AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis...AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis of a randomized controlled trial. We performed NBI-ME for 147 patients with present or a history of squamous cell carcinoma in the head and neck, or esophagus between January 2009 and June 2011. Two expert endoscopistsdetected 89 lesions that were suspicious for SESCC lesions, which had been prospectively evaluated for the following 6 NBI-ME findings in real time: "intervascular background coloration"; "proliferation of intrapapillary capillary loops(IPCL)"; and "dilation", "tortuosity", "change in caliber", and "various shapes(VS)" of IPCLs(i.e., Inoue's tetrad criteria). The histologic examination of specimens was defined as the gold standard for diagnosis. A stepwise logistic regression analysis was used to identify candidates for the simplified criteria from among the 6 NBI-ME findings for diagnosing SESCCs. We evaluated diagnostic performance of the simplified criteria compared with that of Inoue's criteria.RESULTS Fifty-four lesions(65%) were histologically diagnosed as SESCCs and the others as low-grade intraepithelial neoplasia or inflammation. In the univariate analysis, proliferation, tortuosity, change in caliber, and VS were significantly associated with SESCC(P < 0.01). The combination of VS and proliferation was statistically extracted from the 6 NBI-ME findings by using the stepwise logistic regression model. We defined the combination of VS and proliferation as simplified dyad criteria for SESCC. The areas under the curve of the simplified dyad criteria and Inoue's tetrad criteria were 0.70 and 0.73, respectively. No significant difference was shown between them. The sensitivity, specificity, and accuracy of diagnosis for SESCC were 77.8%, 57.1%, 69.7% and 51.9%, 80.0%, 62.9% for the simplified dyad criteria and Inoue's tetrad criteria, respectively.CONCLUSION The combination of proliferation and VS may serve as simplified criteria for the diagnosis of SESCC using NBIME.展开更多
BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleedi...BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation.These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short-and long-term outcomes have not been standardized yet.AIM To investigate the curability including short-and long-term outcomes of ER for SNADETs in a large case series.METHODS This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER.RESULTS In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections(EMRs)(93%) and 11 endoscopic submucosal dissections(ESDs)(7%). The median tumor diameter was 10 mm.The pathology diagnosis was adenocarcinoma(56/147, 38%), high-grade intraepithelial neoplasia(44/147, 30%), or low-grade intraepithelial neoplasia(47/147, 32%). The R0 resection rate was 68%(93/136) in the EMR group and73%(8/11) in the ESD group, respectively. Cap-assisted EMR(known as EMR-C)showed a higher rate of R0 resection compared to the conventional method of EMR using a snare(78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence.CONCLUSION Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs.展开更多
AIM: To evaluate the efficacy of circumferential endoscopic mucosal resection (EMR) with a tissue-anchoring device in comparison to forceps precut EMR and conventional endoscopic submucosal dissection (ESD). METHODS: ...AIM: To evaluate the efficacy of circumferential endoscopic mucosal resection (EMR) with a tissue-anchoring device in comparison to forceps precut EMR and conventional endoscopic submucosal dissection (ESD). METHODS: The study was designed as a prospective, randomized, ex vivo study. Fresh ex vivo specimens were harvested from adult white Yorkshire pigs weighing 30-50 kg. Seventy-five standardized, artificial lesions measuring 3 cm × 3 cm were created by methy- lene blue tattoo at the greater curvature in fresh ex vivo stomachs using the EASIE-R simulator platform (Endosim LLC, Berlin, MA, United States). The three advanced endoscopists performed the three resection techniques such as circumferential EMR using the tissue-anchoring device (TA-EMR), forceps precut EMR (FP-EMR), and endoscopic submucosal dissection. The endoscopists and the type of cutting methods were determined randomly by grouped randomized selection.The resection bed was grossly inspected to determine whether the lesion was resected "en-bloc " (defined as no remaining mucosal tattoo remaining on specimen). The resection bed was also probed for evidence of perforation. The procedural time of circumferential resection, submucosal dissection, and injection frequency were recorded by an independent observer.RESULTS: All 75 created lesions were successfully resected by three advanced endoscopists using the three techniques. The mean ± SD size of resected specimens (long axis) were 39.5 ± 5.6 mm, 36.5 ± 7.3 mm, and 44.6 ± 5.6 mm for TA-EMR, FP-EMR, and ESD respectively. The overall mean dissection time of both the TA- EMR and FP-EMR was significant shorter than ESD (TA- EMR: 5.1 ± 3.3 min, FP-EMR: 3.5 ± 2.0 min vs ESD: 15.8 ± 9.5 min, P < 0.001, P < 0.001). The overall mean total procedure time of both the tissue-anchoring and forceps circumferential EMR was significantly shorter than ESD (TA-EMR: 17.5 ± 6.0 min, FP-EMR: 16.6 ± 6.6 min vs ESD: 28.6 ± 13.9 min, P < 0.001, P < 0.001). The en-bloc resection rate of ESD was 100% (25/25) and the en-bloc resection rate of the TA-EMR (84.0%, 21/25) was higher than for the FP-EMR (60.0%, 15/25), yet not statistically significant (P = 0.18). The perforation rate of each technique was 8.0% (2/25). CONCLUSION: TA-EMR appears to be quicker than ESD, and there was a trend towards improved en bloc resection rate with the TA-EMR when compared to the FP-EMR.展开更多
