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Hasegawa N, Oka A, Awoniyi M, Yoshida Y, Tobita H, Ishimura N, Ishihara S. Dynamic ultrasonography for optimizing treatment position in superior mesenteric artery syndrome: Two case reports and review of literature. World J Gastroenterol 2024; 30:499-508. [PMID: 38414592 PMCID: PMC10895595 DOI: 10.3748/wjg.v30.i5.499] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta (SMA-Ao). Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome, individual variations in the optimal patient position have been noted. In this report, we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient. CASE SUMMARY Case 1: A 90-year-old man with nausea and vomiting. Following diagnosis of SMA syndrome by computed tomography (CT), ultrasonography (US) revealed the SMA-Ao distance in the supine position (4 mm), which slightly improved in the lateral position (5.7-7.0 mm) without the passage of duodenal contents. However, in the sitting position, the SMA-Ao distance was increased to 15 mm accompanied by improved content passage. Additionally, US indicated enhanced passage upon abdominal massage on the right side. By day 2, the patient could eat comfortably with the optimal position and massage. Case 2: An 87-year-old woman with vomiting. After the diagnosis of SMA syndrome and aspiration pneumonia by CT, dynamic US confirmed the optimal position (SMA-Ao distance was improved to 7 mm in forward-bent position, whereas it remained at 5 mm in the supine position). By day 7 when her pneumonia recovered, she could eat with the optimal position. CONCLUSION The optimal position for SMA syndrome varies among individuals. Dynamic US appears to be a valuable tool in improving patient outcomes.
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Affiliation(s)
- Nobuaki Hasegawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Muyiwa Awoniyi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Hepatology Section, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Yuri Yoshida
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, Izumo 693-8501, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Kishimoto K, Shibagaki K, Araki A, Murakami K, Takahashi Y, Kotani S, Oka A, Yazaki T, Fukuba N, Mishima Y, Oshima N, Kawashima K, Ishimura N, Kadota K, Ishihara S. Gastric Metastasis from Salivary Duct Carcinoma Mimicking Scirrhous Gastric Cancer. Intern Med 2024; 63:373-378. [PMID: 37344429 PMCID: PMC10901704 DOI: 10.2169/internalmedicine.1965-23] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
A 59-year-old man underwent submandibular gland excision for salivary duct carcinoma (SDC). One year later, esophagogastroduodenoscopy indicated gastric diffuse mucosal thickening with luminal contraction, mimicking scirrhous gastric carcinoma. Biopsy specimens showed dense proliferation of neoplastic cells expressing androgen receptor and human epidermal growth factor 2, indicating SDC. Gastric diffuse infiltrative metastasis is generally characteristic of gastric metastasis from invasive ductal carcinoma, which shows histologic features similar to SDC. This is the first known report of gastric diffusely infiltrating metastasis in an SDC patient. Rapidly progressing, diffuse gastric wall thickening should also be considered indicative of salivary tumor-associated gastric metastasis.
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Affiliation(s)
- Kenichi Kishimoto
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | | | - Asuka Araki
- Department of Pathology, Faculty of Medicine, Shimane University, Japan
| | - Kotaro Murakami
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Yusuke Takahashi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Satoshi Kotani
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Akihiko Oka
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Tomotaka Yazaki
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Nobuhiko Fukuba
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Yoshiyuki Mishima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Naoki Oshima
- Department of Endoscopy, Shimane University Hospital, Japan
| | - Kousaku Kawashima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
| | - Kyuichi Kadota
- Department of Pathology, Faculty of Medicine, Shimane University, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Japan
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Oka A, Kawashima K, Kishimoto K, Kotani S, Fukunaga M, Fukuba N, Mishima Y, Oshima N, Ishimura N, Awoniyi M, Ishihara S. Validation of rapid fecal calprotectin assay using particle enhanced turbidimetric immunoassay for inflammatory bowel disease. Sci Rep 2024; 14:1653. [PMID: 38238442 PMCID: PMC10796650 DOI: 10.1038/s41598-024-51580-z] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 01/07/2024] [Indexed: 01/22/2024] Open
Abstract
Fecal calprotectin (FC) is a promising biomarker for diagnosis and treatment of inflammatory bowel disease, ulcerative colitis (UC), and Crohn's disease. An enzyme immunoassay (EIA) is widely used for FC detection, though the considerable lag time, up to several days, causes clinical management delay. This study was performed to examine the new rapid kit fCAL-turbo, which is based on a particle-enhanced turbidimetric immunoassay (15 min), by comparing FC values with other EIAs (EliA, PhiCal, Bühlmann) and endoscopic scores. Using 94 samples, fCAL-turbo showed strong significant positive correlations with the other kits (Spearman's r = 0.9178-0.9886). Of 74 UC patients, 69 underwent an endoscopy and fCAL-turbo reflected endoscopic activity with a moderate correlation with Mayo endoscopic subscore (MES) (r = 0.6945, others r = 0.6682-0.7013). Receiver operating characteristic analyses based on MES 0 versus 1-3 showed a similar efficacy as compared to the other kits (cut-off and area under the curve: 89.70 µg/g and 0.8592, respectively, others 62.35-138.4 µg/g and 0.8280-0.8611, respectively). Furthermore, multiple regression analysis confirmed that fCAL-turbo results significantly contributed to prediction of MES 0 with a higher t-value as compared to the other biomarkers. fCAL-turbo showed strong correlations with the other kits and also demonstrated excellent performance for predicting endoscopic remission of UC.
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan.
- Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Shimane, Japan.
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane, Japan.
| | - Kenichi Kishimoto
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan
| | - Satoshi Kotani
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan
| | - Mai Fukunaga
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan
| | - Muyiwa Awoniyi
- Department of Inflammation and Immunity, Digestive Disease and Surgery Institute, Division of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Izumo, Shimane, 693-8501, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Shimane, Japan
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4
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Kotani S, Shibagaki K, Hirahara N, Hasegawa N, Tanabe R, Ebisutani Y, Nonomura S, Kishimoto K, Kodama Y, Takahashi Y, Kataoka M, Oka A, Fukuba N, Mishima Y, Oshima N, Kawashima K, Ishimura N, Araki A, Kadota K, Itawaki A, Nagasaki M, Miyaoka Y, Onuma H, Ishihara S. Clinicopathologic differences of gastric neoplasms between Helicobacter pylori-infected and -naïve patients: a multicenter retrospective analysis. J Gastroenterol 2024; 59:1-10. [PMID: 37855982 DOI: 10.1007/s00535-023-02050-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The incidence of gastric neoplasms in Helicobacter pylori (Hp)-naïve patients has recently increased due to a remarkable decrease in the Hp-infected population in Japan. We investigated the clinicopathologic differences between Hp-infected gastric neoplasms (HpIGNs) and Hp-naïve gastric neoplasms (HpNGNs) that have not been fully elucidated so far. METHODS This retrospective multicenter study investigated 966 consecutive patients with 1131 gastric dysplasia or cancers who underwent endoscopic or surgical treatment for the recent decade. Clinicopathologic features were compared between HpIGN and HpNGN cases. RESULTS One thousand and sixty-eight HpIGNs in 916 patients included 877 differentiated types and 191 undifferentiated types. Sixty-three HpNGNs in 50 patients included 57 differentiated types (35 foveolar types, 15 intestinal types, 6 fundic-gland types, and 1 other differentiated type) and 6 undifferentiated types. HpNGNs occurred in younger (59.5 vs. 71.8 years, p < 0.05) and female patients (40.0% vs. 26.5%, p < 0.05), were found more frequently in the proximal compartment (p < 0.05), and had smaller size (median 4.0 vs. 20.0 mm, p < 0.05). Histologically, HpNGNs and HpIGNs both primarily consisted of differentiated type (90.5% vs. 82.1%, p = 0.089) and HpNGNs showed lower prevalence of invasive cancer (11.1% vs. 37.6%, p < 0.05) and lymphovascular invasion (1.6% vs. 31.6%, p < 0.05). Nearly all HpNGNs (62/63, 98.4%) were diagnosed in early pathological stage, while 16.1% (172/1068) of HpIGNs were diagnosed in advanced stage (p < 0.05). CONCLUSIONS HpNGNs is recently on the increase but shows lower malignant nature regardless of histologic type than HpIGN. Endoscopic gastric cancer screening will be reviewed via cost effectiveness for Hp-naïve individuals in future.
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Affiliation(s)
- Satoshi Kotani
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kotaro Shibagaki
- Department of Endoscopy, Shimane University Hospital, 89-1 Enya, Izumo, 693-8501, Japan.
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Nobuaki Hasegawa
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Ryo Tanabe
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yuri Ebisutani
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Saya Nonomura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kenichi Kishimoto
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yasuhide Kodama
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yusuke Takahashi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Masatoshi Kataoka
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Akihiko Oka
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Nobuhiko Fukuba
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yoshiyuki Mishima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Naoki Oshima
- Department of Endoscopy, Shimane University Hospital, 89-1 Enya, Izumo, 693-8501, Japan
| | - Kousaku Kawashima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Asuka Araki
- Department of Pathology, Shimane University Hospital, Izumo, Japan
| | - Kyuichi Kadota
- Department of Pathology, Shimane University Hospital, Izumo, Japan
| | - Ayako Itawaki
- Department of Gastroenterology, National Hospital Organization Hamada Medical Center, Hamada, Japan
| | - Makoto Nagasaki
- Department of Pathology, National Hospital Organization Hamada Medical Center, Hamada, Japan
| | - Yoichi Miyaoka
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Hideyuki Onuma
- Department of Pathology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
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5
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Shibagaki K, Ishimura N, Kotani S, Fukuyama C, Takahashi Y, Kishimoto K, Yazaki T, Kataoka M, Omachi T, Kinoshita Y, Hasegawa N, Oka A, Mishima Y, Mishiro T, Oshima N, Kawashima K, Nagase M, Araki A, Kadota K, Ishihara S. Endoscopic differential diagnosis between foveolar-type gastric adenoma and gastric hyperplastic polyps in Helicobacter pylori-naïve patients. Gastric Cancer 2023; 26:1002-1011. [PMID: 37543537 DOI: 10.1007/s10120-023-01420-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Foveolar-type gastric adenoma (FGA) occurs in Helicobacter pylori (Hp)-naïve individuals and morphologically mimics Hp-naïve gastric hyperplastic polyp (HpN-GHP). FGA is often difficult to distinguish from HpN-GHP even by biopsy, due to its low-grade histologic atypia. We conducted a retrospective study to create an endoscopic diagnostic index. METHODS We analyzed 51 FGAs in 41 patients and 36 HpN-GHPs in 24 patients. All lesions were photographed by white-light endoscopy (WLE) and narrow-band imaging with magnification endoscopy (NBIME). Three experts and three non-experts reviewed the WLE and WLE+NBIME images to assess six items for lesion diagnosis. We analyzed correlations between the diagnostic items and histologic features and compared the diagnostic accuracy between modalities. We created a composite diagnostic index and calculated its accuracy and consistency. RESULTS FGAs more frequently showed the following features vs. HpN-GHPs: bright-red color (94.1% vs. 44.4%), peripheral hyperplasia (58.8% vs. 8.3%), papillary/gyrus-like microstructure (96.1% vs. 33.3%), visible capillaries (70.6% vs. 38.9%), and demarcation line (98.0% vs. 41.7%) (P < 0.05). White-zone thickening was seen only in HpN-GHPs (52.8%). Diagnostic accuracy (mean, WLE vs. WLE+NBIME) was 90.8 ± 1.1% vs. 93.5 ± 2.4% (P = 0.15) for experts and 88.5 ± 3.0% vs. 86.6 ± 3.5% (P = 0.51) for non-experts. When satisfying the four criteria (bright-red color, papillary/gyrus-like microstructure, demarcation line, and absent white-zone thickening), sensitivity and specificity for FGA were 90.2% and 94.4%, respectively, with a kappa value of ≥ 0.6 for interobserver diagnostic agreement. CONCLUSIONS Composite diagnostic index contributes to the reproducible, accurate, preoperative differential diagnosis of FGA and HpN-GHP.
