記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞潰瘍性大腸炎およびクローン病を含む炎症性腸疾患(IBD)は,単なる症状の改善にとどまらず,内視鏡的な治癒を目指すことにより予後が改善することが証明されている.したがって内視鏡的活動性の把握が重要であり,内視鏡重症度の代替マーカーである,血中,便中マーカーをそれぞれ上手に使いこなすことが肝要である.一方で各マーカーの注意点があり,血中マーカーではCRPだけでなく,近年LRGが利用可能となり,実臨床での活用が期待される.また便中マーカーはとくに疾患活動性が落ちてきたステージでの利用がより有用であり,内視鏡的寛解の判断に強みをもつ.IBD診療においては,各マーカーの長所,注意点に習熟し,より良いモニタリングを行うことが求められる.

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記述言語：日本語   出版者・発行元：(株)先端医学社  

5-アミノサリチル酸(5-ASA)製剤は,安全性が高く,使用しやすい薬剤であり,炎症性腸疾患(IBD),とくに潰瘍性大腸炎においては,軽症～中等症の治療薬の第一選択薬として,寛解導入から寛解維持まで広く用いられている.わが国では,現在使用できる5-ASA製剤は4種類あり,各薬剤の特徴を理解したうえで,病勢や患者の状況に合わせて薬剤の選択をしていく.IBD患者の増加に伴い,5-ASA製剤の使用頻度は今後,さらに増していくであろう一方で,近年は5-ASA製剤の不耐症例も増加している.不耐の特徴や対処法に関する知識も必要とされ,適切な対応を取ることも求められている.(著者抄録)

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

近年,高齢潰瘍性大腸炎(UC)患者数が増加しており,特に若年発症して長期経過を追っている高齢UC症例と異なり,高齢になって新規に発症したUCは治療に難渋する症例が少なくない.また年齢だけで高齢者の全身状態を判断することはできず,症例によって脆弱性やリスクが異なるため,注意が必要である.現在使用できる治療薬はいずれも高齢者を対象とした試験を経ず保険収載されており,リアルワールドデータを基に有効性,安全性の判断をせざるを得ない.高齢者特有の併存疾患の管理,ポリファーマシーと相互作用,認知症,身体機能低下,易感染状態などのリスクを考慮し,重篤な状態になる前に常に早期介入を心掛ける必要がある.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J01118&link_issn=&doc_id=20221116250003&doc_link_id=10.11405%2Fnisshoshi.119.992&url=https%3A%2F%2Fdoi.org%2F10.11405%2Fnisshoshi.119.992&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

近年,高齢潰瘍性大腸炎(UC)患者数が増加しており,特に若年発症して長期経過を追っている高齢UC症例と異なり,高齢になって新規に発症したUCは治療に難渋する症例が少なくない.また年齢だけで高齢者の全身状態を判断することはできず,症例によって脆弱性やリスクが異なるため,注意が必要である.現在使用できる治療薬はいずれも高齢者を対象とした試験を経ず保険収載されており,リアルワールドデータを基に有効性,安全性の判断をせざるを得ない.高齢者特有の併存疾患の管理,ポリファーマシーと相互作用,認知症,身体機能低下,易感染状態などのリスクを考慮し,重篤な状態になる前に常に早期介入を心掛ける必要がある.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01118&link_issn=&doc_id=20221116250003&doc_link_id=%2Fck8syokb%2F2022%2F011911%2F003%2F0992-1003%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fck8syokb%2F2022%2F011911%2F003%2F0992-1003%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)自然科学社  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective Transabdominal ultrasonography (TUS) is a non-invasive procedure that is reportedly useful for managing ulcerative colitis (UC) and assessing bowel wall thickness (BWT), the most common measure of mucosal inflammation. However, the exact range of BWT that reflects disease activity remains undetermined. The present study clarified the BWT due to disease activity by comparing the use of TUS in each segment of the colon versus using colonoscopy (CS) and determined the usefulness of TUS in patients with UC. Methods We divided the colon into five segments and measured the BWT using TUS. The results were then compared to the Mayo endoscopic subscore (MES) classification to determine the accuracy of BWT measurement. Patients Eighty patients with UC who underwent TUS within 14 days of CS were retrospectively registered. Results We evaluated a total of 268 images depicting each segment among 80 patients with UC. The BWT was positively correlated with endoscopic activity (0.69, p<0.0001). In each segment, the relationship between a BWT>2 mm and an MES>0 had the highest sensitivity, specificity, and accuracy (0.85-1.00, 0.67-0.92, and 0.81-0.97, respectively). Conclusion This study concluded that TUS was a useful method of detecting an MES>0, which indicates the presence of inflammation and its location among UC patients. MES>0 was found to be highly accurate when a BWT>2 mm was considered positive. This non-invasive method may help control disease activity in patients with UC.

DOI： 10.2169/internalmedicine.8827-21

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Double balloon enteroscopy (DBE) with retrograde contrast is useful as a monitoring tool for small intestinal lesions in Crohn's disease (CD), but these are burdensome for patients. Intestinal ultrasound (IUS) can be used with ease in daily clinical practice, but there is less evidence regarding the accuracy of detection of small intestinal stenosis in CD. This study aimed to examine the diagnostic power of IUS for small intestinal stenosis in patients with CD. METHODS: The findings of DBE and IUS in 86 patients with CD with small intestinal lesions were evaluated. Using DBE as the reference standard, we examined the detection rate of IUS for small intestinal stenosis. We evaluated three parameters: luminal narrowing, prestenotic dilation, and to-and-fro movement for determining stenosis using IUS. In addition, we compared the characteristics between the stenosis-detectable and stenosis-undetectable groups by IUS. RESULTS: Of the 86 patients, 30 had small intestinal stenosis. In IUS findings, when lesions that met two or more of the three parameters were judged as stenosis, the detection rate was 70.0% for sensitivity, 98.2% for specificity, and 88.4% for accuracy. Moreover, there were patients with a younger age at diagnosis (P < 0.05) and more ileocolonic disease location (P < 0.05) in the stenosis-detectable group by IUS. The stenoses detected by IUS were significantly longer than those undetected by IUS (14.1 mm versus 5.2 mm, P < 0.05). CONCLUSIONS: IUS delivered reliable results for clinically important small intestinal stenosis of CD with high diagnostic accuracy.

DOI： 10.1002/jum.16038

PubMed

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Anti-programmed death 1/programmed death ligand 1 (PD1/PD-L1) antibodies have been successfully used as treatment agents for several solid tumors; however, it is difficult to predict their effectiveness. We evaluated whether biopsy specimens could predict the positive status of PD-L1 in surgically resected tissue. METHODS: Among 91 patients who underwent tissue sampling with endoscopic or liver biopsy before surgery for biliary tract neoplasms in an academic center, 45 (49%) patients were selected for retrospective analysis because the quality and quantity of their biopsy specimens were adequate for histologic evaluation. We performed immunohistochemical staining to investigate the PD-L1 expression in both resected and biopsy specimens. The percentage of the positively stained cells was calculated for subsequent use in the correlation investigation. RESULTS: The biopsy methods were endoscopic retrograde cholangiopancreatography (ERCP) in 28 cases, percutaneous liver biopsy in 10 cases, and endoscopic ultrasound fine-needle aspiration in 7 cases. Among the 45 patients, when patients with > 10% positive tumor cells in surgically resected tissues were regarded as truly positive PD-L1, the positive and negative concordance rates between surgically resected tissues and biopsy samples were 56% (5/9) and 100% (36/36), respectively. With regard to the use of preoperative biopsy as a diagnostic tool, all (5/5) PD-L1-positive patients had a positive resected specimen. The accuracy of each biopsy method was as follows: ERCP, 89% (25/28); fine-needle aspiration, 86% (6/7); and liver biopsy, 100% (10/10). CONCLUSIONS: Biopsy samples could be a surrogate material for the assessment of the PD-L1 expression with substantial positive and high negative concordance rates.

DOI： 10.1007/s11605-021-05197-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Metformin, a commonly prescribed drug for type 2 diabetes mellitus, has been shown to activate AMP-activated protein kinase (AMPK). Notably, AMPK activation has recently been observed to be associated with anti-inflammatory responses. Metformin is also reported to elicit anti-inflammatory responses in CD4+ T cells, resulting in improvement in experimental chronic inflammatory diseases, such as systemic lupus erythematosus. To investigate the effect of metformin on inflammatory bowel disease (IBD), we developed a T cell-transfer model of chronic colitis in which SCID mice were injected with CD4+ CD45RBhigh T cells to induce colitis. We examined the effects of metformin via in vitro and in vivo experiments on lamina propria (LP) CD4+ T cells. We observed that metformin suppresses the frequency of interferon (IFN) -γ-producing LP CD4+ T cells in vitro, which were regulated by AMPK activation, a process possibly induced by the inhibition of oxidative phosphorylation. Furthermore, we examined the effects of metformin on an in vivo IBD model. Metformin-treated mice showed AMPK activation in LP CD4+ T cells and ameliorated colitis. Our study demonstrates that metformin-induced AMPK activation in mucosal CD4+ T cells contributes to the improvement of IBD by suppressing IFN-γ production. Moreover, our results indicate that AMPK may be a target molecule for the regulation of mucosal immunity and inflammation. Thus, AMPK-activating drugs such as metformin may be potential therapeutic agents for the treatment of IBD.

