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

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

80歳以上高齢者膵癌に対する治療法日本膵臓学会アンケート調査

里井壯平, 山本智久, 内田一茂, 藤井努, 金俊文, 浅野賢道, 花田敬士, 糸井隆夫, 五十嵐久人, 江口英利, 黒木保, 清水泰博, 谷眞至, 丹野誠志, 辻喜久, 廣岡芳樹, 正宗淳, 下川敏雄, 山上裕機, 岡崎和一, 日本膵臓学会膵疾患臨床研究推進委員会

膵臓 ( (一社)日本膵臓学会 ) 35 ( 3 ) A104 - A104 2020年07月

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

重症度判定基準の改訂中間報告

廣田衛久, 竹山宜典, 池浦司, 糸井隆夫, 伊藤鉄英, 岩崎栄典, 堀部昌靖, 岸和田昌之, 北村勝哉, 阪上順一, 白井邦博, 鈴木裕, 竹中完, 辻喜久, 正宗淳, 真弓俊彦

膵臓 ( 日本膵臓学会 ) 34 ( 3 ) A108 - A108 2019年06月 [査読有り]

急性膵炎局所合併症の定義の再検討

辻喜久, 池浦司, 糸井隆夫, 岩崎栄典, 岸和田昌之, 北村勝哉, 阪上順一, 白井邦博, 鈴木裕, 竹中完, 廣田衛久, 正宗淳, 真弓俊彦, 堀部昌靖, 能登原憲司, 入江裕之, 蒲田敏文, 竹山宜典

膵臓 ( 日本膵臓学会 ) 34 ( 3 ) A109 - A110 2019年06月 [査読有り]

卒前卒後を通してのシームレスな評価表作成の経験

辻喜久, 伊藤俊之

医学教育 ( (一社)日本医学教育学会 ) 49 ( Suppl. ) 144 - 144 2018年07月 [査読有り]

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

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年10月 [査読有り] [国内誌]

DOI PubMed

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

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

自作アプリケーションを用いたOSCE評価環境の構築の有用性

服部哲久, 辻喜久, 山木照子, 伊藤俊之

医学教育 ( (一社)日本医学教育学会 ) 48 ( Suppl. ) 154 - 154 2017年08月 [査読有り]

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]

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

Evaluation of Tumor-associated Stroma and Its Relationship with Tumor Hypoxia Using Dynamic Contrast-enhanced CT and (18)F Misonidazole PET in Murine Tumor Models.

Sho Koyasu, Yoshihisa Tsuji, Hiroshi Harada, Yuji Nakamoto, Tomomi Nobashi, Hiroyuki Kimura, Kohei Sano, Koji Koizumi, Masatsugu Hamaji, Kaori Togashi

Radiology 278 ( 3 ) 734 - 41 2016年03月 [査読有り] [国際誌]

PURPOSE: To determine the relationship between the fractional interstitial volume (Fis), as calculated at dynamic contrast material-enhanced (DCE) computed tomography (CT), and tumor-associated stroma and to analyze its spatial relationship with tumor hypoxia in several xenograft tumor models. MATERIALS AND METHODS: All animal experiments were approved by the animal research committee. Mice with three different xenograft tumors (U251, CFPAC-1, and BxPC-3; n = 6, n = 8, and n = 6, respectively) underwent DCE CT then hypoxia imaging with fluorine 18 ((18)F) fluoromisonidazole (FMISO) positron emission tomography (PET) within 24 hours. Immunohistochemical analysis was performed in harvested tumors to detect hypoxia markers and to quantify microvascular and stromal density. Two DCE CT parameters (amount of interstitial space associated with the amount of stroma [Fis] and flow velocity [Fv]) were identified and quantitatively validated by using immunohistochemistry. FMISO uptake within the tumor was also assessed in relation to DCE CT parameters. Imaging and immunohistochemical parameters were assessed by using the Kruskal-Wallis test, Wilcoxon rank-sum test with Bonferroni correction, and Pearson correlation coefficient. RESULTS: Almost no α-smooth muscle actin-positive cells were found in the U251 xenograft, while abundant stroma was found in the entire BxPC-3 xenograft and in the periphery of the CFPAC-1 xenograft. Quantitative analysis showed a significant correlation (R = 0.83, P < .0001) between Fis and stromal density. FMISO uptake had a negative correlation with Fis (R = -0.58, P < .0001) and Fv (R = -0.53, P < .0001). CONCLUSION: DCE CT can be used to quantify parameters associated with tumor-associated stroma. Tumor hypoxia was Complementarily localized in tumor-associated stroma in these models.

DOI PubMed

Acute Pancreatitis-Progress and Challenges: A Report on an International Symposium.

Elham Afghani, Stephen J Pandol, Tooru Shimosegawa, Robert Sutton, Bechien U Wu, Santhi Swaroop Vege, Fred Gorelick, Morihisa Hirota, John Windsor, Simon K Lo, Martin L Freeman, Markus M Lerch, Yoshihisa Tsuji, Gil Y Melmed, Wahid Wassef, Julia Mayerle

Pancreas 44 ( 8 ) 1195 - 210 2015年11月 [査読有り] [国際誌]

An international symposium entitled "Acute pancreatitis: progress and challenges" was held on November 5, 2014 at the Hapuna Beach Hotel, Big Island, Hawaii, as part of the 45th Anniversary Meeting of the American Pancreatic Association and the Japanese Pancreas Society. The course was organized and directed by Drs. Stephen Pandol, Tooru Shimosegawa, Robert Sutton, Bechien Wu, and Santhi Swaroop Vege. The symposium objectives were to: (1) highlight current issues in management of acute pancreatitis, (2) discuss promising treatments, (3) consider development of quality indicators and improved measures of disease activity, and (4) present a framework for international collaboration for development of new therapies. This article represents a compilation and adaptation of brief summaries prepared by speakers at the symposium with the purpose of broadly disseminating information and initiatives.

