Papers - TSUJI Yoshihisa

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.]    2021.05  [International journal]

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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  [International journal]

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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

急性膵炎発症後3か月における心身の負担と社会復帰の現状

辻喜久, 石上敬介, 上野真行, 上野真行

膵臓(Web)   36 ( 3 )  2021

J-GLOBAL

Analysis of the risk of prolongation of hospital stay for patients hospitalized on an emergency basis in the department of general medicine of an acute care hospital

若林崇雄, 山本武志, 山本武志, 相馬仁, 辻喜久, 山本和利, 山本和利

日本病院総合診療医学会雑誌(Web)   17 ( 3 )  2021

J-GLOBAL

International comparison of clinical guidelines for acute pancreatitis

辻喜久, 佐藤健太

膵臓(Web)   36 ( 4 )  2021

J-GLOBAL

FileMakerによる情報共有システムの構築 アンプロフェッショナル学生への対応

石井 真理子, 辻 喜久, 伊藤 俊之

医学教育 ( (一社)日本医学教育学会 )  51 ( Suppl. ) 217 - 217  2020.07

Optimal Treatment for Octogenarians With Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: A Multicenter Retrospective Study.

Sohei Satoi, Tomohisa Yamamoto, Kazushige Uchida, Tsutomu Fujii, Toshifumi Kin, Satoshi Hirano, Keiji Hanada, Takao Itoi, Yoshiaki Murakami, Hisato Igarashi, Hidetoshi Eguchi, Tamotsu Kuroki, Yasuhiro Shimizu, Masaji Tani, Satoshi Tanno, Yoshihisa Tsuji, Yoshiki Hirooka, Atsushi Masamune, Toshio Shimokawa, Hiroki Yamaue, Kazuichi Okazaki

Pancreas   49 ( 6 ) 837 - 844  2020.07  [International journal]

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OBJECTIVES: The objective of this study was to clarify the role of pancreatectomy for patients with resectable and borderline resectable pancreatic ductal adenocarcinoma aged 80 years or older using a nationwide audit by the Japan Pancreas Society. METHODS: Data were collected from 39 institutions from 2007 to 2014. The primary endpoint was overall survival, and secondary endpoints were surgical outcomes and predictive factors for prognosis. RESULTS: Data were obtained from 556 octogenarians who underwent pancreatectomy (n = 369, 66%), chemo(radio)therapy (n = 99, 18%), and palliative therapy (n = 88, 16%). Median survival times were 20.6, 18.6, and 8.8 months in each group, respectively. Even after propensity score matching, median survival time in the surgery group (22.8 months) was significantly higher than that in the chemotherapy group (18.5 months; hazard ratio, 0.64 [95% confidence interval, 0.44-0.93]; P = 0.020). Significant independent prognostic factors were body mass index, lymph node metastasis, and tumor diameter in the surgery group, and serum albumin level, American Society of Anesthesiologists classification, body mass index, modified Glasgow prognostic score, second-line chemotherapy, and tumor diameter in the chemotherapy group. CONCLUSIONS: Octogenarians with resectable/borderline resectable pancreatic ductal adenocarcinoma can be recommended for pancreatectomy according to mental and physical fitness for surgical procedures.

DOI PubMed

Nutrition support for pancreatic disease and its relationship with sarcopenia

UENO Masayuki, TSUJI Yoshihisa, HIRA Daichi, ISHIDA Etsuji, MORIMOTO Youichi, MIZUNO Motowo

Suizo ( Japan Pancreas Society )  35 ( 2 ) 166 - 173  2020.04

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Nutrition support is often required for patients with pancreatic disease, because exocrine and endocrine insufficiency can lead to malabsorption and diabetes. There is substantial evidence supporting nutritional therapy for patients with chronic pancreatitis, and an individualized approach based on disease severity and stage is recommended. To provide appropriate nutritional support, evaluation of skeletal muscle volume and physical function is important. A decreased volume of skeletal muscle and sarcopenia are associated with lower quality of life (QOL) and an increased risk of hospitalization and mortality. Evidence for the use of nutritional therapy in patients with acute pancreatitis (subacute or later phase) and pancreatic cancer is still poor, but our studies suggest that adequate nutritional support is also important for patients with these diseases. This article reviews the clinical relevance of nutritional therapy for patients with chronic pancreatitis, acute pancreatitis, and pancreatic cancer, showing some of the results of our recent research.

