Papers - MIHARA Hiroshi

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

Factors, Including Clinical Trial Eligibility, Associated with Induction of Third-Line Treatment for Advanced Gastric Cancer

Takayuki Ando, Ayumu Hosokawa, Miho Sakumura, Iori Motoo, Shinya Kajiura, Katsuhisa Hirano, Takeshi Miwa, Tomotaka Yokota, Naokatsu Nakada, Yuko Ueda, Akira Ueda, Kenichiro Tsukada, Kohei Ogawa, Atsuko Nakaya, Akira Teramoto, Sohachi Nanjo, Hiroshi Mihara, Haruka Fujinami, Tsutomu Fujii, Ichiro Yasuda

Oncology (Switzerland)   101 ( 1 ) 59 - 68  2023.01

　View Summary

Introduction: Third-line chemotherapy has been suggested to improve survival in patients with gastric cancer. This study aimed to identify factors associated with the induction of third-line chemotherapy for advanced gastric cancer, focusing on patient eligibility for clinical trial. Methods: We retrospectively analyzed 335 patients treated for unresectable or recurrent gastric cancer between April 2009 and May 2020. The patients were grouped into those that met the key eligibility criteria for clinical trial (136 patients, 40.6%) and those that did not (199 patients, 59.4%) before receiving first-line chemotherapy. Results: The overall survival (OS) was 16.8 months (95% CI: 14.0-19.6) and 9.3 months (95% CI: 7.8-11.0) in the eligible and ineligible group, respectively. Multivariate analyses to identify the risk factors associated with the induction of third-line chemotherapy revealed ineligibility of clinical trial (OR 1.95; 95% CI: 1.15-3.31), number of metastatic sites (OR 1.99; 95% CI: 1.23-3.22), low albumin concentration (OR 2.24; 95% CI: 1.14-4.38), and a lack of complete or partial response to first-line treatment (OR 1.85; 95% CI: 1.05-3.26). Indeed, in responders to first-line treatment for ineligible patients, the median OS was 17.7 months (95% CI: 10.6-27.9), respectively. Conclusions: Treatment outcomes were different for those eligible for clinical trials and those who were not. However, this study suggested that patients who responded to first-line treatment have more favorable prognosis when treated with salvage chemotherapy, even if they were deemed ineligible for clinical trials.

DOI PubMed

Factors, Including Clinical Trial Eligibility, Associated with Induction of Third-Line Treatment for Advanced Gastric Cancer.

Takayuki Ando, Ayumu Hosokawa, Miho Sakumura, Iori Motoo, Shinya Kajiura, Katsuhisa Hirano, Takeshi Miwa, Tomotaka Yokota, Naokatsu Nakada, Yuko Ueda, Akira Ueda, Kenichiro Tsukada, Kohei Ogawa, Atsuko Nakaya, Akira Teramoto, Sohachi Nanjo, Hiroshi Mihara, Haruka Fujinami, Tsutomu Fujii, Ichiro Yasuda

Oncology   101 ( 1 ) 59 - 68  2023  [International journal]

　View Summary

INTRODUCTION: Third-line chemotherapy has been suggested to improve survival in patients with gastric cancer. This study aimed to identify factors associated with the induction of third-line chemotherapy for advanced gastric cancer, focusing on patient eligibility for clinical trial. METHODS: We retrospectively analyzed 335 patients treated for unresectable or recurrent gastric cancer between April 2009 and May 2020. The patients were grouped into those that met the key eligibility criteria for clinical trial (136 patients, 40.6%) and those that did not (199 patients, 59.4%) before receiving first-line chemotherapy. RESULTS: The overall survival (OS) was 16.8 months (95% CI: 14.0-19.6) and 9.3 months (95% CI: 7.8-11.0) in the eligible and ineligible group, respectively. Multivariate analyses to identify the risk factors associated with the induction of third-line chemotherapy revealed ineligibility of clinical trial (OR 1.95; 95% CI: 1.15-3.31), number of metastatic sites (OR 1.99; 95% CI: 1.23-3.22), low albumin concentration (OR 2.24; 95% CI: 1.14-4.38), and a lack of complete or partial response to first-line treatment (OR 1.85; 95% CI: 1.05-3.26). Indeed, in responders to first-line treatment for ineligible patients, the median OS was 17.7 months (95% CI: 10.6-27.9), respectively. CONCLUSIONS: Treatment outcomes were different for those eligible for clinical trials and those who were not. However, this study suggested that patients who responded to first-line treatment have more favorable prognosis when treated with salvage chemotherapy, even if they were deemed ineligible for clinical trials.

