Details of a Researcher - TSUJI Yoshihisa

Papers - TSUJI Yoshihisa

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Sensing of commensal organisms by the intracellular sensor NOD1 mediates experimental pancreatitis.

Yoshihisa Tsuji, Tomohiro Watanabe, Masatoshi Kudo, Hidenori Arai, Warren Strober, Tsutomu Chiba

Immunity 37 ( 2 ) 326 - 38 2012.08 [Refereed] [International journal]

The intracellular sensor NOD1 has important host-defense functions relating to a variety of pathogens. Here, we showed that this molecule also participates in the induction of a noninfectious pancreatitis via its response to commensal organisms. Pancreatitis induced by high-dose cerulein (a cholecystokinin receptor agonist) administration depends on NOD1 stimulation by gut microflora. To analyze this NOD1 activity, we induced pancreatitis by simultaneous administration of a low dose of cerulein (that does not itself induce pancreatitis) and FK156, an activator of NOD1 that mimics the effect of gut bacteria that have breached the mucosal barrier. The pancreatitis was dependent on acinar cell production of the chemokine MCP-1 and the intrapancreatic influx of CCR2(+) inflammatory cells. Moreover, MCP-1 production involved activation of the transcription factors NF-κB and STAT3, each requiring complementary NOD1 and cerulein signaling. These studies indicate that gut commensals enable noninfectious pancreatic inflammation via NOD1 signaling in pancreatic acinar cells.

DOI PubMed

Hepatic arterial perfusion increases in the early stage of severe acute pancreatitis patients: evaluation by perfusion computed tomography.

Sho Koyasu, Hiroyoshi Isoda, Yoshihisa Tsuji, Hiroshi Yamamoto, Kazuhiro Matsueda, Yuji Watanabe, Tsutomu Chiba, Kaori Togashi

European journal of radiology 81 ( 1 ) 43 - 6 2012.01 [Refereed] [International journal]

PURPOSE: Although hepatic perfusion abnormalities have been reported in patients with acute pancreatitis, hepatic perfusion with severe acute pancreatitis (SAP) has not been quantitatively evaluated in humans. Therefore, we investigated hepatic perfusion in patients with SAP using perfusion CT. MATERIALS AND METHODS: Hepatic perfusion CT was performed in 67 patients with SAP within 3 days after symptom onset. The patients were diagnosed as having SAP according to the Atlanta criteria. Fifteen cases were established as a control group. Perfusion CT was obtained for 54s beginning with a bolus injection of 40 ml of contrast agent (600-630 mgI/kg) at a flow rate of 4 ml/s. Perfusion data were analyzed by the dual-input maximum slope method to obtain hepatic arterial perfusion (HAP) and hepatic portal perfusion (HPP). Finally, we compared HAP and HPP in SAP patients with those in the control group, respectively. RESULTS: Average HAP was significantly higher in SAP patients than in the control group (75.1 ± 38.0 vs. 38.2 ± 9.0 ml/min/100ml; p<0.001). There was no significant difference in average HPP between SAP patients and the control group (206.7 ± 54.9 vs. 204.4 ± 38.5 ml/min/100ml; p=0.92). CONCLUSION: Using quantitative analysis on perfusion CT, we first demonstrated an increase of HAP in the right hepatic lobe in SAP patients.

DOI PubMed

Perfusion CT is useful for the differential diagnosis of autoimmune pancreatitis from pancreatic cancer

HIROTA Morihisa, TAKIKAWA Tetsuya, HAYASHI Shintaro, MIURA Shin, CHIBA Tsutomu, MASAMUNE Atsushi, SHIMOSEGAWA Tooru, TSUDA Masashi, TSUJI Yoshihisa, KANNO Atsushi, KIKUTA Kazuhiro, KUME Kiyoshi, HAMADA Shin, UNNO Jun, ARIGA Hiroyuki

