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Ito S, Hotta K, Sekiguchi M, Takeuchi Y, Oka S, Yamamoto H, Shinmura K, Harada K, Uraoka T, Hisabe T, Sano Y, Kondo H, Horimatsu T, Kikuchi H, Kawamura T, Nagata S, Yamamoto K, Tajika M, Tsuji S, Kusaka T, Okuyama Y, Yoshida N, Moriyama T, Hasebe A, So S, Saito Y, Nakahira H, Ishikawa H, Matsuda T. Short-term outcomes of endoscopic resection for colorectal neuroendocrine tumors: Japanese multicenter prospective C-NET STUDY. Dig Endosc 2023. [PMID: 37986226 DOI: 10.1111/den.14728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/19/2023] [Indexed: 11/22/2023]
Abstract
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.
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Affiliation(s)
- Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masau Sekiguchi
- Endoscopy Division, Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Keita Harada
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takashi Hisabe
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Hyogo, Japan
| | - Hitoshi Kondo
- Department of Gastroenterology, Tonan Hospital, Hokkaido, Japan
| | - Takahiro Horimatsu
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Hidezumi Kikuchi
- Department of Gastroenterology and Hepatology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Katsumi Yamamoto
- Department of Gastroenterology, JCHO Osaka Hospital, Osaka, Japan
| | - Masahiro Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Shigetsugu Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Toshihiro Kusaka
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yusuke Okuyama
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohiko Moriyama
- International Medical Department, Kyushu University Hospital, Fukuoka, Japan
| | - Aki Hasebe
- Department of Gastroenterology, Shikoku Cancer Center, Ehime, Japan
| | - Suketo So
- Department of Gastroenterology, Tobata Kyoritsu Hospital, Fukuoka, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medicine Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
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Sekiguchi M, Hotta K, Takeuchi Y, Tanaka S, Yamamoto H, Shinmura K, Harada K, Uraoka T, Hisabe T, Sano Y, Kondo H, Horimatsu T, Kikuchi H, Kawamura T, Nagata S, Yamamoto K, Tajika M, Tsuji S, Kusaka T, Okuyama Y, Yoshida N, Moriyama T, Hasebe A, So S, Kobara H, Kashida H, Miyanaga R, Kato S, Hayashi Y, Sada M, Fukuzawa M, Kato H, Takayama T, Konishi J, Matsushita HO, Narasaka T, Ohata K, Togashi K, Nakamura H, Moriichi K, Oda Y, Kanda N, Kuwai T, Terai S, Sanomura M, Kitamura S, Miyamoto H, Kiriyama S, Mizuno C, Saito Y, Sekine S, Ito S, Nakahira H, Oka S, Hayashi Y, Yoshimura K, Ishikawa H, Matsuda T. Characteristics of colorectal neuroendocrine tumors in patients prospectively enrolled in a Japanese multicenter study: a first report from the C-NET STUDY. J Gastroenterol 2022; 57:547-558. [PMID: 35554678 DOI: 10.1007/s00535-022-01877-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/23/2022] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Masau Sekiguchi
- Endoscopy Division, Cancer Screening Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Keita Harada
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takashi Hisabe
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Hyogo, Japan
| | - Hitoshi Kondo
- Department of Gastroenterology, Tonan Hospital, Hokkaido, Japan
| | - Takahiro Horimatsu
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Hidezumi Kikuchi
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Katsumi Yamamoto
- Department of Gastroenterology, JCHO Osaka Hospital, Osaka, Japan
| | - Masahiro Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Shigetsugu Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Toshihiro Kusaka
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yusuke Okuyama
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohiko Moriyama
- International Medical Department, Kyushu University Hospital, Fukuoka, Japan
| | - Aki Hasebe
- Department of Gastroenterology, Shikoku Cancer Center, Ehime, Japan
| | - Suketo So
- Department of Gastroenterology, Tobata Kyoritsu Hospital, Fukuoka, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Ryoichi Miyanaga
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Sosuke Kato
- Department of Gastroenterology, NTT Medical Center, Sapporo, Hokkaido, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Miwa Sada
- Department of Gastroenterology, Kitasato University Hospital, Kanagawa, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hiroyuki Kato
- Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Jun Konishi
- Department of Gastroenterology, Tochigi Cancer Center, Tochigi, Japan
| | | | - Toshiaki Narasaka
- Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Ken Ohata
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | | | - Kentaro Moriichi
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
| | - Yasushi Oda
- Oda GI Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | - Naoki Kanda
- Department of Gastroenterology and Hepatology, Takatsuki Red Cross Hospital, Osaka, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Sanomura
- Department of Gastroenterology, Hokusetsu General Hospital, Osaka, Japan
| | - Shinji Kitamura
- Department of Gastroenterology, Sakai City Medical Center, Osaka, Japan
| | - Hayato Miyamoto
- Department of Gastroenterology, Hanwasumiyoshi General Hospital, Osaka, Japan
| | | | - Chiemi Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Sekine
- Division of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshikazu Hayashi
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Kenichi Yoshimura
- Department of Biostatistics, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takahisa Matsuda
- Endoscopy Division, Cancer Screening Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
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Yagi S, Furukawa S, Shiraishi K, Miyake T, Tange K, Hashimoto Y, Kitahata S, Kawamura T, Ninomiya T, Mori K, Suzuki S, Shibata N, Murakami H, Ohashi K, Hasebe A, Tomida H, Yamamoto Y, Takeshita E, Ikeda Y, Hiasa Y. The albumin-to-globulin ratio is associated with clinical outcome in Japanese patients with ulcerative colitis. Ann Coloproctol 2022; 39:155-163. [PMID: 35350093 PMCID: PMC10169554 DOI: 10.3393/ac.2021.01032.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/14/2022] [Indexed: 10/18/2022] Open
Abstract
Purpose The albumin-to-globulin ratio (AGR) is a recognized chronic inflammation marker. No evidence regarding the relationship between AGR level and ulcerative colitis (UC) exists. The aim of this study was to evaluate the association between AGR and clinical outcomes among Japanese subjects with UC. Methods The study subjects consisted of 273 Japanese individuals with UC. AGR was divided into 4 categories (low, moderate, high, and very high). The definition of complete mucosal healing (MH) was based on the Mayo endoscopic subscore of 0. Clinical remission (CR) was defined as no rectal bleeding and no abnormally high stool frequency (<3 times per day). Results The percentage of MH was 26.4%. High AGR and very high AGR were significantly positively correlated with CR (adjusted odds ratio [OR], 5.85; 95% confidence interval [CI], 2.52-14.18 and adjusted OR, 4.97; 95% CI, 2.14-12.04) and complete MH (adjusted OR, 4.03; 95% CI, 1.56-11.51 and adjusted OR, 5.22; 95% CI, 1.97-14.89), respectively after adjustment for confounding factors (P for trend=0.001). Only in the low C-reactive protein (CRP) group (≤0.1 mg/dL), very high AGR was significantly positively correlated with complete MH but not CR (adjusted OR, 4.38; 95% CI, 1.06-21.77; P for trend=0.017). In the high CRP group, no correlation between AGR and complete MH was found. Conclusion Among Japanese patients with UC, AGR may be independently positively correlated with complete MH. In particular, among UC patients with low CRP, AGR might be a useful complementary marker for complete MH.
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Affiliation(s)
- Sen Yagi
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | | | - Kana Shiraishi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruki Miyake
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kazuhiro Tange
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yu Hashimoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shogo Kitahata
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Tomoe Kawamura
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | | | - Seiyuu Suzuki
- Department of Gastroenterology, Sumitomo Besshi Hospital, Niihama, Japan
| | - Naozumi Shibata
- Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama, Japan
| | - Hidehiro Murakami
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | - Katsuhisa Ohashi
- OHASHI Clinic participate in Gastro-Enterology and Ano-Proctology, Niihama, Japan
| | - Aki Hasebe
- Department of Gastroenterology, Shikoku Cancer Center, Matsuyama, Japan
| | - Hideomi Tomida
- Endoscopy Center, Ehime University Hospital, Toon, Japan
| | | | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital, Toon, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
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Furukawa S, Yagi S, Shiraishi K, Miyake T, Tange K, Hashimoto Y, Kitahata S, Kawamura T, Ninomiya T, Mori K, Suzuki S, Shibata N, Murakami H, Ohashi K, Hasebe A, Tomida H, Yamamoto Y, Takeshita E, Ikeda Y, Hiasa Y. Effect of disease duration on the association between C-reactive protein-albumin ratio and endoscopic activity in ulcerative colitis. BMC Gastroenterol 2022; 22:39. [PMID: 35094678 PMCID: PMC8802502 DOI: 10.1186/s12876-022-02113-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background A simple serum biomarker for clinical outcome in patients with ulcerative colitis (UC) remains an unmet need. Some studies have shown an association between C-reactive protein (CRP)-albumin ratio (CAR) and prognosis in patients with inflammatory bowel disease (IBD), but evidence regarding the association between CAR and UC remains limited. We evaluated the association between CAR and clinical outcome in Japanese patients with UC. Methods Subjects were 273 Japanese patients with UC. Clinical remission was defined as absence of both abnormally high stool frequency (< 3 per day) and rectal bleeding. Mucosal healing (MH) was defined as Mayo endoscopic subscore (MES) 0. Moderate to severe endoscopic activity was defined as MES 2–3. Subjects were divided according to CAR into tertiles (low, moderate, and high). Results The proportions of patients with clinical remission, MH, and moderate to severe endoscopic activity were 57.9%, 26.0%, and 37.0%, respectively. High CAR was significantly positively associated with moderate to severe endoscopic activity but not MH or clinical remission after adjustment (adjusted odds ratio [OR] 2.18 [95% confidence interval (CI) (1.11–4.35)], p for trend 0.023), but only in patients with long disease duration (> 7 years) (adjusted OR 2.95 [95% CI (1.06–8.79)], p for trend 0.023). CAR was not associated with clinical remission or MH. Conclusions CAR may be significantly positively associated with moderate to severe endoscopic activity but not clinical remission or MH in Japanese patients with UC. In patients with long UC duration, CAR might be a useful serum marker for disease activity.
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Shiraishi K, Furukawa S, Yagi S, Mori K, Ninomiya T, Kawasaki K, Mizukami Y, Suzuki S, Uraoka M, Shibata N, Nakamura S, Imamine S, Murakami H, Ohashi K, Torisu M, Yano M, Hasebe A, Yano H, Murakami M, Takeshita E, Ikeda Y, Hiasa Y. Serum Globulin Is Associated with Endoscopic Findings and Mucosal Healing in Japanese Patients with Ulcerative Colitis. Dig Dis Sci 2022; 67:233-240. [PMID: 33537920 DOI: 10.1007/s10620-021-06834-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/07/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Serum globulin is an inflammation marker. To date, no evidence regarding the association between serum globulin and disease activity in patients with ulcerative colitis has been reported. AIMS We evaluated the association between serum globulin and endoscopic activity in patients with ulcerative colitis. METHODS Serum globulin was divided into tertiles based on the distribution of study subjects (low globulin, ≤ 2.7 g/dl (reference); moderate globulin, 2.7-3.1 g/dl; and high globulin, > 3.1 g/dl). A single endoscopic specialist evaluated the endoscopic findings, and mucosal healing was based on Mayo endoscopic subscore. RESULTS A total of 277 patients with ulcerative colitis were included in the study. Serum globulin was independently positively associated with diminished or absent vascular markings [moderate: adjusted odds ratio (OR) 3.70 (95% confidence interval, CI: 1.82-7.88) and high: adjusted OR 2.40 (95%CI: 1.20-4.94), p for trend = 0.005]. A similar positive association between globulin and erosion was found [high: adjusted OR 2.00 (95%CI: 1.05-3.86)]. Serum globulin was independently inversely associated with mucosal healing [moderate: adjusted OR 0.37 (95%CI: 0.18-0.73) and high: adjusted OR 0.31 (95%CI: 0.14-0.64), p for trend = 0.001] and adjusted partial mucosal healing [moderate: OR 0.51 (95%CI: 0.26-0.98), p for trend = 0.048]. The inverse association between globulin and mucosal healing was significant in the low but not the high C-reactive protein group. CONCLUSIONS In patients with ulcerative colitis, serum globulin was significantly positively associated with endoscopic activity, and was significantly inversely associated with mucosal healing, especially in the low C-reactive protein group.
