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-
Cancer chemotherapy and pharmacology 68(3) 677-83 2011年9月 査読有りS-1 is one of the second-line candidate agents for gemcitabine-refractory unresectable pancreatic cancer. Two phase II studies have been reported for second-line chemotherapy with S-1, but these studies did not investigate introduction rate and suitable dose of second-line S-1. Therefore, we conducted a prospective multicenter study in which chemo-na < ve patients were enrolled and had two levels of S-1 dose. Chemo-na < ve patients with unresectable pancreatic cancer were enrolled. This study started with 80 mg/m(2)/day dose of S-1 as second-line chemotherapy and tolerability was checked. When tolerability was not confirmed in initial patients, the dose of S-1 was shifted to 60 mg/m(2)/day. When tolerability was confirmed at 80 or 60 mg/m(2)/day, the study continued, and up to 20 patients were accumulated with the dose. In addition, the introduction rate of second-line S-1 was examined. Six of the initial 7 patients with 80 mg/m(2)/day dose of S-1 completed one course of second-line chemotherapy. Twenty patients were accumulated with an 80 mg/m(2)/day dose of S-1. With the exception of one patient continued gemcitabine chemotherapy, two of the remaining 19 patients withdrew from this study because of toxicity during the period of gemcitabine chemotherapy. Fifteen of the remaining 17 gemcitabine-refractory patients could complete one course of S-1 as second-line chemotherapy with acceptable toxicity. This prospective multicenter study showed that 15 (78.9%) out of 19 chemo-na < ve unresectable pancreatic cancer patients could complete one course of 80 mg/m(2)/day dose of S-1 as second-line chemotherapy after first-line gemcitabine chemotherapy failure with tolerable toxicity.
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胆と膵 32(8) 757-763 2011年8月膵癌診断基準は1992年に日本超音波医学会から正式に公示され、その後約19年が過ぎた。その間に各疾患の診断基準・名称の改定や超音波技術の進歩などに伴い、実情と解離する部分が存在し、問題点として出てきている。そのため、日本超音波医学会用語診断基準委員会のもとで現在、新しい膵癌診断基準の作成が行われており、今回はその新基準案を提示し説明する。(著者抄録)
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Cancer science 102(8) 1532-6 2011年8月 査読有りWe conducted a multicenter, retrospective study to determine the anatomical distribution and prognostic factors of gastrointestinal (GI) follicular lymphoma (FL). This study included 125 patients with stage I and II(1) GI-FL. Of the 125 patients, the small intestine was examined in 70 patients, with double-balloon endoscopy and/or capsule endoscopy. The most frequently involved GI-FL site was the duodenal second portion (DSP) (81%), followed by the jejunum (40%); 85% of patients with involvement of the DSP also had jejunal or ileal lesions. The absence of abdominal symptoms and macroscopic appearance of multiple nodules were significantly present in the DSP-positive group. During a median follow up of 40 months, six patients showed disease progression. Patients with involvement of the DSP had better progression-free survival (PFS) than those without such involvement (P = 0.001). A multivariate analysis revealed that male sex, the presence of abdominal symptoms, and negative involvement of the DSP were independently associated with poor PFS. In conclusion, most patients with GI-FL have duodenal lesions associated with multiple jejunal or ileal lesions. Gastrointestinal follicular lymphomas involving the DSP might be a distinct entity showing a favorable clinical course. (Cancer Sci 2011; 102: 1532-1536)
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JAPANESE JOURNAL OF CLINICAL ONCOLOGY 41(8) 1041-1044 2011年8月 査読有りIn Western countries, the standard treatment for locally advanced rectal cancer is preoperative chemoradiotherapy followed by total mesorectal excision. On the other hand, in Japan, treatment results without radiotherapy are by no means inferior; therefore, extrapolation of results of preoperative treatment in Western countries to Japan is controversial. We consider that survival may be improved by preoperative treatment with new anticancer agents as they are expected not only to decrease the local recurrence rate but also to prevent distant metastases. We are conducting a multicentre Phase II study to evaluate the safety and efficacy of neoadjuvant chemotherapy using XELOX plus bevacizumab without radiotherapy in patients with locally advanced rectal cancer. The primary endpoint of the study is treatment compliance. Secondary endpoints are overall survival, disease-free survival, local recurrence-free survival, objective response rate, R0 resection rate and adverse events. Thirty patients are required for this study.
