記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞消化管に虚血による病変を生じるまれな疾患として,クリオグロブリン血症性血管炎を提示する.患者は40歳代,男性.HCV陽性患者で直接作用型抗ウイルス薬による治療中に腹痛を生じ,消化管検査を行った.十二指腸に不整形の潰瘍を複数認め,大腸にはびらんが散見された.小腸には潰瘍や潰瘍瘢痕が観察された.クリオグロブリン弱陽性であり,クリオフィルトレーションと直接作用型抗ウイルス薬による治療を行った.経過中,横行結腸の瘢痕部から血管炎の所見が得られ,クリオグロブリン血症性血管炎と診断した.報告が少ないため消化管病変の特徴は明らかではないが,治療に結び付けるため鑑別診断として考えることは重要である.

出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000001383

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Clinical and Experimental Nephrology  

BACKGROUND: The intestinal microbiome is involved in the pathogenesis of chronic kidney disease (CKD). Despite its importance, the microbiome of the small intestinal mucosa has been little studied due to sampling difficulties, and previous studies have mainly focused on fecal sources for microbiome studies. We aimed to characterize the small intestinal microbiome of CKD patients by studying the microbiome collected from duodenal and fecal samples of CKD patients and healthy controls. METHODS: Overall, 28 stage 5 CKD patients and 21 healthy participants were enrolled. Mucosal samples were collected from the deep duodenum during esophagogastroduodenoscopy and fecal samples were also collected. The 16S ribosomal RNA gene sequencing using Qiime2 was used to investigate and compare the microbial structure and metagenomic function of the duodenal and fecal microbiomes. RESULTS: The duodenal flora of CKD patients had decreased alpha diversity compared with the control group. On the basis of taxonomic composition, Veillonella and Prevotella were significantly reduced in the duodenal flora of CKD patients. The tyrosine and tryptophan metabolic pathways were enhanced in the urea toxin-related metabolic pathways based on the Kyoto Encyclopedia of Genes and Genomes database. CONCLUSION: The small intestinal microbiome in CKD patients is significantly altered, indicating that increased intestinal permeability and production of uremic toxin may occur in the upper small intestine of CKD patients.

DOI： 10.1007/s10157-023-02434-x

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203479

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203469

CiNii Research

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞患者は70歳代,男性.注腸X線造影検査や大腸内視鏡検査では下部直腸に中心に陥凹を伴った丈の低い隆起性病変を認め,病変右側には一段丈の高い小隆起を伴っていた.NBIや色素拡大観察では病変の大部分を占める丈の低い隆起部で血管や構造不整が目立ち腺癌を疑い,病変右側の小隆起部では血管や構造不整が目立たず腺腫を疑った.一部粘膜下層(SM)浅層浸潤の可能性もあったが,全体的に粘膜内病変と診断し内視鏡的粘膜下層剥離術を施行した.病理組織学的には一部でSM浅層浸潤(400μm)を認めたが大部分が粘膜内にとどまる高分化管状腺癌で,右側の小隆起は低異型度管状腺腫であった.境界部では内視鏡的に両者を明瞭に区別することが可能で,また分子生物学的所見でも腺腫成分のみでNRAS,APCの遺伝子変異を認めたことから,腺腫と腺癌の衝突腫瘍と診断した.

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞過去23年間に当科および関連施設にて診断された大腸の孤立性若年性ポリープ(JP)101例,孤立性PJP(Peutz-Jeghers type polyp)29例,IMGP(inflammatory myoglandular polyp)18例を対象とし,その臨床像,内視鏡像,病理組織像を遡及的に検討した.その結果,JPは平均年齢が低かった.内視鏡所見では,JPはびらん,白苔,白斑,NBI拡大観察下の開大した腺管開口部や疎に分布した腺窩辺縁上皮,細かい血管の増生,色素拡大観察下の星芒状,疎に分布したpitの,PJPは分葉状,NBIや色素拡大観察下の樹枝状構造の,IMGPは白斑,NBI拡大観察下の開大した腺管開口部,細かい血管の増生,色素拡大観察下の星芒状pitの頻度がそれぞれ高かった.以上よりJP,IMGPとPJPは異なる内視鏡像を呈していたが,JPとIMGPの内視鏡像は比較的類似していた.しかしながら,JPはIMGPに比べ,白苔,NBIや色素拡大観察下の疎に分布する腺窩辺縁上皮やpitの頻度が高いことを加味すると鑑別できる可能性があるものと推察する.

記述言語：日本語   出版者・発行元：一般社団法人 日本デザイン学会  

<p>世界中から医学生や医療従事者、患者を対象としたデザイン教育が報告されているが、医療とデザインの両学部を持つ総合大学は少ないため、両学術分野を連携した教育プログラムは限られ、その効果は不明である。著者らは2021年度より九州大学芸術工学研究院と医学研究院・病院を連携した課題解決型教育プログラムを実施しており、本研究では本教育プログラムが受講者の創造性に与える影響について自己評価を用いて明らかにする。5つの医療分野から654件の課題が発見され、486件のアイデアが作成され、13のプロトタイプが発表された。「今後、医療分野のデザインなど、デザインに関係する仕事（業務）に携わりたい（P=.04）」、「新しく画期的なもの・ことを作りたい（P=.05）」に有意な改善が見られたが、「モチベーション」、「スキル」、「キャリアへの期待」のカテゴリごとでは、講義前の高いスコア（3.6-4.6/5 から 4.0-4.6/5）から講義後にも変化はなかった。評価項目の見直しの必要性が示唆された。</p>

DOI： 10.11247/jssd.71.0_338

CiNii Research

記述言語：英語   出版者・発行元：アジアデジタルアートアンドデザイン学会  

Endoscopic submucosal dissection (ESD) is a technique for endoscopic resection oflesions and is used in many cases, including gastrointestinal cancers. However, ESD training has the following problems Time and effort required for preparation and training, which can be a burden for busy doctor. In addition, there are cases in which the training is not integrated as part of the endoscopist’s hospital duties, so there is a need to develop a proactive and easy system to enable busy doctors to continue ESD training on a daily basis. Therefore, in this study, we developed and verified an ESD training system that endoscopists can implement without spending time, resources, and money. The system consists of a game interface that can be operated in the same way as an endoscope and a game designed for ESD training. After the system was developed, two groups of doctors, one with extensive ESD experience and the other with limited ESD experience, were divided into two groups for the same validation. As a result, it was verified that the system allows training during free time in the office without time and effort for preparation, and that the gamification element of the system makes the training fun and continuous.

DOI： 10.20668/adada.28.3_33

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出版者・発行元：Communications in Computer and Information Science  

While several studies have investigated the benefits and the challenges of telemedicine during the COVID-19 pandemic, most concentrate on challenges faced by developed nations. The unique challenges telemedicine encounters in developing countries, such as the Philippines, are often underexplored. This research, leveraging a mixed-methods approach, zeroes in on the Philippines due to its distinct geographical attributes and official use of English. Our objectives are to (a) juxtapose domestic and international telemedicine practices, emphasizing international telemedicine education, and (b) unearth novel interrelationships between various factors. Unlike earlier research that recognized isolated challenges, our study unravels their intricate interconnections. Our methodology involved surveys and interviews of 38 stakeholders, including doctors, technicians, and coordinators involved in telemedicine education within the Philippines. The findings underscore that: (1) public endorsement yields positive results; (2) domestic and international telemedicine exhibit strong linkage; (3) communication and technological hurdles are intertwined; (4) unity and collaboration in hospitals are pivotal; and (5) recognizing the “significance of the mission” fosters favorable outcomes. This research underscores the imperative for enhanced educational support in developing nations and accentuates the importance of synergized endeavors with their developed counterparts.

DOI： 10.1007/978-3-031-62753-8_3

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203400

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Digestive Endoscopy  

OBJECTIVES: The incidence of colorectal neuroendocrine tumors (NETs) has increased with colorectal cancer screening programs and increased colonoscopies. The management of colorectal NETs has recently shifted from radical surgery to endoscopic resection. We aimed to evaluate the short-term outcomes of various methods of endoscopic resection for colorectal NETs. METHODS: Among those registered in the C-NET STUDY, patients with colorectal NETs who underwent endoscopic treatment as the initial therapy were included. Short-term outcomes, such as the en bloc resection rate and R0 resection (en bloc resection with tumor-free margin) rate, were analyzed based on treatment modalities. RESULTS: A total of 472 patients with 477 colorectal NETs received endoscopic treatment. Of these, 418 patients with 421 lesions who met the eligibility criteria were included in the analysis. The median age of the patients was 55 years, and 56.9% of them were men. The lower rectum was the most commonly affected site (88.6%), and lesions <10 mm accounted for 87% of the cases. Endoscopic submucosal resection with a ligation device (ESMR-L, 56.5%) was the most common method, followed by endoscopic submucosal dissection (ESD, 31.4%) and endoscopic mucosal resection using a cap (EMR-C, 8.5%). R0 resection rates <10 mm were 95.5%, 94.8%, and 94.3% for ESMR-L, ESD, and EMR-C, respectively. All 16 (3.8%) patients who developed treatment-related complications could be treated conservatively. Overall, 23 (5.5%) patients had incomplete resection without independent clinicopathological risk factors. CONCLUSION: ESMR-L, ESD, and EMR-C were equally effective and safe for colorectal NETs with a diameter <10 mm.

DOI： 10.1111/den.14728

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203358

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記述言語：日本語  

遠隔会議システムを用いた従来の内視鏡ライブ配信では、視聴者の視点がカメラの画角内に制限されているという課題がある。本研究では内視鏡室を自由な視点で見ることができる全天球カメラによるリアルタイム配信と、VRヘッドセットによる受信の品質を評価した。遠隔会議の画面共有で配信する内視鏡映像と、全天球カメラで配信する内視鏡室の映像について、配信のパフォーマンスの記録および視聴者へのアンケートを実施した。結果、内視鏡映像は解像度1536×864、5～21fpsを推移し、内視鏡室からの映像は解像度1920×960、0～15fpsという結果となった。アンケート結果ではどちらの映像においても精細さ、スムーズさとも9割以上が肯定的に評価した。全天球カメラによる内視鏡室の配信は非常に高評価であったものの、教育効果を高めるため機材の配置や異なる映像品質での配信評価など追加で検討を行っていく必要がある。(著者抄録)

記述言語：日本語   出版者・発行元：(一社)日本遠隔医療学会  

遠隔会議システムを用いた従来の内視鏡ライブ配信では、視聴者の視点がカメラの画角内に制限されているという課題がある。本研究では内視鏡室を自由な視点で見ることができる全天球カメラによるリアルタイム配信と、VRヘッドセットによる受信の品質を評価した。遠隔会議の画面共有で配信する内視鏡映像と、全天球カメラで配信する内視鏡室の映像について、配信のパフォーマンスの記録および視聴者へのアンケートを実施した。結果、内視鏡映像は解像度1536×864、5～21fpsを推移し、内視鏡室からの映像は解像度1920×960、0～15fpsという結果となった。アンケート結果ではどちらの映像においても精細さ、スムーズさとも9割以上が肯定的に評価した。全天球カメラによる内視鏡室の配信は非常に高評価であったものの、教育効果を高めるため機材の配置や異なる映像品質での配信評価など追加で検討を行っていく必要がある。(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Internal Medicine  

Objective Flares of inflammatory bowel disease (IBD) can occur infrequently after vaccination for coronavirus disease 2019 (COVID-19), although the details of this phenomenon are poorly understood. To clarify the possibility of an unfavorable response in patients with IBD, we investigated IBD-related symptoms during the COVID-19 vaccination. Methods Between October 2021 and February 2022, we obtained the COVID-19 vaccination status of 411 IBD patients who were being treated at our institution. The disease course of IBD after vaccination was investigated in 188 patients with ulcerative colitis (UC) and 119 patients with Crohn's disease (CD) who had received at least one dose of the vaccine during the clinical remission phase. The baseline characteristics before vaccination were compared between the patients with UC with or without disease flares. Results During the 30-day follow-up period, eight patients with UC (4.3%) and one patient with CD (0.8%) experienced disease flares following vaccination. Disease flares occurred after the first vaccination in six patients and after the second vaccination in three patients. As for the timing of onset of disease flares, eight events (88.9%) occurred within one week of vaccination. Two patients required hospitalization, and one patient with CD required surgery for an intra-abdominal abscess. The baseline characteristics did not significantly differ between patients with UC who experienced flares and those who did not. Conclusions IBD flares following COVID-19 vaccination are rare and vaccination should therefore be recommended for patients with IBD. However, the possibility of disease flares should be considered for approximately one week after each vaccination, especially in patients with UC.

DOI： 10.2169/internalmedicine.2335-23

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記述言語：その他   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Gastroenterology  

Background: Ferroptosis, a type of programmed cell death triggered by oxidative stress, was suspected to play a role in ulcerative colitis. Indigo naturalis is highly effective against ulcerative colitis, but its mechanism is unclear. This study found that indigo naturalis treatment suppressed ferroptosis. Methods: We analyzed 770 mRNA expressions of patients with ulcerative colitis. Suppression of ferroptosis by indigo naturalis treatment was shown using a cell death assay. Malondialdehyde levels and reactive oxygen species were analyzed in CaCo-2 cells treated with indigo naturalis. Glutathione metabolism was shown by metabolomic analysis. Extraction of the ingredients indigo naturalis from the rectal mucosa was performed using liquid chromatograph—mass spectrometry. Results: Gene expression profiling showed that indigo naturalis treatment increased antioxidant genes in the mucosa of patients with ulcerative colitis. In vitro analysis showed that nuclear factor erythroid-2-related factor 2-related antioxidant gene expression was upregulated by indigo naturalis. Indigo naturalis treatment rendered cells resistant to ferroptosis. Metabolomic analysis suggested that an increase in reduced glutathione by indigo naturalis. The protein expression of CYP1A1 and GPX4 was increased in the rectum by treatment with indigo naturalis. The main ingredients of indigo naturalis, indirubin and indigo inhibited ferroptosis. Indirubin was detected in the rectal mucosa of patients with ulcerative colitis who were treated with indigo naturalis. Conclusions: Suppression of ferroptosis by indigo naturalis in the intestinal epithelium could be therapeutic target for ulcerative colitis. The main active ingredient of indigo naturalis may be indirubin.

DOI： 10.1007/s00535-023-02016-4

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その他リンク： https://link.springer.com/article/10.1007/s00535-023-02016-4/fulltext.html

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203252

CiNii Research

記述言語：その他   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Abstract

Objectives

Artificial intelligence (AI) may be practical for image classification of small bowel capsule endoscopy (CE). However, creating a functional AI model is challenging. We attempted to create a dataset and an object detection CE AI model to explore modeling problems to assist in reading small bowel CE.

Methods

We extracted 18,481 images from 523 small bowel CE procedures performed at Kyushu University Hospital from September 2014 to June 2021. We annotated 12,320 images with 23,033 disease lesions, combined them with 6161 normal images as the dataset, and examined the characteristics. Based on the dataset, we created an object detection AI model using YOLO v5 and we tested validation.

Results

We annotated the dataset with 12 types of annotations, and multiple annotation types were observed in the same image. We test validated our AI model with 1396 images, and sensitivity for all 12 types of annotations was about 91%, with 1375 true positives, 659 false positives, and 120 false negatives detected. The highest sensitivity for individual annotations was 97%, and the highest area under the receiver operating characteristic curve was 0.98, but the quality of detection varied depending on the specific annotation.

Conclusions

Object detection AI model in small bowel CE using YOLO v5 may provide effective and easy‐to‐understand reading assistance. In this SEE‐AI project, we open our dataset, the weights of the AI model, and a demonstration to experience our AI. We look forward to further improving the AI model in the future.

