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1Complete laparoscopic resection of the rectum using natural orifice specimen extraction显示文摘AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction(NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.METHODS: Twenty patients who underwent complete laparoscopic anterior resection with NOSE and 50 patients who underwent laparoscopic assisted anterior resection by the conventional method between 2011 and 2012 were studied. Selection for complete laparoscopic anterior resection with NOSE was decided on the basis of tumor size, localization of the tumor, and body mass index. Outcomes related to surgery, including operation time, postoperative wound pain, hospital stay after surgery, the number of totally dissected lymph nodes, postoperative complications(suture failure and wound infection), and anal function, were reviewed retrospectively. Anal function was assessed at 3 and 6 mo after surgery using the Wexner fecal incontinence scoring system.RESULTS: Complete laparoscopic resection with NOSE was performed to completion in all 20 patients. There was no patient emergency that required conversion to conventional laparoscopic surgery or open surgery. The comparison between complete laparoscopic resection with NOSE and conventional laparoscopic surgery showed no significant differences in the maximal diameter of the tumor, number of totally dissected lymph nodes, bleeding volume, mean operation time, time to start of oral ingestion, postoperative hospital stay, and postoperative complications. On the other hand, with regard to pain after epidural anesthesia, the total usage of analgesia in this novel surgical technique was 1.85 ± 1.8 times, whereas it was 5.89 ± 2.86 in conventional laparoscopic surgery(P < 0.001). The postoperative pain period was 1.9 ± 1.9 d in this novel surgical technique, whereas it was 3.43 ± 1.41 d in conventional laparoscopic surgery(P < 0.004). In complete laparoscopic surgery with NOSE, the mean postoperative follow-up period was 20 mo(range: 12-30 mo). Neither local recurrence nor remote metastasis was observed during the follow-up period.CONCLUSION: Complete laparoscopic anterior resection using NOSE does not require any incision and has excellent cosmetic properties, with mitigated postoperative pain.Masayuki Hisada Kenji Katsumata Tetsuo Ishizaki Masanobu Enomoto Takaaki Matsudo Kazuhiko Kasuya Akihiko Tsuchida 2014World Journal of Gastroenterology2014,20,44:45
2Pancreatic neuroendocrine tumor and solid-pseudopapillary neoplasm: Key immunohistochemical profiles for differential diagnosis显示文摘AIM To reveal better diagnostic markers for differentiating neuroendocrine tumor(NET) from solid-pseudopapillary neoplasm(SPN), focusing primarily on immunohistochemical analysis.METHODS We reviewed 30 pancreatic surgical specimens of NET(24 cases) and SPN(6 cases). We carried out comprehensive immunohistochemical profiling using 9 markers: Synaptophysin, chromogranin A, pancytokeratin, E-cadherin, progesterone receptor,vimentin, α-1-antitrypsin, CD10, and β-catenin.RESULTS E-cadherin staining in NETs, and nuclear labeling of β-catenin in SPNs were the most sensitive and specific markers. Dot-like staining of chromogranin A might indicate the possibility of SPNs rather than NETs. The other six markers were not useful because their expression overlapped widely between NETs and SPNs. Moreover, two cases that had been initially diagnosed as NETs on the basis of their morphological features, demonstrated SPN-like immunohistochemical profiles. Careful diagnosis is crucial as we actually found two confusing cases showing disagreement between the tumor morphology and immunohistochemical profiles.CONCLUSION E-cadherin, chromogranin A, and β-catenin were the most useful markers which should be employed for differentiating between NET and SPN.Yusuke Ohara Tatsuya Oda Shinji Hashimoto Yoshimasa Akashi Ryoichi Miyamoto Tsuyoshi Enomoto Kaishi Satomi Yukio Morishita Nobuhiro Ohkohchi 2016World Journal of Gastroenterology2016,22,38:19