DOI PubMed

Activation-Induced Cytidine Deaminase Contributes to Pancreatic Tumorigenesis by Inducing Tumor-Related Gene Mutations.

Yugo Sawai, Yuzo Kodama, Takahiro Shimizu, Yuji Ota, Takahisa Maruno, Yuji Eso, Akira Kurita, Masahiro Shiokawa, Yoshihisa Tsuji, Norimitsu Uza, Yuko Matsumoto, Toshihiko Masui, Shinji Uemoto, Hiroyuki Marusawa, Tsutomu Chiba

Cancer research 75 ( 16 ) 3292 - 301 2015年08月 [査読有り] [国際誌]

Pancreatic ductal adenocarcinoma (PDAC) develops via an accumulation of various gene mutations. The mechanism underlying the mutations in PDAC development, however, is not fully understood. Recent insight into the close association between the mutation pattern of various cancers and specific mutagens led us to investigate the possible involvement of activation-induced cytidine deaminase (AID), a DNA editing enzyme, in pancreatic tumorigenesis. Our immunohistochemical findings revealed AID protein expression in human acinar ductal metaplasia, pancreatic intraepithelial neoplasia, and PDAC. Both the amount and intensity of the AID protein expression increased with the progression from precancerous to cancerous lesions in human PDAC tissues. To further assess the significance of ectopic epithelial AID expression in pancreatic tumorigenesis, we analyzed the phenotype of AID transgenic (AID Tg) mice. Consistent with our hypothesis that AID is involved in the mechanism of the mutations underlying pancreatic tumorigenesis, we found precancerous lesions developing in the pancreas of AID Tg mice. Using deep sequencing, we also detected Kras and c-Myc mutations in our analysis of the whole pancreas of AID Tg mice. In addition, Sanger sequencing confirmed the presence of Kras, c-Myc, and Smad4 mutations, with the typical mutational footprint of AID in precancerous lesions in AID Tg mice separated by laser capture microdissection. Taken together, our findings suggest that AID contributes to the development of pancreatic precancerous lesions by inducing tumor-related gene mutations. Our new mouse model without intentional manipulation of specific tumor-related genes provides a powerful system for analyzing the mutations involved in PDAC.

DOI PubMed

【microbiome(腸内細菌)と肝胆膵領域の新世紀】膵臓とmicrobiome 良性膵疾患と腸内細菌

森田敏広, 児玉裕三, 大田悠司, 辻喜久, 渡邉智裕

肝・胆・膵 ( (株)アークメディア ) 70 ( 6 ) 895 - 900 2015年06月 [査読有り]

Usefulness of Adalimumab for Treating a Case of Intestinal Behçet's Disease With Trisomy 8 Myelodysplastic Syndrome.

Masamichi Kimura, Yoshihisa Tsuji, Masako Iwai, Masahiro Inagaki, Ali Madian, Takuya Yoshino, Minoru Matsuura, Hiroshi Nakase

Intestinal research 13 ( 2 ) 166 - 9 2015年04月 [査読有り] [国際誌]

Behçet's disease (BD) is a systemic vasculitis, while myelodysplastic syndrome (MDS) is a heterogeneous group of clonal hematologic disorders characterized by ineffective hematopoiesis. Some studies suggest a relationship between MDS and BD, especially intestinal BD, and trisomy 8 seems to play an important role in both diseases. There are several reports on patients with BD comorbid with MDS involving trisomy 8 that frequently have intestinal lesions refractory to conventional medical therapies. Tumor necrosis factor (TNF)-α is strongly involved in the pathophysiology of several autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and BD. In addition, TNF-α plays an important role in the pathophysiology of MDS by inhibiting normal hematopoiesis and inducing the programmed cell death of normal total bone marrow cells and normal CD34+ cells. Recent clinical reports demonstrate the favorable effect of TNF-α antagonists in patients with refractory intestinal BD and in those with MDS. We present the case of a patient with intestinal BD and MDS involving trisomy 8 who was successfully treated with adalimumab.

DOI PubMed

Evaluation of intratumoral microenvironment with 18F-misonidazole PET and dynamic contrast enhanced CT in tumor-bearing mice models

Sho Koyasu, Yuji Nakamoto, Hiroshi Harada, Hiroyuki Kimura, Kohei Sano, Koji Koizumi, Yoshihisa Tsuji, Tomomi Nobashi, Kensuke Kurihara, Kaori Togashi

JOURNAL OF NUCLEAR MEDICINE ( SOC NUCLEAR MEDICINE INC ) 55 2014年05月 [査読有り]

Long-term efficacy of infliximab for refractory ulcerative colitis: results from a single center experience.