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Affiliation(s)
- Kotaro Shibagaki
- Department of Endoscopy, Shimane University Hospital, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
| | - Norihisa Ishimura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Satoshi Kotani
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Chika Fukuyama
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yusuke Takahashi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kenichi Kishimoto
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tomotaka Yazaki
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Masatoshi Kataoka
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Taisuke Omachi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yasuhito Kinoshita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Nobuaki Hasegawa
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Akihiko Oka
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yoshiyuki Mishima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tsuyoshi Mishiro
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Naoki Oshima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kousaku Kawashima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Mamiko Nagase
- Department of Pathology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Asuka Araki
- Department of Pathology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kyuichi Kadota
- Department of Pathology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
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Oka A, Awoniyi M, Hasegawa N, Yoshida Y, Tobita H, Ishimura N, Ishihara S. Superior mesenteric artery syndrome: Diagnosis and management. World J Clin Cases 2023; 11:3369-3384. [PMID: 37383896 PMCID: PMC10294176 DOI: 10.12998/wjcc.v11.i15.3369] [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: 12/29/2022] [Revised: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
Superior mesenteric artery (SMA) syndrome (also known as Wilkie's syndrome, cast syndrome, or aorto-mesenteric compass syndrome) is an obstruction of the duodenum caused by extrinsic compression between the SMA and the aorta. The median age of patients is 23 years old (range 0-91 years old) and predominant in females over males with a ratio of 3:2. The symptoms are variable, consisting of postprandial abdominal pain, nausea and vomiting, early satiety, anorexia, and weight loss and can mimic anorexia nervosa or functional dyspepsia. Because recurrent vomiting leads to aspiration pneumonia or respiratory depression via metabolic alkalosis, early diagnosis is required. The useful diagnostic modalities are computed tomography as a standard tool and ultrasonography, which has advantages in safety and capability of real-time assessments of SMA mobility and duodenum passage. The initial treatment is usually conservative, including postural change, gastroduodenal decompression, and nutrient management (success rates: 70%-80%). If conservative therapy fails, surgical treatment (i.e., laparoscopic duodenojejunostomy) is recommended (success rates: 80%-100%).
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Muyiwa Awoniyi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Hepatology Section, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Nobuaki Hasegawa
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yuri Yoshida
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, Izumo 693-8501, Shimane, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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7
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Kawashima K, Oshima N, Kishimoto K, Kataoka M, Fukunaga M, Kotani S, Sonoyama H, Oka A, Mishima Y, Kazumori H, Ishikawa N, Araki A, Ishihara S. Low Fecal Calprotectin Predicts Histological Healing in Patients with Ulcerative Colitis with Endoscopic Remission and Leads to Prolonged Clinical Remission. Inflamm Bowel Dis 2023; 29:359-366. [PMID: 35583193 DOI: 10.1093/ibd/izac095] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Consensus regarding the cutoff value of fecal calprotectin (FC) for predicting histological healing (HH) in ulcerative colitis (UC) is lacking. This study aimed to determine an optimal FC cutoff value for predicting HH in patients with UC with clinical and endoscopic remission. Furthermore, FC's predictability for prolonged clinical remission (CR) was investigated. METHODS Patients with UC in clinical and endoscopic remission, defined as a partial Mayo score (PMS) ≤ 2 points and a Mayo endoscopic subscore 0-1, were prospectively enrolled. Biopsy samples were evaluated by Geboes score (GS), with HH defined as a GS < 2.0. Patients were followed for 2 years or until relapse, defined as a PMS > 2 or medication escalation. RESULTS Seventy-six patients with UC were included. The median FC value in patients with HH (n = 40) was 56.2 µg/g, significantly lower than that in those with histological activity (118.1 µg/g; P < .01). The area under the curve (AUC) in a receiver operating characteristic (ROC) curve analysis to predict HH for FC was 0.71 (95% confidence interval [CI], 0.59-0.83), with an optimal cutoff value of 82.7 µg/g (73% sensitivity; 64% specificity; P < .01). Of 74 patients observed for 2 years, 54 (73%) had prolonged CR. In the ROC curve analysis, the AUC to predict prolonged CR for FC was 0.79 (95% CI, 0.68-0.90), equivalent to that for HH (0.73; 95% CI, 0.64-0.86; P = .40). The optimal FC cutoff value to predict prolonged CR was 84.6 µg/g (72% sensitivity; 85% specificity; P < .01). CONCLUSIONS Fecal calprotectin < 82 µg/g predicts HH in patients with UC with clinical and endoscopic remission. Low FC leads to prolonged CR, equivalent to HH.
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Affiliation(s)
- Kousaku Kawashima
- Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Shimane, Japan
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kenichi Kishimoto
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Masatoshi Kataoka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Mai Fukunaga
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Satoshi Kotani
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Hideaki Kazumori
- Division of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane, Japan
| | - Noriyoshi Ishikawa
- Department of Pathology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Asuka Araki
- Department of Pathology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shunji Ishihara
- Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Shimane, Japan
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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8
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Mishiro T, Shibagaki K, Fukuyama C, Kataoka M, Notsu T, Yamashita N, Oka A, Nagase M, Araki A, Kawashima K, Ishimura N, Maruyama R, Kinoshita Y, Ishihara S. KLF4 Mutation Shapes Pathologic Characteristics of Foveolar-Type Gastric Adenoma in Helicobacter pylori-Naive Patients. Am J Pathol 2022; 192:1250-1258. [PMID: 35750256 DOI: 10.1016/j.ajpath.2022.06.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/20/2022]
Abstract
Along with a recent remarkable decrease in Helicobacter pylori-infected individuals, reports of gastric neoplasms such as sporadic foveolar-type gastric adenoma (FGA) in H. pylori-naive patients have been increasing. This tumor, with its raspberry-like appearance, is common in H. pylori-naive gastric mucosa. The current study investigated the genomic features of sporadic FGA. Fresh-frozen sporadic FGA tissue samples from H. pylori-naive patients were subjected to whole genome analysis using a next-generation sequencer. Proliferation ability and apoptotic profiles of human gastric epithelial cells, along with plasmid transfection of candidate variants, were examined. A mean of 6.65 × 108 total reads were obtained for each sample. Common genetic abnormalities in well-known proliferation driver genes of conventional gastric dysplasia/cancer were not found. However, a common single-nucleotide variation (SNV) was noted within the DNA-binding domain of the tumor suppressor gene KLF4. This novel SNV was located in the zinc finger 2 region. Additional experiments showed that it significantly suppressed proliferation of gastric epithelial cells compared with wild-type KLF4 plasmid-transfected cells, although suppression was reduced in early apoptotic phase-related genes. A novel SNV in the KLF4 zinc finger 2 region was commonly found in sporadic FGA tissue samples, which may explain the slow-growing properties of this neoplasm.
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Affiliation(s)
- Tsuyoshi Mishiro
- Department of Gastroenterology and Hepatology, Izumo, Shimane, Japan.
| | | | - Chika Fukuyama
- Department of Gastroenterology and Hepatology, Izumo, Shimane, Japan
| | - Masatoshi Kataoka
- Department of Gastroenterology and Hepatology, Izumo, Shimane, Japan
| | - Takumi Notsu
- Department of Gastroenterology and Hepatology, Izumo, Shimane, Japan
| | | | - Akihiko Oka
- Department of Gastroenterology and Hepatology, Izumo, Shimane, Japan
| | - Mamiko Nagase
- Organ Pathology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Asuka Araki
- Organ Pathology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Kousaku Kawashima
- Department of Gastroenterology and Hepatology, Izumo, Shimane, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology and Hepatology, Izumo, Shimane, Japan
| | - Riruke Maruyama
- Organ Pathology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Yoshikazu Kinoshita
- Department of Medicine, Steel Memorial Hirohata Hospital, Himeji, Hyogo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology and Hepatology, Izumo, Shimane, Japan
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9
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Buttimer C, Sutton T, Colom J, Murray E, Bettio PH, Smith L, Bolocan AS, Shkoporov A, Oka A, Liu B, Herzog JW, Sartor RB, Draper LA, Ross RP, Hill C. Impact of a phage cocktail targeting Escherichia coli and Enterococcus faecalis as members of a gut bacterial consortium in vitro and in vivo. Front Microbiol 2022; 13:936083. [PMID: 35935217 PMCID: PMC9355613 DOI: 10.3389/fmicb.2022.936083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/01/2022] [Indexed: 01/14/2023] Open
Abstract
Escherichia coli and Enterococcus faecalis have been implicated as important players in human gut health that have been associated with the onset of inflammatory bowel disease (IBD). Bacteriophage (phage) therapy has been used for decades to target pathogens as an alternative to antibiotics, but the ability of phage to shape complex bacterial consortia in the lower gastrointestinal tract is not clearly understood. We administered a cocktail of six phages (either viable or heat-inactivated) targeting pro-inflammatory Escherichia coli LF82 and Enterococcus faecalis OG1RF as members of a defined community in both a continuous fermenter and a murine colitis model. The two target strains were members of a six species simplified human microbiome consortium (SIHUMI-6). In a 72-h continuous fermentation, the phage cocktail caused a 1.1 and 1.5 log (log10 genome copies/mL) reduction in E. faecalis and E. coli numbers, respectively. This interaction was accompanied by changes in the numbers of other SIHUMI-6 members, with an increase of Lactiplantibacillus plantarum (1.7 log) and Faecalibacterium prausnitzii (1.8 log). However, in germ-free mice colonized by the same bacterial consortium, the same phage cocktail administered twice a week over nine weeks did not cause a significant reduction of the target strains. Mice treated with active or inactive phage had similar levels of pro-inflammatory cytokines (IFN-y/IL12p40) in unstimulated colorectal colonic strip cultures. However, histology scores of the murine lower GIT (cecum and distal colon) were lower in the viable phage-treated mice, suggesting that the phage cocktail did influence the functionality of the SIHUMI-6 consortium. For this study, we conclude that the observed potential of phages to reduce host populations in in vitro models did not translate to a similar outcome in an in vivo setting, with this effect likely brought about by the reduction of phage numbers during transit of the mouse GIT.
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Affiliation(s)
- Colin Buttimer
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Tom Sutton
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Joan Colom
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Ellen Murray
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Pedro H. Bettio
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Linda Smith
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | | | | | - Akihiko Oka
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Bo Liu
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jeremy W. Herzog
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - R. Balfour Sartor
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - R. Paul Ross
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Colin Hill
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
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10
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Ishikawa Y, Tanaka N, Asano Y, Kodera M, Shirai Y, Akahoshi M, Hasegawa M, Matsushita T, Kazuyoshi S, Motegi S, Yoshifuji H, Yoshizaki A, Kohmoto T, Takagi K, Oka A, Kanda M, Tanaka Y, Ito Y, Nakano K, Kasamatsu H, Utsunomiya A, Sekiguchi A, Niro H, Jinnin M, Makino K, Makino T, Ihn H, Yamamoto M, Suzuki C, Takahashi H, Nishida E, Morita A, Yamamoto T, Fujimoto M, Kondo Y, Goto D, Sumida T, Ayuzawa N, Yanagida H, Horita T, Atsumi T, Endo H, Shima Y, Kumanogoh A, Hirata J, Otomo N, Suetsugu H, Koike Y, Tomizuka K, Yoshino S, Liu X, Ito S, Hikino K, Suzuki A, Momozawa Y, Ikegawa S, Tanaka Y, Ishikawa O, Takehara K, Torii T, Sato S, Okada Y, Mimori T, Matsuda F, Matsuda K, Imoto I, Matsuo K, Kuwana M, Kawaguchi Y, Ohmura K, Terao C. OP0112 THE EVER-LARGEST ASIAN GWAS FOR SYSTEMIC SCLEROSIS AND TRANS-POPULATION META-ANALYSIS IDENTIFIED SEVEN NOVEL LOCI AND A CANDIDATE CAUSAL SNP IN A CIS-REGULATORY ELEMENT OF THE FCGR REGION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.665] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGenome-wide association studies (GWASs) have identified 29 disease-associated single nucleotide polymorphisms (SNPs) for systemic sclerosis (SSc) in non-human leukocyte antigen (HLA) regions (1-7). While these GWASs have clarified genetic architectures of SSc, study subjects were mainly Caucasians limiting application of the findings to Asians.ObjectivesThe study was conducted to identify novel causal variants for SSc specific to Japanese subjects as well as those shared with European population. We also aimed to clarify mechanistic effects of the variants on pathogenesis of SSc.MethodsA total of 114,108 subjects comprising 1,499 cases and 112,609 controls were enrolled in the two-staged study leading to the ever-largest Asian GWAS for SSc. After applying a strict quality control both for genotype and samples, imputation was conducted using the reference panel of the phase 3v5 1,000 genome project data combined with a high-depth whole-genome sequence data of 3,256 Japanese subjects. We conducted logistic regression analyses and also combined the Japanese GWAS results with those of Europeans (6) by an inverse-variance fixed-effect model. Polygenicity and enrichment of functional annotations were evaluated by linkage disequilibrium score regression (LDSC), Haploreg and IMPACT programs. We also constructed polygenic risk score (PRS) to predict SSc development.ResultsWe identified three (FCRLA-FCGR, TNFAIP3, PLD4) and four (EOMES, ESR1, SLC12A5, TPI1P2) novel loci in Japanese GWAS and a trans-population meta-analysis, respectively. One of Japanese novel risk SNPs, rs6697139, located within FCGR gene clusters had a strong effect size (OR 2.05, P=4.9×10-11). We also found the complete LD variant, rs10917688, was positioned in cis-regulatory element and binding motif for an immunomodulatory transcription factor IRF8 in B cells, another genome-wide significant locus in our trans-ethnic meta-analysis and the previous European GWAS. Notably, the association of risk allele of rs10917688 was significant only in the presence of the risk allele of the IRF8. Intriguingly, rs10917688 was annotated as one enhancer-related histone marks, H3K4me1, in B cells, implying that FCGR gene(s) in B cells may play an important role in the pathogenesis of SSc. Furhtermore, significant heritability enrichment of active histone marks and a transcription factor C-Myc were found in B cells both in European and Japanese populations by LDSC and IMPACT, highlighting a possibility of a shared disease mechanism where abnormal B-cell activation may be one of the key drivers for the disease development. Finally, PRS using effects sizes of European GWAS moderately fit in the development of Japanese SSc (AUC 0.593), paving a path to personalized medicine for SSc.ConclusionOur study identified seven novel susceptibility loci in SSc. Downstream analyses highlighted a novel disease mechanism of SSc where an interactive role of FCGR gene(s) and IRF8 may accelerate the disease development and B cells may play a key role on the pathogenesis of SSc.References[1]F. C. Arnett et al. Ann Rheum Dis, 2010.[2]T. R. Radstake et al. Nat Genet, 2010.[3]Y. Allanore et al. PLoS Genet, 2011.[4]O. Gorlova et al. PLoS Genet, 2011.[5]C. Terao et al. Ann Rheum Dis, 2017.[6]E. López-Isac et al. Nat Commun, 2019.[7]W. Pu et al. J Invest Dermatol, 2021.Disclosure of InterestsNone declared
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11
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Yazaki T, Moriyama I, Tobita H, Sonoyama H, Okimoto E, Oka A, Mishima Y, Oshima N, Shibagaki K, Kawashima K, Ishimura N, Nagami T, Maruyama R, Shiina H, Ishihara S. The Simultaneous Onset of Pancreatitis and Colitis as Immune-related Adverse Events in a Patient Receiving Nivolumab Treatment for Renal Cell Carcinoma. Intern Med 2022; 61:1485-1490. [PMID: 34744104 PMCID: PMC9177368 DOI: 10.2169/internalmedicine.7911-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs), which have anti-tumor effects, are currently approved for treatment of several kinds of advanced malignancies. However, with their increasing use, a variety of immune-related adverse events (irAEs) in administered patients have been reported. We herein report a rare case of the simultaneous onset of acute pancreatitis and colitis as irAEs during nivolumab treatment given to a patient with renal cell carcinoma, who then shown marked improvement with corticosteroid therapy.