DOI PubMed

EUS下胆道ドレナージルートから胆道鏡下結石破砕術を行った総胆管結石の一例

北村 和紀, 井上 祐真, 圓谷 俊貴, 広島 康久, 松野 潤, 中村 佳史, 林 伸彦, 元尾 伊織, 植田 亮, 南條 宗八, 三原 弘, 梶浦 新也, 安藤 孝将, 藤浪 斗, 田尻 和人, 安田 一朗

ENDOSCOPIC FORUM for digestive disease ( (株)癌と化学療法社 )  38 ( 2 ) 177 - 177  2022.12

【診療ガイドラインに基づいた胆膵疾患の診断】胆嚢結石・総胆管結石の診断

井上 祐真, 安田 一朗, 圓谷 俊貴, 松野 潤, 広島 康久, 中村 佳史, 林 伸彦, 元尾 伊織, 植田 亮, 南條 宗八, 三原 弘, 梶浦 新也, 安藤 孝将, 藤浪 斗, 田尻 和人

消化器クリニカルアップデート ( 医学図書出版(株) )  4 ( 1 ) 18 - 22  2022.10

　View Summary

臨床の場で遭遇することの多い疾患である胆嚢結石,総胆管結石の診断について診療ガイドラインに基づいて概説した。胆嚢結石は診断そのものに迷うことは少ないが,急性胆嚢炎や総胆管結石の合併を見逃さないように検査を進める。総胆管結石については非石灰化結石や微小結石などで見落としやすい症例がある。臨床症状・所見や血液検査などから存在が疑われる場合には,USやCTのみでなく適宜MRIやEUSも組み合わせて診断を行う。(著者抄録)

胆道狭窄鑑別診断におけるPOCS下生検の現時点での位置づけ

松野 潤, 林 伸彦, 安田 一朗, 中村 佳史, 井上 祐真, 元尾 伊織, 南條 宗八, 三原 弘, 梶浦 新也, 安藤 孝将, 藤浪 斗, 田尻 和人

胆道 ( (一社)日本胆道学会 )  36 ( 3 ) 382 - 382  2022.09

Protein-losing Enteropathy Complicated with Primary Intestinal Follicular Lymphoma.

Tomoki Minemura, Shohei Kikuchi, Hiroshi Mihara, Yusuke Kamihara, Akinori Wada, Mayo Fuchino, Sohachi Nanjo, Akira Noguchi, Takashi Minamisaka, Jun Murakami, Ichiro Yasuda, Tsutomu Sato

Internal medicine (Tokyo, Japan)   61 ( 13 ) 2051 - 2055  2022.07  [Domestic journal]

　View Summary

Protein-losing enteropathy (PLE) is a rare syndrome characterized by hypoproteinemia due to gastrointestinal (GI) protein loss. Primary intestinal follicular lymphoma (PIFL), a specific variant of follicular lymphoma with essential only GI involvement, has not been reported as an etiology of PLE. We herein report a case of PLE complicated with PIFL that was successfully treated with rituximab, resulting in rapid improvement of PLE and a complete response of PIFL. Macroscopic findings of ulcerative lesions with diffuse involvement, which were precisely described by capsule and double-balloon enteroscopy at the diagnosis, also improved following the treatment. This case provides a clue suggesting factors that promote PLE in PIFL.

DOI PubMed

自作過敏性腸症候群検出用大腸内視鏡画像AIモデルにおける有症状者検出精度の検討

田畑 和久, 三原 弘, 安藤 孝将, 元尾 伊織, 高橋 冴子, 寺本 彰, 作村 美穂, 南條 宗八, 藤浪 斗, 梶浦 新也, 安田 一朗

ENDOSCOPIC FORUM for digestive disease ( (株)癌と化学療法社 )  38 ( 1 ) 96 - 96  2022.07

上部消化管内視鏡撮影部位のAI判定とスクリーニング内視鏡への応用

藤浪 斗, 三原 弘, 高橋 冴子, 植田 優子, 作村 美穂, 元尾 伊織, 寺本 彰, 南條 宗八, 安藤 孝将, 梶浦 新也, 安田 一朗

ENDOSCOPIC FORUM for digestive disease ( (株)癌と化学療法社 )  38 ( 1 ) 99 - 99  2022.07

ERCP胆管挿管困難例に対する当院のストラテジーとEUS-rendezvous法の有用性

北村 和紀, 林 伸彦, 松野 潤, 中村 佳史, 井上 祐真, 元尾 伊織, 南條 宗八, 三原 弘, 梶浦 新也, 安藤 孝将, 藤浪 斗, 田尻 和人, 安田 一朗

ENDOSCOPIC FORUM for digestive disease ( (株)癌と化学療法社 )  38 ( 1 ) 98 - 98  2022.07

膵神経内分泌腫瘍の術後再発病変に対して術前EUS-guided fine needle tattooing(EUS-FNT)が有効であった1例

中尾 萌音, 林 伸彦, 松野 潤, 中村 佳史, 井上 祐真, 元尾 伊織, 南條 宗八, 三原 弘, 梶浦 新也, 安藤 孝将, 藤浪 斗, 田尻 和人, 平野 勝久, 渋谷 和人, 藤井 努, 安田 一朗