Satoshi Yamada, Takuya Yoshino, Minoru Matsuura, Naoki Minami, Takahiko Toyonaga, Yusuke Honzawa, Yoshihisa Tsuji, Hiroshi Nakase

BMC gastroenterology 14 80 - 80 2014年04月 [査読有り] [国際誌]

BACKGROUND: The long-term efficacy of infliximab (IFX) for patients with refractory ulcerative colitis (UC) is unclear. The aim of this study was to assess the long-term outcomes of IFX treatment in patients with refractory UC. METHODS: Thirty-three patients with refractory UC who received IFX treatment at Kyoto University Hospital between 2003 and 2013 were retrospectively evaluated. IFX intensification was defined as a dose escalation (up to 10 mg/kg) and/or shorter intervals between infusions (every 4-6 weeks). RESULTS: Of the 33 patients who received scheduled infusions of IFX, 24 (72.7%) achieved clinical remission within 8 weeks after initiating IFX treatment. Of these 24 responders, 17 (70.8%) experienced a relapse of UC and required IFX intensification, and 16 (66.7%) eventually maintained clinical remission with IFX treatment, including IFX intensification. Of the 33 patients, 6 (18.2%) underwent colectomy during IFX treatment. Multivariate regression analysis showed that a serum C-reactive protein (CRP) concentration <5 mg/L two weeks after starting IFX was a predictor of a positive clinical response to IFX induction therapy. No severe adverse events occurred in UC patients treated with IFX. CONCLUSION: IFX intensification was necessary for long-term maintenance of remission and to prevent colectomy in patients with refractory UC.

DOI PubMed

Subtraction color map of contrast-enhanced and unenhanced CT for the prediction of pancreatic necrosis in early stage of acute pancreatitis.

Yoshihisa Tsuji, Naoki Takahashi, Joel G Fletcher, David M Hough, Brendan P McMenomy, David M Lewis, Santhi S Vege, Suresh T Chari, Cynthia H McCollough, Katharine L Grant, Ernst Klotz

AJR. American journal of roentgenology 202 ( 4 ) W349-56 2014年04月 [査読有り] [国際誌]

OBJECTIVE: The objective of our study was to evaluate the accuracy of subtraction color-map images created from contrast-enhanced CT (CECT) and unenhanced CT for the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. MATERIALS AND METHODS: Forty-eight patients underwent unenhanced CT and CECT within 72 hours from the onset of acute pancreatitis. Subtraction color-map images were created from unenhanced CT and CECT using a 3D nonrigid registration method. Three radiologists reviewed two image sets: CECT alone and subtraction color-map images in conjunction with CECT. Readers evaluated each image set for the presence of pancreatic necrosis. The reference standard for pancreatic necrosis was CT or MRI 1 week or more after the onset of acute pancreatitis. The performance of each image set for the prediction of pancreatic necrosis was calculated and compared using the McNemar test. RESULTS: Eleven of the 48 patients developed pancreatic necrosis. There were no technical failures creating the subtraction images. The sensitivity, specificity, and accuracy for predicting pancreatic necrosis with CECT were 64%, 97%, and 90%, respectively, for reader 1; 73%, 87%, and 83% for reader 2; and 73%, 87%, and 83% for reader 3. The sensitivity, specificity, and accuracy for predicting pancreatic necrosis with the subtraction color maps were 100%, 100%, and 100%, respectively, for reader 1; 100%, 95%, and 96% for reader 2; and 82%, 92%, and 90% for reader 3. Accuracy significantly improved with the addition of subtraction color maps compared with CECT alone for reader 1 (p = 0.03) and reader 2 (p = 0.02) but not for reader 3 (p = 0.37). CONCLUSION: A subtraction color map is accurate in the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis.

DOI PubMed

Perfusion in the tissue surrounding pancreatic cancer and the patient's prognosis.

Yoshihiro Nishikawa, Yoshihisa Tsuji, Hiroyoshi Isoda, Yuzo Kodama, Tsutomu Chiba

BioMed research international 2014 648021 - 648021 2014年 [査読有り] [国際誌]

OBJECTIVE: The objective was to investigate the relationship between prognosis in case of pancreatic cancer and perfusion in tissue surrounding pancreatic cancer using perfusion CT. METHODS: We enrolled 17 patients diagnosed with inoperable pancreatic adenocarcinoma. All patients were examined by perfusion CT and then underwent chemotherapy using gemcitabine. The time density curve (TDC) of each CT pixel was analyzed to calculate area under the curve (AUC) and blood flow (BF) using a mathematical algorithm based on the single-compartment model. To measure the AUC and BF of tumor (AUCT and BFT) and peritumoral tissue (AUCPTT and BFPTT), regions of interest were manually placed on the cancer and in pancreatic tissue within 10 mm of proximal pancreatic parenchyma. Survival days from the date of perfusion CT were recorded. Correlation between AUC or BF and survival days was assessed. RESULTS: We found a significant correlation between AUCPTT or BFPTT and survival days (P = 0.04 or 0.0005). Higher AUCPTT or BFPTT values were associated with shorter survival. We found no significant correlation between AUCT or BFT and survival. CONCLUSIONS: Our results suggest that assessments of perfusion in pancreatic tissue within 10 mm of proximal pancreatic parenchyma may be useful in predicting prognosis.

