Faculty Profiles - TAKAKI Akinobu

Papers - TAKAKI Akinobu

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A case of celecoxib-induced multiple ulcers of the small intestine observed on capsule endoscopy

Yuki Aoyama, Sakuma Takahashi, Tomoki Inaba, Mariko Colvin, Shigenao Ishikawa, Masaki Wato, Yoshiyasu Kono, Seiji Kawano, Akinobu Takaki, Hiroyuki Okada

Gastroenterological Endoscopy 60 ( 10 ) 2297 - 2302 2018.10

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Gastroenterological Endoscopy Society

The patient was a 75-year-old man with melena. Capsule endoscopy revealed colonic diverticular bleeding as well as 2-to 3-mm erosions scattered in the small intestine. The colonic diverticular bleeding was treated by endoscopic clipping. Two months later, administration of celecoxib was started for knee pain. Nine months later, black stools and iron-deficiency anemia were observed, and multiple ulcers were found in the intestine on capsule endoscopy. The patient was diagnosed as having nonsteroidal anti-inflammatory drug-induced small intestinal ulcer. The cele-coxib therapy was discontinued, and administration of misoprostol, rebamipide, and polaprezinc was started. Capsule endoscopy performed three months after starting the treatment demonstrated improvement of the ulcers. Celecoxib is a cyclooxygenase-2 (COX-2) selective inhibitor and is considered to confer a low risk of mucosal injury, but the risk of mucosal injury may increase with chronic administration of celecoxib or combination therapy with a proton pump inhibitor. Therefore, careful attention should be paid to patients who are being treated with celecoxib.

DOI： 10.11280/gee.60.2297

Clinical features of autoimmune hepatitis with acute presentation: a Japanese nationwide survey.

Satoru Joshita, Kaname Yoshizawa, Takeji Umemura, Hiromasa Ohira, Atsushi Takahashi, Kenichi Harada, Nguyen Canh Hiep, Koichi Tsuneyama, Masayoshi Kage, Masayuki Nakano, Jong-Hon Kang, Kazuhiko Koike, Mikio Zeniya, Tetsuya Yasunaka, Akinobu Takaki, Takuji Torimura, Masanori Abe, Osamu Yokosuka, Atsushi Tanaka, Hajime Takikawa

Journal of gastroenterology 53 ( 9 ) 1079 - 1088 2018.9

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Autoimmune hepatitis (AIH) is characterized by progressive inflammation and necrosis of hepatocytes and eventually leads to a variety of phenotypes, including acute liver dysfunction, chronic progressive liver disease, and fulminant hepatic failure. Although the precise mechanisms of AIH are unknown, environmental factors may trigger disease onset in genetically predisposed individuals. Patients with the recently established entity of AIH with acute presentation often display atypical clinical features that mimic those of acute hepatitis forms even though AIH is categorized as a chronic liver disease. The aim of this study was to identify the precise clinical features of AIH with acute presentation. METHODS: Eighty-six AIH patients with acute presentation were retrospectively enrolled from facilities across Japan and analyzed for clinical features, histopathological findings, and disease outcomes. RESULTS: Seventy-five patients were female and 11 were male. Patient age ranged from adolescent to over 80 years old, with a median age of 55 years. Median alanine transaminase (ALT) was 776 U/L and median immunoglobulin G (IgG) was 1671 mg/dL. There were no significant differences between genders in terms of ALT (P = 0.27) or IgG (P = 0.51). The number of patients without and with histopathological fibrosis was 29 and 57, respectively. The patients with fibrosis were significantly older than those without (P = 0.015), but no other differences in clinical or histopathological findings were observed. Moreover, antinuclear antibody (ANA)-positive (defined as × 40, N = 63) and -negative (N = 23) patients showed no significant differences in clinical or histopathological findings or disease outcomes. Twenty-five patients experienced disease relapse and two patients died during the study period. ALP ≥ 500 U/L [odds ratio (OR) 3.20; 95% confidence interval (CI) 1.12-9.10; P < 0.030] and GGT ≥ 200 U/L (OR 2.98; 95% CI 1.01-8.77; P = 0.047) were identified as independent risk factors of disease relapse. CONCLUSIONS: AIH with acute presentation is a newly recognized disease entity for which diagnostic hallmarks, such as ALT, fibrosis, and ANA, are needed. Further investigation is also required on the mechanisms of this disorder. Clinicians should be mindful of disease relapse during patient care.