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Affiliation(s)
- Kana Shiraishi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Shinya Furukawa
- Health Services Center, Ehime University, Matsuyama, Bunkyo, Ehime, Japan.
| | - Sen Yagi
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Yamanishi, Matsuyama, Ehime, Japan
| | - Kenichirou Mori
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Kasuga, Matsuyama, Ehime, Japan
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Kasuga, Matsuyama, Ehime, Japan
| | - Keitarou Kawasaki
- Department of Internal Medicine, Saiseikai Imabari Hospital, Kita, Imabari, Ehime, Japan
| | - Yuji Mizukami
- Department of Gastroenterology, Matsuyama Shimin Hospital, Ote, Matsuyama, Ehime, Japan
| | - Seiyuu Suzuki
- Department of Gastroenterology, Sumitomo Besshi Hospital, Oji, Niihama, Ehime, Japan
| | | | - Naozumi Shibata
- Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Hongo, Niihama, Ehime, Japan
| | - Sanae Nakamura
- Department of Gastroenterology, Shinsenkai Matsuyama Madonna Hospital, Kiyo, Matsuyama, Ehime, Japan
| | - Satoshi Imamine
- Department of Internal Medicine, Shiritsu Oozu Hospital, Nishioozu, Oozu, Ehime, Japan
| | - Hidehiro Murakami
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Yamanishi, Matsuyama, Ehime, Japan
| | - Katsuhisa Ohashi
- Ohashi Clinic Participate in Gastro-Enterology and Ano-Proctology, Funaki, Niihama, Ehime, Japan
| | - Masamoto Torisu
- Department of Internal Medicine, Saiseikai Saijo Hospital, Tsuitachi, Saijo, Ehime, Japan
| | - Makoto Yano
- Yano Clinic, Higashinagato, Matsuyama, Ehime, Japan
| | - Aki Hasebe
- Department of Gastroenterology, Shikoku Cancer Center, Minamiumenomoto, Matsuyama, Ehime, Japan
| | - Harumi Yano
- Department of Gastroenterology, Saijo City Shuso Hospital, Nyugawa, Saijo, Ehime, Japan
| | - Masato Murakami
- Department of Gastroenterology, Murakamikinen Hospital, Oomachi, Saijo, Ehime, Japan
| | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
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6
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Watanabe J, Furukawa S, Yagi S, Shiraishi K, Hanayama M, Tange K, Hashimoto Y, Kitahata S, Mori K, Ninomiya T, Suzuki S, Shibata N, Murakami H, Ohashi K, Hasebe A, Tomida H, Yamamoto Y, Takeshita E, Ikeda Y, Hiasa Y. Time spent per day in strenuous activity and total physical activity are inversely associated with mucosal healing but not with clinical remission in patients with ulcerative colitis. Ann Gastroenterol 2021; 34:796-801. [PMID: 34815645 PMCID: PMC8596212 DOI: 10.20524/aog.2021.0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Epidemiological evidence on the association between physical activity (PA) and ulcerative colitis (UC) is limited, and the effect of PA on the prognosis of UC is currently unknown. We evaluated the association between PA and clinical outcomes, including clinical remission and mucosal healing (MH), in Japanese patients with UC. Methods The study subjects were 327 Japanese patients with UC. Subjects were asked about the average time spent per day on 4 types of PA (sedentary, standing, walking, and strenuous activity) and metabolic equivalents (METs) using a validated questionnaire. Clinical outcomes were complete MH, MH, and clinical remission. The association between PA, including hours spent on each type of PA and average daily METs, and clinical outcomes was assessed by multivariate logistic regression. Results Plentiful strenuous activity was significantly inversely associated with MH and complete MH after adjustment (MH: adjusted odds ratio [OR] 0.45, 95% confidence interval [CI] 0.23-0.89; complete MH: adjusted OR 0.24, 95%CI 0.07-0.62; P for trend=0.008). A very high daily MET total was significantly inversely associated with complete MH after adjustment (adjusted OR 0.37, 95%CI 0.16-0.80; P for trend=0.010). In contrast, no association between PA and clinical remission was found (plentiful strenuous activity: adjusted OR 1.10, 95%CI 0.55-2.23; very high daily total METs: adjusted OR 0.74, 95%CI 0.37-1.46). Conclusion In Japanese patients with UC, time spent per day on strenuous activity and total PA per day may be significantly inversely associated with complete MH, but not with clinical remission.
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Affiliation(s)
- Junichi Watanabe
- Department of Rehabilitation, Ehime Prefectural Central Hospital, Matsuyama (Junichi Watanabe)
| | | | - Sen Yagi
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime (Sen Yagi, Hidehiro Murakami)
| | - Kana Shiraishi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Masakazu Hanayama
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Kazuhiro Tange
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Yu Hashimoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Shogo Kitahata
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Kenichirou Mori
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama (Kenichirou Mori, Tomoyuki Ninomiya)
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama (Kenichirou Mori, Tomoyuki Ninomiya)
| | - Seiyuu Suzuki
- Department of Gastroenterology, Sumitomo Besshi Hospital, Niihama (Seiyuu Suzuki)
| | - Naozumi Shibata
- Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama (Naozumi Shibata)
| | - Hidehiro Murakami
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime (Sen Yagi, Hidehiro Murakami)
| | - Katsuhisa Ohashi
- Ohashi Clinic participate in Gastro-Enterology and Ano-Proctology, Niihama, Ehime (Katsuhisa Ohashi)
| | - Aki Hasebe
- Department of Gastroenterology, Shikoku Cancer Center, Matsuyama, Ehime (Aki Hasebe)
| | - Hideomi Tomida
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine (Hideomi Tomida, Eiji Takeshita)
| | - Yasunori Yamamoto
- Endoscopy Center, Ehime University Hospital (Yasunori Yamamoto, Yoshio Ikeda), Japan
| | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine (Hideomi Tomida, Eiji Takeshita)
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital (Yasunori Yamamoto, Yoshio Ikeda), Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
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7
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Furukawa S, Ikeda Y, Yagi S, Miyake T, Shiraishi K, Tange K, Hashimoto Y, Mori K, Ninomiya T, Suzuki S, Shibata N, Murakami H, Ohashi K, Hasebe A, Tomida H, Yamamoto Y, Takeshita E, Hiasa Y. Association Between Peripheral Blood Monocyte Count and Mucosal Healing in Japanese Patients With Ulcerative Colitis. Clin Transl Gastroenterol 2021; 12:e00429. [PMID: 34797817 PMCID: PMC8604008 DOI: 10.14309/ctg.0000000000000429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Monocytes play an important role in innate immunity. Some epidemiological evidence indicates an association between peripheral blood monocytes and ulcerative colitis (UC). The association between peripheral blood monocytes and mucosal healing (MH), however, remains unclear. We evaluated this issue in patients with UC. METHODS Study subjects consisted of 272 Japanese patients with UC. Monocyte counts were taken in the morning after overnight fasting. Monocyte count was divided into tertiles based on the distribution of values among all study subjects. Information on clinical remission was obtained from medical records. MH was assessed using the Mayo endoscopic subscore. RESULTS The mean monocyte count was 360.1 ± 155.3/mm3. Rates of clinical remission, MH, and complete MH were 61.0%, 66.2%, and 27.9%, respectively. High monocyte count was significantly inversely associated with clinical remission, MH, and complete MH (adjusted odds ratio [OR] 0.45 [95% confidence interval [CI]: 0.23-0.89], OR 0.45 [95% CI: 0.23-0.89], and OR 0.48 [95% CI: 0.23-0.97], respectively). Patients were also classified according to C-reactive protein (CRP) levels; in the low CRP group (<0.1 mg/dL), high monocyte count was independently inversely associated with complete MH but not with clinical remission or MH (OR 0.33 [95% CI: 0.10-0.92], P for trend = 0.027). In the high CRP group, there was no association between monocyte count and clinical outcomes. DISCUSSION Our findings suggest that peripheral blood monocyte count can be used as a serum supplemental marker for MH in UC patients with low CRP levels.
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Affiliation(s)
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital, Ehime, Japan;
| | - Sen Yagi
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime, Japan;
| | - Teruki Miyake
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan;
| | - Kana Shiraishi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan;
| | - Kazuhiro Tange
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Ehime, Japan;
| | - Yu Hashimoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan;
| | - Kenichirou Mori
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan;
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan;
| | - Seiyuu Suzuki
- Department of Gastroenterology, Sumitomo Besshi Hospital, Niihama, Japan;
| | - Naozumi Shibata
- Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama, Ehime, Japan;
| | - Hidehiro Murakami
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime, Japan;
| | - Katsuhisa Ohashi
- Ohashi Clinic Participate in Gastro-Enterology and Ano-Proctology, Niihama, Ehime, Japan;
| | - Aki Hasebe
- Department of Gastroenterology, Shikoku Cancer Center, Matsuyama, Ehime, Japan.
| | - Hideomi Tomida
- Endoscopy Center, Ehime University Hospital, Ehime, Japan;
| | | | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Ehime, Japan;
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan;
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8
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Yagi S, Furukawa S, Shiraishi K, Hashimoto Y, Tange K, Mori K, Ninomiya T, Suzuki S, Shibata N, Murakami H, Ohashi K, Hasebe A, Tomida H, Yamamoto Y, Takeshita E, Ikeda Y, Hiasa Y. Effect of disease duration on the association between serum albumin and mucosal healing in patients with ulcerative colitis. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000662. [PMID: 34099464 PMCID: PMC8186756 DOI: 10.1136/bmjgast-2021-000662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022] Open
Abstract
Objective Serum albumin is used as a marker of acute inflammation. Several studies have addressed the association between serum albumin and clinical outcome in patients with ulcerative colitis (UC). While mucosal healing (MH) has been indicated as the therapeutic goal for UC, the association between serum albumin and MH remains unclear. We evaluated this issue in patients with UC overall and explored whether duration of UC affected this association. Design This cross-sectional study recruited consecutive patients with UC. Study subjects consisted of 273 Japanese patients with UC. Serum albumin was divided into tertiles based on its distribution in all study subjects. One endoscopy specialist was responsible for measuring partial MH and MH, which were defined as a Mayo endoscopic subscore of 0–1 and 0, respectively. The association between serum albumin and clinical outcomes was assessed by multivariate logistic regression. Results Rates of clinical remission, partial MH and MH were 57.9%, 63% and 26%, respectively. Only high serum albumin (>4.4 mg/dL) was significantly positively associated with MH (OR 2.29 (95% CI: 1.03 to 5.29), p for trend=0.043). In patients with short UC duration (<7 years) only, high serum albumin was significantly positively associated with MH and clinical remission. In patients with long UC duration (≥7 years), in contrast, no association between serum albumin and clinical outcomes was found. Conclusion In Japanese patients with UC, serum albumin was significantly positively associated with MH. In patients with short UC duration, serum albumin might be a useful complementary marker for MH.
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Affiliation(s)
- Sen Yagi
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | | | - Kana Shiraishi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yu Hashimoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kazuhiro Tange
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Toon, Japan
| | | | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Seiyuu Suzuki
- Department of Gastroenterology, Sumitomo Besshi Hospital, Niihama, Japan
| | - Naozumi Shibata
- Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama, Japan
| | - Hidehiro Murakami
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | - Katsuhisa Ohashi
- Ohashi Clinic participate in Gastro-Enterology and Ano-Proctology, Niihama, Japan
| | | | - Hideomi Tomida
- Endoscopy Center, Ehime University Hospital, Toon, Japan
| | | | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital, Toon, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
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9
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Furukawa S, Yagi S, Shiraishi K, Hashimoto Y, Kitahata S, Hanayama M, Tange K, Mori K, Ninomiya T, Suzuki S, Shibata N, Murakami H, Ohashi K, Hasebe A, Tomida H, Yamamoto Y, Takeshita E, Ikeda Y, Hiasa Y. The inverse association between unhealthy eating habit and mucosal healing among patients with ulcerative colitis. BMC Gastroenterol 2021; 21:152. [PMID: 33827432 PMCID: PMC8028202 DOI: 10.1186/s12876-021-01724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although the association between eating habits which can be modified and digestive diseases has been reported, to date, no research has evaluated the association between eating habits and ulcerative colitis (UC). Thus, we investigate the association between eating behavior and clinical outcome in Japanese patients with UC. Methods Eating quickly, eating until full, and skipping breakfast data was obtained from a self-administered questionnaire. Information on clinical outcome was collected from medical records. Mucosal healing (MH) and partial MH was defined as a Mayo endoscopic subscore of 0 or 0–1, respectively. Age, sex, BMI, current smoking, current drinking, prednisolone use, and anti-TNFα monoclonal antibody use were selected a priori as potential confounding factors. Results Study subjects consisted of 294 Japanese patients with UC. Eating at speed moderate and eating quickly were independently inversely associated with MH: the adjusted odds ratios (ORs) were 0.38 (95% confidence interval [CI] 0.16–0.85) and 0.38 (95% CI 0.17–0.81) (p for trend = 0.033). Eating until full was independently inversely associated with MH: the adjusted OR was 0.38 (95% CI 0.27–0.86). MH in patients who skipped breakfast was marginally lower than that in patients who did not skip breakfast. No association between eating habits and clinical remission or partial MH was found. Conclusion Among patients with UC, eating rate and eating until full may be independently inversely associated with MH but not clinical remission.