DOI： 10.1096/fj.202100831RR

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.11405/nisshoshi.119.992

PubMed

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：日本語   出版者・発行元：(株)先端医学社  

5-アミノサリチル酸(5-ASA)製剤は軽症から中等症の潰瘍性大腸炎(UC)に対する第一選択薬で基本的には安全な薬剤である。しかしながら、5-ASA製剤の投与に伴いUCの増悪と鑑別がむずかしい下痢・血便の増悪を伴う『5-ASAアレルギー』が起こり得、さらに最近、その頻度も増加傾向にあるとされ注目されている。まず5-ASAアレルギーという病態があることを認識し、経過から5-ASAアレルギーの可能性を疑う場合、5-ASA製剤を中止する『勇気』をもつことが大事である。また、その後の経過が難治になる症例もありうるため、早めに専門医への紹介を考慮すべきである。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Leucine-rich alpha-2 glycoprotein (LRG) may be a novel serum biomarker for patients with inflammatory bowel disease. The association of LRG with the endoscopic activity and predictability of mucosal healing (MH) was determined and compared with those of C-reactive protein (CRP) and fecal markers (fecal immunochemical test [FIT] and fecal calprotectin [Fcal]) in 166 ulcerative colitis (UC) and 56 Crohn's disease (CD) patients. In UC, LRG was correlated with the endoscopic activity and could predict MH, but the performance was not superior to that of fecal markers (areas under the curve [AUCs] for predicting MH: LRG: 0.61, CRP: 0.59, FIT: 0.75, and Fcal: 0.72). In CD, the performance of LRG was equivalent to that of CRP and Fcal (AUCs for predicting MH: LRG: 0.82, CRP: 0.82, FIT: 0.70, and Fcal: 0.88). LRG was able to discriminate patients with MH from those with endoscopic activity among UC and CD patients with normal CRP levels. LRG was associated with endoscopic activity and could predict MH in both UC and CD patients. It may be particularly useful in CD.

DOI： 10.1038/s41598-021-90441-x

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIM: Although oral mesalamine is the first-choice drug for treating mild-to-moderate ulcerative colitis (UC), some patients show symptoms of intolerance, including exacerbation of diarrhea and abdominal pain. The present study clarified the current state and clinical courses of patients with mesalamine intolerance. METHODS: Patients who were diagnosed with UC and administered oral mesalamine at eight hospitals in Japan with a follow-up period exceeding 1 year were analyzed. RESULTS: Sixty-seven (11%) of 633 patients showed intolerance to at least one formulation of oral mesalamine. The frequency of mesalamine intolerance has increased in recent years, rising from 5.3% in 2007-2010 to 9.1% in 2011-2013 and 16.2% in 2014-2016. The most common complications were the exacerbation of diarrhea (n = 29), a fever (n = 25), and abdominal pain (n = 22). Readministration of mesalamine/sulfasalazine was attempted in 43 patients, mostly with other types of formulation of mesalamine, and more than half of these patients proved to be tolerant. The risk factors for mesalamine intolerance were female gender (odds ratio [OR] = 1.83; 95% confidence interval [CI], 1.08-3.12), age < 60 years old (OR = 2.82; CI, 1.19-8.33), and pancolitis (OR = 2.09; 95% CI, 1.23-3.60). There were no significant differences in the use of anti-tumor necrosis factor-α agents, colectomy, or steroid-free remission at the last visit between patients with and without mesalamine intolerance. CONCLUSIONS: Mesalamine intolerance is not rare, and its frequency has been increasing recently. The prognosis of patients with mesalamine intolerance did not differ significantly from that of those without intolerance.

DOI： 10.1111/jgh.15138

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It is often difficult to diagnose inflammatory bowel disease (IBD)-associated neoplasia endoscopically due to background inflammation. In addition, due to the absence of sensitive tumor biomarkers, countermeasures against IBD-associated neoplasia are crucial. The purpose of this study is to develop a new diagnostic method through the application of liquid biopsy. METHODS: Ten patients with IBD-associated cancers and high-grade dysplasia (HGD) with preserved tumor tissue and blood were included. Tumor and non-tumor tissues were analyzed for 48 cancer-related genes using next-generation sequencing. Simultaneously, circulating tumor DNA (ctDNA) was analyzed for mutations in the target genes using digital PCR. RESULTS: Out of 10 patients, seven had IBD-related cancer and three had IBD-related HGD. Two patients had carcinoma in situ; moreover, three had stageII and two had stage III. To avoid false positives, the mutation rate cutoff was set at 5% based on the control results; seven of 10 (70%) tumor tissue samples were mutation-positive. Mutation frequencies for each gene were as follows: TP53 (20.9%; R136H), TP53 (25.0%; C110W), TP53 (8.5%; H140Q), TP53 (31.1%; R150W), TP53 (12.8%; R141H), KRAS (40.0%; G12V), and PIK3CA (34.1%; R 88Q). The same mutations were detected in the blood of these seven patients. However, no mutations were detected in the blood of the remaining three patients with no tumor tissue mutations. The concordance rate between tumor tissue DNA and blood ctDNA was 100%. CONCLUSION: Blood liquid biopsy has the potential to be a new method for non-invasive diagnosis of IBD-associated neoplasia.

DOI： 10.1186/s12885-020-07699-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND STUDY AIMS: The propriety of cold forceps polypectomy (CFP) using jumbo biopsy forceps for diminutive polyps remains controversial. We conducted a prospective study to evaluate the complete CFP resection rate of 3-5-mm polyps using additional endoscopic mucosal resection (EMR) specimens following CFP. PATIENTS AND METHODS: Patients with 3-5-mm protruded or flat elevated colorectal polyps diagnosed endoscopically as adenomas or serrated lesions were prospectively enrolled. CFP using jumbo biopsy forceps was used to remove the eligible polyps and repeated until the absence of residuals were confirmed via image-enhanced endoscopy or chromoendoscopy. After CFP, saline was injected at the defect, and the marginal specimen of the defect was resected using EMR to histologically evaluate the residue. The primary outcome was the complete CFP resection rate, which was defined as no residue at the EMR site. Other outcomes were the number of CFP bites and the complete resection rate by lesion size. RESULTS: Eighty patients with 120 polyps were enrolled. The mean polyp size was 4.1 ± 0.7 mm. The overall complete resection rate was 96.7% (95% confidence interval [CI], 91.7-98.7), and the rates for 3-, 4- and 5-mm polyps were 100% (95% CI, 86.7-100), 96.0% (95% CI, 86.5-98.9) and 95.5% (95% CI, 85.1-98.8), respectively. The one-bite CFP rates were 92%, 60% and 31% for the 3-, 4- and 5-mm polyps, respectively. CONCLUSIONS: The complete CFP resection rate for 3-5-mm polyps was acceptable, although the one-bite clearance rate decreased as the polyp size increased (UMIN000028841).

DOI： 10.1111/den.13895

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Odontogenic infections, generally caused by dental caries and periodontal disease, can result in fatal illness. We herein report a 71-year-old Japanese woman with type 2 diabetes and hemodialysis who suffered from multiple dentofacial abscesses mainly caused by multidrug-resistant Streptococcus oralis. She complained of pain and swelling of her face, with an extraoral fistula from the left cheek. Following 3 surgical debridement procedures and partial mandibulectomy, in addition to 12 weeks of antimicrobial therapy, the multiple dentofacial abscesses were ameliorated. A combination of surgical and antimicrobial treatments following an early diagnosis is essential for reducing further complications.

DOI： 10.2169/internalmedicine.4283-20

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Determining factors that predict a favorable disease course without anti-tumor necrosis factor (TNF) agents would help establish a more cost-effective strategy for Crohn's disease (CD). A retrospective chart review was performed for CD patients with disease durations > 10 years who had not received anti-TNF agents as first-line therapy. Patients were divided into 2 groups: those who received neither anti-TNF agents nor bowel resection (G1), and those who had received an anti-TNF agent and/or bowel resection (G2). The patient backgrounds, therapies and clinical courses were compared between the groups. A total of 62 CD patients met the inclusion criteria (males: 71%; median duration of follow-up: 19 years). Six patients were included in G1; they were significantly less likely to have upper gastrointestinal lesions than G2 (p=0.007). A multivariate analysis revealed that the significant factors for avoidance of bowel resection without anti-TNF treatment were non-stricturing and non-penetrating behaviors, and absence of upper gastrointestinal lesions at the diagnosis (hazard ratios 0.41 and 0.52; p=0.004 and 0.04, respectively). In consideration of the long treatment course of CD, patients with non-stricturing and non-penetrating behaviors and no upper gastrointestinal lesions should not be treated with anti-TNF agents as first-line therapy.