DOI： 10.1007/s00535-018-1444-4

抗ドナーHLA抗体陽性の肝移植の短期・長期成績と問題点抗ドナー抗体陽性生体肝移植の現状と問題点

楳田祐三, 八木孝仁, 田中健大, 吉田龍一, 信岡大輔, 杭瀬崇, 吉田一博, 安井和也, 吉田真里, 白川靖博, 柳井広行, 高木章乃夫, 藤原俊義

移植 53 ( 総会臨時 ) 257 - 257 2018.9

Symptoms and health-related quality of life in Japanese patients with primary biliary cholangitis. Reviewed

Yagi M, Tanaka A, Abe M, Namisaki T, Yoshiji H, Takahashi A, Ohira H, Komori A, Yamagiwa S, Kikuchi K, Yasunaka T, Takaki A, Ueno Y, Honda A, Matsuzaki Y, Takikawa H

Scientific reports 8 ( 1 ) 12542 2018.8

Mixed HCV Infection of Genotype 1B and Other Genotypes Influences Non-response during Daclatasvir + Asunaprevir Combination Therapy.

Nozomu Wada, Fusao Ikeda, Chizuru Mori, Koichi Takaguchi, Shin-Ichi Fujioka, Haruhiko Kobashi, Yoichi Morimoto, Kazuya Kariyama, Kosaku Sakaguchi, Noriaki Hashimoto, Akio Moriya, Mitsuhiko Kawaguchi, Hirokazu Miyatake, Hiroaki Hagihara, Junichi Kubota, Hiroki Takayama, Yasuto Takeuchi, Tetsuya Yasunaka, Akinobu Takaki, Yoshiaki Iwasaki, Hiroyuki Okada

Acta medica Okayama 72 ( 4 ) 401 - 406 2018.8

Language：English Publishing type：Research paper (scientific journal)

Daclatasvir (DCV) + asunaprevir (ASV) combination therapy has become available for patients with hepatitis C virus (HCV) serogroup 1 infection. We studied the efficacy of this therapy by focusing on the factors associated with sustained virological responses (SVR) including resistance-associated variants (RAVs) and mixed infection of different HCV genotypes. We enrolled 951 HCV serogroup 1-positive patients who received this combination therapy at our hospital or affiliated hospitals. The presence of RAVs in non-structural (NS) regions 3 and 5A was analyzed by direct sequencing. HCV genotypes were determined by PCR with genotype-specific primers targeting HCV core and NS5B regions. SVR was achieved in 91.1% of patients. Female sex, age > 70 years, and RAVs were significantly associated with non-SVR (p<0.01 for all). Propensity score-matching results among the patients without RAVs regarding sex, age, and fibrosis revealed that mixed HCV infection determined by HCV NS5B genotyping showed significantly lower SVR rates than 1B-mono infection (p=0.02). Female sex and RAVs were significant factors associated with treatment failure of this combination therapy for patients with HCV serogroup 1 infection. Mixed HCV infection other than 1B-mono infection would be useful for predicting treatment failure.

