Degree 【 display / non-display 】

Degree 【 display / non-display 】

• 富山大学大学院   博士（医学）

Research Areas 【 display / non-display 】

Research Areas 【 display / non-display 】

• Life sciences   Internal medicine - General  

• Humanities & social sciences   Education - general  

• Life sciences   Gastroenterology  

Affiliation 【 display / non-display 】

Affiliation 【 display / non-display 】

• 富山大学附属病院第三内科  

• Sapporo Medical University   総合診療医学講座   准教授  

Papers 【 display / non-display 】

Papers 【 display / non-display 】

• 急性腹症診療ガイドライン改訂 教育章

  井上 祐真, 井上 明星, 刑部 恵介, 貝田 佐知子, 亀井 誠二, 亀田 徹, 近藤 浩史, 関根 慎一, 渡口 真史, 畠 二郎, 丸山 憲一, 矢吹 拓, 山岸 俊介, 山田 岳史, 和田 慎司, 三原 弘

  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2 ) 110 - 110  2024.09

• ボーリング生検により診断し得た局所進行食道verrucous carcinomaの1例

  田畑 和久, 元尾 伊織, 安藤 孝将, 中嶋 隆彦, 芳尾 幸松, 作村 美穂, 三原 弘, 梶浦 新也, 中谷 敦子, 安田 一朗

  Gastroenterological Endoscopy ( (一社)日本消化器内視鏡学会 )  66 ( 8 ) 1581 - 1587  2024.08

  　View Summary

  症例は63歳男性.嚥下困難を主訴に受診し,上部消化管内視鏡検査で胸部下部食道に全周性の疣状,角化の目立つ白色隆起性病変を認めた.また,切歯28cmに深い陥凹を認め,左気管支と瘻孔を形成していた.3回の内視鏡検査により生検を繰り返したが,癌の診断には至らず,特徴的な内視鏡像から食道verrucous carcinoma(VC)を疑った.瘻孔に沿ってボーリング生検を施行した結果,VCに矛盾しない太い釘脚の下方への進展像が確認でき,食道VCと診断し得た.本症例のように切除不能な食道VCの診断においてボーリング生検は考慮すべき手技であると考えられた.(著者抄録)

• Feasibility and reliability of the pandemic-adapted online-onsite hybrid graduation OSCE in Japan.

  Satoshi Hara, Kunio Ohta, Daisuke Aono, Toshikatsu Tamai, Makoto Kurachi, Kimikazu Sugimori, Hiroshi Mihara, Hiroshi Ichimura, Yasuhiko Yamamoto, Hideki Nomura

  Advances in health sciences education : theory and practice   29 ( 3 ) 949 - 965  2024.07  [International journal]

  　View Summary

  Objective structured clinical examination (OSCE) is widely used to assess medical students' clinical skills. Virtual OSCEs were used in place of in-person OSCEs during the COVID-19 pandemic; however, their reliability is yet to be robustly analyzed. By applying generalizability (G) theory, this study aimed to evaluate the reliability of a hybrid OSCE, which admixed in-person and online methods, and gain insights into improving OSCEs' reliability. During the 2020-2021 hybrid OSCEs, one examinee, one rater, and a vinyl mannequin for physical examination participated onsite, and a standardized simulated patient (SP) for medical interviewing and another rater joined online in one virtual breakout room on an audiovisual conferencing system. G-coefficients and 95% confidence intervals of the borderline score, namely border zone (BZ), under the standard 6-station, 2-rater, and 6-item setting were calculated. G-coefficients of in-person (2017-2019) and hybrid OSCEs (2020-2021) under the standard setting were estimated to be 0.624, 0.770, 0.782, 0.759, and 0.823, respectively. The BZ scores were estimated to be 2.43-3.57, 2.55-3.45, 2.59-3.41, 2.59-3.41, and 2.51-3.49, respectively, in the score range from 1 to 6. Although hybrid OSCEs showed reliability comparable to in-person OSCEs, they need further improvement as a very high-stakes examination. In addition to increasing clinical vignettes, having more proficient online/on-demand raters and/or online SPs for medical interviews could improve the reliability of OSCEs. Reliability can also be ensured through supplementary examination and by increasing the number of online raters for a small number of students within the BZs.

