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Yuki Wada, Hideyuki Tamai,
Akiko Uno,
Akira Kawashima,
Naoki Shingaki,
Yoshiyuki Mori,
Kosaku Moribata,
Kaori Miyata,
Katsuhiko Higashi,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi,
Jun Kato,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: AIM: Rapid virological response (RVR), defined as serum hepatitis C virus (HCV) RNA negativity at 4 weeks, is the most useful predictor of sustained virological response (SVR) to standard pegylated interferon (PEG IFN) plus ribavirin therapy for patients infected with genotype 2 HCV. The aim of the present study was to predict SVR using viral response within 2 weeks of therapy initiation. METHODS: Of 64 HCV genotype 2 patients with a high viral load treated with standard PEG IFN-α-2b plus weight-based ribavirin for 24 weeks, 58 patients whose adherence was more than 67% were analyzed. RNA and core antigen levels were measured at four time points: the day of therapy initiation, the following day, and at 1 and 2 weeks. RESULTS: SVR was achieved in 73% (47/64) of patients. Univariate analysis of SVR contributing factors showed significant differences with age, bodyweight, white blood cell count, platelet count, fibrosis marker levels, baseline core antigen level and viral response. The area under the receiver-operator curve (AUC) of the core antigen level at 1 week (AUC, 0.940) was the highest among the significant SVR predicting factors. Setting 100 fmol/L as the cut-off value for core antigen level at 1 week, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for predicting SVR were 100%, 86%, 96%, 100% and 97%, respectively, and for predicting RVR were 66%, 93%, 97%, 46% and 72%, respectively. CONCLUSION: The HCV core antigen level at 1 week after therapy initiation is the most useful predictor for SVR.
Hepatology Research 02/2013; · 2.20 Impact Factor
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Takeichi Yoshida,
Jun Kato,
Takao Maekita,
Satoshi Yamashita,
Shotaro Enomoto,
Takayuki Ando,
Tohru Niwa,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Mikitaka Iguchi, Hideyuki Tamai,
Toshikazu Ushijima,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Chronic inflammation triggered by Helicobacter pylori causes altered DNA methylation in stomach mucosae, which is deeply involved in gastric carcinogenesis. This study aimed to elucidate the correlation between altered mucosal DNA methylation levels and activity of H. pylori-related gastritis, because inflammatory activity shows particular correlations with the development of diffuse-type cancer. METHODS: Methylation levels in stomach mucosae of 78 healthy volunteers were determined by real-time methylation-specific PCR or bisulfite pyrosequencing. Examined loci were the promoter CpG islands of six genes (FLNc, HAND1, THBD, p41ARC, HRASLS, and LOX) and the CpG sites of non-coding repetitive elements (Alu and Satα) that are reportedly altered by H. pylori infection. Activity of H. pylori-related gastritis was evaluated using two serum markers: H. pylori antibody titer and pepsinogen II. RESULTS: Methylation levels of the six CpG islands were consistently increased, and those of the two repetitive elements were consistently decreased in a stepwise manner with the activity of gastric inflammation as represented by serum marker levels. Each serum marker level was well correlated with the overall DNA methylation status of stomach mucosa, and these two serologic markers were additive in the detection of the mucosa with severely altered DNA methylation. CONCLUSIONS: Alteration in mucosal DNA methylation level was closely correlated with activity of H. pylori-related gastritis as evaluated by serum markers. The observed correlation between altered DNA methylation levels and activity of H. pylori-related gastritis appears to be one of the relevant molecular mechanisms underlying the development of diffuse-type cancer.