DOI： 10.1002/deo2.258

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203181

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203108

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

BACKGROUND AND AIM: The aim of this study was to elucidate the continuous use of antithrombotic medications during the peri-colorectal endoscopic submucosal dissection (ESD) period. METHODS: This study included 468 patients with colorectal epithelial neoplasms treated by ESD, consisting of 82 under antithrombotic medications and 386 patients without the medications. Among patients taking antithrombotic medications, antithrombotic agents were continued during the peri-ESD period. Clinical characteristics and adverse events were compared after propensity score matching. RESULTS: Before and after propensity score matching, post-colorectal ESD bleeding rate was higher in patients continuing antithrombotic medications (19.5&#37; and 21.6&#37;, respectively) than in those not taking antithrombotic medications (2.9&#37; and 5.4&#37;, respectively). In the Cox regression analysis, continuation of antithrombotic medications was associated with post-ESD bleeding risk (hazard ratio, 3.73; 95&#37; confidence interval, 1.2-11.6; P < 0.05) compared with patients without antithrombotic therapy. All patients who experienced post-ESD bleeding were successfully treated by endoscopic hemostasis procedure or conservative therapy. CONCLUSIONS: Continuation of antithrombotic medications during the peri-colorectal ESD period increases the risk of bleeding. However, the continuation may be acceptable under careful monitoring for post-ESD bleeding.

DOI： 10.1111/jgh.16149

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Internal Medicine  

Objective T helper (Th) cells play a central role in the pathogenesis of ulcerative colitis (UC). The present study analyzed the changes in circulating T cells by administration of ustekinumab (UST), an interleukin-12/ 23p40 antibody. Methods CD4 T cells were isolated from peripheral blood at 0 and 8 weeks after UST treatment, and we analyzed the proportion of CD4 T cells by flow cytometry. Clinical information and laboratory data were obtained at 0, 8, and 16 weeks. Patients We evaluated 13 patients with UC who received UST for the induction of remission between July 2020 and August 2021. Results The median partial Mayo score improved from 4 (1-7) to 0 (0-6) (p<0.001) with UST. Among serological parameters, albumin concentrations, C-reactive protein concentrations, the sedimentation rate, and leucine-rich alpha 2 glycoprotein concentrations showed significant improvement with UST. A flow cytometric analysis of circulating CD4 T cells showed that the percentage of Th17 cells was significantly decreased by UST treatment in all patients (1.85% to 0.98%, p<0.0001). Th1 cells were significantly increased by UST treatment (9.52% to 10.4%, p<0.05), but Th2 and regulatory T cells were not significantly different. The high-Th17 subgroup had a significantly better partial Mayo score than the low-Th17 subgroup at 16 weeks after UST treatment (0 vs. 1, p=0.028). Conclusion Treatment with UST decreases circulating Th17 cells, suggesting that this change may be related to the anti-inflammatory effect of UC.

DOI： 10.2169/internalmedicine.1724-23

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Gastroenterologia y Hepatologia  

Background: Adenocarcinoma is preceded by chronic atrophic gastritis, gastric intestinal metaplasia and dysplasia. Trefoil factor 3 (TFF3) is a peptide secreted by goblet cells, which is abundantly present in intestinal metaplasia. Aim: To evaluate the utility of serum TFF3 as a non-invasive biomarker for the diagnosis of intestinal metaplasia and gastric cancer. Methods: Single-center, cross-sectional study of 274 patients who consecutively underwent upper gastrointestinal endoscopy with gastric biopsies (updated Sydney system). TFF3 levels were measured in serum by a commercial ELISA kit. Patients with normal histology or chronic atrophic gastritis without intestinal metaplasia comprised the control group. In addition, 14 patients with invasive gastric cancer were included as a reference group. The association between TFF3 levels and intestinal metaplasia was assessed by logistic regression. Results: Patients with intestinal metaplasia (n = 110) had a higher median TFF3 level as compared to controls (n = 164), 13.1 vs. 11.9 ng/mL, respectively (p = 0.024). Multivariable logistic regression showed a no significant association between TFF3 levels and intestinal metaplasia (OR = 1.20; 95%CI: 0.87–1.65; p-trend = 0.273). The gastric cancer group had a median TFF3 level of 20.5 ng/mL, and a significant association was found (OR = 3.26; 95%CI: 1.29–8.27; p-trend = 0.013). Conclusion: Serum levels of TFF3 do not discriminate intestinal metaplasia in this high-risk Latin American population. Nevertheless, we confirmed an association between TFF3 levels and invasive gastric cancer.

DOI： 10.1016/j.gastrohep.2022.04.004

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掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：International Conference on Information and Communication Technologies for Ageing Well and e-Health, ICT4AWE - Proceedings  

A multitude of studies have investigated the opportunities and limitations of telemedicine pre- and post-COVID-19 pandemic. However, most of the research has focused on telemedicine's constraints in the context of international, regional, and developed nations, with few studies examining the specific challenges that may affect telemedicine's progress in developing countries where the pandemic may have exacerbated existing technological and geographical difficulties. This study takes the Philippines as a case study due to its archipelagic location, use of English as an official language, and other factors that influence its adaptability to international telemedicine. We assessed the barriers and challenges to the advancement of telemedicine from four viewpoints: policy, organization, individual, and collaboration between organizations. Therefore, the significance of this study is twofold: (a) to concentrate on international telemedicine education by contrasting domestic and international practices, and (b) to newly reveal connections between each component, as prior research highlighted barriers and difficulties but did not clarify relationships among different elements. We surveyed and interviewed 38 physicians, technicians, coordinators, and staff involved in telemedicine education in the Philippines. The study found that (1) public support yields favourable results, (2) a strong correlation exists between domestic and international telemedicine, (3) communication and technical obstacles are interconnected, (4) unity and cooperation in intra-hospital collaboration are critical, and (5) comprehending the "significance of work" has a positive impact. This study underscores the intersectionality of several barriers to telemedicine development. It also recommends providing greater support for telemedicine education in developing nations and promoting collaboration between developing and developed nations.

DOI： 10.5220/0011997600003476

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記述言語：英語   出版者・発行元：International Society for Telemedicine & eHealth(ISfTeH)  

Purpose: With the spread of COVID-19, medical education and research events have either been cancelled or shifted to online or hybrid mode. However, there are no accurate records containing the exact number of these events in new modes. This study explores trends in event modes of medical education and research in Japan using registered event data from a web service. / Methods: We collected event data from January 2019 to December 2021. Text mining was used to extract and classify data into categories such as on-site and online events. Then, the annual and monthly numbers of categories were counted. / Results: The total number of events in March 2020 was drastically reduced, but it recovered in November 2021 to a level equivalent to that of the peak month in 2019. The majority of the events were online by December 2020, increasing in number from March 2020. Hybrid events that integrate on-site and online modes later outnumbered online events and accounted for approximately 20% of the total in June, October, and November 2021. / Conclusions: The online and hybrid modes ensured the continuation of medical education and research events during the pandemic. Though online events may reduce after COVID-19, the hybrid mode could become a popular mode that offers diversity.

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Heliyon  

Background: The use of international telemedicine conferences for doctor-to-doctor education has increased following the coronavirus disease 2019 pandemic to ensure health and safety. Previous studies have shown that administrative tasks are an obstacle to promoting international telemedicine conferences but have not identified the type of system needed to alleviate this burden. Objective: The Asia-Pacific Advanced Network Medical Working Group (APAN-MWG) is an international telemedicine network that includes 1171 medical institutions and 3653 members as of July 21, 2021. The APAN-MWG has supported international telemedicine conferences since 2005 and implemented a program management system in 2014. The present study explores the conference organizers' tasks and evaluates the APAN-MWG management system through a survey of organizers. Methods: We developed a system called med-hok for managing conference programs, international medical institutions, and their members. We investigated all event programs using the med-hok system from June 3, 2015 to July 21, 2021. The target samples included 64 conference programs in 12 series hosted by 13 program organizers. The effectiveness of the system was evaluated using a four-point Likert scale (very good, good, poor, and very poor). The User Experience Questionnaire (UEQ) was used to assess user experience. Results: The survey response rate of the program organizers, who hosted 11 different program series in 7 Asian countries, was 92% (12/13). The administrative tasks for managing the programs were primarily handled by physicians (67%, 8/12), followed by technicians (17%, 2/12). The average program scope encompassed 7 countries, 10 institutions, and 44 members. The largest program comprised 194 members from 49 institutions in 25 countries and was managed by two physicians and one technician. Most program organizers (8/12, 67%) indicated that verifying member information was the most burdensome aspect of organizing teleconferences. Over 90% of respondents positively evaluated med-hok in the following areas: "Confirmation of institution information," "Confirmation of member information," "Confirmation of technical information," "Maintaining the latest status of the program," "Announcing and publicizing the event," and "Formatting and correcting misspellings." They rated user experience positively for all aspects (attractiveness: 1.22; practical quality: 1.42; and hedonic quality: 1.24). Conclusions: Many tasks of organizing casual international telemedicine conferences are handled by physicians and technicians with no operating funds or staff, unlike those in large academic conferences. The proposed system was found to help program organizers manage participants and communicate information effectively. These findings suggest that international telemedicine networks should implement an administrative support system to conduct program operations efficiently.

DOI： 10.1016/j.heliyon.2022.e11297

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

BACKGROUND AND AIM: Adrenomedullin is a bioactive peptide with many pleiotropic effects, including mucosal healing and immunomodulation. Adrenomedullin has shown beneficial effects in rodent models of inflammatory bowel disease and, more importantly, in clinical trials including patients with ulcerative colitis. We performed a successive clinical trial to investigate the efficacy and safety of adrenomedullin in patients with Crohn's disease (CD). METHODS: This was a multicenter, double-blind, placebo-controlled phase 2a trial that evaluated 24 patients with biologic-resistant CD in Japan. Patients were randomly assigned to three groups and were given an infusion of 10 or 15 ng/kg/min of adrenomedullin or placebo for 8 h per day for 7 days. The primary endpoint was the change in the CD activity index (CDAI) at 8 weeks. The main secondary endpoints included changes in CDAI from week 4 to week 24. RESULTS: No differences in the primary or secondary endpoints were observed between the three groups by the 8th week. Changes in CDAI in the placebo group gradually decreased and disappeared at 24 weeks, but those in the adrenomedullin-treated groups (10 or 15 ng/kg/min group) remained at steady levels for 24 weeks. Therefore, a significant difference was observed between the placebo and adrenomedullin-treated groups at 24 weeks (P = 0.043) in the mixed-effects model. We noted mild adverse events caused by the vasodilatory effect of adrenomedullin. CONCLUSION: In this trial, we observed a long-lasting (24 weeks) decrease in CDAI in the adrenomedullin-treated groups. Adrenomedullin might be beneficial for biologic-resistant CD, but further research is needed.

DOI： 10.1111/jgh.15945

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CiNii Research

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記述言語：日本語   出版者・発行元：日本遠隔医療学会  

遠隔会議を用いた内視鏡ライブ配信は教育コンテンツとして人気が高い。その技術的な配信手法の検討や実際の準備には一定の知識や技能が必要である一方、新たにライプ配信を企画する医療施設は十分な技術参照情報を得られないのが現状の課題である。本研究では内視鏡ライプ配信に必要となる技術面での負担を明らかにするべく、過去の支援内容およぴCOVID-19感染拡大前後での変化を評価する。2015年から2021年に行われた九州大学病院アジア遠隔医療開発センターによる内視鏡ライプ配信環境を持たない施設への技術支援を対象に、技術支援の件数、配信に用いたシステム、機材手配の内訳、技術支援者の現地立会いを年ことに計上した。さらに各データは2019年までと2020年以降で比較を行った。配信に用いたシステムは2019年まではハードウェア型だったものが2020年以降はすべてソフトウェア型に置き換わった。機材手配については2020年以降に配信端末、カメラ、音声機器が有意に減少した(p< 0.05)。また2020年以降は配信端末とカメラの手配が0件となった一方で、キャプチャーデバイスは全例で手配するようになった。技術支援者の立会いは、いずれの期間においても現地とオンラインの両方が見られた。全期間を通じて機材手配と技術支援者の立会いが見られたものの、COVID-19感染拡大以降に普及したソフトウェア型遠隔会議は内視鏡ライプ配信における技術面での負担の軽減が見込まれた。今後は熟錬の術者による手技の配信に留まらず、地方や海外の医療施設の術者がエキスパートから指導を受けるなど新しい活用方法を見出すことが期待できる。

CiNii Research

記述言語：英語  

記述言語：日本語  

遠隔会議を用いた内視鏡ライブ配信は教育コンテンツとして人気が高い。その技術的な配信手法の検討や実際の準備には一定の知識や技能が必要である一方、新たにライブ配信を企画する医療施設は十分な技術参照情報を得られないのが現状の課題である。本研究では内視鏡ライブ配信に必要となる技術面での負担を明らかにするべく、過去の支援内容およびCOVID-19感染拡大前後での変化を評価する。2015年から2021年に行われた九州大学病院アジア遠隔医療開発センターによる内視鏡ライブ配信環境を持たない施設への技術支援を対象に、技術支援の件数、配信に用いたシステム、機材手配の内訳、技術支援者の現地立会いを年ごとに計上した。さらに各データは2019年までと2020年以降で比較を行った。配信に用いたシステムは2019年まではハードウェア型だったものが2020年以降はすべてソフトウェア型に置き換わった。機材手配については2020年以降に配信端末、カメラ、音声機器が有意に減少した(p<0.05)。また2020年以降は配信端末とカメラの手配が0件となった一方で、キャプチャーデバイスは全例で手配するようになった。技術支援者の立会いは、いずれの期間においても現地とオンラインの両方が見られた。全期間を通じて機材手配と技術支援者の立会いが見られたものの、COVID-19感染拡大以降に普及したソフトウェア型遠隔会議は内視鏡ライブ配信における技術面での負担の軽減が見込まれた。今後は熟練の術者による手技の配信に留まらず、地方や海外の医療施設の術者がエキスパートから指導を受けるなど新しい活用方法を見出すことが期待できる。(著者抄録)

記述言語：日本語  

新型コロナウィルス感染症(COVID-19)の拡大により、大学医学部ではそれまで対面で行っていた研究教育活動や試験におけるオンライン実施を余儀なくされた。医学系大学院の博士学位申請者は県外や海外にいることも珍しくなく、学位論文予備審査をオンラインでどのように行うか、審査の厳格性を確保できるかという点が課題となるが、実施方法やその評価は明らかでない。当学ではパンデミックによる移動制限下に、博士取得の申請者を対象としてオンラインでの予備審査を15件実施し、審査を担当した評価者と申請者に対してアンケート調査を実施した。オンライン予備審査は15件全てが無事に実施され、評価者、申請者から概ね良好な反応が得られ、評価者全員から今後もこの方法を活用したほうが良いとの返答を得た。その一方で、オンライン予備審査中の評価者と申請者のコミュニケーションに若干の課題があった。移動にかかる時間やコストを削減できるオンライン予備審査は多忙な医療者にとって有用であることが示唆され、今後の積極的な活用が期待される。(著者抄録)

記述言語：日本語  

遠隔医療教育は地域間、国家間における医療格差の縮小に有用である。しかし、多くの医療施設には遠隔医療教育の環境設置・運用支援に特化した技術スタッフはなく、研修を通じた担当者の育成が必要である。これまでにオンライン医療研修が多数報告されているが、国際間の遠隔医療教育のための技術研修では、研修者と評価者が地理的に離れていることによる客観的評価の困難さがあげられていた。また、リッカート尺度による評価は個人差が生じやすいことが指摘されたため、尺度に対応する技能を文章で表現したルーブリックによる評価指標が開発された。そこで本研究では、アジア発展途上国を対象にオンラインでの遠隔医療教育技術研修を実施し、現地の同僚による客観的評価を行い、本オンライン研修プログラムの効果と客観的評価方法を検討する。本研究の対象は、TEMDECが主催した技術研修へ参加したアジア発展途上国の7か国20人とした。研修は2021年11月と2月にZOOMミーティングで実施された。まず研修者から、自施設における遠隔会議への技術支援と課題について発表した後、抽出された課題について要因と解決策を議論し、取り組む解決策を選択し、2月に自施設での解決策の検討結果を議論した。開発されたルーブリックを用いて研修者の同僚2名に研修前後の客観的評価を取得させた。参加率は1日目90%(18/20)、2日目95%(19/20)、3日目95%(19/20)、4日目80%(16/20)、5日目65%(13/20)であった。「遠隔会議に活用できる専用の会議室の不足」「遠隔からの参加者による技術トラブル」「技術担当者・専門知識の不足」の3つの課題が抽出された。研修者のうち14名(70%)の同僚28名が評価し、すべての項目についてプログラム後に有意に向上した。研修者、指導者が数名づつ離れている場合のオンライン研修における客観的評価の信頼性の確保は課題があり、遠隔地の指導者が評価できるためのより多くの情報を入手したり、オンラインで実施可能な客観的評価ツールの必要性が示唆された。(著者抄録)