Suizo ( Japan Pancreas Society ) 27 ( 4 ) 601 - 607 2012

Radiological findings of autoimmune pancreatitis (AIP) are sometimes similar to those of pancreatic cancer (PC). The aim of this study was to clarify the utility of perfusion computed tomography (CT) for the differential diagnosis of AIP from PC. Perfusion CT was performed in 12 patients with AIP and 22 patients with PC. All AIP patients were diagnosed as type 1. Parameters including pancreatic volumetric blood flow F_V, volume of distribution V_D and blood perfusion pattern R² were determined from a single-compartment kinetic model. Pancreatic F_V values of the 12 AIP patients (81.3/min) were significantly higher than those of 22 PC patients (19.3/min, p=0.0005). Pancreatic V_D values of the AIP patients (28.8) were significantly lower than those of the PC patients (93.6, p=0.0084). Moreover, pancreatic R² values of the AIP patients (0.659) were significantly higher than those of the PC patients (0.250, p<0.0001). Perfusion CT is useful to distinguish AIP from PC by the comparison of the parameters of blood flow, distribution and blood perfusion pattern.

DOI CiNii J-GLOBAL

Perfusion computed tomography findings of autoimmune pancreatitis.

Morihisa Hirota, Masashi Tsuda, Yoshihisa Tsuji, Atsushi Kanno, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Jun Unno, Hiromichi Ito, Hiroyuki Ariga, Tsutomu Chiba, Atsushi Masamune, Kennichi Satoh, Tooru Shimosegawa

Pancreas 40 ( 8 ) 1295 - 301 2011.11 [Refereed] [International journal]

OBJECTIVES: The aim of this study was to clarify the pancreatic blood perfusion in patients with autoimmune pancreatitis (AIP) and the changes after steroid treatment. METHODS: Perfusion computed tomography was performed in 11 patients with AIP and 12 control subjects. Pancreatic volumetric blood flow (F(V)), volume of distribution (V(D)), and blood transit time τ were determined from a single-compartment kinetic model. Nine patients with AIP were reexamined by perfusion computed tomography after corticosteroid administration. RESULTS: The pancreatic F(V) values of the 11 patients with AIP (82.7/min) were significantly lower than those of control subjects (163.5/min, P = 0.0006). On the other hand, the pancreatic V(D) and τ values were not significantly different between AIP and normal. After steroid treatment, the F(V) values of 9 reexamined patients with AIP (76.2/min) were significantly elevated (109.8/min, P = 0.0391). However, the changes of the values after the treatment differed in degree among individuals. The values of 4 patients were dramatically elevated to greater than 100/min, whereas those of 4 other patients did not improve well. The value of the remaining patient whose initial F(V) value was normal (168.09/min) did not change after the treatment. CONCLUSIONS: Pancreatic volumetric perfusion was attenuated in AIP patients. The perfusion was improved after the steroid treatment.

DOI PubMed

Relationship between serum angiopoietin-2 level and perfusion CT parameters in severe acute pancreatitis.

Tsubasa Watanabe, Yoshihisa Tsuji, Yuzo Kodama, Hiroyoshi Isoda, Hiroshi Yamamoto, Tsutomu Chiba

The American journal of gastroenterology 106 ( 10 ) 1859 - 61 2011.10 [Refereed] [International journal]

DOI PubMed

Ischemic penumbra in early stage of severe acute pancreatitis

辻喜久, 辻喜久, 渡邉翼, 塩川雅広, 栗田亮, 澤井勇悟, 上野憲司, 塩せいじ, 宇座徳光, 児玉裕三, 小泉幸司, 磯田裕義, 渡邊祐司, 山本博, 千葉勉

Suizo ( Japan Pancreas Society ) 26 ( 1 ) 59 - 65 2011.02 [Refereed]

Introduction: We investigated the existence of an ischemic penumbra, which indicates ischemic but still viable lesion, in the early stage of severe acute pancreatitis (SAP).
Methods: Seventy-one consecutive patients with SAP were enrolled. We divided the pancreas into three regions, the head, body and tail, and measured pancreatic blood flow(F_V) and volume(V_D) in each region by perfusion CT with one compartment method within three days after the onset of symptoms. Three weeks later, all patients underwent contrast-enhanced CT to diagnose each region for the development of pancreatic necrosis.
Results: Of the 227 pancreatic regions from 71 SAP patients, 30 regions were diagnosed as positive for pancreatic necrosis. F_V and V_D in regions that developed pancreatic necrosis were significantly lower than those in regions without necrosis (35.7±50.7 vs. 197.0±227.6ml/min, p<0.01 and 2.0±2.6 vs. 8.5±8.8 (%), p<0.01). All 19 regions with F_V <37.5ml/min and V_D <3.4% developed pancreatic necrosis. Of 60 regions with F_V ≥37.5ml/min and V_D <3.4%, 7 (11.7%) developed necrosis and of 7 regions with F_V <37.5ml/min and V_D ≥3.4%, 4 (11.7%) developed necrosis. None of 141 regions with F_V ≥37.5ml/min and V_D ≥3.4% developed necrosis.
Discussion: If F_V or V_D was low, not all regions developed pancreatic necrosis; therefore, we considered that these regions could include zones of ischemic penumbra.

