研究者詳細 - 辻　喜久

論文 - 辻　喜久

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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

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年

J-GLOBAL

一般内科における入院患者の入院日数の延長に関するリスクの検討

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年

J-GLOBAL

急性膵炎臨床におけるガイドラインの国際比較

辻喜久, 佐藤健太

膵臓(Web) 36 ( 4 ) 2021年

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年07月

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年07月 [国際誌]

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

膵疾患に対する栄養サポートの意義：サルコペニアとの関連を踏まえて

上野真行, 辻喜久, 平大地, 石田悦嗣, 守本洋一, 水野元夫

膵臓 ( 一般社団法人日本膵臓学会 ) 35 ( 2 ) 166 - 173 2020年04月

膵疾患患者では外分泌・内分泌機能が低下し，消化・吸収障害や糖尿病の合併率が高いため適切な栄養サポートが必要となることが少なくない．慢性膵炎に対する栄養療法に関しては多くのエビデンスがあり，個々の重症度や病期に応じたサポートが推奨されている．慢性膵炎患者に栄養サポートを行う上で骨格筋量や運動機能は重要な評価指標の1つである．骨格筋量が低下しサルコペニアを合併すると生活の質（QOL）が低下し，入院リスクや全死亡リスクが増加するので，正確な評価に基づき適切にサポートすることが重要である．急性膵炎の亜急性期～回復期や膵癌患者における栄養療法のエビデンスはまだ乏しいが，当院の研究ではいずれの疾患においても適切な栄養サポートが重要であることが示唆された．本稿では，慢性膵炎，急性膵炎，膵癌の各疾患における栄養療法の意義について，自施設の研究成果を紹介しつつ概説する．

DOI CiNii

社会構造の変遷と医師のプロフェッショナリズムの整理

辻喜久, 辻喜久

医学教育 ( 日本医学教育学会 ) 51 ( 1 ) 15 - 28 2020年

背景 : 本邦の医師プロフェッショナリズムは複数の意味で捉えられている可能性がある. 方法 : 西欧-本邦の医師プロフェッショナリズム形成史を比較した. 結果 : 西欧では産業革命と科学の進歩により知識と職業教育の専門化し "西欧近代的医師像" が生じ, ノスタルジック・プロフェッショナリズムと脱構築されたプロフェッショナリズムへと発展し本邦にも輸入された. 本邦では, " 伝統的自己犠牲的医師像" がノスタルジック・プロフェッショナリズムと結びつき, 脱構築されたプロフェッショナリズムと並立した. 考察 : 医師プロフェッショナリズムは本邦の伝統的価値観を背景に二義的に使用されている可能性が考えられた.

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年12月 [査読有り] [国際誌]

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.

DOI PubMed

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年 [査読有り] [招待有り]

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年

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年06月 [査読有り] [国際誌]

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年10月 [査読有り] [国内誌]

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.

Journal of gastroenterology 52 ( 10 ) 1147 - 1148 2017年10月 [査読有り] [国内誌]

DOI PubMed

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年05月 [査読有り]

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年 [査読有り]

J-GLOBAL

Dual Energy CTを用いた膵石の成分分析の有用性

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年

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年12月

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年08月 [査読有り] [国際誌]

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

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