A Terano

Dokkyo Medical University, Totigi, Tochigi, Japan

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Publications (216)1059.88 Total impact

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    ABSTRACT: Background: Training for colon capsule endoscopy (CCE) procedures is currently performed as a lecture and hands-on seminar. The aims of this pilot study were to assess the utility of an electronic learning system for CCE (ELCCE) designed for the Japanese Association for Capsule Endoscopy using an objective scoring engine, and to evaluate the efficacy of ELCCE on the acquisition of CCE reading competence. Methods: ELCCE is an Internet-based learning system with the following steps: step 1, introduction; step 2, CCE reading competence assessment test (CCAT), which evaluates the competence of CCE reading prior to training; step 3, learning reading theory; step 4, training with guidance; step 5, training without guidance; step 6, final assessment; and step 7, the same as step 2. The CCAT, step 5 and step 6 were scored automatically according to: lesion detection, diagnosis (location, size, shape of lesion), management recommendations, and quality of view. Ten trainee endoscopists were initially recruited (cohort 1), followed by a validating cohort of 11 trainee endoscopists (cohort 2). Results: All but one participant finished ELCCE training within 7 weeks. In step 6, accuracy ranged from 53 to 98 % and was not impacted by step 2 pretest scores. The average CCAT scores significantly increased between step 2 pretest and step 7 in both cohorts, from 42 ± 18 % to 79 ± 15 % in cohort 1 (p = 0.0004), and from 52 ± 15 % to 79 ± 14 % in cohort 2 (p = 0.0003). Conclusions: ELCCE is useful and effective for improving CCE reading competence.
    No preview · Article · Nov 2015 · Journal of Gastroenterology
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    ABSTRACT: The relationship between Helicobacter pylori infection and gastric cancer has been demonstrated, and the risk of gastric cancer occurrence is known to increase with the progression of atrophic changes associated with chronic gastritis. Endoscopic evaluation of the degree and extent of atrophy of the gastric mucosa is a simple and very important means of identifying a group at high risk for gastric cancer. This study aimed to clarify the carcinogenic risk in relation to the degree of atrophy. A total of 27,777 patients (272 with early gastric cancer and 135 with advanced gastric cancer) were included in this study. Endoscopically evaluated atrophy of the gastric mucosa was classified as C-0 to O-3 according to the Kimura and Takemoto classification system. The cancer detection rate in relation to the degree of gastric mucosal atrophy was 0.04% (2/4,183 patients) for C-0, 0% (0/4,506) for C-1, 0.25% (9/3,660) for C-2, 0.71% (21/2,960) for C-3, 1.32% (75/5,684) for O-1, 3.70% (140/3,780) for O-2 and 5.33% (160/3,004) for O-3. As to the proportions of differentiated and undifferentiated cancers, the latter were relatively frequent in the C-0 to C-2 groups, but differentiated cancers became predominant as atrophy progressed. On the other hand, the number of both differentiated and undifferentiated cancers detected increased as gastric mucosal atrophy progressed. In addition, open-type atrophy was found in 29 (96.7%) of 30 patients with synchronous multiple gastric cancers and in all 20 patients with metachronous multiple gastric cancers. Endoscopic evaluation of gastric mucosal atrophy can provide a simple and reliable predictive index for both current and future carcinogenic risk. © 2015 S. Karger AG, Basel.
    No preview · Article · Feb 2015 · Digestion
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    ABSTRACT: In 1979, a new mechanism of gastric defense named cytoprotection was followed by numerous reports elucidating this interesting and important phenomenon. During this decade, however, the concept and definition of gastric cytoprotection have been modified from the morphological and ultrastructural viewpoints. This review attempts to describe the concept and mechanisms of cytoprotection as well as its pathophysiological features. Specifically, in vitro studies using isolated cells or monolayer cultured cells as well as molecular investigations of signal transduction system have been documented.
    No preview · Article · Jan 2008 · Acta pathologica japonica
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    K Fu · T Nakamura · H Masuyama · H Yamagishi · Y Kaji · T Fujimori · A Terano