DOI CiNii J-GLOBAL

Measurement of canine pancreatic perfusion using dynamic computed tomography: influence of input-output vessels on deconvolution and maximum slope methods.

Miori Kishimoto, Yoshihisa Tsuji, Nana Katabami, Junichiro Shimizu, Ki-Ja Lee, Toshiroh Iwasaki, Yoh-Ichi Miyake, Shujiro Yazumi, Tsutomu Chiba, Kazutaka Yamada

European journal of radiology 77 ( 1 ) 175 - 81 2011.01 [Refereed] [International journal]

OBJECTIVE: We investigated whether the prerequisite of the maximum slope and deconvolution methods are satisfied in pancreatic perfusion CT and whether the measured parameters between these algorithms are correlated. METHODS: We examined nine beagles injected with iohexol (200 mgI kg(-1)) at 5.0 ml s(-1). The abdominal aorta and splenic and celiac arteries were selected as the input arteries and the splenic vein, the output veins. For the maximum slope method, we determined the arterial contrast volume of each artery by measuring the area under the curve (AUC) and compared the peak enhancement time in the pancreas with the contrast appearance time in the splenic vein. For the deconvolution method, the artery-to-vein collection rate of contrast medium was calculated. We calculated the pancreatic tissue blood flow (TBF), tissue blood volume (TBV), and mean transit time (MTT) using both algorithms and investigated their correlation based on vessel selection. RESULTS: The artery AUC significantly decreased as it neared the pancreas (P<0.01). In all cases, the peak time of the pancreas (11.5±1.6) was shorter than the appearance time (14.1±1.6) in the splenic vein. The splenic artery-vein combination exhibited the highest collection rate (91.1%) and was the only combination that was significantly correlated between TBF, TBV, and MTT in both algorithms. CONCLUSION: Selection of a vessel nearest to the pancreas is considered as a more appropriate prerequisite. Therefore, vessel selection is important in comparison of the semi-quantitative parameters obtained by different algorithms.

DOI PubMed

Severe Acute Pancreatitis and Non Occlusive Mesenteric Ischemia

辻喜久, 辻喜久, 山本博, 能登原憲司, 児玉祐三, 千葉勉

日本腹部救急医学会雑誌 ( Japanese Society for Abdominal Emergency Medicine ) 31 ( 7 ) 1029 - 1037 2011 [Refereed]

The mechanism and pathology of patients with severe acute pancreatitis with non-occlusive mesenteric ischemia (NOMI) are still unclear. Currently, there are some reports that vasoconstriction associated factors (angiopoietin-2, endothelin-1 and VEGF et al. ) have important role in the development of NOMI with severe acute pancreatitis. In our experience, one of characteristic pathological findings of NOMI is the non-consecutive enterointestinal damage. The diagnosis of NOMI is not easy in the early stage, so we attempt to use hepatic perfusion CT to diagnose it. Hepatic perfusion CT can evaluate hepatic portal flow (HPF) and hepatic arterial flow (HAF), separately. In our study, HPF of acute pancreatitis patients with NOMI was significantly slower than those without NOMI. Therefore, evaluation of hepatic perfusion in the early stage might be extremely helpful in the diagnosis of NOMI. In this paper, we would like to report the mechanism, pathology, diagnosis and treatment of NOMI in severe acute pancreatitis.

DOI CiNii J-GLOBAL

Perfusion CT is superior to angiography in predicting pancreatic necrosis in patients with severe acute pancreatitis.