DOI： 10.18926/AMO/56178

Beneficial and Paradoxical Roles of Anti-Oxidative Nutritional Support for Non-Alcoholic Fatty Liver Disease. Reviewed International journal

Uchida D, Takaki A, Adachi T, Okada H

Nutrients 10 ( 8 ) 2018.7

Language：English Publishing type：Research paper (scientific journal)

Oxidative stress is being recognized as a key factor in the progression of chronic liver disease (CLD), especially non-alcoholic fatty liver disease (NAFLD). Many NAFLD treatment guidelines recommend the use of antioxidants, especially vitamin E. Many prospective studies have described the beneficial effects of such agents for the clinical course of NAFLD. However, as these studies are usually short-term evaluations, lasting only a few years, whether or not antioxidants continue to exert favorable long-term effects, including in cases of concomitant hepatocellular carcinoma, remains unclear. Antioxidants are generally believed to be beneficial for human health and are often commercially available as health-food products. Patients with lifestyle-related diseases often use such products to try to be healthier without practicing lifestyle intervention. However, under some experimental NAFLD conditions, antioxidants have been shown to encourage the progression of hepatocellular carcinoma, as oxidative stress is toxic for cancer cells, just as for normal cells. In this review, we will highlight the paradoxical effects of antioxidants against NAFLD and related hepatocellular carcinoma.

DOI： 10.3390/nu10080977

進行肝細胞癌におけるソラフェニブ治療の長期生存症例と短期終了症例のそれぞれの特徴

足立卓哉, 能祖一裕, 大山淳史, 和田望, 安中幸, 竹内康人, 安中哲也, 大西秀樹, 池田房雄, 白羽英則, 高木章乃夫, 高口浩一, 植松周二, 高畠弘行, 萩原宏明, 岡田裕之

The Liver Cancer Journal ( Suppl.1 ) 77 - 77 2018.6

New Left Lobe Transplantation Procedure with Caval Reconstruction Using an Inverted Composite Graft for Chronic Budd-Chiari Syndrome in Living-Donor Liver Transplantation—A Case Report Reviewed

T. Yagi, K. Takagi, R. Yoshida, Yuzo Umeda, D. Nobuoka, T. Kuise, T. Fujiwara, A. Takaki

Transplantation Proceedings 50 ( 4 ) 1192 - 1195 2018.5

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier USA

When the Budd-Chiari syndrome (BCS) lesion extends to the inferior vena cava (IVC) or the orifices of the hepatic vein, the thickened IVC and/or hepatic vein wall must be removed and IVC reconstruction is required in living-donor liver transplantation (LDLT). In various reports about IVC resection in LDLT for BCS, there are none about left lobe liver transplantation with reconstruction of the retrohepatic IVC (rhIVC). To overcome removal and reconstruction of the rhIVC in LDLT for BCS, we introduced a composite IVC graft that is applicable to both right and left lobe partial liver grafts for LDLT for BCS. Pathogenic IVC was removed together with the native liver between the lower edge of the right atrium and 5 cm above the renal vein junction with the use of venovenous bypass. The e-polytetrafluoroethylene graft was anastomosed to the suprarenal intact IVC. Then the native part was detached at the level of just above the renal junction. The composite graft was inverted and a half rim of the native part of the graft was anastomosed to the posterior wall of the right atrium. Next, the common venous orifice of the left lobe graft was anastomosed to the wall defect which was composed of the anterior wall of the right atrium and the distal end of the native part of the composite graft. In conclusion, our inverted composite graft technique will overcome the weak points of LDLT for BCS, such as incomplete removal of the pathogenic caval wall and reconstruction of the rhIVC.

DOI： 10.1016/j.transproceed.2017.11.078

Correction to: Efficacy and safety of glecaprevir/pibrentasvir in HCV-infected Japanese patients with prior DAA experience, severe renal impairment, or genotype 3 infection.

Hiromitsu Kumada, Tsunamasa Watanabe, Fumitaka Suzuki, Kenji Ikeda, Ken Sato, Hidenori Toyoda, Masanori Atsukawa, Akio Ido, Akinobu Takaki, Nobuyuki Enomoto, Koji Kato, Katia Alves, Margaret Burroughs, Rebecca Redman, David Pugatch, Tami J Pilot-Matias, Preethi Krishnan, Rajneet K Oberoi, Wangang Xie, Kazuaki Chayama

Journal of gastroenterology 53 ( 5 ) 689 - 689 2018.5

Language：English Publishing type：Research paper (scientific journal)

Unfortunately, in the original publication of this article, the copyright line was incorrectly published in PDF as "© The Author(s) 2017" instead of "©The Author(s) 2017 This article is an open access publication" and also the CC-BY description was not included. The description should be as follows.