DOI PubMed

Pancreatic Blood Flow Measurements in the Pig Pancreatitis Model Using Perfusion CT with Deconvolution Method

Yoshihisa Tsuji, Kazutaka Yamada, Miori Kisimoto, Shujiro Yazumi, Hiroyoshi Isoda, Tsutomu Chiba

ABDOMINAL IMAGING: COMPUTATIONAL AND CLINICAL APPLICATIONS ( SPRINGER-VERLAG BERLIN ) 8676 94 - 102 2014年 [査読有り]

Introduction: We compared pancreatic blood flow (PBF) measured by perfusion CT with deconvolution method and Laser Doppler Flow (LDF) to determine whether uncollected contrast material from the pancreas affects measurement of perfusion CT, using porcine pancreatitis model (n = 7). Materials and Methods: The pancreas was divided into head and tail. We arranged that PBF of tail was circulated by single input/output vessel. Ischemic pancreatitis was induced to tail, shutting off input/output vessel for 30 min. PBF was measured both by perfusion CT with deconvolution method and LDF, during the overall course. We calculated uncollected ratio of contrast material, assuming area-under-curve differences between the input and output vessels correspond to uncollected. Results: tail PBF measured by perfusion CT with deconvolution was significantly correlated with LDF, despite of pancreatitis (P < 0.05). The uncollected ratio was 19 %. Discussion: Although the uncollected ratio was not few, result of perfusion CT was significantly related with LDF.

DOI

Risk of cancer in patients with autoimmune pancreatitis.

Masahiro Shiokawa, Yuzo Kodama, Kenichi Yoshimura, Chiharu Kawanami, Jun Mimura, Yukitaka Yamashita, Masanori Asada, Masataka Kikuyama, Yoshihiro Okabe, Tetsuro Inokuma, Masaya Ohana, Hiroyuki Kokuryu, Kazuo Takeda, Yoshihisa Tsuji, Ryuki Minami, Yojiro Sakuma, Katsutoshi Kuriyama, Yuji Ota, Wataru Tanabe, Takahisa Maruno, Akira Kurita, Yugo Sawai, Norimitsu Uza, Tomohiro Watanabe, Hironori Haga, Tsutomu Chiba

The American journal of gastroenterology 108 ( 4 ) 610 - 7 2013年04月 [査読有り] [国際誌]

OBJECTIVES: Although simultaneous occurrences of autoimmune pancreatitis (AIP) and cancer are occasionally observed, it remains largely unknown whether cancer and AIP occur independently or these disorders are interrelated. The aim of this study was to examine the relationship between AIP and cancer. METHODS: We conducted a multicenter, retrospective cohort study. One hundred and eight patients who met the Asian diagnostic criteria for AIP were included in the study. We calculated the proportion, standardized incidence ratio (SIR), relative risk, and time course of cancer development in patients with AIP. We also analyzed the clinicopathological characteristics of AIP patients with cancer in comparison with those without cancer. RESULTS: Of the 108 AIP patients, 18 cancers were found in 15 patients (13.9%) during the median follow-up period of 3.3 years. The SIR of cancer was 2.7 (95% confidence interval (CI) 1.4-3.9), which was stratified into the first year (6.1 (95% CI 2.3-9.9)) and subsequent years (1.5 (95% CI 0.3-2.8)) after AIP diagnosis. Relative risk of cancer among AIP patients at the time of AIP diagnosis was 4.9 (95% CI 1.7-14.9). In six of eight patients whose cancer lesions could be assessed before corticosteroid therapy for AIP, abundant IgG4-positive plasma cell infiltration was observed in the cancer stroma. These six patients experienced no AIP relapse after successful cancer treatment. CONCLUSIONS: Patients with AIP are at high risk of having various cancers. The highest risk for cancer in the first year after AIP diagnosis and absence of AIP relapse after successful treatment of the coexisting cancers suggest that AIP may develop as a paraneoplastic syndrome in some patients.

DOI PubMed

Technique and clinical applications of hepatic perfusion ct with dual-input algorithms

Sho Koyasu, Yoshihisa Tsuji

Computed Tomography: New Research ( Nova Science Publishers, Inc. ) 65 - 73 2013年03月

Perfusion computed tomography (CT) is a new technology used to evaluate tissue hemodynamics. More specifically, Perfusion CT is a technique used to obtain a time density curve (TDC) of targeted tissue from an image dataset of dynamic contrasted enhanced CT to measure several perfusion parameters in normal and pathologic tissue in patients with liver disease (e.g., malignant and inflammatory disease). Since liver perfusion involves two input vessels, the hepatic artery and portal vein, we must measure hepatic arterial and portal perfusion separately to truly evaluate hepatic perfusion. Actually, advanced perfusion algorithms that measure hepatic perfusion require both TDCs for administered contrast material in the hepatic artery and portal vein. This chapter reviews the techniques and clinical applications of hepatic perfusion CT based on dual-input algorithms. © 2013 Nova Science Publishers, Inc. All rights reserved.

Relationship between pancreatic perfusion parameters and clinical complications of severe acute pancreatitis.

