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
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2023年2月 - 現在
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2022年9月 - 現在
受賞
4-
2022年10月
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2019年10月
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2015年10月
論文
270-
The Journal of dermatology 2024年9月30日 査読有り
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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
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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.
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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.
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日本消化器病学会雑誌 121(臨増総会) A190-A190 2024年3月
MISC
1258-
胆道 = Journal of Japan Biliary Association 18(5) 614-619 2004年12月28日
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胆道 18(5) 614-619 2004年12月31歳男.黒色便,貧血を認め,内視鏡検査で十二指腸乳頭部に腫瘍を認め,紹介入院となる.低緊張性十二指腸造影所見で十二指腸乳頭部に一致して約2cm大の隆起性病変を認めた.超音波内視鏡所見でも十二指腸乳頭部に一致して長径18mm大の腫瘍を認め,その大部分は粘膜下に存在した.腹部造影CT所見でも十二指腸乳頭部に径10mm大の造影効果に乏しい腫瘍を認めた.以上の検査所見より,十二指腸乳頭部カルチノイドで,胆膵管への伸展(-),リンパ節転移(-),遠隔転移(-)と診断し,膵頭十二指腸第二部切除を施行した.病理組織所見では病変部はspindle cell,carcinoid-like cell,ganglion-like cellが混在していた.いずれも異型は認めなかった.免疫組織染色では,ganglion-like cellはS100陽性,carcinoid-like cellはChromogranin A,シナプトフィジンが陽性であった.以上より,十二指腸gangliocytic paragangliomaと診断した
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消化器医学 2 12-18 2004年10月Virtual biopsyの手段としての拡大内視鏡の有用性について検討した.対象は,早期胃癌67例と良性病変31例(胃潰瘍23例,慢性胃炎3例,腺腫5例)で,拡大内視鏡画像と組織像を比較した.その結果,1)早期胃癌と良性病変のsmall regular patternは各々40.3%,19.4%,2)irregular patternは53.7%,6.5%,3)lack of visible structureは46.3%,9.7%,4)abnormal vesselsは49.3%,16.1%であった.粘膜微細所見は1)ではpitの微細化と密度上昇,密な構造異型の少ない腺管,2)ではpitの大小が明らかで破壊像を伴い,構造異型の強い腺管,3)ではpitの完全消失,腺管構造の破壊・消失,4)では分化型は径不整で蛇行する血管,未分化型は血管長の短い血管が観察された.4)の平均血管径は良性病変例に比し早期胃癌例で有意に大きかった.画像解析で胃粘膜微細血管構造の定量的評価は可能であり,拡大内視鏡は有用と考えられた
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Gastroenterological Endoscopy 46(Suppl.2) 1811-1811 2004年9月
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日本消化器病学会雑誌 101(臨増大会) A551-A551 2004年9月
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European journal of gastroenterology & hepatology 16(7) 693-700 2004年7月 査読有りObjectives Some subjects infected by Helicobacter pylori have enlarged folds in the gastric body, the precise mechanism of which remains obscure. The aim of this study was to clarify the association of tumour necrosis factor-alpha (TNFA) gene polymorphism with susceptibility to hyper-rugosity. We also examined the association of TNFA polymorphism with gastric carcinoma. Subjects and methods Four hundred and seventy-two subjects (male/female = 351/121, aged 26-81 years) without gastric carcinoma (control group), and 300 patients (male/female = 218/82, aged 32-91 years) with gastric carcinoma. Barium meal roentgenograms were performed in 396 subjects in the control group and fold width was measured at the greater curvature of the middle portion of the gastric body. Fasting plasma anti-H. pylori IgG titres, pepsinogens (PGs) I and II were analysed, and TNFA -857 promoter polymorphism was distinguished by the 5' nuclease polymerase chain reaction assay and polymerase chain reaction restriction fragment length polymorphism using HincII in both groups. Results Adjusted odds ratios of TNFA-857 T/T genotype and H. pylori seropositivity for hyper-rugosity (fold width 6.0 mm) were 6.7 (95% confidence interval (CI) 1.5-28, P < 0.01) and 18.2 (95% Cl 4.2-78, P < 0.0001), respectively. There were no significant differences in any genotype or allele frequencies between the control and total gastric carcinoma group. In a subgroup of gastric carcinoma patients who were negative for the PG assay, however, the odds ratio of the T allele was 1.4 (95% Cl 1.0-2.0, P < 0.05). Conclusion The TNFA -857 T/T genotype and H. pylori infection were strongly associated with rugal hyperplastic gastritis. The TNFA -857 T allele may promote gastric carcinoma without severe atrophy.