Gastric Cancer 01/2013; · 2.42 Impact Factor
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[show abstract]
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ABSTRACT: Objectives- The aim of this study was to evaluate the ability of contrast-enhanced endoscopic sonography for discrimination of mural nodules from mucous clots in intraductal papillary mucinous neoplasms of the pancreas. Methods- Contrast-enhanced endoscopic sonography was performed in 17 consecutive patients who had an intraductal papillary mucinous neoplasm with mural lesions. To perform contrast-enhanced endoscopic sonography, we used a second-generation sonographic contrast agent. After reconstitution with 2 mL of sterile water for injection, 0.7 mL of the agent was administered through a peripheral vein. From 10 to 30 seconds after injection of the contrast agent, the presence or absence of vascularity in mural lesions was assessed. All cases were referred to surgery, and diagnoses were finally obtained by pathologic examination. Diagnoses of mural nodules versus mucous clots based on the sonographic results were compared with tumor histopathologic findings. Results- Pathologic findings revealed 12 cases with mural nodules and 5 cases without. Contrast-enhanced endoscopic sonography depicted vascularity in all 12 cases with pathologically confirmed mural nodules, whereas all 4 cases without vascularity had mucous clots. Only 1 case without a pathologically confirmed mural nodule was overestimated by contrast-enhanced endoscopic sonography as having a mural nodule. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of contrast-enhanced endoscopic sonography for mural nodule detection were 100%, 80%, 92%, 100%, and 94%, respectively. Conclusions- Evaluation of vascularity by contrast-enhanced endoscopic sonography could be useful for distinguishing mural nodules from mucous clots in intraductal papillary mucinous neoplasms. Contrast-enhanced endoscopic sonography could be a necessary option to determine surgical indications for intraductal papillary mucinous neoplasms when mural lesions are observed.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2013; 32(1):61-8. · 1.25 Impact Factor
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Kosaku Moribata, Hideyuki Tamai,
Naoki Shingaki,
Yoshiyuki Mori,
Tatsuya Shiraki,
Shotaro Enomoto,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: To investigate the association between B-mode ultrasound classification of small hepatocellular carcinoma (HCC) and outcome after radiofrequency ablation (RFA).
Ninety-seven cases of HCC treated using RFA between April 2001 and March 2006 were reviewed. Ultrasound images were classified as follows: type 1, with halo (n = 29); and type 2, without halo (n = 68). Type 2 was further categorized into three subgroups: type 2a, homogenous hyperechoic (n = 9); type 2b, hypoechoic with smooth margins (n = 43); and type 2c (n = 16), hypoechoic with irregular or unclear margins. Patients with type 2a HCC were excluded from analysis due to the small number of cases.
Two year recurrence rates for type 2b, type 1 and type 2c were 26%, 42% and 69%, respectively, with significant differences between type 2b and type 2c (P < 0.01), and between type 1 and type 2c (P < 0.05). Five year survival rates were 89%, 43% and 65%, respectively. Survival was significantly longer for type 2b than for other types (type 1 vs type 2b, P < 0.01; type 2b vs type 2c, P < 0.05). On univariate analysis, factors contributing to recurrence were number of tumors, tumor stage, serum level of lens culinaris agglutinin-reactive alpha-fetoprotein and ultrasound classification (P < 0.05). Factors contributing to survival were tumor stage and ultrasound classification (P < 0.05). Multivariate analysis identified ultrasound classification as the only factor independently associated with both recurrence and survival (P < 0.05).
B-mode ultrasound classification of small HCC is a predictive factor for outcome after RFA.
World journal of hepatology. 12/2012; 4(12):374-81.
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Takao Maekita,
Jun Kato,
Yukihiko Nakatani,
Shotaro Enomoto,
Takashi Kayama,
Masahiro Tsuji,
Tsuyoshi Nakaya,
Yosuke Muraki,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Mikitaka Iguchi, Hideyuki Tamai,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: No mouthpiece has been designed to control salivary flow during endoscopic procedures. A new continuous suction mouthpiece (CSM) was developed, and its usefulness for percutaneous endoscopic gastrostomy (PEG) was evaluated. PATIENTS AND METHODS: Seventy-two patients who were scheduled to undergo PEG or the exchange of a gastrostomy button or tube were assigned to one of two groups: the group using the CSM and the group using the conventional mouthpiece. Aspiration pneumonia, procedure duration, extent of salivary flow, frequency of saliva suction, and number of choking episodes during the procedures were evaluated and compared between the two groups. RESULTS: The same number of patients was randomly allocated to each group. There were no significant differences between the two groups in sex, age, procedure type, duration of procedure,depth of sedation, and indication for the procedure. The grade of salivary flow was significantly lower in patients with the CSM than in patients with the conventional mouthpiece (P < 0.001). Significantly fewer suctions and choking episodes were observed in patients with the CSM than in patients with the conventional mouthpiece (P = 0.013, and P = 0.015, respectively). Aspiration pneumonia and other significant adverse events were not observed in either group. CONCLUSIONS: CSM reduced the number of episodes associated with salivary flow in PEG-related procedures. The device is expected to reduce complications such as aspiration not only in PEG but in other upper endoscopic procedures.