記述言語：日本語  

遠隔会議を用いた内視鏡ライブ配信は教育コンテンツとして人気が高い。その技術的な配信手法の検討や実際の準備には一定の知識や技能が必要である一方、新たにライブ配信を企画する医療施設は十分な技術参照情報を得られないのが現状の課題である。本研究では内視鏡ライブ配信に必要となる技術面での負担を明らかにするべく、過去の支援内容およびCOVID-19感染拡大前後での変化を評価する。2015年から2021年に行われた九州大学病院アジア遠隔医療開発センターによる内視鏡ライブ配信環境を持たない施設への技術支援を対象に、技術支援の件数、配信に用いたシステム、機材手配の内訳、技術支援者の現地立会いを年ごとに計上した。さらに各データは2019年までと2020年以降で比較を行った。配信に用いたシステムは2019年まではハードウェア型だったものが2020年以降はすべてソフトウェア型に置き換わった。機材手配については2020年以降に配信端末、カメラ、音声機器が有意に減少した(p<0.05)。また2020年以降は配信端末とカメラの手配が0件となった一方で、キャプチャーデバイスは全例で手配するようになった。技術支援者の立会いは、いずれの期間においても現地とオンラインの両方が見られた。全期間を通じて機材手配と技術支援者の立会いが見られたものの、COVID-19感染拡大以降に普及したソフトウェア型遠隔会議は内視鏡ライブ配信における技術面での負担の軽減が見込まれた。今後は熟練の術者による手技の配信に留まらず、地方や海外の医療施設の術者がエキスパートから指導を受けるなど新しい活用方法を見出すことが期待できる。(著者抄録)

記述言語：日本語  

新型コロナウィルス感染症(COVID-19)の拡大により、大学医学部ではそれまで対面で行っていた研究教育活動や試験におけるオンライン実施を余儀なくされた。医学系大学院の博士学位申請者は県外や海外にいることも珍しくなく、学位論文予備審査をオンラインでどのように行うか、審査の厳格性を確保できるかという点が課題となるが、実施方法やその評価は明らかでない。当学ではパンデミックによる移動制限下に、博士取得の申請者を対象としてオンラインでの予備審査を15件実施し、審査を担当した評価者と申請者に対してアンケート調査を実施した。オンライン予備審査は15件全てが無事に実施され、評価者、申請者から概ね良好な反応が得られ、評価者全員から今後もこの方法を活用したほうが良いとの返答を得た。その一方で、オンライン予備審査中の評価者と申請者のコミュニケーションに若干の課題があった。移動にかかる時間やコストを削減できるオンライン予備審査は多忙な医療者にとって有用であることが示唆され、今後の積極的な活用が期待される。(著者抄録)

記述言語：日本語  

遠隔医療教育は地域間、国家間における医療格差の縮小に有用である。しかし、多くの医療施設には遠隔医療教育の環境設置・運用支援に特化した技術スタッフはなく、研修を通じた担当者の育成が必要である。これまでにオンライン医療研修が多数報告されているが、国際間の遠隔医療教育のための技術研修では、研修者と評価者が地理的に離れていることによる客観的評価の困難さがあげられていた。また、リッカート尺度による評価は個人差が生じやすいことが指摘されたため、尺度に対応する技能を文章で表現したルーブリックによる評価指標が開発された。そこで本研究では、アジア発展途上国を対象にオンラインでの遠隔医療教育技術研修を実施し、現地の同僚による客観的評価を行い、本オンライン研修プログラムの効果と客観的評価方法を検討する。本研究の対象は、TEMDECが主催した技術研修へ参加したアジア発展途上国の7か国20人とした。研修は2021年11月と2月にZOOMミーティングで実施された。まず研修者から、自施設における遠隔会議への技術支援と課題について発表した後、抽出された課題について要因と解決策を議論し、取り組む解決策を選択し、2月に自施設での解決策の検討結果を議論した。開発されたルーブリックを用いて研修者の同僚2名に研修前後の客観的評価を取得させた。参加率は1日目90%(18/20)、2日目95%(19/20)、3日目95%(19/20)、4日目80%(16/20)、5日目65%(13/20)であった。「遠隔会議に活用できる専用の会議室の不足」「遠隔からの参加者による技術トラブル」「技術担当者・専門知識の不足」の3つの課題が抽出された。研修者のうち14名(70%)の同僚28名が評価し、すべての項目についてプログラム後に有意に向上した。研修者、指導者が数名づつ離れている場合のオンライン研修における客観的評価の信頼性の確保は課題があり、遠隔地の指導者が評価できるためのより多くの情報を入手したり、オンラインで実施可能な客観的評価ツールの必要性が示唆された。(著者抄録)

記述言語：日本語   出版者・発行元：(一社)日本遠隔医療学会  

遠隔医療教育は地域間、国家間における医療格差の縮小に有用である。しかし、多くの医療施設には遠隔医療教育の環境設置・運用支援に特化した技術スタッフはなく、研修を通じた担当者の育成が必要である。これまでにオンライン医療研修が多数報告されているが、国際間の遠隔医療教育のための技術研修では、研修者と評価者が地理的に離れていることによる客観的評価の困難さがあげられていた。また、リッカート尺度による評価は個人差が生じやすいことが指摘されたため、尺度に対応する技能を文章で表現したルーブリックによる評価指標が開発された。そこで本研究では、アジア発展途上国を対象にオンラインでの遠隔医療教育技術研修を実施し、現地の同僚による客観的評価を行い、本オンライン研修プログラムの効果と客観的評価方法を検討する。本研究の対象は、TEMDECが主催した技術研修へ参加したアジア発展途上国の7か国20人とした。研修は2021年11月と2月にZOOMミーティングで実施された。まず研修者から、自施設における遠隔会議への技術支援と課題について発表した後、抽出された課題について要因と解決策を議論し、取り組む解決策を選択し、2月に自施設での解決策の検討結果を議論した。開発されたルーブリックを用いて研修者の同僚2名に研修前後の客観的評価を取得させた。参加率は1日目90%(18/20)、2日目95%(19/20)、3日目95%(19/20)、4日目80%(16/20)、5日目65%(13/20)であった。「遠隔会議に活用できる専用の会議室の不足」「遠隔からの参加者による技術トラブル」「技術担当者・専門知識の不足」の3つの課題が抽出された。研修者のうち14名(70%)の同僚28名が評価し、すべての項目についてプログラム後に有意に向上した。研修者、指導者が数名づつ離れている場合のオンライン研修における客観的評価の信頼性の確保は課題があり、遠隔地の指導者が評価できるためのより多くの情報を入手したり、オンラインで実施可能な客観的評価ツールの必要性が示唆された。(著者抄録)

記述言語：英語   出版者・発行元：(一社)日本遠隔医療学会  

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記述言語：日本語   出版者・発行元：(一社)日本遠隔医療学会  

新型コロナウィルス感染症(COVID-19)の拡大により、大学医学部ではそれまで対面で行っていた研究教育活動や試験におけるオンライン実施を余儀なくされた。医学系大学院の博士学位申請者は県外や海外にいることも珍しくなく、学位論文予備審査をオンラインでどのように行うか、審査の厳格性を確保できるかという点が課題となるが、実施方法やその評価は明らかでない。当学ではパンデミックによる移動制限下に、博士取得の申請者を対象としてオンラインでの予備審査を15件実施し、審査を担当した評価者と申請者に対してアンケート調査を実施した。オンライン予備審査は15件全てが無事に実施され、評価者、申請者から概ね良好な反応が得られ、評価者全員から今後もこの方法を活用したほうが良いとの返答を得た。その一方で、オンライン予備審査中の評価者と申請者のコミュニケーションに若干の課題があった。移動にかかる時間やコストを削減できるオンライン予備審査は多忙な医療者にとって有用であることが示唆され、今後の積極的な活用が期待される。(著者抄録)

記述言語：日本語   出版者・発行元：(一社)日本遠隔医療学会  

新型コロナウィルス感染症(COVID-19)の拡大により、大学医学部ではそれまで対面で行っていた研究教育活動や試験におけるオンライン実施を余儀なくされた。医学系大学院の博士学位申請者は県外や海外にいることも珍しくなく、学位論文予備審査をオンラインでどのように行うか、審査の厳格性を確保できるかという点が課題となるが、実施方法やその評価は明らかでない。当学ではパンデミックによる移動制限下に、博士取得の申請者を対象としてオンラインでの予備審査を15件実施し、審査を担当した評価者と申請者に対してアンケート調査を実施した。オンライン予備審査は15件全てが無事に実施され、評価者、申請者から概ね良好な反応が得られ、評価者全員から今後もこの方法を活用したほうが良いとの返答を得た。その一方で、オンライン予備審査中の評価者と申請者のコミュニケーションに若干の課題があった。移動にかかる時間やコストを削減できるオンライン予備審査は多忙な医療者にとって有用であることが示唆され、今後の積極的な活用が期待される。(著者抄録)

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202993

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出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000000301

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Gastroenterology  

BACKGROUND: This is the first report from a multicenter prospective cohort study of colorectal neuroendocrine tumor (NET), the C-NET STUDY, conducted to assess the long-term outcomes of the enrolled patients. This report aimed to elucidate the clinicopathological features of the enrolled patients and lesions. METHODS: Colorectal NET patients aged 20-74 years were consecutively enrolled and followed up at 50 institutions. The baseline characteristics and clinicopathological findings at enrollment and treatment were assessed. RESULTS: A total of 495 patients with 500 colorectal NETs were included. The median patient age was 54 years, and 85.3% were asymptomatic. The most frequent lesion location was the lower rectum (88.0%); 99.4% of the lesions were clinically diagnosed to be devoid of metastatic findings, and 95.4% were treated with endoscopic resection. Lesions < 10 mm comprised 87.0% of the total, 96.6% had not invaded the muscularis propria, and 92.6% were classified as WHO NET grade 1. Positive lymphovascular involvement was found in 29.2% of the lesions. Its prevalence was high even in small NETs with immunohistochemical/special staining for pathological assessment (26.4% and 40.9% in lesions sized < 5 mm and 5-9 mm, respectively). Among 70 patients who underwent radical surgery primarily or secondarily, 18 showed positive lymph node metastasis. CONCLUSIONS: The characteristics of real-world colorectal NET patients and lesions are elucidated. The high positivity of lymphovascular involvement in small NETs highlights the necessity of assessing the clinical significance of positive lymphovascular involvement based on long-term outcomes, which will be examined in later stages of the C-NET STUDY. TRIAL REGISTRATION NUMBER: UMIN000025215.

DOI： 10.1007/s00535-022-01877-5

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202910

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202793

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202812

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1016/j.gastrohep

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1159/000524023

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Digestion  

INTRODUCTION: An association has been found between human-gut microbiota and various diseases (e.g., metabolic disease) by analyzing fecal or colonic microbiota. Despite the importance of the small intestinal microbiota, sampling difficulties prevent its full analysis. We investigated the composition and metagenomic functions of microbiota along the small intestine and compared them with the microbiota from feces and from other gastrointestinal (GI) sites. METHODS: Mucosal samples from the six GI sites (stomach, duodenum, distal jejunum, proximal ileum, terminal ileum, and rectum) were collected under balloon-assisted enteroscopy. Fecal samples were collected from all participants. The microbial structures and metagenomic functions of the small intestinal mucosal microbiota were compared with those from feces and other GI sites using 16S ribosomal RNA gene sequencing. RESULTS: We analyzed 133 samples from 29 participants. Microbial beta diversity analysis showed that the jejunum and ileum differed significantly from the lower GI tract and the feces (p < 0.001). Jejunal and duodenal microbiotas formed similar clusters. Wide clusters spanning the upper and lower GI tracts were observed with the ileal microbiota, which differed significantly from the jejunal microbiota (p < 0.001). Veillonella and Streptococcus were abundant in the jejunum but less so in the lower GI tract and feces. The metagenomic functions associated with nutrient metabolism differed significantly between the small intestine and the feces. CONCLUSIONS: The fact that the compositional structures of small intestinal microbiota differed from those of fecal and other GI microbiotas reveals that analyzing the small intestinal microbiota is necessary for association studies on metabolic diseases and gut microbiota.

DOI： 10.1159/000524023

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Intestinal Research  

BACKGROUND/AIMS: Recent studies suggested a favorable effect of indigo naturalis (IN) in inducing remission for refractory ulcerative colitis (UC), however, the maintenance effect of IN for patients with UC remains unknown. Therefore, we conducted a prospective uncontrolled open-label study to analyze the efficacy and safety of IN for patients with UC. METHODS: Patients with moderate to severe active UC (clinical activity index [CAI] ≥ 8) took 2 g/day of IN for 52 weeks. CAI at weeks 0, 4, 8, and 52 and Mayo endoscopic subscore (MES) and Geboes score (GS) at weeks 0, 4, and 52 were assessed. Clinical remission (CAI ≤ 4), mucosal healing (MES ≤ 1), and histological healing (GS ≤ 1) rates at each assessment were evaluated. Overall adverse events (AEs) during study period were also evaluated. The impact of IN on mucosal microbial composition was assessed using 16S ribosomal RNA gene sequences. RESULTS: Thirty-three patients were enrolled. The rates of clinical remission at weeks 4, 8, and 52 were 67%, 76%, and 73%, respectively. The rates of mucosal healing at weeks 4 and 52 were 48% and 70%, respectively. AEs occurred in 17 patients (51.5%) during follow-up. Four patients (12.1%) showed severe AEs, among whom 3 manifested acute colitis. No significant alteration in the mucosal microbial composition was observed with IN treatment. CONCLUSIONS: One-year treatment of moderate to severe UC with IN was effective. IN might be a promising therapeutic option for maintaining remission in UC, although the relatively high rate of AEs should be considered.

DOI： 10.5217/ir.2021.00124

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記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.5217/ir.2021.00124

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： http://doi.org/10.1089/tmj.2021.0046

記述言語：日本語  

CiNii Research

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The indication for endoscopic resection for submucosally invasive colorectal cancer (T1-CRC) depends on the preoperative diagnosis of invasion depth. The aim of this investigation was to evaluate the association between barium enema examination (BE) profile views and depth of submucosal (SM) invasion in CRCs. METHODS: We reviewed the radiographic and endoscopic findings of 145 T1-CRCs diagnosed from 2008 to 2019. We measured the widths of horizontal and vertical rigidity under a BE profile view corresponding to CRC and compared the values with SM invasion depth. Horizontal rigidity was defined as the horizontal length and vertical rigidity as the vertical width of the barium defect corresponding to each target lesion. The most appropriate cut-off values for predicting SM invasion ≥1.8 mm were calculated by receiver operating characteristic curve analysis. RESULTS: Values of horizontal rigidity (r = 0.626, P < 0.05) and vertical rigidity (r = 0.482, P < 0.05) correlated significantly with SM invasion depth. The most appropriate cut-off values for the prediction of SM invasion depth ≥ 1.8 mm were 4.5 mm for horizontal rigidity, with an accuracy of 80.7%; and 0.7 mm for vertical rigidity, with an accuracy of 77.9%. The prevalence of lympho-vascular invasion was significantly different when those cut-off values were applied (43.2% vs. 17.5% for horizontal rigidity, P < 0.005). CONCLUSIONS: In T1-CRC, values of horizontal and vertical rigidities under a BE profile view were correlated with SM invasion depth. While the accuracy of the rigidities for the prediction of SM invasion depth ≥ 1.8 mm was not high, horizontal rigidity may be predictive of lympho-vascular invasion, thus aiding in therapeutic decision-making.