DOI： 10.18926/AMO/60363

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞炎症性腸疾患(IBD)診療における治療の選択肢は年々増えており,多くの患者に速やかな寛解導入,長期の寛解維持が望めるようになってきた.しかし,いったん寛解となっても再燃する場合はあり,その場合にはいかに早期に治療介入できるかが,重要となってくる.再燃を早期に発見するためには,臨床症状の確認とともに,粘膜治癒と相関し,かつ,非侵襲性で繰り返し測定可能なバイオマーカーをうまく利用することが重要である.バイオマーカーの有力な候補として,便中マーカーである便中カルプロテクチン,免疫学的便潜血法がある.臨床的寛解であっても継続的にそれら測定値の上昇を認めた場合は,再燃の可能性を考える必要がある.

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)先端医学社  

shared decision making(SDM)は困難な課題に対して医療従事者と患者とのあいだでなされるべき「意思決定の共有」であり、同時に合意形成をおこなうための重要なコミュニケーションツールである。炎症性腸疾患(IBD)は不均一な患者群で構成されているだけでなく、近年、検査や薬剤の開発が進み、診療の選択肢の幅が急激に増加し複雑化しているため、その診療における選択肢は多岐にわたり、SDMの重要性はいっそう増している。SDMを用いて、エビデンスに基づいたデータを患者の希望や価値観に沿った形で提供することで、患者の疾患に対する理解度、満足度は高まり、より良いIBD診療につなげることが可能となる。(著者抄録)

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intestinal graft-vs.-host disease (GVHD) is a serious complication of allo-hematopoietic stem cell transplantation (allo-HSCT). Villous atrophy in the terminal ileum is considered a useful diagnostic indicator for GVHD. However, the inter- and intra-observer agreement regarding the ileocolonoscopic findings indicative of acute intestinal GVHD, i.e., villous atrophy in the terminal ileum, are currently insufficient in multiple institutions. Thus, the present study aimed to investigate the incidence of villous atrophy in the terminal ileum to diagnose acute intestinal GVHD and determine the inter- and intra-observer agreement regarding this result for experienced endoscopists from multiple institutions. Consecutive patients who underwent allo-HSCT were referred to our institution between May 2008 and September 2015. A total of 54 patients underwent total ileocolonoscopy after allo-HSCT due to suspected intestinal acute GVHD. Subsequently, three observers from different institutions evaluated the cases for the presence of villous atrophy in the terminal ileum. In this study, the pathology results were a gold standard to evaluate the predictive value of ileocolonoscopy detection. Definitive pathological and non-pathological GVHD was diagnosed in 22 and 32 cases, respectively. The results of examining whether villous atrophy could predict GVHD were as follows. For three observers (A, B and C), the sensitivity of villous atrophy in the terminal ileum was 86.4, 77.3 and 79.2%, respectively, whereas the specificity was 62.5, 62.5 and 86.7%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of villous atrophy for GVHD were as follows: The PPV of appearance was 61.3, 58.6 and 82.6%, respectively, whereas the NPV was 87.0, 80.0 and 83.9%, respectively. Kappa coefficients for the inter-observer reliability were 0.85, 0.63 and 0.63 for observers A and B, A and C, and B and C, respectively. The intra-observer kappa coefficient was 0.88 for observer A, 0.73 for observer B and 0.75 for observer C. A substantial observer agreement was achieved for the analysis of villous atrophy in the terminal ileum and the agreement for the predictive histological diagnosis was also excellent. Based on the results of the present study, identification of villous atrophy in the terminal ileum was a clinically effective diagnostic parameter, even if different endoscopists were involved in the diagnosis at multiple institutions. The present study was registered as a trial with the University Hospital Medical Information Network (UMIN; registration no. UMIN000025390).

DOI： 10.3892/etm.2020.8538

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

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DOI： 10.3390/jcm8122109

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.13581

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recently, therapeutic antibodies against programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) have shown promising clinical results for several solid tumors, including pancreatic cancer. In this study, we evaluated the relationship between the PD-L1 expression of surgical resected and fine-needle aspiration (FNA) specimens for patients with pancreatic cancer. METHODS: Of 121 patients who underwent endoscopic ultrasound-guided (EUS)-FNA before surgery for pancreatic cancer in an academic center, the 94 (78%) with adequate FNA specimens for a histological evaluation were retrospectively analyzed. All the patients had undergone upfront surgery without any chemotherapy or radiotherapy. We performed immunohistochemistry (IHC) staining to investigate the PD-L1 expression in both resected and FNA specimens. The positive-stained cells were counted, and their percentage was used for the investigation. RESULTS: Of the 94 patients, 16 (17%) and 11 (10%) were defined as positive on resected cancer specimens using cutoff points of 5% and 10% positively stained cancer cell counts, respectively. The concordance rates for the positive frequency of PD-L1 expression between resected and FNA specimens were 44% (7/16) and 55% (6/11) when the positivity was set to ≥ 5% and ≥ 10%, respectively. The concordance rates for the negative frequency of PD-L1 expression between two specimens were 97% (76/78) and 99% (82/83) when the positivity was set to ≥ 5% and ≥ 10%, respectively. CONCLUSIONS: Approximately, half of the patients with PD-L1 expression positive and almost all the patients with PD-L1 expression negative could be diagnosed on FNA specimens.

DOI： 10.1007/s00535-019-01586-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00535-019-01638-x

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記述言語：英語  

DOI： 10.18926/AMO/57377

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記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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DOI： 10.2169/internalmedicine.3718-19

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/s41598-019-48331-w

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/ccr3.2148

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.5217/ir.2018.00086

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/cancers11020213

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.18926/AMO/56463

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/ccr3.1901

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本アフェレシス学会  

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記述言語：英語  

DOI： 10.1159/000492815

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Despite NUDT15 variants showing significant association with thiopurine-induced adverse events (AEs) in Asians, it remains unclear which variants of NUDT15 or whether additional genetic variants should be tested to predict AEs. To clarify the best pharmacogenetic test to be used clinically, we performed association studies of NUDT15 variants and haplotypes with AEs, genome-wide association study (GWAS) to discover additional variants, and ROC analysis to select the model to predict severe AEs. METHODS: Overall, 2630 patients with inflammatory bowel disease (IBD) were enrolled and genotyped for NUDT15 codon 139; 1291 patients were treated with thiopurines. diplotypes were analyzed in 970 patients, and GWASs of AEs were performed with 1221 patients using population-optimized genotyping array and imputation. RESULTS: We confirmed the association of NUDT15 p.Arg139Cys with leukopenia and alopecia (p = 2.20E-63, 1.32E-69, OR = 6.59, 12.1, respectively), and found a novel association with digestive symptoms (p = 6.39E-04, OR = 1.89). Time to leukopenia was significantly shorter, and when leukopenia was diagnosed, thiopurine doses were significantly lower in Arg/Cys and Cys/Cys than in Arg/Arg. In GWASs, no additional variants were found to be associated with thiopurine-induced AEs. Despite strong correlation of leukopenia frequency with estimated enzyme activities based on the diplotypes (r2 = 0.926, p = 0.0087), there were no significant differences in the AUCs of diplotypes from those of codon 139 to predict severe AEs (AUC = 0.916, 0.921, for acute severe leukopenia, AUC = 0.990, 0.991, for severe alopecia, respectively). CONCLUSIONS: Genotyping of NUDT15 codon 139 was sufficient to predict acute severe leukopenia and alopecia in Japanese patients with IBD.

