1.A Case of Surgical Revascularization for Abdominal Angina
Akira Furutachi ; Hitoshi Ohteki ; Kozo Naito ; Junichi Murayama ; Masanori Takamatsu
Japanese Journal of Cardiovascular Surgery 2012;41(1):8-11
A 68-year-old woman with multiple gastric ulcers was admitted to our hospital due to post-prandial abdominal pain. Multirow detector computed tomography (MDCT) showed severe stenoses of both the celiac trunk and superior mesenteric artery (SMA) ; therefore, we decided to operate based on the presumed diagnosis of abdominal angina. We bypassed the stenoses using a saphenous vein graft from the right external iliac artery to the SMA, distal to the stenosis. The patient was symptom-free postoperatively. In summary, this case of abdominal angina was accurately evaluated preoperatively with MDCT and the flow meter®. Thereafter, a focal stenosis in the superior mesenteric artery was successfully treated with an external iliac-SMA bypass using a saphenous vein graft.
2.Development Process of Medical Education Assets Library (MEAL)
Hirotaka Onishi ; Masaru Kawasaki ; Michio Shiibashi ; Yukie Abe ; Yumiko Okubo ; Hitomi Kataoka ; Naomi Sugimoto ; Akiteru Takamura ; Akira Naito ; Masayuki Niwa
Medical Education 2012;43(3):215-220
Committee for Information Infrastructure in the 16th term of JSME Board Members was newly created to edit Medical Education White Book issued every four years and to provide sooner and more comprehensive information infrastructure provision. MEAL was opened as a website for medical education information since August 2011. MEAL consists of glossary, articles, books and more resources using a system like Wiki or Blog on the Web. By such technological progress, not only one–way information provision from JSME but also bidirectional communication between JSME members and committees/board members became available. Internationally, similar websites are known, such as MedEdPORTAL by AAMC (Association of American Medical Colleges), and expected to be new scholarly information added to journals.
3.Physicians' Use of Local Dialects during Communication with Patients
Yasuharu Tokuda ; Yasuo Yoshioka ; Masao Aizawa ; Makiro Tanaka ; Sachiko Ohde ; Kazuhisa Motomura ; Akira Naito ; Keiko Hayano ; Tsuguya Fukui
General Medicine 2008;9(1):13-19
OBJECTIVE: To investigate Japanese physicians' use of dialects related to geographic areas and to elucidate how physicians respond to dialect-using patients.
METHODS: We conducted a web-based open survey, to which 170 anonymous physicians reported. We examined the following 1) whether dialects are used during communication with patients; 2) how to communicate with patients using dialects; and, 3) reasons for having difficulty in communicating with patients who regularly use dialects. Geographical areas were divided into the following 8 areas Hokkaido-Tohoku, Kanto, Koshinetsu-Hokuriku, Tokai, Kinki, Chugoku, Shikoku and Kyushu-Okinawa.
RESULTS: Of 170 physicians, 61.2% (95% CI: 53.4-68.5%) reported using dialects. These proportions differed by geographic area (F= 8.141; p<0.001) . Physicians practicing in Shikoku and Chugoku used dialects most frequently, while those practicing in Kanto and Hokkaido-Tohoku used dialects least frequently. Many dialect-using physicians thought that physicians should use the same dialect as dialect-using patients. In addition, dialect-using physicians were more likely to think that a physician-related factor was responsible for having difficulty in garnering clinical information.
CONCLUSIONS: Use of dialects by Japanese physicians during communication with patients seems common and may differ by geographic areas. Physicians' use of dialects could be a useful tool for effective clinical communication.
