Shin Maeda

Yokohama City University, Yokohama, Kanagawa, Japan

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Publications (284)1870.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: AimWe examined the efficacy and tolerability of hepatic arterial infusion chemotherapy (HAIC) using cisplatin as an alternative option to sorafenib for the treatment of hepatocellular carcinoma (HCC) patients who had not responded to transarterial chemoembolization (TACE).Methods We investigated the medical records of 127 consecutive HCC patients without extrahepatic metastasis (cisplatin, n = 44; sorafenib, n = 83) who had not responded to prior TACE at four institutions. An inverse probability of treatment weighting using propensity scoring was used to adjust for selection biases.ResultsSerious adverse events accounting for treatment discontinuation occurred in 2.3% of the patients in the cisplatin group and 32.5% of those in the sorafenib group. The median overall survival (OS) period was 11.2 months (95% confidence interval [CI]: 4.8–17.7) in the cisplatin group and 10.2 months (95% CI: 8.8–11.5) in the sorafenib group, respectively. After an inverse probability of treatment weighting adjustment, the survival outcome of the HAIC treatment group was not inferior to that of the sorafenib treatment group (hazard ratio, 0.758; 95% CI, 0.471–1.219; P = 0.253).ConclusionHAIC using cisplatin may be an alternative treatment option in select HCC patients who have not responded to prior TACE and cannot tolerate sorafenib.
    Journal of Digestive Diseases 12/2014; · 1.85 Impact Factor
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    ABSTRACT: OBJECTIVES:No previous reports have shown an association between location of diverticular disease (DD) and the irritable bowel syndrome (IBS).METHODS:We included 1,009 consecutive patients undergoing total colonoscopy in seven centers in Japan from June 2013 to September 2013. IBS was diagnosed using Rome III criteria, and diverticulosis was diagnosed by colonoscopy with transparent soft-short-hood. Left-sided colon was defined as sigmoid colon, descending colon, and rectum. Right-sided colon was defined as cecum, ascending colon, and transverse colon. We divided the patients into IBS and non-IBS groups and compared characteristics.RESULTS:Patient characteristics included mean age, 64.2±12.9 years and male:female ratio, 1.62:1. Right-sided DD was identified in 21.6% of subjects. Left-sided and bilateral DD was identified in 6.6 and 12.0% of subjects, respectively. IBS was observed in 7.5% of subjects. Multiple logistic regression analysis showed left-sided DD (odds ratio, 3.1; 95% confidence interval (CI): 1.4-7.1; P=0.0060) and bilateral DD (odds ratio, 2.6; 95% CI, 1.3-5.2; P=0.0070) were independent risk factors for IBS. Right-sided DD was not a risk factor for IBS.CONCLUSIONS:Our data showed that the presence of left-sided and bilateral DD, but not right-sided disease, was associated with a higher risk of IBS, indicating that differences in pathological factors caused by the location of the DD are important in the development of IBS. Clarifying the specific changes associated with left-sided DD could provide a better understanding of the pathogenic mechanisms of IBS (Trial registration # R000012739).Am J Gastroenterol advance online publication, 21 October 2014; doi:10.1038/ajg.2014.323.
    The American journal of gastroenterology. 10/2014;
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    ABSTRACT: The natural immunomodulator lactoferrin is known to possess anti-inflammatory effects. However, there have been no studies examining the mode of action of lactoferrin in protecting the esophageal mucosa against damage. We investigated the effect of lactoferrin on gastric acid secretion and in protecting against acute acid reflux-induced esophagitis in rats. Male Wistar rats aged 8 weeks, weighing 210-240 g, were used for all the experiments. A gastric perfusion system was installed using the method of Ghosh et al. Lactoferrin was administered once via the caudate vein, starting 24 hours before an acute acid reflux (treatment mode), or saline (control). Statistical comparison of the parameters between the two test conditions was performed. No significant differences in basal or stimulated gastric acid secretion, or in the serum gastrin level were observed between the two test conditions. Esophageal damage was attenuated by lactoferrin in a dose-dependent manner, as reflected by the improvement in the esophageal tissue weight and macroscopic scores. Significant reductions in the histological scores, myeloperoxidase activity and the levels of proinflammatory cytokines, tumor necrosis factor-α and interleukin-1β were also observed following lactoferrin administration. We concluded that lactoferrin exerts a protective effect against acute acid reflux-induced esophageal damage in rats.