3Noninvasive assessment of liver fibrosis in patients with chronic hepatitis B显示文摘Infection with hepatitis B virus is an important healthproblem worldwide:it affects more than 350 millionpeople and is a leading cause of liver-related morbidity,accounting for 1 million deaths annually.Hepatic fibrosis is a consequence of the accumulation of extracellular matrix components in the liver.An accurate diagnosis of liver fibrosis is essential for the management of chronic liver disease.Liver biopsy has been considered the gold standard for diagnosing disease,grading necroinflammatory activity,and staging fibrosis.However,liver biopsy is unsuitable for repeated evaluations because it is invasive and can cause major complications,including death.Several noninvasive evaluations have been introduced for the assessment of liver fibrosis:serum biomarkers,combined indices or scores,and imaging techniques including transient elastography,acoustic radiation force impulse,real-time tissue elastography,and magnetic resonance elastography.Here,we review the recent progress of noninvasive assessment of liver fibrosis in patients with chronic hepatitis B.Most noninvasive evaluations for liver fibrosis have been validated first in patients with chronic hepatitis C,and later in those with chronic hepatitis B.The establishment of a noninvasive assessment of liver fibrosis is urgently needed to aid in the management of this leading cause of chronic liver disease.Masaru Enomoto Hiroyasu Morikawa Akihiro Tamori Norifumi Kawada 2014World Journal of Gastroenterology2014,20,34:16
4流血和与内视镜的 submucosal 解剖联系的人工的胃的溃疡的管理显示文摘 Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharma-cotherapy during the healing process are essential.Yosuke Muraki Shotaro Enomoto Mikitaka Iguchi Mitsuhiro Fujishiro Naohisa Yahagi Masao Ichinose 2012World Journal of Gastrointestinal Endoscopy2012,4,1:14
5Liver fibrosis markers of nonalcoholic steatohepatitis显示文摘Nonalcoholic fatty liver disease(NAFLD) is one of themajor causes of chronic liver injury. NAFLD includes a wide range of clinical conditions from simple steatosis to nonalcoholic steatohepatitis(NASH), advanced fibrosis, and liver cirrhosis. The histological findings of NASH indicate hepatic steatosis and inflammation with characteristic hepatocyte injury(e.g., ballooning degeneration), as is observed in the patients with alcoholic liver disease. NASH is considered to be a potentially health-threatening disease that can progress to cirrhosis. A liver biopsy remains the most reliable diagnostic method to appropriately diagnose NASH, evaluate the severity of liver fibrosis, and determine the prognosis and optimal treatment. However, this invasive technique is associated with several limitations in routine use, and a number of biomarkers have been developed in order to predict the degree of liver fibrosis. In the present article, we review the current status of noninvasive biomarkers available to estimate liver fibrosis in the patients with NASH. We also discuss our recent findings on the use of the glycated albuminto-glycated hemoglobin ratio, which is a new index that correlates to various chronic liver diseases, including NASH.Hirayuki Enomoto Yukihiro Bando Hideji Nakamura Shuhei Nishiguchi Masafumi Koga 2015World Journal of Gastroenterology2015,21,24:12
6Nutritional status in relation to lifestyle in patients with compensated viral cirrhosis显示文摘AIM:To assess the nourishment status and lifestyle of non-hospitalized patients with compensated cirrhosis by using noninvasive methods.METHODS:The subjects for this study consisted of 27 healthy volunteers,59 patients with chronic viral hepatitis,and 74 patients with viral cirrhosis,from urban areas.We assessed the biochemical blood tests,anthropometric parameters,diet,lifestyle and physical activity of the patients.A homeostasis model assessment-insulin resistance(HOMA-IR) value of ≥ 2.5 was considered to indicate insulin resistance.We measured height,weight,waist circumference,arm circumference,triceps skin-fold thickness,and handgrip strength,and calculated body mass index,arm muscle circumference(AMC),and arm muscle area(AMA).We interviewed the subjects about their dietary habits and lifestyle using health