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Affiliation(s)
- Tomotaka Yazaki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Hepatology, Shimane University Hospital, Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Cancer Center, Shimane University Hospital, Japan
| | - Hiroshi Tobita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Hepatology, Shimane University Hospital, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Eiko Okimoto
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Kotaro Shibagaki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Endoscopy, Shimane University Hospital, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Taichi Nagami
- Department of Urology, Shimane University Faculty of Medicine, Japan
| | - Riruke Maruyama
- Organ Pathology Unit, Department of Pathology, Shimane University Faculty of Medicine, Japan
| | - Hiroaki Shiina
- Department of Urology, Shimane University Faculty of Medicine, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
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12
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Zhang S, Morgan XC, Dogan B, Martin FP, Strickler SR, Oka A, Herzog J, Liu B, Dowd SE, Huttenhower C, Pichaud M, Dogan EI, Satsangi J, Longman R, Yantiss R, Mueller LA, Scherl E, Sartor RB, Simpson KW. Mucosal metabolites fuel the growth and virulence of E. coli linked to Crohn's disease. JCI Insight 2022; 7:157013. [PMID: 35413017 PMCID: PMC9220930 DOI: 10.1172/jci.insight.157013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
Elucidating how resident enteric bacteria interact with their hosts to promote health or inflammation is of central importance to diarrheal and inflammatory bowel diseases across species. Here, we integrated the microbial and chemical microenvironment of a patient’s ileal mucosa with their clinical phenotype and genotype to identify factors favoring the growth and virulence of adherent and invasive E. coli (AIEC) linked to Crohn’s disease. We determined that the ileal niche of AIEC was characterized by inflammation, dysbiosis, coculture of Enterococcus, and oxidative stress. We discovered that mucosal metabolites supported general growth of ileal E. coli, with a selective effect of ethanolamine on AIEC that was augmented by cometabolism of ileitis-associated amino acids and glutathione and by symbiosis-associated fucose. This metabolic plasticity was facilitated by the eut and pdu microcompartments, amino acid metabolism, γ-glutamyl-cycle, and pleiotropic stress responses. We linked metabolism to virulence and found that ethanolamine and glutamine enhanced AIEC motility, infectivity, and proinflammatory responses in vitro. We connected use of ethanolamine to intestinal inflammation and L-fuculose phosphate aldolase (fucA) to symbiosis in AIEC monoassociated IL10–/– mice. Collectively, we established that AIEC were pathoadapted to utilize mucosal metabolites associated with health and inflammation for growth and virulence, enabling the transition from symbiont to pathogen in a susceptible host.
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Affiliation(s)
- Shiying Zhang
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, United States of America
| | - Xochitl C Morgan
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Belgin Dogan
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, United States of America
| | - Francois-Pierre Martin
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Susan R Strickler
- Plant Research, Boyce Thompson Institute, Ithaca, United States of America
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Jeremy Herzog
- Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Bo Liu
- Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Scot E Dowd
- MR DNA: Molecular Research LP, Shallowater, United States of America
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | | | - Esra I Dogan
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, United States of America
| | - Jack Satsangi
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Randy Longman
- Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, Cornell University, New York, United States of America
| | - Rhonda Yantiss
- Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, Cornell University, New York, United States of America
| | - Lukas A Mueller
- Plant Research, Boyce Thompson Institute, Ithaca, United States of America
| | - Ellen Scherl
- Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, Cornell University, New York, United States of America
| | - R Balfour Sartor
- Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Kenneth W Simpson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, United States of America
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13
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Cha N, Oshima N, Kishimoto K, Kotani S, Okimoto E, Yazaki T, Sonoyama H, Oka A, Mishima Y, Shibagaki K, Tobita H, Kawashima K, Ishimura N, Ishihara S. Long-lasting renal dysfunction following tacrolimus induction therapy in ulcerative colitis patients. J Clin Biochem Nutr 2022; 70:297-303. [PMID: 35692680 PMCID: PMC9130057 DOI: 10.3164/jcbn.21-139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Na Cha
- Internal Medicine II, Shimane University Faculty of Medicine
| | - Naoki Oshima
- Internal Medicine II, Shimane University Faculty of Medicine
| | | | - Satoshi Kotani
- Internal Medicine II, Shimane University Faculty of Medicine
| | - Eiko Okimoto
- Internal Medicine II, Shimane University Faculty of Medicine
| | - Tomotaka Yazaki
- Internal Medicine II, Shimane University Faculty of Medicine
| | - Hiroki Sonoyama
- Internal Medicine II, Shimane University Faculty of Medicine
| | - Akihiko Oka
- Internal Medicine II, Shimane University Faculty of Medicine
| | | | | | - Hiroshi Tobita
- Internal Medicine II, Shimane University Faculty of Medicine
| | - Kousaku Kawashima
- Inflammatory Bowel Disease Center, Shimane University Faculty of Medicine
| | | | - Shunji Ishihara
- Internal Medicine II, Shimane University Faculty of Medicine
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14
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Kataoka M, Saitoh T, Kawashima K, Yazaki T, Sonoyama H, Okimoto E, Oka A, Mishima Y, Mishiro T, Oshima N, Shibagaki K, Tobita H, Moriyama I, Ishimura N, Nagase M, Hirahara N, Tajima Y, Ishihara S. Primary Extragastrointestinal Stromal Tumor of Greater Omentum with Intraperitoneal Bleeding. Intern Med 2021; 60:3413-3419. [PMID: 34024850 PMCID: PMC8627809 DOI: 10.2169/internalmedicine.6519-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) develop in the digestive tract, mainly in the stomach, small intestine, colon, or esophagus. However, primary tumors with the same pathologic features as GISTs have been reported to occur outside of the digestive tract and are called extragastrointestinal stromal tumor (EGIST). We herein report a rare case of EGIST arising from the greater omentum in a patient with abdominal pain caused by intraperitoneal bleeding from the tumor.
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Affiliation(s)
- Masatoshi Kataoka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Hepatology, Shimane University Hospital, Japan
| | - Tsukasa Saitoh
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Gastroenterology, Matsue Red Cross Hospital, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
| | - Tomotaka Yazaki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Hepatology, Shimane University Hospital, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Eiko Okimoto
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Tsuyoshi Mishiro
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Kotaro Shibagaki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Endoscopy, Shimane University Hospital, Japan
| | - Hiroshi Tobita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Hepatology, Shimane University Hospital, Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Cancer Center, Shimane University Hospital, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Mamiko Nagase
- Department of Organ Pathology, Shimane University Faculty of Medicine, Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
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15
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Rousta E, Oka A, Liu B, Herzog J, Bhatt AP, Wang J, Habibi Najafi MB, Sartor RB. The Emulsifier Carboxymethylcellulose Induces More Aggressive Colitis in Humanized Mice with Inflammatory Bowel Disease Microbiota Than Polysorbate-80. Nutrients 2021; 13:3565. [PMID: 34684567 PMCID: PMC8540676 DOI: 10.3390/nu13103565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 12/11/2022] Open
Abstract
Commonly used synthetic dietary emulsifiers, including carboxymethylcellulose (CMC) and polysorbate-80 (P80), promote intestinal inflammation. We compared abilities of CMC vs. P80 to potentiate colitis and impact human microbiota in an inflammatory environment using a novel colitis model of ex-germ-free (GF) IL10-/- mice colonized by pooled fecal transplant from three patients with active inflammatory bowel diseases. After three days, mice received 1% CMC or P80 in drinking water or water alone for four weeks. Inflammation was quantified by serial fecal lipocalin 2 (Lcn-2) and after four weeks by blinded colonic histologic scores and colonic inflammatory cytokine gene expression. Microbiota profiles in cecal contents were determined by shotgun metagenomic sequencing. CMC treatment significantly increased fecal Lcn-2 levels compared to P80 and water treatment by one week and throughout the experiment. Likewise, CMC treatment increased histologic inflammatory scores and colonic inflammatory cytokine gene expression compared with P80 and water controls. The two emulsifiers differentially affected specific intestinal microbiota. CMC did not impact bacterial composition but significantly decreased Caudoviricetes (bacteriophages), while P80 exposure non-significantly increased the abundance of both Actinobacteria and Proteobacteria. Commonly used dietary emulsifiers have different abilities to induce colitis in humanized mice. CMC promotes more aggressive inflammation without changing bacterial composition.
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Affiliation(s)
- Esmat Rousta
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA; (E.R.); (A.O.); (B.L.); (J.H.); (A.P.B.)
- Department of Food Science and Technology, Faculty of Agriculture, Ferdowsi University of Mashhad, Mashhad 9177948974, Iran
| | - Akihiko Oka
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA; (E.R.); (A.O.); (B.L.); (J.H.); (A.P.B.)
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane 693-8501, Japan
| | - Bo Liu
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA; (E.R.); (A.O.); (B.L.); (J.H.); (A.P.B.)
| | - Jeremy Herzog
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA; (E.R.); (A.O.); (B.L.); (J.H.); (A.P.B.)
| | - Aadra P. Bhatt
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA; (E.R.); (A.O.); (B.L.); (J.H.); (A.P.B.)
- Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA;
| | - Jeremy Wang
- Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA;
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA
| | - Mohammad B. Habibi Najafi
- Department of Food Science and Technology, Faculty of Agriculture, Ferdowsi University of Mashhad, Mashhad 9177948974, Iran
| | - Ryan Balfour Sartor
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA; (E.R.); (A.O.); (B.L.); (J.H.); (A.P.B.)
- Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA;
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC 27599, USA
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16
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Oka A, Ishimura N, Ishihara S. A New Dawn for the Use of Artificial Intelligence in Gastroenterology, Hepatology and Pancreatology. Diagnostics (Basel) 2021; 11:1719. [PMID: 34574060 PMCID: PMC8468082 DOI: 10.3390/diagnostics11091719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) is rapidly becoming an essential tool in the medical field as well as in daily life. Recent developments in deep learning, a subfield of AI, have brought remarkable advances in image recognition, which facilitates improvement in the early detection of cancer by endoscopy, ultrasonography, and computed tomography. In addition, AI-assisted big data analysis represents a great step forward for precision medicine. This review provides an overview of AI technology, particularly for gastroenterology, hepatology, and pancreatology, to help clinicians utilize AI in the near future.
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan; (N.I.); (S.I.)
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17
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van der Lelie D, Oka A, Taghavi S, Umeno J, Fan TJ, Merrell KE, Watson SD, Ouellette L, Liu B, Awoniyi M, Lai Y, Chi L, Lu K, Henry CS, Sartor RB. Rationally designed bacterial consortia to treat chronic immune-mediated colitis and restore intestinal homeostasis. Nat Commun 2021; 12:3105. [PMID: 34050144 PMCID: PMC8163890 DOI: 10.1038/s41467-021-23460-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
Environmental factors, mucosal permeability and defective immunoregulation drive overactive immunity to a subset of resident intestinal bacteria that mediate multiple inflammatory conditions. GUT-103 and GUT-108, live biotherapeutic products rationally designed to complement missing or underrepresented functions in the dysbiotic microbiome of IBD patients, address upstream targets, rather than targeting a single cytokine to block downstream inflammation responses. GUT-103, composed of 17 strains that synergistically provide protective and sustained engraftment in the IBD inflammatory environment, prevented and treated chronic immune-mediated colitis. Therapeutic application of GUT-108 reversed established colitis in a humanized chronic T cell-mediated mouse model. It decreased pathobionts while expanding resident protective bacteria; produced metabolites promoting mucosal healing and immunoregulatory responses; decreased inflammatory cytokines and Th-1 and Th-17 cells; and induced interleukin-10-producing colonic regulatory cells, and IL-10-independent homeostatic pathways. We propose GUT-108 for treating and preventing relapse for IBD and other inflammatory conditions characterized by unbalanced microbiota and mucosal permeability.
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Affiliation(s)
| | - Akihiko Oka
- Departments of Medicine, Microbiology and Immunology, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | | | - Junji Umeno
- Departments of Medicine, Microbiology and Immunology, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | | | | | | | | | - Bo Liu
- Departments of Medicine, Microbiology and Immunology, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Muyiwa Awoniyi
- Departments of Medicine, Microbiology and Immunology, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yunjia Lai
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liang Chi
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kun Lu
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - R Balfour Sartor
- Departments of Medicine, Microbiology and Immunology, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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18
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Kishimoto K, Kawashima K, Fukunaga M, Kotani S, Sonoyama H, Oka A, Mishima Y, Oshima N, Ishimura N, Ishikawa N, Maruyama R, Ishihara S. Intermittent Purpura Development Associated with Leukocytoclastic Vasculitis Induced by Infliximab for Crohn's Disease. Intern Med 2021; 60:385-389. [PMID: 32863363 PMCID: PMC7925289 DOI: 10.2169/internalmedicine.5340-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Anti-tumor necrosis factor (TNF) α agents, widely used for the treatment of Crohn's disease (CD), can sometimes induce skin-associated adverse events, which mainly include psoriasis-like eruptions, eczema, and cutaneous infections. In contrast, purpura caused by vasculitis is rarely seen. We herein report a unique case of leukocytoclastic vasculitis induced by infliximab administered for CD in which intermittent purpura development was noted. Fluorescent immunostaining showed no immunoglobulin A deposition on the vessel walls. No purpura was initially seen after starting infliximab, but it appeared approximately 10 months later; however, administration did not have to be discontinued, and the condition was later resolved. The present findings provide important details regarding vasculitis induced by anti-tumor necrosis factor-α agent administration.
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Affiliation(s)
- Kenichi Kishimoto
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Mai Fukunaga
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Satoshi Kotani
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | | | - Riruke Maruyama
- Department of Pathology, Shimane University Faculty of Medicine, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
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19
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Mishima Y, Oka A, Ishihara S. Detection and Quantification of Transforming Growth Factor-β1 Produced by Murine B Cells: Pros and Cons of Different Techniques. Methods Mol Biol 2021; 2270:113-124. [PMID: 33479896 DOI: 10.1007/978-1-0716-1237-8_7] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transforming growth factor (TGF)-β1 is one of the regulatory cytokines produced by B cells and has a pivotal role in intestinal homeostasis. TGF-β1 can determine the fate of naive T cells, such as differentiation, proliferation, and apoptosis, which are relevant to the pathogenesis of autoimmunity, infection, inflammation, allergy, and cancer. Here, we describe detailed methods for detection and quantification of TGF-β1 secreted by B cells using ELISA, flow cytometry, and real-time PCR.
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Affiliation(s)
- Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan.
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
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20
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Abstract
Although the inflammatory cytokine IL-10 is pivotal in regulatory B-cell function, detecting IL-10-producing B cells by intracellular IL-10 staining requires multiple steps and tedious preparation. In contrast, the Il10-eGFP reporter mouse model (VertX), generated in 2009, allows easier and quicker detection of IL-10-producing B cells with the possibility of sorting viable cells without membrane permeabilization and ex vivo activation. Even though detecting IL-10+ cells is simpler, several nuances are important. For example, methanol-containing buffers delete GFP signal, while long-term fixation can maintain GFP intensity but decreases other intracellular signals (FOXP3, etc.). Here, we provide optimized and improved protocols for GFP detection in intestinal B cells and isolation techniques of lamina propria, spleen, mesenteric lymph node, peritoneum, and blood cells from VertX mice.
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Affiliation(s)
- Akihiko Oka
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Bo Liu
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeremy W Herzog
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R Balfour Sartor
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- National Gnotobiotic Rodent Resource Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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21
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Tobita H, Yazaki T, Kataoka M, Kotani S, Oka A, Mishiro T, Oshima N, Kawashima K, Ishimura N, Naora K, Sato S, Ishihara S. Comparison of dapagliflozin and teneligliptin in nonalcoholic fatty liver disease patients without type 2 diabetes mellitus: a prospective randomized study. J Clin Biochem Nutr 2020; 68:173-180. [PMID: 33879970 DOI: 10.3164/jcbn.20-129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/16/2020] [Indexed: 12/17/2022] Open
Abstract
There are no reports regarding the efficacy of sodium-glucose cotransporter 2 inhibitor (SGLT2i) and dipeptidyl peptidase 4 inhibitor (DPP4i) administrations in nonalcoholic fatty liver disease (NAFLD) patients without type 2 diabetes mellitus. The purpose of this study was to evaluate the efficacy of those drugs in such patients. NAFLD patients without type 2 diabetes mellitus were enrolled in this single center double-blind randomized prospective study, and allocated to receive either dapagliflozin (SGLT2i) or teneligliptin (DPP4i) for 12 weeks. Laboratory variables and body compositions were assessed at the baseline and end of treatment. The primary endpoint was alanine aminotransferase (ALT) reduction level at the end of treatment. Twenty-two eligible patients (dapagliflozin group, n = 12; teneligliptin group, n = 10) were analyzed. In both groups, the serum concentration of ALT was significantly decreased after treatment (p<0.05). Multiple regression analysis results showed that decreased body weight of patients with dapagliflozin administration was significantly related to changes in total body water and body fat mass. Administration of dapagliflozin or teneligliptin decreased the serum concentration of ALT in NAFLD patients without type 2 diabetes mellitus. With dapagliflozin, body weight decreased, which was related to changes in total body water and body fat mass (UMIN000027304).
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Affiliation(s)
- Hiroshi Tobita
- Division of Hepatology, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.,Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Tomotaka Yazaki
- Division of Hepatology, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.,Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Masatoshi Kataoka
- Division of Hepatology, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.,Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Satoshi Kotani
- Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Tsuyoshi Mishiro
- Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Kohji Naora
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Shuichi Sato
- Department of International Medicine, Izumo City General Medical Center, Izumo, Shimane 693-8501, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
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22
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Kawashima K, Fukuba N, Uemura Y, Ota K, Kazumori H, Sonoyama H, Oka A, Tada Y, Mishima Y, Oshima N, Yuki T, Katsube T, Kinoshita Y, Ishihara S. Comorbid irritable bowel syndrome symptoms and headache have greater association with anxiety than depression: Annual health check-up survey results. Medicine (Baltimore) 2020; 99:e23059. [PMID: 33217807 PMCID: PMC7676610 DOI: 10.1097/md.0000000000023059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
High rates of co-existing irritable bowel syndrome (IBS) and headache have been reported in western countries. We investigated that comorbidity in individuals in Japan, along with anxiety and depression in subjects with and without IBS symptoms and/or headache.This cross-sectional study was performed from April 2012 to January 2013 at the Matsue Seikyo General Hospital Health Check Center. Questionnaires concerning symptoms related to IBS (Rome III) and headache, as well as anxiety/depression score were sent to individuals scheduled to undergo an annual health check-up, then returned during the visit and analyzed in a blinded manner.A total of 2885 individuals returned completed questionnaires and were enrolled, of whom 218 (7.6%) met the IBS criteria. The rates of co-existing headache in subjects with and without IBS symptoms were 44.0% (96/218) and 22.9% (611/2667), respectively, indicating a significantly higher rate of co-existing headache in subjects with as compared to without IBS (odds ratio [OR] 2.65, P < .001). Furthermore, the percentage of subjects with anxiety along with comorbid IBS symptoms and headache was significantly greater as compared to those with IBS (OR 3.01, P = .001) or headache (OR 2.41, P < .001) alone. Unlike anxiety, the percentage of subjects with depression was not significantly different among the IBS/non-headache, non-IBS/headache, and IBS/headache groups.Subjects with IBS symptoms had a higher rate of co-existing headache as compared to those without IBS. Furthermore, those with comorbid IBS symptoms and headache had a greater association with anxiety than with depression, as compared to those with only IBS or headache.
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Affiliation(s)
- Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
- Department of Internal Medicine
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Yusuke Uemura
- Department of Neurology, Matsue Seikyo General Hospital, 8-8-8 Nishitsuda
| | - Kuniko Ota
- Department of Neurology, Matsue Seikyo General Hospital, 8-8-8 Nishitsuda
| | | | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Tomoko Katsube
- Department of Preventive Medicine, Matsue Red Cross Hospital, 200 Horo-machi, Matsue, Shimane
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
- Steel Memorial Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, Hyogo, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
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23
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Montrose DC, Nishiguchi R, Basu S, Staab HA, Zhou XK, Wang H, Meng L, Johncilla M, Cubillos-Ruiz JR, Morales DK, Wells MT, Simpson KW, Zhang S, Dogan B, Jiao C, Fei Z, Oka A, Herzog JW, Sartor RB, Dannenberg AJ. Dietary Fructose Alters the Composition, Localization, and Metabolism of Gut Microbiota in Association With Worsening Colitis. Cell Mol Gastroenterol Hepatol 2020; 11:525-550. [PMID: 32961355 PMCID: PMC7797369 DOI: 10.1016/j.jcmgh.2020.09.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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: 06/17/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The incidence of inflammatory bowel diseases has increased over the last half century, suggesting a role for dietary factors. Fructose consumption has increased in recent years. Recently, a high fructose diet (HFrD) was shown to enhance dextran sodium sulfate (DSS)-induced colitis in mice. The primary objectives of the current study were to elucidate the mechanism(s) underlying the pro-colitic effects of dietary fructose and to determine whether this effect occurs in both microbially driven and genetic models of colitis. METHODS Antibiotics and germ-free mice were used to determine the relevance of microbes for HFrD-induced worsening of colitis. Mucus thickness and quality were determined by histologic analyses. 16S rRNA profiling, in situ hybridization, metatranscriptomic analyses, and fecal metabolomics were used to determine microbial composition, spatial distribution, and metabolism. The significance of HFrD on pathogen and genetic-driven models of colitis was determined by using Citrobacter rodentium infection and Il10-/- mice, respectively. RESULTS Reducing or eliminating bacteria attenuated HFrD-mediated worsening of DSS-induced colitis. HFrD feeding enhanced access of gut luminal microbes to the colonic mucosa by reducing thickness and altering the quality of colonic mucus. Feeding a HFrD also altered gut microbial populations and metabolism including reduced protective commensal and bile salt hydrolase-expressing microbes and increased luminal conjugated bile acids. Administration of conjugated bile acids to mice worsened DSS-induced colitis. The HFrD also worsened colitis in Il10-/- mice and mice infected with C rodentium. CONCLUSIONS Excess dietary fructose consumption has a pro-colitic effect that can be explained by changes in the composition, distribution, and metabolic function of resident enteric microbiota.