Digestive Endoscopy 12/2012; · 1.19 Impact Factor
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Hideyuki Tamai,
Kosaku Moribata,
Yoshiyuki Mori,
Naoki Shingaki,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi,
Jun Kato,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: AIM: Elderly and/or cirrhotic patients with hepatitis C virus (HCV) are at high risk of adverse effects during interferon therapy. The aim of the present study was to evaluate the efficacy, safety and predictive factors for sustained virological response (SVR) of low-dose pegylated interferon-α-2a (PEG IFN-α-2a) monotherapy in elderly and/or cirrhotic patients with HCV genotype-2 or genotype-1 low level infection. METHODS: Sixty-four elderly (≥65 years) and/or cirrhotic patients with HCV genotype-2 or genotype-1 low level (<5 logIU/mL) infection underwent low-dose PEG IFN-α-2a (90 μg/week) monotherapy for 24 weeks. Sixty patients were available for efficacy assessment. RESULTS: SVR was achieved in 78.3%. SVR rates according to genotype-1 low, genotype-2 low and genotype-2 high viral load were 90.0%, 87.1% and 57.9%, respectively. The discontinuation rate was 12.5%. PEG IFN-α-2a was interrupted or discontinued in four patients because of severe thrombocytopenia (<25 000/mm(3) ). The baseline platelet counts of all these patients were less than 70 000/mm(3) . On univariate analysis of factors contributing to SVR, significant differences were noted in viral load, platelet count, γ-glutamyltransferase, ferritin, α-fetoprotein level and rapid viral response (RVR). On multivariate analysis, RVR was the only independent factor (P = 0.010, odds ratio = 47.27). The positive and negative SVR-predictive values based on RVR were 95% and 82%, respectively. CONCLUSION: Low-dose PEG IFN-α-2a monotherapy was effective and tolerable in elderly and/or cirrhotic patients with genotype-2 or genotype-1 low HCV level infection. However, a baseline platelet count of more than 70 000/mm(3) is needed for safety. RVR can predict SVR accurately.
Hepatology Research 11/2012; · 2.20 Impact Factor
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Shotaro Enomoto,
Mika Watanabe,
Takeichi Yoshida,
Chizu Mukoubayashi,
Kosaku Moribata,
Yosuke Muraki,
Naoki Shingaki,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi, Hideyuki Tamai,
Jun Kato,
Mitsuhiro Fujishiro,
Masashi Oka,
Osamu Mohara,
Masao Ichinose
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[hide abstract]
ABSTRACT: Although frequent vomiting reflexes during esophagogastroduodenoscopy (EGD) causes suffering in patients, very few studies have investigated the characteristics of subjects who frequently develop vomiting reflexes. This study examined the incidence of the vomiting reflex and related factors, especially upper gastrointestinal symptoms, among individuals undergoing transoral EGD.
Subjects included 488 consecutive adults (mean age, 56.1 ± 8.9 years) who underwent transoral EGD for gastric cancer screening between February 2010 and March 2011. All procedures were performed by an endoscopist with 15 years of experience. Based on a questionnaire survey using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), symptoms (dyspepsia and acid reflux symptoms) and the number of vomiting reflexes during EGD were recorded.
Of the 488 subjects, 271 (56%) developed vomiting reflexes (mean, 4.2 times). This reflex-positive group was younger (54.3 ± 9.5 years) than the reflex-negative group (58.3 ± 7.7 years, P < 0.001). The number of subjects in the reflex-positive group with a high FSSG dyspepsia score (2.27 ± 2.57 vs 1.23 ± 1.84; P < 0.001), acid reflux symptom score (1.96 ± 2.22 vs 1.34 ± 2.14; P < 0.01) or an esophageal hiatal hernia (14.8% vs 4.6%; P < 0.001) was significantly higher than in the reflex-negative group. Multivariate analysis also showed a significant correlation between these four factors and the occurrence of vomiting reflexes. Using an FSSG dyspepsia score of 1 as the cut-off offered 68% sensitivity and 57% specificity for predicting the occurrence of vomiting reflexes.
Based on FSSG questionnaire responses on upper gastrointestinal symptoms, dyspepsia symptoms, in particular, are related to presence of vomiting reflexes during EGD.
Digestive Endoscopy 09/2012; 24(5):325-30. · 1.19 Impact Factor
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Kazuhiro Fukatsu,
Kazuki Ueda,
Hiroki Maeda,
Yasunobu Yamashita,
Masahiro Itonaga,
Yoshiyuki Mori,
Kosaku Moribata,
Naoki Shingaki,
Hisanobu Deguchi,
Shotaro Enomoto,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi, Hideyuki Tamai,
Jun Kato,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: Endoscopic ultrasonography (EUS) was performed on a patient being treated for chronic pancreatitis because a submucosal tumor was observed in the stomach during gastrointestinal endoscopy. As internal pulsatile blood flow on Doppler was present, the diagnosis of an aneurysm was made. The pseudoaneurysm of the left gastric artery was embolized with histoacryl and lipiodol and the splenic artery was embolized with coils at the location of the pseudoaneurysm to prevent hemorrhage. Follow up EUS confirmed the cessation of blood flow from the pseudoaneurysm. Clinicians encountering a gastric submucosal tumor-like protrusion in a patient with chronic pancreatitis should use EUS to investigate the possibility of a pseudoaneurysm, which must be treated as quickly as possible once identified.