    Hepatogastroenterology. 09/2014; 61(134):1595-600.
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    ABSTRACT: Colorectal flat-type tumors include laterally spreading tumors (LSTs) and flat depressed-type tumors. The former of which shows a predominant lateral spreading growth rather than an invasive growth. The present study examined the morphological characteristics of LSTs, in comparison with polypoid- or flat depressed-type tumors, along with the expression of atypical protein kinase C (aPKC) λ/ι, a pivotal cell polarity regulator, and the hallmarks of cell polarity, as well as with type IV collagen, β-catenin and E-cadherin. In total, 37 flat-type (24 LSTs and 13 flat depressed-type tumors) and 20 polypoid-type colorectal tumors were examined. The LSTs were classified as 15 LST adenoma (LST-A) and nine LST cancer in adenoma (LST-CA). An immunohistochemical examination was performed on aPKC λ/ι, type IV collagen, β-catenin and E-cadherin. The LST-A and -CA showed a superficial replacing growth pattern, with expression of β-catenin and E-cadherin in the basolateral membrane and type IV collagen along the basement membrane. In addition, 86.6% of LST-A and 55.6% of LST-CA showed aPKC λ/ι expression of 1+ (weak to normal intensity staining in the cytoplasm compared with the normal epithelium). Furthermore, ~45% of the polypoid-type adenomas showed 2+ (moderate intensity staining in the cytoplasm and/or nucleus) and 66.7% of the polypoid-type cancer in adenoma were 3+ (strong intensity staining in the cytoplasm and nucleus). A statistically significant positive correlation was observed between the expression of aPKC λ/ι and β-catenin (r=0.842; P<0.001), or type IV collagen (r=0.823; P<0.001). The LSTs showed a unique growth pattern, different from the expanding growth pattern presented by a polypoid tumor and invasive cancer. The growth characteristics of LST appear to be caused by adequate coexpression of β-catenin, type IV collagen and aPKC λ/ι.
    Oncology letters 09/2014; 8(3):977-984. · 0.24 Impact Factor
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    ABSTRACT: The aim of this study was to comparatively examine the convenience of use of the QUEST and GerdQ questionnaires as self-administered diagnostic instruments. This was a two-way crossover study conducted from December 2011 to April 2012. The subjects were 70 third-year nursing students of Yokohama Soei University in Yokohama, Japan. They were randomly assigned to fill in either of the study questionnaires first, and then the other on a later. A significant difference was observed in the questionnaire completion time between the QUEST and GerdQ questionnaires (125.5 vs. 44 seconds, P < 0.0001) and also in the number of subjects asking questions while completing the questionnaires (26 vs. 1 subject, respectively: P < 0.0001). To detect GERD based on a QUEST score of ≥4, ROC analysis revealed an area under the curve for the GerdQ score of 0.616. The optimal cutoff value of the GerdQ score was 6, and the sensitivity and specificity calculated using this cutoff value were 0.842 and 0.312, respectively. This study revealed that Japanese subjects may find it easier to complete the GerdQ than the QUEST questionnaire.