DOI： 10.1007/s00535-017-1409-z

A subclinical high tricuspid regurgitation pressure gradient independent of the mean pulmonary artery pressure is a risk factor for the survival after living donor liver transplantation. Reviewed International journal

Saragai Y, Takaki A, Umeda Y, Matsusaki T, Yasunaka T, Oyama A, Kaku R, Nakamura K, Yoshida R, Nobuoka D, Kuise T, Takagi K, Adachi T, Wada N, Takeuchi Y, Koike K, Ikeda F, Onishi H, Shiraha H, Nakamura S, Morimatsu H, Ito H, Fujiwara T, Yagi T, Okada H

BMC gastroenterology 18 ( 1 ) 62 - 62 2018.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver. We investigated the impact of a subclinical high TRPG on the survival of small grafted living donor liver transplantation (LDLT). METHODS: We retrospectively analyzed 84 LDLT candidates. Patients exhibiting a TRPG ≥25 mmHg on echocardiography were categorized as potentially having liver congestion (subclinical high TRPG; n = 34). The mean pulmonary artery pressure (mPAP) measured after general anesthesia with FIO20.6 (mPAP-FIO20.6) was also assessed. Patients exhibiting pO2 < 80 mmHg and an alveolar-arterial oxygen gradient (AaDO2) ≥ 15 mmHg were categorized as potentially having HPS (subclinical HPS; n = 29). The clinical course after LDLT was investigated according to subclinical high TRPG. RESULTS: A subclinical high TRPG (p = 0.012) and older donor age (p = 0.008) were correlated with a poor 40-month survival. Although a higher mPAP-FIO20.6 was expected to correlate with a worse survival, a high mPAP-FIO20.6 with a low TRPG was associated with high frequency complicating subclinical HPS and a good survival, suggesting a reduction in the PH pressure via pulmonary shunt. CONCLUSION: In cirrhosis patients, mPAP-FIO20.6 may not accurately reflect the congestive pressure to the liver, as the pressure might escape via pulmonary shunt. A subclinical high TRPG is an important marker for predicting a worse survival after LDLT, possibly reflecting congestive pressure to the grafted small liver.

DOI： 10.1186/s12876-018-0793-z

Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation: Which Patient Needs Potent Prophylaxis? Reviewed International journal

Utsumi M, Umeda Y, Yagi T, Nagasaka T, Shinoura S, Yoshida R, Nobuoka D, Kuise T, Fuji T, Takagi K, Takaki A, Fujiwara T

Digestive surgery 36 ( 1 ) 59 - 66 2018.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Invasive fungal infection (IFI) is associated with high mortality after living donor liver transplant (LDLT). The aim of this study was to identify the risk factors for post-LDLT IFI for early diagnosis and improvement of antifungal treatment outcome. METHODS: Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. RESULTS: During the follow-up period (1,553 ± 73 days, range 20-2,946 days), 15 patients (9.8%) developed IFI classified as "proven" (n = 8) and "probable" (n = 7) with fungal pathogens including Candida spp. (n = 10), Aspergillus spp. (n = 4), and Trichosporon (n = 2). Of these patients, 7 patients with IFI died despite treatment. The 1-, 3-, and 5-year survival rates were lower in patients with IFI than those without IFI (66.7/59.3/44.4 vs. 90.4/85.7/81.8%, respectively; p = 0.0026). Multivariate analysis identified model for end-stage liver disease score of ≥26 (OR 16.0, p = 0.0012) and post-transplant acute kidney injury (RIFLE criteria I- or F-class; OR 4.87, p = 0.047) as independent risk factors for IFI. CONCLUSION: Preoperative recipients' status and postoperative kidney dysfunction can affect an occurrence of post-transplant IFI. These risk factors would be taken into consideration for designation of proper antifungal therapy.