DOI： 10.1186/s40644-021-00437-z

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1007/s11604-021-01157-x

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1186/s40644-021-00437-z

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.2169/internalmedicine.6341-20

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

記述言語：日本語  

記述言語：日本語  

Evaluation of live endoscopy transmission with HD resolution through web-conferencing software

記述言語：日本語  

Implementation and evaluation of an on-line engineering training program for international remote medical education

記述言語：英語   掲載種別：研究論文（学術雑誌）  

ABSTRACT: To investigate the mucosal microbiota in the stomach of patients with Helicobacter pylori-negative mucosa-associated lymphoid tissue (MALT) lymphoma by means of metagenomic analysis.Although some gastric MALT lymphomas are associated with the presence of H. pylori, other gastric MALT lymphomas occur independently of H. pylori infection. The pathogenesis of H. pylori-negative MALT lymphoma remains unclear.Mucosal biopsy specimens were collected from the gastric body from 33 MALT lymphoma patients with gastric lesions, including both H. pylori-infection naïve patients and posteradication patients, as well as 27 control participants without H. pylori infection or cancer. Subsequently, the samples were subjected to 16S rRNA gene sequencing. Quantitative insights into microbial ecology, linear discriminant analysis effect size, and phylogenetic investigation of communities by reconstruction of unobserved states softwares were used to analyze the participants' microbiota.H. pylori-negative MALT lymphoma patients had significantly lower alpha diversity (P = .04), compared with control participants. Significant differences were evident in the microbial composition (P = .04), as determined by comparison of beta diversity between the 2 groups. Taxonomic composition analysis indicated that the genera Burkholderia and Sphingomonas were significantly more abundant in MALT lymphoma patients, while the genera Prevotella and Veillonella were less abundant. Functional microbiota prediction showed that the predicted gene pathways "replication and repair," "translation," and "nucleotide metabolism" were downregulated in MALT lymphoma patients.H. pylori-negative MALT lymphoma patients exhibited altered gastric mucosal microbial compositions, suggesting that altered microbiota might be involved in the pathogenesis of H. pylori-negative MALT lymphoma.

DOI： 10.1097/MD.0000000000027287

記述言語：英語  

Lectures' and students' perspectives toward the shift to online teaching owing to COVID-19 : a case at Kyushu University School of Medicine

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1007/s10620-020-06600-z

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1097/MD.0000000000027287

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

＜文献概要＞過去10年間に注腸X線造影検査(BE)が施行された大腸T1癌133例を対象とし,BEの側面変形と粘膜下層(SM)浸潤距離の関係とSM 1,800μm以深癌の検出能を検討した.X線造影所見として二重造影像における病変部位の変形に着目し,管腔に対して水平方向および垂直方向の変形長を計測した.その結果,水平変形長(相関係数r=0.6657,p<0.01),垂直変形長(r=0.5197,p<0.01)ともにSM浸潤距離と正の相関を示した.SM 1,800μm以深癌の検出におけるカットオフ値は水平変形長4.5mm,垂直変形長0.5mmで,正診率はそれぞれ82.0%,79.7%であった.以上のカットオフ値に従って変形を陽・陰性に分けると,水平変形陽性例で陰性例よりもリンパ管侵襲,静脈侵襲の割合が高かった.以上より,水平変形長は脈管侵襲の予測因子であり,4.5mmまでの変形は内視鏡治療選択の指標となる可能性が示唆された.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Ustekinumab (UST), an antibody targeting the p40 subunit of interleukin (IL)-12 and IL-23, is effective in treating Crohn's disease (CD). To clarify the mechanism of UST, we investigated T-cell differentiation in CD patients treated with UST. METHODS: Twenty-seven patients with active CD were enrolled in this study. Seventeen patients were treated with UST, and 10 patients were treated with anti-tumor necrosis factor (TNF)-alpha therapy. The changes in the proportions of T-cell subsets after these therapies were analyzed by flow cytometry. Comprehensive gene expression changes in the colonic mucosa were also evaluated. RESULTS: The frequency of T helper (Th) 17 cells was significantly decreased in the peripheral blood of patients with active CD after UST therapy. Anti-TNF therapy had a minimal effect on Th17 cells but increased the proportion of regulatory T cells. Enrichment analysis showed the expression of genes involved in the Th17 differentiation pathway was downregulated in the colonic mucosa after UST but not anti-TNF therapy. There were no common differentially expressed genes between CD patients treated with UST and anti-TNF therapy, suggesting a clear difference in their mechanism of action. CONCLUSION: In patients with active CD, UST therapy suppressed Th17 cell differentiation both in the peripheral blood and colonic tissues.

DOI： 10.1159/000518103

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

DOI： 10.1007/978-3-030-80091-8_129

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1159/000518103.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The aim of this investigation was to evaluate the clinical value of barium enema (BE) examination for the management of colorectal epithelial neoplasms. METHODS: We reviewed the colonoscopy records at our institution from 2014 to 2019 and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms evaluated by BE, conventional colonoscopy, magnifying narrow-band imaging colonoscopy (M-NBI), and magnifying chromoendoscopy (MCE). The yield of each modality for the diagnosis of massively submucosal invasive (mSM) colorectal cancer was evaluated by a receiver-operating characteristic analysis including the area under the curve (AUC). RESULTS: We analyzed the records of 105 patients (17 adenomas, 53 high-grade dysplasias (HGDs), and 35 cancers). Smooth surface, irregularity in depression, and eccentric deformity on the profile view with BE were observed more frequently in mSM cancers than adenomas/HGDs/slightly submucosal invasive cancers (p < 0.01). The AUC of BE was 0.8355, the value of which was not different from the other three modalities (conventional colonoscopy 0.7678; M-NBI 0.7835; MCE 0.8376). Although the specificity, PPV, and accuracy of BE were lower than those of M-NBI and MCE, the sensitivity and NPV of BE were the highest among the four types of examinations. CONCLUSION: BE is still available and may serve as a supplementary modality for the diagnosis of mSM cancers.

DOI： 10.1007/s11604-021-01157-x

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background With recent advances in endoscopic modalities, small bowel vascular lesions (SBVLs) are often now detected in patients with gastrointestinal bleeding. Given the high invasiveness of endoscopic treatment, it is important to select patients at high risk for bleeding. Aim To assess the risk of rebleeding in patients with SBVLs as a systemic disease rather than a gastrointestinal disease in relation to their general health. Methods We retrospectively analyzed the clinical data of 55 patients with SBVLs among patients with obscure gastrointestinal bleeding. The possible association between the clinical findings and the updated Charlson comorbidity index with rebleeding was evaluated. Results Gastrointestinal rebleeding occurred in 20 patients (36.4%) during the follow-up period. The presence of multiple comorbidities as indicated by an updated Charlson comorbidity index of ≥4 was a risk factor for rebleeding (hazard ratio, 3.64; P = 0.004). Other risk factors were arteriosclerosis of the superior mesenteric artery and multiple SBVLs. Endoscopic hemostasis and the discontinuation of antithrombotic medications were not significantly associated with rebleeding. Patients with a high updated Charlson comorbidity index had a high risk of death of causes other than gastrointestinal rebleeding. Conclusions Gastrointestinal rebleeding is not a rare condition among patients with SBVLs. Patients with poor general health may therefore have a higher risk of rebleeding.

DOI： 10.2169/internalmedicine.6341-20

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Mary Ann Liebert Inc  

Background: Telemedicine conferencing is expected to become commonly used internationally. However, national reports on internationally related telemedicine are limited, and related activities and challenges in each country are unclear. In this study, we aimed to clarify the current status and barriers to international telemedicine conferencing in Japan. Methods: The questionnaire was sent to the Internationalization Project Team (I-PT) representatives in all 43 Japanese National University Hospitals. The total of 167 assigned staff comprised 86 medical staff in charge of internationalization (MI) and 81 technical staff in telemedicine (TT). Results: The response rate was 93% (40/43 universities) from 88 staff (44 MI and 44 TT). Most respondents (75%) stated that they had not been active in international telemedicine conferencing during the past 3 years, although a videoconferencing system was installed in 93% of universities. A total of 65% respondents felt that barriers to promoting telemedicine and conferencing existed. Most (43%) respondents reported staff shortage as the most serious barrier overall. Five TT (19%) felt that the most serious barrier was difficulty with English communication, although no MI selected this as a barrier. More MI than TT felt that technical issues were the most serious barrier (MI: 4/29, TT: 1/27). Conclusions: International telemedicine conferencing was found to be insufficiently active in I-PT of Japan, although the installed equipment and technical expertise of TT seemed adequate. This indicates that merely assigning MI and TT to an I-PT is not enough and that improved cooperation between both MI and TT at each university hospital is needed. Establishment of a structured international telemedicine center in each university hospital is to be suggested to accelerate the activities in Japan.

DOI： 10.1089/tmj.2021.0046

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Adrenomedullin (AM) is a bioactive peptide having many pleiotropic effects, including mucosal healing and immunomodulation. AM has shown beneficial effects in rodent models and in preliminary study for patients with ulcerative colitis (UC). We performed a clinical trial to investigate the efficacy and safety of AM in patients with UC. METHODS: This was a multi-center, double-blind, placebo-controlled phase-2a trial evaluating 28 patients in Japan with steroid-resistant UC. Patients were randomly assigned to four groups and given an infusion of 5, 10, 15 ng/kg/min of AM or placebo for 8 h per day for 14 days. The primary endpoint was the change in Mayo scores at 2 weeks. Main secondary endpoints included the change in Mayo scores and the rate of clinical remission at 8 weeks, defined as a Mayo score 0. RESULTS: No differences in the primary or secondary endpoints were observed among the four groups at 2 weeks. Despite the insufficient tracking rate, the Mayo score at 8 weeks was only significantly decreased in the high-dose AM group (15 ng/kg/min) compared with the placebo group (- 9.3 ± 1.2 vs. - 3.0 ± 2.8, P = 0.035), with its rate of clinical remission at 8 weeks being significantly higher (3/3, 100% vs. 0/2, 0%, P = 0.025). We noted mild but no serious adverse events caused by the vasodilatory effect of AM. CONCLUSIONS: In this double-blind randomized trial, we observed the complete remission at 8 weeks in patients with steroid-resistant UC receiving a high dose of AM. CLINICAL TRIAL REGISTRY: JAPIC clinical trials information; Japic CTI-205255 (200410115290). https://www.clinicaltrials.jp/cti-user/trial/Search.jsp .

DOI： 10.1007/s00535-020-01741-4

記述言語：英語  

記述言語：日本語  

新型コロナウイルス感染症(COVID-19)のパンデミックによって学術集会はオンラインでの開催への変更を余儀なくされた。本研究では日本泌尿器科学会福岡地方会において、リアルタイムでの発表とチャットを用いた質疑の形式でのオンライン学術集会における演者への技術支援内容を記録し、参加者に対してオンライン学術集会に関するオンラインアンケートを実施した。結果、演者への支援は主に遠隔会議システムの操作方法に関するものであった。参加者の多くは、自宅や職場から個人の端末を用いて接続していたが、音声映像の品質を高く評価しており、過半数(57&#37;、58/102)が総合評価としてオンライン開催の方が優れていると回答した。しかし全21名のうち1名の演者が発表中の意図しない接続断によって発表を行うことができなかった。また6演題では発表中に口頭で操作方法の助言を行った。オンライン学術集会における課題として参加者の交流や、確実な発表の実施と討論の場の提供を鑑みた開催方式の検討が挙げられる。(著者抄録)

記述言語：英語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：英語  

Japan has a high diagnostic rate of early gastric cancer (EGC), and doctors worldwide are eager to learn advanced tips and skills from Japanese experts. The Telemedicine Development Center of Asia has carried out endoscopy-themed teleconferences, to educate overseas doctors about diagnosing EGC, from which video data are analyzed. The number of comments made varied based on the participant's role in the teleconference. The experts and chair made more comments than the audience participants. Because in-depth discussion about each case study with the experts is important in learning advice for EGC diagnosis, in this paper, we further analyzed the reasons why there were so many silent participants and how to activate discussion by them. We learned that most hesitated when the discussion was concentrated between the experts. Live polling was added to the teleconference to increase activation. Although a direct increase in the number of comments was not seen, the proportion of participants who had questions but remained silent decreased by 53%, and 88% of participants stated that the live polling increased the quality of the discussion. We found that live polling provides valuable feedback to the chair so that the discussion could incorporate the participants' opinions, and thus, it increased the quality of the discussion phase.

記述言語：英語   掲載種別：研究論文（その他学術会議資料等）  

There are many studies addressing how to shift events from face-to-face to virtual under a pre-planned schedule. However, because of the COVID-19 pandemic, rapid replacement of face-to-face events with online events was required at Kyushu University Hospital in Japan. There is limited research on how to accomplish this type of shift in events and no specific guidance exists for making necessary changes. This study aimed to fill this gap in knowledge by evaluating the characteristics and technical support needs of 62 administrative and educational events (25 grouped events) organized by 15 university departments between March and May 2020. We also distributed open-ended questionnaires to the departments that received technical support for their events. Technical support services comprised professional support services and equipment/system support. Three of the most frequently required support services were equipment/system support, on-site support, and venue arrangement. More than half (9/16) of administrative events included individuals from outside of the university, while those that were limited to individuals within Kyushu University also included multiple departments. Results also indicated that a physical "headquarters" room was important to many departments, despite the potential risk of disease transmission. Although online events are relatively simple for large numbers of people to access, they require a large amount of technical support, including technical management and direction.

記述言語：英語   掲載種別：研究論文（その他学術会議資料等）  

The COVID-19 pandemic has caused a shift in the style of academic conferences from in-person to virtual. There have been reports about virtual academic conferences; however, the advantages and disadvantages are not readily apparent from the participants' perspective. This study evaluated a virtual academic conference compared with a conventional one from the viewpoint of participants based on the results of the 24th Japan Association of Medical Informatics Spring Symposium; that association held a virtual conference for the first time. The conference was conducted in three parallel virtual venues using Zoom® webinars. All the panelists and audience members participated from their own sites. The operating team acted as host control for the Zoom® webinar, master of ceremonies, and monitoring and responding to online comments. Questionnaires using the Google Form were sent by e-mail to all registrants after the conference. The number of registrants was about twice that in previous years: 2345 in 2020, 1189 in 2019, and 1007 in 2018. The response rate to the questionnaire was 68&#37; (1591/2345). Most respondents said that the virtual conference was better than the conventional one in terms of image quality of presentation slides (75&#37;), being able to concentrate on presentations (77&#37;), session accessibility (59&#37;), and feasibility of asking questions (53&#37;). In contrast, most (63&#37;) respondents stated that the inperson conference was better for communicating with other participants. Finally, 97&#37; (1535/1591) of participants evaluated the virtual academic conference positively. The virtual conference was highly evaluated by participants because of its advantages compared with conventional ones. However, difficulties in human networking should be addressed in the future.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although combining thiopurine with infliximab (IFX) is considered to improve the clinical efficacy of IFX when treating Crohn's disease (CD), it also increases the risk of adverse events (AEs). We compared the efficacy and safety of delayed thiopurine addition after loss of response (LOR) to IFX with the efficacy and safety of an earlier combination of thiopurine and IFX. METHODS: This retrospective study analyzed patients with CD who started IFX as a first-line biologic at Kyushu University Hospital between June 2002 and July 2018. Patients were assigned to either the early-combination (EC) group, who started IFX and thiopurine simultaneously, or the late-combination (LC) group, who were treated with IFX alone until they developed LOR. We compared the cumulative IFX continuation rates and AE incidence between the two groups. RESULTS: One hundred seventy-six patients were enrolled in this study; 49 were enrolled in the EC group, and 127 were enrolled in the LC group. Disease activity at baseline did not significantly differ between the groups, nor did the cumulative IFX continuation rates differ between the groups (P = 0.30); however, the AE rate was significantly higher in the EC group than in the LC group (38.7&#37; vs. 21.2&#37;; P = 0.02). The severe AE rate was also higher in the EC group than in the LC group (18.3&#37; vs 3.1&#37;; P = 0.001). CONCLUSION: Considering the risk-benefit balance, delayed addition of thiopurine after LOR to IFX might be an alternative strategy when using IFX to treat CD.