assessment computer software.We surveyed daily physical activity using a pedometer.Univariate and multivariate logistic regression modeling were used to identify the relevant factors for insulin resistance.RESULTS:The rate of patients with HOMA-IR ≥ 2.5(which was considered to indicate insulin resistance) was 14(35.9%) in the chronic hepatitis and 17(37.8%) in the cirrhotic patients.AMC(%)(control vs chronic hepatitis,111.9% ± 10.5% vs 104.9% ± 10.7%,P = 0.021;control vs cirrhosis,111.9% ± 10.5% vs 102.7% ± 10.8%,P = 0.001) and AMA(%)(control vs chronic hepatitis,128.2% ± 25.1% vs 112.2% ± 22.9%,P = 0.013;control vs cirrhosis,128.2% ± 25.1% vs 107.5% ± 22.5%,P = 0.001) in patients with chronic hepatitis and liver cirrhosis were significantly lower than in the control subjects.Handgrip strength(%) in the cirrhosis group was significantly lower than in the controls(control vs cirrhosis,92.1% ± 16.2% vs 66.9% ± 17.6%,P < 0.001).The results might reflect a decrease in muscle mass.The total nutrition intake and amounts of carbohydrates,protein and fat were not significantly different amongst the groups.Physical activity levels(kcal/d)(control vs cirrhosis,210 ± 113 kcal/d vs 125 ± 74 kcal/d,P = 0.001),number of steps(step/d)(control vs cirrhosis,8070 ±3027 step/d vs 5789 ± 3368 step/d,P = 0.011),and exercise(Ex)(Ex/wk)(control vs cirrhosis,12.4 ± 9.3 Ex/wk vs 7.0 ± 7.7 Ex/wk,P = 0.013) in the cirrhosis group was significantly lower than the control group.The results indicate that the physical activity level of the chronic hepatitis and cirrhosis groups were low.Univariate and multivariate logistic regression modeling suggested that Ex was associated with insulin resistance(odds ratio,6.809;95% CI,1.288-36.001;P = 0.024).The results seem to point towards decreased physical activity being a relevant factor for insulin resistance.CONCLUSION:Non-hospitalized cirrhotic patients may need to maintain an adequate dietary intake and receive lifestyle guidance to increase their physical activity levels.Fumikazu Hayashi Chika Momoki Miho Yuikawa Yuko Simotani Etsushi Kawamura Atsushi Hagihara Hideki Fujii Sawako Kobayashi Shuji Iwai Hiroyasu Morikawa Masaru Enomoto Akihiro Tamori Norifumi Kawada Satoko Ohfuji Wakaba Fukusima Daiki Habu 2012World Journal of Gastroenterology2012,18,40:11
7Effects of lysedEnterococcus faecalis FK-23 on experimental allergic rhinitis in a murine model显示文摘In the current study,we sought to investigate whether lysed Enterococcus faecalis FK-23(LFK),a heat-killed probiotic preparation,attenuated eosinophil influx into the upper airway and had immunomodulatory activity in a murine allergic rhinitis model.Eighteen BALB/c mice were divided into three groups;the ovalbumin(OVA)-sensitized/challenged group,which received saline orally for 6 weeks(OVA group),the OVA-sensitized/challenged group,which received LFK orally for 6 weeks(LFK-fed group),and the non-sensitized group,which received saline for 6 weeks(saline control group).Nasal rubbing and sneezing were monitored during the study.After the final challenge,interleukin(IL)-4,interferon(IFN)-γ,and OVA-specific IgE levels in the sera and splenocyte culture supernatants were determined,eosinophilic infiltrate into the upper airway was quantified,and splenic CD4+CD25+ regulatory T cells(Tregs) were examined by flow cytometry.We found that nasal rubbing was significantly reduced in LFK-fed mice compared to the OVA group on d 27 and 35,and sneezing was significantly inhibited by LFK administration for 35 d.LFK-fed mice had significantly less eosinophil influx into the nasal mucosa than the OVA group.There were no significant differences between the LFK-fed group and OVA group in the serum and splenocyte culture supernatant levels of IL-4,IFN-γ,and OVA-specific IgE.Interestingly,the LFK-fed mice had a significantly greater percentage of splenic CD4+CD25+ Tregs than OVA group.Our results indicate that oral administration of LFK may alleviate nasal symptoms,reduce nasal eosinophilia,and increase the percentage of CD4+CD25+ Tregs in experimental allergic rhinitis.Luping Zhu Takashi Shimada Ruoxi Chen Meiping Lu Qingzhao Zhang Wenmin Lu Min Yin Tadao Enomoto Lei Cheng 2012The Journal of Biomedical Research2012,26,3:11