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Affiliation(s)
| | | | - Srijani Basu
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Hannah A. Staab
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Xi Kathy Zhou
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Hanhan Wang
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Lingsong Meng
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | | | | | - Diana K. Morales
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
| | - Martin T. Wells
- Department of Biological Statistics and Computational Biology, Cornell University, Ithaca, New York
| | | | - Shiying Zhang
- Department of Clinical Sciences, Cornell University, Ithaca, New York
| | - Belgin Dogan
- Department of Clinical Sciences, Cornell University, Ithaca, New York
| | - Chen Jiao
- Boyce Thompson Institute for Plant Research, Cornell University, Ithaca, New York
| | - Zhangjun Fei
- Boyce Thompson Institute for Plant Research, Cornell University, Ithaca, New York
| | - Akihiko Oka
- Departments of Medicine, Microbiology, and Immunology, University of North Carolina, Chapel Hill, North Carolina
| | - Jeremy W. Herzog
- Departments of Medicine, Microbiology, and Immunology, University of North Carolina, Chapel Hill, North Carolina
| | - R. Balfour Sartor
- Departments of Medicine, Microbiology, and Immunology, University of North Carolina, Chapel Hill, North Carolina
| | - Andrew J. Dannenberg
- Department of Medicine, Weill Cornell Medicine, New York, New York,Correspondence Address correspondence to: Andrew J. Dannenberg, MD, Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, Room E-803, New York, New York 10065. fax: (646) 962-0891.
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24
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Kotani S, Fukuba N, Kawashima K, Mishima Y, Sonoyama H, Okimoto E, Tada Y, Oka A, Tamagawa Y, Oshima N, Mishiro T, Tobita H, Shibagaki K, Moriyama I, Ishimura N, Kushiyama Y, Fujishiro H, Ishihara S. Prevalence of functional dyspepsia-like symptoms in ulcerative colitis patients in clinical remission and overlap with irritable bowel syndrome-like symptoms. Scand J Gastroenterol 2020; 55:560-564. [PMID: 32412797 DOI: 10.1080/00365521.2020.1761998] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: Quiescent ulcerative colitis (UC) patients often have irritable bowel syndrome (IBS)-like symptoms and we recently showed that the prevalence of IBS-like symptoms in UC patients in clinical remission was significantly higher as compared to healthy control subjects. However, the prevalence of functional dyspepsia (FD)-like symptoms in quiescent UC patients remains unknown. The purpose of this study was to evaluate the prevalence of FD-like symptoms and the overlap with IBS-like symptoms in such patients.Materials and Methods: We reanalyzed the records of UC patients in remission using the subject cohort from our previous study. Clinical remission was defined as a clinical activity index (CAI) value ≤4 for at least 6 months. Diagnoses of FD- and IBS-like symptoms were evaluated by questionnaire according to the Rome III criteria.Results: One hundred seventy-two UC patients in clinical remission and 330 healthy control subjects were analyzed. Of the 172 patients, 9 (5.2%) met the criteria of FD, which was comparable with the controls (22/330, 6.7%). The prevalence rate of FD-like symptoms in UC patients with IBS-like symptoms (7/46, 15.2%) was lower as compared to that of the control subjects (6/16, 37.5%). On the other hand, a high percentage of the UC patients with FD-like symptoms also had IBS-like symptoms (7/9, 77.8%).Conclusions: Although the prevalence of FD-like symptoms in quiescent UC patients with IBS-like symptoms was low, UC patients with FD-like symptoms frequently had IBS-like symptoms.
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Affiliation(s)
- Satoshi Kotani
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine, Izumo City General Medical Center, Izumo, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan.,Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Eiko Okimoto
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Yuji Tamagawa
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Tsuyoshi Mishiro
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Hiroshi Tobita
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Kotaro Shibagaki
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | | | - Hirofumi Fujishiro
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan.,Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Japan
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25
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Abstract
Inflammatory bowel diseases (IBD), including Crohn's disease, ulcerative colitis, and pouchitis, are chronic, relapsing intestinal inflammatory disorders mediated by dysregulated immune responses to resident microbiota. Current standard therapies that block immune activation with oral immunosuppressives or biologic agents are generally effective, but each therapy induces a sustained remission in only a minority of patients. Furthermore, these approaches can have severe adverse events. Recent compelling evidence of a role of unbalanced microbiota (dysbiosis) driving immune dysfunction and inflammation in IBD supports the therapeutic rationale for manipulating the dysbiotic microbiota. Traditional approaches using currently available antibiotics, probiotics, prebiotics, and synbiotics have not produced optimal results, but promising outcomes with fecal microbiota transplant provide a proof of principle for targeting the resident microbiota. Rationally designed oral biotherapeutic products (LBPs) composed of mixtures of protective commensal bacterial strains demonstrate impressive preclinical results. Resident microbial-based and microbial-targeted therapies are currently being studied with increasing intensity for IBD primary therapy with favorable early results. This review presents current evidence and therapeutic mechanisms of microbiota modulation, emphasizing clinical studies, and outlines prospects for future IBD treatment using new approaches, such as LBPs, bacteriophages, bacterial function-editing substrates, and engineered bacteria. We believe that the optimal clinical use of microbial manipulation may be as adjuvants to immunosuppressive for accelerated and improved induction of deep remission and as potential safer solo approaches to sustained remission using personalized regimens based on an individual patient's microbial profile.
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Affiliation(s)
- Akihiko Oka
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - R Balfour Sartor
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, 111 Mason Farm Road, Chapel Hill, NC, 27599, USA.
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, 125 Mason Farm Road, Chapel Hill, NC, 27599, USA.
- National Gnotobiotic Rodent Resource Center, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC, 27514, USA.
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26
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Rogala AR, Oka A, Sartor RB. Strategies to Dissect Host-Microbial Immune Interactions That Determine Mucosal Homeostasis vs. Intestinal Inflammation in Gnotobiotic Mice. Front Immunol 2020; 11:214. [PMID: 32133003 PMCID: PMC7040030 DOI: 10.3389/fimmu.2020.00214] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
When identifying the key immunologic-microbial interactions leading to either mucosal homeostasis in normal hosts or intestinal inflammatory responses in genetically susceptible individuals, it is important to not only identify microbial community correlations but to also define the functional pathways involved. Gnotobiotic rodents are a very effective tool for this purpose as they provide a highly controlled environment in which to identify the function of complex intestinal microbiota, their individual components, and metabolic products. Herein we review specific strategies using gnotobiotic mice to functionally evaluate the role of various intestinal microbiota in host responses. These studies include basic comparisons between host responses in germ-free (GF), specific-pathogen-free or conventionally raised wild-type mice or those with underlying genetic susceptibilities to intestinal inflammation. We also discuss what can be learned from studies in which GF mice are colonized with single wild-type or genetically-modified microbial isolates to examine the functions of individual bacteria and their targeted bacterial genes, or colonized by multiple defined isolates to determine interactions between members of defined consortia. Additionally, we discuss studies to identify functions of complex microbial communities from healthy or diseased human or murine hosts via fecal transplant into GF mice. Finally, we conclude by suggesting ways to improve studies of immune-microbial interactions using gnotobiotic mice.
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Affiliation(s)
- Allison R Rogala
- Division of Comparative Medicine, Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Akihiko Oka
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - R Balfour Sartor
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Departments of Medicine, Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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27
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Oka A, Khan Z, Kodre A. Hepatic dysfunction in dengue fever and it's correlation with the severity of the disease. J Assoc Physicians India 2020; 68:92. [PMID: 31979869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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28
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Oka A, Mishima Y, Liu B, Herzog JW, Steinbach EC, Kobayashi T, Plevy SE, Sartor RB. Phosphoinositide 3-Kinase P110δ-Signaling Is Critical for Microbiota-Activated IL-10 Production by B Cells that Regulate Intestinal Inflammation. Cells 2019; 8:cells8101121. [PMID: 31546615 PMCID: PMC6829312 DOI: 10.3390/cells8101121] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Abstract
The phosphoinositide 3-kinase catalytic subunit p110δ (PI3Kδ) gene maps to a human inflammatory bowel diseases (IBD) susceptibility locus, and genetic deletion of PI3Kδ signaling causes spontaneous colitis in mice. However, little is known regarding the role of PI3Kδ on IL-10-producing B cells that help regulate mucosal inflammation in IBD. We investigated the role of PI3Kδ signaling in B cell production of IL-10, following stimulation by resident bacteria and B cell regulatory function against colitis. In vitro, B cells from PI3KδD910A/D910A mice or wild-type B cells treated with PI3K specific inhibitors secreted significantly less IL-10 with greater IL-12p40 following bacterial stimulation. These B cells failed to suppress inflammatory cytokines by co-cultured microbiota-activated macrophages or CD4+ T cells. In vivo, co-transferred wild-type B cells ameliorated T cell-mediated colitis, while PI3KδD910A/D910A B cells did not confer protection from mucosal inflammation. These results indicate that PI3Kδ-signaling mediates regulatory B cell immune differentiation when stimulated with resident microbiota or their components, and is critical for induction and regulatory function of IL-10-producing B cells in intestinal homeostasis and inflammation.
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Affiliation(s)
- Akihiko Oka
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
| | - Yoshiyuki Mishima
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
| | - Bo Liu
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Jeremy W Herzog
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Erin C Steinbach
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
| | - Taku Kobayashi
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Minato-ku, Tokyo 108-8642, Japan.
| | - Scott E Plevy
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Synlogic Therapeutics, Boston, MA 02139, USA.
| | - R Balfour Sartor
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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29
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Oka A, Ishihara S, Mikami H, Sonoyama H, Mishiro T, Tobita H, Kawashima K, Miyake T, Ishimura N, Furuta K, Kinoshita Y, Nishina M. Retained Rice Cake: A Unique Upper Gastrointestinal Foreign Body: Case Report and a Literature Review. Intern Med 2019; 58:2485-2494. [PMID: 31178509 PMCID: PMC6761341 DOI: 10.2169/internalmedicine.2760-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
As a rarely recognized foreign body in the upper gastrointestinal tract, rice cake frequently requires endoscopic removal. We herein report six patients with characteristic sonography, computed tomography (CT), spectroscopy, endoscopy, and histological findings. A review of all published cases, including ours, revealed that retained rice cake in the stomach typically shows the following: abdominal pain (93.3%), mucosal injury (93.3%) with bleeding (42.9%); high-density (120-206 Hounsfield units) CT findings; and indication for endoscopy (80%). In the esophagus, hot, toasted rice cake causes thermal injury. Primary physicians should be aware of this popular-food-induced, but rare, disorder.
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Affiliation(s)
- Akihiko Oka
- Department of Emergency and Critical Care Medicine, Shimane University, Faculty of Medicine, Japan
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, USA
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
| | - Hironobu Mikami
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Division of Gastroenterology, National Hospital Organization Hamada Medical Center, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Tsuyoshi Mishiro
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Division of Gastroenterology, National Hospital Organization Hamada Medical Center, Japan
| | - Hiroshi Tobita
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
| | - Tatsuya Miyake
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Division of Hepatology, Shimane Prefectural Central Hospital, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Kenji Furuta
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Otsu Internal Medicine Clinic, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Masayoshi Nishina
- Department of Emergency and Critical Care Medicine, Shimane University, Faculty of Medicine, Japan
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30
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Burgess SL, Oka A, Liu B, Bolick DT, Oakland DN, Guerrant RL, Bartelt L. Intestinal parasitic infection alters bone marrow derived dendritic cell inflammatory cytokine production in response to bacterial endotoxin in a diet-dependent manner. PLoS Negl Trop Dis 2019; 13:e0007515. [PMID: 31260452 PMCID: PMC6602177 DOI: 10.1371/journal.pntd.0007515] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 06/04/2019] [Indexed: 01/09/2023] Open
Abstract
Giardia lamblia is a common intestinal parasitic infection that although often acutely asymptomatic, is associated with debilitating chronic intestinal and extra-intestinal sequelae. In previously healthy adults, a primary sporadic Giardia infection can lead to gut dysfunction and fatigue. These symptoms correlate with markers of inflammation that persist well after the infection is cleared. In contrast, in endemic settings, first exposure occurs in children who are frequently malnourished and also co-infected with other enteropathogens. In these children, Giardia rarely causes symptoms and associates with several decreased markers of inflammation. Mechanisms underlying these disparate and potentially enduring outcomes following Giardia infection are not presently well understood. A body of work suggests that the outcome of experimental Giardia infection is influenced by the nutritional status of the host. Here, we explore the consequences of experimental Giardia infection under conditions of protein sufficiency or deficiency on cytokine responses of ex vivo bone marrow derived dendritic cells (BMDCs) to endotoxin stimulation. We show that BMDCs from Giardia- challenged mice on a protein sufficient diet produce more IL-23 when compared to uninfected controls whereas BMDCs from Giardia challenged mice fed a protein deficient diet do not. Further, in vivo co-infection with Giardia attenuates robust IL-23 responses in endotoxin-stimulated BMDCs from protein deficient mice harboring enteroaggregative Escherichia coli. These results suggest that intestinal Giardia infection may have extra-intestinal effects on BMDC inflammatory cytokine production in a diet dependent manner, and that Giardia may influence the severity of the innate immune response to other enteropathogens. This work supports recent findings that intestinal microbial exposure may have lasting influences on systemic inflammatory responses, and may provide better understanding of potential mechanisms of post-infectious sequelae and clinical variation during Giardia and enteropathogen co-infection.
