Updated on 2024/12/04

Information

 

写真a

 
YOSHIMARU KOICHIRO
 
Organization
Kyushu University Hospital Pediatric Surgery Lecturer
Title
Lecturer
Tel
0926425573
Profile
平成29年度は九州大学大学院医学研究院 小児外科学分野助教として、臨床・研究・教育を担当した。
External link

Degree

  • bachelor

Research Interests・Research Keywords

  • Research theme:Regenerative Therapy

    Keyword:Hirschsprung's disease

    Research period: 2013.4 - 2018.6

Awards

  • 2016年 第43回日本小児栄養消化器肝臓学会 優秀演題賞

    2016.10  

  • 2016年 第28回日本小腸移植研究会 研究奨励賞

    2016.3  

  • 2013年 小児科臨床賞 (雑誌「小児科臨床」)

    2013.3  

  • 2012年 大分県立病院 ヤング・アウォード

    2012.6  

Papers

  • Cutting-edge regenerative therapy for Hirschsprung disease and its allied disorders

    Yoshimaru, K; Matsuura, T; Uchida, Y; Sonoda, S; Maeda, S; Kajihara, K; Kawano, Y; Shirai, T; Toriigahara, Y; Kalim, AS; Zhang, XY; Takahashi, Y; Kawakubo, N; Nagata, K; Yamaza, H; Yamaza, T; Taguchi, T; Tajiri, T

    SURGERY TODAY   54 ( 9 )   977 - 994   2024.9   ISSN:0941-1291 eISSN:1436-2813

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    Language:English   Publisher:Surgery Today  

    Hirschsprung disease (HSCR) and its associated disorders (AD-HSCR) often result in severe hypoperistalsis caused by enteric neuropathy, mesenchymopathy, and myopathy. Notably, HSCR involving the small intestine, isolated hypoganglionosis, chronic idiopathic intestinal pseudo-obstruction, and megacystis-microcolon-intestinal hypoperistalsis syndrome carry a poor prognosis. Ultimately, small-bowel transplantation (SBTx) is necessary for refractory cases, but it is highly invasive and outcomes are less than optimal, despite advances in surgical techniques and management. Thus, regenerative therapy has come to light as a potential form of treatment involving regeneration of the enteric nervous system, mesenchyme, and smooth muscle in affected areas. We review the cutting-edge regenerative therapeutic approaches for managing HSCR and AD-HSCR, including the use of enteric nervous system progenitor cells, embryonic stem cells, induced pluripotent stem cells, and mesenchymal stem cells as cell sources, the recipient intestine's microenvironment, and transplantation methods. Perspectives on the future of these treatments are also discussed.

    DOI: 10.1007/s00595-023-02741-6

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  • Multiple endocrine neoplasia type 2B diagnosed after small intestinal volvulus with progressive megacolon in an adolescent

    Sakai, Y; Nakayama, Y; Kurasawa, S; Sado, T; Kato, S; Hidaka, N; Takamizawa, S; Yoshizawa, K; Yoshimaru, K; Taguchi, T

    CLINICAL JOURNAL OF GASTROENTEROLOGY   17 ( 4 )   640 - 646   2024.8   ISSN:1865-7257 eISSN:1865-7265

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    Language:English   Publisher:Clinical Journal of Gastroenterology  

    Multiple endocrine neoplasia type 2B is a rare autosomal dominant disease characterized by the presence of medullary thyroid carcinoma, pheochromocytoma, Marfan-like fatigue, a peculiar face with thickening of the lips, mucosal neuromas on the lips and tongue, and gastrointestinal phenomena. Most patients harbor pathological variants of the RET gene. Herein, we present the first case of a 14 year-old boy who experienced small intestinal volvulus along with a megacolon, and he was diagnosed with multiple endocrine neoplasia type 2B. The patient complained of constipation since he was 2 years old and slowly progressive abdominal distension at school age. At 14 years of age, he presented with remarkable megacolon mimicking Hirschsprung’s disease and complicated with small intestinal volvulus. The volvulus was successfully repaired, and the particularly dilated transverse colon was resected following a rectal biopsy. Histopathological evaluation of the resected transverse colon revealed to be compatible with ganglioneuromatosis. After emergency surgery, the patient was diagnosed with multiple endocrine neoplasia type 2B with medullary thyroid carcinoma, and a de novo variant of RET was confirmed. Gastroenterologists should consider it when treating patients with constipation, especially those with megacolon. Therefore, timely diagnosis may lead to appropriate treatment of medullary thyroid carcinoma and improve mortality.

    DOI: 10.1007/s12328-024-01979-y

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  • Multiple endocrine neoplasia type 2B diagnosed after small intestinal volvulus with progressive megacolon in an adolescent(タイトル和訳中)

    Sakai Yusuke, Nakayama Yoshiko, Kurasawa Shingo, Sado Tomomitsu, Kato Sawako, Hidaka Nao, Takamizawa Shigeru, Yoshizawa Katsumi, Yoshimaru Koichiro, Taguchi Tomoaki

    Clinical Journal of Gastroenterology   17 ( 4 )   640 - 646   2024.8   ISSN:1865-7257

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    Language:English   Publisher:シュプリンガー・ジャパン(株)  

  • A Novel Objective Pathologic Criterion for Isolated Hypoganglionosis

    Tamaki, A; Kohashi, K; Yoshimaru, K; Hino, Y; Hamada, H; Kawakubo, N; Taguchi, T; Tajiri, T; Oda, Y

    AMERICAN JOURNAL OF SURGICAL PATHOLOGY   48 ( 7 )   803 - 812   2024.7   ISSN:0147-5185 eISSN:1532-0979

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    Language:English   Publisher:American Journal of Surgical Pathology  

    Isolated hypoganglionosis (IHG) is histologically characterized by small numbers of myenteric ganglion cells and small myenteric ganglia; however, no numerical diagnostic criteria for IHG have been established. Therefore, this study aimed to develop quantitative pathologic criteria for IHG. We evaluated 160 resected intestinal tissue specimens from 29 pediatric autopsies and 10 IHG cases. These specimens were obtained from the jejunum, ileum, ascending colon, transverse colon, and rectum. Morphologic features of the myenteric ganglion cells and myenteric ganglia were quantified and analyzed in digitized HuC/HuD-immunostained and CD56-immunostained sections, respectively. Quantitative criteria were developed with a scoring system that used parameters with the area under the receiver operating characteristic curve (AUC) values > 0.7 and sensitivity and specificity exceeding 70%. The selected parameters were the number of myenteric ganglion cells per cm and the number of myenteric ganglia with an area > 2500 µm2per cm. The score for each parameter ranged from −1 to 2, and the total score of the scoring system ranged from −2 to 4. With a cutoff value of ≥ 2 (AUC, 0.98; 95% CI: 0.96-1.00), the scoring system had a sensitivity of 96% (95% CI: 0.82-1.00) and a specificity of 99% (95% CI: 0.95-1.00). We devised a novel pathologic criterion based on the quantification of the number of myenteric ganglion cells and ganglia. Furthermore, this criterion showed high diagnostic accuracy and could lead to a definitive diagnosis of IHG in clinical practice.

    DOI: 10.1097/PAS.0000000000002243

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  • Chronic intestinal pseudo-obstruction due to adult-onset acquired isolated hypoganglionosis with muscular atrophy in the small intestine: a case report and review of literature

    Tayama, S; Furuta, Y; Morito, M; Naoe, H; Yoshii, D; Uchida, Y; Yoshimaru, K; Miyamoto, Y; Taguchi, T; Tanaka, Y

    CLINICAL JOURNAL OF GASTROENTEROLOGY   17 ( 2 )   244 - 252   2024.4   ISSN:1865-7257 eISSN:1865-7265

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    Language:English   Publisher:Clinical Journal of Gastroenterology  

    Background: Chronic intestinal pseudo-obstruction (CIPO) is a rare intestinal disorder characterized by impaired propulsion of the digestive tract and associated with symptoms of intestinal obstruction, despite the absence of obstructive lesions. CIPO includes several diseases. However, definitive diagnosis of its etiology is difficult only with symptoms or imaging findings. Case presentation: A 56-year-old man was referred to our hospital due to a 3-year history of continuous abdominal distention. Imaging, including computed tomography of the abdomen, and endoscopy revealed marked dilatation of the entire small intestine without any obstruction point. Therefore, he was diagnosed with CIPO. Since medical therapy didn’t improve his symptoms, enterostomy and percutaneous endoscopic gastro-jejunostomy were performed. These procedures improved abdominal symptoms. However, he required home central venous nutrition due to dehydration. The pathological findings of full-thickness biopsies of the small intestine taken during surgery revealed decreased number and degeneration of ganglion cells in the normal plexus. These findings led to a final diagnosis of CIPO due to acquired isolated hypoganglionosis (AIHG). Conclusions: Here, we report the case of a patient with CIPO secondary to adult-onset AIHG of the small intestine. Since AIHG cannot be solely diagnosed using clinical findings, biopsy is important for its diagnosis.