4.Possible Involvement of p38 MAP Kinase in Retinoid-stimulated Expression of Indian Hedgehog in Prehypertrophic Chondrocytes
Tsuyoshi Shimo ; Eiki Koyama ; Soichiro Ibaragi ; Naito Kurio ; Daisuke Yamamoto ; Tatsuo Okui ; Koji Kishimoto ; Hiroshi Mese ; Akira Sasaki
Oral Science International 2008;5(1):1-14
The mandibular condyle formation during temporomandibular joint (TMJ) development exhibits endochondral bone formation, and the elongation process is dependent on the normal cartilage proliferation and differentiation. Retinoids are important for maturation of growth-plate chondrocytes, but the identity of their downstream effectors remains unclear. In this study, we carried out a series of studies at the cellular, biochemical, and molecular levels to determine whether, and if so how, retinoid signaling is related to the expression and function of Indian hedgehog (Ihh) in chondrocyte proliferation. First we analyzed the RA receptor (RAR) and Ihh expression pattern in E18 mandibular condyle. RARα and RARβ mRNA were characterized in the perichondrium around the condyle, whereas RARγ mRNA was expressed in the immature and prehypertrophic chondrocytes and the expression was overlapped with Ihh gene expression. Next we established a high-density culture model of chick cephalic chondrocytes in the prehypertrophic stage. We found that all-trans retinoic acid (RA) induced Ihh mRNA gene expression in this system. The RA pan-antagonist Ro 41-5253 inhibited both endogenous and RA-induced Ihh mRNA in a dose-dependent manner. The Ihh mRNA expression induced by RA required de novo protein synthesis, and was mediated by RARγ. Immunoblots showed that the prehypertrophic chondrocytes contained sizable levels of phosphorylated p38 mitogen-activated protein (MAP) kinase that were time- and dose-dependently increased by the RA treatment. Experimental p38 inhibition led to a severe drop in baseline and RA-stimulated Ihh expression. Exogenous recombinant Ihh stimulated the proliferation of proliferating chondrocytes, whereas RA inhibited the proliferation of these chondrocytes through p38 MAPK. Retinoids appear to play a primary role in controlling both the expression and function of Ihh in prehypertrophic chondrocytes and do so via p38 MAP kinase.
5.Relationship between the gut microbiota and bile acid composition in the ileal mucosa of Crohn’s disease
Shigeki BAMBA ; Osamu INATOMI ; Atsushi NISHIDA ; Masashi OHNO ; Takayuki IMAI ; Kenichiro TAKAHASHI ; Yuji NAITO ; Junichi IWAMOTO ; Akira HONDA ; Naohiro INOHARA ; Akira ANDOH
Intestinal Research 2022;20(3):370-380
Background/Aims:
Crosstalk between the gut microbiota and bile acid plays an important role in the pathogenesis of gastrointestinal disorders. We investigated the relationship between microbial structure and bile acid metabolism in the ileal mucosa of Crohn’s disease (CD).
Methods:
Twelve non-CD controls and 38 CD patients in clinical remission were enrolled. Samples were collected from the distal ileum under balloon-assisted enteroscopy. Bile acid composition was analyzed by liquid chromatography-mass spectrometry. The gut microbiota was analyzed by 16S rRNA gene sequencing.
Results:
The Shannon evenness index was significantly lower in endoscopically active lesions than in non-CD controls. β-Diversity, evaluated by the UniFrac metric, revealed a significant difference between the active lesions and non-CD controls (P=0.039). The relative abundance of Escherichia was significantly higher and that of Faecalibacterium and Roseburia was significantly lower in CD samples than in non-CD controls. The increased abundance of Escherichia was more prominent in active lesions than in inactive lesions. The proportion of conjugated bile acids was significantly higher in CD patients than in non-CD controls, but there was no difference in the proportion of primary or secondary bile acids. The genera Escherichia and Lactobacillus were positively correlated with the proportion of conjugated bile acids. On the other hand, Roseburia, Intestinibacter, and Faecalibacterium were negatively correlated with the proportion of conjugated bile acids.
Conclusions
Mucosa-associated dysbiosis and the alteration of bile acid composition were identified in the ileum of CD patients. These may play a role in the pathophysiology of ileal lesions in CD patients.
6.In vitro model of atherosclerosis using coculture of arterial wall cells and macrophage.
Youichiro WADA ; Akira SUGIYAMA ; Takahide KOHRO ; Mika KOBAYASHI ; Motohiro TAKEYA ; Makoto NAITO ; Tatsuhiko KODAMA
Yonsei Medical Journal 2000;41(6):740-755
In order to determine the precise mechanism of the interactions between different types of cells, which are common phenomena in tissues and organs, the importance of coculture techniques are becoming increasingly important. In the area of cardiology, artificial arteries have been developed, based on the understanding of physiological communication of the arterial smooth muscle cells (SMC), endothelial cells (EC), and the extracellular matrix (ECM). In the study of atherosclerosis, the modification of low-density lipoprotein (LDL), which result in the recruitment and accumulation of white blood cells, especially, monocytes/macrophages, and foam cell formation, are hypothesized. Although there are well known animal models, an in vitro model of atherogenesis with a precisely known atherogenesis mechanism has not yet been developed. In this paper, an arterial wall reconstruction model using rabbit primary cultivated aortic SMCs and ECs, was shown. In addition, human peripheral monocytes were used and the transmigration of monocytes was observed by scanning electron and laser confocal microscopy. Monocyte differentiation into macrophages was shown by immunohistochemistry and comprehensive gene expression analysis. With the modified form of LDL, the macrophages were observed to accumulate lipids with a foamy appearance and differentiate into the foam cells in the ECM between the ECs and SMCs in the area of our coculture model.