Yoshihisa Tsuji, Kyoko Hamaguchi, Yuji Watanabe, Akira Okumura, Hiroyoshi Isoda, Naoki Yamamoto, Osamu Kikuchi, Hiroyuki Yamamoto, Kazuhiro Matsueda, Kenji Ueno, Shinsuke Tada, Kaori Togashi, Hiroshi Yamamoto, Tsutomu Chiba

Journal of gastroenterology 45 ( 11 ) 1155 - 62 2010.11 [Refereed] [Domestic journal]

BACKGROUND: We performed perfusion computed tomography (P-CT) and angiography of the pancreas in patients with severe acute pancreatitis (SAP) and compared the usefulness of these two methods in predicting the development of pancreatic necrosis. METHODS: We compared P-CT and angiography results taken within 3 days after symptom onset in 21 SAP patients. We divided the pancreas into three areas, the head, body, and tail, and examined each area for perfusion defects (via P-CT) and arterial vasospasms (by angiography). Three weeks later, all patients underwent contrast-enhanced CT to determine whether pancreatic necrosis had developed. RESULTS: Of the 21 SAP patients, 16 exhibited perfusion defects, while 17 proved positive for vasospasms in at least one area. Fourteen patients developed pancreatic necrosis. Of the 63 pancreatic areas from the 21 SAP patients, perfusion defects appeared in 25 areas (39.7%), 24 of which showed vasospasms (96.0%). Angiography showed 33 areas with vasospasms (52.4%), of which 24 showed perfusion defects (72.7%). Of the 25 areas with perfusion defects, 21 developed pancreatic necrosis (84.0%). Of the 33 areas with vasospasms, 21 developed necrosis (63.6%). Pancreatic necrosis developed only in the areas positive both for perfusion defects and for vasospasms. No areas without perfusion defect or vasospasms developed pancreatic necrosis. P-CT predicted the development of pancreatic necrosis with significantly higher accuracy than angiography. CONCLUSION: While both P-CT and angiography are useful in predicting the development of pancreatic necrosis in patients with SAP, P-CT appears to be more accurate for this purpose.

DOI PubMed CiNii

NOD1 contributes to mouse host defense against Helicobacter pylori via induction of type I IFN and activation of the ISGF3 signaling pathway.

Tomohiro Watanabe, Naoki Asano, Stefan Fichtner-Feigl, Peter L Gorelick, Yoshihisa Tsuji, Yuko Matsumoto, Tsutomu Chiba, Ivan J Fuss, Atsushi Kitani, Warren Strober

The Journal of clinical investigation 120 ( 5 ) 1645 - 62 2010.05 [Refereed] [International journal]

Nucleotide-binding oligomerization domain 1 (NOD1) is an intracellular epithelial cell protein known to play a role in host defense at mucosal surfaces. Here we show that a ligand specific for NOD1, a peptide derived from peptidoglycan, initiates an unexpected signaling pathway in human epithelial cell lines that results in the production of type I IFN. Detailed analysis revealed the components of the signaling pathway. NOD1 binding to its ligand triggered activation of the serine-threonine kinase RICK, which was then able to bind TNF receptor-associated factor 3 (TRAF3). This in turn led to activation of TANK-binding kinase 1 (TBK1) and IkappaB kinase epsilon (IKKepsilon) and the subsequent activation of IFN regulatory factor 7 (IRF7). IRF7 induced IFN-beta production, which led to activation of a heterotrimeric transcription factor complex known as IFN-stimulated gene factor 3 (ISGF3) and the subsequent production of CXCL10 and additional type I IFN. In vivo studies showed that mice lacking the receptor for IFN-beta or subjected to gene silencing of the ISGF3 component Stat1 exhibited decreased CXCL10 responses and increased susceptibility to Helicobacter pylori infection, phenotypes observed in NOD1-deficient mice. These studies thus establish that NOD1 can activate the ISGF3 signaling pathway that is usually associated with protection against viral infection to provide mice with robust type I IFN-mediated protection from H. pylori and possibly other mucosal infections.

DOI PubMed

The radiological exposure of pancreatic perfusion computed tomography.