Tsubasa Watanabe, Yoshihisa Tsuji, Naoki Takahashi, Tsukasa Yoshida, Masashi Tamaoki, Osamu Kikuchi, Yuji Watanabe, Yuzo Kodama, Hiroyoshi Isoda, Hiroshi Yamamoto, Tsutomu Chiba

Pancreas 42 ( 1 ) 180 - 2 2013年01月 [査読有り] [国際誌]

DOI PubMed

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年08月 [査読有り] [国際誌]

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年01月 [査読有り] [国際誌]

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

膵血流解析による自己免疫性膵炎と膵癌の鑑別

廣田衛久, 滝川哲也, 林晋太郎, 三浦晋, 千葉勉, 正宗淳, 下瀬川徹, 津田雅視, 辻喜久, 菅野敦, 菊田和宏, 粂潔, 濱田晋, 海野純, 有賀宏之

膵臓 ( 日本膵臓学会 ) 27 ( 4 ) 601 - 607 2012年

自己免疫性膵炎（AIP）は膵癌（PC）との鑑別が臨床上の問題である．本研究では，Perfusion CTによる膵血流解析が両者の鑑別に有用であるかを検討した．AIP 12症例（全例type 1）とPC 22症例にPerfusion CTを施行し，single-compartment kinetic model法を用いて画像解析を行い，3つのパラメータを用いて両者を比較した．F_V値はAIPで平均81.3/分に対しPCでは平均19.3/分と有意に低値（p=0.0005），V_D値はAIPが28.8に対しPCでは93.6と有意に高値（p=0.0084），R²値はAIPが0.659に対しPCでは0.250と有意に低値（p<0.0001）であった．また，カラーマップ画像も鑑別に有用であった．本研究は，AIPとPCの鑑別におけるPerfusion CTの有用性を示す最初の報告である．

DOI CiNii

Pancreatic Perfusion CT in Early Stage of Severe Acute Pancreatitis.

Yoshihisa Tsuji, Naoki Takahashi, Chiba Tsutomu

International journal of inflammation 2012 497386 - 497386 2012年 [査読有り] [国際誌]

Early intensive care for severe acute pancreatitis is essential for improving SAP mortality rates. However, intensive therapies for SAP are often delayed because there is no ideal way to accurately evaluate severity in the early stages. Currently, perfusion CT has been shown useful to predict prognosis of SAP in the early stage. In this presented paper, we would like to review the clinical usefulness and limitations of perfusion CT for evaluation of local and systemic complications in early stage of SAP.

DOI PubMed

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年11月 [査読有り] [国際誌]

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年10月 [査読有り] [国際誌]

DOI PubMed

【膵疾患画像診断における最近の進歩】重症急性膵炎発症早期における"可逆性-非可逆性膵虚血"の診断

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

膵臓 ( 日本膵臓学会 ) 26 ( 1 ) 59 - 65 2011年02月 [査読有り]

[背景と目的]脳虚血性疾患では、虚血領域は2種類に分けられ、壊死に至る不可逆性の領域と、虚血であるものの治療によって壊死することなく治癒する可逆性虚血領域である。今回、重症急性膵炎にPerfusion CTを用いれば、可逆性虚血領域が診断できるか検討した。[方法]発症3日以内に、Perfusion CTを撮像した71人の重症急性膵炎患者を対象とした。全ての膵実質を、頭部、体部、尾部に分け、膵血流速度(FV)、膵血流量(VD)をPerfusion CT(Single compartment kinetic model)にて測定した。3週間後に造影CTを行い、頭部、体部、尾部がそれぞれ壊死したか診断した。[結果]発症早期に、FV、VDどちらも低下している場合、高率に壊死した。発症早期に、FV、VD片方だけ低下している場合、壊死する場合もあれば、回復する場合もあった。発症早期に、FV、VDどちらも低下していなければ壊死しなかった。[考察]発症早期にFV、VDどちらも低下した実質は高率に壊死し、このような実質は不可逆性膵虚血/早期壊死であると考えられた。単一のParameterのみ低下した実質は、必ずしも壊死しない場合があり、こうした実質は可逆性膵虚血である場合があると考えられた。以上から、複数のPerfusion Parameterを用いることで、可逆性-非可逆性膵虚血を診断しうる可能性があると考えられたが、こうしたPerfusion CTの所見と病理との比較や、用語の定義など、今後の課題であると考えられた。(著者抄録)

DOI

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年01月 [査読有り] [国際誌]

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

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年11月 [査読有り] [国内誌]

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

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年05月 [査読有り] [国際誌]

DOI PubMed

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年05月 [査読有り] [国際誌]

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

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年 [査読有り] [国内誌]

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年10月 [査読有り] [国際誌]

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年06月 [査読有り] [国内誌]

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

Simultaneous occurrence of inflammatory bowel disease and myelodysplastic syndrome due to chromosomal abnormalities in bone marrow cells.

Fumiyasu Nakamura, Tomohiro Watanabe, Kimiko Hori, Yoshiaki Ohara, Kouhei Yamashita, Yoshihisa Tsuji, Yoshihide Ueda, Sakae Mikami, Hiroshi Nakase, Tsutomu Chiba

Digestion 79 ( 4 ) 215 - 9 2009年 [査読有り] [国際誌]

BACKGROUND/AIMS: Although chromosomal abnormalities in bone marrow (BM) cells, such as trisomy 8, are risk factors for the development of inflammatory bowel diseases (IBD) as well as myelodysplastic syndrome (MDS), the mechanisms of how these cytogenetic abnormalities cause intestinal inflammation are poorly understood. METHODS AND RESULTS: A 55-year-old man with a 3-month history of watery diarrhea, fever and abdominal pain was admitted. Blood examinations revealed pancytopenia. Pathological analysis and endoscopic images of the entire colon led to the diagnosis of IBD of unclassified type. BM examination showed that the pancytopenia was due to MDS and that his BM cells had dual chromosomal abnormalities: 47, XY, +1, der(1;7)(q10;p10), +8. Immunological studies using peripheral blood monocytes from this patient revealed that the dual chromosomal abnormalities of BM cells led to the development of colitogenic monocytes producing a large amount of pro-inflammatory cytokines and showing resistance to apoptosis upon stimulation with microbial antigens. CONCLUSION: An abnormal karyotype of BM cells is not only responsible for the development of MDS, but also for IBD in this case.