    DOI: 10.1007/s12328-023-01902-x

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  • 小腸の筋萎縮を合併した成人発症後天性孤立性低ガングリオン症による慢性腸管偽閉塞症 症例報告と文献のレビュー(Chronic intestinal pseudo-obstruction due to adult-onset acquired isolated hypoganglionosis with muscular atrophy in the small intestine: a case report and review of literature)

    Tayama Sayoko, Furuta Yoki, Morito Miyuki, Naoe Hideaki, Yoshii Daiki, Uchida Yasuyuki, Yoshimaru Koichiro, Miyamoto Yuji, Taguchi Tomoaki, Tanaka Yasuhito

    Clinical Journal of Gastroenterology   17 ( 2 )   244 - 252   2024.4   ISSN:1865-7257

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    慢性腸管偽閉塞症(CIPO)は稀な疾患で、消化管の内容物進行不全と、閉塞性病変がないにもかかわらず腸閉塞症状を伴うことがその特徴である。CIPOには様々な疾患が含まれるが、その原因の確定診断は症状や画像診断からは困難である。症例は56歳男性で、3年前からの腹部膨満のため紹介受診となった。腹部CTを含む画像診断および内視鏡検査で著明な全小腸の拡張が認められたが、閉塞機転は認められなかった。以上より、CIPOと診断した。内科的治療によっては症状が改善しなかったため、腸瘻造設および内視鏡的胃空腸吻合を行った。これら処置により腹部症状は改善したが、脱水のため家庭での中心静脈栄養が必要となった。手術中に採取した小腸全層生検の組織学的検査で、正常な嚢内におけるガングリオン細胞の減少と変性が認められた。これらの所見より、後天性孤立性低ガングリオン症(AIHG)によるCIPOと確定診断された。本稿では、小腸における成人発症AIHGに続発したCIPO症例を報告した。AIHGは臨床所見のみからは診断できないので、その診断において生検が重要であることが示された。

  • 先天性胆道拡張症術後の小児肝管空腸吻合部狭窄に対する新規アプ ローチ法

    髙橋 良彰, 松浦 俊治, 藤森 尚, 吉丸 耕一朗, 前田 翔平, 内田 康幸, 田尻 達郎

    日本膵・胆管合流異常研究会プロシーディングス   47 ( 0 )   36 - 37   2024   ISSN:18834116 eISSN:24353140

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    Language:Japanese   Publisher:日本膵・胆管合流異常研究会  

    DOI: 10.34410/jspbm.47.0_36

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  • The advantages of duct-to-duct biliary reconstruction in pediatric living donor liver transplantation

    Toriigahara, Y; Matsuura, T; Yanagi, Y; Yoshimaru, K; Uchida, Y; Kajihara, K; Shirai, T; Kawano, Y; Kawakubo, N; Nagata, K; Tajiri, T

    PEDIATRIC SURGERY INTERNATIONAL   39 ( 1 )   286   2023.11   ISSN:0179-0358 eISSN:1437-9813

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    Language:English   Publisher:Pediatric Surgery International  

    Background/Purpose: Whether Roux-en-Y hepatic jejunectomy (HJ) or duct-to-duct biliary reconstruction (DD) is more useful in pediatric living donor liver transplantation has not yet been fully investigated. Therefore, to assess the feasibility and safety of DD, we compared the surgical outcomes of DD to HJ. Methods: We divided 45 patients, excluding those with biliary atresia, into the DD group (n = 20) and the HJ group (n = 25), according to the type of biliary reconstruction they received. Results: The 5-year survival rates (DD vs. HJ = 79.7% vs. 83.6%, p = 0.70) and the incidence of biliary complications, including bile leakage and stricture (DD vs. HJ = 1 [5.0%] vs. 1 [4.0%], p = 0.87) were not significantly different between the groups. However, intestinal complications, including bowel perforation or ileus, were significantly common in the HJ group (9/25 [36.0%]) than in the DD group (1/20 [5.0%]; p = 0.01). The three patients in the HJ group with intestinal perforation all suffered perforation at the anastomosed site in the Roux-en-Y procedure. The subgroup analysis showed the non-inferiority of DD to HJ for biliary or intestinal complications in patients weighting < 10 kg. Conclusion: With a proper selection of cases, DD should be a safe method for biliary reconstruction in pediatric recipients with little risk of biliary complications equivalent to HJ and a reduced risk of intestinal complications.

    DOI: 10.1007/s00383-023-05568-x

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  • The Factors Associated with the Selection of Early Excision Surgery for Congenital Biliary Dilatation with a Prenatal Diagnosis

    Shirai, T; Matsuura, T; Tamaki, A; Kajihara, K; Uchida, Y; Kawano, Y; Toriigahara, Y; Obata, S; Kawakubo, N; Yoshimaru, K; Yanagi, Y; Nagata, K; Kohashi, K; Oda, Y; Tajiri, T

    JOURNAL OF PEDIATRIC SURGERY   58 ( 7 )   1246 - 1251   2023.7   ISSN:0022-3468 eISSN:1531-5037

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    Language:English   Publisher:Journal of Pediatric Surgery  

    Purpose: The aim of this study was to clarify the appropriate management after birth for congenital biliary dilatation (CBD, choledochal cyst) patients with a prenatal diagnosis. Method: Thirteen patients with a prenatal diagnosis of CBD who underwent liver biopsy during excision surgery were divided into two groups and retrospectively analyzed: group A, with liver fibrosis above F1 and group B, without liver fibrosis. Results: Excision surgery was performed earlier in group A (F1–F2), at a median of 106 days old (p = 0.04). There were significant differences between the two groups in the presence symptoms and sludge, the cyst size, and the level of serum bilirubin and gamma glutamyl transpeptidase (GGT) before excision surgery (p < 0.05). Especially, in group A, prolonged serum GGT elevation and larger cysts were consistently observed from birth. The cut-off values of predictions for the presence of liver fibrosis in serum GGT and cyst size were 319 U/l and 45 mm. No significant differences were observed in the postoperative liver function or complications during the follow-up period. Conclusion: In patients with prenatally diagnosed CBD, the postnatal serial changes of serum GGT values and cyst size, in addition to symptoms, could help to prevent progressive liver fibrosis. Level of Evidence: Ⅲ. Type of Study: Treatment Study.

    DOI: 10.1016/j.jpedsurg.2023.01.050

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  • The Volume of Intestinal Decompression can Predict the Necessity of Surgical Intervention for Adhesive Small Bowel Obstruction

    Kono, J; Yoshimaru, K; Kondo, T; Takahashi, Y; Toriigahara, Y; Fukuta, A; Obata, S; Kawakubo, N; Nagata, K; Matsuura, T; Tajiri, T

    JOURNAL OF PEDIATRIC SURGERY   58 ( 7 )   1252 - 1257   2023.7   ISSN:0022-3468 eISSN:1531-5037

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    Language:English   Publisher:Journal of Pediatric Surgery  

    Background: There is no standard timing for switching to surgical management for children with adhesive small bowel obstruction (ASBO) who initially receive conservative treatment. We hypothesized that an increased gastrointestinal drainage volume may indicate the need for surgical intervention. Methods: The study population included 150 episodes in the patients less than 20 years of age who received treatment for ASBO in our department from January 2008 to August 2019. Patients were divided into two groups: the successful conservative treatment group (CT) and the eventual surgical treatment group (ST). Following the analysis of all episodes (Study 1), we limited our analysis to only first ASBO episodes (Study 2). We retrospectively reviewed their medical records. Results: There were statistically significant differences in the volume on the 2nd day in both Study 1 (9.1 ml/kg vs. 18.7 ml/kg; p < 0.01) and study 2 (8.1 ml/kg vs. 19.7 ml/kg; p < 0.01). The cut-off value was the same for both Study 1 and Study 2 (11.7 ml/kg). Conclusions: The gastrointestinal drainage volume on the 2nd day in ST was significantly larger than that in CT. Accordingly, we considered that the drainage volume may predict eventual surgical intervention for children with ASBO who initially receive conservative treatment. Level of evidence: Level IV.

    DOI: 10.1016/j.jpedsurg.2023.01.052

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  • Massive bleeding from a duodenal ulcer in a child with influenza infection: A case report of endoscopic findings

    Ishimoto, K; Yoshimaru, K; Uchida, Y; Kajihara, K; Obata, S; Matsuura, T; Tajiri, T

    DEN OPEN   3 ( 1 )   e155   2023.4   ISSN:2692-4609

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    Language:English   Publisher:DEN Open  

    Gastrointestinal bleeding or perforation following influenza infection is rare. We encountered a pediatric case of hemorrhagic duodenal ulcer following influenza A infection. The patient was a 1-year and 4-month-old boy who was diagnosed with influenza A infection and treated with laninamivir octanoate. After inhalation, he had diarrhea, poor appetite, and melena. The next day, he had hematochezia and developed hemorrhagic shock. Contrast-enhanced computed tomography showed extravasation in the descending part of the duodenum. Esophagogastroduodenoscopy revealed spurting bleeding from a Dieulafoy's lesion on the oral side of the major papilla, and he underwent hemostasis by clipping. From the bulb to the descending part of the duodenum, the mucosa appeared atrophic with spotty redness on the circular folds and multiple and irregularly shaped erosions. Almost all mucosal lesions had healed by the eighth day, and he was monitored as an outpatient for more than one year without re-bleeding. Intestinal ischemia, viral invasion, and drug reaction of laninamivir octanoate may be involved in duodenal mucosal injury. Acute duodenal ulcers may occur in children with influenza infection, especially young children.