DOI： 10.1007/s10620-020-06600-z

記述言語：英語   掲載種別：研究論文（その他学術会議資料等）  

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020. International education programs that use videoconferencing (VC) are common now and many are being implemented in the medical field. Irrespective of the value of the content, the learning process can be disrupted when technical quality of VC is compromised. In this study, a participatory design (PD) was used with focus group discussion between technical support staff to determine and classify the causes of technical issues in international remote medical education by VC. As a result, a quality of experience (QoE) -based framework was developed based on the technical issues raised. User behavior and three factors (context, human and system factors) influence technical errors, either preventing or creating difficulties, and affecting each other. For future prototyping of the PD process, it is suggested to have a flexible and specific operational procedure which considers variables of engineers’ background.

DOI： 10.1007/978-3-030-51828-8_24

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Because the pathogenesis of gastrointestinal follicular lymphoma (GI-FL) remains unclear, no standardized treatment strategy has been established. Of the gastrointestinal lymphomas, gastric mucosa-associated lymphoid tissue lymphomas are strongly associated with Helicobacter pylori; hence, the microbiota may be involved in GI-FL pathogenesis. However, the association between GI-FL and the microbiota remains uninvestigated. Therefore, we compared the mucosal microbiotas of GI-FL patients with those of controls to identify microbiota changes in GI-FL patients. Mucosal biopsy samples were obtained from the second portion of the duodenum from 20 GI-FL patients with duodenal lesions and 20 controls. Subsequent 16S rRNA gene sequencing was performed on these samples. QIIME pipeline and LEfSe software were used to analyze the microbiota. The GI-FL patients had significantly lower alpha diversity (P = .049) than did the controls, with significant differences in the microbial composition (P = .023) evaluated by the beta diversity metrics between the two groups. Comparing the taxonomic compositions indicated that the genera Sporomusa, Rothia, and Prevotella and the family Gemellaceae were significantly less abundant in the GI-FL patients than in the controls. GI-FL patients presented altered duodenal mucosal microbial compositions, suggesting that the microbiota might be involved in the GI-FL pathogenesis.

DOI： 10.1002/hon.2717

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: There is no definite evidence of the feasibility and safety of laparoscopic distal gastrectomy (LDG) for patients who have undergone incomplete endoscopic resection (ER). We investigated the influence of ER prior to LDG by a propensity score matching analysis. METHODS: We retrospectively analyzed the outcomes of gastric cancer patients who underwent LDG with or without prior ER from 2000 to 2014. Propensity score matching was performed to compare the two groups of patients. RESULTS: After matching, 47 patients in the ER group and 94 patients in the non-ER group were selected from a total of 365 patients. A residual tumor was observed in 10 of 47 patients (21.3&#37;). The mean number of dissected lymph nodes in the non-ER group (39.4 ± 14.5) was higher than that in the ER group (31.7 ± 13.5) (P = 0.003). However, other perioperative data, such as the operation time and blood loss volume were similar. The complication rate of the ER group (17.0&#37;) and the non-ER group (9.6&#37;) did not differ to a statistically significant extent (P = 0.2). Among these patients, 6 died during the 5-year follow-up period, but no patients showed signs of recurrence. CONCLUSION: ER prior to surgical resection showed no significant influence on postoperative complications or mortality. LDG can be safely performed to achieve radical resection after incomplete ER.

DOI： 10.1007/s00595-020-02012-8

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIM: Indigo naturalis (IN) is a traditional Chinese herbal medicine reported to be effective in inducing remission in ulcerative colitis (UC). We conducted a retrospective observational study to investigate the efficacy and safety of IN for induction and maintenance therapy in patients with inflammatory bowel disease. METHODS: Data were collected from the electric medical records of patients with inflammatory bowel disease who had started IN treatment between March 2015 and April 2017 at Kyushu University Hospital. Clinical response and remission rates were assessed based on the clinical activity index determined by Rachmilewitz index or Crohn's disease (CD) activity index. Cumulative IN continuation rates were estimated using the Kaplan-Meier method. Overall adverse events (AEs) during follow-up were also analyzed. RESULTS: Seventeen UC patients and eight CD patients were enrolled. Clinical response and remission rates at week 8 were 94.1&#37; and 88.2&#37; in UC patients and 37.5&#37; and 25.0&#37; in CD patients, respectively. Clinical remission rates, as assessed through non-responders imputation analyses at weeks 52 and 104, were 76.4&#37; and 70.4&#37; in UC patients and 25.0&#37; and 25.0&#37; in CD patients, respectively. Ten patients (40&#37;) experienced AEs during follow-up. Three patients (12&#37;) experienced severe AEs, including acute colitis requiring hospitalization in two patients and acute colitis with intussusception requiring surgery in one patient. CONCLUSIONS: Indigo naturalis showed favorable therapeutic efficacy in UC, whereas its therapeutic efficacy in CD appeared to be modest. The risk of severe AEs should be recognized for IN treatment.

DOI： 10.1111/jgh.14823

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: While there is an association between successful eradication of Helicobacter pylori (HP) and reflux esophagitis (RE), risk factors associated with RE remain obscure. The aim of this study is to determine risk factors associated with the development of RE after HP eradication.Materials and methods: Among all patients treated with successful HP eradication from 2008 to 2016, we retrospectively analyzed those who were free from RE at initial esophagogastroduodenoscopy (EGD) and who were followed up with EGD after eradication. Patients were classified according to the presence or absence of RE at the follow-up EGD. RE was defined as mucosal breaks proximal to the squamous-columnar junction. Demographic data, underlying diseases, medications and endoscopic findings at the initial EGD were compared between patients with and without RE.Results: Among 1575 patients, 142 (9.0&#37;) had RE at the follow-up EGD. The time interval from HP eradication until EGD ranged from 4 to 24 months. The endoscopic grade of RE was higher in males than in females. Multivariate analysis revealed that male sex (odds ratio [OR], 1.51; 95&#37; confidence interval [CI], 1.04-2.24), body mass index ≥25 kg/m2 (OR, 2.91; 95&#37; CI, 2.00-4.22), use of calcium channel blockers (OR, 1.70; 95&#37; CI, 1.12-2.55), and hiatal hernia (OR, 3.46; 95&#37; CI, 2.41-5.00) were associated with the development of RE.Conclusions: Calcium channel blocker use was found to be a risk factor for the development of RE after eradication of HP.

DOI： 10.1080/00365521.2019.1671487

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: It remains uncertain which patients with stricturing-type Crohn's disease (CD) require early small bowel surgery after the initial diagnosis. We aimed to clarify clinical characteristics associated with the intervention in such condition of CD. METHODS: We retrospectively evaluated the clinical course of 53 patients with CD and small bowel strictures who were initially treated with medications after the initial diagnosis. We investigated possible associations between small bowel surgery and the following: clinical factors and radiologic findings at initial diagnosis and the types of medications administered during follow-up. RESULTS: Twenty-eight patients (53&#37;) required small bowel resection during a median follow-up period of 5.0 years (range, 0.5-14.3 years). The cumulative incidence rates of small bowel surgery at 2, 5, and 10 years were 26.4&#37;, 41.0&#37;, and 63.2&#37;, respectively. Univariate analysis indicated that obstructive symptoms (P=0.036), long-segment stricture (P<0.0001), and prestenotic dilation (P<0.0001) on radiography were associated with small bowel surgery, and immunomodulatory (P=0.037) and biological therapy (P=0.008) were significant factors during follow-up. Multivariate analysis revealed that long-segment stricture (hazard ratio [HR], 4.25; 95&#37; confidence interval [CI], 1.78-10.53; P=0.001) and prestenotic dilation (HR, 3.41; 95&#37; CI, 1.24-9.62; P=0.018) on radiography showed a positive correlation with small bowel surgery, and biological therapy (HR, 0.40; 95&#37; CI, 0.15-0.99; P=0.048) showed a negative correlation. CONCLUSIONS: CD patients with long-segment stricture and prestenotic dilation on radiography seem to be at a higher risk of needing small bowel surgery. For such patients, early surgical intervention might be appropriate, even at initial diagnosis.

DOI： 10.5217/ir.2018.00107

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: Gastrointestinal stromal tumor (GIST) is one of the most common types of submucosal tumors (SMTs). Because of GIST's malignant potential, it is crucial to differentiate it from other SMTs. The present study aimed to identify characteristic endoscopic findings of GISTs in the small intestine. METHODS: We reviewed the clinicopathological and endoscopic findings of 38 patients with endoscopically or surgically resected SMTs in the small intestine. SMTs were classified into GIST and non-GIST groups, and clinicopathological and endoscopic findings were compared between the 2 groups. RESULTS: Fifteen patients had GIST and 23 patients had other types of SMTs in the small intestine. Comparison of the endoscopic findings between the 2 groups revealed that dilated vessels in the surrounding mucosa were significantly more in number in the GIST group than in the non-GIST group (P<0.05). However, there were no other differences in endoscopic findings between the 2 groups. Among patients with GISTs, the presence of dilated vessels in the surrounding mucosa was not associated with bleeding risk, tumor size, or metastasis rate at diagnosis. CONCLUSIONS: Dilated vessels in the surrounding mucosa, identified during balloon-assisted endoscopy, may be a diagnostic indicator for GIST in the small intestine. However, its clinical significance should be further analyzed.

DOI： 10.5217/ir.2018.00161

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Anti-tumor necrosis factor (TNF) therapy induces and maintains clinical remission in patients with Crohn’s disease (CD). However, the effect of anti-TNF therapy on the natural course of CD remains controversial. We aimed to investigate the effect of anti-TNF therapy on the initial intestinal surgery for CD. Methods: In this single-center retrospective cohort study, clinical course of 199 CD patients of inflammatory type at the initial diagnosis (the period between 1973 and 2014) was precisely reviewed until the end of 2016. Patients were divided into TNF and non-TNF groups based on anti-TNF agent use. After comparisons of clinical characteristics and medical treatments, propensity scores were calculated for covariates. Risk of intestinal surgery was compared by a Cox proportional hazards model using the propensity scores. The effect of immunomodulators on initial intestinal surgery was assessed in the TNF group. Results: During the study period, 108 patients received anti-TNF therapy. The patients in the TNF group were diagnosed more recently, and more frequently had isolated colonic involvement, and perianal disease. Immunomodulators were more frequently used in the TNF group. Cumulative probability of initial intestinal surgery was significantly lower in the TNF group (P < 0.0001). The hazard ratio in the TNF group was 0.32 (95&#37; CI 0.13–0.74). Immunomodulators did not decrease the risk of initial intestinal surgery. Conclusions: Anti-TNF therapy can decrease the risk of intestinal surgery among patients with inflammatory-type CD at the initial diagnosis. Further studies should be necessary to determine the additive effect of immunomodulators on the risk of intestinal surgery.

DOI： 10.1007/s00535-018-1511-x

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Anti-tumor necrosis factor (TNF) therapy induces and maintains clinical remission in patients with Crohn's disease (CD). However, the effect of anti-TNF therapy on the natural course of CD remains controversial. We aimed to investigate the effect of anti-TNF therapy on the initial intestinal surgery for CD. METHODS: In this single-center retrospective cohort study, clinical course of 199 CD patients of inflammatory type at the initial diagnosis (the period between 1973 and 2014) was precisely reviewed until the end of 2016. Patients were divided into TNF and non-TNF groups based on anti-TNF agent use. After comparisons of clinical characteristics and medical treatments, propensity scores were calculated for covariates. Risk of intestinal surgery was compared by a Cox proportional hazards model using the propensity scores. The effect of immunomodulators on initial intestinal surgery was assessed in the TNF group. RESULTS: During the study period, 108 patients received anti-TNF therapy. The patients in the TNF group were diagnosed more recently, and more frequently had isolated colonic involvement, and perianal disease. Immunomodulators were more frequently used in the TNF group. Cumulative probability of initial intestinal surgery was significantly lower in the TNF group (P < 0.0001). The hazard ratio in the TNF group was 0.32 (95&#37; CI 0.13-0.74). Immunomodulators did not decrease the risk of initial intestinal surgery. CONCLUSIONS: Anti-TNF therapy can decrease the risk of intestinal surgery among patients with inflammatory-type CD at the initial diagnosis. Further studies should be necessary to determine the additive effect of immunomodulators on the risk of intestinal surgery.

DOI： 10.1007/s00535-018-1511-x

記述言語：英語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and aims: Colonic endoscopic submucosal dissection (ESD) is time-consuming and bears a high risk of perforation. The aim of the present study was to compare the safety and efficacy between novel articulating devices and conventional ESD in live porcine colon models. Methods: Thirty ESDs in ten pigs were carried out at three different locations (15, 25, and 35 cm from the anus) by the conventional method (n = 15) and by the new method (n = 15). Procedure times, adverse events (perforation, bleeding), and damage to the muscular layer were recorded, and the ESD time per unit area of the specimens was calculated. Results: The perforation rate using the conventional method was 6.7&#37; (1/15), whereas that using the new method was 0.0&#37;. The number of sites of muscular damage was significantly lower in the new than conventional method (6 vs. 37, respectively; P = 0.024). The mean procedure time was significantly shorter in the new than conventional method (4.6 ± 2.0 vs. 7.0 ± 4.1 min/cm
²
, respectively; P = 0.042). Conclusions: Use of the new ESD method allows for reduced adverse events and a shortened resection time.

DOI： 10.1007/s00464-018-6408-5

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Aims: Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms. Methods: This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient. Results: From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients’ backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95&#37; confidence interval [CI],.78-.97] vs.53 [95&#37; CI,.46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95&#37; CI, 1.22-1.45] vs 1.14 [95&#37; CI, 1.03-1.24],.46 [95&#37; CI,.40-.53] vs.60 [95&#37; CI,.53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95&#37; CI,.54-.70] vs.30 [95&#37; CI,.25-.36]) but not in the left-sided colon and rectum (.26 [95&#37; CI,.21-.32] vs.23 [95&#37; CI,.19-.28]). Conclusions: Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.)

DOI： 10.1016/j.gie.2018.11.012

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Although capsule endoscopy (CE) is useful to evaluate obscure gastrointestinal bleeding (OGIB), CE does not always identify the responsible lesions in patients with overt OGIB. Objectives: To identify factors predictive of rebleeding after negative CE in patients with overt OGIB. Methods: We retrospectively analyzed the clinical data of 221 patients who underwent CE for overt OGIB. Among 120 patients with negative CE findings, clinical course of 112 patients after CE was followed-up. Clinical factors associated with rebleeding after negative CE and lesions responsible for rebleeding were investigated. Results: Rebleeding was identified in 37 patients (33.0&#37;) during follow-up after negative CE, and 36 patients (32.1&#37;) developed rebleeding within 24 months after negative CE. Multivariate analyses showed that ongoing overt OGIB (OR 2.67; 95&#37; CI 1.07-5.80; p = 0.036) and severe anemia at the initial CE examination (OR 2.54; 95&#37; CI 1.33-4.96; p = 0.005) were independent factors -associated with rebleeding. Rebleeding source was detected in 13 patients. Conclusions: Rebleeding is not a rare condition among patients with overt OGIB after negative CE. Patients with ongoing overt OGIB or severe anemia at the initial CE examination seem to have a higher risk of rebleeding.

DOI： 10.1159/000496826

記述言語：英語  

記述言語：日本語  

Technical agenda considering QoE in large multiparty videoconferencing for clinical case study

記述言語：英語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Aim: The gut microbiota is suggested to play an important role in the pathogenesis of ulcerative colitis (UC). However, interindividual and spatial variations hamper the identification of UC-related changes. We thus investigated paired mucosa-associated microbiota obtained from both inflamed and non-inflamed sites of UC patients and corresponding sites of non-inflammatory bowel disease (IBD) controls. Methods: Mucosal biopsies of both inflamed and non-inflamed sites were obtained from 14 patients with active UC of the left-sided or proctitis type. Paired mucosal biopsies of the corresponding sites were obtained from 14 non-IBD controls. The microbial community structure was investigated using 16S ribosomal RNA gene sequences, followed by data analysis using qiime and LEfSe softwares. Results: Microbial alpha diversity in both inflamed and non-inflamed sites was significantly lower in UC patients compared with non-IBD controls. There were more microbes of the genus Cloacibacterium and the Tissierellaceae family, and there were less microbes of the genus Neisseria at the inflamed site when compared with the non-inflamed site in UC patients. Decreased abundance of the genera Prevotella, Eubacterium, Neisseria, Leptotrichia, Bilophila, Desulfovibrio, and Butyricimonas was evident at the inflamed site of UC patients compared with the corresponding site of non-IBD controls. Among these taxa, the genera Prevotella and Butyricimonas were also less abundant at the non-inflamed site of UC patients compared with the corresponding site in non-IBD controls. Conclusions: Mucosal microbial dysbiosis occurs at both inflamed and non-inflamed sites in UC patients. The taxa showing altered abundance in UC patients might mediate colonic inflammation.