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World journal of clinical oncology 2(5) 217-24 2011年5月10日 査読有りIn the early 2000s, the main stream of endoscopic ultrasonography (EUS) changed from a mechanical scanning method to electronic radial or linear scanning methods. Subsequently, useful applications in trans-abdominal ultrasonography came within reach of EUS. In particular, contrast-enhanced EUS (CE-EUS) and EUS-elastography became cutting-edge diagnostic modalities for pancreatic disorders. Each type of pancreatic disorder has characteristic hemodynamics. CE-EUS uses color Doppler flow imaging and harmonic imaging to classify pancreatic lesions. EUS-elastography can assess tissue hardness by measuring its elasticity. This parameter appears to correlate with the malignant potential of the lesions. Tissue elasticity studies can provide information on both its pattern and distribution. The former is the conventional method of morphological diagnosis, but it is restricted to observations made in a region of interest (ROI). The latter is an unbiased analysis that can be performed by image analysis software and is theoretically constant, regardless of the ROI. Though EUS-fine needle aspiration (FNA) is also a very useful diagnostic tool, there are several limitations. Diagnostic EUS-FNA of pancreatic cystic lesions has marginal utility mainly due to low sensitivity. Therefore, in particular, endoscopists should keep this limitation in mind.
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GASTROENTEROLOGY 140(5) S859-S859 2011年5月
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GASTROENTEROLOGY 140(5) S715-S715 2011年5月
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Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 23 Suppl 1(Suppl 1) 72-4 2011年5月 査読有りIn this case, narrow-band imaging helped to distinguish esophagitis. The case involved an 81-year-old female was being seen as an outpatient because of Gastroesophageal Reflux Disease (GERD) symptoms associated with an esophageal hiatal hernia. Endoscopy showed long reddish lesions on the posterior wall of the lower thoracic esophagus. Non-magnifying endoscopic images with white light initially suggested reflux esophagitis. Magnifying endoscopy with narrow-band imaging showed proliferation of intraepithelial papillary capillary loop-like vessels as well as irregular widening and narrowing of vessels, so the patient's condition was diagnosed as superficial esophageal cancer. Endoscopic submucosal dissection was carried out.
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膵臓 26(2) 204-211 2011年4月通常型膵癌に比較して膵内分泌腫瘍では、主膵管途絶を呈することは稀である。我々はERPにて主膵管途絶を来たした膵内分泌腫瘍の2例を経験した。症例1は40歳代男性。心窩部痛で近医受診し、膵腫瘍を指摘。当院精査にて膵内分泌腫瘍と診断し、膵体尾部切除術施行。リンパ節転移を認めwell-differentiated endocrine carcinomaであった。症例2は40歳代男性。主膵管拡張精査目的で当院受診し、膵体部に8mm大の膵腫瘍を認め、膵癌疑いで膵体尾部切除術施行。膵内神経浸潤を認め、well-differentiated endocrine tumor(uncertain behavior)と診断。また造影EUSでは、2症例ともに造影効果の乏しい画像所見を呈した。膵内分泌腫瘍における主膵管途絶所見と造影EUSにおける非典型的造影パターンは悪性度の高い膵内分泌腫瘍を示唆する重要な所見と考えられた。(著者抄録)
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BMC gastroenterology 11 29-29 2011年3月31日 査読有りBackground: Real-time tissue sonoelastography (EG) is a new non-invasive technique that visualizes differences in tissue strain. We evaluated the usefulness of EG in patients with ulcerative colitis (UC) by investigating the association between EG and colonoscopic findings and disease activity. Methods: Thirty-seven UC patients undergoing EG and colonoscopy were invited to enroll. EG findings were classified as normal, homogeneous, random, or hard, and colonoscopic findings as normal, mucosal edema and erosion, punched-out ulcer, and extensive mucosal abrasion. Clinical findings were evaluated using clinical activity index (CAI) scores for each patient at colonoscopy. Results: On EG, 10 cases were classified as normal, 11 as homogeneous, 6 as random, and 10 as hard. EG findings showed a significant correlation those of colonoscopy (p < 0.001). Seven of 10 (70%) normal-type patients were in the remission phase, while all 6 random-type patients were in the active phase. Among active-phase patients, 4 of 7 (57%) homogeneous-type patients responded to steroid or leukocytapheresis therapy, while 3 of 6 (50%) random-type patients required treatment with cyclosporine. Three of 10 (30%) hard-type patients required colectomy. Conclusions: In this small series, EG findings reflected colonoscopic findings and correlated with disease activity among patients with UC.