8Hepatitis B virus infection and alcohol consumption显示文摘Hepatocellular carcinoma(HCC) is the most common type of primary liver cancer, and the second most common cause of cancer deaths worldwide. The top three causes of HCC are hepatitis B virus(HBV),hepatitis C virus(HCV), and alcoholic liver disease. Owing to recent advances in direct-acting antiviral agents, HCV can now be eradicated in almost all patients. HBV infection and alcoholic liver disease are expected, therefore, to become the leading causes of HCC in the future. However, the association between alcohol consumption and chronic hepatitis B in the progression of liver disease is less well understood than with chronic hepatitis C. The mechanisms underlying the complex interaction between HBV and alcohol are not fully understood, and enhanced viral replication, increased oxidative stress and a weakened immune response could each play an important role in the development of HCC. It remains controversial whether HBV and alcohol synergistically increase the incidence of HCC. Herein, we review the currently available literature regarding the interaction of HBV infection and alcohol consumption on disease progression.ayako iida-ueno masaru enomoto akihiro tamori norifumi kawada 2017World Journal of Gastroenterology2017,23,15:11
9Elevation of the glycated albumin to glycated hemoglobin ratio during the progression of hepatitis C virus related liver fibrosis显示文摘AIM: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.METHODS: The study retrospectively included consecutive hepatitis C virus positive chronic liver disease patients (n = 142) who had undergone percutaneous liver biopsy between January 2008 and March 2010 at our institution. The ratios of GA/HbA1c were calculated in all patients to investigate the relationship with the degree of the liver fibrosis. The values of the aspartate aminotransferase-to-platelet ratio index (APRI), an excellent marker for the evaluation of liver fibrosis, were also calculated. In addition, we combined the ratio of GA/HbA1c and the APRI in order to improve our ability to detect the presence of significant liver fibrosis. RESULTS: Sixty-one (43%) patients had either no fibrosis or minimal fibrosis (METAVIR score: F0-F1), while 25 (17%) had intermediate fibrosis (F2). Fifty-six (39%) patients had severe fibrosis (F3-F4) and 27 of them had cirrhosis (F4). The mean values of the GA/HbA1c increased with the progression of the fibrosis (F0-1: 2.83 ± 0.24, F2: 2.85 ± 0.24, F3: 2.92 ± 0.35, F4: 3.14 ± 0.54). There was a significant dif- ference between the F0-F1 vs F4, F2 vs F4, and F3 vs F4 groups (P < 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). The GA/HbA1c ratio was significantly higher in the patients with cirrhosis (F4) than in those without cirrhosis (F0-F3) (3.14 ± 0.54 vs 2.85 ± 0.28, P < 0.0001). The GA/HbA1c ratio was also significantly higher in the patients with severe fibrosis (F3-F4) than in those without severe liver fibrosis (F0-F2) (3.03 ± 0.41 vs 2.84 ± 0.24, P < 0.001). Furthermore, the GA/ HbA1c ratio was also significantly higher in the patients with significant fibrosis (F2-F4) than in those without significant liver fibrosis (F0-F1) (2.98 ± 0.41 vs 2.83 ± 0.24, P < 0.001). The diagnostic performance of the increased GA/HbA1c ratio (> 3.0) was as follows: its sensitivity and specificity for the detection of liver cirrhosis (F4) were 59.3% and 70.4%, respectively and its sensitivity and specificity for the detection of severe liver fibrosis (F3-F4) were 50.0% and 74.4%,respectively. With regard to the detection of significant fibrosis (F2-F4), its sensitivity was 44.4% and its specificity was 77.0%. Although even the excellent marker APRI shows low sensitivity (25.9%) for distinguishing patients with or without significant fibrosis, the combination of the APRI and GA/HbA1c ratio increased the sensitivity up to 42.0%, with only a modest decrease in the specificity (from 90.2% to 83.6%). CONCLUSION: The GA/HbA1c ratio increased in line with the histological severity of liver fibrosis, thus suggesting that this ratio is useful as a supportive index of liver fibrosis.Nobuhiro Aizawa Hirayuki Enomoto Hiroyasu Imanishi Masaki Saito Yoshinori Iwata Hironori Tanaka Naoto Ikeda Yoshiyuki Sakai Tomoyuki Takashima Takashi Iwai Ei-ichiro Moriwaki Soji Shimomura Hiroko Iijima Hideji Nakamura Shuhei Nishiguchi 2012World Journal of Hepatology2012,4,1:10