  DOI PubMed

• Artificial intelligence model for analyzing colonic endoscopy images to detect changes associated with irritable bowel syndrome.

  Kazuhisa Tabata, Hiroshi Mihara, Sohachi Nanjo, Iori Motoo, Takayuki Ando, Akira Teramoto, Haruka Fujinami, Ichiro Yasuda

  PLOS digital health   2 ( 2 ) e0000058  2023.02  [International journal]

  　View Summary

  IBS is not considered to be an organic disease and usually shows no abnormality on lower gastrointestinal endoscopy, although biofilm formation, dysbiosis, and histological microinflammation have recently been reported in patients with IBS. In this study, we investigated whether an artificial intelligence (AI) colorectal image model can identify minute endoscopic changes, which cannot typically be detected by human investigators, that are associated with IBS. Study subjects were identified based on electronic medical records and categorized as IBS (Group I; n = 11), IBS with predominant constipation (IBS-C; Group C; n = 12), and IBS with predominant diarrhea (IBS-D; Group D; n = 12). The study subjects had no other diseases. Colonoscopy images from IBS patients and from asymptomatic healthy subjects (Group N; n = 88) were obtained. Google Cloud Platform AutoML Vision (single-label classification) was used to construct AI image models to calculate sensitivity, specificity, predictive value, and AUC. A total of 2479, 382, 538, and 484 images were randomly selected for Groups N, I, C and D, respectively. The AUC of the model discriminating between Group N and I was 0.95. Sensitivity, specificity, positive predictive value, and negative predictive value of Group I detection were 30.8%, 97.6%, 66.7%, and 90.2%, respectively. The overall AUC of the model discriminating between Groups N, C, and D was 0.83; sensitivity, specificity, and positive predictive value of Group N were 87.5%, 46.2%, and 79.9%, respectively. Using the image AI model, colonoscopy images of IBS could be discriminated from healthy subjects at AUC 0.95. Prospective studies are needed to further validate whether this externally validated model has similar diagnostic capabilities at other facilities and whether it can be used to determine treatment efficacy.

  DOI PubMed

• Colonic TRPV4 overexpression is related to constipation severity.

  Hiroshi Mihara, Kunitoshi Uchida, Yoshiyuki Watanabe, Sohachi Nanjo, Miho Sakumura, Iori Motoo, Takayuki Ando, Masami Minemura, Jibran Sualeh Muhammad, Hiroyuki Yamamoto, Fumio Itoh, Ichiro Yasuda

  BMC gastroenterology   23 ( 1 ) 13 - 13  2023.01  [International journal]

  　View Summary

  BACKGROUND: Chronic constipation is prevalent and involves both colon sensitivity and various changes in intestinal bacteria, particularly mucosa-associated microflora. Here we examined regulatory mechanisms of TRPV4 expression by co-culturing colon epithelial cell lines with intestinal bacteria and their derivatives. We also investigated TRPV4 expression in colon epithelium from patients with constipation. METHODS: Colon epithelial cell lines were co-cultured with various enterobacteria (bacterial components and supernatant), folate, LPS, or short chain fatty acids. TRPV4 expression levels and promoter DNA methylation were assessed using pyrosequencing, and microarray network analysis. For human samples, correlation coefficients were calculated and multiple regression analyses were used to examine the association between clinical background, rectal TRPV4 expression level and mucosa-associated microbiota. RESULTS: Co-culture of CCD841 cells with P. acnes, C. perfringens, or S. aureus transiently decreased TRPV4 expression but did not induce methylation. Co-culture with clinical isolates and standard strains of K. oxytoca, E. faecalis, or E. coli increased TRPV4 expression in CCD841 cells, and TRPV4 and TNF-alpha expression were increased by E. coli culture supernatants but not bacterial components. Although folate, LPS, IL-6, TNF-alpha, or SCFAs alone did not alter TRPV4 expression, TRPV4 expression following exposure to E. coli culture supernatants was inhibited by butyrate or TNF-alphaR1 inhibitor and increased by p38 inhibitor. Microarray network analysis showed activation of TNF-alpha, cytokines, and NOD signaling. TRPV4 expression was higher in constipated patients from the terminal ileum to the colorectum, and multiple regression analyses showed that low stool frequency, frequency of defecation aids, and duration were associated with TRPV4 expression. Meanwhile, incomplete defecation, time required to defecate, and number of defecation failures per 24 h were associated with increased E. faecalis frequency. CONCLUSIONS: Colon epithelium cells had increased TRPV4 expression upon co-culture with K. oxytoca, E. faecalis, or E. coli supernatants, as well as TNFα-stimulated TNFαR1 expression via a pathway other than p38. Butyrate treatment suppressed this increase. Epithelial TRPV4 expression was increased in constipated patients, suggesting that TRPV4 together with increased frequency of E. faecalis may be involved in the pathogenesis of various constipation symptoms.

