研究者詳細 - 辻　喜久

論文 - 辻　喜久

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膵癌における術前化学療法に対する腫瘍内血流速度の臨床的意義

前平博充, 辻喜久, 森治樹, 新田信人, 前川毅, 石川原, 竹林克士, 小島正継, 貝田佐知子, 三宅亨, 新谷修平, 稲富理, 谷眞至

日本癌治療学会学術集会抄録集 ( (一社)日本癌治療学会 ) 62回 O48 - 3 2024年10月

急性膵炎発症が生活の質に及ぼす影響についての多施設共同前向きコホート研究

上野真行, 辻喜久, 江口考明, 福田晃久, 栗田裕介, 高山敬子, 石田悦嗣, 山上裕機, 正宗淳, 里井壯平, 竹山宜典, 水野元夫

膵臓 ( (一社)日本膵臓学会 ) 39 ( 3 ) A149 - A149 2024年07月

在宅終末期ケアを担う訪問診療同行看護師の役割

奥岡由美, 本田日奈子, 古山悦子, 神野敦, 市来智子, 日下勝博, 辻喜久

木村看護教育振興財団看護研究集録 ( (公財)木村看護教育振興財団 ) ( 31 ) 1 - 24 2024年07月

江別訪問診療所に関連する医療介護職19名と患者家族5名に半構造化インタビューを行い、訪問診療同行看護師に期待する役割および実際に実践されている役割について聴取し、カテゴリー化した。結果、医療介護職グループでは9つのカテゴリーが抽出され、患者家族グループでは7つのカテゴリーが抽出された。両グループに共通するカテゴリーとして【診療補助】【医師の説明に対する理解の促進】【意思決定支援】【患者・家族への直接的ケア】【診療におけるサポーティブな環境づくり】【全人的な視点で情報収集・アセスメント】【多職種とのコーディネーション】があり、医療介護職グループではこれらに加え【医師との協働】【終末期・緩和ケア教育】があった。

在宅終末期ケアにおける訪問診療同行看護師の役割検討同行看護師および多職種、患者家族を対象としたインタビュー

奥岡由美, 本田日奈子, 古山悦子, 神野敦, 市来智子, 日下勝博, 辻喜久, 辻喜久

Palliative Care Research ( (NPO)日本緩和医療学会 ) 19 ( Suppl. ) S.555 - S.555 2024年06月

検診2週間後に発症したバリウム虫垂炎の一例

村田直哉, 真部建郎, 市来智子, 江口考明, 大島侑, 辻喜久

日本病院総合診療医学会雑誌 ( (一社)日本病院総合診療医学会 ) 20 ( 臨増1 ) 122 - 122 2024年03月

造影CTで肝実質に特異的な所見を示した門脈・脾静脈・上腸間膜静脈血栓症の1例

津久井麟, 真部建郎, 市来智子, 江口考明, 高橋憲一郎, 辻喜久

日本病院総合診療医学会雑誌 ( (一社)日本病院総合診療医学会 ) 20 ( 臨増1 ) 236 - 236 2024年03月

Gut microbiota and metabolites in patients with COVID-19 are altered by the type of SARS-CoV-2 variant.

Yoshihiro Yokoyama, Tomoko Ichiki, Tsukasa Yamakawa, Yoshihisa Tsuji, Koji Kuronuma, Satoshi Takahashi, Eichi Narimatsu, Akio Katanuma, Hiroshi Nakase

Frontiers in microbiology 15 1358530 - 1358530 2024年 [国際誌]