DOI： 10.1007/s00535-018-1486-7

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記述言語：日本語   出版者・発行元：岡山医学会  

症例は80歳代男性で、約60年前に嚥下障害を発症し、食道アカラシアと診断されていた。約15年前に症状が悪化し、食道アカラシアバルーン拡張術を2回施行された。一旦は症状が改善したが、5年前に再度悪化をきたし、Heller-Dor手術を施行された。症状は改善していたが、1年前より嚥下障害と嘔吐が出現した。アカラシアバルーン拡張術およびHeller-Dor手術を施行後、新たに発生した下部食道の運動異常と、それに伴う逆流が、症状再発の原因と診断し、経口内視鏡下筋層切開術(POEM)を施行した。下部食道の運動異常は消失し、バリウムの逆流も認めなかった。経過は良好で、術後4病日に退院となった。現在まで、症状の悪化や再発はきたしていない。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00175&link_issn=&doc_id=20180806220002&doc_link_id=10.4044%2Fjoma.130.67&url=https%3A%2F%2Fdoi.org%2F10.4044%2Fjoma.130.67&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12876-018-0829-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.5009/gnl17236

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.18926/AMO/55849

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.18926/AMO/55850

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Editorial Office of Gut and Liver  

Background/Aims: Both fecal immunochemical test (FIT) and fecal calprotectin (Fcal) results are useful biomarkers for ulcerative colitis (UC). However, the situations in which each marker should be used are largely unknown. Methods: A total of 110 colonoscopy intervals of UC patients were assessed, and correlations between changes in colonoscopic findings and changes in the two aforementioned fecal markers were examined. Results: Among patients with mucosal healing (MH) and negative FIT or Fcal results at the initial colonoscopy, FIT and Fcal findings exhibited accuracies of 93% (38/41) and 79% (26/33), respectively, for predicting the results of the subsequent examination. Among the 24 patients who showed endoscopic activity at the precedent colonoscopy and MH at the subsequent examination, positive-to-negative conversion of FIT and Fcal findings at the subsequent examination was observed in 92% (12/13) and 62% (8/13) of patients, respectively. Among the 43 patients who showed endoscopic activity at both the precedent and subsequent examinations, Fcal findings reflected the change in endoscopic activity better than FIT results (r=0.59, p&lt
0.0001 vs r=0.30, p=0.054). Conclusions: The FIT is useful for confirming MH and the occurrence of relapse. In contrast, Fcal is useful for monitoring the mucosal status of patients with active inflammation. (Gut Liver 2018
12:142-148).

DOI： 10.5009/gnl17013

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

40歳男性。21歳時にクローン病と診断され加療中。イレウス症状を繰り返すため当院紹介。CT検査では回腸狭窄および同部位に高吸収の人工物を認めた。ダブルバルーン内視鏡検査では回腸に多発狭窄を認め、小腸部分切除を施行したところ、狭窄部の近位側に異物を認めた。抽出した異物の解析により、30ヵ月前に嚥下したパテンシーカプセルの非溶解性コーティング膜の滞留と診断した。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01118&link_issn=&doc_id=20180223480008&doc_link_id=130006379165&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130006379165&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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

Background: Both faecal calprotectin [Fcal] and the faecal immunochemical test [FIT] are useful to predict clinical relapse of ulcerative colitis [UC]. However, the difference between Fcal and FIT in ability to predict relapse has scarcely been reported. Whether the combined use of these two faecal markers increases the predictability is also unknown. Methods: UC patients in clinical remission who underwent colonoscopy were enrolled prospectively, and the Fcal and FIT values were examined at enrolment. Their clinical course was observed for 2 years or until relapse. The correlation between the incidence of relapse and the values of the two markers was examined. Results: A total of 113 patients were enrolled, and 48 [42%] relapsed. Fcal = 75 μg/g and FIT = 110 ng/mL were defined as Fcal-positive and FIT-positive, respectively, according to the receiver operating characteristic curves. Both Fcal-positive and FIT-positive statuses were independent predictive factors of clinical relapse (hazard ratio [HR] 2.29
95% confidence interval [CI], 1.23-4.49
p = 0.0086, and HR 2.91
95% CI, 1.49-5.50
p = 0.0022, respectively). Categorisation of patients into three groups according to the faecal marker status [FIT-positive, FIT-negative and Fcal-positive, and both negative] can efficiently stratify the risk of relapse with graded increases in risk [FIT-negative and Fcal-positive: HR 2.05
95% CI, 1.02-4.43
p = 0.0045, and FIT-positive: HR 5.43
95% CI, 2.57- 11.76
p &lt
0.0001, compared with both negative]. Conclusions: Fcal vs FIT showed distinct properties regarding the prediction of relapse in UC. A risk assessment using both faecal markers could increase the predictability for relapse.

DOI： 10.1093/ecco-jcc/jjx118

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Gastroenterology  

A 40-year-old Japanese man with abdominal pain was referred to our hospital. The patient had been diagnosed with Crohn's disease at the age of 21 years and had since then received treatment with mesalazine and had been advocated an elemental diet. About 30 months before his visit to the hospital, he had swallowed a patency capsule, the retention of which in the ileum was subsequently detected on abdominal ultrasonography. The patient was advised to undergo the evaluation of stenosis, but he refused further investigation at that time. Computed tomography scanning performed at our institution revealed stenosis of the ileum and the presence of a high-density material in the proximal side of the stenosis. Double-balloon enteroscopy and enterography with contrast media revealed multiple stenoses of the ileum. The stenotic ileum was surgically resected, and a foreign body was removed. Electron microscopy analysis revealed that the foreign body was the cellophane wall of the PillCamTM patency capsule. Thus, the retention of the cellophane wall of a patency capsule after consumption was diagnosed for the current case on the basis of the study findings.

DOI： 10.11405/nisshoshi.115.203

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DOI： 10.3389/fpls.2018.00780

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.5217/ir.2018.16.1.75

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

Background: Patients with Crohn's disease (CD) with small bowel strictures are at risk of surgery. Double-balloon enteroscopy (DBE) can evaluate the status of the small intestine, and retrograde contrast through the scope enables the surgeon to obtain information beyond the reach of the scope. This study aimed to examine whether a retrograde contrast study through DBE could be used as a predictor of subsequent surgery in patients with CD with small intestinal strictures.
Methods: The findings of DBE with retrograde contrast in 48 patients CD with small bowel strictures were examined.
Results: Of the 48 patients, 14 (29%) underwent surgery for small intestinal strictures during a median observation period of 2.4 years (interquartile range: 1.4-3.7 yr). According to the results of the multivariate analysis, a maximum length of strictures &gt;= 20 mm and the ratio of the maximum diameter of prestenotic dilations to the diameter of the normal small intestine &gt;= 1.4 were independent risk factors of surgery for small intestinal strictures (risk ratio = 7.6 [95% confidence interval, 1.8-42.0], P = 0.006; and risk ratio = 52.0 [95% confidence interval, 3.5-2485.1], P = 0.002, respectively). The latter predicted subsequent surgery with 92% sensitivity and 88% specificity. Cumulative surgery-free rates were discriminated significantly according to the presence or absence of these 2 risk factors (log-rank test: P &lt; 0.001).
Conclusions: Findings of retrograde contrast through DBE are helpful to predict risk of surgery in patients with CD with small intestinal strictures.

DOI： 10.1097/MIB.0000000000001175

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/s-0043-111792

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記述言語：日本語   出版者・発行元：岡山医学会  

39歳男。食事摂取後の嚥下困難を主訴に近医受診し、上部消化管内視鏡検査で食道アカラシアと診断され、精査加療目的に当院紹介となった。食道X線造影検査(バリウム50ml内服)で食道内に5分間以上のバリウム停滞を認め、異常蠕動を認めた。高解像度食道内圧検査(嚥下試験)で下部食道の収縮圧は24mmHgであり、胃食道接合部の弛緩は認めなかった。これらの所見から、食道アカラシアのシカゴ分類type Iと診断し、POEMを施行した。翌日の食道X線造影検査でバリウムは速やかに胃内へ流入することが確認され、その後の経過も良好で、術後4日目に退院となり、1年後の現在まで症状の再燃は認めていない。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00175&link_issn=&doc_id=20170817260005&doc_link_id=10.4044%2Fjoma.129.115&url=https%3A%2F%2Fdoi.org%2F10.4044%2Fjoma.129.115&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語  

DOI： 10.1159/000475753

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本臨床免疫学会  

<p>【背景】生薬であるベルベリン（BBR）は下痢止めとして臨床応用されているが，抗炎症など多彩な作用も有することが明らかになっている．BBRは細胞のエネルギーの調節因子であるAMPKを活性化させることが知られており，近年，このAMPKがT細胞を含む免疫細胞の応答に関わっていることが報告されている．【目的，方法】慢性腸炎マウスモデルを用いて，大腸炎粘膜のCD4⁺T細胞（LP CD4⁺T細胞）におけるBBRの抗炎症作用とその機序についての検証をin vitroおよびIn vivoで行う．1）CD4⁺CD45RB^highT細胞移入腸炎マウスのLPCD4⁺T細胞をPMA/Ionomysinで刺激し，IFN-γ産生細胞を誘導，BBRの効果について，AMPKの関与も含めて検討．2）上記腸炎マウスにBBRを含んだ餌を投与し，腸炎の抑制効果について検討．【結果】1）LP CD4⁺T細胞はBBRと共培養すると，IFN-γ産生細胞が優位に低下し，ウェスタンブロッティングでは，AMPKの活性化を認めた．次に，AMPKのagonistとantagonistを用いた培養系でIFN-γの産生を調べたところ，agonistで抑制，antagonistで増加を認めた．以上から，BBRにより活性化されたAMPKがIFN-γを制御していることが示唆された．2）上記腸炎マウスにBBRを経口投与した結果，腸炎は優位に抑制された．【結論】BBRは，慢性腸炎マウスモデルの腸炎を抑制し，その作用機序の一つとしてAMPKを介した機序が示唆された．</p>