DOI： 10.1159/000486548

Non-alcoholic fatty liver disease in patients with autoimmune hepatitis. International journal

Atsushi Takahashi, Teruko Arinaga-Hino, Hiromasa Ohira, Kazumichi Abe, Takuji Torimura, Mikio Zeniya, Masanori Abe, Kaname Yoshizawa, Akinobu Takaki, Yoshiyuki Suzuki, Jong-Hon Kang, Nobuhiro Nakamoto, Tomoo Fujisawa, Atsushi Tanaka, Hajime Takikawa

JGH open : an open access journal of gastroenterology and hepatology 2 ( 2 ) 54 - 58 2018.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND AND AIM: The incidence of non-alcoholic fatty liver disease (NAFLD) is increasing all over the world. NAFLD develops in patients with liver disease, including patients with autoimmune hepatitis (AIH). NAFLD and AIH have some similar laboratory and histological findings. The aim of this study was to elucidate the characteristics of AIH patients with NAFLD. METHODS: We re-evaluated the nationwide survey performed in Japan in 2015 of AIH patients diagnosed between 2009 and 2013. RESULTS: A total of 1151 subjects (144 men and 1007 women) were enrolled in the present study. The overall prevalence of NAFLD was 17.0%. Compared to AIH without NAFLD, AIH patients with NAFLD had the following characteristics: (i) low female-to-male ratio, (ii) older age, (iii) mild elevation in hepatobiliary enzymes, (iv) histologically progressive fibrosis and mild plasma cell infiltration or mild lobular hepatitis, (v) lower prevalence of prednisolone administration and higher prevalence of ursodeoxycholic acid administration, (vi) higher levels of hepatic enzymes and immunoglobulin G after treatment, and (vii) similar prevalence of autoimmune and malignant complications. CONCLUSION: AIH patients with NAFLD have many features that are different from AIH patients without NAFLD. Understanding these differences is essential for the proper diagnosis and treatment of AIH patients with NAFLD.

DOI： 10.1002/jgh3.12046

Transcatheter Arterial Chemoembolization to Reduce Size of Hepatocellular Carcinoma before Radiofrequency Ablation. Reviewed

Ako S, Nakamura S, Nouso K, Dohi C, Wada N, Morimoto Y, Takeuchi Y, Yasunaka T, Kuwaki K, Onishi H, Ikeda F, Shiraha H, Takaki A, Okada H

Acta medica Okayama 72 ( 1 ) 47 - 52 2018.2

Language：English Publishing type：Research paper (scientific journal)

Transcatheter arterial chemoembolization (TACE) is often performed before radiofrequency ablation (RFA) for the treatment of early-stage hepatocellular carcinoma (HCC). TACE prior to RFA can expand the ablated area and reduce the tumor size, facilitating complete ablation. However, the factors correlated with size reduction remain uncertain. The aim of this study was to identify the factors associated with size reduction by TACE and develop a formula to predict the reduction rate. A total of 100 HCC patients treated with TACE followed by RFA at least 20 days later were enrolled. The tumor size was measured at the time of TACE and RFA, and correlations between the reduction rate and 13 clinical factors were examined. A formula to predict the reduction rate was built using the factors obtained by the analysis. Reduction in the tumor size was observed in 69 nodules, and the median reduction rate was 16.2%. A multivariate regression analysis revealed that a large tumor size (p< 0.01) and a long interval between the therapies (p= 0.01) were factors for a high tumor reduction rate, with tumor size more strongly related to the degree of reduction. A size reduction of more than 10% can be expected by waiting 20 days after TACE when the size of the tumor at TACE is over 25 mm in diameter. The tumor size.