    DOI: 10.1002/deo2.155

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  • 内視鏡的電気凝固による梨状窩嚢胞および瘻孔の治療(Successful management of pyriform sinus cyst and fistula using endoscopic electrocauterization)

    Kawakubo Naonori, Obata Satoshi, Yoshimaru Koichiro, Miyoshi Kina, Izaki Tomoko, Tajiri Tatsuro

    DEN Open   3 ( 1 )   1 of 5 - 5 of 5   2023.4

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    Language:English   Publisher:John Wiley & Sons Australia, Ltd  

    梨状窩嚢胞(PSC)および梨状窩瘻孔(PSF)に対して、電気凝固療法を施行した症例を後方視的に検討した。内部開口部は全身麻酔下で内視鏡により同定し、DualKnifeJにより焼灼した。3例のPSCおよび3例のPSFに対して加療を行い、処置後の経過は全例良好であった。頸部痛がみられた症例はなく、反回神経麻痺を呈した症例も認めなかった。6例中5例(83%)で初回焼灼により開口部が閉鎖され、1例(16.6%)で複数回の処置が必要であった。経過観察期間(中央値1年)中に、再発は認められなかった。新生児PSCに対しても電気凝固は有効であった。大規模臨床試験が必要と考えられた。

  • インフルエンザ感染小児に認められた十二指腸潰瘍からの大量出血 内視鏡所見の症例報告(Massive bleeding from a doudenal ulcer in a child with influenza infection: A case report of endoscopic findings)

    Ishimoto Kenta, Yoshimaru Koichiro, Uchida Yasuyuki, Kajihara Keisuke, Obata Satoshi, Matsuura Toshiharu, Tajiri Tatsuro

    DEN Open   3 ( 1 )   1 of 5 - 5 of 5   2023.4

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    症例は1歳4ヵ月男児で、A型インフルエンザに罹患し、ラニナミビルオクタン酸を投与された。吸入後、下痢、食欲低下、黒色便が出現し、翌日には下血が認められ、出血性ショックに陥った。造影CT検査で、十二指腸下行脚からの造影剤の血管外漏出が認められた。上部消化管内視鏡検査で、十二指腸の主乳頭近位のデュラフォイ病変からの噴出性出血が確認され、クリッピングによる止血を行った。十二指腸球部から下行脚にかけて、粘膜は萎縮性で、輪状襞上に点状発赤が認められ、多発する不整形糜爛を伴っていた。第8病日にはほぼすべての粘膜病変が治癒した。その後1年以上外来で経過観察したが、再出血は認められなかった。

  • Successful management of pyriform sinus cyst and fistula using endoscopic electrocauterization

    Kawakubo, N; Obata, S; Yoshimaru, K; Miyoshi, K; Izaki, T; Tajiri, T

    DEN OPEN   3 ( 1 )   e128   2023.4   ISSN:2692-4609

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    Objectives: Pyriform sinus cyst (PSC) and pyriform sinus fistula (PSF) is a rare congenital malformation that arises from the third or fourth branchial structure. In our study, we describe the safety and the utility of endoscopic electrocauterization against PSC/PSF. Methods: We retrospectively reviewed the records of patients who underwent endoscopic electrocauterization for PSC/PSF at our hospital. The internal opening of the fistula was identified under general anesthesia using a flexible endoscope (XQ-260 or H-290; Olympus, Tokyo, Japan), and the DualKnifeJ (KD-655L; Olympus) was used to ablate the internal opening. Results: We experienced three PSF and three PSC patients. The postoperative course was uneventful in all cases. The patients declared no pain in the neck, and there were no cases showing recurrent nerve paralysis. Five in six cases (83%), the closure of fistula was archived in the first cauterization. One case (16.6%) required repeated cauterization. No recurrence was found during the follow-up period (median: 1 year) in any cases. Conclusions: Owing to its rarity in neonates, the diagnosis and treatment of PSC remains complicated and not clearly described. Complete removal of the fistula and the cyst with or without affected thyroid tissue was previously the most commonly used treatment. From our experience, we believe that endoscopic electrocauterization can be the first choice not only for PSF but also for neonatal PSC. In conclusion, endoscopic electrocauterization is feasible even for neonatal PSC. Further investigations including multicenter analyses are needed.

    DOI: 10.1002/deo2.128

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  • COVID19 detection in appendix of acute appendicitis in a child: a case report and review of literature

    Kono, J; Yoshimaru, K; Matsuura, T; Tamaki, A; Takemoto, J; Matsumoto, S; Hotta, T; Kohashi, K; Oda, Y; Tajiri, T

    SURGICAL CASE REPORTS   9 ( 1 )   37   2023.3   ISSN:2198-7793

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  • 急性虫垂炎の小児患者の虫垂におけるCOVID-19の検出 症例報告と文献レビュー(COVID19 detection in appendix of acute appendicitis in a child: a case report and review of literature)

    Kono Jun, Yoshimaru Koichiro, Matsuura Toshiharu, Tamaki Akihiko, Takemoto Junkichi, Matsumoto Shinya, Hotta Taeko, Kohashi Kenichi, Oda Yoshinao, Tajiri Tatsuro

    Surgical Case Reports   9   1 of 7 - 7 of 7   2023.3

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    症例は7歳男児。父親に新型コロナウイルス感染症(SARS-CoV-2)の既往があった。2日前からの下腹部痛のため救急医療部へ搬送された。搬送時の体温は39.1度で、血圧は102/61mmHg、心拍数は101bpmであった。受診時に腹部膨満を認め、下腹部にびまん性の圧痛を認めた。臨床検査で白血球数は9900/μL、C反応性蛋白は12.3mg/dLであった。造影CTで腫大した虫垂を認めた。虫垂根部に異常はなく、虫垂内部に糞石と穿孔を認めた。穿孔性虫垂炎と診断し、腹腔鏡下虫垂切除術を施行した。サージカルマスク、N95マスク、フェイスシールド等の個人防護具を装着し、緊急手術を施行した。手術時間は93分であった。術後の培養検査で大腸菌、Streptococcus constellatus、Bacteroides fragilisが検出された。抗菌剤をタゾバクタム/ピペラシリンからメロペネムとメトロニダゾールに変更した。切除標本を用いたリアルタイムPCR法でSARS-CoV-2に陽性を認めた。術後経過は良好で、呼吸器症状もなく、17日後に退院となった。

  • Surgical outcome and prognosis of pediatric solid-pseudopapillary neoplasm

    Kawakubo, N; Takemoto, J; Irie, K; Souzaki, R; Maniwa, J; Obata, S; Yoshimaru, K; Nagata, K; Miyata, J; Matsuura, T; Tajiri, T

    PEDIATRICS INTERNATIONAL   65 ( 1 )   e15666   2023.1   ISSN:1328-8067 eISSN:1442-200X

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    Language:English   Publisher:Pediatrics International  

    Background: The aim of this study was to clarify the characteristics and outcomes of pediatric patients with solid pseudopapillary neoplasms (SPNs) who underwent pancreatectomy. Methods: Pediatric patients with SPNs who underwent pancreatectomy at our institution between 1995 and 2020 were included in the study. Results: During the period under review, 12 patients underwent pancreatectomy for SPNs (median age: 10 years; range: 6–15 years). The surgical procedures included pancreatoduodenectomy (n = 2; 16.6%), distal pancreatectomy (n = 3; 25%), and enucleation (n = 7; 58.3%). The most common postoperative complication was postoperative pancreatic fistula (n = 6; 50%). Patients who underwent enucleation tended to have higher postoperative complication rates compared with those who underwent other procedures. All patients were alive without recurrence at the end of the study period. Conclusions: SPN is associated with a good prognosis, regardless of the surgical procedure. If surgeons select enucleation for pediatric SPNs, they should bear in mind that it is associated with a higher complication rate.