DOI PubMed

IgG4-related autoimmune pancreatitis involving the colonic mucosa.

Kenji Ueno, Tomohiro Watanabe, Yukiko Kawata, Tomoyuki Gotoh, Yoshihisa Tsuji, Hiroshi Ida, Shinsuke Tada, Shujiro Yazumi, Tsutomu Chiba

European journal of gastroenterology & hepatology 20 ( 11 ) 1118 - 21 2008年11月 [査読有り] [国際誌]

We report a case of autoimmune pancreatitis involving the colonic mucosa. Although serum level of IgG4 was normal, computed tomography and endoscopic retrograde cholangiopancreatography showed diffuse enlargement of the pancreas and irregular narrowing of the pancreatic ducts, respectively. Colonoscopy revealed a polypoidal lesion in the ascending colon. A lymphoplasmacytic infiltration was seen both in the pancreas and in the polypoidal lesion of the colon. Furthermore, immunohistochemical analysis showed abundant IgG4-positive plasma cells in these lesions. This is the first case report of a simultaneous occurrence of autoimmune pancreatitis and a colonic polypoidal lesion, both of which are characterized with increased IgG4 responses.

DOI PubMed

Are prophylactic antibiotics really ineffective in reducing the risk of pancreatic necrosis?

Yoshihisa Tsuji, Tsutomu Chiba

The American journal of gastroenterology 103 ( 8 ) 2145 - 6 2008年08月 [査読有り] [国際誌]

DOI PubMed

Biliary complications in donors for living donor liver transplantation.

Seiji Shio, Shujiro Yazumi, Kohei Ogawa, Kazunori Hasegawa, Yoshihisa Tsuji, Masaya Kida, Junichi Yamauchi, Hiroshi Ida, Shinsuke Tada, Shinji Uemoto, Tsutomu Chiba

The American journal of gastroenterology 103 ( 6 ) 1393 - 8 2008年06月 [査読有り] [国際誌]

OBJECTIVES: With the increasing number of living donor liver transplantations, biliary complications in donors have emerged as a major postoperative problem. The aim of the present study was to characterize the features of the biliary complications that occur in donors. METHODS: The study subjects comprised 731 consecutive patients who donated liver grafts (434 right-lobe and 297 left-lobe grafts) for transplantation at Kyoto University Hospital from July 1999 to December 2006. Donors whose biliary complications could not be cured by conservative therapy were referred for endoscopic treatment. RESULTS: Postoperative biliary complications occurred in 55 (7.5%) donors. Initially, 48 of these 55 donors had biliary leakage and 7 had biliary stricture. Subsequently, 5 of 48 donors with leakage developed biliary stricture. The respective incidences of biliary leakage and overall biliary complications were significantly higher among donors of right-lobe grafts (9.9% and 11.1%) than among donors of left-lobe grafts (1.7% and 2.4%). Among 55 donors with biliary complications, 24 were cured by conservative therapy, and 1 was converted to surgical repair due to ileus. Endoscopic treatment was successful in 24 of 30 (80%) donors treated by endoscopic retrograde cholangiography, while the remaining 6 (20%) patients underwent surgery due to difficulties with cannulation (N = 2), excessive biliary leakage (N = 2), or complete biliary obstruction (N = 2). CONCLUSIONS: Donors of right-lobe grafts have a significantly higher incidence of biliary complications than donors of left-lobe grafts. When conservative therapy fails, endoscopic treatment is effective for these complications, and should be attempted as the first-line therapy before surgical repair.

DOI PubMed

Surround modulation in visual cortex can predict border-ownership selectivity: psychophysical study of border-ownership-dependent tilt aftereffect.

Tadashi Sugihara, Yoshihisa Tsuji, Ko Sakai

Journal of the Optical Society of America. A, Optics, image science, and vision 25 ( 6 ) 1426 - 34 2008年06月 [査読有り] [国際誌]

Recent physiological studies revealed that neurons in the macaque visual cortex encode the direction of a figure along a contour (border ownership, BO). Although their cortical mechanisms have not been clarified, a computational model for BO has suggested that surround modulation in early vision can play an important role. Here we examined psychophysically how the strength of BO-dependent tilt aftereffect (BO-TAE) is modulated by a stimulus outside the adapted location in relation to the strength of surround modulation reported in physiological experiments. The results showed systematic change of the strength of BO-TAE, depending on the difference in orientation and spatial frequency between the bars placed outside and at the adapted location, indicating a crucial role of surround modulation in the neural mechanism underlying BO selectivity.

PubMed

[Marked effect of combination chemotherapy with tegafur-gimeracil-oteracil potassium and gemcitabine on a suspected case of pancreas cancer or gallbladder cancer metastasis to bone: further diagnosis of disseminated carcinomatosa of bone marrow recurrence after the 23 years of gastric cancer operation by autopsy findings].