10Novel risk markers for gastric cancer screening: Present status and future prospects显示文摘Initial identification of populations at high risk of gastric cancer (GC) is important for endoscopic screening of GC. As serum pepsinogen (PG) test-positive subjects with progression of chronic atrophic gastritis (CAG) show a high likelihood of future cancer development, this population warrants careful follow-up observation as a high-risk GC group. By combining the PG test with Helicobacter pylori (HP) antibody titers, the HP-related chronic gastritis stage can be classified, thus identifying not only a GC high-risk group but also a low-risk group. Among PG test-negative patients without CAG, those with high serum PG Ⅱ levels and HP antibody titers are thought to have severe gastric mucosal inflammation and the risk of diffuse-type GC is also high. Meanwhile, in gastric mucosae obtained by endoscopic biopsy, HP infection induces aberrant DNA methylation in CpG islands in multiple gene regions and the extent of methylation clearly correlates with GC risk. By quantifying aberrant DNA methylation in suitable gene markers, we can determine the extent of the epigenetic field for cancerization. These novel concepts and risk markers will have many clinical applications in gastrointestinal endoscopy, including more efficient endoscopic GC screening and a strategic approach to metachronous multiple GCs after endoscopic treatment.Shotaro Enomoto Takao Maekita Hiroshi Ohata Kimihiko Yanaoka Masashi Oka Masao Ichinose 2010World Journal of Gastrointestinal Endoscopy2010,2,12:10
11Stratifying the risk of lymph node metastasis in undifferentiated-type early gastric cancer显示文摘AIM:To study how lymph node metastasis(LNM) risk is stratified in undifferentiated-type early gastric cancer(undiff-EGC) dependent on combinations of risk factors.METHODS:Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined retrospectively.Using clinicopathological factors of patient age,location,size,an endoscopic macroscopic tumor form,ulceration,depth,histology,lymphatic involvement(LI) and venous involvement(VI),LNM risk was examined and stratified by conventional statistical analysis and datamining analysis.RESULTS:LNM was positive in 44 of 567 cases(7.8%).Univariate analysis revealed > 2 cm,protrusion,submucosal(sm),mixed type,LI and VI as significant prognostic factors and > 2 cm and LI-positive were independent factors by multivariate analysis.In preoperatively evaluable factors excluding LVI,sm and > 2 cm were independent factors.According to the depth and size,cases were categorized into the low-risk group [m and ≤ 2 cm,0%(LNM incidence)],the moderaterisk group(m and > 2 cm,5.6%; and sm and ≤ 2 cm,6.0%),and the high-risk group(sm and > 2 cm,19.3%).On the other hand,LNM occurred in 1.4% in all LI-negative cases,greatly lower than 28.2% in all LI-positive cases,and LNM incidence was low in LInegative cases even in the moderate- and high-risk groups.CONCLUSION:LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size postoperatively.Among these factors,LI was the most significantly correlated factor.Yukiko Asakawa Masahiko Ohtaka Shinya Maekawa Mitsuharu Fukasawa Yasuhiro Nakayama Tatsuya Yamaguchi Taisuke Inoue Tomoyoshi Uetake Minoru Sakamoto Tadashi Sato Yoshihiko Kawaguchi Hideki Fujii Kunio Mochizuki Masao Hada Toshio Oyama Tomotaka Yasumura Kosaku Omata Atsushi Nishiyama Keiichi Naito Hideo Hata Yoshiaki Haba Kazuyuki Miyata Haruhisa Saitoh Yoichi Yamadera Kazuo Miura Akira Kawaoi Tohru Abe Hajime Tsunoda Yuji Honda Masayuki Kurosaki Nobuyuki Enomoto 2015World Journal of Gastroenterology2015,21,9:8