  DOI PubMed

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Books and Other Publications 【 display / non-display 】

Books and Other Publications 【 display / non-display 】

• うんこのつまらない話

  三原, 弘

  中外医学社  2020.01 ISBN: 9784498140509

Misc 【 display / non-display 】

Misc 【 display / non-display 】

• 【内科医のための臨床問題集】症例問題 消化管(Question74) 35歳女性 主訴「心窩部痛と満腹感」

  三原 弘

  Medicina ( (株)医学書院 )  61 ( 4 ) 167,176 - 167,176  2024.04

• 【患者さんからよく尋ねられる内科診療のQuestion】(第7章)消化管 [38歳女性,機能性ディスペプシア]胃もたれが続いています.内視鏡は苦手なので,薬だけ処方してもらうことはできないでしょうか?

  三原 弘

  内科 ( (株)南江堂 )  133 ( 4 ) 834 - 836  2024.04

• 【内科医のための臨床問題集】症例問題 消化管(Question73) 70歳女性 主訴「黒色便」

  三原 弘

  Medicina ( (株)医学書院 )  61 ( 4 ) 166,175 - 166,175  2024.04

• 【急性腹症診療ガイドライン】急性腹症診療ガイドライン初版発刊が診療内容と被引用論文に与えた影響

  三原 弘, 前田 重信, 佐藤 格夫, 小豆畑 丈夫, 西舘 敏彦, 辻川 知之, 高山 祐一, 山田 岳史, 山岸 俊介, 佐藤 雄, 貝田 佐知子, 亀井 誠二, 関根 慎一, 井上 明星, 播摩 裕, 狩野 謙一, 和田 慎司, 近藤 浩史, 神野 敦, 井上 祐真, 藤野 紘貴, 真弓 俊彦, 吉田 雅博

  日本腹部救急医学会雑誌 ( (一社)日本腹部救急医学会 )  44 ( 3 ) 489 - 500  2024.03

  　View Summary

  【背景】急性腹症診療ガイドライン(以下,GL2015)評価のため普及度を調査した。【方法】(1)2014年と2022年に日本腹部救急医学会と日本プライマリ・ケア連合学会を対象にアンケート調査を実施した。(2)書籍販売数とMindsアクセス数を解析した。(3)被引用文献のレビューを行った。【結果】(1)回答者の60.9%がGL2015を認識し,64%の診療内容が変化し,周知群でより変化した。2-step methodの実践は乏しく,教育機会は不十分と回答された。2014年に比べ1ヶ所での腹部聴診,打診痛,腹壁圧痛試験,血中プロカルシトニン測定,疼痛管理,腹部大動脈破裂の転院調整が増加し,超音波検査の実施は減じた。(2)書籍は発刊月にもっとも販売され,Mindsは安定してアクセスされていた。(3)GL2015は105編で引用された。【結論】GL2015は普及し,診療行動を変化させたが,改善の必要性も示された。(著者抄録)