    DOI: 10.1111/ped.15666

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  • 小児solid-pseudopapillary neoplasmの手術アウトカムと予後(Surgical outcome and prognosis of pediatric solid-pseudopapillary neoplasm)

    Kawakubo Naonori, Takemoto Junkichi, Irie Keiko, Souzaki Ryota, Maniwa Junnosuke, Obata Satoshi, Yoshimaru Koichiro, Nagata Kouji, Miyata Junko, Matsuura Toshiharu, Tajiri Tatsuro

    Pediatrics International   65 ( 1 )   1 of 4 - 4 of 4   2023   ISSN:1328-8067

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    1995~2020年に膵切除術が施行されたsolid-pseudopapillary neoplasm(SPN)児12例(年齢6~15歳)の特徴とアウトカムについて検討した。術式は膵頭十二指腸切除術(2例;16.6%)、膵体尾部切除術(3例;25%)、膵腫瘍核出術(7例;58.3%)であった。術後合併症としては術後膵液瘻が最も多かった(6例;50%)。膵腫瘍核出術を施行した患児では他の術式の患児に比べ、術後30日までの合併症発生率が高い傾向を示し(85% vs 20%、p=0.04)、CT画像でトレースした膵切除断端外縁長が有意に長かった(34±10mm vs 10±2mm、p<0.01)。研究期間終了時点で全例が再発をみることなく生存している。

  • 特集 巨大臍帯ヘルニア治療update 臍帯ヘルニア治療の最近の問題点と長期経過 長期フォロー

    永田 公二, 福田 篤久, 近藤 琢也, 河野 淳, 鳥井ケ原 幸博, 白井 剛, 川久保 尚徳, 吉丸 耕一朗, 松浦 俊治, 田尻 達郎

    小児外科   54 ( 12 )   1237 - 1243   2022.12   ISSN:03856313

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    DOI: 10.24479/ps.0000000319

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  • "A salvage technique using a fibrous sheath to avoid the loss of the central veins in cases of pediatric intestinal failure"

    Kondo, T; Nagata, K; Jimbo, T; Kono, J; Kawakubo, N; Obata, S; Yoshimaru, K; Miyoshi, K; Esumi, G; Matsuura, T; Masumoto, K; Tajiri, T; Taguchi, T

    PEDIATRIC SURGERY INTERNATIONAL   38 ( 12 )   1855 - 1860   2022.12   ISSN:0179-0358 eISSN:1437-9813

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    Purpose: The number of accessible central veins (CVs) affects the prognosis of patients with intestinal failure (IF). The loss of residual CVs should be avoided. We, therefore, evaluated the efficacy of a new CV catheter-exchange technique using a subcutaneous fibrous sheath (FS) in pediatric IF patients. Methods: We retrospectively collected the CV catheter (CVC) data of pediatric IF patients managed from January 2009 to December 2019. The data were divided into two groups; Groups 1 (CVCs placed with the FS method) and Group 2 (CVCs placed by the primary or another insertion). The main outcome was the CVC indwelling time. Results: Eighty-five CVCs were analyzed. The FS method was attempted in 47 cases and succeeded in 40 (85%). No significant difference was observed between the groups regarding characteristics. A log-rank test revealed an equivalent CVC indwelling time between the two groups (Group 1: 268 [126–588] days vs. Group 2: 229 [126–387] days, p = 0.256). Conclusions: The FS method is highly recommended for pediatric IF patients, as its attempt showed a high success rate with an indwelling time equivalent to primary insertion. The FS method leads to the prolonged use of a single CV and thereby contributes to improving the outcomes of pediatric IF patients.

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  • Targeting hepatic oxidative stress rescues bone loss in liver fibrosis

    Yamaza, T; Sonoda, S; Murata, S; Yamaza, H; Yuniartha, R; Fujiyoshi, J; Yoshimaru, K; Matsuura, T; Oda, Y; Ohga, S; Tajiri, T; Taguchi, T

    MOLECULAR METABOLISM   66   101599   2022.12   ISSN:2212-8778

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    Objective: Chronic liver diseases often involve metabolic damage to the skeletal system. The underlying mechanism of bone loss in chronic liver diseases remains unclear, and appropriate therapeutic options, except for orthotopic liver transplantation, have proved insufficient for these patients. This study aimed to investigate the efficacy and mechanism of transplantation of immature hepatocyte-like cells converted from stem cells from human exfoliated deciduous teeth (SHED-Heps) in bone loss of chronic liver fibrosis. Methods: Mice that were chronically treated with CCl4 received SHED-Heps, and trabecular bone density, reactive oxygen species (ROS), and osteoclast activity were subsequently analyzed in vivo and in vitro. The effects of stanniocalcin 1 (STC1) knockdown in SHED-Heps were also evaluated in chronically CCl4 treated mice. Results: SHED-Hep transplantation (SHED-HepTx) improved trabecular bone loss and liver fibrosis in chronic CCl4-treated mice. SHED-HepTx reduced hepatic ROS production and interleukin 17 (Il-17) expression under chronic CCl4 damage. SHED-HepTx reduced the expression of both Il-17 and tumor necrosis factor receptor superfamily 11A (Tnfrsf11a) and ameliorated the imbalance of osteoclast and osteoblast activities in the bone marrow of CCl4-treated mice. Functional knockdown of STC1 in SHED-Heps attenuated the benefit of SHED-HepTx including anti-bone loss effect by suppressing osteoclast differentiation through TNFSF11–TNFRSF11A signaling and enhancing osteoblast differentiation in the bone marrow, as well as anti-fibrotic and anti-ROS effects in the CCl4-injured livers. Conclusions: These findings suggest that targeting hepatic ROS provides a novel approach to treat bone loss resulting from chronic liver diseases.

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  • Immunohistochemistry reveals an increased number of ganglion cells in the normal-size plexus, as a pathological feature of immaturity of ganglia

    Yoshimaru K., Miyoshi K., Kinoshita Y., Obata S., Yanagi Y., Takahashi Y., Kajihara K., Irie K., Uchida Y., Toriigahara Y., Kawano Y., Kohashi K., Yoshioka T., Nakazawa A., Matsuura T., Oda Y., Tajiri T., Taguchi T.

    Comparative Clinical Pathology   31 ( 6 )   951 - 957   2022.12   ISSN:16185641

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    Immaturity of ganglia (IG), is a rare entity of an allied disorder of Hirschsprung’s disease. We reviewed our IG cases to provide further pathological insight into IG. The clinical data and pathological findings of IG cases in our department from 2011 to 2020 were examined. Hematoxylin and eosin (HE) staining and immunostaining for HuC/D, BCL-2, SOX10, and CD56 were performed on full-thickness specimens. Sufficient clinical data and pathological specimens were available in five cases during the study period. The patient profiles were as follows: four term infants and one preterm infant with initial symptoms of abdominal distension or vomiting; all cases underwent ileostomy at a median age of 2 days and stoma closure at a median age of 5 months. Although the interpretation of HE staining was difficult, immunostaining for HuC/D and SOX10 clearly distinguished ganglion cells from glial cells. The number of ganglion cells in the IG group was significantly greater than that in the control group (p < 0.05), while the number of enteric glial cells and total area of the myenteric nerve plexus did not differ. The finding of the increased number of ganglion cells in a normal-size myenteric plexus is a novel feature of IG that contributes to its accurate diagnosis.

    DOI: 10.1007/s00580-022-03390-w

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  • I CLINICAL CHARACTERISTICS AND SURGICAL OUTCOMES OF PEDIATRIC PANCREATIC TUMOR -A SINGLE CENTER EXPERIENCE-

    Kawakubo, N; Takemoto, J; Souzaki, R; Obata, S; Yoshimaru, K; Matsuura, T; Tajiri, T

    PEDIATRIC BLOOD & CANCER   69   2022.11   ISSN:1545-5009 eISSN:1545-5017

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  • LIVER TRANSPLANTATION FOR PEDIATRIC LANGERHANS CELL HISTIOCYTOSIS WITH SECONDARY SCLEROSING CHOLANGITIS

    Ichiki, A; Fukano, R; Okazaki, S; Ohta, H; Iida, Y; Ichimura, T; Yoshimaru, K; Matsuura, T; Kudo, K; Hasegawa, S

    PEDIATRIC BLOOD & CANCER   69   2022.11   ISSN:1545-5009 eISSN:1545-5017

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  • 腹膜透析カテーテル関連合併症の挿入法間での比較

    岩屋 友香, 西山 慶, 吉丸 耕一朗, 松浦 俊治, 田尻 達郎, 大賀 正一

    日本小児PD・HD研究会雑誌   33   76 - 78   2022.10   ISSN:2186-4896

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    腹膜透析(PD)カテーテル留置における腹腔鏡手術は近年増加傾向にある。腹腔鏡補助下PDカテーテル留置術は開腹術に比べて術後に透析液リークを起こす危険性が高いのではないかとの仮説を立て、挿入法によるPDカテーテル関連合併症を後方視的に評価した。2004~2021年の18年間に当院で維持PDを導入した末期腎不全患者34例(32名)を対象とした。腹腔鏡未使用群19例、使用群15例であり、腸管損傷、出血についてはいずれの群でも認めなかった。PDカテーテル閉塞/位置異常については使用群が0例であったのに対し、未使用群が6例(31.5%)と有意に多かった。鼠径ヘルニア/陰嚢水腫/Nuck管水腫についても使用群2例(13.3%)に対し未使用群9例(47.3%)と有意に多かった。透析液リークは5例で発症し、うち4例が臍部を中心とした皮下への漏出であった。全例が腹腔鏡術後に発生しており、さらに5例中4例(80%)が単孔式ポートを使用していた。PDカテーテル関連合併症において、術式間(腹腔鏡未使用群と使用群)でのPDカテーテル留置術後の合併症に差がみられた。

  • Anesthesia management in living-donor liver transplantation in a patient with carbamoyl phosphate synthetase deficiency: a case report

    Matsushita, H; Fujiyoshi, T; Yoshimaru, K; Matsuura, T; Mushimoto, Y; Karashima, Y; Yamaura, K

    JA CLINICAL REPORTS   8 ( 1 )   71   2022.9   ISSN:2363-9024

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    Background: Carbamoyl phosphate synthetase deficiency (CPS1D) is a urea-cycle disorder (UCD). We report successful perioperative management of pediatric living donor liver transplantation (LDLT) in a CPS1D patient. Case presentation: A 10-year-old female patient with CPS1D underwent LDLT. Proper administration of dextrose 50% and 60 kcal/kg/day with l-arginine and l-carnitine resulted in the avoidance of intraoperative hyperammonemia induced by hypercatabolism. Serum ammonia level transiently increased to 61 mmol/L in the anhepatic phase and decreased to 44 mmol/L after reperfusion. Conclusions: We suggest anesthesia management with administration of dextrose to avoid hyperammonemia during LDLT in patients with CPS1D.