Animal
;
Aorta/physiology*
;
Aorta/cytology*
;
Arteriosclerosis/etiology*
;
Cell Differentiation/physiology
;
Cell Movement
;
Coculture
;
Endothelium, Vascular/physiology
;
Endothelium, Vascular/cytology
;
Extracellular Matrix/metabolism
;
Foam Cells/ultrastructure
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Foam Cells/cytology
;
Macrophages/physiology*
;
Macrophages/cytology
;
Male
;
Microscopy, Confocal
;
Microscopy, Electron
;
Microscopy, Electron, Scanning
;
Monocytes/ultrastructure
;
Monocytes/physiology
;
Muscle, Smooth, Vascular/physiology
;
Muscle, Smooth, Vascular/cytology
;
Myosin/metabolism
;
Protein Isoforms/metabolism
;
Rabbits
7.Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases
Hayato YAMAGUCHI ; Masakatsu FUKUZAWA ; Takashi KAWAI ; Takahiro MURAMATSU ; Taisuke MATSUMOTO ; Kumiko UCHIDA ; Yohei KOYAMA ; Akira MADARAME ; Takashi MORISE ; Shin KONO ; Sakiko NAITO ; Naoyoshi NAGATA ; Mitsushige SUGIMOTO ; Takao ITOI
Clinical Endoscopy 2023;56(6):778-789
Background/Aims:
Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD).
Methods:
We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes.
Results:
Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]).
Conclusions
RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.
8.Twenty years of otsu medical stucents association since 1969.
Michiya Ohtaka ; Tsuyoshi Ikai ; Shinji Fushiki ; Kiyoaki Kitamura ; Yasuyuki Tatsugami ; Junichiro Morikawa ; Yoshio Nakamura ; Takeshi Aoyama ; Tetsuya Yoshikawa ; Akira Matsuda ; Yoshifumi Yokota ; Takuzo Nambu ; Takeshi Moridera ; Nobuki Yamaoka ; Hiroyuki Naito ; Fumikazu Ikeda ; Hiroyuki Furukawa ; Hiroshi Yakushigawa ; Hiroshi Fujimoto ; Kishiko Hayashi ; Tsuyoshi Ohtaka ; Noboru Takano ; Yoshie Ibuki ; Tsutomu Yamanaka ; Akira Matsuda
Medical Education 1991;22(2):115-120
9.Development of Low-intensity Home-based Resistance Training for Elderly Patients with Advanced Cancer: The Exercise Component of the NEXTAC Program
Noriatsu TATEMATSU ; Taro OKAYAMA ; Tetsuya TSUJI ; Akira IWAMURA ; Akira TANUMA ; Tateaki NAITO ; Shuichi MITSUNAGA ; Satoru MIURA ; Katsuhiro OMAE ; Keita MORI ; Koichi TAKAYAMA
Palliative Care Research 2018;13(4):373-381
Objectives: We developed the multimodal program Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC program). The aim of our study is to show algorithm of the home-based resistance training prescription and its compliance. Methods: We recruited 30 patients aged≥70 years scheduled to receive first-line chemotherapy for advanced pancreatic or non-small-cell lung cancer. Three educational sessions were planned in 8-week study period. Our resistance training consists of 3 or 5 of following 5 exercises components: (1) sit-to-stand, (2) calf raise, (3) knee extension, (4) knee raise, (5) side leg raise. Physiotherapist chose optimal prescription according to the modified Borg-scale. We assessed patient compliance, and safety. Results: Median proportion of days in which patients performed full or modified exercise program was 91%. Adverse events possibly related to the NEXTAC program were observed in 5 patients and included muscle pain (grade 1 in 2 patients), arthralgia (grade 1 in one patient), dyspnea on exertion (grade 1 in one patient), and plantar aponeurositis (grade 1 in one patient). Patient physical function and physical activity were maintained during the study period. Conclusion: Our resistance training showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non-small-cell lung cancer receiving concurrent chemotherapy. Although this study was not designed to show the efficacy of the resistance training, our data indicate a potential protective effect on physical function and physical activity.