DOI： 10.1111/jgh.14129

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2018 Siriraj Medical Journal. The development of information and communication technology has had a dramatic impact on people's lives, including medical matters. The Internet has made it possible for telemedicine to be implemented with excellent image quality at low cost; such telemedicine was first applied between Japan and South Korea in 2002. The technology is not restricted to advanced countries: it can also be applied in developing nations, and it has expanded rapidly to other parts of Asia and beyond. In 2005 Thailand became the seventh country to be associated with the Telemedicine Development Center of Asia (TEMDEC). As of 2017, TEMDEC operates 144 programs in Thailand, mainly in endoscopy (55, 38%) and surgery (40, 28%): 17 hospitals or medical institutions are active members, and there are 165 telemedicine connections. Siriraj Hospital, Mahidol University was the first participant; it has 71 telemedicine connections; King Chulalongkorn Memorial Hospital became the second participant; it has 52 such connections. These two hospitals account for 74.5% (123/165) of all telemedicine activities in Thailand. Compared with outside Bangkok, the number of telemedicine connections is 14 times (154/11) greater and the number of such connections per hospital is 10 times (15.4/1.6) greater in the capital-even though the number of hospitals is only 1.4 times (10/7) greater in Bangkok. To efficiently meet local needs, we strongly hope that telemedicine will expand into rural parts of Thailand and into more medical specialties through ongoing technological development.

DOI： 10.14456/smj.2018.75

記述言語：日本語  

抗TNFα抗体製剤による寛解導入後に内視鏡による治療効果判定を行い,その後の臨床経過が1年以上追えた大腸型もしくは小腸・大腸型Crohn病(CD)37例を対象に,臨床的二次無効予測に対するSES-CDの有用性を遡及的に評価した.その結果,SES-CD>10群ではSES-CD≦10群に比べて有意に二次無効率が高かった.一方,5mm以上の潰瘍性病変の有無で二次無効率を比較した場合,2群間で二次無効率に差を認めなかった.多数例を用いた前向き研究による検証が必要であるが,SES-CDによる内視鏡的活動性のスコアリングは抗TNFα抗体製剤治療における二次無効予測に有用である可能性が示唆された.(著者抄録)

記述言語：英語  

記述言語：英語  

記述言語：日本語  

活動性大腸結核を有した54例の臨床像,X線造影・内視鏡所見を遡及的に検討した.24例(44&#37;)では明らかな臨床症状を認めなかったが,盲腸(74&#37;)と上行結腸(72&#37;)を中心に,不整形潰瘍(63&#37;),輪状潰瘍(56&#37;),びらん(50&#37;)などの活動性病変が観察された.このうち,80&#37;では腸管変形や回盲弁開大,萎縮瘢痕帯などの所見も併存していたが,軽微な活動性病変のみの症例も11&#37;にみられた.一方,生検標本における結核菌同定は培養法の48&#37;が最も高く,乾酪性肉芽腫は15&#37;で確認されたのみであった.以上より,大腸結核の診断はX線造影・内視鏡検査における所見の拾い上げが中心となるが,軽微な病変のみの症例ではIFN-γ遊離試験を含めた総合的な判断が必要と考えられた.(著者抄録)

記述言語：日本語  

十二指腸病変の経過が追えた家族性大腸腺腫症40例を対象に,乳頭部腺腫と十二指腸腺腫症の内視鏡所見および病理組織像の経時的推移(中央値12.7年)を検討した.初回検査では31例で乳頭部腺腫が確認された.最終観察時までに乳頭部腺腫を新たに2例で認め,6例で乳頭部の形態変化が出現したが,病理組織学的にはいずれも中等度異型の管状腺腫であった.一方,十二指腸腺腫症は初回検査で全例陽性で,大部分は多発する褪色調の小隆起ないし陥凹性病変として認識された.最終観察時には6例がSpigelman分類Stage IVに分類されたが,病理組織学的には高度異型腺腫を1例に認めるのみで,腺癌の出現はなかった.以上より,本症の十二指腸病変の進行は緩徐であり,癌化もまれと考えられた.(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Both tacrolimus (Tac) and infliximab (IFX) are effective for moderate-to-severe ulcerative colitis (UC). The aim of this study was to compare the therapeutic efficacy and safety of both drugs. MATERIALS AND METHODS: We performed a retrospective analysis of 46 patients with moderate-to-severe UC who were treated either by Tac (n = 21) or IFX (n = 25). We compared the remission and response rates for 10 weeks between the two groups. In patients who achieved a clinical response, the subsequent relapse rate was compared. The overall adverse events were also compared between the two groups. RESULTS: The remission and response rates at week 10 did not differ between patients treated with Tac (67&#37; and 86&#37;, respectively) and patients treated with IFX (76&#37; and 92&#37;, respectively). Among 41 patients showing a clinical response, eight of 23 patients treated with IFX and eight of 18 patients treated with Tac showed a subsequent relapse. The risk of relapse was not different between the two groups. While no serious adverse events were observed, the incidence of adverse events was higher in patients treated with Tac than in those treated with IFX. CONCLUSION: Tac and IFX may be equally efficacious for the induction and maintenance of remission in patients with UC while minor adverse events are more frequent with the former treatment.

DOI： 10.3109/00365521.2016.1138239

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recent genome-wide association studies have identified nearly 100 susceptibility genes for ulcerative colitis (UC). However, the contribution of susceptibility variants for UC to clinical outcome has scarcely been reported. The aim of this study was to investigate whether UC-associated genetic variants confer a risk of clinical relapse. METHODS: One hundred and nine consecutive Japanese subjects with quiescent UC were recruited. Four genetic variants of HLA-DRB1*1502, rs6671847 at FCGR2A, rs17085007 at 13q12, and rs2108225 at SLC26A3 were genotyped by Invader assay. The clinical courses were followed after blood sampling, and the risk of relapse according to these genotypes was calculated by Cox proportional hazard model. RESULTS: During the mean follow-up period of 35 months (range 1-81 months), 49 of 109 subjects (45 &#37;) relapsed. Carriers of the G allele of rs6671847 showed an increased risk of relapse compared with non-carriers [adjusted hazard ratio (HR), 2.27; 95 &#37; confidence interval (CI), 1.20-4.32; p = 0.01]. Patients with the CT or TT genotypes of rs17085007 also had an increased risk of relapse compared to subjects with the CC genotype (for CT: adjusted HR, 2.16; 95 &#37; CI, 1.10-4.23; p = 0.03; for TT: adjusted HR, 3.25; 95 &#37; CI, 1.18-8.95; p = 0.02). These two risk variants multiplied the risk of relapse by 2.74 times (95 &#37; CI, 1.10-4.23; p = 0.01) in patients with one risk genotype and 5.40 times (95 &#37; CI, 2.06-14.13; p = 0.0006) in patients with both risk genotypes. CONCLUSIONS: Genetic variants of rs6671847 at FCGR2A and rs17085007 at 13q12 conferred a risk of relapse in patients with UC.

DOI： 10.1007/s00535-015-1062-3

記述言語：日本語  

腸管ベーチェット病(BD)とNSAIDs起因性小腸粘膜傷害のカプセル内視鏡(CE)所見を比較した.いずれも,空腸および回腸に粘膜病変が多発していたが,腸管BDでは空腸病変は少なく,回腸を中心に病変が出現していた.潰瘍の形態に着目すると,いずれの疾患でも不整形潰瘍を呈する例が多く,腸管BDに特徴的な類円形の打ち抜き様潰瘍を認めたのは3例で出現率は高くなかった.なお,CE施行時に消化器症状を伴わなかった1例で後に小腸穿孔をきたし腸管切除術を要した.腸管BDの鑑別疾患としてNSAIDs起因性小腸粘膜傷害が挙げられるが,病変の分布や形態に着目すれば両疾患はある程度鑑別しうると思われた.また,腸管BDでは無症状でも小腸病変を伴う場合が多く,CEによる小腸病変の評価が望ましいと思われた.(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: Infliximab (IFX) is an effective treatment for maintaining clinical remission in patients with initially moderate-to-severe Crohn's disease (CD). However, a certain number of patients become unresponsive to IFX, subsequently requiring intensified therapy. The aim of this study was to compare the short- and long-term therapeutic efficacy of intensified regimens in CD patients who fail to respond to IFX. METHODS: The clinical courses of 33 CD patients who failed to respond to treatment with IFX were investigated retrospectively. An intensified regimen involving doubling the dose of IFX was chosen in 13 patients (DD group) versus shortening the IFX interval in 13 patients (SI group) and switching to adalimumab (ADA) in 7 patients (SA group). RESULTS: The clinical response and rate of clinical remission at 4 weeks were 62 and 54&#37; in the DD group, 77 and 62&#37; in the SI group and 57 and 43&#37; in the SA group, respectively (p = 0.59 for clinical response, p = 0.90 for clinical remission). The rate of sustained remission at 48 weeks was 44&#37; in the DD group, 54&#37; in the SI group and 33&#37; in the SA group (p = 0.88). CONCLUSION: The short- and long-term efficacy of doubling the dose of IFX, shortening the interval of IFX or switching to ADA is similar for CD patients who no longer respond to IFX.

DOI： 10.1159/000368815

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Colonoscopy is considered the gold standard for detecting colorectal tumors; however, conventional colonoscopy can miss flat tumors. We aimed to determine whether visualization of colorectal flat lesions was improved by autofluorescence imaging and narrow-band imaging image analysis in conjunction with a new endoscopy system. Eight physicians compared autofluorescent, narrow-band, and chromoendoscopy images to 30 corresponding white-light images of flat tumors. Physicians rated tumor visibility from each image set as follows: +2 (improved), +1 (somewhat improved), 0 (equivalent to white light), -1 (somewhat decreased), and -2 (decreased). The eight scores for each image were totalled and evaluated. Interobserver agreement was also examined. Autofluorescent, narrow-band, and chromoendoscopy images showed improvements of 63.3&#37; (19/30), 6.7&#37; (2/30), and 73.3&#37; (22/30), respectively, with no instances of decreased visibility. Autofluorescence scores were generally greater than narrow-band scores. Interobserver agreement was 0.65 for autofluorescence, 0.80 for narrow-band imaging, and 0.70 for chromoendoscopy. In conclusion, using a new endoscopy system in conjunction with autofluorescent imaging improved visibility of colorectal flat tumors, equivalent to the visibility achieved using chromoendoscopy.

DOI： 10.1111/den.12445

記述言語：英語  

記述言語：英語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: Infliximab (IFX) is an effective treatment for maintaining clinical remission in patients with initially moderate-to-severe Crohn's disease (CD). However, a certain number of patients become unresponsive to IFX, subsequently requiring intensified therapy. The aim of this study was to compare the short- and long-term therapeutic efficacy of intensified regimens in CD patients who fail to respond to IFX. METHODS: The clinical courses of 33 CD patients who failed to respond to treatment with IFX were investigated retrospectively. An intensified regimen involving doubling the dose of IFX was chosen in 13 patients (DD group) versus shortening the IFX interval in 13 patients (SI group) and switching to adalimumab (ADA) in 7 patients (SA group). RESULTS: The clinical response and rate of clinical remission at 4 weeks were 62 and 54&#37; in the DD group, 77 and 62&#37; in the SI group and 57 and 43&#37; in the SA group, respectively (p = 0.59 for clinical response, p = 0.90 for clinical remission). The rate of sustained remission at 48 weeks was 44&#37; in the DD group, 54&#37; in the SI group and 33&#37; in the SA group (p = 0.88). CONCLUSION: The short- and long-term efficacy of doubling the dose of IFX, shortening the interval of IFX or switching to ADA is similar for CD patients who no longer respond to IFX.

DOI： 10.1159/000368815

記述言語：日本語  

寛解期潰瘍性大腸炎における潰瘍性大腸炎関連腫瘍(UCAN)と散発性腫瘍(SCA)の注腸X線造影所見を比較した.UCAN 15病変は9病変が表面型,6病変が隆起型であった.一方,SCA 6病変は表面型が4病変,隆起型が2病変であった.表面型を呈したUCANとSCAのそれぞれ2病変でバリウム斑を有していた.表面型UCANでは9病変のうち7病変で病変境界が不明瞭であったのに対し,表面型SCAでは4病変とも明瞭な病変境界を有していた(p=0.02).一方,隆起型腫瘍ではUCANはSCAに比べて隆起の大小不同が顕著であった.以上より,早期病変におけるUCANとSCAの鑑別には,X線造影像における病変境界所見と隆起の大小不同に着目することが有用と考えられた.(著者抄録)

記述言語：日本語  

記述言語：日本語  

自験消化管アミロイドーシス46例の上部内視鏡所見,および生検組織所見を遡及的に検討し,十二指腸病変の推移も解析した.胃病変の内視鏡像は,AL型で粘膜下腫瘍様隆起を,AA型で微細顆粒状粘膜と結節状小隆起の多発を特徴としていた.十二指腸病変では,AL型において粘膜下腫瘍様多発隆起が高頻度に認められ,その出現率は軽度沈着例においても50%であった.一方,AA型では粗ぞう・顆粒状粘膜を高率に認めたが,アミロイド高度沈着例でも異常所見を示さない症例が存在した.また,約半数の症例では内視鏡所見や組織所見に経時的変化はみられず,逆に治療が奏効して改善傾向を示す症例もあった.以上より,消化管アミロイドーシスの内視鏡所見は多彩であり,その沈着程度とは必ずしも相関しないこと,進行は比較的緩徐であることが示唆された.(著者抄録)

記述言語：日本語  

九州大学内視鏡的粘膜下層剥離術(ESD)データベースに登録された分化型胃癌1570病変(男性1182名、女性388名、年齢中央値73歳)と、未分化型胃癌74病変(男性44名、女性30名、年齢中央値69歳)を対象に、治療成績を比較・検討した。未分化型胃癌/分化型胃癌の切除標本長径(mm)は41/35と有意差を認めたが、病変長径(mm)は15/13と有意差はなかった。分化型胃癌に比べ未分化型胃癌では肉眼型で陥凹型、深達度でSM、断端評価で水平断端陽性、リンパ管侵襲陽性が有意に高率であった。ESDの治療成績では、一括切除率に差はなかったが、未分化型胃癌で完全一括摘除率が有意に低率で、治療時間が有意に長かった。偶発症の頻度に差はなかった。未分化型胃癌の完全一括摘除56病変中30病変が適応拡大基準外病変とされ、うち10病変が外科切除となり、不完全摘除18病変中7病変に外科切除が行われた。ESD後平均観察期間33ヵ月で再発や原病死は認めなかった。

記述言語：日本語  

虚血性小腸炎24例の臨床像および検査所見を検討した.病変が回腸に限局する症例は,回腸以外にも病変を有する症例よりも高齢であり,高率に高度狭窄に至っていた.また,続発性の症例は,特発性の症例よりも高度狭窄に至る症例が多かった.小腸X線検査所見では,狭小化・管状狭窄が最も高率にみられ,経過とともに狭窄の程度が高度となっていた.術前の内視鏡検査による病変の観察は9例(37.5%)で可能であり,全周性区域性潰瘍が特徴的であった.15例(62.5%)で外科的切除を要したが,高度狭窄の1例では内視鏡的バルーン拡張術を行い,保存的に加療可能であった.(著者抄録)

記述言語：日本語  

記述言語：日本語  

十二指腸を含む小腸カルチノイド29例の臨床病理学的特徴を検討した.占居部位は十二指腸球部17例,下行脚4例,回腸8例であり,十二指腸の1例と小腸の2例で多発病変を認めた.基本的な形態は広基性ないし亜有茎性隆起であり,十二指腸病変より小腸病変のほうが大きかった.内視鏡では黄白色調の粘膜下腫瘍様隆起が特徴的で,点状発赤や拡張した血管,頂部陥凹を伴う病変も存在した.WHO分類では全例がNET G1に相当したが,リンパ節転移や肝転移を来した症例も存在した.リンパ節転移の有無が判明した13例を検討したところ,陽性例は小腸病変が多い傾向にあったが,WHO分類に差はなかった.以上より,NETのWHO分類を本邦の小腸カルチノイドに適応させるか否かに関してはさらに症例を集積して検討する必要があると思われた.(著者抄録)