INTRODUCTION: Patients with COVID-19 have dysbiosis of the intestinal microbiota with altered metabolites in the stool. However, it remains unclear whether the differences among SARS-CoV-2 variants lead to differences in intestinal microbiota and metabolites. Thus, we compared the microbiome and metabolome changes for each SARS-CoV-2 variant in patients with COVID-19. MATERIALS AND METHODS: We conducted a multicenter observational study of patients with COVID-19 and performed fecal microbiome, metabolome, and calprotectin analyses and compared the results among the different SARS-CoV-2 variants. RESULTS: Twenty-one patients with COVID-19 were enrolled and stratified according to the SARS-CoV-2 strain: six with the Alpha, 10 with the Delta, and five with the Omicron variant. Fecal microbiome analysis showed that α-diversity was reduced in the order of the Omicron, Delta, and Alpha variants (p = 0.07). Linear discriminant analysis revealed differences in the abundance of short-chain fatty acid-producing gut microbiota for each SARS-CoV-2 variant. Fecal metabolome analysis showed that the Omicron and Delta variants had markedly reduced propionic and lactic acid levels compared to the Alpha strain (p < 0.05). CONCLUSION: The intestinal microbiota of patients with COVID-19 varies depending on the SARS-CoV-2 variant. Dysbiosis of the intestinal microbiota due to differences in SARS-CoV-2 variants causes a decrease in intestinal short-chain fatty acids.

DOI PubMed

Sex-based differences in metabolic protection by the ANP genetic variant rs5068 in the general population.

Tomoko Ichiki, Valentina Cannone, Christopher G Scott, Seethalakshmi R Iyer, S Jeson Sangaralingham, Kent R Bailey, Jens P Goetze, Yoshihisa Tsuji, Richard J Rodeheffer, John C Burnett Jr

American journal of physiology. Heart and circulatory physiology 325 ( 3 ) H545-H552 2023年09月 [国際誌]

Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are produced in the heart and secreted into the circulation. As hormones, both peptides activate the guanylyl cyclase receptor A (GC-A), playing a role in blood pressure (BP) regulation. A significant role for ANP and BNP includes favorable actions in metabolic homeostasis. Sex-based high prevalence of risk factors for cardiovascular disease in males compared with females is well established, but sex-based differences on cardiometabolic protection have not been investigated in relation to ANP (NPPA) and BNP (NPPB) gene variants. We included 1,146 subjects in the general population from Olmsted County, Minnesota. Subjects were genotyped for the ANP gene variant rs5068 and BNP gene variant rs198389. Cardiometabolic parameters and medical records were reviewed. In the presence of the minor allele of rs5068, diastolic BP, creatinine, body mass index (BMI), waist measurement, insulin, and prevalence of obesity and metabolic syndrome were lower, whereas HDL was higher in males with only trends observed in females. We observed no associations of the minor allele with echocardiographic parameters in either males or females. Regarding rs198389 genotype, the minor allele was not associated with any BP, metabolic, renal, or echocardiographic parameters in either sex. In the general community, the minor allele of the ANP gene variant rs5068 is associated with a favorable metabolic phenotype in males. No associations were observed with the BNP gene variant rs198389. These studies support a protective role of the ANP pathway on metabolic function and underscore the importance of sex in relationship to natriuretic peptide responses.NEW & NOTEWORTHY Males are characterized by lower ANP and BNP with greater prevalence of cardiometabolic disease. The ANP genetic variant rs5068 was associated with less metabolic dysfunction in males, whereas no metabolic profile was related to the BNP genetic variant rs198389 in the general population. ANP may play a more biological role in metabolic homeostasis compared with BNP in the general population with greater physiological metabolic actions in males compared with females.

DOI PubMed

差異に着目した地域医療教育のデザインとその実践報告

神野敦, 佐藤健太, 風間友江, 野村和史, 三原弘, 杉原伸明, 中川貴史, 真部建郎, 市来智子, 辻喜久

日本病院総合診療医学会雑誌 ( (一社)日本病院総合診療医学会 ) 19 ( 臨増2 ) 172 - 172 2023年08月

Impact of S‐1 adjuvant chemotherapy longer than 6 months on survival in patients with resected pancreatic cancer: a nationwide survey by the Japan Pancreas Society based on real‐world data

Yoshito Tomimaru, Hidetoshi Eguchi, Yosuke Inoue, Yuichi Nagakawa, Akihiro Ohba, Hideki Takami, Michiaki Unno, Tomohisa Yamamoto, Shoji Kawakatsu, Tsuyoshi Hayashi, Ryota Higuchi, Hirohisa Kitagawa, Satoshi Hattori, Tsutomu Fujii, Yoshiki Hirooka, Hisato Igarashi, Masayuki Kitano, Tamotsu Kuroki, Atsushi Masamune, Yasuhiro Shimizu, Masaji Tani, Satoshi Tanno, Yoshihisa Tsuji, Hiroki Yamaue, Sohei Satoi, Yoshifumi Takeyama

Cancer ( Wiley ) 129 ( 5 ) 728 - 739 2022年12月 [査読有り]

DOI

Self-assessment scale for the community-based and emergency practice.