    Preview · Article · Sep 2007 · Journal of Gastroenterology and Hepatology

  • No preview · Article · Mar 2007 · Endoscopy

  • No preview · Article · Jul 2006
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    ABSTRACT: Trefoil factor family (TFF) is a group of small peptides secreted by gastrointestinal epithelial cells. Among three known TFF peptides, TFF1 (formerly pS2) is expressed at a high level in gastric epithelial cells and plays an essential and critical role in maintaining the integrity of the gastric mucosa. Recent evidence also suggests that TFF1 acts as a tumour suppressor gene in the stomach. TFF1 was originally discovered as an oestrogen-inducible gene in MCF-7 breast cancer cells, and its expression is dependent on oestrogen in MCF-7 and other hormone-dependent breast cancer cells. Although gastric epithelial cells express oestrogen receptors (ERs), gastric TFF1 expression appears to be independent of oestrogen signalling. Instead, several cis-regulatory elements are involved in the regulation of gastric TFF1 expression and balanced signalling from gp130, a common IL-6 family coreceptor, has been shown to be necessary for the proper expression of TFF1 in the stomach. Epigenetic regulation, such as DNA methylation in the promoter region of the TFF1 gene, may be also important for tissue-specific expression of TFF1 in the stomach. However, further studies are still needed to fully understand the detailed regulatory mechanisms of TFF1 expression in gastric epithelial cells.
    Full-text · Article · Jun 2006 · Alimentary Pharmacology & Therapeutics Symposium Series
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    ABSTRACT: Capsule endoscopy (PillCam™SB, Given Imaging, Yoqneam, Israel) is a novel noninvasive method allowing visualization of the small intestine. A small video capsule swallowed by the patient, records digital images that are downloaded onto a RAPID® workstation, and the images are viewed as a digital video by a physician. In capsule endoscopy, image acquisition and interpretation is fundamental, however, it is time consuming for untrained physicians. Assuming the capsule transmits images for about 8 h, a total of 57,600 images will be recorded, and viewing time for the examiner will be between 30 and 60 minutes in our hospital. In spite of technology advantages in capsule endoscopy, diagnostic accuracy depends on the physician's experience. In this paper, we describe the procedure and the point of image acquisition and interpretation in capsule endoscopy.
    No preview · Article · May 2006
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    ABSTRACT: Wireless capsule endoscopy (WCE) is a innovative diagnostic tool for gastrointestinal (GI) tract. PillCam™SB (Given Imaging, Yoqneam, Israel) is the most popular WCE in the world. The most suitable indication of PillCam™SB is obscure GI bleeding. The other current indications are investigation of Crohn's disease, evaluation of the side effects of nonsteroidal anti-inflammatory drugs and surveillance of hereditary polyposis syndrome. The first clinical trial of WCE for the small bowel including Crohn's disease was carried out in Dokkyo University hospital and Social Insurance Central General Hospital in 2003. However, Japanese government has not approved it for reimbursement by the national health insurance system as yet. Recently, a new WCE for esophagus (PillCam™ESO) has been developed and approved in USA and Europe. WCE for colon is under development and clinical trial of Japanese WCE for small intestine is now on going. Various types of WCE will be developed and endoscopic diagnosis and treatment could be dramatically changed in the near future.
    No preview · Article · Nov 2005 · Endoscopic Forum for Digestive Disease