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  • カルバモイルリン酸合成酵素欠損症患者の生体肝移植における麻酔管理 1症例報告(Anesthesia management in living-donor liver transplantation in a patient with carbamoyl phosphate synthetase deficiency: a case report)

    Matsushita Hiroki, Fujiyoshi Tetsushiro, Yoshimaru Koichiro, Matsuura Toshiharu, Mushimoto Yuichi, Karashima Yuji, Yamaura Ken

    JA Clinical Reports   8   1 of 4 - 4 of 4   2022.9

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    症例は10歳女児で、7歳時にカルバモイルリン酸合成酵素欠損症と診断され、9歳時に生体肝移植を受けていた。術前検査で特記すべき異常はなかった。肝機能はChild-Pugh分類クラスAであったが、血清アンモニア値は45μmol/Lであった。術中、60kcal/kg/日に相当するブドウ糖50%、L-アルギニン、L-カルニチンを投与して、高アンモニア血症を回避した。無肝期に血清アンモニア値が一時的に61mmol/Lまで上昇したが、再灌流後に44mmol/Lまで低下し、手術終了時は50mmol/Lであった。術後、ICUに入室し、L-カルニチンとブドウ糖の投与を継続した。血清アンモニア値は術後3日目に正常範囲に低下した。経過は良好で術後3日目に一般病棟に転棟し、27日目に退院した。

  • Palisading-like arrangement of immature ganglion cell in myenteric ganglia is a unique pathological feature of immaturity of ganglia

    Yoshimaru, K; Tamaki, A; Matsuura, T; Kohashi, K; Kajihara, K; Irie, K; Hino, Y; Uchida, Y; Toriigahara, Y; Kawano, Y; Shirai, T; Oda, Y; Tajiri, T; Taguchi, T

    JOURNAL OF PEDIATRIC SURGERY   57 ( 7 )   1269 - 1273   2022.7   ISSN:0022-3468 eISSN:1531-5037

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    Background: Immaturity of ganglia (IG), an allied disorder of Hirschsprung disease (AD-HSCR), develops as neonatal ileus, but the dysmotility spontaneously resolves after several months. The diagnosis of IG using HE staining is often difficult. We herein report a new pathological finding of IG called the ‘palisading-like pattern’, which may be helpful for improving the diagnostic accuracy. Methods: Cases of IG that were managed over the past 28 years were retrospectively reviewed. We investigated the clinical course and pathological findings for Hematoxylin-Eosin (HE) staining. The conventional diagnostic criteria for IG were (1) a normal or slightly increased number of ganglion cells and (2) ganglion cells with small nuclei. Results: Among the 155 cases, 28 were diagnosed with IG, and 10 were retrospectively confirmed by HE staining. A palisading-like pattern was confirmed at the time of the initial ileostomy (median age, 2.5 days), and the palisading-like pattern had completely disappeared by the time of stoma closure (median age, 215 days) in all 10 cases. A palisading-like pattern is not present in other diseases. Conclusions: Even if immunostaining data are not available for a further analysis, the detection of a palisading-like pattern on HE staining makes an accurate diagnosis possible. Level of evidence: LEVEL IV.

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  • Protocol to generate xenogeneic-free/serum-free human dental pulp stem cells

    Sonoda, S; Yamaza, H; Yoshimaru, K; Taguchi, T; Yamaza, T

    STAR PROTOCOLS   3 ( 2 )   101386   2022.6   ISSN:2666-1667

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    Human dental pulp stem cell (hDPSCs)-based therapy is a feasible option for regenerative medicine, such as dental pulp regeneration. Here, we show the steps needed to colony-forming unit-fibroblasts (CFU-F)-based isolation, expansion, and cryopreservation of hDPSCs for manufacturing clinical-grade products under a xenogeneic-free/serum-free condition. We also demonstrate the characterization of hDPSCs by CFU-F, flow cytometric, and in vitro multipotent assays. For complete details on the use and execution of this protocol, please refer to Iwanaka et al. (2020).

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  • Serum matrix metalloproteinase-7 in biliary atresia: A Japanese multicenter study

    Sakaguchi, H; Konishi, KI; Yasuda, R; Sasaki, H; Yoshimaru, K; Tainaka, T; Fukahori, S; Sanada, Y; Iwama, I; Shoji, H; Kinoshita, M; Matsuura, T; Fujishiro, J; Uchida, H; Nio, M; Yamashita, Y; Mizuochi, T

    HEPATOLOGY RESEARCH   52 ( 5 )   479 - 487   2022.5   ISSN:1386-6346 eISSN:1872-034X

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    Background: Biliary atresia (BA) is among the commonest indications for liver transplantation (LT) in children. We examined whether serum matrix metalloproteinase-7 (MMP-7) is useful for diagnosis of BA in Japanese infants, and whether serum MMP-7 concentrations before and after Kasai portoenterostomy (KP) predicted LT within a year. Methods: Subjects under 6 months old at eight pediatric centers in Japan were enrolled retrospectively, including patients with cholestasis and normal controls (NC) without liver disease. Patients with cholestasis were divided into groups representing BA versus cholestasis from other causes (non-BA). Serum samples were collected from patients with BA at diagnosis and 1 and 4 weeks after KP, as well as from non-BA and NC. Results: Serum MMP-7 concentrations were significantly higher in BA at diagnosis (median, 89.1 ng/ml) than in non-BA (11.0; p < 0.001) or NC (10.3; p < 0.001). Receiver operating characteristic (ROC) analysis of MMP-7 for BA versus non-BA yielded an area under the ROC curve of 0.99 (95% confidence interval, 0.96–1.00). An optimal cut-off value of 18.6 ng/ml for serum MMP-7 in diagnosing BA demonstrated sensitivity and specificity of 100% and 90%, respectively. Serum MMP-7 before and 1 week and 4 weeks after KP did not differ significantly between BA requiring only KP and BA requiring LT after KP. Conclusion: Serum MMP-7 is a useful marker for diagnosis of BA in Japanese infants, but it could not predict LT within a year.

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  • 胆道閉鎖症における血清マトリックスメタロプロテアーゼ-7 日本の多施設共同研究(Serum matrix metalloproteinase-7 in biliary atresia: A Japanese multicenter study)

    Sakaguchi Hirotaka, Konishi Ken-ichiro, Yasuda Ryosuke, Sasaki Hideyuki, Yoshimaru Koichiro, Tainaka Takahisa, Fukahori Suguru, Sanada Yukihiro, Iwama Itaru, Shoji Hiromichi, Kinoshita Masahiro, Matsuura Toshiharu, Fujishiro Jun, Uchida Hiroo, Nio Masaki, Yamashita Yushiro, Mizuochi Tatsuki

    Hepatology Research   52 ( 5 )   479 - 487   2022.5   ISSN:1386-6346

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    日本人乳児の胆道閉鎖症(BA)診断における血清マトリックスメタロプロテアーゼ7(MMP-7)の有用性と、葛西式肝門部空腸吻合術(KP)前後の血清MMP-7濃度による1年以内の肝臓移植(LT)予測能を後ろ向き多施設共同観察研究で検討した。月齢6ヵ月未満の胆汁うっ滞小児47例および正常対照29名(NC)を対象とした。胆汁うっ滞小児は、BA群27例(男児8例、女児19例、日齢中央値56日)と他の原因による胆汁うっ滞群(非BA群)20例(男児13例、女児7例、日齢中央値51日)に分けて検討した。血清サンプルはBA群では診断時、KP後1および4週間で採取し、非BA群およびNC群でも採取した。診断時の血清MMP-7濃度は、他群よりもBAで有意に高かった。BAに対する診断マーカーとしてのMMP-7の診断精度を受信者操作特性(ROC)曲線解析で検討した。その結果、非BAからBAを鑑別する場合の血清MMP-7のROC曲線下面積は0.99であった。またBA診断における血清MMP-7の最適カットオフ値は18.6ng/mLで、感度および特異度は各々100%と90%であった。KP前と1および4週間後の血清MMP-7は、KPのみを必要とするBA群とKP後にLTを必要とするBA群の間で、有意差は見られなかった。血清MMP-7は、当該BAの有用な診断マーカーであるが、1年以内のLT必要性は予測できなかった。