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GASTROENTEROLOGY 126(4) A455-A456 2004年4月
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GASTROENTEROLOGY 126(4) A455-A455 2004年4月
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Gastroenterological Endoscopy 46(Suppl.1) 557-557 2004年4月
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Gastroenterological Endoscopy 46(Suppl.1) 601-601 2004年4月
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Gastroenterological Endoscopy 46(Suppl.1) 706-706 2004年4月
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Journal of gastroenterology and hepatology 19(4) 454-9 2004年4月 査読有りBackground and Aim: It is common knowledge that endoscopic ultrasonography (EUS) can accurately diagnose pancreatic diseases. Echoendoscopes for EUS are roughly classified into two categories, the mechanical radial scanning echoendoscope (MR-ES) and the electronic linear array echoendoscope, both of which have their merits and demerits. In 2000, a newly designed echoendoscope, the electronic radial scanning echoendoscope (ER-ES), appeared. The aim of the present study was to compare B-mode image quality between the ER-ES and the MR-ES in pancreatic diseases. Methods: Patients with pancreatic diseases (30 cystic diseases and 22 solid diseases) underwent EUS with both ER-ES and MR-ES. The B-mode images obtained using both echoendoscopes were graded using a scoring system and statistically analyzed. The assessed point for cystic lesions was the existence of mechanical-noise-like ring-like artifacts derived using multiple reflections ('ring-down'), grating robe and so on, and that for solid lesions was the scale of penetration. The authors compared maneuverability, endurance and endoscopic images between the two types of echoendoscopes. Results: The ER-ES had a significantly higher score than the MR-ES (P < 0.05) in the analysis of both cystic and solid diseases. There was no apparent difference as to maneuverability, endurance and endoscopic images. Conclusion: Ultrasound images acquired by ER-ES appear better compared with those acquired by MR-ES. (C) 2004 Blackwell Publishing Asia Pty Ltd.
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ENDOSCOPY 36(2) 165-169 2004年2月 査読有りBackground and Study Aims: We investigated the characteristic findings of early gastric cancer revealed by magnifying endoscopy, and clarified their relationship with histopathological features. Patients and Methods: A total of 74 patients with early gastric cancer underwent magnifying endoscopy ( x 80) between March 2000 and December 2001. The endoscopic findings demonstrated 11 elevated-type carcinomas and 63 depressed-type, and histological examination showed 56 differentiated carcinomas and 18 undifferentiated carcinomas. The histopathological results were compared with findings from magnifying endoscopy regarding minute surface structure and microvessels. Results: We were able to roughly classify the minute surface structure of early gastric cancer as shown by magnifying endoscopy into three patterns, as follows: (i) a small regular pattern of sulci and ridges; (ii) an irregular pattern of sulci and ridges; and (iii) a lack of visible structure. Abnormal microvessels observed in cancerous lesions were classified according to two patterns: irregular minute vessels and variation of vessel caliber. The small regular pattern of sulci and ridges was significantly more frequently observed in differentiated carcinoma (30/56, 53.6%) than in undifferentiated carcinoma (2/18, 11.1%). Lack of visible structure and irregular minute vessels were significantly more frequently observed in undifferentiated carcinoma (44.4% and 77.7%) than in differentiated carcinomas (5.4% and 51.8%). Conclusion: The minute surface structure and microvessels observed by magnifying endoscopy were related to histopathological findings. Magnifying endoscopy is valuable for predicting the histological nature in the diagnosis of early gastric cancer.
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消化器外科 27(3) 347-352 2004年著者等が行った超音波大腸内視鏡下穿刺について概説した.具体的な対象は粘膜下腫瘍(GIST,腸管子宮内膜症など),粘膜下を中心に発育した癌(カルチノイド腫瘍や4型の大腸癌など),直腸癌や結腸癌術後の再発,他の悪性腫瘍による消化管近傍の腫瘤,直腸或いは下部消化管周囲の膿瘍であった.スライディングチューブやガイドワイヤーを用いることにより,深部結腸への挿入も可能であった.EUS-FNABを行った大腸疾患22例中,95.5%で組織診断が可能であった.EUS-FNAB施行後に治療方針が変更となった症例も多く認めた.以上,本法の開発で悪性腫瘍との鑑別が必要な消化管及びその周囲の腫瘤に対して下部消化管からもアプローチが可能となった
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Ulser Research 31(2) 181-183 2004年Interleukin-1(IL-1)遺伝子多型とその発現の関連を,末梢血単核球培養,胃癌患者28名の胃粘膜組織器官培養を行い検討した.その結果,末梢血単核球培養,胃粘膜組織器官培養共にIL-1B-31T/T型でIL-1β発現が有意に高く,高発現型と考えられた
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Gastroenterological Endoscopy 45(Suppl.2) 1541-1541 2003年9月
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
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第62回日本小腸学会学術集会 2024年10月19日
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7所属学協会
12共同研究・競争的資金等の研究課題
31-
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