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Affiliation(s)
- Shinya Furukawa
- Health Services Center, Ehime University, Matsuyama, Ehime, Japan.
| | - Sen Yagi
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime, Japan
| | - Kana Shiraishi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yu Hashimoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shogo Kitahata
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masakazu Hanayama
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazuhiro Tange
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kenichiro Mori
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Seiyuu Suzuki
- Department of Gastroenterology, Sumitomo Besshi Hospital, Niihama, Ehime, Japan
| | - Naozumi Shibata
- Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama, Ehime, Japan
| | - Hidehiro Murakami
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime, Japan
| | - Katsuhisa Ohashi
- Ohashi Clinic Participating in Gastro-Enterology and Ano-Proctology, Niihama, Ehime, Japan
| | - Aki Hasebe
- Department of Gastroenterology, Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Hideomi Tomida
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Ehime, Japan
| | | | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital, Ehime, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
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10
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Furukawa S, Yagi S, Shiraishi K, Mori K, Ninomiya T, Kawasaki K, Mizukami Y, Suzuki S, Uraoka M, Shibata N, Nakamura S, Imamine S, Murakami H, Ohashi K, Torisu M, Hasebe A, Yano H, Murakami M, Takeshita E, Ikeda Y, Hiasa Y. Association between platelet count and mucosal healing in Japanese patients with ulcerative colitis: a cross-sectional study. BMC Gastroenterol 2020; 20:384. [PMID: 33198664 PMCID: PMC7670794 DOI: 10.1186/s12876-020-01538-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background Mucosal healing (MH) has been indicated as the therapeutic goal for ulcerative colitis (UC). Platelet count is known as an inflammation evaluation. However, the association between platelet count and MH among patients with UC is still scarce. We therefore assessed this issue among Japanese patients with UC. Methods The study subjects consisted of 345 Japanese patients with UC. Platelet count was divided into quartiles on the basis of the distribution of all study subjects (low, moderate, high, and very high). Several endoscope specialists were responsible for evaluating MH and partial MH, which was defined as a Mayo endoscopic subscore of 0 and 0–1, respectively. Estimations of crude odds ratios (ORs) and their 95% confidence intervals (CIs) for partial MH and MH in relation to platelet count were performed using logistic regression analysis. Age, sex, CRP, steroid use, and anti-Tumor necrosis factor α (TNFα) preparation were selected a priori as potential confounding factors. Results The percentage of partial MH and MH were 63.2 and 26.1%, respectively. Moderate and very high was independently inversely associated with partial MH (moderate: OR 0.40 [95%CI 0.19–0.810], very high: OR 0.37 [95%CI 0.17–0.77], p for trend = 0.034). Similarly, moderate, high, and very high were independently inversely associated with MH (moderate: OR 0.37 [95% CI 0.18–0.73], high: OR 0.41 [95% CI 0.19–0.83], and very high: OR 0.45 [95% CI 0.21–0.94], p for trend = 0.033) after adjustment for confounding factors. Conclusions Among patients with UC, platelet count was independently inversely associated with MH
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Affiliation(s)
- Shinya Furukawa
- Health Services Center, Ehime University, Bunkyo,Matsuyama, Ehime, 790-8577, Japan.
| | - Sen Yagi
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime, 791-8026, Japan
| | - Kana Shiraishi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0205, Japan
| | - Kenichirou Mori
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, 790-0024, Japan
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, 790-0024, Japan
| | - Keitarou Kawasaki
- Department of Internal Medicine, Saiseikai Imabari Hospital, Imabari, Ehime, 799-1592, Japan
| | - Yuji Mizukami
- Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama, Ehime, 790-0067, Japan
| | - Seiyuu Suzuki
- Department of Gastroenterology, Sumitomo Besshi Hospital, Niihama, Ehime, 792-8543, Japan
| | - Masayoshi Uraoka
- Uraoka Gastrointestinal Clinic, Matsuyama, Ehime, 790-0852, Japan
| | - Naozumi Shibata
- Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama, Ehime, 792-0042, Japan
| | - Sanae Nakamura
- Department of Gastroenterology, NTT Matsuyama Hospital, Matsuyama, Ehime, 790-0802, Japan
| | - Satoshi Imamine
- Department of Internal Medicine, Shiritsu Oozu Hospital, Oozu, Ehime, 795-0013, Japan
| | - Hidehiro Murakami
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime, 791-8026, Japan
| | - Katsuhisa Ohashi
- Ohashi Clinic Participating in Gastro-Enterology and Ano-Proctology, Niihama, Ehime, 792-0856, Japan
| | - Masamoto Torisu
- Department of Internal Medicine, Saiseikai Saijo Hospital, Saijo, Ehime, 793-00257, Japan
| | - Aki Hasebe
- Department of Gastroenterology, Shikoku Cancer Center, Matsuyama, Ehime, 791-0280, Japan
| | - Harumi Yano
- Department of Gastroenterology, Saijo City Shuso Hospital, Saijo, Ehime, 793-0027, Japan
| | - Masato Murakami
- Department of Gastroenterology, Murakamikinen Hospital, Saijo, Ehime, 793-0030, Japan
| | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Matsuyama, Ehime, 791-0205, Japan
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital, Toon, Ehime, 791-0205, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0205, Japan
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11
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Hino K, Kajiwara T, Nishina T, Inoue T, Yoshimatsu M, Sakaguchi C, Nakasya A, Nishide N, Asagi A, Hasebe A, Terao T, Hori S, Nadano S, Hamamoto Y, Kataoka M, Tanimizu M. [Tolerability of Definitive Chemoradiotherapy in Elderly Patients with Esophageal Cancer]. Gan To Kagaku Ryoho 2020; 47:1577-1581. [PMID: 33268731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Definitive chemoradiotherapy(CRT)for esophageal cancer is the standard treatment and alternative to surgery. However, the tolerability of CRT in elderly patients is not well known. In this study, we retrospectively analyzed 60 patients with esophageal cancer who were treated with CRT(5-FU 700 mg/m2, cisplatin 70 mg/m2, radiation 60 Gy)at our hospital between January 2015 and September 2017. The patients were divided into 2 groups: an elderly group comprising 16 patients aged >75 years and a non-elderly group comprising 44 patients aged <74 years. The relative dose intensity of cisplatin in the elderly group was significantly lower than that in the non-elderly group. Radiotherapy was successfully executed in both groups. More patients in the elderly(25%)than the non-elderly group(7%)developed pneumonitis, and all patients who developed severe pneumonitis in the elderly group died. Application of definitive CRT and irradiation methods in elderly patients with a subpleural reticular shadow should be carefully considered before initiating therapy.
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Affiliation(s)
- Kaori Hino
- Dept. of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center
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12
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Shigemori H, Ishida T, Hasebe A, Zhao X. Biological Activity of Sinapic Acid Derivatives Isolated from Raphanus sativus. HETEROCYCLES 2019. [DOI: 10.3987/com-19-14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Saeki A, Sugiyama M, Hasebe A, Suzuki T, Shibata K. Activation of NLRP3 inflammasome in macrophages by mycoplasmal lipoproteins and lipopeptides. Mol Oral Microbiol 2018; 33:300-311. [PMID: 29682880 DOI: 10.1111/omi.12225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 12/29/2022]
Abstract
The NLRP3 inflammasome, an intracellular sensor consisting of the nucleotide-binding oligomerization domain-like receptor family, pyrin domain containing 3 (NLRP3), the adaptor protein apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC), and procaspase-1, plays critical roles in host defense against microbial pathogens by inducing production of interleukin-1β (IL-1β) and IL-18. Mycoplasma salivarium and Mycoplasma pneumoniae cells activated murine bone marrow-derived macrophages (BMMs) to induce production of IL-1α, IL-1β, and IL-18. The IL-1β production-inducing activities of these mycoplasmas toward BMMs from Toll-like receptor 2 (TLR2)-deficient mice were significantly attenuated compared with those from C57BL/6 mice (B6BMMs). This result suggests the possibility that their lipoproteins as TLR2 agonists are involved in the activity. Lipoproteins of M. salivarium and M. pneumoniae (MsLP and MpLP), and the M. salivarium-derived lipopeptide FSL-1 induced IL-1β production by B6BMMs, but not by BMMs from caspase-1-, NLRP3- or ASC-deficient mice. The activities of MsLP and MpLP were not downregulated by the proteinase K treatment, suggesting that the active sites are their N-terminal lipopeptide moieties. B6BMMs internalized the mycoplasmal N-terminal lipopeptide FSL-1 at least 30 min after incubation, FSL-1-containing endosomes started to fuse with the lysosomes around 2 hours, and then FSL-1 translocated into the cytosol from LAMP-1+ endosomes. The artificial delivery of FSL-1 into the cytosol of B6BMMs drastically enhanced the IL-1β production-inducing activity. FSL-1 as well as the representative NLRP3 inflammasome activator nigericin induced the NLRP3/ASC speck, but FSL-1 located in a compartment different from the NLRP3/ASC speck.
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Affiliation(s)
- A Saeki
- Department of Oral Molecular Microbiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - M Sugiyama
- Department of Oral Molecular Microbiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - A Hasebe
- Department of Oral Molecular Microbiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - T Suzuki
- Department of Bacterial Pathogenesis, Infection and Host Response Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Shibata
- Department of Oral Molecular Microbiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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14
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Kuroda T, Kumagi T, Yokota T, Azemoto N, Hasebe A, Seike H, Nishiyama M, Inada N, Shibata N, Miyata H, Kawamura T, Imai Y, Ueno-Toshimori A, Tanaka Y, Terao T, Imamura Y, Koizumi M, Yamanishi H, Ohno Y, Hiasa Y. Efficacy of chemotherapy in elderly patients with unresectable pancreatic cancer: a multicenter review of 895 patients. BMC Gastroenterol 2017; 17:66. [PMID: 28532457 PMCID: PMC5440997 DOI: 10.1186/s12876-017-0623-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 05/10/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The efficacy of chemotherapy for unresectable pancreatic cancer has improved. However, it is occasionally difficult to make treatment decisions for elderly patients. We reviewed the outcomes of elderly patients with unresectable pancreatic cancer by using a large cohort and evaluated whether they had received chemotherapy and the reason why. METHODS Data for 895 pancreatic cancer patients who were treated using chemotherapy or best supportive care were analyzed considering demographics, clinical stage, treatment, and outcome. Data were analyzed using the chi-square test, Student t-test, or Mann-Whitney U-test, as appropriate. Outcomes were analyzed using the Kaplan-Meier method. Differences in survival were analyzed using the log-rank test. RESULTS The median survival time was significantly shorter in elderly patients (≥65 years) than in younger patients (<65 years) (181 vs. 263 days, P = 0.0001). The median survival time of patients treated with chemotherapy was not significantly different between the elderly and the younger group (274 days vs. 333 days, P = 0.09), and nor was that of patients choosing best supportive care (84 days vs. 78 days, P = 0.83). These results held true even when the age cut-off between younger and elder patients was increased to 70, 75, and 80 years. Elderly patients treated with chemotherapy had a significantly longer median survival time than those choosing best supportive care (274 vs. 86 days, P < 0.0001); a significantly greater proportion of elderly patients chose best supportive care compared to younger patients (47.8 vs. 25.8%, P < 0.0001). The reason for choosing best supportive care was established in 261 elderly patients (82.9%); 133 (51.0%) met the eligibility criteria for chemotherapy, but of these, 78 (58.6%) were not informed about their disease. The treatment preferences of elderly patients were not always considered; they often received only best supportive care per family members preference (N = 65, 48.8%) or because the physician based their treatment decision only on the patient's age (N = 68, 51.1%). CONCLUSIONS Chemotherapy appears effective for elderly pancreatic cancer patients with unresectable disease, but treatment needs to be optimized to improve prognosis.