  • 慢性特発性偽性腸閉塞症に対する脳死単独小腸移植後の栄養管理

    内田 康幸, 梶原 啓資, 河野 雄紀, 鳥井ヶ原 幸博, 白井 剛, 高橋 良彰, 吉丸 耕一朗, 松浦 俊治, 田尻 達郎

    移植   57 ( 1 )   125 - 131   2022.5   ISSN:0578-7947

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    慢性特発性偽性腸閉塞症の30歳代男性に対する脳死単独小腸移植後の栄養管理について報告した。本例は既に初診時に中心静脈ルートがなく周術期管理が困難であった。鬱滞した自己胃・十二指腸内容はGJチューブを用いて排液・減圧し、経腸栄養はチューブ腸瘻からグラフト腸管への直接注入を中心として行った。チューブ腸瘻を介した経腸栄養は比較的早期に安定し、単独小腸移植後60日に静脈栄養から離脱可能となった。また、自己腸管からの排液であるGJチューブ排液自体をチューブ腸瘻を介してグラフト腸管へ注入し、補液から離脱できた。

  • Dental pulp stem cells as a therapy for congenital entero-neuropathy

    Yoshimaru, K; Yamaza, T; Kajioka, S; Sonoda, S; Yanagi, Y; Matsuura, T; Yoshizumi, J; Oda, Y; Iwata, N; Takai, C; Nakayama, S; Taguchi, T

    SCIENTIFIC REPORTS   12 ( 1 )   6990   2022.4   ISSN:2045-2322

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    Hirschsprung’s disease is a congenital entero-neuropathy that causes chronic constipation and intestinal obstruction. New treatments for entero-neuropathy are needed because current surgical strategies have limitations5. Entero-neuropathy results from enteric nervous system dysfunction due to incomplete colonization of the distal intestine by neural crest-derived cells. Impaired cooperation between the enteric nervous system and intestinal pacemaker cells may also contribute to entero-neuropathy. Stem cell therapy to repair these multiple defects represents a novel treatment approach. Dental pulp stem cells derived from deciduous teeth (dDPSCs) are multipotent cranial neural crest-derived cells, but it remains unknown whether dDPSCs have potential as a new therapy for entero-neuropathy. Here we show that intravenous transplantation of dDPSCs into the Japanese Fancy-1 mouse, an established model of hypoganglionosis and entero-neuropathy, improves large intestinal structure and function and prolongs survival. Intravenously injected dDPSCs migrate to affected regions of the intestine through interactions between stromal cell-derived factor-1α and C-X-C chemokine receptor type-4. Transplanted dDPSCs differentiate into both pacemaker cells and enteric neurons in the proximal colon to improve electrical and peristaltic activity, in addition to their paracrine effects. Our findings indicate that transplanted dDPSCs can differentiate into different cell types to correct entero-neuropathy-associated defects.

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  • 特集 小児の便秘:最近の知見 Hirschsprung病術後の便秘症の管理

    田口 智章, 黒木 まどか, 石井 綾子, 小幡 聡, 吉丸 耕一朗, 田尻 達郎

    小児外科   54 ( 4 )   364 - 370   2022.4   ISSN:03856313

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    DOI: 10.24479/ps.0000000098

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  • Characteristics of intussusception in the period of arbitrary Rotavirus vaccination

    Nakamura, M; Yoshimaru, K; Matsuura, T; Hamada, H; Motomura, Y; Hayashida, M; Ohga, S; Tajiri, T; Hara, T; Taguchi, T

    PEDIATRICS INTERNATIONAL   64 ( 1 )   e15332   2022.1   ISSN:1328-8067 eISSN:1442-200X

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    Language:English   Publisher:Pediatrics International  

    Background: In November 2011, rotavirus (RV) vaccine was launched in Japan as a voluntary vaccination to prevent RV-associated gastroenterocolitis. We examined the characteristics of intussusception following RV vaccination in our two centers. Methods: We investigated intussusception patients <16 years old from January 2006 to September 2020. Patients were categorized according to the period (before [Group A] or after the introduction of arbitrary RV vaccination [Group B]). The patient characteristics and treatment of intussusception were retrospectively investigated. Results: During the study period, 560 patients (group A, n = 233; group B, n = 327) were identified. The distribution of patients who were 0–6 months old was not significantly different between the groups (group A, n = 12, 5.2%; group B, n = 18, 5.5%). Among these 18 patients in Group B, 7 were vaccinated against RV, and 10 were not. One patient was excluded due to incomplete data. On comparing patients with and without RV vaccination, the mean age at the onset of intussusception was 3.3 ± 0.4 versus 4.0 ± 0.3 months (P = 0.19), the mean interval from the onset to treatment was 7.5 ± 2.4 versus 16.0 ± 2.2 h (P = 0.03), the time of the contrast enema for treatment was 9.1 ± 3.3 versus 7.7 ± 2.8 min (P = 0.76), and the final pressure of the contrast enema was 92.5 ± 4.4 versus 92.2 ± 4.4 cmH2O (P = 0.97). Conclusions: Arbitrary RV vaccination did not influence the age distribution of intussusception, and the interval from the onset to treatment was significantly shorter in the patients with RV vaccination than in those without it. Recognizing the presence of intussusception following RV vaccination enables accurate treatment.

    DOI: 10.1111/ped.15332

    Web of Science

    Scopus

    PubMed

  • 手術治療に至った難治性機能性便排出障害型便秘症の1例

    錦織 英知, 高野 正太, 田渕 聡, 伊禮 靖苗, 桑原 大作, 中村 寧, 久野 三朗, 辻 順行, 山田 一隆, 高野 正博, 吉丸 耕一朗, 田口 智章

    日本大腸肛門病学会雑誌   75 ( 1 )   27 - 35   2022.1   ISSN:0047-1801

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    Language:Japanese   Publisher:(一社)日本大腸肛門病学会  

    機能性便排出障害に対してバイオフィードバック療法をはじめとした保存的治療は有用とされる一方で手術適応については明確でない.われわれは,保存的治療無効な機能性便排出障害で著しくQOL低下をきたしたために外科的腸管切除を施行した症例を経験したので報告する.症例は71歳女性.10年前から便排出困難,著明な腹部膨満認め下剤使用も改善なく精査加療目的入院となる.排便造影検査にて便排出を認めず,大腸通過時間検査にて24時間後に不透過マーカーが直腸まで到達していることを確認.保存的治療を3ヵ月間施行も症状改善認めず,横行結腸双孔式人工肛門造設施行.腹部膨満改善するも人工肛門脱出を認めたため,腹腔鏡下左側結腸切除,直腸切除,横行結腸単孔式人工肛門造設術施行した.ストーマからの便排出良好で患者およびご家族の満足度も高い.患者QOLの向上への貢献を第一に考え,個々の症例に応じた手術術式を選択すべきであると考える.(著者抄録)

  • Future Prospects of Biliary Atresia Reviewed

    田口 智章, 吉丸 耕一朗, 松浦 俊治

    Introduction to Biliary Atresia   -   329 - 339   2022

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  • A Case of Refractory Functional Defecation Disorder (Dyssynergic Defecation) Constipation Leading to Surgical Treatment

    Nishigori Hideaki, Takano Syouta, Tabuchi Satoshi, Irei Yasue, Kuwahara Daisaku, Nakamura Yasushi, Hisano Saburou, Tsuji Yoriyuki, Yamada Kazutaka, Takano Masahiro, Yoshimaru Koichiro, Taguchi Tomoaki

    Nippon Daicho Komonbyo Gakkai Zasshi   75 ( 1 )   27 - 35   2022   ISSN:00471801 eISSN:18829619

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    Language:Japanese   Publisher:The Japan Society of Coloproctology  

    <p>Conservative treatment such as biofeedback therapy is considered to be useful for functional defecation disorder (dyssynergic defecation), but the indications for surgery are not clear. In this study, we report a case of surgical bowel resection in a 71-year-old woman with dyssynergic defecation who did not respond to conservative treatment and had a markedly decreased QOL.</p><p>The patient was a 71-year-old woman who was admitted to the hospital for examination and treatment of dyssynergic defecation and marked abdominal distension for 10 years. Defecography showed no fecal discharge, and a colonic transit time test showed that the opacity marker had reached the rectum after 24 hours. After 3 months of conservative treatment, no improvement was observed, and a transverse loop colostomy was performed. However, stomal prolapse was observed postoperatively, the patient underwent laparoscopic resection of the left side colon, rectum, and transverse end colostomy. The patient and her family were highly satisfied with the good discharge of stool from the stoma. We believe that improving the patient's QOL should be the first priority, and that the surgical technique should be selected according to the individual case.</p>

    DOI: 10.3862/jcoloproctology.75.27

    CiNii Research

  • Nutritional management after isolated intestinal transplantation for chronic idiopathic intestinal pseudo-obstruction