記述言語：英語  

経鼻内視鏡検査の前処置方法について、スプレー法、スティック法、併用法で比較検討を行った。

記述言語：日本語  

消化管ポリポーシスにおける胃病変の臨床的意義を明らかにするため,既知の消化管ポリポーシスおよび最近疾患概念が提唱された家族性胃底腺ポリポーシス(FFGP)の胃病変の頻度と経過を遡及的に検討した.対象は家族性大腸腺腫症(FAP)122例,MUTYH関連大腸腺腫症(MAP)3例,Peutz-Jeghers症候群(PJS)18例,若年性ポリポーシス(JP)6例,Cowden病(CD)9例,FFGP 10例,Cronkhite-Canada症候群(CCS)7例の計175例であった.各疾患群における胃病変陽性率と胃癌発生率は,FAPで73%および8%,MAPで33%および33%,PJSで72%および17%,JPで67%および33%,CDで78%および0%,FFGPで100%および30%,CCSで100%および0%であった.以上より,消化管ポリポーシスでは胃病変が高率に発生することが確認された.また,FAP,MAP,PJS,JP,および新たな疾患であるFFGPは胃癌の高危険群であると結論した.(著者抄録)

記述言語：英語  

DOI： 10.1111/j.1443-1661.2011.01223.x

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

腸管Behcet病・単純性潰瘍15例におけるカプセル内視鏡とバルーン内視鏡内視鏡所見を遡及的に検討し,不全型Behcet病(DBD),Behc疑い(SBD),狭義の単純性潰瘍(non-BD)で比較した.15例中5例で回盲部より口側の小腸病変が認められ,その所見は多発潰瘍(5例),アフタ様病変(1例),敷石様所見(1例)に大別された.病型別に検討すると,DBD・SBD 11例中4例(36%)に小腸病変が認められ,2例(18%)ではアフタ様病変あるいは敷石様所見が認められた.一方,non-BD 4例中1例(25%)にのみ小腸の多発潰瘍が認められた.15例中,小腸と結腸・直腸のいずれかに病変が認められたのは10例であったが,両部位が罹患したのはnon-BDの1例のみであった.以上より,腸管Behcet病・単純性潰瘍では小腸病変が少なくないこと,および両疾患における回盲部以外の病変の性状が異なる可能性が示唆された.(著者抄録)

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Aim Autofluorescence imaging (AFI) is a novel technology for endoscopy, which enhances neoplastic lesions of the gastrointestinal tract. The aim of this investigation was to examine whether AFI colonoscopy can identify dysplasia in ulcerative colitis.
Method We examined 48 patients with ulcerative colitis by AFI colonoscopy. Apparently flat, coarse granular mucosa and visible protruding lesions under conventional colonoscopy were observed by AFI. Those target areas were classified into low AF and high AF according to the colour under AFI colonoscopy. The grade of dysplasia was determined in the specimens obtained from the target areas.
Results About 126 sites (35 protruding lesions and 91 flat areas) were examined by AFI colonoscopy. AF was determined to be high in 42 areas and to be low in 84 areas. The positive rate of dysplasia was higher in protrusions (31%) than in flat mucosa (3.3%, P < 0.0001). The rate of positive dysplasia was not statistically different between lesions determined to be low AF (14%) and those to be high AF (5%, P = 0.09). The positive rate of dysplasia in protruding lesions was significantly higher in low AF than in high AF (45.0% vs 13.3%, P = 0.043), while the value in flat lesions was not different between low AF and high AF (8.2% vs 0%, P = 0.3).
Conclusions Autofluorescence imaging colonoscopy seems to have a role for the detection of dysplaia in ulcerative colitis.

DOI： 10.1111/j.1463-1318.2009.02181.x

記述言語：日本語  

記述言語：日本語  

小腸病変を有するCrohn病60例の術後臨床経過を遡及的に検討し,インフリキシマブ(IFX)の術後再発抑制効果を評価した.非IFX群では平均24.2ヵ月の観察期間において,34例中21例で臨床的再発が確認された.一方,IFX群では平均20.8ヵ月の観察期間中の臨床的再発は26例中2例のみであり,再発率はIFX群で有意に低かった(p<0.005).また,術後画像評価を行ったIFX群13例のうち,臨床的再発を来した1例では大腸に活動性病変を認めた.臨床的非再発と判断された12例中1例は,術後29ヵ月目に吻合部口側小腸に浮腫性変化と不整形バリウム斑が出現し吻合部再発と判断したが,11例では活動性病変は指摘しえなかった.以上より,IFXは小腸病変を有するCrohn病の有効な術後維持治療になりうる可能性が示唆された.(著者抄録)

記述言語：日本語  

記述言語：英語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim was to determine the prevalence of small bowel involvement in patients with gastrointestinal (GI) lymphoma by double-balloon endoscopy (DBE). We examined 29 patients with primary GI lymphoma by oral and anal DBEs. Clinicopathologic features related to the prevalence of diminutive small bowel involvement and the clinical outcome were retrospectively investigated. Diminutive small bowel lesions were found in 14 patients. The prevalence of the lesions was not different between patients with primary small bowel lymphoma and those with primary extra-small bowel lymphoma (50% versus 47%, P = 0.6). However, clinical stage was more advanced in patients with the lesions than in those without (P < 0.05). The lesions were more frequently found in T-cell lymphoma (100%) and follicular lymphoma (77%) than in the other types of lymphoma (15%) (P < 0.05). Diminutive small intestinal lesions occur in patients with GI lymphoma, especially in those with follicular lymphoma and T-cell lymphoma. GI lymphomas of these histologic types are candidates for scrutiny by DBE.

DOI： 10.1007/s10620-009-0713-8

記述言語：日本語  

記述言語：日本語  

診断前に大腸のアフタ様病変が確認された潰瘍性大腸炎(E型UC)8例,およびUCの経過中にアフタ様病変が出現した症例(アフタ随伴UC)5例の内視鏡所見を検討した.アフタ様病変は,リンパ濾胞様小隆起(I型),大型のリンパ濾胞様隆起(II型),および発赤を伴う小白点(III型)に大別した.E型UCでは,主たるアフタはI型1例,II型4例,III型3例で,1～66ヵ月(平均22ヵ月)後に全大腸炎型UC6例,左側大腸炎型UC1例,ないし直腸炎型UC1例に進展した.アフタ随伴UCの罹患範囲は,直腸炎型1例,左側大腸炎型2例,全大腸炎型1例,区域性1例で,初回診断時より25ヵ月から264ヵ月後にアフタが診断され,その所見はI型が1例,II型およびIII型が各2例ずつであった.以上より,大腸アフタ様病変はUCの初期病変の1つと考えられた.(著者抄録)

記述言語：日本語  

記述言語：日本語  

非特異性多発性小腸潰瘍症(CNSU)9例とNSAIDs起因性小腸潰瘍(NSAIDs腸症)14例の内視鏡所見を比較した.単発ないし多発性狭窄はCNSU 9例(100%)とNSAIDs腸症4例(29%)にみられ,前者の8例と後者の2例で開放性潰瘍を伴っていた.非狭窄性輪状潰瘍はCNSUの6例(67%)とNSAIDs腸症の7例(50%)にみられ,前者全例と後者の4例は開放性であった.CNSUの4例(44%)とNSAIDs腸症の1例(7%)で開放性の縦走・斜走潰瘍を認めた.一方,NSAIDs腸症7例(50%)で多発症潰瘍,アフタ,潰瘍瘢痕などの小病変が確認できたが,CNSUでは2例(22%)にすぎなかった.以上より,CNSUでは慢性開放性潰瘍が,NSAIDs腸症では治癒傾向の強い潰瘍と小病変が内視鏡的特徴と考えられた.(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Small-intestinal adenoma occurs in patients with familial adenomatous polyposis (FAP). OBJECTIVES: The aim was to analyze the diagnostic yield of a double-balloon endoscopy (DBE) and an intraoperative enteroscopy (IOE) for small-intestinal involvement in FAP. PATIENTS: Forty-one patients with FAP. INTERVENTIONS: We examined 12 patients with FAP by using oral DBE before a colectomy and 29 patients with FAP by using IOE. The incidence and the endoscopic findings of adenoma were compared between the 2 procedures. Phenotypes of FAP and genotypes of adenomatous polyposis coli (APC) were then compared between patients with small-intestinal adenomas and those without. The genotype was classified into a 5' mutation (exons 1-14), a 3' mutation (exon 15), and a negative mutation of APC. MAIN OUTCOME MEASUREMENT: The prevalence of adenoma. RESULTS: A DBE detected small-intestinal adenomas in 9 of 12 patients (75%), as did an IOE in 15 of 29 patients (52%, P > .05). The adenomas occurred predominantly in the jejunum, with a configuration of diminutive polyps in 22 patients. In addition, a DBE detected nonpolypoid adenoma in a patient, and nodular, broad-based protrusion (advanced lesions) in 3 patients, whereas an IOE detected advanced lesions in a patient. Patients with small-intestinal adenoma had more severe duodenal adenomatosis than those patients without small-intestinal adenoma (P < .001). In cases in which APC was analyzed, the prevalence of small-intestinal adenoma was higher in patients with a 3' mutation (100%) than in those with a 5' mutation (44%) and with a negative mutation (42%, P < .02). LIMITATION: Not a prospective randomized study. CONCLUSIONS: A DBE is equal to an IOE for scrutiny of small-intestinal adenomas in FAP. There seems to be a genotype-jejunal phenotype correlation in FAP.

DOI： 10.1016/j.gie.2008.02.067

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Small-bowel radiography may be replaced by enteroscopy in the diagnosis of small-intestine lesions. We retrospectively elucidated the diagnostic yield of small-bowel radiography performed before double-balloon endoscopy. MATERIALS AND METHODS: One hundred twenty-four patients who underwent double-balloon endoscopy during the period 2004-2006 were classified into those with abnormal radiographic findings (n = 45), normal radiographic findings (n = 31), and no small-bowl radiographs (n = 48). The classification was based on the use of small-bowel radiography and the diagnosis before double-balloon endoscopy. The indications for, approaches to, and diagnostic yields of double-balloon endoscopy were compared for the three groups. The diagnostic yield of small-bowel radiography was considered positive when any sign of pathologic change in the small bowel was identified. The diagnostic yield of double-balloon endoscopy was considered positive when endoscopic or biopsy findings explained the clinical manifestations. RESULTS: The group with abnormal findings on small-bowel radiography was younger (15-86 years) and less frequently had obscure bleeding (8.9%) than the group with normal findings on small-bowel radiography (age, 17-84 years; frequency of obscure bleeding, 45.2%) (p = 0.01) or the group without small-bowel radiographs (age, 15-91 years; frequency of obscure bleeding, 64.6%) (p < 0.0001). The positive diagnostic yield of double-balloon endoscopy was highest in the group with abnormal findings on small-bowel radiography (71.1%), followed by the group with no small-bowel radiographs (45.8%) and the group with normal findings on small-bowel radiography (35.5%) (p = 0.0002). Among patients who did undergo small-bowl radiography, the accuracy of the technique was 68.4%, the positive predictive value was 71.1%, and the negative predictive value was 64.5%. The positive diagnostic yields of small-bowel radiography and double-balloon endoscopy were not statistically different (59.2% for small-bowel radiography, 56.6% for double-balloon endoscopy; p > 0.1). CONCLUSION: The diagnostic accuracy of double-balloon endoscopy seems to improve if the procedure is preceded by small-bowel radiography.

DOI： 10.2214/AJR.07.3155

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

自験Crohn病に対するinfliximabの維持投与効果を臨床的活動性と消化管病変から検討した.(1)30週以上維持投与した27例において,臨床的活動指数による治療効果判定に影響を及ぼしたのはinfliximabの投与理由で,非有効例の50%は瘻孔性病変であったが,有効例にはこの投与理由はなかった.(2)治療前と経過観察最終時の大腸X線・内視鏡所見を検討できた10例中7例では活動性病変(縦走潰瘍,敷石像,多発潰瘍)が改善したが,3例では不変であった.改善例は不変例よりも投与開始時の年齢が高かった.一方,小腸病変の推移は3例で検討可能で,1例では開放性潰瘍が残存し,他の2例では非活動性病変が不変のまま経過した.(3)臨床的活動指数による評価と大腸病変の判定が一致したのは3例,乖離したのは7例であった.以上より.infliximabはCrohn病の粘膜病変に有効であるが,その効果は臨床的活動性からは推測困難と考えた.(著者抄録)

記述言語：日本語  

sulindac(SU)を投与した家族性大腸腺腫症(FAP)11例の消化管病変の経過を検討し,大腸病変の短期経過については,SU非投与6例の経過と比較した.(1)SU投与例では12ヵ月後の注腸X線上の隆起密度と最大隆起サイズは投与前より有意に低下したが,SU非投与例ではいずれも不変であった.(2)SU投与例では遠位大腸よりも近位大腸において隆起密度が低下する傾向がみられた.(3)SUの効果はAPC変異部位には明らかな影響を受けなかった.(4)12ヵ月以上継続投与した8例では大腸の表面型腺腫が残存し,1例では投与前に存在した隆起型腺腫が,3例では経過中に出現した亜有茎性隆起ないし結節集簇様病変が増大し内視鏡的切除を要したが,癌発生はなかった.(5)SU投与前に十二指腸腺腫を認めた5例では,SU投与後に十二指腸病変の性状に変化はなかった.以上より,SUはFAPの大腸腺腫に対して退縮効果を有するが,その効果は小型かつ隆起型腺腫にとどまると推測した.(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The microsatellite instability and CpG island hypermethylation of p14 ( ARF ) and p16 ( INK4a ) are related to the pathogenesis of neoplasia in ulcerative colitis. This study was designed to assess the significance of those genetic or epigenetic alterations for cancer surveillance in ulcerative colitis. METHODS: During surveillance colonoscopy in 39 patients with ulcerative colitis, biopsy specimens were obtained from the cecum and the rectum as well as from any other areas suspected of being neoplasia by chromoscopy. Using DNA extracts, the methylation status of p14 ( ARF ) and p16 ( INK4a ) and the microsatellite status were determined. RESULTS: Microsatellite instability was positive in one of five dysplasias, but it was negative in the cecum and the rectum. The incidence of hypermethylation of p14 ( ARF ) was 0 percent in the cecum, 26 percent in the rectum, and 100 percent in dysplasia, whereas that of p16 ( INK4a ) was 10, 10, and 0 percent, respectively. Patients who were positive for the hypermethylation of p14 ( ARF )in the rectum had a longer duration of ulcerative colitis than those who were negative for such hypermethylation. Two of 10 patients who were positive for p14 ( ARF ) hypermethylation in the rectum and 1 of 29 patients who were negative for the hypermethylation had dysplasia. During the subsequent surveillance of 36 patients, dysplasia was detected in 2 of 8 patients with p14 ( ARF ) hypermethylation and in none of 28 patients without hypermethylation (P = 0.044). CONCLUSIONS: In patients with ulcerative colitis, hypermethylation of p14 ( ARF ) seems to be associated with an early stage of dysplasia. The hypermethylation may be one of candidates for potential biomarker to identify patients at a high risk of dysplasia.