World journal of gastrointestinal endoscopy. 07/2012; 4(7):335-8.
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Nobutake Yamamichi,
Masashi Oka,
Ken-ichi Inada,
Maki Konno-Shimizu,
Natsuko Kageyama-Yahara, Hideyuki Tamai,
Jun Kato,
Mitsuhiro Fujishiro,
Shinya Kodashima,
Keiko Niimi,
Satoshi Ono,
Yutaka Tsutsumi,
Masao Ichinose,
Kazuhiko Koike
[show abstract]
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ABSTRACT: Rebamipide is usually used for mucosal protection, healing of gastric ulcers, treatment of gastritis, etc., but its effects on gastric malignancy have not been elucidated. Using Lewis and Buffalo rat strains treated with peroral administration of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), we evaluated the effect of rebamipide on the induction of tumor-suppressive dendritic cells, which are known to be heterogeneous antigen-presenting cells of bone marrow origin and are critical for the initiation of primary T-cell responses. Using CD68 as a marker for dendritic cells, the stomach pyloric mucosae of Lewis and Buffalo rats were immunohistochemically analyzed in the presence or absence of rebamipide and MNNG. After a 14-day treatment of rebamipide alone, no significant change in number of CD68-expressing cells was detected in either rat strain. However, after concurrent exposure to MNNG for 14 days, treatment with rebamipide slightly increased CD68-positive cells in the Lewis strain, and significantly increased them in the Buffalo strain. Analysis of two chemotactic factors of dendritic cells, IL-1β and TNF-α, in the gastric cancer cells showed that expression of IL-1β, but not TNF-α, was induced by rebamipide in a dose-dependent manner. A luciferase promoter assay using gastric SH-10-TC cells demonstrated that an element mediating rebamipide action exists in the IL-1β gene promoter region. In conclusion, rebamipide has potential tumor-suppressive effects on gastric tumorigenesis via the recruitment of dendritic cells, based on the upregulation of the IL-1β gene in gastric epithelial cells.
Biochemical and Biophysical Research Communications 06/2012; 424(1):124-9. · 2.48 Impact Factor
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Kazuki Ueda, Hideyuki Tamai,
Momoyo Matsumoto,
Hiroki Maeda,
Kazuyuki Nakazawa,
Kosaku Moribata,
Naoki Shingaki,
Hisanobu Deguchi,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi,
Kimihiko Yanaoka,
Masashi Oka,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: A 79-year-old woman complaining of epigastric pain was examined by her local physician, who found an abdominal mass and referred
the patient to our department. Abdominal plain computed tomography revealed a mass, 50mm in size, with slight calcification
on the ventral side of the head of the pancreas. On abdominal ultrasound, the mass lesion consisted of an aggregation of hypoechoic
masses, with a heterogeneous hyperechoic region at its center. On contrast ultrasonography, only the hyperechoic region was
stained. 18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed FDG accumulation in the same region. It was difficult
to differentiate between a malignant pancreatic tumor and an inflammatory disease on imaging, but since QuantiFERON TB2G testing
was positive, pancreatic tuberculosis was suspected, and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA)
was performed to obtain a definitive diagnosis. Samples from the hypoechoic region consisted of necrotic tissue, while those
from the hyperechoic region consisted of pancreatic tissue together with granulation tissue. BCG immunostaining was positive,
and a diagnosis of pancreatic tuberculosis was made. If EUS-FNA is performed on stained areas seen on contrast ultrasonography,
this will probably enable a more accurate diagnosis of pancreatic tuberculosis with low invasiveness.
KeywordsContrast-enhanced ultrasonography-Endoscopic ultrasound-Fine-needle aspiration biopsy-Interferon-γ-Pancreatic tuberculosis
Clinical Journal of Gastroenterology 04/2012; 3(3):159-164.
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Yosuke Muraki,
Shotaro Enomoto,
Mikitaka Iguchi,
Toru Niwa,
Takao Maekita,
Takeichi Yoshida,
Kosaku Moribata,
Naoki Shingaki,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue, Hideyuki Tamai,
Jun Kato,
Mitsuhiro Fujishiro,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: To investigate risk factors and adverse events related to high-dose diazepam administration during endoscopic submucosal dissection for gastric neoplasias.