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Affiliation(s)
- Taira Kuroda
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, To-on, Ehime, Japan
| | - Teru Kumagi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, To-on, Ehime, Japan.
| | - Tomoyuki Yokota
- Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Nobuaki Azemoto
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Aki Hasebe
- Department of Internal Medicine, Saiseikai Imabari Hospital, Imabari, Ehime, Japan
| | - Hirotaka Seike
- Department of Gastroenterology, Uwajima Municipal Hospital, Uwajima, Ehime, Japan
| | - Mari Nishiyama
- Department of Gastroenterology, Matsuyama Municipal Hospital, Matsuyama, Ehime, Japan
| | - Nobu Inada
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime, Japan
| | - Naozumi Shibata
- Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama, Ehime, Japan
| | - Hideki Miyata
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Tomoe Kawamura
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Yusuke Imai
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Akiko Ueno-Toshimori
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Yoshinori Tanaka
- Department of Gastroenterology, Matsuyama Municipal Hospital, Matsuyama, Ehime, Japan
| | - Takashi Terao
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, To-on, Ehime, Japan
| | - Yoshiki Imamura
- Department of Gastroenterology, Matsuyama Municipal Hospital, Matsuyama, Ehime, Japan
| | - Mitsuhito Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, To-on, Ehime, Japan
| | - Hirofumi Yamanishi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, To-on, Ehime, Japan
| | - Yoshinori Ohno
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, To-on, Ehime, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, To-on, Ehime, Japan
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15
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Sugiyama M, Saeki A, Hasebe A, Kamesaki R, Yoshida Y, Kitagawa Y, Suzuki T, Shibata K. Activation of inflammasomes in dendritic cells and macrophages by Mycoplasma salivarium. Mol Oral Microbiol 2015; 31:259-69. [PMID: 26177301 DOI: 10.1111/omi.12117] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 01/27/2023]
Abstract
Interleukin-1β (IL-1β) plays crucial roles in the pathogenesis of periodontal disease. It is produced after the processing of pro-IL-1β by caspase-1, which is activated by the inflammasome-a multiprotein complex comprising nucleotide-binding domain leucine-rich repeat-containing receptor (NLR), the adaptor protein apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC), and procaspase-1. Mycoplasma salivarium preferentially inhabits the gingival sulcus and the incidence and number of organisms in the oral cavity increase significantly with the progression of periodontal disease. To initially clarify the association of this organism with periodontal diseases, this study determined whether it induces IL-1β production by innate immune cells such as dendritic cells or macrophages by using Mycoplasma pneumoniae as a positive control. Both live and heat-killed M. salivarium and M. pneumoniae cells induced IL-1β production by XS106 murine dendritic cells as well as pyroptosis. The activities were significantly downregulated by silencing of caspase-1. Bone-marrow-derived macrophage (BMMs) from wild-type and NLR-containing protein 3 (NLRP3)-, ASC-, and caspase-1-deficient mice were examined for IL-1β production in response to these mycoplasmas. Live M. salivarium and M. pneumoniae cells almost completely lost the ability to induce IL-1β production by BMMs from ASC- and caspase-1-deficient mice. Their activities toward BMMs from NLRP3-deficient mice were significantly but not completely attenuated. These results suggest that live M. salivarium and M. pneumoniae cells can activate several types of inflammasomes including the NLRP3 inflammasome. Both M. salivarium and M. pneumoniae cells can activate THP-1 human monocytic cells to induce IL-1β production. Hence, the present finding that M. salivarium induces IL-1β production by dendritic cells and macrophages may suggest the association of this organism with periodontal diseases.
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Affiliation(s)
- M Sugiyama
- Division of Oral Molecular Microbiology, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan.,Division Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - A Saeki
- Division of Oral Molecular Microbiology, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - A Hasebe
- Division of Oral Molecular Microbiology, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - R Kamesaki
- Division Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - Y Yoshida
- Division of Biomaterials and Bioengineering, Department of Oral Health Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - Y Kitagawa
- Division Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - T Suzuki
- Department of Molecular Bacteriology and Immunology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - K Shibata
- Division of Oral Molecular Microbiology, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
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16
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Oouchi M, Hasebe A, Hata H, Segawa T, Yamazaki Y, Yoshida Y, Kitagawa Y, Shibata KI. Age-related alteration of expression and function of TLRs and NK activity in oral candidiasis. Oral Dis 2015; 21:645-51. [PMID: 25704085 DOI: 10.1111/odi.12329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/09/2015] [Accepted: 02/14/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Roles of aging or immune responses mediated by Toll-like receptors and natural killer cell in the onset or progression of human candidiasis remain unclear. This study was designed to elucidate the roles using peripheral blood mononuclear cells from healthy donors and patients with oral candidiasis. SUBJECTS AND METHODS Subjects tested were healthy volunteers and patients who visited Dental Clinical Division of Hokkaido University Hospital. The patients with oral candidiasis included 39 individuals (25-89 years of age) with major complaints on pain in oral mucosa and/or dysgeusia. Healthy volunteers include students (25-35 years of age) and teaching staffs (50-65 years of age) of Hokkaido University Graduate School of Dental Medicine. RESULTS Functions of Toll-like receptors 2 and 4 were downregulated significantly and the natural killer activity was slightly, but not significantly downregulated in aged healthy volunteers compared with healthy young volunteers. Functions of Toll-like receptors 2 and 4 and the natural killer activity were significantly downregulated in patients with oral candidiasis compared with healthy volunteers. CONCLUSION Downregulation of functions of Toll-like receptors 2 and 4 as well as natural killer activity is suggested to be associated with the onset or progression of oral candidiasis in human.
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Affiliation(s)
- M Oouchi
- Division of Oral Diagnosis, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Japan.,Division of Oral Molecular Microbiology, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Japan
| | - A Hasebe
- Division of Oral Molecular Microbiology, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Japan
| | - H Hata
- Division of Oral Diagnosis, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Japan
| | - T Segawa
- Division of Oral Molecular Microbiology, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Japan
| | - Y Yamazaki
- Department of Gerondontology, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine, Japan
| | - Y Yoshida
- Department of Biomaterials and Bioengineering, Division of Oral Health Sciences, Hokkaido University Graduate School of Dental Medicine, Japan
| | - Y Kitagawa
- Division of Oral Diagnosis, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Japan
| | - K-I Shibata
- Division of Oral Molecular Microbiology, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Japan
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17
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Saeki A, Segawa T, Abe T, Sugiyama M, Arimoto T, Hara H, Hasebe A, Ohtani M, Tanizume N, Ohuchi M, Kataoka H, Kawanami M, Yokoyama A, Shibata K. Toll-like receptor 2-mediated modulation of growth and functions of regulatory T cells by oral streptococci. Mol Oral Microbiol 2013; 28:267-80. [PMID: 23413817 DOI: 10.1111/omi.12023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2013] [Indexed: 11/30/2022]
Abstract
This study was designed to determine whether oral streptococci modulate the growth and functions of regulatory T cells. Heat-killed cells of wild-type strains of Streptococcus gordonii and Streptococcus mutans induced the Toll-like receptor 2 (TLR2) -mediated nuclear factor-κB (NF-κB) activation, but their lipoprotein-deficient strains did not. Stimulation with these streptococci resulted in a significant increase in the frequency of CD4(+) CD25(+) Foxp3(+) regulatory T cells in splenocytes derived from both TLR2(+/+) and TLR2(-/-) mice, but the level of increase in TLR2(+/+) splenocytes was stronger than that in TLR2(-/-) splenocytes. Both strains of S. gordonii enhanced the proliferation of CD4(+) CD25(+) Foxp3(+) regulatory T cells isolated from TLR2(+/+) mice at the same level as those from TLR2(-/-) mice in an interleukin-2-independent manner. However, wild-type and lipoprotein-deficient strains of both streptococci did not enhance the suppressive activity of the isolated regulatory T cells in vitro, but rather inhibited it. TLR ligands also inhibited the suppressive activity of the regulatory T cells. Inhibition of the suppressive activity was recovered by the addition of anti-IL-6 antibody. Pretreatment of antigen-presenting cells with the NF-κB inhibitor BAY11-7082 enhanced the suppressive activity of the regulatory T cells. These results suggested that interleukin-6 produced by antigen-presenting cells inhibits the suppressive activity of the regulatory T cells. Wild-type strain, but not lipoprotein-deficient strain, of S. gordonii reduced the frequency of CD4(+) CD25(+) Foxp3(+) regulatory T cells in the acute infection model, whereas both strains of S. gordonii increased it in the chronic infection model mice. Hence, this study suggests that oral streptococci are capable of modulating the growth and functions of regulatory T cells in vitro and in vivo.
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Affiliation(s)
- A Saeki
- Division of Oral Molecular Microbiology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
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18
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Yorimitsu N, Hiraoka A, Utsunomiya H, Imai Y, Tatsukawa H, Tazuya N, Yamago H, Shimizu Y, Hidaka S, Tanihira T, Hasebe A, Miyamoto Y, Ninomiya T, Abe M, Hiasa Y, Matsuura B, Onji M, Michitaka K. Colonic intussusception caused by anisakiasis: a case report and review of the literature. Intern Med 2013; 52:223-6. [PMID: 23318852 DOI: 10.2169/internalmedicine.52.8629] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 67-year-old woman presented with periumbilical pain. Contrast-enhanced computed tomography findings indicated intussusception of the ascending colon without ischemia or necrosis, and we performed successful colonoscopy to treat the condition. Furthermore, an edematous area caused by anisakis was detected in the ascending colon and the anisakis was removed. The patient noted that she had eaten raw fish one day before the symptoms developed. Although colonic intussusception caused by anisakiasis is extremely rare, colonoscopy should be performed in colonic intussusception patients suspected of having anisakiasis in order to avoid invasive resection.
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19
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Hiraoka A, Hidaka S, Shimizu Y, Utsunomiya H, Imai Y, Tatsukawa H, Tazuya N, Yamago H, Yorimitsu N, Tanihira T, Hasebe A, Miyamoto Y, Ninomiya T, Kawasaki H, Hirooka M, Abe M, Hiasa Y, Matsuura B, Onji M, Michitaka K. Recent trends of Japanese hepatocellular carcinoma due to HCV in aging society. ACTA ACUST UNITED AC 2012; 59:1893-5. [PMID: 22193439 DOI: 10.5754/hge11732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS The mean age of hepatocellular carcinoma (HCC) patients has increased (=65 years old). We want to identify the recent trend of the clinical features of HCC patients due to hepatitis C virus (HCV) (HCV-HCC). METHODOLOGY From 2000 to 2009, 855 naive HCC patients were admitted. HCV-HCC patients were divided into two groups, first period group (2000-04, n=270) and second period group (2005-09, n=343) and the clinical features of HCV-HCC were investigated. RESULTS There was no difference in gender, TNM stage and percentages of HCV-HCC between the periods. On the other hand, the ratio of HCV-HCC patients with worse liver function (Child-Pugh B or C), elderly (=75 years old) and the population of patients treated with low invasive radiofrequency ablation were increased (30.0% to 42.0%, 17.2% to 35.8% and 25.1% to 36.2%, respectively; p<0.01). The 1y-, 3y- and 5y-survival rate of HCV-HCC did not show differences (82.1%, 60.5% and 44.7% vs. 81.8%, 56.9% and 37.7%, respectively; p=0.219). CONCLUSIONS The ratio of aged HCV-HCC as well as HCV-HCC patients with worse liver function was increased. The less invasive treatment for HCC in these patients and the quick anti-viral treatment for HCV patients should be considered to avoid occurrence of HCC in Japan.
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Affiliation(s)
- Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
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20
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Hiraoka A, Nakahara H, Kawasaki H, Shimizu Y, Hidaka S, Imai Y, Utsunomiya H, Tatsukawa H, Tazuya N, Yamago H, Yorimitsu N, Tanihira T, Hasebe A, Miyamoto Y, Ninomiya T, Abe M, Hiasa Y, Matsuura B, Onji M, Michitaka K. Huge pancreatic acinar cell carcinoma with high levels of AFP and fucosylated AFP (AFP-L3). Intern Med 2012; 51:1341-9. [PMID: 22687839 DOI: 10.2169/internalmedicine.51.6536] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 25-year-old Japanese woman with a large abdominal tumor (10 cm in diameter) and high level of serum alpha-fetoprotein (AFP, 1,222.4 ng/mL) was introduced and admitted to our hospital in January 2011. Pre-operative imaging modalities could not identify the tumor origin. There was no chronic hepatic viral disease, however, the elevated level of fucosylated AFP (87.8%) and connection with the left hepatic lobe led us to diagnose the tumor as a hepatocellular carcinoma. Surgical resection was performed in February. Histological findings revealed a pancreatic acinar cell carcinoma (ACC). Herein, we provide details of this difficulty to diagnose a case of ACC.
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Affiliation(s)
- Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan.
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21
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Miyoshi T, Hiraoka A, Hidaka S, Shimizu Y, Ninomiya K, Utsunomiya H, Tazuya N, Tanihira T, Hasebe A, Miyamoto Y, Ninomiya T, Abe M, Hiasa Y, Onji M, Michitaka K. An adult patient with acute infection with hepatitis B virus genotype C that progressed to chronic infection. Intern Med 2012; 51:173-6. [PMID: 22246485 DOI: 10.2169/internalmedicine.51.6142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In 2008, a 28-year-old woman consulted our hospital due to general fatigue. Her ALT level was within normal range but she was positive for hepatitis B surface antigen (HBsAg). Her ALT level was nearly within normal range thereafter and she was consistently positive for HBeAg. Later, it was proven that she was negative for HBsAg in 1999. She had been a sex worker in 2007-2008. Complete genome sequencing revealed that her HBV was genotype C. The present case may indicate that it is possible for acute infection with HBV genotype C to progress to chronic infection in adults.