DOI： 10.2177/jsci.40.311b

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記述言語：日本語   出版者・発行元：岡山医学会  

&emsp;A 58-year-old Japanese man visited a local clinic for the evaluation of a stomachache. He was diagnosed with intestinal obstruction. His medical history included a proctocolectomy at the age of 38 years, due to familial adenomatous polyposis (FAP). He was referred to our institution, where he underwent a computed tomography examination and endoscopy of the small intestine. The pathological diagnosis was adenocarcinoma. No invasive or metastatic lesions were observed. Therefore, partial resection of the ileum with lymphadenectomy and reconstruction of the ileostomy were performed. Pathological examination revealed that the tumor was type 2, pT3 (SS) , pN1, pPM0, pDM0, pRM0, INFb, ly1, v1, pEX0, PN0. Twenty-nine days after the surgery, the patient was diagnosed with lung metastasis and he underwent lung radiofrequency ablation. We suggest that long-term follow-up is necessary for patients after surgery for FAP, because of the risk of malignant disease developing in other organs.

DOI： 10.4044/joma.129.111

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記述言語：日本語   出版者・発行元：岡山医学会  

&emsp;Esophageal achalasia is a disorder of the lower esophageal sphincter muscle. Patients present with dysphagia, chest pain, vomiting, and aspiration. Esophageal achalasia had traditionally been treated with esophageal achalasia balloon dilatation and the Heller-Dor method, but in recent years, the use of per-oral endoscopic myotomy (POEM) has increased. Our patient, a 39-yr-old male, began experiencing dysphagia 4 years prior to his referral to our hospital. Based on the results of esophagogastroduodenoscopy, esophageal radiography and high-resolution manometry, we made the diagnosis of esophageal achalasia (Chicago classification type I) . After informed consent from the patient and his family and approval from our hospital's ethics committee were obtained, we performed a POEM. The patient was discharged on the 4th day post-surgery. At the 1-year post-operative examination, no worsening of symptoms and no relapse were observed. POEM is an excellent treatment method for esophageal achalasia from the perspective of therapeutic effect and prevention of invasion. We recommend that it be considered as the first-choice treatment for achalasia. However, accessibility to the procedure itself is limited due to the few adequately trained operators worldwide. POEM should thus be performed by an expert operator at a high-volume center.

DOI： 10.4044/joma.129.115

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その他リンク： http://search.jamas.or.jp/link/ui/2017339773

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

We have reported that results of the quantitative faecal immunochemical test (FIT; haemoglobin concentrations in faeces measured using an antibody for human haemoglobin) effectively reflect the mucosal status of ulcerative colitis (UC). The aim of this study was to evaluate the predictability of flare-up in quiescent UC patients by consecutive FIT evaluation.
Patients with UC who fulfilled the following criteria by index colonoscopy were enrolled: clinical remission; mucosal healing (Mayo endoscopic subscore 0); and negative FIT (less than 100ng/mL). These patients were followed up prospectively every 1-3 months by monitoring patient symptoms and FIT results between index and subsequent colonoscopies.
The intervals between 2 colonoscopies (median 2.51 years) of 83 patients (49 males, median age at onset 34 years, median disease duration 9.74 years) were analysed. None of the 43 (52%) patients who maintained negative FIT throughout the observation period exhibited clinical relapse. On the other hand, 25/40 (63%) patients who showed positive conversion of FIT during the period experienced relapse. The cutoff FIT value of 450ng/mL could predict relapse with 73% positive predictive value and 96% negative predictive value. Moreover, positive conversion of FIT preceded occurrence of symptoms by 1 month or more in nearly one-third of patients with relapse.
Consecutive measurements of FIT in quiescent UC patients who achieved mucosal healing with negative FIT would help identify patients with clinical relapse whose symptoms had not yet presented. Further investigations are required for more precise prediction of relapse with this modality.

DOI： 10.1093/ecco-jcc/jjw025

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

AIM: To assess the risk of relapse in ulcerative colitis (UC) patients in clinical remission using mucosal status and fecal immunochemical test (FIT) results.
METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores (MESs) and FIT results.
RESULTS: Patients with an MES of 0 (n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3 (n = 100, 52%) (HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result (fecal hemoglobin concentrations &lt;= 100 ng/mL) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score (HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission &gt; 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse (HR = 0.11, 95%CI: 0.04-0.23).
CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing (MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.

DOI： 10.3748/wjg.v22.i21.5079

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

Background: Mucosal healing (MH) has been proposed as a treatment goal of inflammatory bowel disease patients. We reported recently that not only fecal calprotectin (Fcal) but also the fecal immunochemical test (FIT) can predict MH in ulcerative colitis. However, the predictive power of the fecal markers for MH in Crohn's disease (CD), particularly with small bowel lesions, has not been reported in detail. The aim of this study was to evaluate the predictability of FIT versus Fcal for MH in CD.
Methods: Consecutive CD patients underwent colonoscopy or balloon-assisted enteroscopy according to the disease location. FIT and Fcal were examined using stool samples collected the day before endoscopy.
Results: Seventy-one CD patients were analyzed, of whom 42 (59%) underwent balloon-assisted enteroscopy because of the presence of affected lesions in the small intestine. Both the Fcal and the FIT results were significantly correlated with endoscopic activity (r = 0.67 and 0.54, respectively). However, the FIT results did not correlate with the activity in patients with small bowel lesions alone, whereas Fcal did (r = 0.42 versus 0.78). Fcal predicted MH in CD with 87% sensitivity and 71% specificity, whereas the values for FIT were 96% and 48%, respectively. The specificity for MH among patients with small bowel lesions alone was low for FIT (40%) compared with Fcal (80%).
Conclusions: Both FIT and Fcal were correlated with the mucosal status of CD. However, the specificity of FIT was not satisfactory, particularly for small bowel lesions.

DOI： 10.1097/MIB.0000000000000728

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

チオプリン製剤は潰瘍性大腸炎においてステロイド依存例に対するステロイド減量効果,および寛解維持効果を有する貴重な薬剤である.活性体である6-TGN(6-thioguanine nucleotide)に変換され安定して薬効を発揮するまでに時間が必要であり,しばしば副作用を伴うことから使用に当たり習熟が不可欠である.しかし投与開始後から慎重にモニタリングを行うことで対応可能であり,その有効性,利便性,医療経済の観点から抗TNFα抗体製剤に優先してチオプリン製剤を活用すべきである.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01937&link_issn=&doc_id=20160530220007&doc_link_id=10.19020%2FJ01937.2016299263&url=https%3A%2F%2Fdoi.org%2F10.19020%2FJ01937.2016299263&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：日本大腸検査学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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

Autophagy plays important roles in metabolism, differentiation, and survival in T cells. TNFAIP3/A20 is a ubiquitin-editing enzyme that is thought to be a negative regulator of autophagy in cell lines. However, the role of TNFAIP3 in autophagy remains unclear. To determine whether TNFAIP3 regulates autophagy in CD4 T cells, we first analyzed Tnfaip3-deficient naive CD4 T cells in vitro. We demonstrated that Tnfaip3-deficient CD4 T cells exhibited reduced MAP1LC3/LC3 (microtubule-associated protein 1 light chain 3) puncta formation, increased mitochondrial content, and exaggerated reactive oxygen species (ROS) production. These results indicate that TNFAIP3 promotes autophagy after T cell receptor (TCR) stimulation in CD4 T cells. We then investigated the mechanism by which TNFAIP3 promotes autophagy signaling. We found that TNFAIP3 bound to the MTOR (mechanistic target of rapamycin) complex and that Tnfaip3-deficient cells displayed enhanced ubiquitination of the MTOR complex and MTOR activity. To confirm the effects of enhanced MTOR activity in Tnfaip3-deficient cells, we analyzed cell survival following treatment with Torin1, an MTOR inhibitor. Tnfaip3-deficient CD4 T cells exhibited fewer cell numbers than the control cells in vitro and in vivo. In addition, the impaired survival of Tnfaip3-deficient cells was ameliorated with Torin1 treatment in vitro and in vivo. The effect of Torin1 was abolished by Atg5 deficiency. Thus, enhanced MTOR activity regulates the survival of Tnfaip3-deficient CD4 T cells. Taken together, our findings illustrate that TNFAIP3 restricts MTOR signaling and promotes autophagy, providing new insight into the manner in which MTOR and autophagy regulate survival in CD4 T cells.