Takao Wakabayashi, Yoshihisa Tsuji, Takeshi Yamamoto, Hitoshi Sohma, Wari Yamamoto

BMC medical education 22 ( 1 ) 799 - 799 2022年11月 [国際誌]

BACKGROUND: For current medical education, community-based primary care for the elderly is an essential topic. This study aimed to establish a scale of community-based assessment for clinical and emergency practice (C-CEP). METHODS: A self-assessment scale for C-CEP was developed according to four steps. Initially, we reviewed publications from the societies of the United States, British, and Japan regarding educational goals. In addition, we searched MEDLINE for educational goals regarding attitude, skills, and knowledge. Getting together, we established 23 items as the educational goals of the C-CEP. Second, we collected responses for these 23 items from 5th-grade medical students (n = 195). Third, we conducted an exploratory factor analysis (EFA) using their responses to determine the fundamental structure of the self-assessment scale. Finally, a confirmatory factor analysis (CFA) was performed to assess the fitness of the self-assessment scale developing the EFA, resulting in modification of the items. RESULTS: In EFA and CFA results, C-CEP Scale consisted of four factors with 15 items: "Attitude and communication in emergency care," Basic clinical skills," "Knowledge of community healthcare," and "Knowledge of evidence-based medicine perseverance." The model fit indices were acceptable (Goodness of Fix Index = 0.928, Adjusted Goodness of Fit Index = 0.900, Comparative Fit Index = 0.979, and Root Mean Square Error of Approximation = 0.045). The values of McDonald's omega as an estimate of scale reliability were more than 0.7 in all four factors. As for test-retest reliability, the intraclass correlation coefficients were ≥ 0.58 for all factors. All four factors of the C-CEP Scale correlated positively with the Medical Professionalism Evaluation Scale subscales. CONCLUSIONS: We developed a valid and reliable self-assessment scale to assess student competence.

DOI PubMed

Natriuretic Peptide-Based Novel Therapeutics: Long Journeys of Drug Developments Optimized for Disease States.

Tomoko Ichiki, Atsushi Jinno, Yoshihisa Tsuji

Biology 11 ( 6 ) 2022年06月 [国際誌]

The field of natriuretic peptides (NPs) as an endocrine hormone has been developing since 1979. There are three peptides in humans: atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP), which bind to the guanylyl cyclase-A (GC-A) receptor (also called natriuretic peptide receptor-A (NPR-A)), and C-type natriuretic peptide (CNP), which binds to the GC-B receptor (also called the NPR-B) and then synthesizes intracellular cGMP. GC-A receptor stimulation has natriuretic, vasodilatory, cardiorenal protective and anti-renin-angiotensin-aldosterone system actions, and GC-B receptor stimulation can suppress myocardial fibrosis and can activate bone growth before epiphyseal plate closure. These physiological effects are useful as therapeutics for some disease states, such as heart failure, hypertension, and dwarfism. To optimize the therapeutics for each disease state, we must consider drug metabolism, delivery systems, and target receptor(s). We review the cardiac NP system; new designer NPs, such as modified/combined NPs and modified peptides that can bind to not only NP receptors but receptors for other systems; and oral drugs that enhance endogenous NP activity. Finally, we discuss prospective drug discoveries and the development of novel NP therapeutics.

DOI PubMed

Blue Foreign Body in the Esophagus.