    Hepato-gastroenterology 09/2014; 61(134):1605-10. · 0.77 Impact Factor
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    ABSTRACT: Endoscopic treatment for postoperative benign bile duct stricture (BBS) is a therapeutic challenge. No previous studies have compared endoscopic treatments for BBS and malignant bile duct stricture (MBS). The aim of this study was to compare endoscopic treatments for postoperative BBS and MBS. This study enrolled 22 consecutive patients with a diagnosis of postoperative BBS and 110 patients diagnosed with MBS. Cases involving digestive tract reconstruction were excluded. We compared the length of the bile duct strictures, the success rate of endoscopic treatment, and the incidence of complications. The following results were obtained for the postoperative BBS and MBS groups, respectively: length of bile duct stricture, 6.50 mm vs. 24.3 mm (P<0.0001); success rate of endoscopic treatment, 90.9% vs. 93.6% (P=0.6551). Post-ERCP pancreatitis occurred after 11 sessions (10.7%) vs. 7 sessions (1.83%) (P=0.0002), and post-ERCP cholangitis occurred after 7 sessions (6.80%) vs. 4 sessions (1.04%) (P=0.0021). BBS was a significant risk factor for post-ERCP pancreatitis and cholangitis based on a multivariate analysis (OR, 10.732; P=0.0022; OR, 6.443; P=0.0260). Post-ERCP-related complications were more frequent after postoperative BBS than after MBS. The need for careful endoscopic treatment may be greater for postoperative BBS cases than for MBS cases.
    Hepato-gastroenterology 09/2014; 61(134):1507-18. · 0.77 Impact Factor
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    ABSTRACT: This study compared the impacts of intragastric balloon (IGB) therapy and intensive lifestyle modification therapy on abdominal fat distribution. Sixteen extremely obese Japanese patients were assigned to an intensive lifestyle modification therapy group with educational hospitalisation (8 patients) or an IGB therapy group (8 patients) and were followed up for 6 months. The main outcome measures were the differences at 6 months, relative to the baseline values, in the visceral fat area (VFA), subcutaneous fat area (SFA), and liver volume as measured using computed tomography. At 0 month, the body weights (BWs) were 121.3 ± 19.0 kg and 127.1 ± 24.4 kg and the VFAs were 299 ± 55 cm2 and 257 ± 56 cm2 in the intensive lifestyle modification therapy group and the IGB therapy group, respectively. No statistically significant differences in the baseline characteristics were observed between these two groups. At 6 months, no difference in the changes in BW from the baseline value (−11.5 [−16.4, −6.6] kg vs. −11.2 [−18.9, −3.4] kg) was seen between the two groups. However, a statistically significant difference in the change in the VFA (−66 [−87, −44] cm2 vs. −22 [−70, 26] cm2 [P = 0.027]) was observed; no significant changes in the SFA or liver volume were seen. In conclusion, IGB therapy was as effective as intensive lifestyle modification therapy for weight reduction but was less effective with respect to the improvement in abdominal visceral fat accumulation and liver steatosis in super-obese Japanese patients.
    Obesity Research & Clinical Practice 08/2014; 8(4):e331–e338. · 0.51 Impact Factor
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    ABSTRACT: Ramosetron is a new selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist that reportedly has more potent antiemetic effects than other 5-HT3 receptor antagonists. The aim of this study was to determine the effect of ramosetron pretreatment on gastric emptying using the 13C-acetic acid breath test. Ten healthy male and female volunteers participated in this randomized, twoway crossover study. After they had fasted overnight, the subjects were randomly assigned to receive 0.1 mg ramosetron 1 hour before ingestion of a test meal (200 kcal per 200 mL, containing 100 mg 13C acetate) or to receive the test meal alone. Under both conditions, breath samples were collected for 150 min following ingestion of the meal. Statistical comparison of the parameters between the two test conditions was performed. No significant differences in the calculated parameters, including T 1/2, T lag, GEC or β and κ, were observed between the two test conditions. The present study revealed that 0.1 mg ramosetron had no significant effect on the rate of gastric emptying. Thus, our results suggest that ramosetron can be administered safely, without gastrointestinal adverse effects, even to terminal cancer patients with delayed or accelerated gastric emptying abnormality.