12Excessive portal flow causes graft failure in extremely small-for-size liver transplantation in pigs显示文摘AIM: To evaluate the effects of a portocaval shunt on the decrease of excessive portal flow for the prevention of sinusoidal microcirculatory injury in extremely smallfor-size liver transplantation in pigs.METHODS: The right lateral lobe of pigs, i.e. the 25%of the liver, was transplanted orthotopically. The pigs were divided into two groups: graft without portocaval shunt (n = 11) and graft with portocaval shunt (n=11).Survival rate, portal flow, hepatic arterial flow, and histological findings were investigated.RESULTS: In the group without portocaval shunt, all pigs except one died of liver dysfunction within 24 h after transplantation. In the group with portocaval shunt,eight pigs survived for more than 4 d. The portal flow volumes before and after transplantation in the group without portocaval shunt were 118.2±26.9 mL/min/100 g liver tissue and 270.5±72.9 mL/min/100 g liver tissue,respectively. On the other hand, in the group with portocaval shunt, those volumes were 124.2±27.8 mL/min/100 g liver tissue and 42.7±32.3 mL/min/100 g liver tissue, respectively (P<0.01). As for histological findings in the group without portocaval shunt, destruction of the sinusoidal lining and bleeding in the peri-portal areas were observed after reperfusion, but these findings were not recognized in the group with portocaval shunt.CONCLUSION: These results suggest that excessive portal flow is attributed to post transplant liver dysfunction after extreme small-for-size liver transplantation caused by sinusoidal microcirculatory injury.Hong-Sheng Wang Nobuhiro Ohkohchi Yoshitaka Enomoto Masahiro Usuda Shigehito Miyagi Takeshi Asakura Hiroo Masuoka Takashi Aiso Keisuke Fukushima Tomohiro Narita Hideyuki Yamaya Atsushi Nakamura Satoshi Sekiguchi Naoki Kawagishi Akira Sato Susumu Satomi 2005World Journal of Gastroenterology2005,11,44:8
13The future of bone marrow stromal cell transplantation for the treatment of spinal cord injury显示文摘Bone marrow stromal cell(BMSC)transplantation therapy is a promising approach for treating spinal cord injury(SCI),based on a number of experimental and clinical reports(Wright et al.,2011).BMSCs are a source of neuroregenerative somatic stem cells that are without the potential for tumorigenicity.Although clinical studies of autologous BMSC transplantation have been reported inMitsuhiro Enomoto 2015Neural Regeneration Research2015,10,3:6
14Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry显示文摘AIM:To identify criteria for predicting successful drainage of unresectable malignant hilar biliary strictures(UMHBS) because no ideal strategy currently exists.METHODS:We examined 78 patients with UMHBS who underwent biliary drainage.Drainage was considered effective when the serum bilirubin level decreased by ≥ 50% from the value before stent placement within 2 wk after drainage, without additional intervention.Complications that occurred within 7 d after stent placement were considered as early complications.Before drainage, the liver volume of each section(lateral and medial sections of the left liver and anterior and posterior sections of the right liver) was measured using computed tomography(CT) volumetry.Drained liver volume was calculated based on the volume of each liver section and the type of bile duct stricture(according to the Bismuth classification).Tumor volume, which was calculated by using CT volumetry, was excluded from the volume of each section.Receiver operating characteristic(ROC) analysis was performed to identify the optimal cutoff values for drained liver volume.In addition, factors associated with the effectiveness of drainage and early complications were evaluated.RESULTS:Multivariate analysis showed that drained liver volume [odds ratio(OR) = 2.92, 95%CI:1.648-5.197; P < 0.001] and impaired liver function(with decompensated liver cirrhosis)(OR = 0.06, 95%CI:0.009-0.426; P = 0.005) were independent factors contributing to the effectiveness of drainage.ROC analysis for effective drainage showed cutoff values of 33% of liver volume for patients with preserved liver function(with normal liver or compensated livercirrhosis)and 50%for patients with impaired liver function(with