Ryosuke Tomiyama, Tomoko Ichiki, Yoshihisa Tsuji

Gastroenterology 162 ( 7 ) e14-e15 2022年06月 [国際誌]

DOI PubMed

Two Types of Immune Checkpoint Inhibitor-related Pancreatitis.

Tomoko Ichiki, Yasuki Hori, Yoshihisa Tsuji

Internal medicine (Tokyo, Japan) 61 ( 10 ) 1477 - 1478 2022年05月 [国内誌]

DOI PubMed

Estimated tumor blood flow as a predictive imaging indicator of therapeutic response in pancreatic ductal adenocarcinoma: use of three-phase contrast-enhanced computed tomography.

Hiromitsu Maehira, Yoshihisa Tsuji, Hiroya Iida, Haruki Mori, Nobuhito Nitta, Takeru Maekawa, Sachiko Kaida, Toru Miyake, Masaji Tani

International journal of clinical oncology 27 ( 2 ) 373 - 382 2022年02月 [国内誌]

BACKGROUND: Preoperative chemotherapy or chemoradiotherapy is a common strategy for treating pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the association between the therapeutic response in PDAC and tumor blood circulation. METHODS: The medical records of patients who underwent chemotherapy or chemoradiotherapy prior to pancreatectomy for PDAC were reviewed. Of these, patient data that included three-phase contrast-enhanced computed tomography (CECT) findings before treatments were used in this study. We evaluated the estimated tumor blood flow (eTBF) using CECT. According to the therapeutic histopathological response defined by the Evans classification, patients were divided into poor (grade I/IIa) and good (grade IIb/III/IV) responder groups. The variables, including eTBF, were compared between the two groups. RESULTS: Thirty patients were enrolled in this study. Of these, 13 (43.3%) (grade IIB/III/IV: 8/4/1 patients) were categorized into the good responder group and 17 patients (56.7%) (grade I/IIA: 4/13 patients) were categorized into the poor responder group. eTBF was significantly higher in the good responder group (0.39 s-1 vs. 0.32 s-1, p = 0.007). An eTBF ≥ 0.36 s-1 was found to be an independent predictive factor for the destruction of over 50% of tumor cells (p = 0.036; odds ratio, 9.71; 95% confidence interval, 1.16-81.30). CONCLUSIONS: eTBF can be used to predict the therapeutic histopathological response in PDAC prior to treatment.

DOI PubMed

Fatal Immune Checkpoint Inhibitor-related Pancreatitis.

Masayuki Ueno, Yoshihisa Tsuji, Toshihide Yokoyama, Takashi Koyama, Yosuke Uenishi, Etsuji Ishida, Motowo Mizuno

Internal medicine (Tokyo, Japan) 60 ( 24 ) 3905 - 3911 2021年12月 [国内誌]

We herein report a case of fatal pancreatitis induced by an immune checkpoint inhibitor. A 62-year-old man with cancer of unknown primary was treated with pembrolizumab. After 12 cycles, immune-related pneumonitis developed and was treated with prednisolone. Three months later, pancreatitis developed, which was successfully treated with hydration and protease inhibitors. Eight months later, another attack of pancreatitis occurred, which did not respond to therapy, including high-dose corticosteroids, and he eventually died. This is the first report describing fatal immune checkpoint inhibitor-related pancreatitis. Despite the rarity of this complication, attention should be paid to its potential severity and treatment.

DOI PubMed

The clinical efficacy of azathioprine as maintenance treatment for autoimmune pancreatitis: a systematic review and meta-analysis.

Yoshiharu Masaki, Hiroshi Nakase, Yoshihisa Tsuji, Masanori Nojima, Kyoko Shimizu, Nobumasa Mizuno, Tsukasa Ikeura, Kazushige Uchida, Akio Ido, Yuzo Kodama, Hiroshi Seno, Kazuichi Okazaki, Seiji Nakamura, Atsushi Masamune

Journal of gastroenterology 56 ( 10 ) 869 - 880 2021年10月 [国内誌]