    Hepato-gastroenterology 07/2014; 61(133):1279-82. · 0.77 Impact Factor
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    ABSTRACT: Leptin, secreted by the adipose tissue and known to be related to obesity, is considered to be involved in the onset and progression of colorectal cancer. However, the exact role of leptin in colorectal carcinogenesis is still unclear, as several controversial reports have been published on the various systemic effects of leptin. The aim of this study was to clarify the local and precise roles of leptin receptor-mediated signaling in colonic carcinogenesis using intestinal epithelium-specific leptin-receptor b (LEPRb)-conditional knockout (cKO) mice. We produced and used colonic epithelium-specific LEPRb cKO mice to investigate the carcinogen-induced formation of aberrant crypt foci (ACF) and tumors in the colon, using their littermates as control. There were no differences in the body weight or systemic condition between the control and cKO mice. The tumor sizes and number of large-sized tumors were significantly lower in the cKO mice as compared with those in the control mice. On the other hand, there was no significant difference in the proliferative activity of the normal colonic epithelial cells or ACF formation between the control and cKO mice. In the control mice, marked increase of the LEPRb expression level was observed in the colonic tumors as compared with that in the normal epithelium; furthermore, signal transducer and activator of transcription (STAT3) was activated in the tumor cells. These findings suggest that STAT3 is one of the important molecules downstream of LEPRb, and LEPRb/STAT3 signaling controls tumor cell proliferation. We demonstrated the importance of local/regional leptin receptor-mediated signaling in colorectal carcinogenesis.
    Carcinogenesis 06/2014; · 5.64 Impact Factor
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    ABSTRACT: Crohn's disease (CD) is routinely evaluated using clinical symptoms, laboratory variables, and the CD activity index (CDAI). However, clinical parameters are often nonspecific and do not precisely reflect the actual activity of CD small-intestinal lesions. The purposes of this prospective study were to compare color Doppler ultrasound (US) findings with histological findings from surgically resected specimens and confirm the hypothesis that color Doppler US can distinguish tissue inflammation and fibrosis.
    BMC Research Notes 06/2014; 7(1):363.
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    ABSTRACT: To develop appropriate management strategies for patients who take low-dose aspirin, it is important to identify the risk factors for GI injury. However, few studies have described the risk factors for small-bowel injury in these patients. To investigate factors influencing the risk of small-bowel mucosal breaks in individuals taking continuous low-dose aspirin. Capsule endoscopy data were collected prospectively from 5 institutions. Yokohama City University Hospital and 4 other hospitals. A total of 205 patients receiving treatment with low-dose aspirin for over 3 months. Colonoscopic and upper GI endoscopy had been performed in all of the patients before the capsule endoscope evaluation. Risk factors for small-bowel mucosal breaks. Of the 198 patients (141 male; mean age 71.9 years) included in the final analysis, 114 (57.6%) had at least 1 mucosal break. Multivariate analysis identified protein pump inhibitor (PPI) use (OR 2.04; 95% confidence interval [CI], 1.05-3.97) and use of enteric-coated aspirin (OR 4.05; 95% CI, 1.49-11.0) as independent risk factors for the presence of mucosal breaks. Cross-sectional study. PPI use appears to increase the risk of small-bowel injury in patients who take continuous low-dose aspirin. Clinicians should be aware of this effect of PPIs; new strategies are needed to treat aspirin-induced gastroenteropathy.
    Gastrointestinal endoscopy 05/2014; · 6.71 Impact Factor
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    ABSTRACT: Background and AimSelf-expandable metallic stents have mainly been used for the palliation of malignant gastric outlet obstruction (GOO). However, their use in long-term survivors and the feasibility, safety and benefit of additional intervention for stent dysfunction remain controversial. The present study examined the long-term benefits of endoscopic gastroduodenal stenting.Methods We reviewed 61 patients treated with Niti-S stents at several hospitals and estimated the efficacy of stent intervention, stent patency, eating period and factors related to poor effectiveness.ResultsAll 61 first stent interventions and 14 additional stent interventions (11 second interventions and 3 third interventions) were successfully carried out. Clinical success rates were 83.6% and 85.7%, and median stent patency was 214 days and 146 days (P = 0.47), respectively. Fifty patients could be treated with a first stent only, and 11 patients received additional stents. At the time of study termination or death, 70.0% of the former group and 63.6% of the latter group maintained oral intake (P = 0.71), and each 86% and 100% among the group could maintain oral intake for a period exceeding half of their remaining lives after first stent intervention. Karnofsky performance status ≤50 (P = 0.03), ascites (P = 0.009), and peritoneal dissemination (P = 0.001) appeared to be factors related to poor effectiveness.Conclusions Despite the presence of factors related to poor effectiveness, endoscopic gastroduodenal stenting would be the first treatment of choice for GOO and provide long-term benefits. If stent dysfunction occurs, additional stent intervention enables continued oral intake safely.