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Intestine 15(2) 167-172 2011年3月近年,小腸内視鏡はカプセル内視鏡およびダブルバルーン内視鏡の出現によりめざましく進歩した.とくにダブルバルーン内視鏡の開発によりこれまで困難であった深部小腸の内視鏡治療が比較的容易に行えるようになった.本稿ではまずPeutz-Jeghers症候群の概説後,自験例を併せPeutz-Jeghers症候群の診断,治療およびサーベイランス方法につき説明する.(著者抄録)
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Gastroenterological Endoscopy 53(Suppl.1) 632-632 2011年3月
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Gastroenterological Endoscopy 53(Suppl.1) 636-636 2011年3月
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Gastroenterological Endoscopy 53(Suppl.1) 905-905 2011年3月
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Gastroenterological Endoscopy 53(Suppl.1) 991-991 2011年3月
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日本消化器病学会雑誌 108(臨増総会) A56-A56 2011年3月
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日本消化器病学会雑誌 108(臨増総会) A295-A295 2011年3月
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HEPATO-GASTROENTEROLOGY 58(106) 453-458 2011年3月 査読有りBackgrounds/Aims: A prospective correlation study of symptomatic changes due to administration of prokinetic drugs and changes of transit time of capsule endoscopy (CE), for patients with constipation-predominant irritable bowel syndrome (IBS-C), and examination of usefulness of CE in the objective evaluation of IBS-C. Methodology: Mosapride citrate was administered to ten subjects and CE transit evaluated together with a symptom questionnaire before and after administration. Frequency and severity of abdominal pain, times of defecation and Bristol stool scales were listed and scored. Primary and secondary endpoints were the correlation between symptomatic changes due to the administration and changes of CE transit and the effect of mosapride citrate on IBS-C, CE findings, and gastric and small bowel transit time (GTT, SBTT). Results: After administration for 4 weeks, the mean scores of evaluated symptoms all improved. GTT was not significantly changed, but SBTT showed significant shortening post-administration (p=0.02). In only one patient's CE, three small erosions were detected. The changes in the times of defecation before and after the administration were significantly correlated with those in the SBTT of CE (R=0.888, p=0.0006). However, other symptoms were not significantly correlated with SBTT. Conclusions: CE transit correlated with intestinal motility in symptomatic changes and could be a possible index for the objective assessment of motility in IBS-C.
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胃と腸 46(2) 161-165 2011年2月カプセル内視鏡の登場によりNSAID起因性小腸病変の臨床像が明らかにされつつある.NSAIDは内服期間の長短にかかわらず高率に小腸粘膜病変を引き起こす.COX-2選択的阻害薬は短期的には小腸病変の発症を軽減するが,長期的には非選択的NSAIDと同等のリスクがあるという報告もあり,NSAID起因性小腸病変の予防・治療薬が望まれている.近年レバミピドやミソプロストールなどがNSAID起因性小腸病変に対して有用であると報告されているが,少数例でもあり今後さらなる症例検討が必要である.またカプセル内視鏡にて多数の小腸病変を認めるも臨床的に無症状例も多く,治療適応や長期予後など今後の検討課題は多い.(著者抄録)
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
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-
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厚生労働省 先進医療B 2021年2月 - 2024年6月
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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
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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