Akihiro Sakai, Yoshihisa Tsuji, Osamu Kikuchi, Akiko Jinno, Wataru Tanabe, Yoshihiko Terashima, Yuki Maeda, Akira Doi, Takako Hata, Naoki Yamamoto, Ikuo Aoyama, Osamu Arai, Yoshie Kiyosuke, Sachiko Katayama, Ken Hirao, Masatsugu Miyoshi, Hirokazu Mouri, Kazuhiro Matsueda, Hiroshi Yamamoto

Gan to kagaku ryoho. Cancer & chemotherapy 35 ( 3 ) 529 - 32 2008年03月 [査読有り] [国内誌]

A 70-year-old woman who underwent proximal gastrectomy for gastric cancer (poorly-differentiated adenocarcinoma) of Stage IIIB at age 46 visited our hospital April 2004 because of exacerbated pain by movement in the buttocks since November 2003. She showed multiple bone metastasis by CT (computerized tomography). Pancreas cancer or gallbladder cancer was suspected by CT, and a high tumor marker score (CA19-9 18,625 U/mL, DUPAN-II 15,000 U/ mL elevations were acknowledged). Although her symptoms were severe with performance status (PS) 4, she was administered combination chemotherapy with gemcitabine and cisplatin. After 2 cycle therapy, her PS was improved to 2, but the tumor markers had elevated. So we changed the chemotherapy menu to S-1 and gemcitabine. Her tumor markers lowered and PS was improved to 1. There was a remarkable response to this chemotherapy, and the result of CT and bone scintigraphy suggested that her bone metastasis was improved. Because of hematologic relapse due to DIC at 1 year after the first treatment, she was readmitted to our hospital and later died. The autopsical result revealed recurrence of gastric cancer 23 years post-operatively.

PubMed

Obesity as a risk factor for GERD in Japan.

Masahiro Sakaguchi, Hiroshi Oka, Takashi Hashimoto, Yutaka Asakuma, Miyuki Takao, Goki Gon, Makoto Yamamoto, Yoshihisa Tsuji, Norihiko Yamamoto, Mamoru Shimada, Kyowon Lee, Kiyoshi Ashida

Journal of gastroenterology 43 ( 1 ) 57 - 62 2008年 [査読有り] [国内誌]

BACKGROUND: In Europe and the United States, it is known that obesity, which is increasing, is closely associated with gastroesophageal reflux disease (GERD), but in Japan no definite consensus has been reached on this relationship. Clarification of the relationship between the two is an important issue. METHODS: After screening, gastrointestinal endoscopic examinations were conducted on 1813 subjects who were surveyed using a questionnaire in which they recorded body weight, height, weight loss or gain, chief complaints, and underlying disease to prospectively examine the relationship between obesity and GERD. Differences in GERD prevalence and esophageal hiatal hernia prevalence in thin (body mass index less than 18.5 kg/m2), normal (18.5 to 25.0), and obese (greater than 25.0) subjects were examined, and the differences in GERD prevalence in patients with weight loss or gain were also investigated. RESULTS: GERD prevalence was 20.96% in the thin group, 24.42% in the normal group, and 31.86% in the obese group, indicating a significantly higher prevalence in the obese group compared with the other groups. The prevalence of hernia was also significantly higher in the obese group. GERD prevalence in the weight gain group was significantly higher than in the unchanged weight group and weight loss group. CONCLUSIONS: Both GERD prevalence and the prevalence of hernia were significantly higher in obese subjects, and the prevalence of GERD in subjects who had gained weight was also significantly higher. From these results, it was concluded that obesity is a risk factor for GERD in Japan.

DOI PubMed

Small bowel anisakiasis with self-limiting clinical course.

Tomohiro Watanabe, Sakiko Ohta, Satoru Iwamoto, Yoshihisa Tsuji, Shuko Morita, Isao Doi, Yasunori Ueda, Tsutomu Chiba

Internal medicine (Tokyo, Japan) 47 ( 24 ) 2191 - 2 2008年 [査読有り] [国内誌]

PubMed

Perfusion computerized tomography can predict pancreatic necrosis in early stages of severe acute pancreatitis.

Yoshihisa Tsuji, Hiroshi Yamamoto, Shujiro Yazumi, Yuji Watanabe, Kazuhiro Matsueda, Hiroyuki Yamamoto, Tsutomu Chiba

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 5 ( 12 ) 1484 - 92 2007年12月 [査読有り] [国際誌]

BACKGROUND & AIMS: The mortality rate associated with severe acute pancreatitis (SAP) with necrosis remains high because early prediction of pancreatic necrosis is difficult. We evaluated whether perfusion computerized tomography (CT), which is used to identify early stage ischemia in the brain, could detect ischemic changes in the pancreas in the early stages of SAP and predict development of necrosis. PATIENTS AND METHODS: Thirty consecutive patients with a diagnosis of SAP according to the Atlanta criteria and whose score was greater than 6 were enrolled in this study. All patients were hospitalized within 3 days after onset of symptoms indicative of acute pancreatitis and underwent perfusion CT. Three weeks later, all patients underwent conventional contrast-enhanced CT to detect progression of their disease. RESULTS: Perfusion CT showed that 10 of the 30 patients had pancreatic ischemia at the time of diagnosis. Contrast-enhanced CT disclosed that pancreatic necrosis developed in 9 of these 10 patients, but not in the 20 patients who did not have pancreatic ischemia. The sensitivity and specificity of perfusion CT for predicting pancreatic necrosis was calculated to be 100% and 95.3%, respectively. CONCLUSIONS: Perfusion CT is a useful tool for early detection of ischemic changes in the pancreas that lead to pancreatic necrosis.