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Affiliation(s)
- Toru Miyoshi
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
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22
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Michitaka K, Hiraoka A, Imai Y, Utsunomiya H, Tatsukawa H, Shimizu Y, Ninomiya K, Yamago H, Tanihira T, Hasebe A, Ninomiya T, Horiike N, Abe M, Hiasa Y, Onji M, Abe E, Ochi H. Clinical features and hepatitis B virus (HBV) genotypes in pregnant women chronically infected with HBV. Intern Med 2012; 51:3317-22. [PMID: 23257514 DOI: 10.2169/internalmedicine.51.8596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The purpose of this study was to clarify the clinical features and hepatitis B virus (HBV) genotypes in pregnant women chronically infected with HBV. METHODS Among 1,489 pregnant women who visited our hospital in 2010, 26 were positive for hepatitis B surface antigens (HBsAg). Of these subjects, 21 from whom informed consent was obtained were included in this study. The clinical features and HBV markers, including genotypes, were investigated. RESULTS No adverse events were observed in the subjects or the neonates during pregnancy or the perinatal period. The HBV genotypes were C in 14 cases, D in six cases, and undetermined in one case. Hepatitis B e antigens and a high viral load (>7.0 log copies/mL) were found in four and six subjects with genotype C, respectively, and in none of subjects with genotype D. The alanine aminotransferase (ALT) levels and platelet counts were within the normal ranges during pregnancy in all subjects except two and three subjects with genotype C, respectively. Three subjects with genotype C showed transient elevations of ALT after delivery. CONCLUSION The majority of subjects were anti-HBe-positive with normal ALT levels; however, some subjects with genotype C showed a high viral load, elevated ALT levels and/or low platelet counts. The pregnancies and deliveries were safe; however, transient elevations of ALT after delivery were observed in some subjects with genotype C.
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Affiliation(s)
- Kojiro Michitaka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan.
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23
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Hiraoka A, Tazuya N, Hidaka S, Uehara T, Ichiryu M, Nakahara M, Tanabe A, Shimizu Y, Tanihira T, Hasebe A, Miyamoto Y, Ninomiya T, Kawasaki H, Ochi H, Koizumi Y, Hirooka M, Abe M, Hiasa Y, Matsuura B, Onji M, Michitaka K. Hepatic resection assisted by ablative therapy for advanced hepatocellular carcinoma. Hepatogastroenterology 2011; 58:955-959. [PMID: 21830423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIMS We attempted combinations of resection and ablative therapies (ethanol injection (EI) or radiofrequency therapy (RFA)) in hepatocellular carcinoma (HCC) patients. METHODOLOGY Thirty-one patients with naive HCC treated from January 2000 to June 2010 were enrolled. All were tumor node metastasis stage III and the number of tumors was countable (< or = 5). Twelve were treated with resection assisted with an ablative therapy (combination group) and 19 with resection only (resection group). Clinical backgrounds and prognosis were investigated. RESULTS The total scores for up-to-seven criteria were larger in the combination group than in the resection group (p=0.01), while other clinical background findings were not significantly different between the groups. In the combination group, 10 cases underwent resection combined with RFA and 2 with EI. The 1- and 3-year survival rates were not significantly different between the groups (combination group, 88.2% and 88.2%, respectively; resection group, 90.9% and 80.8%, respectively). There were no severe complications. CONCLUSION Our results indicate that combination therapy is a therapeutic option for cases with countable HCCs who are difficult to treat by resection only.
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Affiliation(s)
- Atsushi Hiraoka
- Center of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, Japan.
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24
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Koizumi Y, Hiraoka A, Michitaka K, Tazuya N, Ichiryu M, Nakahara H, Ochi H, Tanabe A, Hidaka S, Kodama A, Uehara T, Hasebe A, Miyamoto Y, Ninomiya T, Kumagi T, Abe M, Matsuura B, Horiike N, Hiasa Y, Onji M. Severe hypoglycemia associated with insulin-like growth factor II-producing liver metastasis from gastric carcinoma treated with overnight total parenteral nutrition via a central vein catheter reserve port. Clin J Gastroenterol 2011; 4:68-72. [PMID: 26190708 DOI: 10.1007/s12328-010-0200-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 11/21/2010] [Indexed: 11/28/2022]
Abstract
Hypoglycemia caused by insulin-like growth factor II is difficult to control. A 77-year-old woman was diagnosed with gastric cancer and multiple liver metastases in September 2006 and underwent chemotherapy; however, at that time there were no symptoms of hypoglycemia. From January 2007 onwards, hypoglycemic comas and symptoms of hypoglycemia began to appear frequently. Her serum level of insulin was normal; thus, we suspected the presence of big insulin-like growth factor II was causing the hypoglycemia. This was proven by Western immunoblotting and we diagnosed non-islet cell tumor hypoglycemia associated with gastric cancer. Overnight nutrition provided via a central venous catheter port to prevent hypoglycemia allowed the patient to become ambulant and to remain free of hypoglycemic coma at follow-up until her death 7 months later.
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Affiliation(s)
- Yohei Koizumi
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Kojiro Michitaka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Nayu Tazuya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Misa Ichiryu
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Hiromasa Nakahara
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Hironori Ochi
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Atsushi Tanabe
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Satoshi Hidaka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Akihiro Kodama
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Takahide Uehara
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Aki Hasebe
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Yasunao Miyamoto
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Teru Kumagi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Bunzo Matsuura
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Norio Horiike
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.
| | - Morikazu Onji
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
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25
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Ikegawa S, Hiraoka A, Shimizu Y, Hidaka S, Tazuya N, Ichiryu M, Nakahara H, Tanabe A, Tanihira T, Hasebe A, Miyamoto Y, Ninomiya T, Hirooka M, Kumagi T, Abe M, Hiasa Y, Onji M, Michitaka K. Hepatocellular carcinoma in a case of Wilson's disease treated with radiofrequency ablation therapy. Intern Med 2011; 50:1433-7. [PMID: 21720066 DOI: 10.2169/internalmedicine.50.5203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
A 37-year-old Japanese man was diagnosed with liver cirrhosis due to Wilson's disease in 2001 and treated with D-penicillamine. Thereafter, he was admitted to our hospital for further examination of a space occupying lesion in the liver. The patient was diagnosed with hepatocellular carcinoma (HCC) (7th segment, 2.5 cm in diameter) in May 2010 and treated with radiofrequency ablation therapy. Biopsy findings from a non-cancerous area revealed a fatty liver, though cirrhotic nodules were not found. Long-term treatment for Wilson's disease may improve hepatic fibrosis, and careful screening for HCC by abdominal imaging is needed in such cases.
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26
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Hiraoka A, Kume M, Miyagawa M, Tazuya N, Ichiryu M, Ochi H, Tanabe A, Nakahara H, Shinbata Y, Kan M, Doi S, Hidaka S, Uehara T, Tanihira T, Hasebe A, Miyamoto Y, Ninomiya T, Hirooka M, Abe M, Hiasa Y, Matsuura B, Onji M, Michitaka K. Diagnostic value of sonazoid for hepatic metastasis: comparison with FDG PET/CT. Hepatogastroenterology 2010; 57:1237-1240. [PMID: 21410065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND/AIMS This study was conducted to evaluate the diagnostic efficacy of contrast enhanced ultrasonography (CEUS) with perflubutane (Sonazoid) for hepatic metastasis and compared it with that of 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT). METHODOLOGY From January 2007 to July 2009, 109 Japanese patients with gastrointestinal tract cancer were enrolled, of whom 4 had esophageal cancer, 28 gastric cancer, 1 duodenal cancer, and 76 colorectal cancer. After a bolus injection with Sonazoid (0.5 ml/body), the liver was scanned in both arterial and Kupffer phases. The results of PET/CT and other abdominal imaging examinations were not shown to the CEUS operators. We compared diagnostic efficacy between CEUS and PET/CT. RESULTS Average values for age, body mass index, and maximum diameter of the hepatic metastasis were 68.7 +/- 11.0 years, 21.2 +/- 4.2, and 29.2 +/- 20.5mm, respectively. Hepatic metastasis were suspected in 31 patients based on PET/CT findings and 32 by CEUS. Finally, hepatic metastasis was diagnosed in 30 patients. The sensitivity, specificity, and accuracy rates for CEUS and PET/CT were similar (100% vs. 100%, 97.5% vs. 98.7%, and 95.5% vs. 93.6%, respectively). CONCLUSION CEUS had a diagnostic value similar to that of PET/CT for hepatic metastasis.
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Affiliation(s)
- Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
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27
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Kan M, Hiraoka A, Uehara T, Hidaka S, Ichiryu M, Nakahara H, Ochi H, Tanabe A, Kodama A, Hasebe A, Miyamoto Y, Ninomiya T, Abe M, Hiasa Y, Matsuura B, Onji M, Shinbata Y, Kameoka C, Doi S, Tamura H, Furuya K, Michitaka K. Evaluation of contrast-enhanced ultrasonography using perfluorobutane (Sonazoid(®)) in patients with small hepatocellular carcinoma: comparison with dynamic computed tomography. Oncol Lett 2010; 1:485-488. [PMID: 22966329 DOI: 10.3892/ol_00000085] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 02/08/2010] [Indexed: 11/06/2022] Open
Abstract
This study aimed to elucidate the efficacy of contrast-enhanced ultrasonography (CEUS) with perfluorobutane (Sonazoid(®)) in the diagnosis of hepatocellular carcinomas (HCCs), particularly small HCCs, by comparing the results with dynamic computed tomography (Dy-CT). Seventy-nine nodules in 69 patients with chronic liver disease, suspected as HCCs were studied. The nodules were selected based on the results of B-mode ultrasonography and/or Dy-CT conducted between January and August 2007. The nodules were divided into two groups: the S-group with tumors ≤2 cm (49 nodules), and the L-group with tumors >2 cm (30 nodules). Typical HCCs were defined, and the nodules were enhanced and shown as defects in the arterial and late phase of Dy-CT, respectively. Target lesions were scanned using CEUS, and the results were compared with those of Dy-CT. The L-group nodules diagnosed as HCCs using Dy-CT were also diagnosed as HCCs using CEUS. In the S-group, the diagnostic sensitivity of CEUS was 94.7% and the specificity was 81.8%. We diagnosed two liver tumors that were detected by CEUS but not by Dy-CT; biopsies revealed one tumor to be a well-differentiated HCC and the other to be an atypical adenomatous hyperplasia. The sensitivity and specificity of CEUS against HCC were high even in the small-size HCCs. Thus, Sonazoid is useful in the screening for small HCCs.
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Affiliation(s)
- Miki Kan
- Department of Medical Laboratory, Ehime Prefectural Central Hospital, Ehime, Japan
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28
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Michitaka K, Hiraoka A, Kume M, Uehara T, Hidaka S, Ninomiya T, Hasebe A, Miyamoto Y, Ichiryu M, Tanihira T, Nakahara H, Ochi H, Tanabe A, Uesugi K, Tokumoto Y, Mashiba T, Abe M, Hiasa Y, Matsuura B, Onji M. Amino acid imbalance in patients with chronic liver diseases. Hepatol Res 2010; 40:393-8. [PMID: 20236360 DOI: 10.1111/j.1872-034x.2009.00614.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study is to clarify the amino acid imbalance in patients with chronic hepatitis (CH) as well as those with liver cirrhosis (LC). METHODS We assayed total branched-chain amino acids (BCAA), tyrosine (Tyr) levels and their ratio (BTR) in sera of 101 patients with CH (37 in fibrosis stage F1, 23 in F2, 21 in F3) and 20 with LC (F4) who were diagnosed by liver biopsy. Their levels in relation to the staging of liver fibrosis were analyzed. RESULTS The percentage of patients whose BTR was less than the normal range was 32.1% in CH and 75.0% in LC. The levels of BTR and BCAA were significantly lower (P < 0.001, P < 0.05, respectively) and that of Tyr was significantly higher (P < 0.001) in patients with LC than those in CH. The levels of BTR decreased according to the staging. The levels of Tyr increased according the staging, whereas the levels of BCAA deceased prominently in F4 (487 +/- 103 in F1, 483 +/- 122 in F2, 487 +/- 111 in F3 and 423 +/- 94 in F4). CONCLUSION A considerable number of patients not only with LC but also with CH showed lower levels of BTR. It has been clarified that amino acid imbalance of Tyr was found in the early stage of liver disease, whereas decrease of BCAA was found mainly in F4 stage.