DOI CiNii

History of Japanese and Western Medical Professionalism Developed in the Context of Social Structure

辻喜久, 辻喜久

医学教育 ( Japan Society for Medical Education )  51 ( 1 ) 15 - 28  2020

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Introduction: Currently, there is confusion about what constitutes medical professionalism in Japan. Method: We compared the histories of the development professionalism in western countries and Japan based on the stage theory of economic development and a literature review. Using the information we gathered, we discuss the reasons why the confusion occurred. Result: In most of western countries, medical professionalism was affected by the industrial revolution and Protestantism. As Weber noted, for Protestants, working industriously and using the gift of one’s talent to earn much money was consistent with the teachings of God. Thus, reward was an important proof of their faith. Meanwhile, the Japanese social system and professionalism were developed independently from the industrial revolution. Since Japan was less influenced by the industrial revolution, knowledge was not subdivided. This resulted in undeveloped specialist jobs and the continuation of classical education based on Buddhism and Confucianism. Japanese professionalism, which included sacrificial altruism, differed from western professionalism, particularly with regard to the concept of reward. Discussion: Due to globalization, Japanese society now has two types of professionalism: one from western ideals and another from classical Japanese ideals. Because these two types of professionalism conflict on certain points, such as the concept of reward, there is confusion about what constitutes Japanese professionalism.

DOI CiNii J-GLOBAL

Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy: A nationwide, cancer registry-based study from the Japan Pancreas Society.

Hiroyoshi Tsuchida, Tsutomu Fujii, Masamichi Mizuma, Sohei Satoi, Hisato Igarashi, Hidetoshi Eguchi, Tamotsu Kuroki, Yasuhiro Shimizu, Masaji Tani, Satoshi Tanno, Yoshihisa Tsuji, Yoshiki Hirooka, Atsushi Masamune, Kazuhiro Mizumoto, Takao Itoi, Shinichi Egawa, Yuzo Kodama, Shin Hamada, Michiaki Unno, Hiroki Yamaue, Kazuichi Okazaki

Surgery   166 ( 6 ) 997 - 1003  2019.12  [Refereed]  [International journal]

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BACKGROUND: The importance of peritoneal washing cytology status both as a sign of irresectability and as a prognostic factor for pancreatic ductal adenocarcinoma remains controversial. The purpose of this nationwide, cancer registry-based study was to clarify the clinical implications of operative resection in patients who had positive cytology status. METHODS: Clinical data from 1,970 patients who underwent tumor resection were collected from the Pancreatic Cancer Registry in Japan. Clinicopathologic factors and overall survival curves were analyzed, and multivariate Cox proportional hazard models were evaluated. RESULTS: Among the 1,970 patients analyzed, positive cytology status was found in 106 patients and negative cytology status was found in 1,864 patients. The positive cytology status group had a greater frequency of pancreatic body and tail cancer and greater preoperative serum carbohydrate antigen 19-9 levels than the negative cytology status group (P < .001 each). The ratio of peritoneal recurrence tended to be greater in the positive cytology status group (14% vs 43%; P < .001). Overall median survival times were less in the positive cytology status group (17.5 months vs 29.4 months; P < .001). The 5-year survival rates were 13.7% and 31.1% in the positive cytology status and negative cytology status groups, respectively. Multivariate analysis of positive cytology status patients revealed that adjuvant chemotherapy was an independent prognostic factor. CONCLUSION: Positive cytology status was an adverse prognostic factor in patients who underwent resection for pancreatic ductal adenocarcinoma but did not preclude attempted curative resection. Curative resection followed by adjuvant chemotherapy may contribute to long-term prognosis in patients with positive cytology status.

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消化器画像診断における時間軸画像の有用性—TIME AXIS IMAGING FOR DIAGNOSIS OF DIGESTIVE DISEASE—生涯教育セミナー記録 平成30年度 第26回日本外科学会生涯教育セミナー 最新の診断技術 ; 中部地区

辻 喜久

日本外科学会雑誌 = Journal of Japan Surgical Society / 日本外科学会 編 ( 東京 : 日本外科学会 )  120 ( 2 ) 261 - 263  2019  [Refereed]  [Invited]

CiNii

消化器画像診断における時間軸画像の有用性

辻喜久

日本外科学会雑誌   120 ( 2 )  2019

J-GLOBAL

Chemokine CXCL16 mediates acinar cell necrosis in cerulein induced acute pancreatitis in mice.

Yojiro Sakuma, Yuzo Kodama, Takaaki Eguchi, Norimitsu Uza, Yoshihisa Tsuji, Masahiro Shiokawa, Takahisa Maruno, Katsutoshi Kuriyama, Yoshihiro Nishikawa, Yuki Yamauchi, Motoyuki Tsuda, Tatsuki Ueda, Tomoaki Matsumori, Toshihiro Morita, Teruko Tomono, Nobuyuki Kakiuchi, Atsushi Mima, Yuko Sogabe, Saiko Marui, Takeshi Kuwada, Akihiko Okada, Tomohiro Watanabe, Hiroshi Nakase, Tsutomu Chiba, Hiroshi Seno

Scientific reports   8 ( 1 ) 8829 - 8829  2018.06  [Refereed]  [International journal]