• 急性腹症診療ガイドライン改訂の検討 画像

  亀井 誠二, 近藤 浩史, 井上 明星, 和田 慎司, 渡口 真史, 三原 弘, 真弓 俊彦, 吉田 雅博

  日本腹部救急医学会雑誌 ( (一社)日本腹部救急医学会 )  44 ( 2 ) 327 - 327  2024.02

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Research Projects 【 display / non-display 】

Research Projects 【 display / non-display 】

• Research for induction or normalization factor for colonic TRPV4 methylation aiming at curing constipation

  Grant-in-Aid for Scientific Research (C)

  Project Year :

  2019.04

  -

  2022.03

   

  Mihara Hiroshi

  　View Summary

  TRPV4 ion channel, a receptor for stretching and microinflammation, was highly expressed in the epithelium in constipated patients from the small intestine to the rectum and was associated with decreased stool frequency and duration of disease. When colon epithelial cell lines and bacteria were co-cultured, bacteria was divided into those that transiently decreased, those that remained constant, and those that increased TRPV4 expression. ; K.oxytoca, E.faecalis, and E.coli increased TRPV4 expression; the bacteria themselves did not increase the expression, but culture components did. Butyrate, a short-chain fatty acid, and TNF-α inhibitors suppressed increased expression, and constipation symptoms were associated with the ratio of E.faecalis in the colonic mucosa of constipated patients, suggesting that maintaining butyrate-producing bacteria and suppressing the TNF-α pathway may prevent or treat chronic constipation.

• TRP ion channel related to the pathogenic mechanism of small intestinal ulceration induced by NSAIDs use

  Grant-in-Aid for Scientific Research (C)

  Project Year :

  2015.04

  -

  2019.03

   

  Sugiyama Toshiro

  　View Summary

  NSAIDs-induced small intestinal ulcerations are rapidly increasing, however the effective prevention has not been established. As the ulcerations are prevented by the use of broad spectrum antibiotics, the intestinal inflammation by intestinal flora or the metabolites should be attributed. However, the molecular mechanism related to increased permeability of small intestinal epithelial cells by NSAIDs use is not elucidated. By the permeability experiment with small intestinal epithelial cells, NSAIDs accelerated the permeability via the accumulation of 8, 9 EET, which is the metabolites of membrane arachidonic acids and activated TRPV4. The activated TRPV4 is attributed to the increase of permeability. By this assay system, one candidate drug was selected, which showed the inhibition of TRPV4 activation and inhibited the increased permeability of intestinal epithelial cells induced by NSAIDs. Clinical trials are planning to confirm the preventing effect of the candidate.

• Molecular mechanism of luminal pressure reception and ATP release in gastrointestinal epithelium

  Grant-in-Aid for Young Scientists (B)

  Project Year :

  2014.04

  -

  2018.03

   

  Mihara Hiroshi, NISHIZONO Hirofumi, SUGIYAMA Toshiro, TOMINAGA Makoto, TABUCHI Yoshiaki, WATANABE Shiro, UCHIDA Kunitoshi, KOIZUMI Schuichi, Boudaka Ammar, YAMAWAKI Hidemoto, SUZUKI Nobuhiro, Muhammad Jibran Sualeh, KOZAWA Toyomi, Fujinami Haruka, ANDO Takayuki, NANJO Sohachi

  　View Summary

  Approximately 15% of Japanese people have chronic abdominal pain of unknown origin and hypersensitivity to gastrointestinal pressure is one of possible causes. The esophagus senses a tension with mechano-sensitive TRPV4 ion channel and releases bag-like adenosine triphosphate (ATP) using its transporter (VNUT). As a result of the study, TRPV4 and VNUT are present not only in the esophagus but also from the stomach to the rectum, and ATP is released via VNUT by TRPV4 stimulation, including stretch stimuli. Mice lacking TRPV4 have gastric motor abnormality and Helicobacter pylori infection decreases TRPV4 (gene methylation). It has also succeeded in quantifying the TRPV4 stimulating component synthesized in the gastrointestinal tract and so the possibility of quantifying invisible abdominal pain has come out.