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Affiliation(s)
- Stacey L. Burgess
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Akihiko Oka
- Center for Gastrointestinal Biology and Disease and the Departments of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Bo Liu
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - David T. Bolick
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - David Noah Oakland
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Richard L. Guerrant
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Luther Bartelt
- Center for Gastrointestinal Biology and Disease and the Departments of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
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31
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Mishima Y, Oka A, Liu B, Herzog JW, Eun CS, Fan TJ, Bulik-Sullivan E, Carroll IM, Hansen JJ, Chen L, Wilson JE, Fisher NC, Ting JP, Nochi T, Wahl A, Garcia JV, Karp CL, Sartor RB. Microbiota maintain colonic homeostasis by activating TLR2/MyD88/PI3K signaling in IL-10-producing regulatory B cells. J Clin Invest 2019; 129:3702-3716. [PMID: 31211700 DOI: 10.1172/jci93820] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Resident microbiota activate regulatory cells that modulate intestinal inflammation and promote and maintain intestinal homeostasis. IL-10 is a key mediator of immune regulatory function. Our studies described the functional importance and mechanisms by which gut microbiota and specific microbial components influenced the development of intestinal IL-10-producing B cells. We used fecal transplant to germ-free (GF) Il10+/EGFP reporter and Il10-/- mice to demonstrate that microbiota from specific pathogen-free mice primarily stimulated IL-10-producing colon-specific B cells and T regulatory-1 cells in ex-GF mice. IL-10 in turn down-regulated microbiota-activated mucosal inflammatory cytokines. TLR2/9 ligands and enteric bacterial lysates preferentially induced IL-10 production and regulatory capacity of intestinal B cells. Analysis of Il10+/EGFP mice crossed with additional gene-deficient strains and B cell co-transfer studies demonstrated that microbiota-induced IL-10-producing intestinal B cells ameliorated chronic T cell-mediated colitis in a TLR2, MyD88 and PI3K-dependent fashion. In vitro studies implicated PI3Kp110δ and AKT downstream signaling. These studies demonstrated that resident enteric bacteria activated intestinal IL-10-producing B cells through TLR2, MyD88 and PI3K pathways. These B cells reduced colonic T cell activation and maintained mucosal homeostasis in response to intestinal microbiota.
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Affiliation(s)
- Yoshiyuki Mishima
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Akihiko Oka
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Bo Liu
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Jeremy W Herzog
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Chang Soo Eun
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Ting-Jia Fan
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,Department of Microbiology and Immunology
| | | | - Ian M Carroll
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,Department of Nutrition
| | - Jonathan J Hansen
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,Department of Microbiology and Immunology
| | - Liang Chen
- Lineberger Comprehensive Cancer Center, Department of Genetics, and
| | - Justin E Wilson
- Lineberger Comprehensive Cancer Center, Department of Genetics, and
| | | | - Jenny Py Ting
- Lineberger Comprehensive Cancer Center, Department of Genetics, and
| | - Tomonori Nochi
- Department of Medicine, Division of Infectious Diseases, UNC, Chapel Hill, North Carolina, USA.,Mucosal Immunology Laboratory, Graduate School of Agricultural Science, Tohoku University, Sendai, Japan
| | - Angela Wahl
- Department of Medicine, Division of Infectious Diseases, UNC, Chapel Hill, North Carolina, USA
| | - J Victor Garcia
- Department of Medicine, Division of Infectious Diseases, UNC, Chapel Hill, North Carolina, USA
| | - Christopher L Karp
- Division of Molecular Immunology, Department of Pediatrics, Cincinnati Children's Hospital Research Center, Cincinnati, Ohio, USA
| | - R Balfour Sartor
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,Department of Microbiology and Immunology
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32
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Sonoyama H, Kawashima K, Ishihara S, Kotani S, Fukuba N, Oka A, Kusunoki R, Tada Y, Mishima Y, Oshima N, Moriyama I, Yuki T, Onishi K, Kinoshita Y. Capabilities of fecal calprotectin and blood biomarkers as surrogate endoscopic markers according to ulcerative colitis disease type. J Clin Biochem Nutr 2019; 64:265-270. [PMID: 31138962 PMCID: PMC6529695 DOI: 10.3164/jcbn.18-92] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/19/2018] [Indexed: 12/15/2022] Open
Abstract
Fecal calprotectin level in ulcerative colitis patients is correlated with endoscopic findings. However, its association with various ulcerative colitis disease types has not been elucidated. In the present study, we investigated the correlation of fecal calprotectin level with endoscopic findings as compared to blood biomarkers according to ulcerative colitis disease type. Fecal calprotectin as well as the blood biomarkers: C-reactive protein (CRP), white blood count (WBC), erythrocyte sedimentation rate (ESR), hemoglobin, platelet count (PLT), and serum albumin (Alb) were measured in patients who underwent a complete colonoscopy. Disease type was divided into proctitis, left-sided colitis, and extensive colitis. Correlations of fecal calprotectin and blood biomarker levels with Mayo endoscopic subscore were analyzed. A total of 186 colonoscopy examinations were performed in 124 patients with ulcerative colitis. Fecal calprotectin level showed a significant correlation with Mayo endoscopic subscore regardless of disease type (proctitis, r = 0.54, p<0.01; left-sided colitis, r = 0.75, p<0.01; extensive colitis, r = 0.78, p<0.01), and clearly discriminated inactive (Mayo endoscopic subscore 0) from active stages (Mayo endoscopic subscore 1–3). On the other hand, none of the examined blood biomarkers showed a correlation with Mayo endoscopic subscore in the proctitis group, while weak correlations of several biomarkers (CRP, WBC, ESR, PLT and Alb) with Mayo endoscopic subscore were found in left-sided colitis and extensive colitis cases. This is the first report to elucidate the capabilities of fecal calprotectin and blood biomarkers as endoscopic surrogate markers according to ulcerative colitis disease type.
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Affiliation(s)
- Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.,Inflammatory Bowel Disease Center, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.,Inflammatory Bowel Disease Center, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Satoshi Kotani
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Ryusaku Kusunoki
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.,Cancer Center, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Koji Onishi
- Division of Internal Medicine, Matsue Seikyo General Hospital, 8-8-8 Nishitsuda, Matsue, Shimane 690-8522, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
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33
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Kagimoto M, Yatsu K, Oka A, Sumida G, Ehara Y, Ooki Y, Hirawa N, Sugano T, Ishigami T, Ishikawa T, Tamura K. 2353Plasma lysoGb3 useful as biomarker in screening for Fabry disease in patients with mild left ventricular hypertrophy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Kagimoto
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - K Yatsu
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - A Oka
- Tokai University, The Institute of Medical Sciences, Isehara, Japan
| | - G Sumida
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - Y Ehara
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - Y Ooki
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - N Hirawa
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - T Sugano
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - T Ishigami
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - T Ishikawa
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - K Tamura
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
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34
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Ishihara S, Tada Y, Kawashima K, Kataoka M, Sonoyama H, Yamashita N, Oka A, Kusunoki R, Fukuba N, Mishima Y, Oshima N, Moriyama I, Yuki T, Kinoshita Y. Serum amyloid A level correlated with endoscopic findings in patients with Crohn's disease-Possible biomarker for evaluating mucosal healing. Dig Liver Dis 2018; 50:553-558. [PMID: 29311027 DOI: 10.1016/j.dld.2017.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 09/24/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mucosal healing (MH) has been proposed as an essential therapeutic goal for treatment of Crohn's disease (CD) patients. The utility of serum amyloid A (SAA) for prediction of MH in CD patients is lacking. AIMS This study was conducted to evaluate the correlation of SAA with CD-related endoscopic disease activity. METHODS SAA levels in serum samples obtained from CD patients as well as endoscopic findings based on a simple endoscopic score for CD (SES-CD) were assessed in relation to CD activity index (CDAI). The diagnostic ability of MH in correlation with SAA level was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS Fifty-five patients with CD were enrolled. Mean SAA level was significantly higher in clinical and endoscopic active phases as compared to an inactive phase. SAA level was also significantly correlated with SES-CD (r = 0.64, p < 0.01) and CDAI (r = 0.42, p < 0.01). The area under the ROC curve for SAA level was 0.77 and the optimal cut-off value for SAA to predict MH was 5.9 μg/dl. SAA level was shown to be associated with MH, with a sensitivity of 68% and specificity of 83%. CONCLUSIONS SAA may be a possible biomarker for evaluating MH in CD patients.
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Affiliation(s)
- Shunji Ishihara
- Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Japan; Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan.
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kousaku Kawashima
- Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Japan; Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masatoshi Kataoka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Noritsugu Yamashita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Ryusaku Kusunoki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan; Cancer Center, Shimane University Hospital, Izumo, Japan
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
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Fukunaga M, Ishimura N, Fukuyama C, Izumi D, Ishikawa N, Araki A, Oka A, Mishiro T, Ishihara S, Maruyama R, Adachi K, Kinoshita Y. Celiac disease in non-clinical populations of Japan. J Gastroenterol 2018; 53:208-214. [PMID: 28389733 DOI: 10.1007/s00535-017-1339-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 12/04/2016] [Accepted: 03/28/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Celiac disease is a chronic autoimmune enteropathy caused by gluten ingestion. While its prevalence in Western countries is reported to be as high as 1%, the prevalence has not been evaluated in a large-scale study of a Japanese population. The aim of our study was to clarify the possible presence of celiac disease in a Japanese non-clinical population as well as in patients showing symptoms suggestive of the disease. METHODS Serum samples were collected from 2008 non-clinical adults and 47 patients with chronic unexplained abdominal symptoms between April 2014 and June 2016. The anti-tissue transglutaminase (TTG) immunoglobulin A antibody titer was determined as a screening test for celiac disease in all subjects, and individuals with a value of >2 U/mL subsequently underwent testing for the presence of serum endomysial IgA antibody (EMA) as confirmation. Those testing positive for EMA or with a high concentration (>10 U/mL) of TTG were further investigated by histopathological examinations of duodenal mucosal biopsy specimens and HLA typing tests. RESULTS Of the 2008 non-clinical adults from whom serum samples were collected, 161 tested positive for TTG, and all tested negative for EMA. Four subjects who had a high TTG titer were invited to undergo confirmatory testing, and the histopathological results confirmed the presence of celiac disease in only a single case (0.05%). Of the 47 symptomatic patients, one (2.1%) was found to have a high TTG titer and was diagnosed with celiac disease based on duodenal histopathological findings. CONCLUSION The presence of celiac disease in a non-clinical Japanese population was low at 0.05% and was rarely found in patients with unexplained chronic abdominal symptoms.