Yoshihisa Tsuji, Koji Koizumi, Hiroyoshi Isoda, Kenji Ueno, Shinsuke Tada, Tsutomu Chiba, Ryuichirou Doi

Pancreas 39 ( 4 ) 541; author reply 541-3 2010.05 [Refereed] [International journal]

DOI PubMed

重症急性膵炎に合併したNOMIの病理所見と治療選択についての考察

辻喜久, 辻喜久, 能登原憲司, 山本博, 千葉勉

日本消化器病学会雑誌 107 2010

J-GLOBAL

Perfusion CTによる自己免疫性膵炎と膵癌の鑑別

廣田衛久, 辻喜久, 下瀬川徹

日本消化器病学会雑誌 107 2010

J-GLOBAL

重症急性膵炎発症早期における“Ischemia penumbra”について

辻喜久, 山本博, 千葉勉

日本消化器病学会雑誌 107 2010

J-GLOBAL

膵蔵Perfusion-CTにおける装置間の違い-自作ファントムにおける検討-

梶谷尊郁, 辻喜久, 山本浩之, 森山一郎, 矢田伸広, 氏平武樹, 奥井彰二, 小松明夫

日本放射線技術学会雑誌 66 ( 9 ) 2010

J-GLOBAL

急性膵炎の重症化に関わる自然免疫担当分子の同定とその分子機序の解明

辻喜久, 渡邉智裕, 千葉勉

日本消化器病学会雑誌 107 2010

J-GLOBAL

Spontaneous rupture of liver plasmacytoma mimicking hepatocellular carcinoma.

Kosuke Ueda, Hiroyuki Matsui, Tomohiro Watanabe, Junya Seki, Tatsuo Ichinohe, Yoshihisa Tsuji, Kayoko Matsumura, Yugo Sawai, Hiroshi Ida, Yoshihide Ueda, Tsutomu Chiba

Internal medicine (Tokyo, Japan) 49 ( 7 ) 653 - 7 2010 [Refereed] [Domestic journal]

Extramedullary plasmacytoma of the liver is rare. Here, we report a case presenting with rupture of extramedullary plasmacytoma of the liver. She had a past history of multiple myeloma with IgA lambda type. Her serum was positive for hepatitis C virus infection and exhibited elevated levels of serum protein induced by vitamin K absence or antagonist-II. She was initially diagnosed as rupture of hepatocellular carcinoma (HCC) and then treated with transarterial chemoembolization (TACE) since bloody ascites and formation of hematoma were seen around hyper-vascular liver tumors on computed tomography. However, the clinical course of this case after TACE was atypical for HCC rupture, as shown by the development of a huge intra-abdominal abscess extending from the liver tumor. Immuno-histochemical analysis of the tumor biopsy specimen revealed massive infiltration of plasma cells expressing IgA and lambda chain. To our knowledge, this is the first case of rupture of extramedullary liver plasmacytoma.

PubMed

Colonic polyposis associated with autoimmune pancreatitis.

Hiroyuki Matsui, Tomohiro Watanabe, Kenji Ueno, Satoru Ueno, Yoshihisa Tsuji, Kayoko Matsumura, Masato Nakatsuji, Yoshihide Ueda, Tsutomu Chiba

Pancreas 38 ( 7 ) 840 - 2 2009.10 [Refereed] [International journal]

DOI PubMed

Massive jejunal bleeding due to Heyde syndrome successfully treated with double balloon endoscopy.

Sakiko Ohta, Tomohiro Watanabe, Shuko Morita, Satoru Ueno, Yoshihisa Tsuji, Hiroshi Nakase, Tsutomu Chiba

Clinical journal of gastroenterology 2 ( 3 ) 187 - 189 2009.06 [Refereed] [Domestic journal]

There is a well-documented relationship between aortic valve stenosis and recurrent gastrointestinal bleeding from angiodysplasia in elderly patients, called Heyde syndrome. We report a case of Heyde syndrome with massive jejunal bleeding. Capsule endoscopy showed bleeding from jejunal angiodysplasia. Spurting bleeding from jejunal angiodysplasia was identified and treated by double balloon endoscopy. No gastrointestinal bleeding was seen after the endoscopic treatment and aortic valve replacement was performed. This case suggests that capsule endoscopy and double balloon endoscopy were very useful for the diagnosis and treatment of small intestinal bleeding due to Heyde syndrome.

DOI PubMed

重症急性膵炎症例における腹部臓器血流障害

辻喜久, 山本博, 千葉勉

日本消化器病学会雑誌 106 2009

J-GLOBAL

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Papers - TSUJI Yoshihisa