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Affiliation(s)
- Kojiro Michitaka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama
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29
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Hiraoka A, Michitaka K, Horiike N, Hidaka S, Uehara T, Ichikawa S, Hasebe A, Miyamoto Y, Ninomiya T, Sogabe I, Ishimaru Y, Kawasaki H, Koizumi Y, Hirooka M, Yamashita Y, Abe M, Hiasa Y, Matsuura B, Onji M. Radiofrequency ablation therapy for hepatocellular carcinoma in elderly patients. J Gastroenterol Hepatol 2010; 25:403-7. [PMID: 19929922 DOI: 10.1111/j.1440-1746.2009.06037.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM With the aging of society, the number of elderly patients with hepatocellular carcinoma (HCC) has been increasing in Japan. The Government of Japan defines elderly as being over 65 and has divided the elderly into two stages: the first elderly stage (< 75 years old) and the second elderly stage (> or = 75). We investigated the efficacy and safety of radiofrequency ablation therapy (RFA) in patients in the second elderly stage in comparison with other HCC patients, retrospectively. METHODS Two hundred six patients with HCC, who were within the Milan criteria, with low-grade performance status (0 or 1) and a Child-Pugh classification of A or B were enrolled. All were treated with RFA from January 2000 to December 2008 as an initial therapy and were divided into elderly HCC group (e-HCC group; > or = 75, n = 63) and non e-HCC group (< 75, n = 143), and their clinical data and survival rates were compared. RESULTS Age and the level of protein induced by vitamin K absence or antagonist (PIVKA-II) were higher in the e-HCC group as compared with the non e-HCC group (78.3 +/- 3.2 vs 64.2 +/- 7.5 years, 676.3 +/- 2643.7 vs 142.4 +/- 442.2 mAU/mL: P < 0.01, respectively). There were no significant differences for Child-Pugh class, tumor node metastasis stage, and Japan Integrated Stage score and in survival rates after 3, and 5 years between the groups (e-HCC group: 82.5% and 49.7%, respectively; non e-HCC group: 78.3% and 57.5%, respectively). There were no severe complications in the e-HCC group. CONCLUSIONS Elderly HCC patients, who have good performance status, should be treated in the same manner and with the same strategy as young HCC patients.
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Affiliation(s)
- Atsushi Hiraoka
- Department of Gastroenterology, Ehime University Graduate School of Medicine, Ehime, Japan.
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30
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Hiraoka A, Hirooka M, Koizumi Y, Hidaka S, Uehara T, Ichikawa S, Hasebe A, Miyamoto Y, Ninomiya T, Michitaka K, Horiike N, Yamashita Y, Hiasa Y, Matsuura B, Onji M. Modified technique for determining therapeutic response to radiofrequency ablation therapy for hepatocellular carcinoma using US-volume system. Oncol Rep 2010; 23:493-497. [PMID: 20043112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
In radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC), microbubbles appearing during the procedure make it difficult to determine effectiveness with ultrasonography (US) imaging. We developed a modified US-volume system and evaluated its efficacy for demonstrating response to therapeutic RFA. Our US-volume system displays multiplanar reconstruction (MPR) images providing a synchronized view with a US image along with past US-volume data in real-time side-by-side on a personal computer. Seventy-eight patients (94 nodules) were enrolled, of whom 35 (47 nodules) were evaluated using this system (US-volume group) and compared to the other 43 (47 nodules) examined before development of our system (control group). All nodules were clearly depicted by US. If the shortage of margin was predicted with US-volume system, we performed additional needle insertion. Tumor necrosis following RFA was graded by dynamic computed tomography as follows: Grade A, necrotic area surrounded in all directions with an adequate margin (>or=5 mm); Grade B, necrotic area surrounded in all directions, though some margin areas <5 mm; and Grade C, residual tumor or necrotic area smaller than the target tumor. In the US-volume group, the average tumor size was not smaller than that in the control (15.9+/-4.9 vs. 16.0+/-4.3 mm) and adequate margins were obtained (Grade A, B, C, 45/1/1 vs. 35/8/4; P<0.01). Further, there was a significant reduction in numbers of RFA sessions as compared to the control (1.03+/-0.17 vs. 1.12+/-0.32; P<0.01). In HCC patients undergoing RFA, our modified US-volume system accurately demonstrated therapeutic response, which led to a reduced number of RFA sessions.
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Affiliation(s)
- Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, Japan.
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31
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Hiraoka A, Ichiryu M, Tazuya N, Ochi H, Tanabe A, Nakahara H, Hidaka S, Uehara T, Ichikawa S, Hasebe A, Miyamoto Y, Ninomiya T, Hirooka M, Abe M, Hiasa Y, Matsuura B, Onji M, Michitaka K. Clinical translation in the treatment of hepatocellular carcinoma following the introduction of contrast-enhanced ultrasonography with Sonazoid. Oncol Lett 2010; 1:57-61. [PMID: 22966256 DOI: 10.3892/ol_00000010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 08/06/2009] [Indexed: 01/28/2023] Open
Abstract
Some hepatocellular carcinoma (HCC) nodules are detectable with dynamic computed tomography, but not by conventional B-mode ultrasonography (US). Contrast-enhanced US (CEUS) with Sonazoid, a new injectable contrast agent, has been used in Japan since January 2007. The primary advantage of this agent is the ability to maintain observations continuously in the Kupffer phase. We assessed the clinical role of CEUS with Sonazoid for radiofrequency ablation (RFA). From January 2005 to December 2008, 1142 patients were treated with surgical resection, RFA, percutaneous ethanol injection or transcatheter arterial chemoembolization, following the exclusion of those patients treated with chemotherapy or supportive care. The patients included in the study were divided into the pre-CEUS (n=451, 2005 and 2006) and post-CEUS (n=691, 2007 and 2008) groups. Clinical background (e.g., etiology, Child-Pugh classification, tumor node metastasis stage, percentage of patients matched with Milan criteria and selected therapies) was compared between the two groups. In addition, naïve cases were compared between the groups. There were 130 naïve HCC cases in the pre-CEUS group and 171 in the post-CEUS group. Although there were no significant differences for clinical background, the percentage of RFA cases increased from 21 (n=95) to 32% (n=219) and from 32 (n=41) to 52% (n=89) for total and naïve subjects, respectively, after CEUS was introduced (P<0.01). In naïve cases treated with RFA, tumor numbers in the post-CEUS group were larger than those of the pre-CEUS group (1.15±0.48 vs. 1.40±0.67; P<0.01). CEUS with Sonazoid, therefore, makes it possible to perform RFA in a considerable number of HCC cases that would otherwise be invisible by conventional B-mode US.
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Affiliation(s)
- Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime University Graduate School of Medicine, Ehime, Japan
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32
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Hidaka S, Hiraoka A, Ochi H, Uehara T, Ninomiya T, Miyamoto Y, Hasebe A, Tanihira T, Tanabe A, Ichiryu M, Nakahara H, Tazuya N, Ninomiya I, Michitaka K. Malignant pheochromocytoma with liver metastasis treated by transcatheter arterial chemo-embolization (TACE). Intern Med 2010; 49:645-51. [PMID: 20371953 DOI: 10.2169/internalmedicine.49.3061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Multiple liver metastatic lesions were shown by computed tomography and scintigraphy with 123I- metaiodobenzylguanidine (MIBG) in a 76-year-old woman 2 years after resection of a pheochromocytoma of the right adrenal gland. Transcatheter arterial chemo-embolization (TACE) was performed for the liver metastasis, with blood pressure strictly controlled by administration of doxazosin and phentolamine for the prevention of hypertensive crisis after TACE. There were no severe adverse events associated with the treatment, and the number and size of the lesions were decreased. TACE with strict blood pressure control was an effective and safe therapy for multiple liver metastatic lesions related to malignant pheochromocytoma.
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Affiliation(s)
- Satoshi Hidaka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama.
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33
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Hiraoka A, Horiike N, Yamashita Y, Koizumi Y, Doi H, Yamamoto Y, Ichikawa S, Hasebe A, Yano M, Miyamoto Y, Ninomiya T, Ootani H, Takamura K, Kawasaki H, Otomi Y, Kogame M, Sogabe I, Ishimaru Y, Kashihara K, Miyagawa M, Hirooka M, Hiasa Y, Matsuura B, Michitaka K, Onji M. Risk factors for death in 224 cases of hepatocellular carcinoma after transcatheter arterial chemoembolization. Hepatogastroenterology 2009; 56:213-217. [PMID: 19453060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND/AIMS Transcatheter arterial chemoembolization (TACE) has been reported as effective therapy for unresectable hepatocellular carcinoma (HCC), however, few have described methods for predicting prognosis, especially in patients treated by repeated TACE. To determine risk factors for death and try to predict the prognosis, we evaluated clinical data. METHODOLOGY We retrospectively analyzed the clinical parameters of 224 patients with unresectable HCC treated with repeated TACE from January 1997 to December 2007. TACE was repeated when recurrence was diagnosed by tumor marker elevation and/or dynamic computed tomography findings. Factors affecting survival were evaluated using multivariate analysis after univariate analysis. Next, we combined the score for each significant factor into a single prognostic score and added up the positive factors in each case, then analyzed the significance of prognosis, after which the results were compared with other prognostic scoring systems. RESULTS Multivariate analysis revealed that bilobular HCC, alpha-fetoprotein (> or = 400 ng/ml), tumor invasion of the portal vein, tumor size (> or = 10 cm), and albumin (< 2.8 g/dl) were related to poor prognosis, and developed a prognostic scoring system from those. According to that score, patients were classified into 5 groups. CONCLUSION Our scoring system was easily performed and the results showed that repeated TACE should not be administered to patients with scores of 3 or more.
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Affiliation(s)
- Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, Japan.
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34
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Doi H, Ichikawa S, Hiraoka A, Ichiryu M, Nakahara H, Ochi H, Tanabe A, Kodama A, Hasebe A, Miyamoto Y, Ninomiya T, Horiike N, Takamura K, Kawasaki H, Kameoka C, Kan M, Doi S, Soga Y, Tamura H, Maeda T, Asaki A, Seno S, Iguchi H, Hasegawa T. Primitive neuroectodermal tumor of the pancreas. Intern Med 2009; 48:329-33. [PMID: 19252356 DOI: 10.2169/internalmedicine.48.1484] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The primitive neuroectodermal tumor (PNET) of the pancreas, a member of Ewing's sarcoma family of tumors, is extremely rare. We treated a 37-year-old Japanese man who had a solitary pancreatic tumor 40 mm in diameter and multiple hepatic tumors with surgical resection. The PNET was positive for CD99 on immunohistochemical staining. Fluorescence in situ hybridization (FISH) was also performed, which revealed a Ewing sarcoma breakpoint region 1 (EWSR1) 22q12 rearrangement. According to the Japan-Ewing protocol, chemotherapy with Ifomide (ifosfamide), etoposide, vincristine, and cyclophosphamide was given after surgery. To the best of our knowledge, to date 13 PNET cases have been reported with a mean age for all patients of 19.3 years old. Surgical resection was performed in most cases and some patients received postoperative chemotherapy. The clinicopathologic characteristics and management of this extremely rare disease are also discussed.
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Affiliation(s)
- Hirokazu Doi
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama
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35
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Hiraoka A, Horiike N, Yamashita Y, Koizumi Y, Doi K, Yamamoto Y, Hasebe A, Ichikawa S, Yano M, Miyamoto Y, Ninomiya T, Otomi Y, Kokame M, Iwamura T, Ishimaru Y, Sogabe I, Kashihara K, Nishiura S, Ootani H, Takamura K, Kawasaki H. Efficacy of radiofrequency ablation therapy compared to surgical resection in 164 patients in Japan with single hepatocellular carcinoma smaller than 3 cm, along with report of complications. Hepatogastroenterology 2008; 55:2171-2174. [PMID: 19260499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND/AIMS Radiofrequency ablation therapy (RFA) has become widely used against hepatocellular carcinoma (HCC), mainly because of its ease of use, lower level of invasiveness, and high level of effectiveness. To compare the efficacy and safety of RFA with surgery, we retrospectively investigated relevant patient clinical data. METHODOLOGY The patients with a single HCC (3 cm > or =, Child-Pugh A or B) who were treated with RFA (RFA-group: n=105) or surgery (Surgery-group: n=59) from January 2000 to June 2007 were enrolled. RESULTS The ratio of patients classified as Child-Pugh B was greater in RFA-group (24.8% vs. 8.5%, P=0.011), though the sizes of the tumors were not significantly different. There were no significant differences for survival rates or disease free survival rates after 3- and 5-years (RFA-group vs. Surgery-group; survival: 87.8 and 59.3% vs. 91.4 and 59.4%, disease free survival: 58.7 and 24.6% vs. 64.3 and 22.4%, respectively). As for complications, in RFA-group there was no severe complication while there was 1 case of postoperative hepatic failure death and 2 with a postoperative abscess in Surgery-group. CONCLUSIONS In the present study, patients with a single HCC smaller than 3cm who underwent RFA had a lower frequency of severe complications, thus the efficacy of RFA was thought to be equal to a surgical procedure.
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Affiliation(s)
- Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, Japan.