    Digestive Endoscopy 05/2014; · 1.61 Impact Factor
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    ABSTRACT: To investigate the usefulness of contrast-enhanced three-dimensional ultrasonography (CE 3D US) for differential diagnosis of solid pancreatic lesions. Eighty-five patients with solid pancreatic lesions who underwent CE 3D US were retrospectively analyzed. Sixty-four patients had pancreatic ductal adenocarcinoma (PDAC), 10 had mass-forming pancreatitis (MFP), and 11 had neuroendocrine tumor (NET). Two blinded readers evaluated the enhancement patterns using four features: vascularity in the arterial phase, vascularity in the venous phase, vessel location, and vessel form. Vascularity in both phases was classified as hypervascular, isovascular, or hypovascular. Vessel location was classified into peritumoral or intratumoral. Vessel form was classified into fine or irregular. Kappa values were used to assess inter-reader agreement. The institutional review board approved this study, and informed consent was obtained. Kappa values of the four features were 0.75, 0.72, 0.85, and 0.65, which were graded as good or excellent. The most typical combined enhancement pattern in PDAC was hypovascularity in both phases with peritumoral and irregular vessels; MFP was isovascular in both phases with intratumoral and fine vessels; and NETs were hypervascular in both phases with intratumoral and irregular vessels. The sensitivity and positive predictive value of the three patterns were 93.8% and 96.7% for the PDAC pattern, 80.0% and 100% for the MFP pattern, and 81.8%, and 69.2% for the NET pattern, respectively. The accuracy of these diagnostic criteria was 90.5%. CE 3D US allows detailed visualization of the enhancement patterns of various pancreatic lesions and can be used for the differential diagnosis.
    Abdominal Imaging 04/2014; · 1.91 Impact Factor
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    ABSTRACT: Purpose To retrospectively compare radiofrequency ablation (RFA) combined with the multikinase inhibitor sorafenib (hereafter, sorafenib-RFA) and RFA alone in the treatment of hepatocellular carcinoma (HCC). Materials and Methods Institutional review board approval and informed consent were obtained. Between January 2007 and December 2011, 16 patients (mean age, 72.8 years; age range 52-84 years; 10 men, six women) with HCC tumors less than 3 cm in diameter were included in the sorafenib-RFA group, and 136 patients (mean age, 72.1 years; age range, 51-86 years; 92 men, 44 women) with HCC tumors less than 3 cm in diameter were included in the RFA alone (control) group. Mean diameters of the greatest long-axis dimensions of HCC were 22.8 mm ± 4.6 (standard deviation) in the sorafenib-RFA group and 18.1 mm ± 4.4 in the control group. RFA was performed immediately after the 7-day administration of sorafenib. Propensity score matching analysis was used to adjust for potential biases. Results Fifteen of the 16 patients in the sorafenib-RFA group and 30 of the 136 patients in the control group were selected during propensity score matching. No significant differences between the sorafenib-RFA group (n = 15) and the control group (n = 30) were observed with regard to age, sex, etiology, Child-Pugh class, tumor size, puncture number, needle size, location at the liver margin, or location adjacent to a main vessel. The respective mean diameters of the greatest long- and short-axis dimensions of the RFA-induced ablated area were 46.3 mm ± 10.3 and 33.0 mm ± 6.9 in the sorafenib-RFA group and 32.9 mm ± 7.6 and 25.6 mm ± 5.7 in the control group; both of these dimensions were significantly larger in the sorafenib-RFA group (both P < .001). Conclusion Sorafenib-RFA may be superior to standard RFA alone in the treatment of HCC tumors smaller than 3 cm in diameter. © RSNA, 2014.