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Severe acute pancreatitis is a lethal inflammatory disease frequently accompanied by pancreatic necrosis. We aimed to identify a key regulator in the development of pancreatic necrosis. A cytokine/chemokine array using sera from patients with acute pancreatitis (AP) revealed that serum CXCL16 levels were elevated according to the severity of pancreatitis. In a mouse model of AP, Cxcl16 expression was induced in pancreatic acini in the late phase with the development of pancreatic necrosis. Cxcl16-/- mice revealed similar sensitivity as wild-type (WT) mice to the onset of pancreatitis, but better resisted development of acinar cell necrosis with attenuated neutrophil infiltration. A cytokine array and immunohistochemistry revealed lower expression of Ccl9, a neutrophil chemoattractant, in the pancreatic acini of Cxcl16-/- mice than WT mice. Ccl9 mRNA expression was induced by stimulation with Cxcl16 protein in pancreatic acinar cells in vitro, suggesting a Cxcl16/Ccl9 cascade. Neutralizing antibody against Cxcl16 ameliorated pancreatic injury in the mouse AP model with decreased Ccl9 expression and less neutrophil accumulation. In conclusion, Cxcl16 expressed in pancreatic acini contributes to the development of acinar cell necrosis through the induction of Ccl9 and subsequent neutrophil infiltration. CXCL16 could be a new therapeutic target in AP.

DOI PubMed CiNii

Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis.

Yoshihisa Tsuji, Naoki Takahashi, Hiroyoshi Isoda, Koji Koizumi, Sho Koyasu, Miho Sekimoto, Yuichi Imanaka, Shujiro Yazumi, Masanori Asada, Yoshihiro Nishikawa, Hiroshi Yamamoto, Osamu Kikuchi, Tsukasa Yoshida, Tetsuro Inokuma, Shinji Katsushima, Naoki Esaka, Akihiro Okano, Chiharu Kawanami, Nobuyuki Kakiuchi, Masahiro Shiokawa, Yuzo Kodama, Ichiro Moriyama, Takafumi Kajitani, Yoshikazu Kinoshita, Tsutomu Chiba

Journal of gastroenterology   52 ( 10 ) 1130 - 1139  2017.10  [Refereed]  [Domestic journal]

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BACKGROUND: Perfusion CT can diagnose pancreatic necrosis in early stage of severe acute pancreatitis, accurately. However, no study to date has examined whether early diagnosis of pancreatic necrosis is useful in predicting persistent organ failure (POF). METHODS: We performed a multi-center prospective observational cohort study to investigate whether perfusion CT can predict the development of POF in the early stage of AP, based on early diagnosis of the development of pancreatic necrosis (PN). From 2009 to 2012, we examined patients showing potential early signs of severe AP (n = 78) on admission. Diagnoses for the development of PN were made prospectively by on-site physicians on the admission based on perfusion CT (diagnosis 1). Blinded retrospective reviews were performed by radiologists A and B, having 8 and 13 years of experience as radiologists (diagnosis 2 and 3), respectively. Positive diagnosis for the development of PN were assumed equivalent to positive predictions for the development of POF. We then calculated the area under the curve (AUC) of the receiver operating characteristic for POF predictions. RESULTS: Fourteen (17.9%) and 23 patients (29.5%) developed PN and POF, respectively. For diagnoses 1, 2, and 3, AUCs for POF predictions were 74, 68, and 73, respectively. CONCLUSIONS: Perfusion CT diagnoses pancreatic necrosis and on that basis predicts the development of POF; http://www.umin.ac.jp/ctr/index-j.htm,UMIN000001926 .

DOI PubMed

Erratum to: Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis.

Yoshihisa Tsuji, Naoki Takahashi, Hiroyoshi Isoda, Koji Koizumi, Sho Koyasu, Miho Sekimoto, Yuichi Imanaka, Shujiro Yazumi, Masanori Asada, Yoshihiro Nishikawa, Hiroshi Yamamoto, Osamu Kikuchi, Tsukasa Yoshida, Tetsuro Inokuma, Shinji Katsushima, Naoki Esaka, Akihiro Okano, Chiharu Kawanami, Nobuyuki Kakiuchi, Masahiro Shiokawa, Yuzo Kodama, Ichiro Moriyama, Takafumi Kajitani, Yoshikazu Kinoshita, Tsutomu Chiba

Journal of gastroenterology   52 ( 10 ) 1147 - 1148  2017.10  [Refereed]  [Domestic journal]