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36
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Doi H, Horiike N, Hiraoka A, Koizumi Y, Yamamoto Y, Hasebe A, Ichikawa S, Yano M, Miyamoto Y, Ninomiya T, Ishimaru Y, Miyagawa M, Takamura K, Kawasaki H, Kozuka T, Maeda T, Yoshino T. Primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue type: case report and review of the literature. Int J Hematol 2008; 88:418-423. [PMID: 18807227 DOI: 10.1007/s12185-008-0153-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 06/22/2008] [Accepted: 07/04/2008] [Indexed: 12/12/2022]
Abstract
A primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT) is very rare. We found a solitary mass 27 mm in size in the left lobe of the liver of a 58-year-old Japanese man with a history of hepatitis-C infection. Based on the results of imaging studies, the tumor was diagnosed as a hepatocellular carcinoma (HCC). The left lobe of the liver was lobectomized and microscopic findings showed that the tumor was a hepatic MALT lymphoma, while immunohistochemistry showed it to be positive for CD20 and CD79a. In a fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning (FDG-PET CT) before surgery, the tumor was revealed to have a high standardized uptake value (SUV) for FDG. The patient received chemotherapy after surgery. To the best of our knowledge, 45 cases had been reported with a mean age for all patients of 61.4 years. The pathogenesis remains unclear, although half of the patients had a past history of chronic inflammatory liver disease. Surgical resection was performed in most cases and some patients received postoperative chemotherapy or radiotherapy. The clinicopathologic characteristics and management of this extremely rare disease are also discussed.
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Affiliation(s)
- Hirokazu Doi
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
| | - Norio Horiike
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Yohei Koizumi
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Yasunori Yamamoto
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Aki Hasebe
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Soichi Ichikawa
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Makoto Yano
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Yasunao Miyamoto
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Yoshihiro Ishimaru
- Department of Radiology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Masao Miyagawa
- Department of Radiology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Kazuhito Takamura
- Department of Surgery, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Hideki Kawasaki
- Department of Surgery, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Teruhiko Kozuka
- Department of Hematology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Toshiharu Maeda
- Department of Medical Laboratory, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
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37
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Hiraoka A, Horiike N, Koizumi Y, Tazuya N, Ichiryu M, Nakahara H, Ochi H, Tanabe A, Doi H, Kodama A, Hasebe A, Ichikawa S, Miyamoto Y, Ninomiya T, Asagi A, Matsubara H, Nadano S, Nishizaki O, Umeda M. Brain metastasis from hepatocellular carcinoma treated with a cyber-knife. Intern Med 2008; 47:1993-6. [PMID: 19015615 DOI: 10.2169/internalmedicine.47.1373] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old right-handed Japanese man who had undergone surgical resection for hepatocellular carcinoma (HCC) 2 years earlier was diagnosed with lung metastasis 3 months before consulting our hospital with a headache and visual field disturbance. Head computed tomography revealed a brain tumor with an intracerebral hemorrhage. Using (99m)Tc-PMT (pyridoxal-5-methly-triptophan) scintigraphy, we determined that the brain tumor was metastasis from the HCC and utilized the cyber-knife for treatment. The prognosis of patients with brain metastasis from HCC has been reported to be poor. Use of the cyber-knife was non-invasive, and proved to be effective for improving prognosis and quality of life.
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Affiliation(s)
- Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama.
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38
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Hiraoka A, Yamashita Y, Uesugi K, Koizumi Y, Yamamoto Y, Doi H, Hasebe A, Ichikawa S, Yano M, Miyamoto Y, Ninomiya T, Matsuura B, Horiike N, Michitaka K, Hiasa Y, Nishikage S, Onji M. Three cases of liver abscesses complicated with colon cancer without liver metastasis: importance of screening for digestive disease. Intern Med 2007. [PMID: 18084126 DOI: jst.jstage/internalmedicine/46.0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We treated 3 patients complicated with colon cancer without liver metastasis, who were admitted to our hospital because of a high fever and diagnosed with liver abscesses. In a general screening after performing percutaneous transhepatic abscess drainage, colon cancer was detected in each, though hepatobiliary diseases were not found. Hepatobiliary diseases were the most common etiology of hepatic abscesses in our hospital in the past 41 cases from 1990 to 2005, 3 of which were due to colon cancer. If a cause is not determined, general screening, especially of the colon tract, should be performed in hepatic abscesses patients.
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Affiliation(s)
- Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital.
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39
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Hiraoka A, Yamashita Y, Uesugi K, Koizumi Y, Yamamoto Y, Doi H, Hasebe A, Ichikawa S, Yano M, Miyamoto Y, Ninomiya T, Matsuura B, Horiike N, Michitaka K, Hiasa Y, Nishikage S, Onji M. Three cases of liver abscesses complicated with colon cancer without liver metastasis: importance of screening for digestive disease. Intern Med 2007; 46:2013-7. [PMID: 18084126 DOI: 10.2169/internalmedicine.46.0080] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We treated 3 patients complicated with colon cancer without liver metastasis, who were admitted to our hospital because of a high fever and diagnosed with liver abscesses. In a general screening after performing percutaneous transhepatic abscess drainage, colon cancer was detected in each, though hepatobiliary diseases were not found. Hepatobiliary diseases were the most common etiology of hepatic abscesses in our hospital in the past 41 cases from 1990 to 2005, 3 of which were due to colon cancer. If a cause is not determined, general screening, especially of the colon tract, should be performed in hepatic abscesses patients.
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Affiliation(s)
- Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital.
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40
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Furukawa S, Akbar SMF, Hasebe A, Horiike N, Onji M. Production of hepatitis B surface antigen-pulsed dendritic cells from immunosuppressed murine hepatitis B virus carrier: evaluation of immunogenicity of antigen-pulsed dendritic cells in vivo. Immunobiology 2005; 209:551-7. [PMID: 15568619 DOI: 10.1016/j.imbio.2004.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Vaccines containing hepatitis B surface antigen (HBsAg) induce antibody to HBsAg (anti-HBs) in most normal individuals and protects them from hepatitis B virus (HBV) infection. However, these vaccines are not efficient at inducing anti-HBs in immunosuppressed individuals, especially in immunosuppressed HBV carriers. The aim of this study was to prepare and to assess the efficacy of a dendritic cell (DC)-based vaccine in an immunosuppressed HBV transgenic mouse (HBV-Tg), an animal model of the HBV carrier state. In order to prepare immunosuppressed HBV-Tg, HBV-Tg were injected with FK-506, an immunosuppressive agent, once daily, intraperitoneally for 15 days. Spleen cells of immunosuppressed HBV-Tg expressed very little mRNAs for interleukin-2 and interferon-gamma. DCs were isolated from the spleen of immunosuppressed HBV-Tg and cultured with HBsAg (100 microg) for 48 h to prepare HBsAg-pulsed DCs. Immunosuppressed HBV-Tg expressing HBsAg in the sera were administered with HBsAg-pulsed DCs or unpulsed DCs or HBsAg in adjuvant for different durations. Immunosuppressed HBV-Tg (n = 8) twice administered with HBsAg-pulsed DCs expressed anti-HBs in the sera within 6 weeks of first injection. Seven of eight immunosuppressed HBV-Tg remained positive for anti-HBs in the sera for the next 12 weeks of observation in spite of receiving daily injection of FK-506 for the entire duration. However, immunosuppressed HBV-Tg administered with unpulsed DCs or HBsAg in adjuvant did not express anti-HBs in the sera. The data show that DCs from immunosuppressed HBV-Tg can be loaded with HBsAg to prepare immunogenic HBsAg-pulsed DCs. HBsAg-pulsed DCs induced anti-HBs in immunosuppressed HBV-Tg. This approach may be of use to induce and maintain anti-HBs in immunosuppressed human HBV carriers.
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Affiliation(s)
- Shinya Furukawa
- Third Department of Internal Medicine, Ehime University, School of Medicine, Shigenobu-Cho, Onsen-Gun, Ehime 791-0295, Japan
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41
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Akbar SMF, Furukawa S, Hasebe A, Horiike N, Michitaka K, Onji M. Production and efficacy of a dendritic cell-based therapeutic vaccine for murine chronic hepatitis B virus carrierer. Int J Mol Med 2005. [PMID: 15254781 DOI: 10.3892/ijmm.14.2.295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Recently a new field of immunological research and clinical application of vaccines for therapeutic purposes (vaccine therapy) has been developed for treating several chronic viral infections including chronic hepatitis B virus (HBV) infection. Administration of vaccine containing hepatitis B surface antigen (HBsAg) for 1 year has resulted in negative HBsAg and development of antibody to HBsAg (anti-HBs) in some, but not in all, HBV transgenic mouse (HBV-Tg). In order to develop more potent regimen of vaccine therapy for chronic HBV carrier, we prepared a dendritic cell (DC)-based therapeutic vaccine and evaluated their therapeutic potential in HBV-Tg. DCs were isolated from single cell suspensions of murine spleen cells by collagenase digestion, density centrifugation and depletion of lymphocytes. Spleen DCs were cultured with HBsAg (100 microg) for 24 h to produce HBsAg-pulsed DCs. HBV-Tg expressing HBsAg and HBV DNA in the sera were randomly assigned to receive either HBsAg-pulsed DCs (n = 20) or unpulsed DC (n = 20) or vaccine containing HBsAg (n = 39) or complete Freund's adjuvant (n = 20) or left untreated (n = 20). Only two intraperitoneal injections of HBsAg-pulsed DCs resulted in negative HBsAg and production of anti-HBs in the sera in all HBV-Tg (n = 20). However, administration of un-pulsed DCs (n = 20) or vaccine containing HBsAg (n = 39) or only complete Freund's adjuvant did not induce negative HBsAg or production of anti-HBs in any HBV-Tg within 6 months of therapy commencement. Taken together, this study showed that HBsAg-pulsed DCs represent a highly potent therapeutic vaccine for chronic HBV infection and inspire optimism of using this vaccine in clinical conditions. A clinical trial of HBsAg-pulsed DC in patients with chronic hepatitis B is warranted.
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Affiliation(s)
- S M F Akbar
- Third Department of Internal Medicine, Ehime University School of Medicine, Ehime, Japan
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42
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Hiraoka A, Kurose K, Hamada M, Azemoto N, Tokumoto Y, Hirooka M, Hasebe A, Kumagi T, Hirata M, Michitaka K, Minami H, Murakami M, Isobe Y, Horiike N, Onji M. Hepatic encephalopathy due to intrahepatic portosystemic venous shunt successfully treated by interventional radiology. Intern Med 2005; 44:212-6. [PMID: 15805709 DOI: 10.2169/internalmedicine.44.212] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We treated a 66-year-old woman with hepatic encephalopathy secondarily induced by an intrahepatic portosystemic venous shunt (IPSVS). In serial observations, the volume of the liver became smaller and encephalopathy could not be controlled with conservative therapy. We occluded the IPSVS successfully using percutaneous transcatheter embolization with micro coils. Following embolization, encephalopathy disappeared and blood flow of all branches of portal vein improved. In cases with an IPSVS without liver cirrhosis, blood flow in the portal vein and liver volume must be followed carefully, and interventional radiology may be considered effective in those who do not show a satisfactory response to conservative therapy.
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Affiliation(s)
- Atsushi Hiraoka
- Third Department of Internal Medicine, Ehime University of Medicine, Toon, Ehime 791-0295
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43
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Hasebe A, Akbar SMF, Furukawa S, Horiike N, Onji M. Impaired functional capacities of liver dendritic cells from murine hepatitis B virus (HBV) carriers: relevance to low HBV-specific immune responses. Clin Exp Immunol 2005; 139:35-42. [PMID: 15606611 PMCID: PMC1809262 DOI: 10.1111/j.1365-2249.2005.02676.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The chronic hepatitis B virus (HBV) carrier exhibits ongoing replication of HBV and expresses abundant amounts of HBV-related antigens in the liver. However, HBV-specific immune responses are either absent or narrowly focused in these subjects. With the postulation that impaired functional abilities of liver dendritic cells (DCs) might be responsible for this, we assessed the functions of liver DCs in HBV transgenic mice (HBV-TM), an animal model of the HBV carrier state. Liver DCs were isolated from normal C57BL/6 mice and HBV-TM without the use of cytokines or growth factors. Lymphoproliferative assays were conducted to evaluate the ability of liver DCs to induce the proliferation of allogenic T lymphocytes and hepatitis B surface antigen (HBsAg)-enriched T lymphocytes. Liver DCs were stimulated with viral and bacterial products to assess their cytokine-producing capacities. In comparison to liver DCs from normal C57BL/6 mice, liver DCs from HBV-TM exhibited significantly decreased T cell proliferation-inducing capacities in allogenic mixed leucocyte reaction (P <0.05) and HBsAg-enriched T lymphocytes proliferation assays (P <0.05). Liver DCs from HBV-TM produced significantly lower levels of interleukin-12p70, tumour necrosis factor-alpha, interferon-gamma, and interleukin-6 (P <0.05) compared to liver DCs from normal C57BL/6 mice. This study provides evidence that liver DCs from HBV-TM had impaired ability to induce both innate and adaptive immune responses. This might account for a weak and almost undetectable HBV-specific immune response in chronic HBV carriers. This inspires hope that up-regulation of the functions of liver DCs in situ may have therapeutic implications in chronic HBV carriers.