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    ABSTRACT: We have investigated the factors underlying the local recurrence of hepatocellular carcinoma (HCC) after percutaneous radiofrequency ablation (RFA). Forty-five nodules in 43 HCC patients, consisting of 29 men and 14 women with a mean age of 66.5 ± 10.3 years, were studied. The cause of HCC was HBV in 4 patients, HCV in 40, and cryptogenic in 1. The mean tumor diameter was 2.2 ± 0.7 cm (1.0-4.5). Fourteen patients had single HCC nodule and 29 patients had multiple HCC nodules. Two treatment groups were set up: the RFA alone group of 20 nodules and the combined group of 25 nodules that were treated with another medical therapy together with RFA. After treatment, all nodules were evaluated by dynamic CT, and those judged as having "no residual tumor" were examined for local recurrence factors using multivariate analysis. The recurrence rate was calculated by the Kaplan-Meier method. CT for outcome assessment, carried out in 43 nodules in 41 patients excluding 2 patients (2 nodules) with renal failure revealed that 39 nodules (90.7%) had no residual tumor. The 4 nodules, suspected of having a residual tumor, were not additionally treated because of the presence of complications. The local recurrence rates at 1, 2 and 3 years after treatment in the "no residual tumor" group (n = 39) were 20.5, 27.5 and 27.5%, respectively. The multivariate analysis revealed that neither of age, sex, tumor diameter, clinical stage, combined therapy, nor AFP value statistically contributed to local recurrence. Only PIVKA-II value was a statistically independent factor for local recurrence of HCC. In conclusion, detailed examination with dynamic CT appears necessary for the assessment of RFA treatment for HCC. PIVKA-II value is likely the most important factor to predict the local recurrence of HCC after RFA.
    No preview · Article · Oct 2005 · Dokkyo Journal of Medical Sciences
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    ABSTRACT: The majority of gastro-oesophageal reflux disease (GERD) seems to be non-erosive reflux disease. Nonerosive reflux disease includes minimal change oesophagitis (whitish or reddish, oedematous change and erosion that is not regarded as mucosal break) and no endoscopic abnormalities. To investigate the accurate proportion of those with minimal change oesophagitis and to clarify its characteristics. In addition, we evaluated the effect of famotidine (40 mg/day) in those with minimal change. Prospective endoscopic assessment was performed for consecutive 606 out-patients. Of the 582 patients suitable for analysis, 347 were non-treated. The latter were divided into those with erosive GERD or minimal change, and their endoscopic findings and characteristics were compared. Among 347 non-treated patients, 88 (25%) had erosive GERD and 249 (72%) had minimal change. Compared with patients who have erosive GERD and those with minimal change, the latter were less likely to have hiatal hernia or bile reflux, but more likely to have gastric atrophy. Symptomatic patients (n = 55) with minimal change oesophagitis were more likely to have hiatal hernia than those who were asymptomatic (n= 194). Most patients preferred taking famotidine on-demand, during a 4-week follow-up period. Most non-erosive reflux disease can be classified as minimal change oesophagitis, and that have different characteristics from erosive GERD. On-demand famotidine may be a suitable alternative treatment for patients with minimal change disease.
    Preview · Article · Jul 2005 · Alimentary Pharmacology & Therapeutics