DOI： 10.1080/15548627.2015.1055439

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

OBJECTIVES: We previously showed that a quantitative fecal immunochemical test (FIT) can predict mucosal healing (MH) in ulcerative colitis (UC). Fecal calprotectin (Fcal) has also been reported as an important biomarker of UC activity. The aim of this study was to compare the predictive ability of these two fecal markers for MH in UC.
METHODS: FIT and Fcal were examined in stool samples from consecutive UC patients who underwent colonoscopy. Mucosal status was assessed via the Mayo endoscopic subscore (MES).
RESULTS: In total, 105 colonoscopies in 92 UC patients were evaluated in conjunction with the FIT and Fcal results. Both FIT and Fcal results were significantly correlated with MES (Spearman's rank correlation coefficient: 0.61 and 0.58, respectively). The sensitivity and specificity of the FIT values (&lt;100 ng/ml) for predicting MH (MES 0 alone) were 0.95 and 0.62, respectively, whereas those of Fcal (&lt;250 mu g/g) were 0.82 and 0.62, respectively. The sensitivities became similar when MH was defined as MES 0 or 1 (0.86 vs. 0.86). Although the predictability of MH evaluated by the area under the receiver operating characteristics curve was similar for the two fecal markers (FIT 0.83 vs. Fcal 0.82 for MES 0 alone), the FIT results were relatively robust regardless of the cutoff value selected.
CONCLUSIONS: Both FIT and Fcal can efficiently predict MH in UC, but FIT appears to be more sensitive than Fcal for predicting MES 0 alone.

DOI： 10.1038/ajg.2015.66

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1080/15548627.2015.1055439

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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

Colitogenic memory CD4(+) T cells are important in the pathogenesis of inflammatory bowel disease (IBD). Although memory stem cells with high survival and self-renewal capacity were recently identified in both mice and humans, it is unclear whether a similar subset is present in chronic colitis mice. We sought to identify and purify a long-lived subset of colitogenic memory CD4(+) T cells, which may be targets for treatment of IBD. A long-lived subset of colitogenic memory CD4(+) T cells was purified using a long-term culture system. The characteristics of these cells were assessed. Interleukin (IL)-7 promoted the in vitro survival for &gt;8 weeks of lamina propria (LP) CD4(+) T cells from colitic SOD mice previously injected with CD4(+)CD45RB(high) T cells. These cells were in a quiescent state and divided a maximum of 5 times in 4 weeks. LP CD4(+) T cells expressed higher levels of Bcl-2, integrin-alpha 4 beta 7, CXCR3 and CD25 after than before culture, as well as secreting high concentrations of IL-2 and low concentrations of IFN-gamma and IL-17 in response to intestinal bacterial antigens. LP CD4(+) T cells from colitic mice cultured with IL-7 for 8 weeks induced more severe colitis than LP CD4(+) T cells cultured for 4 weeks. We developed a novel culture system to purify a long-lived, highly pathogenic memory subset from activated LP CD4(+) T cells. IL-7 promoted long-term in vitro survival of this subset in a quiescent state. This subset will be a novel, effective target for the treatment of IBD. (C) 2013 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.imlet.2013.09.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.imlet.2013.09.001

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

Objective
Interleukin (IL)-7 is mainly produced in bone marrow (BM) that forms the niche for B cells. We previously demonstrated that BM also retains pathogenic memory CD4 T cells in murine models of inflammatory bowel disease (IBD). However, it remains unknown whether BM-derived IL-7 is sufficient for the development of IBD and which cells form the niche for colitogenic memory CD4 T cells in BM.
Design
To address these questions, we developed mice in which IL-7 expression was specific for BM, and identified colitis-associated IL-7-expressing mesenchymal stem cells (MSC) in the BM.
Results
IL-7(-/-)xRAG-1(-/-) mice injected with BM cells from IL-7(+/+)xRAG-1(-/-) mice, but not from IL-7(-/-)xRAG-1(-/-) mice, expressed IL-7 in BM, but not in their colon, and developed colitis when injected with CD4(+)CD45RB(high) T cells. Cultured BM MSC stably expressed a higher level of IL-7 than that of primary BM cells. IL-7-sufficient, but not IL-7-deficient, BM MSC supported upregulation of Bcl-2 in, and homeostatic proliferation of, colitogenic memory CD4 T cells in vitro. Notably, IL-7(-/-)xRAG-1(-/-) mice transplanted with IL-7-sufficient, but not IL-7-deficient, BM MSC expressed IL-7 in BM, but not in their colon, and developed colitis when transplanted with CD4(+)CD45RB(high) T cells.
Conclusions
We demonstrate for the first time that BM MSC are a major source of IL-7 and play a pathological role in IBD by forming the niche for colitogenic CD4 memory T cells in BM.

DOI： 10.1136/gutjnl-2012-302029

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1136/gutjnl-2012-302029

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.4049/jimmunol.1202930

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

Although intestinal microbiota are essential for the development of T cell-mediated colitis, it remains undetermined whether they enhance or suppress the chronic extraintestinal inflammation that often complicates inflammatory bowel diseases. In this study, we investigate the role of intestinal microbiota in the development of colitis and extraintestinal manifestations in a mouse model in which colitis was induced in SCID mice by adoptive transfer of CD4(+) CD45RB(high) T cells. Under specific pathogen-free conditions, these mice developed both colitis and extraintestinal interstitial pneumonia, whereas mice given a mixture of antibiotics did not develop colitis, but, surprisingly, developed Th1/Th17-mediated IP. Irrespective of antibiotic treatment, cotransfer of CD4(+) CD25(+) regulatory T cells suppressed the development of pneumonitis and colitis, with all local CD4(+) CD45RB(high) T cell-derived cells converted to CD44(high) CD62L(-) IL-7R alpha(high) effector-memory T cells. Retransfer of CD4(+) effector-memory T cells from the lungs of antibiotic-treated mice with IP not only induced IP in both antibiotic-treated and -untreated recipients but also induced colitis in the untreated recipients. In summary, we have established a unique model of Th1/Th17-mediated IP in microbiota-free and antibiotic-treated mice. This model may be valuable in investigating the immunological mechanisms underlying extraintestinal disorders in patients with inflammatory bowel disease.

DOI： 10.4049/jimmunol.1202930

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

Although hyoscine butyl bromide (HB) and glucagon (GL) are often used as antispasmodic drugs during esophagogastroduodenoscopy (EGD), these agents may cause adverse effects. Recently, it was reported that peppermint oil solution (PO) was very effective and had few side effects.
We clarified the efficacy and usefulness of PO as an antispasmodic during upper endoscopy, especially for elderly patients.
This study was a non-randomized prospective study. The antispasmodic score (1-5, where 5 represents no spasm) was defined according to the degree of spasms of the antrum and difficulty of biopsy. We compared the antispasmodic scores between non-elderly patients (younger than 70) and elderly patients (70 years old or older) according to the antispasmodic agent.
A total of 8,269 (Group PO: HB: GL: NO (no antispasmodic) = 1,893: 6,063: 157: 156) EGD procedures were performed. There was no significant difference in the antispasmodic score between Group PO (mean score +/- A standard deviation: 4.025 +/- A 0.925) and Group HB (4.063 +/- A 0.887). Among the non-elderly patients, those in Group PO (n = 599, 3.923 +/- A 0.935) had a worse antispasmodic score than those in Group HB (n = 4,583, 4.062 +/- A 0.876, P &lt; 0.001). However, among the elderly patients, those in Group PO (n = 1,294, 4.073 +/- A 0.917) had similar scores to those in Group HB (n = 1,480, 4.064 +/- A 0.921, P = 0.83), and significantly better scores than those in Group GL (n = 69, 3.797 +/- A 0.933, P &lt; 0.05).
Peppermint oil was useful as an antispasmodic during EGD, especially for elderly patients.