    Radiology 04/2014; · 6.34 Impact Factor
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    ABSTRACT: To further understanding of the genetic basis of type 2 diabetes (T2D) susceptibility, we aggregated published meta-analyses of genome-wide association studies (GWAS), including 26,488 cases and 83,964 controls of European, east Asian, south Asian and Mexican and Mexican American ancestry. We observed a significant excess in the directional consistency of T2D risk alleles across ancestry groups, even at SNPs demonstrating only weak evidence of association. By following up the strongest signals of association from the trans-ethnic meta-analysis in an additional 21,491 cases and 55,647 controls of European ancestry, we identified seven new T2D susceptibility loci. Furthermore, we observed considerable improvements in the fine-mapping resolution of common variant association signals at several T2D susceptibility loci. These observations highlight the benefits of trans-ethnic GWAS for the discovery and characterization of complex trait loci and emphasize an exciting opportunity to extend insight into the genetic architecture and pathogenesis of human diseases across populations of diverse ancestry.
    Nature Genetics 03/2014; 46(3):234-244. · 35.21 Impact Factor
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    ABSTRACT: E-cadherin is an important adhesion molecule whose loss is associated with progression and poor prognosis of liver cancer. However, it is unclear whether the loss of E-cadherin is a real culprit or a bystander in liver cancer progression. In addition, the precise role of E-cadherin in maintaining liver homeostasis is also still unknown, especially in vivo. Here we demonstrate that liver-specific E-cadherin knockout mice develop spontaneous periportal inflammation via an impaired intrahepatic biliary network, as well as periductal fibrosis, which resembles primary sclerosing cholangitis. Inducible gene knockout studies identified E-cadherin loss in biliary epithelial cells as a causal factor of cholangitis induction. Furthermore, a few of the E-cadherin knockout mice developed spontaneous liver cancer. When knockout of E-cadherin is combined with Ras activation or chemical carcinogen administration, E-cadherin knockout mice display markedly accelerated carcinogenesis and an invasive phenotype associated with epithelial-mesenchymal transition, up-regulation of stem cell markers, and elevated ERK activation. Also in human hepatocellular carcinoma, E-cadherin loss correlates with increased expression of mesenchymal and stem cell markers, and silencing of E-cadherin in hepatocellular carcinoma cell lines causes epithelial-mesenchymal transition and increased invasiveness, suggesting that E-cadherin loss can be a causal factor of these phenotypes. Thus, E-cadherin plays critical roles in maintaining homeostasis and suppressing carcinogenesis in the liver.
    Proceedings of the National Academy of Sciences 01/2014; · 9.81 Impact Factor
  • Endoscopy 01/2014; 46 Suppl 1:E539-40. · 5.74 Impact Factor
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    ABSTRACT: Abstract Objective. Ultrasonography (US) is a simple, inexpensive and minimally invasive method. We evaluated the vascularity of small intestinal lesions in Crohn's disease using color Doppler US (CD-US) and retrospectively compared them with endoscopic and surgical macroscopic findings. Material and methods. In order to compare CD-US and endoscopic findings, 108 Crohn's disease patients who underwent examination of the terminal ileum by both colonoscopy and CD-US were included in the study. Vascularity was evaluated in CD-US using a semiquantitative method, the Limberg score. We analyzed correlations between Limberg score and simple endoscopic score for Crohn's disease (SES-CD), an index reflecting endoscopic activity. Scores of SES-CD 3 and higher were defined as endoscopically active. For comparison with surgical macroscopic findings, 22 Crohn's disease patients who received CD-US and subsequent iliectomies were included. Lesions with apparent open ulcers were defined as active, and those without as non-active. These findings were compared with the Limberg score. Results. A substantial positive correlation was observed between Limberg scores and SES-CD (ρ = 0.709 [p < 0.001]). Notably, all 27 cases with a Limberg score of 3 or 4 were classified as endoscopically active. Compared to surgical macroscopic activity, Limberg scores of active lesions were significantly higher than those of non-active lesions (p = 0.005). In particular, all 11 cases with a Limberg score of 3 or 4 were classified as active lesions. Conclusion. Vascularity of small intestinal lesions of Crohn's disease evaluated by CD-US with Limberg score is well correlated with endoscopic and surgical macroscopic findings.