We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University...We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University Hospital with severe jaundice. Although endoscopic retrograde cholangiography and liver biopsy revealed the findings consistent with PSC, abdominal computed tomography revealed numerous large perihepatic lymph nodes with a maximum diameter of more than 3 cm. Therefore, EUS-FNA was done in order to exclude malignant lymphadenopathy, and adequate specimens obtained by EUS-FNA showed reactive hyperplasia of lymphnode. The patients were scheduled to undergo liver transplantation.展开更多
BACKGROUND Gastric mixed adenoma-neuroendocrine tumors(NETs)are quite rare.In the 2019 world health organization classification of tumors of the digestive system,these were designated as a combination of grade 1 or gr...BACKGROUND Gastric mixed adenoma-neuroendocrine tumors(NETs)are quite rare.In the 2019 world health organization classification of tumors of the digestive system,these were designated as a combination of grade 1 or grade 2 NETs and adenomas or tubular adenomas.There are no treatment guidelines for these tumors,and pathological and clinical studies are ongoing.Herein,we review previous case reports and present a case of gastric mixed adenoma-NET.CASE SUMMARY A 66-year-old man underwent gastrointestinal endoscopy for the evaluation of upper abdominal pain.Histopathological examination of the biopsy specimen indicated the possibility of gastric cancer.A histopathological examination by endoscopic submucosal dissection showed a mixed adenoma-NET that was completely excised by endoscopic submucosal dissection.No recurrence was observed on gastrointestinal endoscopy at the 6-mo follow-up.CONCLUSION Clinicians'awareness of this rare tumor is important for its timely diagnosis and treatment.展开更多
We examined the influence of oral malodor on psychological stress among patients with a chief complaint of oral malodor. A total of 101 patients (40 male and 61 female) who visited our clinic with a chief complaint of...We examined the influence of oral malodor on psychological stress among patients with a chief complaint of oral malodor. A total of 101 patients (40 male and 61 female) who visited our clinic with a chief complaint of oral malodor were included in this study. The primary compounds of oral malodor—volatile sulfur compounds (VSC)—were measured using the Oral ChromaTM instrument. Salivary stress markers, cortisol, and chromogranin A were measured using an enzyme-linked immunosorbent assay (ELISA) kit. The mood was measured using the Profile of Mood States 2nd Edition (POMS2). Among the participants, 60.3% had at least one level above the threshold in the following three markers: hydrogen sulfide, methyl mercaptan, and dimethyl sulfide. The gender distribution was 35 female (57.4%) and 25 male (62.5%). Salivary cortisol levels, a biomarker of stress, did not vary depending on the presence or absence of oral malodor. Chromogranin A levels were higher in the oral malodor female group than in the no oral malodor female group. With respect to the POMS2, regardless of the presence or absence of oral malodor measured using gas chromatography, the participants had higher scores for “Anger-Hostility” and “Fatigue-Inertia”. Analysis by gender showed that “Depression-Dejection” was significantly higher in the oral malodor female group than in the no oral malodor female group. These results suggest that those who are worried about oral malodor have higher psychological stress than those who are not, regardless of the presence or absence of oral malodor measured using gas chromatography.展开更多
In an era where the health-damaging effects of wheat flour (gluten) are increasingly recognized, rice flour has become an important alternative for many people, yet its psychophysiological effects remain largely unkno...In an era where the health-damaging effects of wheat flour (gluten) are increasingly recognized, rice flour has become an important alternative for many people, yet its psychophysiological effects remain largely unknown. Here, we report the potential beneficial effects of rice flour for sleep disturbances in stressed mice. Four-week-old male ddY mice were reared in social isolation for 4 weeks. The control group was reared in a social group. Rice flour was given orally in food to isolated mice at a dose of 2.5 w/w% and 5.0 w/w% for 4 weeks from the start of isolation rearing. MF food was given to the control group. Pentobarbital-induced (40 mg/kg, i.p.) time to sleep induction and righting reflex was measured to determine the effects of rice flour on sleep behavior. Blood samples were obtained after the experiments, and serum corticosterone was measured. Sections from the prefrontal cortex and the brainstem were isolated to measure serotonin, dopamine and interleukin (IL)-6 concentrations. We found that the administration of rice flour dose-dependently improved time to sleep and reduced sleep time in socially isolated mice. Blood corticosterone concentrations, which increased after isolation stress, were decreased after the administration of rice flour. Serotonin and dopamine concentrations in the prefrontal cortex which decreased after isolation stress improved after the administration of rice flour. Brainstem IL-6 concentrations increased after isolation stress, but decreased dose-dependently after rice flour administration. Our results suggest that rice flour reverses sleep disturbances in mice induced by social isolation.展开更多