DOI： 10.1007/s10620-012-2194-4

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

Objective Platelet counts before starting the treatment affect the discontinuation and dose reduction of peginterferon in chronic hepatitis C. Thrombocytopenia leads to failure to achieve sustained virological response. This study was undertaken to evaluate the efficacy of partial splenic embolization (PSE) prior to starting peginterferon therapy combined with ribavirin in chronic hepatitis C patients showing thrombocytopenia.
Patients and Methods We compared the clinical features of 11 patients receiving PSE (PSE group) prior to starting the combined therapy with those of 13 patients not receiving PSE (non-PSE group). All of the patients showed platelet counts &lt;= 12x10(4)/mm(3) and serum hepatitis C virus-RNA levels &gt;= 100 KIU/mL at baseline. The end-point of PSE was a volume of splenic infarction over 75%. Peginterferon alpha-2b at a dose of 1.2 mu g/kg was administered by subcutaneous injection once a week. The dose of ribavirin was weight adjusted.
Results PSE was successfully performed without serious adverse events. The period from PSE to starting the combined therapy was 14 (6-27) days. After PSE, platelet counts were significantly increased. In PSE group, platelet counts during the combined therapy were maintained above those at baseline. In non-PSE group, platelet counts at the 2nd week after the start of the combined therapy significantly decreased to less than those at baseline. Overall, 80% adherence to expected peginterferon dose was not achieved in 5 patients (45%) of PSE group and in 11 (85%) of non-PSE group (p=0.043).
Conclusion Increased platelet counts after PSE facilitates the adherence to peginterferon therapy in chronic hepatitis C patients with thrombocytopenia.

DOI： 10.2169/internalmedicine.50.6143

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

Background/Aims: The prevalence of reflux esophagitis, which might lead to development of Barrett&apos;s esophagus and esophageal adenocarcinoma, has been increasing. The aim of this study was to assess risk factors for reflux esophagitis. Methods: We conducted a cross-sectional study of 1,495 Japanese subjects undergoing health checkups (822 males and 673 females; median age 50 years) at a tertiary care center. Results: One hundred and twenty-seven subjects (8%) had reflux esophagitis and hiatal hernia was observed in 292 subjects (20%). Reflux esophagitis (13 vs. 3%) and hiatal hernia (28 vs. 9%) were more frequent in males than females. Significant differences in clinical backgrounds were observed between females and males. Multivariate logistic regression analyses revealed that hiatal hernia (OR 6.63, 95% CI 2.47-17.8; p = 0.0002) was associated with reflux esophagitis in females. In males, age (per 1-year increment: OR 0.96, 95% CI 0.94-0.99; p = 0.007), hiatal hernia (OR 3.16, 95% CI 2.05-4.87; p &lt; 0.0001) and waist circumference (per 1-cm increase: OR 1.09, 95% CI 1.02-1.15; p = 0.006) were associated with reflux esophagitis. Conclusions: Abdominal obesity may be an important risk factor for reflux esophagitis in males compared with females. Copyright (C) 2010 S. Karger AG, Basel

DOI： 10.1159/000235919

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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

We report a case of hepatic angiomyolipoma with uncommon clinical features. A 56-year-old man presented with a hepatic tumor in the caudate lobe. The tumor was hypoechoic on ultrasonography, showed early-phase hyperattenuation on enhanced computed tomography and did not absorb iron on superparamagnetic iron oxide-enhanced magnetic resonance imaging. Hepatocellular carcinoma was highly suspected, and the patient underwent hepatic resection. Histologically, the tumor was mainly composed of smooth muscle cells and contained small amounts of adipose cells and blood vessels. On immunohistochemical staining, the smooth muscle cells were positive for a melanocytic cell-specific monoclonal antibody. In cases with uncommon features of angiomyolipoma, it is quite difficult to distinguish angiomyolipoma from hepatocellular carcinoma. (C) 2009 The WJG Press and Baishideng. All rights reserved.

DOI： 10.3748/wjg.15.2930

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記述言語：日本語   出版者・発行元：香川県内科医会  

2000年1月から2007年12月までに当院にて治療をした食道癌患者44例を対象とし、化学放射線療法(chemoradiotherapy:CRT)を施行した26例(CRT群)ならびに手術療法を施行した18例(手術群)に層別化しretrospectiveに比較検討した。年齢は45歳から86歳で中央値69歳であった。患者背景として、年齢、腫瘍占拠部位、臨床病期、PSを比較した結果、手術群で臨床病期が早期であった(p<0.01)。CRT群の奏効率は73%であり、CRT群の生存期間は2年生存率38%、4年生存率25%であった。また、根治術可能な臨床病期0〜IIIまででCRT群と手術群の生存期間を比較した結果、2年生存率はCRT群で46%、手術群で53%であり、両群間の生存期間に差異は認めなかった。食道癌に対するCRTは手術療法と比較し遜色ない治療法であった。(著者抄録)

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記述言語：日本語   出版者・発行元：香川県内科医会  

Gastrointestinal stromal tumor(以下GIST)は全消化管切除腫瘍の0.5〜1.0%程度を占める稀な腫瘍である。今回我々は当院において病理組織学的にGISTと診断された19例を対象とし、その臨床的および病理学的特徴について検討した。発生部位は胃が14例と最多で、全体的に無症状で発見される例が多かった。手術標本の病理組織で診断されたものが13例と大部分を占めていた。腫瘍の大きさ・核分裂指数により評価した臨床的悪性度に基づきリスク分類を行った。転移・再発に関しては全て高リスク例であり、よく相関していた。予後に関しては、高リスク6例のうち死亡転帰は2例であり、リスク分類のみで予後を推測することは困難であった。予後不良因子として腹膜病変が示唆された。術前・術後化学療法の有効性や術後の適切な経過観察期間など、GISTに関して未だに臨床研究段階の項目は多く、今後さらなる症例数の集積が望まれる。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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

Of patients with severe exacerbation of chronic hepatitis B accompanied by jaundice and coagulopathy, 20%-30% have a fatal outcome. In this report, we describe 2 cases of severe exacerbation of chronic hepatitis B with jaundice and coagulopathy who were successfully treated with a combination of entecavir and corticosteroid. In both cases, rapid reductions in serum hepatitis B virus (HBV)-DNA levels were observed, and corticosteroid was stopped after serum HBV-DNA levels became undetectable. Entecavir treatment was continued. Generally, entecavir treatment reduced serum HBV-DNA levels rapidly, although the improvement in liver function was delayed by a few weeks. During this time lag, liver cell injury continued and the disease progressed. Corticosteroid suppressed the excessive host immune response and was useful for stopping progressive deterioration. A combination of entecavir and early-phase corticosteroid may be a useful treatment in severe exacerbation of chronic hepatitis B. (C) 2009 The WJG Press and Baishideng. All rights reserved.

DOI： 10.3748/wjg.15.1650

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 75-year-old man was admitted to our hospital because of right hypochondralgia. Computed tomography (CT) revealed a large tumor in the right lobe of the liver. Ultrasonography (US) showed vessels in the tumor. Needle biopsy specimens showed malignant lymphoma (Diffuse large B cell lymphoma). Ga scintigraphy and FDG-PET did not demonstrate other lesions and the definitive diagnosis was primary malignant lymphoma of the liver. CHOP with Rituximab therapy (R-CHOP therapy) was performed. After 8 courses of therapy the FDG-PET results were negative and we considered complete remission. We describe a case of primary malignant lymphoma of the liver treated successfully by R-CHOP therapy.

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記述言語：日本語   出版者・発行元：三豊総合病院  

77歳男。全身倦怠感と発熱を主訴とした。血液検査で炎症反応の上昇、尿検査で膿尿を認め、CTで膀胱内にairと大腸に多発する憩室を認めた。結腸膀胱瘻による有熱性尿路感染を疑い、瘻孔を確認するために膀胱鏡、膀胱造影、大腸内視鏡検査、注腸造影を施行したが、瘻孔は確認できなかった。しかし、注腸検査時に工夫を凝らし、インジゴカルミンを混ぜたガストログラフィンを用いて検査を行ったところ、尿道バルーン内にインジゴカルミンの流出を認め、その直後行ったCTでも膀胱内にガストログラフィンの充満を認め、瘻孔の存在を確認できた。結腸膀胱瘻と診断し、左側結腸切除術および膀胱部分切除術を施行した。病理組織学的所見で膀胱が付着する部位は全層にかけてリンパ球、好中球、形質細胞の炎症細胞が浸潤し、瘻孔が形成されているものと考えられた。また、周囲に憩室を認めたことから、憩室が原因と推測した。

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記述言語：日本語   出版者・発行元：(一社)香川県医師会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：香川県内科医会  

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記述言語：日本語   出版者・発行元：香川県内科医会  

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記述言語：英語   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：三豊総合病院  

54歳女。患者は右下腹部痛を主訴とした。腹部造影CTでは膵尾部に単純相で膵臓と同程度の吸収値、動脈相で濃染され、平行相でやや膵よりも高い吸収値の腫瘤を認めた。造影MRIではCTで指摘された腫瘤はT1強調画像で低信号、T2強調画像でやや高信号、Gd造影で動脈性濃染を認めた。非機能性膵ラ氏島腫瘍と考え、膵尾部切除、脾臓摘出術、リンパ節生検を施行したところ、病理組織学的所見では腫瘤は線維性皮膜を有し、赤血球が充満した赤脾髄にリンパ球が集族した白脾髄がみられ、脾臓組織であった。また、リンパ節生検の免疫染色では濾胞性リンパ腫と判明、副脾内の白脾髄の腫大が目立つため免疫染色を行うと、副脾内にもリンパ腫が浸潤していた。以上、これらのことからも、本症例は膵内副脾と濾胞性リンパ腫と確定診断された。