decompensated liver cirrhosis).The sensitivity and specificity of these cutoff values were82%and 80%for preserved liver function,and 100%and 67%for impaired liver function,respectively.Among patients who met these criteria,the rate of effective drainage among those with preserved liver function and impaired liver function was 90%and 80%,respectively.The rates of effective drainage in both groups were significantly higher than in those who did not fulfill these criteria(P<0.001 and P=0.02,respectively).Drainage-associated cholangitis occurred in 9 patients(12%).A smaller drained liver volume was associated with drainage-associated cholangitis(P<0.01).CONCLUSION:Liver volume drainage≥33%in patients with preserved liver function and≥50%in patients with impaired liver function correlates with effective biliary drainage in UMHBS.Ei Takahashi Mitsuharu Fukasawa Tadashi Sato Shinichi Takano Makoto Kadokura Hiroko Shindo Yudai Yokota Nobuyuki Enomoto 2015World Journal of Gastroenterology2015,21,16:6
15The inverse association between tuberculin responses and atopic disorder显示文摘Shirakawa T Enomoto T Shimazu S 0,,:6
16Risk factors for perforation during endoscopic retrograde cholangiopancreatography in post-reconstruction intestinal tract显示文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy has been a major challenge to gastrointestinal endoscopists with low success rates for reaching the target site as well as high complication rates. The knowledge of ERCP-related risk factors is important for reducing unexpected complications.AIM To identify ERCP-related risk factors for perforation in patients with surgically altered anatomy.METHODS The medical records of 187 patients with surgically altered anatomy who underwent ERCP at our institution between April 2009 and December 2017 were retrospectively reviewed. An analysis of patient data, including age, sex, type of reconstruction, cause of surgery, aim of ERCP, success rate of reaching target site,success rate of procedure, adverse events, type of scope, time to reach the target site, and duration of procedure, was performed. In patients with Billroth-Ⅱ reconstruction, additional potential risk factors were the shape of the inserted scope and whether the anastomosis was antecolic or retrocolic.RESULTS All patients(n = 187) had surgical anatomy, such as Billroth-Ⅰ(n = 22), Billroth-Ⅱ(n = 33), Roux-en-Y(n = 54), Child, or Whipple reconstruction(n = 75). ERCP was performed for biliary drainage in 43 cases(23%), stone removal in 29 cases(16%),and stricture dilation of anastomosis in 59 cases(32%). The scope was unable to reach the target site in 17 cases(9%), and an aimed procedure could not be accomplished in 54 cases(29%). Adverse events were pancreatitis(3%),hyperamylasemia(10%), cholangitis(6%), cholestasis(4%), excessive sedation(1%), perforation(2%), and others(3%). Perforation occurred in three cases, all of which were in patients with Billroth-Ⅱ reconstruction; in these patients, further analysis revealed loop-shaped insertion of the scope to be a significant risk for perforation(P = 0.01).CONCLUSION Risk factors for perforation during ERCP in patients with surgically altered anatomy were Billroth-Ⅱ reconstruction and looping of the scope during BillrothⅡ procedure.Shinichi Takano Mitsuharu Fukasawa Hiroko Shindo Ei Takahashi Sumio Hirose Yoshimitsu Fukasawa Satoshi Kawakami Hiroshi Hayakawa Hiroshi Yokomichi Makoto Kadokura Tadashi Sato Nobuyuki Enomoto 2019World Journal of Clinical Cases2019,7,1:6
17Dual therapy with zinc acetate and rifaximin prevents from ethanolinduced liver fibrosis by maintaining intestinal barrier integrity显示文摘BACKGROUND Hepatic overload of gut-derived lipopolysaccharide dictates the progression of alcoholic liver disease(ALD)by inducing oxidative stress and activating Kupffer cells and hepatic stellate cells through toll-like receptor 4 signaling.Therefore,targeting the maintenance of intestinal barrier integrity has attracted attention for the treatment of ALD.Zinc acetate and rifaximin,which is a nonabsorbable antibiotic,had been clinically used for patients with cirrhosis,particularly those with hepatic