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BACKGROUND: Perfusion CT can diagnose pancreatic necrosis in early stage of severe acute pancreatitis, accurately. However, no study to date has examined whether early diagnosis of pancreatic necrosis is useful in predicting persistent organ failure (POF). METHODS: We performed a multi-center prospective observational cohort study to investigate whether perfusion CT can predict the development of POF in the early stage of AP, based on early diagnosis of the development of pancreatic necrosis (PN). From 2009 to 2012, we examined patients showing potential early signs of severe AP (n = 78) on admission. Diagnoses for the development of PN were made prospectively by on-site physicians on the admission based on perfusion CT (diagnosis 1). Blinded retrospective reviews were performed by radiologists A and B, having 8 and 13 years of experience as radiologists (diagnosis 2 and 3), respectively. Positive diagnosis for the development of PN were assumed equivalent to positive predictions for the development of POF. We then calculated the area under the curve (AUC) of the receiver operating characteristic for POF predictions. RESULTS: Fourteen (17.9%) and 23 patients (29.5%) developed PN and POF, respectively. For diagnoses 1, 2, and 3, AUCs for POF predictions were 74, 68, and 73, respectively. CONCLUSIONS: Perfusion CT diagnoses pancreatic necrosis and on that basis predicts the development of POF; http://www.umin.ac.jp/ctr/index-j.htm,UMIN000001926 .

DOI PubMed

膵炎の病態解明を目指した最新の基礎研究 ケモカインCXCL16は壊死性膵炎の形成に重要である

佐久間 洋二朗, 児玉 裕三, 宇座 徳光, 辻 喜久, 塩川 雅広, 渡邉 智裕, 仲瀬 裕志, 千葉 勉, 妹尾 浩

膵臓 ( 日本膵臓学会 )  32 ( 3 ) 339 - 339  2017.05  [Refereed]

J-GLOBAL

膵臓Perfusion CTの撮影条件を最適化するためのデジタルファントムを用いたノイズと腫瘍径に関する検討

小泉幸司, 小泉幸司, 小澤聡, 松田晃, 東村享治, 辻喜久, 上野智弘, 富樫かおり, 杉本直三

電子情報通信学会技術研究報告   116 ( 393(MI2016 71-121) )  2017  [Refereed]

J-GLOBAL

Dual Energy Computed Tomography Analysis of Pancreatic Stones in a Patient with Chronic Pancreatitis

塚本純, 山崎辰洋, 日野真太郎, 石田悦嗣, 辻喜久

倉敷中央病院年報   79  2017

J-GLOBAL

造影ダイナミックCTとフッ素18フルオロミソニダゾール陽電子放出断層撮像法を用いた、腫瘍間質の評価および腫瘍低酸素との関連性の評価

子安 翔, 辻 喜久, 原田 浩, 中本 裕士, 野橋 智美, 木村 寛之, 佐野 紘平, 小泉 幸司, 濱路 政嗣, 富樫 かおり

JSMI Report ( 日本分子イメージング学会 )  10 ( 1 ) 63 - 66  2016.12

J-GLOBAL

Pathogenicity of IgG in patients with IgG4-related disease.

Masahiro Shiokawa, Yuzo Kodama, Katsutoshi Kuriyama, Kenichi Yoshimura, Teruko Tomono, Toshihiro Morita, Nobuyuki Kakiuchi, Tomoaki Matsumori, Atsushi Mima, Yoshihiro Nishikawa, Tatsuki Ueda, Motoyuki Tsuda, Yuki Yamauchi, Ryuki Minami, Yojiro Sakuma, Yuji Ota, Takahisa Maruno, Akira Kurita, Yugo Sawai, Yoshihisa Tsuji, Norimitsu Uza, Kazuyoshi Matsumura, Tomohiro Watanabe, Kenji Notohara, Tatsuaki Tsuruyama, Hiroshi Seno, Tsutomu Chiba

Gut   65 ( 8 ) 1322 - 32  2016.08  [Refereed]  [International journal]

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OBJECTIVE: IgG4-related disease (IgG4-RD) is a systemic disease characterised by elevated serum IgG4 and IgG4-positive lymphoplasmacytic infiltration in the affected tissues. The pathogenic role of IgGs, including IgG4, in patients with IgG4-RD, however, is unknown. DESIGN: We examined the pathogenic activity of circulating IgGs in patients with IgG4-RD by injecting their IgGs into neonatal male Balb/c mice. Binding of patient IgGs to pancreatic tissue was also analysed in an ex vivo mouse organ culture model and in tissue samples from patients with autoimmune pancreatitis (AIP). RESULTS: Subcutaneous injection of patient IgG, but not control IgG, resulted in pancreatic and salivary gland injuries. Pancreatic injury was also induced by injecting patient IgG1 or IgG4, with more destructive changes induced by IgG1 than by IgG4. The potent pathogenic activity of patient IgG1 was significantly inhibited by simultaneous injection of patient IgG4. Binding of patient IgG, especially IgG1 and IgG4, to pancreatic tissue was confirmed in both the mouse model and AIP tissue samples. CONCLUSIONS: IgG1 and IgG4 from patients with IgG4-RD have pathogenic activities through binding affected tissues in neonatal mice.

DOI PubMed