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記述言語：日本語   出版者・発行元：三豊総合病院  

手術不能膵癌について、特に高齢者における抗腫瘍療法の有用性を検討した。対象は過去約1年間に切除不能と診断された膵癌68症例のうち、75歳以上の32例で、これらを抗腫瘍療法(ACT)が施行された17例(ACT群、平均年齢80.1歳)とACTを施行しなかった15例(BCS群、平均年齢83.0歳)に分け調べた。その結果、1)BCS群はACT群に比べて有意にECOGのPerformance Status(PS)が不良であった。2)全体での検討では、ACT群はBCS群よりも生存期間の延長が認められたが、75歳以上の比較ではACT群はBCS群よりも年齢が若く、PSが良好であり、長期生命予後が望めるにもかかわらず、生存期間の延長を認めなかった。3)有害事象の発現率は、75歳以上群と75歳未満群との間に差異は認められなかったが、詳細に検討すると、75歳以上群では抗腫瘍療法を開始した後に症状が強く発現し、急速に全身状態が不良となる症例を認めており、ACT群17例中4例は80日以内と早期に死亡していた。

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記述言語：日本語   出版者・発行元：(一社)日本肝臓学会  

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記述言語：日本語   出版者・発行元：(一社)香川県医師会  

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記述言語：日本語   出版者・発行元：(一社)香川県医師会  

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記述言語：日本語   出版者・発行元：(一社)香川県医師会  

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

Background: Hepatic steatosis is a prominent feature of chronic hepatitis C. Hepatic steatosis was reported recently to be a risk factor for hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC).
Aim: To investigate whether hepatic steatosis influences the postoperative recurrence of HCV-associated HCC.
A retrospective study was conducted in 88 patients undergoing curative resection of HCV-associated HCC. Cumulative tumour recurrence rates were compared between steatosis-positive and steatosis-negative patients, and the factors affecting intrahepatic recurrence were assessed.
Results: The respective tumour recurrence rates at 1, 3, and 5 years were 19%, 76%, and 92% in the steatosis-positive group, and 12%, 52%, and 60% in the steatosis-negative group. The tumour recurrence rate of the steatosis-positive group was significantly higher than that of the steatosis-negative group (P=0.02). Hepatic steatosis [relative risk (RR)=3.31, 95% confidence intervals (CIs)=1.49-7.41, P=0.003], stage of fibrosis (RR=3.17, 95% CI=1.35-7.47, P=0.008), surgical procedure (RR=0.22, 95% CI=0.076-0.64, P=0.005), number of tumours (RR=5.24, 95% CI=1.63-16.80, P=0.005), size of the largest tumour (RR=3.52, 95% CI=1.28-9.69, P=0.02), and vascular invasion (RR=2.72, 95% CI=1.32-5.59, P=0.007) were independent factors for tumour recurrence rate by multivariate analysis.
Conclusions: Hepatic steatosis is a useful predictor of postoperative recurrence of HCV-related HCC.

DOI： 10.1111/j.1478-3231.2007.01462.x

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床免疫学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-中国支部  

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(株)先端医学社  

炎症性腸疾患(IBD)のバイオマーカーとして、欧米で広く使われている便中カルプロテクチンが保険収載された。便中カルプロテクチンは腸管に浸潤した炎症細胞に由来し、潰瘍性大腸炎(UC)・クローン病(CD)の両疾患で内視鏡的活動性と相関を認め、治療効果判定・再燃予測に応用可能と考えられる。免疫学的便潜血検査(FIT)との比較では、UCの粘膜治癒の検出にはFITのほうがすぐれているが、CDにおける小腸病変との関連などはカルプロテクチンのほうがすぐれている。便中マーカーはある一時点の絶対値を重視するのではなく、患者の経過中にくり返し測定し、病勢の推移を推定する指標として使うべきである。(著者抄録)

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：日本語   出版者・発行元：Blackwell Publishing  

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記述言語：日本語   出版者・発行元：ヴァンメディカル  

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その他リンク： http://search.jamas.or.jp/link/ui/2016319938

記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY-BLACKWELL  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：日本語   出版者・発行元：日本臨床免疫学会  

「ワークショップ選出演題「ワークショップW1-4」抄録は330ページ参照」&lt;br&gt;

DOI： 10.2177/jsci.36.380a

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記述言語：日本語   出版者・発行元：日本臨床免疫学会  

【背景】我々は緩解期においても生体内に長期生存する腸炎惹起性メモリーCD4&lt;sup&gt;+&lt;/sup&gt;T細胞が炎症性腸疾患難治性の要因であり，真の治療標的であることを報告してきた．メモリーT細胞には複数の分画があり，近年，幹細胞様の性質を有するMemory Stem Cell (T&lt;sub&gt;SCM&lt;/sub&gt;）が同定されている．【目的，方法】炎症性腸疾患モデルマウスにおける既存のメモリーT細胞分画の役割を明確にすると共に&amp;ldquo;腸炎惹起性memory stem cell&amp;rdquo;の存在を検証した．【結果】CD4&lt;sup&gt;+&lt;/sup&gt;CD45RB&lt;sup&gt;high&lt;/sup&gt;T細胞移入腸炎マウスでは脾臓，リンパ節において数%のCentral memory (T&lt;sub&gt;CM&lt;/sub&gt;）と多数のEffector memory (T&lt;sub&gt;EM&lt;/sub&gt;）を認め，T&lt;sub&gt;SCM&lt;/sub&gt;の分画は認めなかった．このためT&lt;sub&gt;EM&lt;/sub&gt;/T&lt;sub&gt;CM&lt;/sub&gt;を分取し，腸炎誘導能を検証したところ，同等な腸炎を発症した．以上からこの腸炎モデルマウスでは，T&lt;sub&gt;EM&lt;/sub&gt;は長期生存能を有する分画を含むと考えた．次に，我々はメモリーT細胞維持因子のIL-7に着目し，&lt;i&gt;in vitro&lt;/i&gt;で，T&lt;sub&gt;EM&lt;/sub&gt;細胞から生存能の高い細胞集団の同定を試みた．腸炎マウス大腸炎粘膜のCD4+T細胞をIL-7単独添加で培養したところ，4週間培養可能であった．培養後の細胞は，Bcl-2，CD25，腸管へのhoming markerを高発現し，&lt;i&gt;in vitro&lt;/i&gt;におけるサイトカイン産生能はT&lt;sub&gt;CM&lt;/sub&gt;に類似していた．IL-7単独で4週培養した細胞と8週培養した細胞では後者の方が，腸炎誘導能が強かった．【結語】IL-7単独添加による新規培養法を樹立し，生存能/腸炎誘導能の高い新たなメモリーサブセットを同定した．&lt;br&gt;

DOI： 10.2177/jsci.36.330b

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会  

症例は80歳代女性．血便精査で下部消化管内視鏡検査施行したところ，直腸Rbに15mmの褐色調隆起性病変を認めた．NBI観察でpit様構造は消失と整な構造が混在，またCorkscrew様の異常血管を認めた．悪性黒色腫を疑い十分なinformed consent後にEMRを施行し，病理組織学的所見で悪性黒色腫と診断した．9年前に同疾患で経肛門的切除術施行，断端陽性で不完全切除であったが，追加切除されておらず，同部位の局所再発と思われた．悪性黒色腫の予後は極めて悪く，また不完全切除例での長期生存例は稀である．更に，NBI観察しえたことから貴重な症例であると思われた．

DOI： 10.11280/gee.54.3172

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記述言語：日本語   出版者・発行元：一般財団法人 日本消化器病学会  

症例は75歳男性，右季肋部痛を主訴に来院し，CTで肝右葉に巨大な腫瘤を認め入院した．腹部超音波で腫瘤内を貫通する脈管を認め，超音波ガイド下腫瘍生検を行い悪性リンパ腫と診断した．骨髄正常で，脾腫がなくPET-CTにて肝以外にFDGの有意な集積を認めなかったことから肝原発と診断した．Rituximabを併用したCHOP療法を8クール施行し，治療後のPET-CTでFDGの有意な集積を認めず完全寛解と判定した．節外性悪性リンパ腫の0.41%と非常にまれな疾患である肝原発悪性リンパ腫の1例を経験し，R-CHOP療法により完全寛解が得られたので報告する．&lt;br&gt;

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：南山堂  

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