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Affiliation(s)
- Mai Fukunaga
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Chika Fukuyama
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Daisuke Izumi
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Nahoko Ishikawa
- Department of Pathology, Shimane University School of Medicine, Izumo, Japan
| | - Asuka Araki
- Department of Pathology, Shimane University School of Medicine, Izumo, Japan
| | - Akihiko Oka
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Tomoko Mishiro
- Health Center, Shimane Environment and Health Public Corporation, Matsue, Japan
| | - Shunji Ishihara
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Riruke Maruyama
- Department of Pathology, Shimane University School of Medicine, Izumo, Japan
| | - Kyoichi Adachi
- Health Center, Shimane Environment and Health Public Corporation, Matsue, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
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Mikami H, Ishimura N, Oka A, Moriyama I, Yuki T, Kawashima K, Sato S, Ishihara S, Kinoshita Y. Successful Transanal Removal of a Rectal Foreign Body by Abdominal Compression under Endoscopic and X-Ray Fluoroscopic Observation: A Case Report. Case Rep Gastroenterol 2016; 10:646-652. [PMID: 27920656 PMCID: PMC5126614 DOI: 10.1159/000452210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/13/2016] [Accepted: 10/03/2016] [Indexed: 12/03/2022] Open
Abstract
We occasionally encounter patients with various types of rectal foreign bodies. When too large to grasp, transanal removal can be difficult. Here, we report a case of successful manual transanal removal of an 18 × 4 × 4 cm silicon rod without complications. A 50-year-old male came to the emergency department of our hospital 12 h after transanal insertion of a whole silicon rod. An abdominal examination showed no evidence of peritonitis, while X-ray and computed tomography findings revealed a large foreign body in the rectum, without any sign of perforation. Initially, we attempted removal using an endoscopy procedure with conventional endoscopic instruments, including a snare and grasp forceps, though we failed because of the large size. Next, we manually compressed the foreign body from the abdominal wall under endoscopic and X-ray fluoroscopic observation, and successfully removed it in a transanal manner without complications. Endoscopic and X-ray fluoroscopic assistance were helpful to guide the direction and angle of abdominal compression in this case.
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Affiliation(s)
- Hironobu Mikami
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Akihiko Oka
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | | | - Takafumi Yuki
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan; Division of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Kousaku Kawashima
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Shuichi Sato
- Division of Gastrointestinal Endoscopy, Shimane University Hospital, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
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Yamaguchi Y, Torisu H, Kira R, Ishizaki Y, Sakai Y, Sanefuji M, Ichiyama T, Oka A, Kishi T, Kimura S, Kubota M, Takanashi J, Takahashi Y, Tamai H, Natsume J, Hamano S, Hirabayashi S, Maegaki Y, Mizuguchi M, Minagawa K, Yoshikawa H, Kira J, Kusunoki S, Hara T. A nationwide survey of pediatric acquired demyelinating syndromes in Japan. Neurology 2016; 87:2006-2015. [PMID: 27742816 PMCID: PMC5109945 DOI: 10.1212/wnl.0000000000003318] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 07/28/2016] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate the clinical and epidemiologic features of pediatric acquired demyelinating syndromes (ADS) of the CNS in Japan. Methods: We conducted a nationwide survey and collected clinical data on children with ADS aged 15 years or younger, who visited hospitals between 2005 and 2007. Results: Among 977 hospitals enrolled, 723 (74.0%) responded to our inquiries and reported a total of 439 patients as follows: 244 with acute disseminated encephalomyelitis (ADEM), 117 with multiple sclerosis (MS), 14 with neuromyelitis optica (NMO), and 64 with other ADS. We collected and analyzed detailed data from 204 cases, including those with ADEM (66), MS (58), and NMO (10). We observed the following: (1) the estimated annual incidence rate of pediatric ADEM in Japan was 0.40 per 100,000 children (95% confidence interval [CI], 0.34–0.46), with the lowest prevalence in the north; (2) the estimated prevalence rate of MS was 0.69 per 100,000 children (95% CI, 0.58–0.80), with the lowest prevalence in the south; (3) NMO in Japan was rare, with an estimated prevalence of 0.06 per 100,000 children (95% CI, 0.04–0.08); and (4) the sex ratio and mean age at onset varied by ADS type, and (5) male/female ratios correlated with ages at onset in each ADS group. Conclusions: Our results clarify the characteristic clinical features of pediatric ADS in the Japanese population.
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Affiliation(s)
- Y Yamaguchi
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - H Torisu
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
| | - R Kira
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Y Ishizaki
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Y Sakai
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - M Sanefuji
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - T Ichiyama
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - A Oka
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - T Kishi
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - S Kimura
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - M Kubota
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - J Takanashi
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Y Takahashi
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - H Tamai
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - J Natsume
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - S Hamano
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - S Hirabayashi
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Y Maegaki
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - M Mizuguchi
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - K Minagawa
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - H Yoshikawa
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - J Kira
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - S Kusunoki
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - T Hara
- From the Department of Pediatrics (Y.Y., H. Torisu, R.K., Y.I., Y.S., M.S., T.H.) and Department of Neurology, Neurological Institute (J.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics (H. Torisu), Fukuoka Dental College Medical and Dental Hospital, Fukuoka; Department of Pediatrics (T.I.), Yamaguchi University Graduate School of Medicine, Ube; Department of Pediatrics (A.O.), Kyorin University School of Medicine, Hachioji; Department of Pediatrics (T.K.), Tokyo Women's Medical University, Tokyo; Department of Child Development Pediatrics (S. Kimura), Kumamoto University Graduate School, Kumamoto; Division of Neurology (M.K.), National Center for Child Health and Development, Tokyo; Department of Pediatrics (J.T.), Kameda Medical Center, Kamogawa; National Epilepsy Center (Y.T.), Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka; Department of Pediatrics (H. Tamai), Osaka Medical College, Takatsuki; Department of Pediatrics (J.N.), Nagoya University Graduate School of Medicine, Nagoya; Department of Neurology (S. Hamano), Saitama Children's Medical Center, Saitama; Department of Neurology (S. Hirabayashi), Nagano Children's Hospital, Azumino; Division of Child Neurology (Y.M.), Faculty of Medicine, Tottori University, Yonago; Department of Developmental Medical Sciences (M.M.), Graduate School of Medicine, The University of Tokyo; Department of Pediatrics (K.M.), Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo; Department of Pediatric Neurology (H.Y.), Nagaoka Habilitation and Medical Center for Severely Handicapped Children, Nagaoka; and Department of Neurology (S. Kusunoki), Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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Tada Y, Ishihara S, Kawashima K, Fukuba N, Sonoyama H, Kusunoki R, Oka A, Mishima Y, Oshima N, Moriyama I, Yuki T, Ishikawa N, Araki A, Harada Y, Maruyama R, Kinoshita Y. Downregulation of serotonin reuptake transporter gene expression in healing colonic mucosa in presence of remaining low-grade inflammation in ulcerative colitis. J Gastroenterol Hepatol 2016; 31:1443-52. [PMID: 26676714 DOI: 10.1111/jgh.13268] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 07/12/2015] [Revised: 10/19/2015] [Accepted: 12/05/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The serotonin reuptake transporter (SERT) terminates serotonin activity by removing it from interstitial space. Downregulated colonic SERT expression has been reported in irritable bowel disease (IBS), and symptoms resembling IBS occur in cases of inflammatory bowel disease (IBD) in remission; thus, a common pathogenesis for IBS and IBD is possible. However, little is known regarding SERT expression in colonic mucosa of IBD patients during healing. METHODS Twenty-two ulcerative colitis (UC) patients underwent colonoscopy examinations, during which inflamed mucosa was distinguished from that undergoing healing. Healing mucosa was classified into regular and irregular vessel patterns by narrowband imaging magnifying colonoscopy. Expressions of SERT and various inflammation-related genes in biopsy samples were assessed using a polymerase chain reaction array system and real-time polymerase chain reaction. Colitis model mice were established by administration of dextran sodium sulfate or transfer of CD4(+) T cells isolated from SAMP1 mice, then time-course changes of SERT and inflammatory gene expressions were observed in colonic mucosa. RESULTS In UC patients, SERT expression in inflamed mucosa was significantly lower than in healing mucosa. SERT expression was decreased in healing mucosa with an irregular vessel pattern with mildly increased levels of inflammatory gene expression. In mice, SERT expression was suppressed in inflamed mucosa and continuously observed with low-grade mucosal inflammation during colitis healing. CONCLUSIONS Sserotonin reuptake transporter expression is downregulated in healing colonic mucosa of UC patients and that suppression may be dependent on the presence of remaining low-grade colonic inflammation.
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Affiliation(s)
- Yasumasa Tada
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Ryusaku Kusunoki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan.,Cancer Center, Shimane University Hospital, Izumo, Japan
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
| | - Noriyoshi Ishikawa
- Department of Organ Pathology, Shimane University Faculty of Medicine, Matsue, Japan
| | - Asuka Araki
- Department of Organ Pathology, Shimane University Faculty of Medicine, Matsue, Japan
| | - Yuji Harada
- Department of Pathology Laboratory, Shimane University Hospital, Izumo, Japan
| | - Riruke Maruyama
- Department of Organ Pathology, Shimane University Faculty of Medicine, Matsue, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Matsue, Japan
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39
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Kawashima K, Adachi K, Onishi K, Fukuda K, Kazumori H, Ohno Y, Katoh T, Sonoyama H, Tada Y, Kusunoki R, Oka A, Fukuba N, Oshima N, Yuki T, Ishihara S, Kinoshita Y. Usefulness of computed tomography with air insufflation of the stomach prior to percutaneous endoscopic gastrostomy procedure. J Clin Biochem Nutr 2016; 58:246-50. [PMID: 27257351 PMCID: PMC4865598 DOI: 10.3164/jcbn.15-145] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022] Open
Abstract
We examined the results of computed tomography (CT) with and without air insufflation of the stomach prior to performing percutaneous endoscopic gastrostomy (PEG). We retrospectively analyzed 366 patients who underwent PEG. CT images obtained with and without air insufflation were examined for the presence or absence of contact between the gastric anterior wall and abdominal wall. PEG outcome based on CT findings was also examined. CT with and without air insufflation was performed in 272 and 94 patients, respectively. Contact between the gastric anterior wall and abdominal wall was shown in 254 (93.4%) with and 45 (47.9%) without air insufflation, all of whom underwent a successful PEG procedure. In patients without contact between the gastric anterior wall and abdominal wall, PEG was not successful in 3 of 49 (6.1%) examined by CT without and 6 of 18 (33.3%) examined with air insufflation (p = 0.004). Values for diagnostic accuracy for contact between the gastric anterior wall and abdominal wall shown by CT with and without air insufflation in successful PEG cases were 0.96 and 0.51, respectively. In conclusion, CT with air insufflation more often revealed contact between the gastric anterior wall and abdominal wall as compared to CT without air insufflation, which may help to predict PEG procedure success.
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Affiliation(s)
- Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan; Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Kyoichi Adachi
- Health Center, Shimane Environment and Health Public Corporation, Matsue, Shimane 690-0012, Japan
| | - Koji Onishi
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Kosuke Fukuda
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Hideaki Kazumori
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Yasuhiko Ohno
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Takao Katoh
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Ryusaku Kusunoki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
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Kawashima K, Ishihara S, Yuki T, Fukuba N, Oshima N, Kazumori H, Sonoyama H, Yamashita N, Tada Y, Kusunoki R, Oka A, Mishima Y, Moriyama I, Kinoshita Y. Fecal calprotectin level correlated with both endoscopic severity and disease extent in ulcerative colitis. BMC Gastroenterol 2016; 16:47. [PMID: 27071448 PMCID: PMC4830074 DOI: 10.1186/s12876-016-0462-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/07/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The relationship between fecal calprotectin (FC) and disease extent in ulcerative colitis (UC) has not been fully elucidated. The aim of this study was to clarify the correlation of FC with disease extent and severity in UC patients. METHODS UC patients scheduled to undergo an ileocolonoscopy were enrolled and fecal samples for FC measurement were collected prior to the procedure. A Mayo endoscopic subscore (MES) was determined for each of 5 colonic segments. To evaluate the association of FC with extent of affected mucosa as well as disease severity, we assessed the correlation of FC level with the sum of MES (S-MES) for the 5 colonic segments as compared to the maximum score of MES (M-MES). RESULTS FC measurements in conjunction with findings from 136 complete colonoscopies in 102 UC patients were evaluated. FC level showed a stronger correlation with S-MES (correlation coefficient r = 0.86, p < 0.001) as compared to M-MES (r = 0.79, p < 0.001). In patients with an M-MES of 1, 2, and 3, FC level showed a significant correlation with S-MES (r = 0.67, p < 0.001; r = 0.70, p < 0.001; r = 0.47, p = 0.04, respectively). Our findings indicate that FC level is elevated in patients with greater areas of affected mucosa even in those with the same M-MES value. CONCLUSIONS FC level was shown to be correlated with the extent of affected mucosa as well as severity in UC patients, thus it is useful for precise assessment of mucosal inflammation.