文摘AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis of a randomized controlled trial. We performed NBI-ME for 147 patients with present or a history of squamous cell carcinoma in the head and neck, or esophagus between January 2009 and June 2011. Two expert endoscopistsdetected 89 lesions that were suspicious for SESCC lesions, which had been prospectively evaluated for the following 6 NBI-ME findings in real time: "intervascular background coloration"; "proliferation of intrapapillary capillary loops(IPCL)"; and "dilation", "tortuosity", "change in caliber", and "various shapes(VS)" of IPCLs(i.e., Inoue's tetrad criteria). The histologic examination of specimens was defined as the gold standard for diagnosis. A stepwise logistic regression analysis was used to identify candidates for the simplified criteria from among the 6 NBI-ME findings for diagnosing SESCCs. We evaluated diagnostic performance of the simplified criteria compared with that of Inoue's criteria.RESULTS Fifty-four lesions(65%) were histologically diagnosed as SESCCs and the others as low-grade intraepithelial neoplasia or inflammation. In the univariate analysis, proliferation, tortuosity, change in caliber, and VS were significantly associated with SESCC(P < 0.01). The combination of VS and proliferation was statistically extracted from the 6 NBI-ME findings by using the stepwise logistic regression model. We defined the combination of VS and proliferation as simplified dyad criteria for SESCC. The areas under the curve of the simplified dyad criteria and Inoue's tetrad criteria were 0.70 and 0.73, respectively. No significant difference was shown between them. The sensitivity, specificity, and accuracy of diagnosis for SESCC were 77.8%, 57.1%, 69.7% and 51.9%, 80.0%, 62.9% for the simplified dyad criteria and Inoue's tetrad criteria, respectively.CONCLUSION The combination of proliferation and VS may serve as simplified criteria for the diagnosis of SESCC using NBIME.
文摘BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation.These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short-and long-term outcomes have not been standardized yet.AIM To investigate the curability including short-and long-term outcomes of ER for SNADETs in a large case series.METHODS This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER.RESULTS In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections(EMRs)(93%) and 11 endoscopic submucosal dissections(ESDs)(7%). The median tumor diameter was 10 mm.The pathology diagnosis was adenocarcinoma(56/147, 38%), high-grade intraepithelial neoplasia(44/147, 30%), or low-grade intraepithelial neoplasia(47/147, 32%). The R0 resection rate was 68%(93/136) in the EMR group and73%(8/11) in the ESD group, respectively. Cap-assisted EMR(known as EMR-C)showed a higher rate of R0 resection compared to the conventional method of EMR using a snare(78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence.CONCLUSION Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs.
文摘AIM: To evaluate the efficacy of circumferential endoscopic mucosal resection (EMR) with a tissue-anchoring device in comparison to forceps precut EMR and conventional endoscopic submucosal dissection (ESD). METHODS: The study was designed as a prospective, randomized, ex vivo study. Fresh ex vivo specimens were harvested from adult white Yorkshire pigs weighing 30-50 kg. Seventy-five standardized, artificial lesions measuring 3 cm × 3 cm were created by methy- lene blue tattoo at the greater curvature in fresh ex vivo stomachs using the EASIE-R simulator platform (Endosim LLC, Berlin, MA, United States). The three advanced endoscopists performed the three resection techniques such as circumferential EMR using the tissue-anchoring device (TA-EMR), forceps precut EMR (FP-EMR), and endoscopic submucosal dissection. The endoscopists and the type of cutting methods were determined randomly by grouped randomized selection.The resection bed was grossly inspected to determine whether the lesion was resected "en-bloc " (defined as no remaining mucosal tattoo remaining on specimen). The resection bed was also probed for evidence of perforation. The procedural time of circumferential resection, submucosal dissection, and injection frequency were recorded by an independent observer.RESULTS: All 75 created lesions were successfully resected by three advanced endoscopists using the three techniques. The mean ± SD size of resected specimens (long axis) were 39.5 ± 5.6 mm, 36.5 ± 7.3 mm, and 44.6 ± 5.6 mm for TA-EMR, FP-EMR, and ESD respectively. The overall mean dissection time of both the TA- EMR and FP-EMR was significant shorter than ESD (TA- EMR: 5.1 ± 3.3 min, FP-EMR: 3.5 ± 2.0 min vs ESD: 15.8 ± 9.5 min, P < 0.001, P < 0.001). The overall mean total procedure time of both the tissue-anchoring and forceps circumferential EMR was significantly shorter than ESD (TA-EMR: 17.5 ± 6.0 min, FP-EMR: 16.6 ± 6.6 min vs ESD: 28.6 ± 13.9 min, P < 0.001, P < 0.001). The en-bloc resection rate of ESD was 100% (25/25) and the en-bloc resection rate of the TA-EMR (84.0%, 21/25) was higher than for the FP-EMR (60.0%, 15/25), yet not statistically significant (P = 0.18). The perforation rate of each technique was 8.0% (2/25). CONCLUSION: TA-EMR appears to be quicker than ESD, and there was a trend towards improved en bloc resection rate with the TA-EMR when compared to the FP-EMR.