DOI： 10.18926/AMO/55662

改訂自己免疫性肝炎・原発性胆汁性胆管炎診療ガイドライン Reviewed

厚生労働科学研究費補助金, 難治性疾患政策研究事業, 難治性の肝, 胆道疾患に関する調査研究, 班, 自己免疫性肝炎分科会, 原発性胆汁性胆管炎分科会, 田中篤, 大平弘正, 高橋敦史, 小森敦正, 阿部雅則, 姜貞憲, 小池和彦, 鈴木義之, 髙木章乃夫, 有永照子, 島村拓司, 中本伸宏, 原田憲一, 十河剛, 乾あやの, 藤澤知雄, 吉澤要, 玄田拓哉, 銭谷幹男, 下田慎治, 竹山康章, 向坂彰太郎, 谷合麻紀子, 橋本悦子, 中村稔, 浪崎正, 吉治仁志, 本多彰, 松崎靖司, 廣原淳子, 山際訓, 滝川一

肝臓 59 ( 4 ) 211 - 216 2018

Health-related quality of life in patients with autoimmune hepatitis: A questionnaire survey. International journal

Atsushi Takahashi, Kei Moriya, Hiromasa Ohira, Teruko Arinaga-Hino, Mikio Zeniya, Takuji Torimura, Masanori Abe, Akinobu Takaki, Jong-Hon Kang, Ayano Inui, Tomoo Fujisawa, Kaname Yoshizawa, Yoshiyuki Suzuki, Nobuhiro Nakamoto, Kazuhiko Koike, Hitoshi Yoshiji, Aya Goto, Atsushi Tanaka, Zobair M Younossi, Hajime Takikawa

PloS one 13 ( 10 ) e0204772 2018

Language：English Publishing type：Research paper (scientific journal)

AIM: Health-related quality of life is impaired in patients with autoimmune hepatitis, but the association between health-related quality of life and patients' backgrounds remains unknown. We assessed health-related quality of life in patients with autoimmune hepatitis and identified factors associated with its impairment. METHODS: We assessed health-related quality of life in patients with autoimmune hepatitis, patients with chronic hepatitis C, and healthy subjects using the Japanese version of the Chronic Liver Disease Questionnaire and the 36-Item Short Form Survey. We compared health-related quality of life in patients with autoimmune hepatitis with that of patients with chronic hepatitis C and healthy subjects. RESULTS: A total of 265 patients with autoimmune hepatitis, 88 patients with chronic hepatitis C, and 97 healthy subjects were enrolled; most patients were women. The median ages of patients were 65, 66, and 57 years, respectively. Of these patients with autoimmune hepatitis, 10.6% and 57.0% had cirrhosis and comorbid diseases, respectively. The overall Chronic Liver Disease Questionnaire scores (5.5 vs. 6.2, P < 0.001) and physical (48.1 vs. 54.2, P < 0.001) and mental (51.8 vs. 55.0, P = 0.004) component summaries of 36-Item Short Form Survey were significantly lower in patients with autoimmune hepatitis than in healthy subjects, and similar to scores in patients with chronic hepatitis C. Having cirrhosis, comorbid diseases, and treatment for autoimmune hepatitis were associated with impaired health-related quality of life among patients with autoimmune hepatitis. In particular, prednisolone use was associated with lower scores on the worry domain of the Chronic Liver Disease Questionnaire. CONCLUSIONS: Patients with autoimmune hepatitis showed impairment in health-related quality of life, which was associated with not only disease progression, but also comorbid diseases and treatment. Ways to improve health-related quality of life should be considered in patients with AIH when disease outcome is not favorable and when using prednisolone.

DOI： 10.1371/journal.pone.0204772

An activity survey of hepatitis medical care coordinators in Okayama prefecture, Japan

Shihoko Namba, Fusao Ikeda, Fumio Akiyama, Mitsumasa Ishihara, Yasuyuki Shimomura, Noriko Yamasaki, Naomi Inuyama, Michihiro Koyama, Katsunori Kamegawa, Shinnosuke Okubo, Yuko Hasegawa, Kenji Iwai, Akiko Sanki, Rumi Miura, Kanae Yano, Yosuke Fujii, Atsushi Ohyama, Takuya Adachi, Nozomu Wada, Yuki Yasunaka, Tetsuya Yasunaka, Hideki Onishi, Hidenori Shiraha, Akinobu Takaki, Hisami Yamanoi, Hiroyuki Okada