    UCHIDA Yasuyuki, KAJIHARA Keisuke, KAWANO Yuki, TORIIGAHARA Yukihiro, SHIRAI Takeshi, TAKAHASHI Yoshiaki, YOSHIMARU Koichiro, MATSUURA Toshiharu, TAJIRI Tatsuro

    Japanese Journal of Transplantation   57 ( 1 )   125 - 131   2022   ISSN:05787947 eISSN:21880034

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    Language:Japanese   Publisher:The Japan Society for Transplantation  

    <p>Intestinal failure is a complicated medical condition resulting in the loss of absorptive area or in severe gastrointestinal bacterial overgrowth. Prolonged use of parenteral nutrition (PN) puts patients at risk of multiple complications, including catheter-related bloodstream infection (CRBSI), intestinal failure-associated liver disease (IFALD), and renal impairment. Intestinal rehabilitation programs (IRPs) have recently been recognized as playing a significant role in outcome improvement, care coordination, and complication prevention. We herein report an adult case of chronic idiopathic intestinal pseudo-obstruction (CIIP) that underwent isolated intestinal transplantation (ITx) from a deceased donor. Because the loss of central vascular access was his indication for ITx, a catheter for perioperative management was inserted in the azygous vein via intercostal veins punctured under ultrasound guidance. A total of 255 cm of small intestine with a 10-cm ascending colon graft was transplanted, and the proximal side was anastomosed to the native duodenum. Because the native gastro-duodenum dysmotility remained even after isolated ITx for CIIP, decompression of the native gastroduodenum with a gastro-jejunum tube via gastrostomy and feeding via tube enterostomy at the graft intestine were needed during the first four to five months after ITx. However, such management was effective in achieving full enteral feeding at an early stage with stable immunosuppressive therapy. Intervention with an IRP for management before ITx helped prevent CRBSIs and facilitated his continuing parenteral nutrition until ITx. Multidisciplinary collaboration on an IRP team is mandatory for the perioperative management of ITx patients.</p>

    DOI: 10.11386/jst.57.1_125

    CiNii Research

  • ロタウイルスワクチン任意接種期間における腸重積症の特徴(Characteristics of intussusception in the period of arbitrary Rotavirus vaccination)

    Nakamura Mutsumi, Yoshimaru Koichiro, Matsuura Toshiharu, Hamada Hiroshi, Motomura Yoshitomo, Hayashida Makoto, Ohga Shouichi, Tajiri Tatsuro, Hara Toshiro, Taguchi Tomoaki

    Pediatrics International   64 ( 1 )   1 of 7 - 7 of 7   2022   ISSN:1328-8067

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    Language:English   Publisher:John Wiley & Sons Australia, Ltd  

    ロタウイルス(RV)ワクチン接種と腸重積症の関連を評価するため、RVワクチン任意接種導入後の腸重積症の発生率と特徴について検討した。2006年1月~2020年9月に2施設において腸重積症と診断された16歳未満の患児560例を、診断時期によりRVワクチン任意接種導入前(233例、グループA)と導入後(327例、グループB)へ分類した。早期発症型(生後6ヵ月未満)の患児はグループA 12例(5.2%)、グループB 18例(5.5%)と有意差はなく、RVワクチン任意接種は腸重積症の年齢分布に影響を及ぼさないことが示された。グループBの早期発症型患児18例のうち、データが不完全であった1例を除外し、RVワクチン接種を行った7例と行わなかった10例を比較した。その結果、腸重積症発症時の平均月齢はそれぞれ3.3±0.4ヵ月、4.0±0.3ヵ月(P=0.19)、発症から治療までの平均時間はそれぞれ7.5±2.4時間、16.0±2.2時間とワクチン接種例で有意に短く(P=0.03)、注腸整復の所要時間はそれぞれ9.1±3.3分、7.7±2.8分(P=0.76)、整復圧はそれぞれ92.5±4.4cmH2O、92.2±4.4cmH2O(P=0.97)であった。

  • International Collaboration in Biliary Atresia Reviewed

    松浦 俊治, 吉丸 耕一朗, 田口 智章

    Introduction to Biliary Atresia   -   323 - 328   2022

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  • The efficacy of serum brain natriuretic peptide (BNP) for the early detection of portopulmonary hypertension in biliary atresia patients before liver transplantation. Reviewed International journal

    Yoshimaru K, Matsuura T, Takahashi Y, Yanagi Y, Nagata H, Ohga S, Taguchi T.

    Pediatr Transplant.   2018.3

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    Language:English   Publishing type:Research paper (scientific journal)  

  • The evaluation of rectal mucosal punch biopsy in the diagnosis of Hirschsprung’s disease: A thirty-year experience of 954 patients. Reviewed International journal

    2017.10

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    Language:English   Publishing type:Research paper (scientific journal)  

  • Graft reduction using a powered stapler in pediatric living donor liver transplantation. Reviewed International journal

    Yoshimaru K, Matsuura T, Kinoshita Y, Hayashida M, Takahashi Y, Yanagi Y, Harimoto N, Ikegami T, Uchiyama H, Yoshizumi T, Maehara Y, Taguchi T.

    Pediatr Transplant.   2017.9

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    Language:English   Publishing type:Research paper (scientific journal)  

  • Immunostaining for Hu C/D and CD56 is useful for a definitive histopathological diagnosis of congenital and acquired isolated hypoganglionosis. Reviewed International journal

    Yoshimaru K, Taguchi T, Obata S, Takemoto J, Takahashi Y, Iwanaka T, Yanagi Y, Kuda M, Miyoshi K, Matsuura Y, Kinoshita Y, Yoshioka T, Nakazawa A, Oda Y.

    Virchows Arch.   2017.4

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    Language:English   Publishing type:Research paper (scientific journal)  

  • The Safety and Efficacy of Laparoscopic Percutaneous Extraperitoneal Closure for Inguinal Hernia in Neonates and Infants Younger than One Year of Age in Comparison to Older Patients. Reviewed International journal

    Yoshimaru K, Kinoshita Y, Shono T.

    J Laparoendosc Adv Surg Tech A.   2017.1

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    Language:English   Publishing type:Research paper (scientific journal)  

  • Transient hyperphosphatasemia after pediatric liver transplantation Reviewed International journal

    Yoshimaru K, Matsuura T, Hayashida M, Kinoshita Y, Takahashi Y, Yanagi Y, Esumi G, Taguchi T.

    Pediatr Int.   2016.6

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  • Clinical analysis of 70 bowel obstruction cases without a history of laparotomy. Reviewed International journal

    Yoshimaru K, Kinoshita Y, Matsuura T, Esumi G, Wada M, Takahashi Y, Yanagi Y, Hayashida M, Ieiri S, Taguchi T.

    Pediatr Int.   2016.6

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Presentations

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MISC

  • 疾患特異的乳歯幹細胞モデルによる胆管症の病因解明

    園田 聡一朗, 吉丸 耕一朗, 田口 智章, 山座 孝義

    細胞   56 ( 10 )   747 - 749   2024.9   ISSN:1346-7557

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    Language:Japanese   Publisher:(株)ニュー・サイエンス社  

    胆道閉鎖症Biliary Atresia(BA)は,肝外胆管の閉塞によって胆汁がうっ滞する難病であるが,その病因は不明である。乳歯歯髄の体性幹細胞である乳歯幹細胞Stem Cells from Exfoliated Deciduous Teeth(SHED)は,その発生学的起源ゆえ,胎児組織幹細胞でもある。そのため,胎児期の母体内で生じる大きなエピジェネティック変化を記憶している可能性が推測される。四塩化炭素誘導性肝障害モデルマウスを用いたSHED注入実験において,SHEDは,レシピエント肝組織で肝細胞様細胞と胆管様構造を呈する胆管上皮細胞様細胞に分化した。しかし,BA特異的SHEDは,肝細胞様細胞に分化したが,胆管上皮細胞様細胞には分化しなかった。また,ドナー由来の肝芽細胞もレシピエント肝組織で確認できた。したがって,BAの発症機序として,母体内の誘発因子が,肝芽細胞から胆管形成を抑制するのではないかと仮説した。現在,筆者らは,疾患特異的SHEDを用いた研究モデルで,BAなどの胆管症発症分子機序の解明を試みている。(著者抄録)

  • Cutting-edge regenerative therapy for Hirschsprung disease and its allied disorders(タイトル和訳中)

    Yoshimaru Koichiro, Matsuura Toshiharu, Uchida Yasuyuki, Sonoda Soichiro, Maeda Shohei, Kajihara Keisuke, Kawano Yuki, Shirai Takeshi, Toriigahara Yukihiro, Kalim Alvin Santoso, Zhang Xiu-Ying, Takahashi Yoshiaki, Kawakubo Naonori, Nagata Kouji, Yamaza Haruyoshi, Yamaza Takayoshi, Taguchi Tomoaki, Tajiri Tatsuro