Between February 2002 and December 2009, a total of 286 patients with gastric epithelial neoplasia underwent endoscopic submucosal dissection in our hospital. To achieve moderate sedation, 5-7.5 mg of diazepam was administered intravenously by non-anesthesiologists. Intermittent additional administration of 2.5-5 mg diazepam was performed if uncontrollable body movement of the patient was observed. All patients were classified into groups based on the required diazepam dose: low-dose (≤ 17.5 mg, n = 252) and high-dose (> 17.5 mg, n = 79).
Differences between the low- and high-dose diazepam groups were observed in lifetime alcohol consumption (0.30 ± 0.48 vs 0.44 ± 0.52 tons, P = 0.032), body weight (58.4 ± 10.3 vs 62.0 ± 9.9 kg, P = 0.006), tumor size (15 ± 10 vs 23 ± 18 mm, P < 0.001), lesion location (P < 0.001) and the presence of ulcerative findings (14/238 vs 18/61, P < 0.001). Multivariate analysis identified all five variables as independently related to required diazepam dosage. In terms of adverse reactions to diazepam administration, paradoxical excitement was significantly more frequent in the high-dose diazepam group (P < 0.001).
Intermittent administration of diazepam enabled safe completion of gastric endoscopic submucosal dissection except in patients who were alcohol abusers or obese, or who showed complicated lesions.
World journal of gastrointestinal endoscopy. 03/2012; 4(3):80-6.
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Mika Watanabe,
Jun Kato,
Izumi Inoue,
Noriko Yoshimura,
Takeichi Yoshida,
Chizu Mukoubayashi,
Hisanobu Deguchi,
Shotaro Enomoto,
Kazuki Ueda,
Takao Maekita,
Mikitaka Iguchi, Hideyuki Tamai,
Hirotoshi Utsunomiya,
Nobutake Yamamichi,
Mitsuhiro Fujishiro,
Masataka Iwane,
Tatsuya Tekeshita,
Osamu Mohara,
Toshikazu Ushijima,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: This study aimed to elucidate groups at high risk of developing cancer among patients with serologically identified Helicobacter pylori infection and nonatrophic stomach. Annual endoscopy was performed for a mean of 5.4 years in 496 asymptomatic middle-aged men who were H. pylori antibody-positive and pepsinogen (PG) test-negative. Subjects were stratified according to the activity of H. pylori-associated gastritis measured by serum levels of PG and H. pylori antibody, and/or by endoscopic findings of rugal hyperplastic gastritis (RHG), and cancer development was investigated. During the study period, seven cases of cancer developed in the cohort (incidence rate, 261/100,000 person-years), with 85.7% developing in the group showing a PGI/II ratio ≤3.0, reflecting active inflammation-based high PGII levels. Cancer incidence was significantly higher in this group (750/100,000 person-years) than in groups with less active gastritis. Furthermore, cancer incidence for this group was significantly higher in the subgroup with high H. pylori antibody titers than in the low-titer subgroup. Meanwhile, endoscopic findings revealed that 11.7% of subjects showed RHG reflecting localized highly active inflammation, and cancer risk was significantly higher in patients with RHG than in patients without. Combining the two serum tests and endoscopic examination for RHG allowed identification of subjects with more active gastritis and higher cancer risk. No cancer development was observed in these high-risk subjects after H. pylori eradication. Subjects with highly active gastritis identified by the two serological tests and endoscopic RHG constitute a group at high risk of cancer development with H. pylori-infected nonatrophic stomach.
International Journal of Cancer 03/2012; 131(11):2632-42. · 5.44 Impact Factor
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Hideyuki Tamai,
Naoki Shingaki,
Tatsuya Shiraki,
Hiroshi Tukuda,
Yoshiyuki Mori,
Kosaku Moribata,
Shotaro Enomoto,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi,
Kimihiko Yanaoka,
Masashi Oka,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: Aim: Continuation of pegylated interferon (PEG-IFN) plus ribavirin at the recommended dose is difficult in elderly patients and/or patients with cytopenia or complications. Whether the therapeutic efficacy of low-dose PEG-IFN plus ribavirin therapy could be predicted based on virological response within 2 weeks of therapy initiation was evaluated.Methods: A total of 106 patients with a high viral load of genotype-1b hepatitis C virus (HCV) underwent low-dose PEG-IFN plus ribavirin therapy. PEG-IFN alpha 2b (0.75 µg/kg per week) and ribavirin (600–800 mg/day) were administered for 48 weeks.Results: Sustained virological response (SVR) was achieved in 37%, and treatment was discontinued in 9%. On univariate analysis of SVR-contributing factors, significant differences were noted in the white blood cell count, platelet count, fibrosis markers, and viral reduction within 2 weeks from therapy initiation. On multivariate analysis, the platelet count and the reduction in the HCV core antigen level at week 2 were independent factors. The positive predictive value (PPV) and the negative predictive value (NPV) for SVR based on a 1-log or greater HCV-RNA level reduction at week 2 were 65% and 90%, respectively, and those based on HCV core antigen level at week 2 were 64% and 97%, respectively. PPV and NPV based on a 2-log or greater reduction of the RNA level were 86% and 67%, respectively, and those based on the core antigen level were 93% and 69%, respectively.Conclusion: Evaluation of viral reduction at week 2 after therapy initiation is useful for predicting SVR to low-dose PEG-IFN plus ribavirin therapy.