The effectiveness of azathioprine (AZA) in preventing relapse and maintaining autoimmune pancreatitis (AIP) remission has been reported; however, most of these studies are case series with no randomized control trials available in the literature. Therefore, this study performed a systematic review and meta-analysis of the existing literature on this subject to determine the clinical efficacy of AZA as maintenance therapy for AIP patients. A systematic search was performed to identify studies on the clinical efficacy of AZA as maintenance therapy in AIP patients. The crude multiple relapse rate was estimated to assess the ability of AZA to control relapses in AIP. Pooled estimates were obtained using a random-effects model with the DerSimonian-Laird method. We identified AIP patients who did not respond to initial steroid treatment, experienced steroid weaning failure, or those who relapsed during remission as refractory cases. After reviewing the studies, ten articles fulfilled the inclusion criteria and were selected for meta-analysis. Of all 4504 patients, 3534 patients were treated with steroids, and 346 patients were treated with AZA for relapsed AIP. In this meta-analysis, 14/73 (19.2%) patients receiving AZA for refractory AIP relapsed. Meanwhile, 14/47 (29.8%) patients without AZA experienced relapse. The integrated odds ratio for relapse risk in patients receiving AZA was estimated to be 0.52 (p = 0.15). This systematic review and meta-analysis demonstrated the efficacy of AZA in preventing relapse of AIP, which supports the use of AZA as a maintenance treatment in patients with AIP who relapse upon withdrawal of steroid therapy.

DOI PubMed

Reducing the risk of developing walled-off necrosis in patients with acute necrotic collection using recombinant human soluble thrombomodulin.

Takaaki Eguchi, Yoshihisa Tsuji, Akihiko Okada, Dai Inoue, Hironobu Tokumasu, Kosuke Iwane, Yoshitaka Nakai, Toshihiro Kusaka, Yoshito Uenoyama, Koichi Fujita, Masataka Yokode, Yukimasa Yamashita, Yugo Sawai, Masanori Asada, Takao Mikami, Chiharu Kawanami, Yasushi Kudo, Shujiro Yazumi, Tsuyoshi Sanuki, Arata Sakai, Toshihiro Morita, Yojiro Sakuma, Norimitsu Uza, Yutaka Takada, Toshinao Itani, Katsutoshi Kuriyama, Kazuyoshi Matsumura, Kazuki Ikeda, Hitoshi Someda, Eiji Funatsu, Shinji Katsushima, Yuzo Kodama, Hiroshi Seno

Journal of hepato-biliary-pancreatic sciences 28 ( 9 ) 788 - 797 2021年06月 [国内誌]

BACKGROUND/PURPOSE: The purpose of the present study was to investigate the possibility of reducing clinical impacts of acute necrotic collection (ANC) on patients with acute pancreatitis (AP) using recombinant human soluble thrombomodulin (rTM). METHODS: In this retrospective multicenter study, 233 consecutive AP patients with ANC and acute peripancreatic fluid collection (APFC) from 2012 to 2016 were enrolled. To assess clinical impacts of ANC, severity on admission (JPN score, JPN CT grade, and Modified CT severity index), development of walled-off necrosis (WON), imaging costs for follow-up, and mortality were recorded. Finally, we investigated whether rTM could reduce the clinical impacts, adjusting the severity using propensity analysis with Inverse probability of treatment weighting. RESULTS: Patients with ANC developed WON with higher ratio than APFC (58/98 [59.2%] vs 20/135 [14.8%], OR = 8.3, P < .01]. Severity on admission and imaging costs for follow-up in ANC patients were significantly higher than those in APFC (P < .01). However, regarding mortality, there was no significant difference between patients with ANC and APFC (P = .41). Adjusting severity, it was revealed that rTM administration significantly reduced the risk of ANC developed WON (OR = 0.23, P = .01). CONCLUSIONS: While ANC had a higher clinical impact than that of APFC, we found that early administration of rTM may reduce the impact.

DOI PubMed

Non-compliance to practice guidelines still exist in the early management of acute pancreatitis: Time for reappraisal?