Acta Hepatologica Japonica 59 ( 11 ) 625 - 632 2018

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Society of Hepatology

Okayama prefecture has conducted seminars on viral hepatitis primarily for new staff members belonging to the department dealing with liver diseases in public health centers and hospitals
participants have been certified as “hepatitis medical care coordinators.” This survey was planned to (1) evaluate the viral hepatitis awareness activities they conducted after seminars using self-reported questionnaires and (2) clarify whether their knowledge and practices were appropriate to classify them as competent hepatitis medical care coordinators as per the Ministry of Health, Labor and Welfare in Japan. Among all 298 coordinators in the Okayama prefecture, 146 responded to the survey
84 worked at the same department and 45 matched the coordinator in their daily activities. Further, 36 were transferred to different departments and 20 conducted awareness activities as hepatitis medical care coordinators in addition to their daily responsibilities. Transfer of hepatitis medical care coordinators may help expand hepatitis awareness activities across different departments.

DOI： 10.2957/kanzo.59.625

肝移植後C型肝炎再発に対するソホスブビル含有治療の有効性

大山淳史, 高木章乃夫, 安中哲也, 足立卓哉, 池田房雄, 和田望, 竹内康人, 大西秀樹, 中村進一郎, 白羽英則, 高木弘誠, 杭瀬崇, 信岡大輔, 吉田龍一, 楳田祐三, 吉田真理, 有森千聖, 八木孝仁, 岡田裕之

肝臓 58 ( 11 ) 599 - 604 2017.11

Language：Japanese Publisher：(一社)日本肝臓学会

肝移植後C型肝炎に対するDirect Acting Antivirals(DAA)治療効果を検討した。Genotypelは29症例で、ダクラタスビル+アスナプレビル(DCV+ASV)5例、ソホスブビル+レジパスビル(SOF+LDV)25例(含DCV+ASV無効1例)、Genotype2が2症例でSOF+リバビリン治療を行った。DCV+ASVは5例中4例で治療完遂、3例でSustained viral response(SVR)24を達成。SOF+LDVは全例SVR24を達成、移植後2ヵ月以内の肝炎再燃例も含まれているが問題なく治療完遂可能であった。Genotype2はSVR24を達成。SOF中心レジメンで100%のSVR24達成率であり、移植後早期においても問題なくウイルス駆除達成可能であった。C型肝硬変の肝移植適応評価においてC型肝炎のネガティブインパクトはなくなったと言っても過言ではない。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00263&link_issn=&doc_id=20171128110001&doc_link_id=10.2957%2Fkanzo.58.599&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.58.599&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Living Donor Liver Transplantation for Acute Liver Failure : Comparing Guidelines on the Prediction of Liver Transplantation. Reviewed

Kazuhiro Yoshida, Yuzo Umeda, Akinobu Takaki, Takeshi Nagasaka, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kosei Takagi, Tetsuya Yasunaka, Hiroyuki Okada, Takahito Yagi, Toshiyoshi Fujiwara

Acta medica Okayama 71 ( 5 ) 381 - 390 2017.10

Language：English Publishing type：Research paper (scientific journal)

Determining the indications for and timing of liver transplantation (LT) for acute liver failure (ALF) is essential. The King's College Hospital (KCH) guidelines and Japanese guidelines are used to predict the need for LT and the outcomes in ALF. These guidelines' accuracy when applied to ALF in different regional and etiological backgrounds may differ. Here we compared the accuracy of new (2010) Japanese guidelines that use a simple scoring system with the 1996 Japanese guidelines and the KCH criteria for living donor liver transplantation (LDLT). We retrospectively analyzed 24 adult ALF patients (18 acute type, 6 sub-acute type) who underwent LDLT in 1998-2009 at our institution. We assessed the accuracies of the 3 guidelines' criteria for ALF. The overall 1-year survival rate was 87.5%. The new and previous Japanese guidelines were superior to the KCH criteria for accurately predicting LT for acute-type ALF (72% vs. 17%). The new Japanese guidelines could identify 13 acute-type ALF patients for LT, based on the timing of encephalopathy onset. Using the previous Japanese guidelines, although the same 13 acute-type ALF patients (72%) had indications for LT, only 4 patients were indicated at the 1st step, and it took an additional 5 days to decide the indication at the 2nd step in the other 9 cases. Our findings showed that the new Japanese guidelines can predict the indications for LT and provide a reliable alternative to the previous Japanese and KCH guidelines.

