosa. From this we extracted the vascular images corresponding to microvessels and calculated the mean caliber of vessels in the region of interest. Results: Image analysis provided good-quality images of micro-vessels and enabled evaluation of the microvascular architecture. The mean caliber of vessels was 4.454 pixels in 17 differentiated adenocarcinomas, 4.319 pixels in 15 undifferentiated adenocarcinomas, and 4.034 pixels in the 39 benign lesions. This represented a significant difference between gastric cancers and benign lesions (P < 0.0001). Histopathological investigation of surgically resected tumors demonstrated the mean caliber of microvessels in cancerous lesions to be greater than that of microvessels in the surrounding mucosa. Conclusions: Image analysis was useful for evaluating the microvascular architecture of the gastric mucosa, and calculation of the mean caliber of the vessels may prove helpful in the differential diagnosis of gastric cancers. However, analysis was not possible in 61 of the 132 patients studied because of inadequate image quality, and this represents a significant limitation of this diagnostic method.
-
Gastrointestinal endoscopy 62(5) 812-4 2005年11月 査読有り
-
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 14(11 Pt 1) 2487-93 2005年11月 査読有りHost genetic susceptibility may influence gastric carcinogenesis caused by Helicobacter pylori infection. We aimed to clarify the relationship of interleukin (IL)-8 polymorphism with the risk of atrophic gastritis and gastric cancer. We examined IL-8 -251 T > A, IL-1B -511 C > T, and IL-1RN intron 2 polymorphisms in 252 healthy controls, 215 individuals with atrophic gastritis, and 396 patients with gastric cancer. We also investigated the effect of the IL-8 polymorphism on IL-8 production and histologic degree of gastritis in noncancerous gastric mucosa. Although no correlation was found in the analysis of the IL-1B and IL-1RN polymorphisms, IL-8 -251 A/A genotype held a higher risk of atrophic gastritis [odds ratio (OR), 2.35; 95% confidence interval (0), 1.12-4.94] and gastric cancer (OR, 2.22; 95% CI, 1.08-4.56) compared with the T/T genotype. We also found that the A/A genotype increased the risk of upper-third location (OR, 3.66; 95% CI, 1.46-9.17), diffuse (OR, 2.79; 95% CI, 1.21-6.39), poorly differentiated (OR, 2.70; 95% CI, 1.146.38), lymph node (OR, 2.50; 95% CI, 1.01-6.20), and liver metastasis (OR, 5.63; 95% CI, 1.06-30.04), and p53-mutated (OR, 1.91; 95% CI, 1.13-3.26) subtypes of gastric cancer. The A/A and A/T genotypes were significantly associated with higher levels of IL-8 protein compared with the T/T genotype. Neutrophil infiltration score was significantly higher in the A/A genotype than in the T/T genotype. In conclusion, we showed that the IL-8 -251 T > A polymorphism is associated with higher expression of IL-8 protein, more severe neutrophil infiltration, and increased risk of atrophic gastritis and gastric cancer.
-
HEPATO-GASTROENTEROLOGY 52(66) 1764-1767 2005年11月 査読有りA 65-year-old man was referred to our hospital for evaluation of his huge abdominal tumor. He was diagnosed as having a gastrointestinal stromal tumor arising from the stomach. Seven months after surgery, multiple liver metastases and mesenteric dissemination occurred. He was medicated with ST1571, which works by blocking proliferation of malignant cells with expression of c-kit. The tumors shrank and serum lactate dehydrogenase and alkaline phosphatase concentrations fell to below the normal limit three months later. ST1571 was effective medicine for the metastatic gastrointestinal stromal tumor for six months in this case.
-
胆と膵 26(10) 815-818 2005年10月胆嚢癌早期診断における胆嚢壁血流(GWBF)測定の有用性について検討した.対象は腹部超音波検査にて胆嚢壁肥厚あるいは隆起性病変を認めた298例である(胆嚢癌37例,腺腫4例,ACPBS9例,胆嚢腺筋腫症99例,胆嚢炎53例,コレステロールポリープ73例,結石23例).GWBF測定は全体では71.2%,胆嚢癌では94.6%で測定可能であった.胆嚢癌のGWBF値は41.8±14.3cm/sであり,他疾患と比較し高値であった.また早期癌においても32.6±3.6cm/sであり高値の傾向を示した.教室での基準に基づき30cm/sをcut-off値とし評価したところ,胆嚢癌全体では82.9%,早期癌では75.0%で基準を満たした.腹部超音波検査はスクリーニングとして非常に有用な検査であり,GWBF測定は胆嚢癌拾い上げに意義のある検査と考えられた(著者抄録)
-
電子情報通信学会技術研究報告 105(303) 25-30 2005年9月22日消化器官の検査や手術に用いられてきた内視鏡はチューブ型のもので, 挿入時に痛みを供なう.近年, カプセル内視鏡が開発されて患者の負担は軽減したが, 消化管の螺旋運動により受動的に移動しながら体内を撮影するため, 医師は診断時に数万枚の画像の中から異常部位を見つけ出す必要がある.診断部位の中でも小腸は細胞診を行うことなく, 目視のみで診断可能な場合が多いため, 画像処理技術による自動診断法の開発が期待されている.今後ますますカプセル内視鏡による検査数が増加すると予測される.本論文では, 小腸異常の一種である出血点の検出法を提案する.出血点の形状は一意に定義できないため, 色情報を元に認識する.認識手法には, 判別分析法を用いる手法とベイズ決定則を用いる手法を比較する.診断システムとしては出血点の認識率が100[%]かつ正常部位受け入れ率が低い事が望ましい.診断の正解率が100[%]となるようにシステムを設計した際の正常部位受け入れ率を評価する.40枚のテスト画像を用いた結果, 判別分析では19.7[%], ベイズ決定則では4.6[%]の正常部位受け入れ率を得た.
書籍等出版物
46講演・口頭発表等
430-
JDDW2024 第108回日本消化器内視鏡学会 2024年11月1日
-
第62回日本小腸学会学術集会 2024年10月19日
担当経験のある科目(授業)
7所属学協会
12共同研究・競争的資金等の研究課題
31-
日本学術振興会 科学研究費助成事業 2022年4月 - 2025年3月
-
日本学術振興会 科学研究費助成事業 基盤研究(C) 2022年4月 - 2025年3月
-
厚生労働省 先進医療B 2021年2月 - 2024年6月
-
国立研究開発法人日本医療研究開発機構（AMED) 令和6年度 医療機器等研究成果展開事業（開発実践タイプ） 2024年6月
-
国立研究開発法人日本医療研究開発機構（AMED) 令和３年度難治性疾患実用化研究事業 2021年5月 - 2024年3月