日本消化器病学会北陸支部例会プログラム・抄録集 ( 日本消化器病学会-北陸支部 )  133回   37 - 37  2022.06

Borderline resectable膵癌における胆道ドレナージの化学療法と手術に対する影響について

中村 佳史, 林 伸彦, 安田 一朗, 松野 潤, 井上 祐真, 元尾 伊織, 南條 宗八, 三原 弘, 梶浦 新也, 安藤 孝将, 藤浪 斗, 田尻 和人

Gastroenterological Endoscopy ( (一社)日本消化器内視鏡学会 )  64 ( Suppl.1 ) 865 - 865  2022.04

【エキスパートが教える最新胆膵内視鏡診断・治療】ERCP関連手技 急性胆嚢炎に対する経乳頭的ドレナージの基本と応用【動画付】

井上 祐真, 安田 一朗, 松野 潤, 中村 佳史, 林 伸彦, 元尾 伊織, 南條 宗八, 三原 弘, 梶浦 新也, 安藤 孝将, 藤浪 斗, 田尻 和人

胆と膵 ( 医学図書出版(株) )  43 ( 4 ) 313 - 318  2022.04

　View Summary

中等症以上の急性胆嚢炎症例で、緊急あるいは早期の手術が難しく、さらに抗血栓薬内服中などで経皮経肝胆嚢ドレナージ(percutaneous transhepatic gallbladder drainage:PTGBD)が不適の症例に対しては、胆膵内視鏡のエキスパートのいる施設では、内視鏡的経乳頭的胆嚢ドレナージを選択することができる。その手技成功率は、PTGBDに比べるとやや劣るものの、臨床的奏効率は同等とされている。しかし、膵炎以外にもガイドワイヤによる胆嚢管穿孔や胆汁瘻といった偶発症が起こりうるため、手技を安全かつ確実に行うためには、準備をしっかり整えて、処置具や手技のコツを十分に理解したうえで手技に臨む必要がある。(著者抄録)

胆管空腸吻合術後肝内結石に対する内視鏡治療

井上 祐真, 林 伸彦, 安田 一朗, 松野 潤, 中村 佳史, 元尾 伊織, 南條 宗八, 三原 弘, 梶浦 新也, 安藤 孝将, 藤浪 斗, 田尻 和人

日本消化器病学会雑誌 ( (一財)日本消化器病学会 )  119 ( 臨増総会 ) A370 - A370  2022.03

【診療ガイドライン改訂後の膵炎診療】胆道狭窄に対する治療 プラスチックステントor FCSEMS

中村 佳史, 安田 一朗, 松野 潤, 井上 祐真, 林 伸彦, 元尾 伊織, 南條 宗八, 三原 弘, 梶浦 新也, 安藤 孝将, 藤浪 斗, 田尻 和人

肝胆膵 ( (株)アークメディア )  84 ( 3 ) 361 - 367  2022.03

Evidence-based clinical practice guidelines for functional dyspepsia 2021.

Hiroto Miwa, Akihito Nagahara, Akihiro Asakawa, Makoto Arai, Tadayuki Oshima, Kunio Kasugai, Kazuhiro Kamada, Hidekazu Suzuki, Fumio Tanaka, Kazunari Tominaga, Seiji Futagami, Mariko Hojo, Hiroshi Mihara, Kazuhide Higuchi, Motoyasu Kusano, Tomiyasu Arisawa, Mototsugu Kato, Takashi Joh, Satoshi Mochida, Nobuyuki Enomoto, Tooru Shimosegawa, Kazuhiko Koike

Journal of gastroenterology   57 ( 2 ) 47 - 61  2022.02  [Domestic journal]

　View Summary

BACKGROUND: Functional dyspepsia (FD) is a disorder that presents with chronic dyspepsia, which is not only very common but also highly affects quality of life of the patients. In Japan, FD became a disease name for national insurance in 2013, and has been gradually recognized, though still not satisfactory. Following the revision policy of Japanese Society of Gastroenterology (JSGE), the first version of FD guideline was revised this time. METHOD: Like previously, the guideline was created by the GRADE (grading of recommendations assessment, development and evaluation) system, but this time, the questions were classified to background questions (BQs, 24 already clarified issues), future research questions (FRQs, 9 issues cannot be addressed with insufficient evidence), and 7 clinical questions that are mainly associated with treatment. RESULTS AND CONCLUSION: These revised guidelines have two major features. The first is the new position of endoscopy in the flow of FD diagnosis. While endoscopy was required to all cases for diagnosis of FD, the revised guidelines specify the necessity of endoscopy only in cases where organic disease is suspected. The second feature is that the drug treatment options have been changed to reflect the latest evidence. The first-line treatment includes gastric acid-secretion inhibitors, acetylcholinesterase (AChE) inhibitors (acotiamide, a prokinetic agent), and Japanese herbal medicine (rikkunshito). The second-line treatment includes anxiolytics /antidepressant, prokinetics other than acotiamide (dopamine receptor antagonists, 5-HT4 receptor agonists), and Japanese herbal medicines other than rikkunshito. The patients not responding to these treatment regimens are regarded as refractory FD.

DOI PubMed