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    ABSTRACT: Bleeding from duodenal varices is rare. However, it can be fatal for patients with liver cirrhosis. The treatment remains controversial, and there has been no consensus obtained. We herein report two cases of hemorrhagic duodenal varices successfully treated with endoscopic injection sclerotherapy (EIS) using cyanoacrylate (CA). Case 1: A 61-year-old woman was referred to Dokkyo University Hospital for investigation of melena, during the follow up of B type liver cirrhosis. Esophago-gastro-duodenoscopy (EGD) revealed varices at the second portion of the duodenum. Which was regarded as the bleeding point. Since abdominal angiography failed to demonstrate any supplying vessel into the duodenal varices, we treated the duodenal varices with EIS using CA successfully. No bleeding has been observed for a year after the treatment. Case 2: A 67-year-old man was hospitalized for treatment of hepatocellular carcinoma and liver cirrhosis. During the hospitalization, he experienced melena. EGD revenled duodenal varices with red plug. Since IVR approach was technically impossible, we performed EIS with CA successfully. He did not suffer from gastrointestinal bleeding for the following 6 month until he died of liver failure. We conclude that EIS with CA is one of the therapeutic options for ruptured duodenal varices.
    No preview · Article · Mar 2005 · Dokkyo Journal of Medical Sciences
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    ABSTRACT: Corticotropin releasing factor (CRF) is distributed in the central nervous system and acts as a neurotransmitter to regulate gastric functions through vagal-muscarinic pathways. We have recently demonstrated that central CRF aggravates experimental acute liver injury in rats. In the present study, the central effect of CRF on hepatic circulation was investigated. Hepatic surface perfusion was determined by laser Doppler flowmetry in urethane anaesthetised rats. Portal pressure and portal blood flow was simultaneously monitored. CRF (0.1-4 nmol), urocortin II (a selective CRF2 receptor agonist 2.5-100 pmol), or saline vehicle was injected intracisternally, and changes in hepatic circulation were observed for 120 minutes. We examined the effects of various pretreatments with K41498, a selective CRF2 receptor antagonist, atropine, 6-hydroxydopamine, hepatic plexus denervation, or hepatic branch vagotomy, respectively. Intracisternal injection of CRF (0.2-4 nmol) caused a dose dependent decrease in hepatic surface perfusion with a maximum response occurring 60 minutes post injection. Portal pressure was dose dependently elevated and portal blood flow was decreased by intracisternal CRF concurrently with the decrease in hepatic surface perfusion. These changes in hepatic circulation by intracisternal CRF were abolished by 6-hydroxydopamine and hepatic plexus denervation, but not by atropine or hepatic vagotomy. Urocortin II injected intracisternally decreased hepatic surface perfusion and elevated portal pressure at doses within the picomolar range. Intracisternal preadministration of K41498 inhibited the effect of central CRF on the hepatic circulation. These data suggest that CRF acts in the brain to decrease hepatic surface perfusion and elevate portal pressure through central CRF(2) receptor and sympathetic-noradrenergic pathways.
    Full-text · Article · Mar 2005 · Gut
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    ABSTRACT: Swallowable wireless capsule endoscopy (CE) is a new diagnostic tool for the examination of gastrointestinal (GI) tract. PillCam™SB (GIVEN Imaging, Israel) is the most popular tool at the present time and its most suitable indication is obscure GI bleeding. The other indications currently accepted are investigation of Crohn's disease, evaluation of the side effects of nonsteroidal anti-inflammatory drugs and surveillance of hereditary polyposis syndrome. PillCam™SB is widely used in the world but Japanese government does not allow it yet. Recently, a new CE for esophagus (PillCam™SB) is developed and allowed in USA and Europe. CE for colon is under development and clinical trial of Japanese CE for small intestine has just started. Various type of CE will be developed and endoscopic diagnosis and treatment could be dramatically changed in the near future.