    Surgery Today   54 ( 9 )   977 - 994   2024.9   ISSN:0941-1291

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    Language:English   Publisher:シュプリンガー・ジャパン(株)  

  • 【胆道閉鎖症の研究update】オルガノイドを用いた胆道閉鎖症の病態解明

    小西 健一郎, 吉丸 耕一朗

    小児外科   56 ( 2 )   108 - 112   2024.2   ISSN:0385-6313

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    Language:Japanese   Publisher:(株)東京医学社  

  • 【巨大臍帯ヘルニア治療update】[臍帯ヘルニア治療の最近の問題点と長期経過]長期フォロー

    永田 公二, 福田 篤久, 近藤 琢也, 河野 淳, 鳥井ヶ原 幸博, 白井 剛, 川久保 尚徳, 吉丸 耕一朗, 松浦 俊治, 田尻 達郎

    小児外科   54 ( 12 )   1237 - 1243   2022.12   ISSN:0385-6313

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    Language:Japanese   Publisher:(株)東京医学社  

  • 【小児の便秘:最近の知見】Hirschsprung病術後の便秘症の管理

    田口 智章, 黒木 まどか, 石井 綾子, 小幡 聡, 吉丸 耕一朗, 田尻 達郎

    小児外科   54 ( 4 )   364 - 370   2022.4   ISSN:0385-6313

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    Language:Japanese   Publisher:(株)東京医学社  

Professional Memberships

  • 日本再生医療学会

  • 日本移植学会

  • 日本小児外科学会

  • 日本外科学会

Research Projects

  • 乳歯歯髄幹細胞によるヒルシュスプルング病と類縁疾患の病因解明および根治療法の開発

    Grant number:23K21447  2021.4 - 2026.3

    科学研究費助成事業  基盤研究(B)

    田口 智章, 田尻 達郎, 松浦 俊治, 梶岡 俊一, 山座 孝義, 山座 治義, 孝橋 賢一, 樗木 晶子, 吉丸 耕一朗, 松尾 忠行, 中園 栄里, 河野 淳, 桐野 浩輔

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    Grant type:Scientific research funding

    継続課題のため、記入しない。

    CiNii Research

  • ダイレクトリプログラミングによるhiHepPCを用いた細胞移植に関する研究

    Grant number:21K08646  2021.4 - 2024.3

    科学研究費助成事業  基盤研究(C)

    河野 雄紀, 松浦 俊治, 吉丸 耕一朗

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    Grant type:Scientific research funding

    ダイレクトリプログラミングにより、HUVECなどのヒト由来細胞から誘導ヒト肝前駆細胞(human induced hepatic progenitor cells:hiHepPC)の作成が可能である。hiHepPCは培養下での増殖が可能であり、また3次元培養により肝細胞および胆管細胞へ分化することが確認されている。本研究はhiHepPCをマウスに移植し、その治療効果と生着率、および移植細胞の全身における分布を詳細に評価し、臨床応用に向けての有効性と安全性を検証する。また移植後の細胞について解析を行うことで、より効果的な移植法を見出すことを目的とする。

    CiNii Research

  • 腸管運動機能不全における形態学的特徴の解明および新しい診断基準の開発に関する研究

    Grant number:21K08597  2021.4 - 2024.3

    科学研究費助成事業  基盤研究(C)

    玉城 昭彦, 孝橋 賢一, 吉丸 耕一朗, 松浦 俊治, 川久保 尚徳, 日野 祐子

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    Grant type:Scientific research funding

    腸管運動機能不全の診断には、病理診断が必須であり、腸管壁内神経叢および神経節細胞に対する評価が必要となる。しかし、基準となる正常範囲の具体的な数値は無く、個々の病理医の経験に委ねられている現状がある。そのため、正常腸管より得られた検体に免疫組織化学染色を行い、神経叢や神経節細胞の大きさや個数を評価および数値化し、簡便かつ客観的な病理診断基準の基礎データを作成する目的でこの研究を計画した。

    CiNii Research

  • 腸管神経節細胞僅少症への幹細胞移植における大建中湯を用いた治療戦略の開発

    Grant number:19K09073  2019.4 - 2024.3

    科学研究費助成事業  基盤研究(C)

    入江 敬子, 宮田 潤子, 小幡 聡, 伊崎 智子, 吉丸 耕一朗

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    Grant type:Scientific research funding

    腸管神経節細胞僅少症は、消化管蠕動不全のために重篤な機能的腸閉塞症状を来す予後不良の先天性消化管疾患であり、新規治療法の開発が渇望されている疾患である。我々は先行研究で、疾患モデル動物に対し幹細胞移植を行い、腸管蠕動運動の改善効果を得ることができた。
    幹細胞移植効果を、長期間かつ確実なものにする方法を獲得すべく、腸管神経節細胞僅少症に対して実臨床にて現在多く処方されており、複数の作用機序が解明されている大建中湯に着目した。幹細胞移植に大建中湯を併用することで、細胞の定着や神経細胞への分化や成熟に対し、得られる付与効果について評価し、再生医療と伝統医療の融合による新たな治療戦略を開発する。

    CiNii Research

  • 自家細胞移植のための腸管神経節細胞僅少症患者由来乳歯幹細胞の遺伝学的機能的解析

    Grant number:18K16260  2018 - 2021

    日本学術振興会  科学研究費助成事業  若手研究

    吉丸 耕一朗

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    Authorship:Principal investigator  Grant type:Scientific research funding

    <患児由来幹細胞の性質>健常児由来の幹細胞と比較しても増殖能力は同等であり、また細胞の分化能力としても幹細胞の特徴を変わりなく有していた。
    <幹細胞移植効果の検討> 疾患モデルマウスに対する患者由来乳歯幹細胞の移植効果の検討として、移植後の体重増加の推移の観察を終了した。体重増加や腸管の動きの変化、顕微鏡的変化などの結果を得た。患児由来幹細胞移植群においても体重増加は見られ、電気生理学的にも腸管蠕動は改善傾向を示した。今後もさらなる解析をする予定である。

    CiNii Research

  • ヒルシュスプルング病類縁疾患に対するゲノムパネルによる遺伝子学的病因解明と歯髄幹細胞を用いた病態解明

    2018

    平成30年度QRプログラム わかばちゃんレンジ

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    Authorship:Principal investigator  Grant type:On-campus funds, funds, etc.

  • オートファジーからみた腸管不全関連肝障害(IFALD)の病態解明とその制御

    Grant number:19K09074 

    松浦 俊治, 田口 智章, 吉丸 耕一朗, 高橋 良彰

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    Grant type:Scientific research funding

    短腸症の予後を規定する病態として腸管不全関連肝障害(IFALD)が知られている。長期静脈栄養に伴う肝臓での脂質代謝異常を背景に腸内細菌叢の変化や胆汁輸送機構の障害など様々な機序が報告されているが、未だ根本的な発症予防と治療に結びついていない。オートファジーは細胞の恒常性維持や細胞老化に関係する細胞内機構であり、組織の再生や修復に大きくかかわっている。障害された肝細胞におけるオートファジー機構の変化が、IFALDの病態進行にいかに関わっているかについての報告はない。今回の研究において、IFALDに関与するオートファジー関連マーカーを同定することでIFLAD進行例に対する標的治療の開発を目指す。

    CiNii Research

  • ヒルシュスプルング病類縁疾患の新規治療法を目指した遺伝子変異の同定とその機能解析

    Grant number:19K09098 

    河野 淳, 桐野 浩輔, 田口 智章, 吉丸 耕一朗

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    Grant type:Scientific research funding

    腸管神経節細胞僅少症や巨大膀胱短小結腸腸管蠕動不全症、慢性特発性偽性腸閉塞症は著しい腸管蠕動不全を認め、腸からの栄養吸収が困難で機能的腸閉塞に伴う重症腸炎を繰り返す。そのため姑息的手術を繰り返し、経静脈栄養に依存し、その合併症は時に致命的である。しかしこれらの疾患の病因は未だ不明であり、複数の遺伝子変異が報告されているにも関わらず、遺伝子変異による発症のメカニズムは解明されていない。本研究では新規創薬や生体外ゲノム編集によるH類縁の新たな治療法をめざし、遺伝子導入を行った細胞により変異遺伝子の機能解析を行い、H類縁のメカニズムを解明する。これは既存の報告よりも踏み込んだ世界初の試みである。

    CiNii Research

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Educational Activities

  • In addition to day-to-day clinical tasks and basic research activities, students are instructed.

Award for Educational Activities

  • なし

       

Class subject

  • 小児外科(小腸・大腸)

    2018.4 - 2018.9   First semester

Outline of Social Contribution and International Cooperation activities

  • 1) ジャパンハート短期ボランティア 手術支援 2012年9月 ミャンマー.
    2) ジャパンハート短期ボランティア 手術支援 2013年12月 カンボジア.
    3) ジャパンハート短期ボランティア 手術支援 2014年10月 ラオス.
    4) 九州大学小児外科 高度肝胆道系手術支援 2016年11月 ミャンマー.
    5) 九州大学小児外科 高度肝胆道系手術支援 2017年9月 ミャンマー.