Rupjyoti Talukdar, Yoshihisa Tsuji, Nitin Jagtap, R Pradeep, G V Rao, D Nageshwar Reddy

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2021年05月 [国際誌]

INTRODUCTION: Earlier national surveys on the management of acute pancreatitis (AP) had reported non-compliance to practice guidelines. In the past decade, several guidelines were revised based on new evidence. In this multicenter international survey, we aimed to evaluate the practice patterns of early management of AP and compliance to the revised treatment guidelines across different disciplines and practice environments. METHODS: A structured questionnaire was sent via email to a target population of 654 that constituted of medical and surgical gastroenterologists, physicians and general surgeons, paediatricians from academic and non-academic centres across 30 countries. Other than demographic variables, the questionnaire contained items pertaining to early management of AP, such as, assessment at admissions and within first 72 h s, details regarding analgesics, IV hydration, oral/enteral feeding and antibiotic use. RESULTS: The response rate was 46.2% and after exclusions, a total of 297 participant's responses were analysed. Majority of the participants were from Asia, followed by Europe and the Americas. 181 (60.9%) claimed to follow practice guidelines, out of which 59 (32.6%) followed more than one. On further probing, only 41.9% were actually compliant to feeding and 59.7% to antibiotic guidelines. Even though participants opted for aggressive hydration, early feeding and avoidance of prophylactic antibiotics, there were non-compliance and discrepancies in titration of fluid therapy, indications of feeding and antibiotic use. DISCUSSION: Discrepancies and non-compliance still appear to exist in the early management of AP due to lack of strong evidence. We discuss ways that could improve compliance to the existing guidelines until stronger evidence comes to the fore.

DOI PubMed

Dilemma of physician-mothers faced with an increased home burden and clinical duties in the hospital during the COVID-19 pandemic.

Sachiyo Nishida, Kanna Nagaishi, Masayo Motoya, Ayako Kumagai, Noriko Terada, Ai Kasuga, Narumi Kubota, Kotoe Iesato, Motonobu Kimizuka, Satsuki Miyajima, Masayuki Koyama, Hirofumi Ohnishi, Eichi Narimatsu, Naoya Masumori, Kazufumi Tsuchihashi, Taiji Tsukamoto, Yoshihisa Tsuji

PloS one 16 ( 6 ) e0253646 2021年 [国際誌]

PURPOSE: Since December 2019, coronavirus disease 2019 (COVID-19) has spread rapidly across the world. During the pandemic, physicians in our hospital have had to respond both to the issue of treating the patients and the increasing domestic burden associated with social disruption. The purpose of this study was to assess how much the burden on our doctors, especially female doctors, was increasing. MATERIAL AND METHODS: The Physicians' Career Support Committee in Sapporo Medical University conducted a questionnaire survey. The questionnaire inquired about a wide range of subjects with regard to working style and family life during the first and second waves of the COVID-19 pandemic, and was sent to all medical/dental physicians working in Sapporo Medical University. RESULTS: A total of 266 (42.7%) physicians in our hospital responded to our questionnaire and the data for 264 data were analyzed. The total numbers of males, females, and others, including those who did not want to specify, were 178 (67.4%), 82 (31.0%), and 4 (1.5%), respectively. Among them, 62 (23.5%) and 23 (8.7%) answered that their domestic burden was slightly or markedly increased. The increase in the domestic burden showed a significant difference between genders (p = 0.04). Even after correction for background differences using multivariate analysis, being female (p<0.001), having child dependents (p<0.001), and treating COVID-19 patients (p = 0.03) were significantly related to an increased domestic burden. Regarding family style, 58.1% of the physician-fathers were from two-income families (i.e., families with both parents in employment), and they answered that their partner mainly cared for the children. In contrast, 97.3% of physician-mothers were from two-income families, and 94.6% of the physician-mothers had to take care of children by themselves. CONCLUSION: Physician-mothers are caught in a dilemma between an increased home burden and clinical duties in the hospital, with a significantly higher ratio than physician-fathers during the pandemic. As we showed, female doctors could have not continued their careers and take responsible positions in the same way as male doctors. This is a social risk in the timing of a crisis, such as a pandemic.

DOI PubMed

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