Hepatology Research 09/2011; 41(12):1137 - 1144. · 2.20 Impact Factor
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Shotaro Enomoto,
Mika Watanabe,
Chizu Mukoubayashi,
Hiroshi Ohata,
Hirohito Magari,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi,
Kimihiko Yanaoka, Hideyuki Tamai,
Jun Kato,
Masashi Oka,
Masao Ichinose
09/2011; , ISBN: 978-953-307-375-0
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Hiroya Nakata,
Shotaro Enomoto,
Takao Maekita,
Izumi Inoue,
Kazuki Ueda,
Hisanobu Deguchi,
Naoki Shingaki,
Kosaku Moribata,
Yoshimasa Maeda,
Yoshiyuki Mori,
Mikitaka Iguchi, Hideyuki Tamai,
Nobutake Yamamichi,
Mitsuhiro Fujishiro,
Jun Kato,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: To compare the diagnostic performances of transnasal and standard transoral esophagogastroduodenoscopy (EGD) in gastric cancer screening of asymptomatic healthy subjects.
Between January 2006 and March 2010, a total of 3324 subjects underwent examination of the upper gastrointestinal tract by EGD for cancer screening, with 1382 subjects (41.6%) screened by transnasal EGD and the remaining 1942 subjects (58.4%) by standard transoral EGD. Clinical profiles of the screened subjects, detection rates of gastric neoplasia and histopathology of the detected neoplasias were compared between groups according to the stage of Helicobacter pylori(H. pylori)-related chronic gastritis.
Clinical profiles of subjects did not differ significantly between the two EGD groups, except that there were significantly more men in the transnasal EGD group. During the study period, 55 cases of gastric mucosal neoplasias were detected. Of these, 23 cases were detected by transnasal EGD and 32 cases by standard transoral EGD. The detection rate for gastric mucosal neoplasia in the transnasal EGD group was thus 1.66%, compared to 1.65% in the standard transoral EGD group, with no significant difference between the two groups. Detection rates using the two endoscopies were likewise comparable, regardless of H. pylori infection. However, detection rates when screening subjects without extensive chronic atrophic gastritis (CAG) were significantly higher with standard transoral EGD (0.70%) than with transnasal EGD (0.12%, P < 0.05). In particular, standard transoral EGD was far better for detecting neoplasia in subjects with H. pylori-related non-atrophic gastritis, with a detection rate of 3.11% compared to 0.53% using transnasal EGD (P < 0.05). In the screening of subjects with extensive CAG, no significant differences in detection of neoplasia were evident between the two endoscopies, although the mean size of detected cancers was significantly smaller and the percentage of early cancers was significantly higher with standard transoral EGD.
These results strongly suggest that the diagnostic performance of transnasal endoscopy is suboptimal for cancer screening, particularly in subjects with H. pylori-related non-atrophic gastritis.
World journal of gastrointestinal endoscopy. 08/2011; 3(8):162-70.