encephalopathy,and had been known to improve intestinal barrier dysfunction.However,only few studies focused on their efficacies in preventing the ALD-related fibrosis development.AIM To investigate the effects of a combined zinc acetate with rifaximin on liver fibrosis in a mouse ALD model.METHODS To induce ALD-related liver fibrosis,female C57BL/6J mice were fed a 2.5%(v/v)ethanol-containing Lieber-DeCarli liquid diet and received intraperitoneal carbon tetrachloride(CCl4)injection twice weekly(1 mL/kg)for 8 wk.Zinc acetate(100 mg/L)and/or rifaximin(100 mg/L)were orally administered during experimental period.Hepatic steatosis,inflammation and fibrosis as well as intestinal barrier function were evaluated by histological and molecular analyses.Moreover,the direct effects of both agents on Caco-2 barrier function were assessed by in vitro assays.RESULTSIn the ethanol plus CCl4-treated mice,combination of zinc acetate and rifaximin attenuated oxidative lipid peroxidation with downregulation of Nox2 and Nox4.This combination significantly inhibited the Kupffer cells expansion and the proinflammatory response with blunted hepatic exposure of lipopolysaccharide and the toll-like receptor 4/nuclear factor kB pathway.Consequently,liver fibrosis and hepatic stellate cells activation were efficiently suppressed with downregulation of Mmp-2,-9,-13,and Timp1.Both agents improved the atrophic changes and permeability in the ileum,with restoration of tight junction proteins(TJPs)by decreasing the expressions of tumor necrosis factorαand myosin light chain kinase.In the in vitro assay,both agents directly reinforced ethanol or lipopolysaccharide-stimulated paracellular permeability and upregulated TJPs in Caco-2 cells.CONCLUSION Dual therapy with zinc acetate and rifaximin may serve as a strategy to prevent ALD-related fibrosis by maintaining intestinal barrier integrity.Yuki Fujimoto Kosuke Kaji Norihisa Nishimura Masahide Enomoto Koji Murata Soichi Takeda Hiroaki Takaya Hideto Kawaratani Kei Moriya Tadashi Namisaki Takemi Akahane Hitoshi Yoshiji 2021World Journal of Gastroenterology2021,27,48:4
18Rates of pharmacologic venous thromboembolism prophylaxis in hospitalized patients with active ulcerative colitis: Results from a tertiary care center显示文摘Andrew Tinsley Steven Naymagon Laura M. Enomoto Christopher S. Hollenbeak Bruce E. Sands Thomas A. Ullman 2013Journal of Crohn’s and Colitis2013,,:3
19Altered mucosal DNA methylation in parallel with highly active Helicobacter pylori -related gastritis显示文摘Takeichi Yoshida Jun Kato Takao Maekita Satoshi Yamashita Shotaro Enomoto Takayuki Ando Tohru Niwa Hisanobu Deguchi Kazuki Ueda Izumi Inoue Mikitaka Iguchi Hideyuki Tamai Toshikazu Ushijima Masao Ichinose 2013Gastric Cancer2013,,4:3
20Expression of 5-Lipoxygenase in human colorectal cancer显示文摘AIM: To evaluate the 5-lipoxygenases (Loxs) expression level in human colorectal cancer specimens in order to determine its clinicopathologic significance in human tumorigenesis. METHODS: The relative quantity of 5-Lox mRNA in paired 91 colorectal tumor and adjacent normal mucosa samples was determined by real time quantitative PCR. Additionally, the expression of 5-Lox and cyclooxygenase (Cox)-2 proteins was also examined using immunohistochemical staining methods. RESULTS: There was a marked increase in 5-Lox mRNA levels in the tumor compared with paired normal mucosa samples (P < 0.0001). Sixty six (72.5%) tumors showed high 5-Lox mRNA levels. The positivity rate of 5-Lox and Cox-2 protein expression was 68.7% and 79.1% respectively. There was a significant association between tumoral 5-Lox mRNA level and tumor size (Rho = 0.392, P = 0.0002), depth or vessel invasion. CONCLUSION: These results suggest that 5-Lox is up-regulated in colorectal cancer and that inhibition of its expression might be valuable in the prevention and treatment of colorectal cancer.Labile Togba Soumaoro Satoru Iida Hiroyuki Uetake Megumi Ishiguro Yoko Takagi Tetsuro Higuchi Masamichi Yasuno Masayuki Enomoto Kenichi Sugihara 2006World Journal of Gastroenterology2006,12,39:3
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