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Affiliation(s)
- A Hasebe
- Third Department of Internal Medicine, Ehime University School of Medicine, Japan
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44
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Kumagi T, Horiike N, Michitaka K, Hasebe A, Kawai K, Tokumoto Y, Nakanishi S, Furukawa S, Hiasa Y, Matsui H, Kurose K, Matsuura B, Onji M. Recent clinical features of Wilson's disease with hepatic presentation. J Gastroenterol 2004; 39:1165-9. [PMID: 15622480 DOI: 10.1007/s00535-004-1466-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Accepted: 05/10/2004] [Indexed: 02/04/2023]
Abstract
BACKGROUND We carried out this study to evaluate recent clinical features of Wilson's disease (WD) with hepatic presentation, especially in terms of age, degree of liver injury, and association with hepatocellular carcinoma (HCC). METHODS Sixteen patients with hepatic manifestations were diagnosed with WD in the period 1976-2003. We divided this period into two periods, "past" and "recent". The diagnosis was based on the presence of Kayser-Fleisher rings, low serum copper levels, low serum ceruloplasmin levels, increased urinary copper concentrations before or after D-penicillamine challenge, and increased hepatic copper concentrations. This retrospective study was done at Ehime University Hospital. RESULTS Four patients, including a pair of siblings, had a family history of WD. Four patients had parental consanguinity. There were 6 patients aged over 40 years in the recent period, whereas no patients in the past period were over 40. Four patients had neurological manifestations. Ten patients had liver cirrhosis and 5 had chronic hepatitis. Two had fatty liver without obesity. All patients in the past period had liver cirrhosis. Three patients with liver cirrhosis were found to have HCC during the follow up. All patients were treated with either D-penicillamine or trientine chloride, or both. However, four patients had to discontinue these agents due to the side effects. CONCLUSIONS Recently, the number of patients diagnosed with WD has been increasing, not only in terms of those with classical-type WD but also in terms of elderly patients or patients with non-cirrhotic liver injury such as fatty liver and chronic hepatitis. The various clinical features of WD should be recognized and particular attention should focus on HCC as a complication.
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Affiliation(s)
- Teru Kumagi
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu, Ehime, 791-0295, Japan
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45
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Furukawa S, Akbar SMF, Hasebe A, Horiike N, Onji M. Induction and maintenance of anti-HBs in immunosuppressed murine hepatitis B virus carriers by a novel vaccination approach: implications for use in hepatitis B virus-infected subjects with liver transplantation. J Gastroenterol 2004; 39:851-8. [PMID: 15565404 DOI: 10.1007/s00535-004-1401-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Accepted: 02/13/2004] [Indexed: 02/04/2023]
Abstract
BACKGROUND One of the major problems with orthotopic liver transplantation (OLT) in patients with endstage liver diseases due to hepatitis B virus (HBV) is to maintain sustained high levels of antibody to hepatitis B surface antigen (anti-HBs) to block reactivation of HBV infection and allograft rejection. The aim of this study was to induce anti-HBs by a unique vaccination protocol, using hepatitis B surface antigen (HBsAg)-pulsed dendritic cells (DCs) in immunosuppressed murine HBV carriers. METHODS Immunosuppressed murine HBV carriers were produced by injecting FK-506 (2 mg/kg), intraperitoneally, daily for 15 days in HBV-transgenic mice (Tg) expressing HBV-related mRNAs and proteins. HBsAg-pulsed DCs were prepared by culturing murine spleen DCs with HBsAg (100 microg) for 24 h. HBsAg-pulsed DCs were injected twice, at an interval of 2 weeks, to immunosuppressed HBV-Tg and the levels of anti-HBs were measured periodically for 4 months. RESULTS Injection with FK-506 resulted in the production of immunosuppressed HBV-Tg, as evident by their low production of cytokine mRNAs and proteins. Two injections of HBsAg-pulsed DCs from immunosuppressed HBV-Tg induced anti-HBs in all immunosuppressed HBV-Tg within 4-8 weeks after the second injection. More than 10 IU/l of anti-HBs was detected in the sera in all but one immunosuppressed HBV-Tg for more than 4 months, although all immunosuppressed HBV-Tg were continuously provided with FK-506 on a daily basis for the entire duration of the study. CONCLUSIONS The capacity of HBsAg-pulsed DCs to induce anti-HBs in immunosuppressed HBV-Tg inspires optimism for the possible use of this therapeutic regimen for HBV-infected OLT patients.
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Affiliation(s)
- Shinya Furukawa
- Third Department of Internal Medicine, Ehime University School of Medicine, 791-0295 Ehime, Shigenobu-Cho, Onsen-Gun, Japan
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46
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Akbar SMF, Furukawa S, Hasebe A, Horiike N, Michitaka K, Onji M. Production and efficacy of a dendritic cell-based therapeutic vaccine for murine chronic hepatitis B virus carrierer. Int J Mol Med 2004; 14:295-9. [PMID: 15254781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Recently a new field of immunological research and clinical application of vaccines for therapeutic purposes (vaccine therapy) has been developed for treating several chronic viral infections including chronic hepatitis B virus (HBV) infection. Administration of vaccine containing hepatitis B surface antigen (HBsAg) for 1 year has resulted in negative HBsAg and development of antibody to HBsAg (anti-HBs) in some, but not in all, HBV transgenic mouse (HBV-Tg). In order to develop more potent regimen of vaccine therapy for chronic HBV carrier, we prepared a dendritic cell (DC)-based therapeutic vaccine and evaluated their therapeutic potential in HBV-Tg. DCs were isolated from single cell suspensions of murine spleen cells by collagenase digestion, density centrifugation and depletion of lymphocytes. Spleen DCs were cultured with HBsAg (100 microg) for 24 h to produce HBsAg-pulsed DCs. HBV-Tg expressing HBsAg and HBV DNA in the sera were randomly assigned to receive either HBsAg-pulsed DCs (n = 20) or unpulsed DC (n = 20) or vaccine containing HBsAg (n = 39) or complete Freund's adjuvant (n = 20) or left untreated (n = 20). Only two intraperitoneal injections of HBsAg-pulsed DCs resulted in negative HBsAg and production of anti-HBs in the sera in all HBV-Tg (n = 20). However, administration of un-pulsed DCs (n = 20) or vaccine containing HBsAg (n = 39) or only complete Freund's adjuvant did not induce negative HBsAg or production of anti-HBs in any HBV-Tg within 6 months of therapy commencement. Taken together, this study showed that HBsAg-pulsed DCs represent a highly potent therapeutic vaccine for chronic HBV infection and inspire optimism of using this vaccine in clinical conditions. A clinical trial of HBsAg-pulsed DC in patients with chronic hepatitis B is warranted.
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Affiliation(s)
- S M F Akbar
- Third Department of Internal Medicine, Ehime University School of Medicine, Ehime, Japan
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47
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Abe M, Akbar F, Hasebe A, Horiike N, Onji M. Glycyrrhizin enhances interleukin-10 production by liver dendritic cells in mice with hepatitis. J Gastroenterol 2004; 38:962-7. [PMID: 14614603 DOI: 10.1007/s00535-003-1179-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2002] [Accepted: 04/04/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND Glycyrrhizin (GL), an aqueous extract of licorice root, is known to have various immune-modulating and biological response-modifier activities. GL is used in patients with hepatitis to reduce the activity of liver inflammation; however, the mechanism underlying the anti-inflammatory activity of GL is poorly understood. As antigen-presenting dendritic cells (DC) in the tissue play a major role in the regulation of the inflammatory mucosal milieu during tissue inflammation, we studied whether the function of liver DC was altered by GL therapy in a murine model of concanavalin-A (con A)-induced hepatitis. METHODS Liver DC were propagated from control mice or mice with Con-A-induced hepatitis, and the effect of GL on liver DC was evaluated in vivo and in vitro. RESULTS The levels of interleukin (IL)-10 produced by liver DC were significantly lower in mice with Con-A-induced hepatitis compared with control mice. However, treatment with GL caused increased production of IL-10 in mice with Con A-induced hepatitis. The increased production of IL-10 by mice with Con A-induced hepatitis was also confirmed in vitro by culturing liver DC with GL. CONCLUSIONS This study indicates that increased production of IL-10 by liver DC due to GL administration may be involved in downregulation of the levels of liver inflammation in mice with Con A-induced hepatitis. Glycyrrhizin (GL), an aqueous extract of licorice root, is known to have various immune-modulating and biological response-modifier activities. GL is used in patients with hepatitis to reduce the activity of liver inflammation; however, the mechanism underlying the anti-inflammatory activity of GL is poorly understood. As antigen-presenting dendritic cells (DC) in the tissue play a major role in the regulation of the inflammatory mucosal milieu during tissue inflammation, we studied whether the function of liver DC was altered by GL therapy in a murine model of concanavalin-A (Con A)-induced hepatitis.
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Affiliation(s)
- Masanori Abe
- Third Department of Internal Medicine, Ehime University School of Medicine, 791-0295, Ehime, Shigenobu-cho, Japan
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48
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Arima S, Michitaka K, Horiike N, Kawai K, Matsubara H, Nakanishi S, Abe M, Hasebe A, Tokumoto Y, Yamamoto K, Onji M. Change of acute hepatitis B transmission routes in Japan. J Gastroenterol 2004; 38:772-5. [PMID: 14505132 DOI: 10.1007/s00535-003-1144-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 04/04/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many years have passed since various prophylactic policies for preventing hepatitis B virus (HBV) transmission were begun. We studied the chronological alterations in HBV infectious routes in patients with acute hepatitis B in the past 27 years. METHODS Seventy-two patients with acute HBV infection who were admitted to our hospital during the period 1976 to 2002 were enrolled in this study. This study was divided into two periods (first period, 1976-1990; and second period, 1991-2002), and the HBV infectious routes were studied. RESULTS Infectious routes have been changing. Posttransfusion hepatitis was seen only in the first period. In the second period, sexual transmission was the major infectious route (68%), followed by infection at a medical facility or occupational exposure such as needlestick injury (8%). CONCLUSIONS Transmission from sexual contact has become the main infectious route of HBV in Japan.
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Affiliation(s)
- Shouko Arima
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu-cho, Onsen-gun, Ehime 791-0295, Japan
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49
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Hasebe A, Shibata K, Watanabe T. A 4.1-kilodalton polypeptide in the cultural supernatant of Mycoplasma fermentans is one of the substances responsible for induction of interleukin-6 production by human gingival fibroblasts. Infect Immun 2001; 69:7173-7. [PMID: 11598097 PMCID: PMC100118 DOI: 10.1128/iai.69.11.7173-7177.2001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The cultural supernatant of Mycoplasma fermentans induced interleukin-6 production by human gingival fibroblasts. The active entities were divided into hydrophilic and hydrophobic substances. In this study, we purified a 4.1-kilodalton polypeptide from the hydrophilic substances. It reacted with polyclonal antibodies to M. fermentans and activated human macrophages.
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Affiliation(s)
- A Hasebe
- Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, Nishi 7, Kita 13, Kita-ku, Sapporo 060-8586, Japan.
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50
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Ochiai H, Inoue Y, Hasebe A, Kaku H. Construction and characterization of a Xanthomonas oryzae pv. oryzae bacterial artificial chromosome library. FEMS Microbiol Lett 2001; 200:59-65. [PMID: 11410350 DOI: 10.1111/j.1574-6968.2001.tb10693.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Xanthomonas oryzae pv. oryzae is an important plant pathogen which causes bacterial blight of rice. To facilitate genome studies of this bacterium, we have constructed a bacterial artificial chromosome (BAC) library of strain MAFF 311018. It consisted of 750 clones representing 16 genome equivalents, and had an insert size ranging from 20 to 220 kb with an average size of 107 kb. This library is the first to be constructed from a X. oryzae pv. oryzae strain. The usefulness of this library was demonstrated through polymerase chain reaction screening of 11 genes and the 16S--23S rDNA spacer region in a 192-clone subset, representing five genome equivalents. The results obtained showed an average of 5.9 BAC clones per screening. This result is in good agreement with the estimated size of the test library, indicating that the constructed BAC library can be used to facilitate genome analysis of X. oryzae pv. oryzae.
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Affiliation(s)
- H Ochiai
- Department of Genetic Resources, National Institute of Agrobiological Sciences, Kannondai, Tsukuba 305-8602, Japan.
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