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Tatsuya Shiraki,
Eiji Takayama,
Hirohito Magari,
Takahiro Nakata,
Takao Maekita,
Shotaro Enomoto,
Yoshiyuki Mori,
Naoki Shingaki,
Kosaku Moribata,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Masako Mizuno-Kamiya,
Koji Yashiro,
Mikitaka Iguchi, Hideyuki Tamai,
Yasunaga Kameyama,
Jun Kato,
Nobuo Kondoh,
Masao Ichinose
[show abstract]
[hide abstract]
ABSTRACT: Although CD57+ lymphocytes are closely correlated with prognosis in various cancers, the role of subsets of CD57+ cells in hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) is unclear. In the present study, peripheral blood (PB) from HCV-related HCC patients was analyzed. Plasma cytokine levels and in vitro cytokine-producing capabilities were analyzed with enzyme-linked immunosorbent assays, and CD57+ cell subsets were studied using a multi-color FACS system. Interferon (IFN)-γ was undetectable in the plasma of patients with tumors at any stage, whereas the plasma levels of tumor necrosis factor (TNF)-α, interleukin (IL)-10 and IL-18, but not that of IL-12, were significantly higher in stage IV patients compared to patients with earlier-stage tumors. In contrast, the IFN-γ-producing capability of PB was highest in stage I patients and gradually decreased with tumor progression. The IL-10-, IL-18- and IL-12-producing capabilities of PB increased from stage I to III. However, PB-TNF-α, IL-10- and IL-18-producing capabilities were reduced in stage IV patients, probably due to repeated anti-cancer treatments. The percentage of CD4+CD57+αβTCR+ cells (CD4+CD57+ T cells) in peripheral blood lymphocytes (PBLs) increased with tumor progression. Moreover, the percentage of CD4+CD57+ T cells in PBLs and the ratio of CD4+CD57+ T cells to CD4+αβTCR+ cells (CD4+ T cells), but not that of CD4+CD57+ T cells to CD57+αβTCR+ cells (CD57+ T cells), showed a significant inverse correlation with PB-IFN-γ-producing capability. The present results suggest that an increase in CD4+CD57+ T cells controls the capability of PB to produce the anti-tumor cytokine IFN-γ and that PB-IFN-γ production is impaired with HCC tumor progression.
Oncology Reports 07/2011; 26(1):201-8. · 1.84 Impact Factor
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Kiyokazu Shirai, Hideyuki Tamai,
Naoki Shingaki,
Yoshiyuki Mori,
Kosaku Moribata,
Shotaro Enomoto,
Hisanobu Deguchi,
Kazuki Ueda,
Takao Maekita,
Izumi Inoue,
Mikitaka Iguchi,
Kimihiko Yanaoka,
Masashi Oka,
Masao Ichinose
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ABSTRACT: Aim: To clarify the clinical features of and risk factors for extrahepatic seeding, a major complication following radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).Methods: Our prospective database of 351 nodules in 257 patients with HCC who had undergone RFA between April 2001 and April 2008 was reviewed. The following variables were assessed to identify the risk factors for extrahepatic seeding: age, sex, viral markers, Child–Pugh class, tumor size, number of tumors, RFA indication (tumor size ≤3 cm, number of tumors ≤3), tumor biopsy prior to RFA, degree of histological differentiation, tumor markers, tumor location, number of sessions, and combined transcatheter arterial chemoembolization.Results: The median follow-up period was 36.5 months, during which the rate of seeding after was 5.1% and the 5-year cumulative seeding rate was 8.4%. The survival rate after neoplastic seeding was 21% at 5 years. Univariate analysis of the risk factors for neoplastic seeding showed significant differences in tumor size, RFA indication, subcapsular lesion, number of sessions, tumor biopsy prior to RFA, and des-gamma-carboxy prothrombin value. However, multivariate analysis showed that the only independent risk factor was RFA indication.Conclusions: The prognosis of patients with neoplastic seeding was poor. In particular, RFA performed for HCC not satisfying the RFA indication showed a high risk of seeding, and careful consideration should be given to the optimal treatment method and avoiding direct puncture of subcapsular tumors.
Hepatology Research 06/2011; 41(8):738 - 745. · 2.20 Impact Factor
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Shotaro Enomoto, Hideyuki Tamai,
Naoki Shingaki,
Yoshiyuki Mori,
Kosaku Moribata,
Tatsuya Shiraki,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi,
Kimihiko Yanaoka,
Masashi Oka,
Masao Ichinose
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ABSTRACT: To establish a method of assessing the malignant potential of hepatocellular carcinoma (HCC) using magnetic resonance imaging (MRI).
For 69 nodules [12 Edmondson (Ed)-I, 48 Ed-II, 9 Ed-III] in 54 HCC patients, signal intensity patterns and enhancement patterns of gadopentate dimeglumine (Gd-DTPA) dynamic studies were correlated with histological differentiation and serum lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3) level, which is an indicator of poor prognosis.
Hypointensity on T1-weighted imaging was seen in 17, 72, and 89% of Ed-I, Ed-II, and Ed-III HCCs, respectively (P < 0.001). Meanwhile, hyperintensity on T2-weighted imaging was seen in 42, 88, and 89% (P < 0.005). Tumor stain during the arterial phase of Gd dynamic MRI was seen in 75, 86, and 89%. Tumor stain washout during the portal phase was seen in 43% of Ed-II and 100% of Ed-III HCCs (P < 0.005). In the Ed-II and Ed-III HCCs, hypointensity on T1-weighted imaging was seen in 65% of AFP-L3-negative HCCs and 90% of AFP-L3-positive HCCs (P = 0.071). Washout of tumor stain during the portal phase was seen in 39% of AFP-L3-negative HCCs and 75% of AFP-L3-positive HCCs (P < 0.05).