DOI： 10.18926/AMO/55435

肝炎ウイルス検査陽性患者に対する検査報告システムの効果的な運用方法肝臓専門医受診率向上のさらなる工夫

下村泰之, 藤井洋輔, 池田房雄, 安中哲也, 山崎典子, 笠原郁子, 犬山奈穂美, 小山道弘, 難波志穂子, 竹内康人, 和田望, 桑木健志, 大西秀樹, 中村進一郎, 白羽英則, 高木章乃夫, 岡田裕之

肝臓 58 ( 8 ) 427 - 434 2017.8

Language：Japanese Publisher：(一社)日本肝臓学会

非肝臓専門診療科で実施される肝炎ウイルス検査の結果が受検者に適切に説明されるように、当院では2013年に電子カルテ上で検査陽性を知らせるアラートの自動表示システムを導入した。このシステムを利用して担当医が説明した割合は28%と不十分であったため、検査実施診療科了解のもと検査陽性者へ検査報告書を郵送し、検査陽性者への報告率は89%と改善した。肝臓専門医への紹介状と返信用書類を同封、郵送半年後に肝臓専門医受診を確認できていない場合は再送し、肝炎専門医受診把握率は49%から72%に改善した(p<0.001)。検査報告書再送で肝精査の必要性に気づき肝臓専門医を受診し、肝炎治療を受けた症例もあった。肝炎ウイルス検査陽性者への報告を徹底することは肝臓専門医受診率の向上や適切な肝炎治療の受療に有用である。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00263&link_issn=&doc_id=20170830080001&doc_link_id=10.2957%2Fkanzo.58.427&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.58.427&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Association between periodontitis and prognosis of pancreatobiliary tract cancer: A pilot study. Reviewed International journal

Maruyama T, Tomofuji T, Machida T, Kato H, Tsutsumi K, Uchida D, Takaki A, Yoneda T, Miyai H, Mizuno H, Ekuni D, Okada H, Morita M

Molecular and clinical oncology 6 ( 5 ) 683 - 687 2017.5

Language：English Publishing type：Research paper (scientific journal)

Several studies have indicated that periodontitis is a risk factor for cancer. However, the association between periodontitis and the prognosis of pancreatobiliary tract cancer remains unclear. The aim of this pilot study was to investigate the association between periodontitis and prognosis of pancreatobiliary tract cancer. A total of 22 patients diagnosed with pancreatobiliary tract cancer were analyzed. Oral health status, including severity of periodontitis, general health status and biochemical serum markers were evaluated. The Kaplan-Meier method and Cox proportional hazards model were used to assess factors affecting the prognosis of pancreatobiliary tract cancer. The Kaplan-Meier analysis demonstrated that low body mass index, high concentration of serum C-reactive protein (CRP) and severe periodontitis were significant prognostic factors for survival rate. The Cox proportional hazards model revealed that serum carbohydrate antigen 19-9 concentration [hazard ratio (HR)=1.002; 95% confidence interval (CI): 1.000-1.004] and serum CRP concentration (HR=2.57; 95% CI: 1.15-5.74) were significantly associated with the prognosis of pancreatobiliary tract cancer. In addition, cancer patients with severe periodontitis had higher serum CRP concentrations compared with those without severe periodontitis. Therefore, severe periodontitis indirectly affected the prognosis of pancreatobiliary tract cancer through promoting systemic inflammation.

DOI： 10.3892/mco.2017.1220

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