    Scandinavian Journal of Gastroenterology 12/2013; · 2.33 Impact Factor
  • Nihon Naika Gakkai Zasshi 11/2013; 102(11):2980-2.
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    ABSTRACT: Aims/IntroductionWe reinvestigated the clinical usefulness of the modified NAFIC scoring system, modified by changing the weightage assigned to the fasting serum insulin level based on the importance of hyperinsulinemia in the pathogenesis of non-alcoholic steatohepatitis (NASH), in Japanese patients with non-alcoholic fatty liver disease (NAFLD) who had undergone liver biopsy. Materials and Methods The NAFIC score is conventionally calculated as follows: serum ferritin ≥200 ng/mL (female) or ≥300 ng/mL (male), 1 point; serum fasting insulin ≥10 μU/mL, 1 point; and serum type IV collagen 7 s ≥5.0 ng/mL, 2 points. A total of 147 patients with NAFLD who had undergone liver biopsies were included in the estimation group. To validate the modified scoring system, 355 patients from nine hepatology centers in Japan were also enrolled. ResultsIn the estimation group, 74 (50.3%) patients were histologically diagnosed as having NASH, whereas the remaining 73 (49.7%) were diagnosed as not having NASH. As the percentage of NASH patients increased not only among participants with serum insulin levels greater than 10 μU/mL, but also in those with serum levels greater than 15 μU/mL, we advocated use of the modified NAFIC score, as follows: serum fasting insulin 10–15 μU/mL, 1 point and ≥15 μU/mL, 2 points. The modified NAFIC score showed improved sensitivity and negative predictive value for the diagnosis of NASH. This finding was also confirmed in the validation group. Conclusions The modified NAFIC scoring system could be a clinically useful diagnostic screening tool for NASH.
    Journal of Diabetes Investigation. 11/2013; 4(6).

Publication Stats

9k Citations
1,870.31 Total Impact Points

Institutions

  • 2010–2014
    • Yokohama City University
      • Department of Gastroenterology
      Yokohama, Kanagawa, Japan
  • 2013
    • Hiratsuka City Hospital
      Hiratuka, Kanagawa, Japan
  • 2006–2013
    • University Hospital Medical Information Network
      Edo, Tōkyō, Japan
    • City of Hope National Medical Center
      • Department of Cancer Immunotherapeutics & Tumor Immunology
      Duarte, CA, United States
  • 1996–2013
    • The University of Tokyo
      • • Department of Gastroenterology
      • • Department of Internal Medicine
      • • Faculty & Graduate School of Medicine
      • • Division of Internal Medicine
      Tokyo, Tokyo-to, Japan
  • 2012
    • Yokohama Rosai Hospital
      Yokohama, Kanagawa, Japan
    • Toranomon Hospital
      Edo, Tōkyō, Japan
  • 2011
    • Osaka University
      • Department of Pharmacology
      Ōsaka-shi, Osaka-fu, Japan
    • Tokyo Metropolitan Hiroo Hospital
      • Division of Gastroenterology
      Edo, Tōkyō, Japan
  • 2003–2008
    • University of California, San Diego
      • Department of Medicine
      San Diego, CA, United States
  • 2007
    • RIKEN
      Вако, Saitama, Japan
  • 2006–2007
    • Toyota Physical and Chemical Institute
      Seto, Aichi, Japan
  • 1990–2001
    • Shiga University of Medical Science
      • Third Department of Medicine
      Ōtu, Shiga, Japan