Although hyperintensity of tumor on T2-weighted imaging and arterial hypervascularity of tumor are considered to be useful for differential diagnosis between well differentiated HCCs and moderately/poorly differentiated HCCs, hypointensity of tumor on T1-weighted imaging and tumor stain washout during the portal phase of Gd-DTPA dynamic MRI reflected poorer histological differentiation of HCCs and correlated with AFP-L3 levels.
Hepatology International 06/2011; 5(2):730-7. · 2.64 Impact Factor
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Shotaro Enomoto,
Masashi Oka,
Hiroshi Ohata,
Chizu Mukoubayashi,
Mika Watanabe,
Kosaku Moribata,
Yosuke Muraki,
Naoki Shingaki,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi,
Kimihiko Yanaoka, Hideyuki Tamai,
Mitsuhiro Fujishiro,
Osamu Mohara,
Masao Ichinose
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ABSTRACT: To evaluate the association of Helicobacter pylori (H.pylori)-related chronic gastritis stage with upper gastrointestinal symptoms and gastroesophageal reflux disease (GERD).
Subjects underwent upper gastrointestinal endoscopy, a questionnaire using a frequency scale for symptoms of GERD (FSSG), and measurements of serum H.pylori-antibody and pepsinogen (PG) levels. They were classified into the following 4 groups in terms of H.pylori-related chronic gastritis stage: Group A (n = 219), H.pylori(-)PG(-); Group B (n = 310), H.pylori(+)PG(-); Group C (n = 279), H.pylori(+)PG(+); and Group D (n = 17), H.pylori(-)PG(+).
Reflux esophagitis occurred in 30.6% of Group A, 14.5% of Group B, 6.8% of Group C, and 0% of Group D (P < 0.001). Scores for acid reflux symptoms decreased significantly with chronic gastritis stage (from Group A to D) (P < 0.05), while scores for dysmotility symptoms did not differ significantly. The prevalence of non-erosive reflux disease (NERD) did not differ among groups. However, in subjects with GERD, the prevalence of NERD tended to increase with chronic gastritis stage (P = 0.081).
Acid reflux symptoms and the prevalence of reflux esophagitis can be assessed by measuring both serum H.pylori-antibody and PG levels.
World journal of gastrointestinal endoscopy. 04/2011; 3(4):71-7.
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Kosaku Moribata, Hideyuki Tamai,
Naoki Shingaki,
Yoshiyuki Mori,
Shotaro Enomoto,
Tatsuya Shiraki,
Hisanobu Deguchi,
Kazuki Ueda,
Izumi Inoue,
Takao Maekita,
Mikitaka Iguchi,
Kimihiko Yanaoka,
Masashi Oka,
Masao Ichinose
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ABSTRACT: Aim: Evaluation of malignant potential is important to determine the treatment strategy for small hepatocellular carcinoma (HCC). The aim of the present study was to establish a method of assessing the malignant potential of small hypervascular HCC using B-mode ultrasonography. Methods: One hundred and thirteen arterial hypervascular HCC nodules under 3 cm diagnosed by biopsy or surgical resection (20.5 ± 6.3 mm) were classified into two groups ultrasonographically: type 1 with (n = 27) and type 2 without (n = 86) a halo. Type 2 was categorized into three subgroups: type 2a, homogenous hyperechoic (n = 9); type 2b, hypoechoic with a smooth margin (n = 35); and type 2c, hypoechoic with an irregular or unclear margin (n = 42). Results: The mean diameter of type 2a nodules was significantly smaller than that of other HCC types (P < 0.05). Overall, moderately differentiated HCC was the predominant histological type, except for type 2a, all of which were well-differentiated HCC. The percentage of poorly differentiated HCC was significantly higher in type 2c nodules (19%) than in other HCC types (P < 0.01). The percentage of Lens culinaris agglutinin-reactive α-fetoprotein (AFP-L3) positivity was significantly higher in type 2c nodules (55%) than in other HCC types (P < 0.01). Classification on B-mode ultrasonography was correlated with the histological differentiation and serum level, an indicator of a poor prognosis. Conclusion: The malignant potential of type 2a is the lowest and that of type 2c is the highest, both histologically and serologically. Assessment of the malignant potential of small, hypervascular HCC is possible by B-mode ultrasonography.
Hepatology Research 03/2011; 41(3):233-9. · 2.20 Impact Factor