PubMed

[Prevention and treatment of nonsteroidal anti-inflammatory drug-induced gastric ulcers with proton pump inhibitor].

Yoshihisa Tsuji, Toshiyuki Itoh, Tsutomu Chiba

Nihon rinsho. Japanese journal of clinical medicine 65 ( 10 ) 1831 - 4 2007年10月 [査読有り] [国内誌]

PubMed

Case of ampullary cancer presented unique progress in the bile duct

Norihiko Yamamoto, Masayoshi Nishihara, Makoto Yamamoto, Goki Gon, Masahiko Honda, Yoshihisa Tsuji, Mamoru Shimada, An-Na Nishiwaki, Kyo-Won Lee, Masahiro Sakaguchi, Hiroshi Oka, Tadashi Obayashi

Gastroenterological Endoscopy 49 ( 2 ) 212 - 217 2007年02月

We herein report a case of ampullary cancer in 74-year-old man who underwent pancreaticodoudenectomy. Endoscopic Retrograde Cholangio- pancreatography (ERCP) revealed the ampullary cancer which was grew into the bile duct. However, The tumor did not invade to the pancreushead and the duodenum. It was diagnosed pathologically as the special type of well-differentiated tubular adenocarcinoma which was presented as unique progress in the bile duct. We discuss this case with references.

Border-ownership-dependent tilt aftereffect in incomplete figures

Tadashi Sugihara, Yoshihisa Tsuji, Ko Sakai

JOURNAL OF THE OPTICAL SOCIETY OF AMERICA A-OPTICS IMAGE SCIENCE AND VISION ( OPTICAL SOC AMER ) 24 ( 1 ) 18 - 24 2007年01月 [査読有り]

A recent physiological finding of neural coding for border ownership (BO) that defines the direction of a figure with respect to the border has provided a possible basis for figure-ground segregation. To explore the underlying neural mechanisms of BO, we investigated stimulus configurations that activate BO circuitry through psychophysical investigation of the BO-dependent tilt aftereffect (BO-TAE). Specifically, we examined robustness of the border ownership signal by determining whether the BO-TAE is observed when gestalt factors are broken. The results showed significant BO-TAEs even when a global shape was not explicitly given due to the ambiguity of the contour, suggesting a contour-independent mechanism for BO coding. (c) 2006 Optical Society of America.

Usefulness of perfusion computed tomography for early detection of pancreatic ischemia in severe acute pancreatitis.

Yoshihisa Tsuji, Yuji Watanabe, Kazuhiro Matsueda, Hiroyuki Yamamoto, Etsuji Ishida, Hiroshi Yamamoto

Journal of gastroenterology and hepatology 21 ( 9 ) 1506 - 8 2006年09月 [査読有り] [国際誌]

PubMed

[A case of goblet cell carcinoid of the appendix presented as a metastatic ovarian tumor and peritoneal dissemination, and diagnosed by autopsy].

Atsushi Yamada, Hiroshi Yamamoto, Osamu Arai, Yoshie Kiyosuke, Yoshihisa Tsuji, Masato Nakatsuji, Hirotoshi Fukatsu, Masatsugu Miyoshi, Hiroyuki Kono, Hirokazu Mouri, Kazuhiro Matsueda, Takashi Tezen, Junnosuke Shimamura, Choutatsu Tsukayam

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 102 ( 7 ) 905 - 11 2005年07月 [査読有り] [国内誌]

PubMed

Heidenhain variant of Creutzfeldt-Jakob disease: diffusion-weighted MRI and PET characteristics.

Yoshihisa Tsuji, Hiroshi Kanamori, Gaku Murakami, Masayuki Yokode, Takahiro Mezaki, Katsumi Doh-ura, Ken Taniguchi, Kozo Matsubayashi, Hidenao Fukuyama, Toru Kita, Makoto Tanaka

Journal of neuroimaging : official journal of the American Society of Neuroimaging 14 ( 1 ) 63 - 6 2004年01月 [査読有り] [国際誌]

Creutzfeldt-Jakob disease (CJD) is characterized by rapidly progressive dementia with a variety of neurological disorders and a fatal outcome. The authors present a case with visual disturbance as a leading symptom and rapid deterioration in global cognitive functions. The cerebrospinal fluid was positive for 14-3-3 protein, and diffusion-weighted magnetic resonance imaging (MRI) showed marked hyperintensity in the parieto-occipital cortices, where hypometabolism was clearly detected on positron emission tomography (PET). Pattern-reversal visual evoked potentials showed prolonged P100 latencies and increased N/5/P100 amplitudes. All these findings supported a diagnosis of the Heidenhain variant of CJD, whereas a long clinical course, a lack of myoclonus, and an absence of periodic synchronous discharges on electroencephalography were atypical. Diffusion-weighted MRI and PE1 in combination with visual evoked potential recording and 14-3-3 protein detection may be useful for the early diagnosis of CJD.

PubMed

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