    No preview · Article · Mar 2005 · Gastroenterological Endoscopy
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    ABSTRACT: Aim:  Trefoil factor family (TFF) peptides are known to facilitate wound healing in gastric mucosa. However, the regulatory mechanisms of gastric TFF expression are not fully understood yet. In this study, we examined the effect of TNF-α on TFF1 and TFF2 expression in gastric epithelial cells.Methods:  MKN45 cells were used. TFF mRNA expression was analyzed by real-time quantitative RT-PCR. Promoter sequences of TFF1 gene (−956 to +36) and TFF2 gene (−912 to +24) were inserted into pGL3 vector and reporter gene assays were performed. NF-κB activity was monitored by using a NF-κB responsive element-driven reporter vector.Results:  (1) TNF-α(0.1–30 ng/ml) down-regulated TFF1 and TFF2 mRNA expression in a dose-dependent manner. (2) Reporter gene assays also confirmed the down-regulation of TFF1 and TFF2 gene transcription by TNF-α. (3) TNF-α activated NF-κB. (4) Overexpression of dominant negative IκBα prevented both TNF-α-induced NF-κB activation and TNF-α-induced down-regulation of TFF expression.Conclusions:  TNF-α down-regulates gastric TFF expression through NF-κB pathway, suggesting that TFF expression is sensitive to inflammatory stimuli.
    No preview · Article · Jan 2005 · Wound Repair and Regeneration
  • K Kanke · M Nakano · H Hiraishi · A Terano
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    ABSTRACT: Recent evidence suggests that peripheral blood granulocytes and monocytes/macrophages have a major role in the exacerbation of ulcerative colitis. Our objective was to investigate if selective granulocyte and monocyte adsorptive apheresis with Adacolumn promotes remission of active ulcerative colitis and spares corticosteroid. Sixty patients with active ulcerative colitis were studied, of whom 39 had relapsing-remitting ulcerative colitis, 15 had chronic continuous and 6 had their first episode of ulcerative colitis. Granulocytapheresis was done with an Adacolumn filled with cellulose acetate beads as apheresis carriers that adsorb FcgammaR and complement receptors bearing leucocytes (granulocytes, monocytes and a small fraction of lymphocytes). Patients received up to 10 Adacolumn sessions over 12 weeks, one session was 60-90 min at 30 mL/min. No additional medication was given. Efficacy was assessed with Seo's activity index (AI) [Seo M, Okada M, Yao T. An index of disease activity in patients with ulcerative colitis. Am J Gastroenterol 1992;87:971-6]. The mean AL was 197.5 and range 154.4-277.7. AI < 150 was considered significant improvement and AI < 100 was considered clinical remission. Of 60 patients, 50 (83.3 %) improved, 14 achieved remission, granulocytapheresis was most effective in steroid-dependent patients. At entry, the mean dose of prednisolone was 15.3 mg/day per patient and was reduced to 3.6 mg/day after 10 sessions. Granulocytapheresis was well tolerated and no serious side-effects were observed. Based on our experience in patients with diverse ulcerative colitis disease expression and long-term exposure to conventional drug therapy, we believe that granulocytapheresis is an effective adjunct to conventional medication for promoting remission and sparing steroids in patients with active ulcerative colitis.
    No preview · Article · Dec 2004 · Digestive and Liver Disease
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    Y Kim · T Ajiki · T Nakamura · T Fukuyama · S Okumura · A Terano