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Affiliation(s)
- Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Hideaki Kazumori
- Division of Internal Medicine, Matsue Seikyo General Hospital, 8-8-8, Nishitsuda, Matsue, 690-8522 Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Noritsugu Yamashita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Ryusaku Kusunoki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
- Cancer center, Shimane University Hospital, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
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Mishima Y, Ishihara S, Oka A, Fukuba N, Oshima N, Sonoyama H, Yamashita N, Tada Y, Kusunoki R, Moriyama I, Yuki T, Kawashima K, Kinoshita Y. Decreased Frequency of Intestinal Regulatory CD5+ B Cells in Colonic Inflammation. PLoS One 2016; 11:e0146191. [PMID: 26727001 PMCID: PMC4705109 DOI: 10.1371/journal.pone.0146191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/13/2015] [Indexed: 02/06/2023] Open
Abstract
Background CD5+ B cells are a type of regulatory immune cells, though the involvement of this B cell subset in intestinal inflammation and immune regulation is not fully understood. Methods We examined the distribution of CD5+ B cells in various mouse organs. Expression levels of CD11b, IgM, and toll-like receptor (TLR)-4 and -9 in B cells were evaluated. In vitro, TLR-stimulated IL-10 production by colonic lamina propria (LP) CD5+ and CD5- B cells was measured. In vivo, mice with acute or chronic dextran sulfate sodium (DSS)-induced colonic injury were examined, and the frequency of colonic LP CD5+ B cells in those was assessed by flow cytometry. Results The expression level of TLR9 was higher in colonic LP CD5+ B cells as compared to CD5- B cells. Colonic LP CD5+ B cells produced greater amounts of IL-10 following stimulation with TLR ligands, especially TLR9, as compared with the LP CD5- B cells. Acute intestinal inflammation transiently decreased the frequency of colonic LP CD5+ B cells, while chronic inflammation induced a persistent decrease in colonic LP CD5+ B cells and led to a CD5- B cell-dominant condition. Conclusion A persistent altered mucosal B cell population caused by chronic gut inflammation may be involved in the pathogenesis of inflammatory bowel diseases.
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Affiliation(s)
- Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Noritsugu Yamashita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ryusaku Kusunoki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.,Cancer Center, Shimane University Hospital, Izumo, Shimane, Japan
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Fukuba N, Moriyama I, Ishihara S, Sonoyama H, Yamashita N, Tada Y, Oka A, Oshima N, Yuki T, Kawashima K, Kinoshita Y. Primary Pancreatic Malignant Lymphoma Diagnosed from Endoscopic Ultrasound-guided Fine-needle Aspiration Findings. Intern Med 2016; 55:31-5. [PMID: 26726082 DOI: 10.2169/internalmedicine.55.5749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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 60-year-old woman was admitted to our hospital with upper abdominal pain and jaundice. Computed tomography showed a 9-cm mass that was penetrated by the common hepatic artery in the pancreatic head area. Endoscopic retrograde pancreatography revealed no stenosis or obstruction of the main pancreatic duct, and a cytologic examination of the patient's pancreatic juice was negative. Next, endoscopic ultrasound-guided fine needle aspiration was performed. The immunohistological findings of the specimen revealed a diffuse large B-cell lymphoma. The size of the tumor was significantly reduced after 8 cycles of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone).
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MESH Headings
- Abdominal Pain/diagnostic imaging
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Endoscopic Ultrasound-Guided Fine Needle Aspiration
- Female
- Humans
- Jaundice/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Pancreatic Ducts/pathology
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/drug therapy
- Pancreatic Neoplasms/pathology
- Prednisone/administration & dosage
- Radiography, Abdominal
- Rituximab
- Tomography, X-Ray Computed
- Treatment Outcome
- Vincristine/administration & dosage
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Affiliation(s)
- Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University School of Medicine, Japan
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Akamatsu H, Koh Y, Shibaki R, Tabata K, Kogure M, Tanaka A, Oka A, Kanai K, Kikuchi T, Hayata A, Akamatsu K, Ueda H, Nakanishi M, Yamamoto N. 487P Establishment of novel multiplexed assay to detect EGFR mutations using ultra-sensitive digital PCR. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv533.06] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Komiyama T, Hirokawa T, Sato K, Oka A, Kamiguchi H, Nagata E, Sakura H, Otsuka K, Kobayashi H. The Clinical Study for Genetic Evaluation of α2B-AR Gene Polymorphism in Neurally Mediated Syncope. Auton Neurosci 2015. [DOI: 10.1016/j.autneu.2015.07.151] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kusunoki R, Ishihara S, Tada Y, Oka A, Sonoyama H, Fukuba N, Oshima N, Moriyama I, Yuki T, Kawashima K, Ansary MMU, Tajima Y, Maruyama R, Nabika T, Kinoshita Y. Role of milk fat globule-epidermal growth factor 8 in colonic inflammation and carcinogenesis. J Gastroenterol 2015; 50:862-75. [PMID: 25596854 DOI: 10.1007/s00535-014-1036-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 09/18/2014] [Accepted: 12/24/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Milk fat globule-epidermal growth factor 8 (MFG-E8) promotes phagocytic clearance of apoptotic cells to maintain normal tissue homeostasis. However, its functions in intestinal inflammation and carcinogenesis are unknown. METHODS Experimental colitis was induced in MFG-E8 knockout (KO) and wild-type (WT) mice by dextran sodium sulfate (DSS) administration. Colon tissues were used for assessments of colitis activity and epithelial proliferation. A mouse colitis-associated cancer (CAC) model was induced by intraperitoneal injection of azoxymethane (AOM) and then the animals were given a single administration of DSS. A sporadic colon cancer model was established by repeated intraperitoneal injections of AOM. The role of MFG-E8 in epithelial proliferation with or without treatment of siRNA targeting α(v)-integrin was examined in vitro using a WST-1 assay. RESULTS The severity of colitis in KO mice was greater than that in WT mice, while the proliferative potential of colonic epithelial cells in KO mice was lower during the regenerative phase. In both CAC and sporadic models, tumor size in KO was lower as compared to WT mice, while decreased tumor incidence was only found in the CAC model. In vitro findings showed that MFG-E8 promotes epithelial cell proliferation, and treatment with a siRNA targeting α(v)-integrin reduced the proliferation of Colon-26 cells stimulated with recombinant MFG-E8. CONCLUSIONS MFG-E8 promotes tumor growth regardless of the presence or absence of colonic inflammation, whereas colon tumor development is initiated by MFG-E8 under inflammatory conditions. These MFG-E8 functions may be dependent on integrin-mediated cellular signaling.
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Affiliation(s)
- Ryusaku Kusunoki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, Japan
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Oka A, Okazaki K, Takeno A, Kumanomido S, Kusunoki R, Sato S, Ishihara S, Kinoshita Y, Nishina M. Crowned Dens Syndrome: Report of Three Cases and a Review of the Literature. J Emerg Med 2015; 49:e9-e13. [PMID: 25910825 DOI: 10.1016/j.jemermed.2015.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 10/14/2014] [Revised: 01/14/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with crowned dens syndrome (CDS), which is pseudogout of the atlantoaxial junction induced by "crown-like" calcifications around the dens, present with symptoms of severe neck pain, rigidity, and high fever. CDS patients are often misdiagnosed as having meningitis or polymyalgia rheumatica, leading to potentially unnecessary invasive procedures for diagnosis and treatment. CASE REPORT We report 3 patients with CDS who had characteristic findings on computed tomography (CT), all of whom quickly recovered with nonsteroidal antiinflammatory drug (NSAID) administration. In addition, we reviewed 72 published cases, including our patients. CDS typically occurs in elderly people (mean age 71.4 years). Common symptoms include neck pain (100%), neck rigidity (98%), and fever (80.4%), and most show elevated inflammatory markers (88.3%) on serum laboratory tests. Neck pain on rotation is a characteristic and helpful symptom in the diagnosis. The most useful modality is CT (97.1%), showing linear calcium deposits around the dens, mostly in the transverse ligament of atlas (TLA). CT number is especially helpful to distinguish a normal TLA (35-110 HU) from a calcified one (202-258 HU) in our cases. The most effective treatment is NSAID administration (85%), which usually leads to marked resolution of symptoms within days or weeks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Due to acute and severe symptoms, CDS patients often present to an emergency department. To avoid unnecessary invasive procedures for diagnosis and treatment, CDS should be considered in the differential diagnosis of febrile neck pain.
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Affiliation(s)
- Akihiko Oka
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Koichi Okazaki
- Fourth Department of Internal Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Ayumu Takeno
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Satoshi Kumanomido
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Ryusaku Kusunoki
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Shuichi Sato
- Second Department of Internal Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Shunji Ishihara
- Second Department of Internal Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Yoshikazu Kinoshita
- Second Department of Internal Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
| | - Masayoshi Nishina
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Shimane University, Enya-cho, Izumo-City, Shimane Prefecture, Japan
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Yasudo H, Ando T, Takeuchi M, Nakano H, Itonaga T, Takehara H, Isojima T, Miura K, Harita Y, Takita J, Oka A. Systemic lupus erythematosus complicated with liver cirrhosis in a patient with Papillon-Lefèvre syndrome. Lupus 2014; 23:1523-7. [DOI: 10.1177/0961203314547794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report the first case of a girl who presented with Papillon-Lefèvre syndrome (PLS) and subsequently developed systemic lupus erythematosus and liver cirrhosis. This indicates that autoimmune diseases can be a complication in patients with PLS. Cathepsin C gene mutations were not found in our patient or her mother. Thus, other genetic factors may have been involved in this patient.
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Affiliation(s)
- H Yasudo
- Department of Pediatrics, Tokyo University Graduate School of Medicine, Tokyo, Japan
| | - T Ando
- Department of Pediatrics, Tokyo University Graduate School of Medicine, Tokyo, Japan
- Laboratory for Allergic Disease, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | | | - H Nakano
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - T Itonaga
- Department of Pediatrics, Tokyo University Graduate School of Medicine, Tokyo, Japan
| | - H Takehara
- Department of Pediatrics, Tokyo University Graduate School of Medicine, Tokyo, Japan
| | - T Isojima
- Department of Pediatrics, Tokyo University Graduate School of Medicine, Tokyo, Japan
| | - K Miura
- Department of Pediatrics, Tokyo University Graduate School of Medicine, Tokyo, Japan
| | - Y Harita
- Department of Pediatrics, Tokyo University Graduate School of Medicine, Tokyo, Japan
| | - J Takita
- Department of Pediatrics, Tokyo University Graduate School of Medicine, Tokyo, Japan
| | - A Oka
- Department of Pediatrics, Tokyo University Graduate School of Medicine, Tokyo, Japan
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Ishihara S, Tada Y, Fukuba N, Oka A, Kusunoki R, Mishima Y, Oshima N, Moriyama I, Yuki T, Kawashima K, Kinoshita Y. Pathogenesis of irritable bowel syndrome--review regarding associated infection and immune activation. Digestion 2014; 87:204-11. [PMID: 23712295 DOI: 10.1159/000350054] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 02/04/2023]
Abstract
There is increasing evidence regarding the role of immune activation in the etiology of irritable bowel syndrome (IBS), which has been mainly been shown in studies investigating mechanisms of postinfectious IBS (PI-IBS). Exposure to intestinal infection induces persistent low-grade systemic and mucosal inflammation, which is characterized by an altered population of circulating cells, mucosal infiltration of immune cells and increased production of various cytokines in IBS patients. Recent studies have also indicated an increased innate immune response in these patients by evaluating expression and activation of Toll-like receptors (TLRs). These findings suggest that immune activation may play a crucial role in the pathogenesis of IBS. In addition, psychological stress has been reported to be one of the factors that induces immune activation. However, it remains unknown whether immune activation in IBS patients is largely dependent on infectious gastroenteritis and/or psychological stress. Additional studies are necessary to understand the precise mechanism of immune activation and its relationship to the development of IBS.
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Affiliation(s)
- Shunji Ishihara
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Izumo, Japan.
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49
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Fukuba N, Yuki T, Ishihara S, Sonoyama H, Tada Y, Kusunoki R, Oka A, Oshima N, Moriyama I, Kawashima K, Kinoshita Y. Gastric mixed adenoneuroendocrine carcinoma with a good prognosis. Intern Med 2014; 53:2585-8. [PMID: 25400179 DOI: 10.2169/internalmedicine.53.3328] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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 flat, elevated lesion measuring 5 mm in diameter was found in the gastric body of an 80-year-old man. A biopsy showed moderately differentiated adenocarcinoma, and endoscopic ultrasonography revealed a hypoechoic mass located in the submucosa. Endoscopic submucosal dissection was subsequently performed, and a pathological examination revealed a tumor composed of adenocarcinoma and neuroendocrine carcinoma with submucosal infiltration. The pathological diagnosis was gastric mixed adenoneuroendocrine carcinoma (MANEC). An additional gastrectomy procedure was performed, and no recurrence was noted for at least three years. This case is interesting with respect to the carcinogenesis of endocrine cell carcinoma and MANEC.
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Affiliation(s)
- Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University School of Medicine, Japan
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