文摘We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University Hospital with severe jaundice. Although endoscopic retrograde cholangiography and liver biopsy revealed the findings consistent with PSC, abdominal computed tomography revealed numerous large perihepatic lymph nodes with a maximum diameter of more than 3 cm. Therefore, EUS-FNA was done in order to exclude malignant lymphadenopathy, and adequate specimens obtained by EUS-FNA showed reactive hyperplasia of lymphnode. The patients were scheduled to undergo liver transplantation.
文摘BACKGROUND Gastric mixed adenoma-neuroendocrine tumors(NETs)are quite rare.In the 2019 world health organization classification of tumors of the digestive system,these were designated as a combination of grade 1 or grade 2 NETs and adenomas or tubular adenomas.There are no treatment guidelines for these tumors,and pathological and clinical studies are ongoing.Herein,we review previous case reports and present a case of gastric mixed adenoma-NET.CASE SUMMARY A 66-year-old man underwent gastrointestinal endoscopy for the evaluation of upper abdominal pain.Histopathological examination of the biopsy specimen indicated the possibility of gastric cancer.A histopathological examination by endoscopic submucosal dissection showed a mixed adenoma-NET that was completely excised by endoscopic submucosal dissection.No recurrence was observed on gastrointestinal endoscopy at the 6-mo follow-up.CONCLUSION Clinicians'awareness of this rare tumor is important for its timely diagnosis and treatment.
文摘We examined the influence of oral malodor on psychological stress among patients with a chief complaint of oral malodor. A total of 101 patients (40 male and 61 female) who visited our clinic with a chief complaint of oral malodor were included in this study. The primary compounds of oral malodor—volatile sulfur compounds (VSC)—were measured using the Oral ChromaTM instrument. Salivary stress markers, cortisol, and chromogranin A were measured using an enzyme-linked immunosorbent assay (ELISA) kit. The mood was measured using the Profile of Mood States 2nd Edition (POMS2). Among the participants, 60.3% had at least one level above the threshold in the following three markers: hydrogen sulfide, methyl mercaptan, and dimethyl sulfide. The gender distribution was 35 female (57.4%) and 25 male (62.5%). Salivary cortisol levels, a biomarker of stress, did not vary depending on the presence or absence of oral malodor. Chromogranin A levels were higher in the oral malodor female group than in the no oral malodor female group. With respect to the POMS2, regardless of the presence or absence of oral malodor measured using gas chromatography, the participants had higher scores for “Anger-Hostility” and “Fatigue-Inertia”. Analysis by gender showed that “Depression-Dejection” was significantly higher in the oral malodor female group than in the no oral malodor female group. These results suggest that those who are worried about oral malodor have higher psychological stress than those who are not, regardless of the presence or absence of oral malodor measured using gas chromatography.
文摘In an era where the health-damaging effects of wheat flour (gluten) are increasingly recognized, rice flour has become an important alternative for many people, yet its psychophysiological effects remain largely unknown. Here, we report the potential beneficial effects of rice flour for sleep disturbances in stressed mice. Four-week-old male ddY mice were reared in social isolation for 4 weeks. The control group was reared in a social group. Rice flour was given orally in food to isolated mice at a dose of 2.5 w/w% and 5.0 w/w% for 4 weeks from the start of isolation rearing. MF food was given to the control group. Pentobarbital-induced (40 mg/kg, i.p.) time to sleep induction and righting reflex was measured to determine the effects of rice flour on sleep behavior. Blood samples were obtained after the experiments, and serum corticosterone was measured. Sections from the prefrontal cortex and the brainstem were isolated to measure serotonin, dopamine and interleukin (IL)-6 concentrations. We found that the administration of rice flour dose-dependently improved time to sleep and reduced sleep time in socially isolated mice. Blood corticosterone concentrations, which increased after isolation stress, were decreased after the administration of rice flour. Serotonin and dopamine concentrations in the prefrontal cortex which decreased after isolation stress improved after the administration of rice flour. Brainstem IL-6 concentrations increased after isolation stress, but decreased dose-dependently after rice flour administration. Our results suggest that rice flour reverses sleep disturbances in mice induced by social isolation.