    Preview · Article · Oct 2004 · Journal of Gastroenterology and Hepatology

  • No preview · Article · Sep 2004
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    ABSTRACT: Trefoil factor family peptides are expressed in gastrointestinal epithelial cells and play a critical role in maintaining mucosal integrity. Although non-steroidal anti-inflammatory drugs (NSAIDs) are important causative agents of gastric mucosal lesions, few data are available about the effect of NSAIDs on trefoil family peptides in gastric mucosa. To examine whether indometacin, a widely used NSAID, affects trefoil factor family expression in gastric epithelial cells. MKN45, a cell line derived from human gastric cancer, was used. TFF1, TFF2, and TFF3 mRNA expression was assessed by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). TFF2 gene transcription was also examined by luciferase reporter gene assay. Relative expression level of TFF1, TFF2, TFF3 mRNA was 616: 12: 1 in unstimulated MKN45 cells. Although indometacin (1-250 micro mol/L) had no significant effect on the expression of TFF1 and TFF3 mRNA, it up-regulated TFF2 mRNA expression in a dose- and time-dependent manner. Luciferase reporter gene assay confirmed the up-regulation of TFF2 gene transcription by indometacin. Indometacin-induced up-regulation of TFF2 expression was not antagonized by externally applied prostaglandin E2. These results suggest that indometacin up-regulates gastric epithelial cell TFF2 expression through a COX-independent mechanism. Since TFF peptides play an important role in gastric mucosal protection, indometacin-induced TFF2 may reduce the degree of gastric mucosal damage induced by indometacin.
    Preview · Article · Aug 2004 · Alimentary Pharmacology & Therapeutics
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    H Watanabe · H Hiraishi · M Ishida · J J Kazama · A Terano
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    ABSTRACT: The incidence of gastroduodenal diseases is high in patients with chronic renal failure (CRF). However, gastric acidity in CRF has been reported to range in level from low to high. Moreover, it remains unknown whether Helicobacter pylori infection influences gastric acidity in such patients. Thus, we aimed to clarify the pathophysiological perturbation in gastric acidity and to determine the influence of H. pylori infection in CRF. Case-control study. A university hospital. Twenty-seven patients with CRF and 24 control patients, presenting with either gastrointestinal symptoms, positive faecal occult blood, or anaemia (haemoglobin <10 g dL(-1)). The patients underwent gastroduodenal endoscopy with simultaneous determination of H. pylori infection. Gastric ammonium concentration, serum pepsinogen I and II, and basal gastrin level were measured. Thereafter, gastric acid secretion was monitored by 24-h intragastric acidity measurement with calculation of pH-3 holding time (%) (hours showing pH>3/24 h). In the CRF group, pH-3 holding time of H. pylori (+) subgroup was significantly greater than that of H. pylori (-) subgroup (71.2 +/- 32.4% vs. 32.8 +/- 30.0%, mean +/- SD; P=0.03). Pepsinogen I/II ratio was inversely correlated with pH-3 holding time in the control and CRF groups. Gastric ammonium concentration in CRF/H. pylori (+) subgroup (14.1 +/- 9.2 mmol L(-1)) was significantly higher than in CRF/H. pylori (-) (2.5 +/- 2.7 mmol L(-1); P=0.002) and control/H. pylori (+) subgroups (6.1 +/- 4.2 mmol L(-1); P=0.01). Serum gastrin level was significantly higher in the CRF group than in the control group (297 +/-343 pg mL(-1) vs. 116 +/- 69 pg mL(-1); P=0.02) as a whole. However, there was no significant correlation between serum creatinine and gastrin levels in the CRF group. Gastrin level in CRF/H. pylori (+) subgroup was significantly higher than in CRF/H. pylori (-), control/H. pylori (+), and control/H. pylori (-) subgroups (423 +/-398 pg mL(-1) vs. 113 +/- 79, 124 +/- 78, and 96 +/-43 pg mL(-1), respectively; P=0.01-0.03). Significant positive correlations amongst pH-3 holding time, ammonium and gastrin concentrations were found in the CRF group, but not in the control group. CRF without H. pylori infection primarily shows a tendency for high gastric acidity, but without hypergastrinaemia. Persistent H. pylori infection in CRF leads to decreased acidity and, consequently, to fasting hypergastrinaemia via a feedback mechanism. The hypoacidity in CRF with H. pylori infection appears to result from neutralization of acid by ammonia as well as from gastric atrophy. Thus, H. pylori infection status critically determines perturbation in gastric acidity and fasting gastrin level in CRF.
    Full-text · Article · Nov 2003 · Journal of Internal Medicine

Publication Stats

4k Citations
1,059.88 Total Impact Points


  • 1993-2015
    • Dokkyo Medical University
      • • Department of Gastroenterology
      • • Department of Gastroenterology (Hospital)
      • • Department of Surgical and Molecular Pathology
      Totigi, Tochigi, Japan
  • 1986-2008
    • The University of Tokyo
      • • School of Medicine
      • • Department of General Internal Medicine
      • • Division of Internal Medicine
      Edo, Tōkyō, Japan
  • 1991-2002
    • Dokkyo University
      Edo, Tokyo, Japan
  • 1988-1997
    • University of California, Irvine
      • Department of Medicine
      Irvine, California, United States
  • 1995
    • Hitachi, Ltd.
      • Central Research Laboratory
      Edo, Tōkyō, Japan
  • 1988-1992
    • Long Beach Memorial Medical Center
      Long Beach, California, United States
  • 1990
    • Tokyo Medical University
      • Division of Radiology
      Edo, Tōkyō, Japan