記述言語：英語  

記述言語：英語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND OBJECTIVE: Diagnostic accuracy of probe EUS depends on the constant maintenance of luminal medium for acoustic coupling. This study compared the accuracy of probe EUS by a jelly-filled method (EUS-J) and by a water-filled balloon method (EUS-W) for the assessment of invasion depth in superficial esophageal cancer. DESIGN AND SETTING: A prospective, single-center study. PATIENTS: Forty superficial esophageal cancers in 38 patients. INTERVENTIONS: Patients were alternately assigned to EUS-J or EUS-W. The depth of invasion was classified into epithelium or lamina propria mucosae (D1), muscularis mucosae or superficial layer of the submucosa (D2), and deep portion of the submucosa (D3). Depiction rate, interobserver variation between 2 observers, and accuracy for the determination of invasion depth were compared between EUS-J and EUS-W. MAIN OUTCOME MEASUREMENTS AND RESULTS: Eighteen cancers were examined by EUS-J, and 22 cancers were examined by EUS-W. The actual depth of invasion was D1 in 21 cancers, D2 in 9 cancers, and D3 in 10 cancers. Depiction rate (94.4% vs 77.2%, P = .14) and interobserver agreement of EUS determination (82.3% vs 58.8%, P = .13) was higher in EUS-J than in EUS-W. The overall accuracy for the diagnosis of invasion depth was 77.8% in EUS-J and 59.1% in EUS-W (P = .18). The sensitivity for the diagnosis of D1 cancer was significantly higher in EUS-J than in EUS-W (100% vs 50%, P = .03), while the specificity was not different between the 2 procedures (81.8% vs 87.5%). CONCLUSIONS: EUS-J is superior to EUS-W for the assessment of invasion depth in superficial esophageal cancer, especially for intramucosal cancer.

記述言語：日本語  

小腸X線検査とダブルバルーン小腸内視鏡(DBE)の両者を施行した症例(男性19例,女性19例,平均年齢48歳)を遡及的に検討し,DBEの有用性について考察した.1)粘膜所見に関しては,X線で指摘できた大部分がDBEで確認された.2)DBEでは高度の瘢痕狭窄に加えて小腸潰瘍の開放性潰瘍の有無を判定できたが,狭窄のため病変の全体像を観察することは困難であった.3)二重造影法で描出される変形と内視鏡所見を対比しながら,診断を進めることが妥当であると考えられた.4)DBEは小腸疾患の粘膜所見の評価に有用で,生検や内視鏡治療の観点から必要不可欠な手技であると考えられた

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Double-balloon enteroscopy (DBE) is a novel procedure for the diagnosis of small-bowel pathology. The aim of this retrospective study was to compare the performance and the diagnostic value of antegrade DBE with those of push enteroscopy (PE). METHODS: We reviewed endoscopic and histologic findings in 118 patients examined by PE or antegrade DBE during a period 1980 to 2004. The maximal length of insertion under plain radiograph was compared between patients examined by PE and those examined by antegrade DBE. Diagnostic yield was compared among patients stratified by indication for enteroscopy and the duodenal pathology. RESULTS: Ninety-one patients were examined by PE and 27 patients by antegrade DBE. Length of insertion from the ligament of Treitz was significantly greater in antegrade DBE (median, 92 cm; range, 40-144 cm) than in PE (median, 22 cm; range, 0-98 cm; p < 0.0001). In 90 nonbleeding patients with inflammatory or miscellaneous diseases or polyposis, the diagnostic yield was not different between PE and antegrade DBE (64% vs. 82%, p = 0.13). However, it was higher in antegrade DBE (79%) than in PE (31%, p = 0.012) in nonbleeding patients without duodenal pathology. In bleeding patients, the diagnostic yield was 40% in antegrade DBE and 36% in PE (p = 0.61). CONCLUSIONS: Antegrade DBE is superior to PE in exploration of the small intestine and in diagnostic yield for small-intestinal pathology.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Study Aims: Video capsule endoscopy and double-balloon enteroscopy (DBE) are novel methods of enteroscopy. The aim of this investigation was to compare the value of CE and DBE in the diagnosis of small-intestinal pathology.
Patients and Methods: Thirteen patients with gastrointestinal bleeding of obscure origin and nine patients with known gastrointestinal polyposis were examined using antegrade or retrograde DBE, and the most distal or proximal site in the explored small intestine was marked by submucosal injection of sterilized ink. The patients were then evaluated by CE. Video images obtained by CE were reviewed by an observer who was blinded to the DBE findings.
Results: DBE identified positive findings in 12 patients (54.5%). CE identified positive findings in the area explored by DBE in eight patients (36.4%), and in the unexplored area in 11 patients (50.0%). The overall diagnostic yield in the area explored by DBE did not differ between the two procedures. The enteroscopic findings in the area explored by DBE were concordant in 12 of 13 patients with gastrointestinal bleeding of obscure origin. In patients with polyposis, the diagnoses were discordant in three patients, in whom CE failed to detect any polyp. In two of three polyposis patients with concordant positive findings, DBE detected a larger number of polyps than CE did.
Conclusions: DBE appears to be superior to CE in the diagnosis of small-intestinal polyps, whereas the value for diagnosing gastrointestinal bleeding of obscure origin is similar in the two procedures.

DOI： 10.1055/s-870207

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The stomach and the duodenum are frequent sites of involvement by diminutive lesions in Crohn's disease (CD).
Aim: To assess mucosal proinflammatory cytokines and chemokines in gastroduodenat lesions of CD.
Methods: C-13-Urea breath test and upper endoscopy were performed in 29 CD patients and seven control subjects, and biopsy specimens were obtained from the gastric cardia and the duodenum. Histology and mucosal levels of IL-1 beta, IL-8/CXCL8 and RANTES/ CCL5 were assessed and compared according to the presence of gastric cardial lesion [bamboo joint-like appearance (BJA)] and duodenal lesion (notched appearance, aphthous erosion and polypoid lesion). In 11 CD patients, these procedures were repeatedly performed after administration of famotidine.
Results: H. pylori was less frequently positive in CD patients than in controls (10% vs. 71%, P = 0.003). Prevalence of cardial and duodenal lesion was significantly higher in CD than in controls (59% vs. 0%, P = 0.008 for gastric lesion; 45% vs. 0%, P = 0.034 for duodenal lesion). There were no differences in IL-1 beta, IL-8 and RANTES between CD and controls. Duodenal mucosal IL-1 beta and IL-8 were significantly higher in positive duodenal lesion than in negative duodenal lesion. However, there were no such differences with respect to cardial lesions. Endoscopic findings remained unchanged after administration of famotidine, while there was a trend towards decreases in IL-1 beta and IL-8 in the gastric cardia.
Conclusions: The pathogenesis of diminutive lesions of CD may be different between the stomach and the duodenum. Famotidine may not have a therapeutic effect on duodenal lesion in CD.

記述言語：英語  

DOI： 10.1111/j.1365-2036.2005.02480.x

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The role of Helicobacter pylori infection in rheumatoid arthritis (RA) patients during treatment with non-steroidal anti-inflammatory drugs (NSAID) is still unclear. Methods: By means of endoscopy and biopsy, gastroduodenal lesions and H. pylori status were repeatedly examined in 88 RA patients at intervals ranging from 26 to 49 months. Histology and culture were applied to determine H. pylori status. Serial changes in gastroduodenal lesions and histologic score for mucosal atrophy were compared among groups classified by initial and second H. pylori status. Results: There were 28 patients with continuously positive H. pylori infection (CP group), 33 patients with continuously negative H. pylori infection (CN group), 7 patients in whom H. pylori status became negative (PN group), and 20 patients in whom H. pylori status could not be determined (UD group). Age, duration and species of NSAID, disease activity of RA, gastroprotective drugs applied and the prevalence of gastroduodenal mucosal lesions were not different among the groups at either the initial or the second examination. In the PN group, the score for mucosal atrophy at the second examination was significantly lower than at the initial examination, whereas no difference was found for the CP, CN and UD groups. Overall, histologic score for mucosal atrophy was higher in H. pylori-positive patients than in H. pylori-negative patients at both initial and second examination. Conclusions: In RA patients using NSAIDs, H. pylori infection may not affect the course of gastroduodenal lesions and activity of RA, but the infection contributes to mucosal atrophy.

DOI： 10.1080/00365520310008089

記述言語：英語  

DOI： 10.1080/00365520310008089

記述言語：英語  

DOI： 10.1055/s-2003-38138

記述言語：日本語  

手術不能食道癌6症例を対象にステント挿入を行い,その有効性について検討した.その結果,ステント挿入からの生存期間は平均3ヵ月と短かったが,ステント挿入により3例で食事摂取の改善を認めた.食事摂取持続期間は,2/3以上が3例,1/3以下が3例であった.ステント挿入の合併症としてtumor ingrowth,食物残渣による食道閉塞,疼痛,胃酸逆流がみられた.以上より,手術不能の末期癌患者に対するステント挿入は,QOLの重要な部分を占める経口摂取を可能にした点で有効であったと思われた

記述言語：日本語   著書種別：学術書

記述言語：日本語   著書種別：一般書・啓蒙書

記述言語：日本語   著書種別：一般書・啓蒙書

小腸内視鏡の画像所見をどう判断し診断するかを記載した書籍。

記述言語：日本語   著書種別：一般書・啓蒙書

開催年月日： 2021年12月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2020年1月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：ヤンゴン   国名：ミャンマー連邦  

開催年月日： 2019年12月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：モスクワ   国名：ロシア連邦  

開催年月日： 2019年12月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2019年12月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：福岡（遠隔）   国名：日本国  

開催年月日： 2019年11月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2019年10月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Thimphu   国名：ブータン王国  

開催年月日： 2019年7月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Sao Paulo   国名：ブラジル連邦共和国  

開催年月日： 2019年3月 - 2019年2月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Santiago   国名：チリ共和国  

開催年月日： 2019年3月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：東京   国名：日本国  

開催年月日： 2019年2月

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開催地：Bogota   国名：コロンビア共和国  

開催年月日： 2018年10月

記述言語：英語   会議種別：口頭発表（一般）  

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開催年月日： 2018年3月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Ho Chi Minh   国名：ベトナム社会主義共和国  

開催年月日： 2017年12月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Kuala Lumpur   国名：マレーシア  

開催年月日： 2017年11月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Coquimbo   国名：チリ共和国  

開催年月日： 2017年8月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：東京   国名：日本国  

開催年月日： 2017年5月

記述言語：英語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：Chicago   国名：アメリカ合衆国  

開催年月日： 2016年8月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：東京   国名：日本国  

開催年月日： 2015年11月

記述言語：日本語  

開催地：盛岡   国名：日本国  

開催年月日： 2015年4月

記述言語：日本語  

開催地：仙台   国名：日本国  

開催年月日： 2014年8月

記述言語：英語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：Otaru   国名：日本国  

開催年月日： 2012年2月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：仙台   国名：日本国  

当科でESDを施行された早期胃癌187病変を対象とし、ESD後の病理組織学的検索で適応内病変または適応拡大病変と判断したA群170病変と、病理組織学的に適応外と診断したB群17病変について比較検討した。深達度診断に苦慮するような症例に対し、積極的に診断的に胃ESDを行うことは安全性の面からは問題ないと思われる。

開催年月日： 2011年12月

記述言語：その他  

開催地：Florida   国名：アメリカ合衆国  

開催年月日： 2011年12月

記述言語：その他   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2011年11月

記述言語：その他  

開催地：Tokyo   国名：日本国  

開催年月日： 2011年11月

記述言語：その他  

開催地：長崎   国名：日本国  

開催年月日： 2011年11月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：長崎   国名：日本国  

当科でESDを施行された早期食道癌62病変を対象とし、ESD後の病理組織学的検索で深達度がEPもしくはLPMと判断したA群と、それより深達度が深かったB群について比較検討した。深達度診断に苦慮するような症例に対し、積極的に診断的に食道ESDを行うことは安全性の面からは問題ないと思われる。

開催年月日： 2011年8月 - 2012年8月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2011年7月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2011年6月

記述言語：その他  

開催地：久留米   国名：日本国  

開催年月日： 2011年2月

記述言語：その他  

開催地：京都   国名：日本国  

開催年月日： 2010年11月

記述言語：その他  

開催地：宜野湾   国名：日本国  

開催年月日： 2010年11月

記述言語：その他  

開催地：宜野湾   国名：日本国  

開催年月日： 2010年11月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：宜野湾   国名：日本国  

開催年月日： 2010年11月

記述言語：その他  

開催地：宜野湾   国名：日本国  

開催年月日： 2010年11月

記述言語：その他  

開催地：宜野湾   国名：日本国  

開催年月日： 2010年11月

記述言語：その他  

開催地：宜野湾   国名：日本国  

開催年月日： 2010年11月

記述言語：その他  

開催地：宜野湾   国名：日本国  

開催年月日： 2010年10月

記述言語：その他   会議種別：口頭発表（一般）  

開催地：横浜   国名：日本国  

開催年月日： 2010年9月

記述言語：その他   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2010年9月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2010年9月

記述言語：その他   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2010年8月

記述言語：その他  

開催地：佐賀   国名：日本国  

開催年月日： 2010年6月

記述言語：その他  

開催地：横浜   国名：日本国  

開催年月日： 2010年6月

記述言語：その他  

開催地：北九州   国名：日本国  

開催年月日： 2010年6月

記述言語：その他  

開催地：北九州   国名：日本国  

開催年月日： 2010年6月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：北九州   国名：日本国  

開催年月日： 2010年5月

記述言語：その他  

開催地：大分   国名：日本国  

開催年月日： 2010年3月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2010年2月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2009年11月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：熊本   国名：日本国  

開催年月日： 2009年11月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：福岡   国名：日本国  

開催年月日： 2009年11月

記述言語：その他  

開催地：熊本   国名：日本国  

開催年月日： 2009年11月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：福岡   国名：日本国  

開催年月日： 2009年6月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2009年6月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2009年5月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：札幌   国名：日本国  

開催年月日： 2008年12月

記述言語：その他  

開催地：Hong Kong  

開催年月日： 2008年11月

記述言語：その他  

開催地：熊本   国名：日本国  

開催年月日： 2008年11月

記述言語：その他  

開催地：大分   国名：日本国  

開催年月日： 2008年11月

記述言語：その他  

開催地：大分   国名：日本国  

開催年月日： 2008年11月 - 2008年10月

開催地：大分   国名：日本国  

開催年月日： 2008年8月

記述言語：その他  

開催地：沖縄   国名：日本国  

開催年月日： 2008年6月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2008年6月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2008年5月

記述言語：その他  

開催地：横浜   国名：日本国  

開催年月日： 2008年5月

記述言語：その他  

開催地：福岡   国名：日本国  

開催年月日： 2008年5月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：横浜   国名：日本国  

開催年月日： 2005年11月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：熊本   国名：日本国  

開催年月日： 2005年5月

記述言語：その他  

開催地：東京   国名：日本国  

開催年月日： 2005年5月

記述言語：その他   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：東京   国名：日本国  

記述言語：日本語  

記述言語：日本語   会議種別：口頭発表（一般）  

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記述言語：日本語  

記述言語：日本語  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：リモート   国名：エジプト・アラブ共和国  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：リモート   国名：コロンビア共和国  

記述言語：日本語  

国名：その他  

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：リモート   国名：中華人民共和国  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：リモート   国名：大韓民国  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：リモート   国名：大韓民国  

記述言語：日本語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：リモート   国名：ネパール連邦民主共和国  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：ビシュケク   国名：キルギス共和国  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：ビシュケク   国名：キルギス共和国  

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：サンパウロ   国名：ブラジル連邦共和国  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Vina del Mar   国名：チリ共和国  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Vina del Mar   国名：チリ共和国  

記述言語：日本語  

国名：その他  

記述言語：英語   会議種別：口頭発表（一般）  

国名：インドネシア共和国  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：東京   国名：日本国  

記述言語：日本語  

開催地：東京   国名：日本国  

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：鹿児島   国名：日本国  

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：北九州   国名：日本国  

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：東京   国名：日本国  

記述言語：日本語  

開催地：福岡   国名：日本国  

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：佐賀   国名：日本国  

記述言語：日本語  

開催地：神戸   国名：日本国  

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：佐賀   国名：日本国  

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Mexico City   国名：メキシコ合衆国  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：日本語  

国名：その他  

記述言語：英語  

国名：その他  

記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：シンポジウム・ワークショップ パネル（指名）  

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記述言語：英語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：シンポジウム・ワークショップ パネル（指名）  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：シンポジウム・ワークショップ パネル（指名）  

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記述言語：英語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：英語   会議種別：口頭発表（招待・特別）  

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記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：日本語   会議種別：ポスター発表  

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記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：日本語   会議種別：口頭発表（招待・特別）  

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記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語