BACKGROUND Although the usefulness of endoscopic scores,such as the Mayo Endoscopic Subscore(MES),Ulcerative Colitis Endoscopic Index of Severity(UCEIS),and Ulcerative Colitis Colonoscopic Index of Severity(UCCIS),and...BACKGROUND Although the usefulness of endoscopic scores,such as the Mayo Endoscopic Subscore(MES),Ulcerative Colitis Endoscopic Index of Severity(UCEIS),and Ulcerative Colitis Colonoscopic Index of Severity(UCCIS),and biomarkers such as fecal calprotectin(FC)for predicting relapse in ulcerative colitis(UC)has been reported,few studies have included endoscopic scores for evaluating the entire colon.AIM To compare the usefulness of FC value and MES,UCEIS,and UCCIS for predicting relapse in patients with UC in clinical remission.METHODS In total,75 patients with UC in clinical and endoscopic remission who visited our institution between February 2019 and March 2022 were enrolled.The diagnosis of UC was confirmed based on the clinical presentation,endoscopic findings,and histology,according to the current established criteria for UC.Fecal samples were collected the day before or after the colonoscopy for measurement of FC.Endoscopic evaluations were performed using MES,UCEIS,and UCCIS.The primary outcome measure of this study was the assessment of the association between relapse within 12 mo and MES,UCEIS,UCCIS,and FC.The secondary outcome was the comparison between endoscopic scores and biomarkers in en-rolled patients with UC with mucosal healing.RESULTSFC and UCCIS showed a significant correlation with UCEIS (r = 0.537, P < 0.001 and r = 0.957, P < 0.001, respectively).Receiver-operating characteristic analysis for predicting MES 0 showed that the area under the curve ofUCCIS was significantly higher than that of FC (P < 0.01). During the 1-year observation period, 18 (24%) patientsexperienced a relapse, and both the FC and UCCIS of the relapse group were significantly higher than that of theremission group. The cut-off values for predicting relapse were set at FC = 323 mg/kg and UCCIS = 10.2. The areaunder the curve of the receiver-operating characteristic analysis for predicting relapse did not show a significantdifference between FC and UCCIS. The accuracy of the endoscopic scores and biomarkers in predicting relapse was86.7% for UCCIS, 85.3% for UCEIS, 76.0% for FC, and 73.3% for MES.CONCLUSIONThe three endoscopic scores and FC may predict UC relapse during clinical remission. Among these scores, UCEISmay be the most useful in terms of ease of evaluation and accuracy.展开更多
BACKGROUND Primary sclerosing cholangitis(PSC)is an extraintestinal manifestation of ulcerative colitis(UC).PSC is a well-known risk factor for intrahepatic cholangiocarcinoma(ICC),and ICC is known to have a poor prog...BACKGROUND Primary sclerosing cholangitis(PSC)is an extraintestinal manifestation of ulcerative colitis(UC).PSC is a well-known risk factor for intrahepatic cholangiocarcinoma(ICC),and ICC is known to have a poor prognosis.CASE SUMMARY We present two cases of ICC in patients with PSC associated with UC.In the first case,a tumor was found by magnetic resonance imaging(MRI)in the liver of a patient with PSC and UC who presented to our hospital with right-sided rib pain.The second patient was asymptomatic,but we unexpectedly detected two liver tumors in an MRI performed to evaluate bile duct stenosis associated with PSC.ICC was strongly suspected by computed tomography and MRI in both cases,and surgery was performed,but unfortunately,the first patient died of ICC recurrence 16 mo postoperatively,and the second patient died of liver failure 14 mo postoperatively.CONCLUSION Careful follow-up of patients with UC and PSC with imaging and blood tests is necessary for early detection of ICC.展开更多
Public health measures to control the international spread of infectious diseases include strengthening quarantines and sealing borders.Although these measures are effective in delaying the importation of infectious d...Public health measures to control the international spread of infectious diseases include strengthening quarantines and sealing borders.Although these measures are effective in delaying the importation of infectious diseases,they also have a significant economic impact by stopping the flow of people and goods.The arrival time of infectious diseases is often used to assess quarantine effectiveness.Although the arrival time is highly dependent on the number of infected cases in the endemic country,direct comparisons have not yet been made.Therefore,this study derives an explicit relationship between the number of infected cases and arrival time.Transmission behavior is stochastic,and deterministic models are not always realistic.In this study,random differential equations,which are differential equations with stochastic processes,were used to describe the dynamics of infection in an endemic country.Furthermore,the flow of travelers from the endemic country was described in terms of survival time,and the arrival time in each country was calculated.A scenario in which PCR kits were distributed between endemic and diseasefree countries was also considered,and the impact of different distribution rates on arrival time was evaluated.The simulation results showed that increasing the distribution of PCR kits in the endemic country was more effective in delaying arrival times than using PCR kits in quarantine in disease-free countries.It was also found that increasing the proportion of identified infected persons in the endemic country,leading to isolation,was more important and effective in delaying arrival times than increasing the number of PCR tests.展开更多
With the rapid increase in the number of COVID-19 patients in Japan,the number of patients receiving oxygen at home has also increased rapidly,and some of these patients have died.An efficient approach to identify hig...With the rapid increase in the number of COVID-19 patients in Japan,the number of patients receiving oxygen at home has also increased rapidly,and some of these patients have died.An efficient approach to identify high-risk patients with slowly progressing and rapidly worsening COVID-19,and to avoid missing the timing of therapeutic intervention will improve patient prognosis and prevent medical complications.Patients admitted to medical institutions in Japan from November 14,2020 to April 11,2021 and registered in the COVID-19 Registry Japan were included.Risk factors for patients with High Flow Nasal Cannula invasive respiratory management or higher were comprehensively explored using machine learning.Age-specific cohorts were created,and severity prediction was performed for the patient surge period.We were able to obtain a model that was able to predict severe disease with a sensitivity of 57%when the specificity was set at 90%for those aged 40e59 years,and with a specificity of 50%and 43%when the sensitivity was set at 90%for those aged 60e79 years and 80 years and older,respectively.We were able to identify lactate dehydrogenase level(LDH)as an important factor in predicting the severity of illness in all age groups.Using machine learning,we were able to identify risk factors with high accuracy,and predict the severity of the disease.We plan to develop a tool that will be useful in determining the indications for hospitalisation for patients undergoing home care and early hospitalisation.展开更多
Advanced therapies for patients with mild-to-severe ulcerative colitis(UC)may result in treatment failure.We examined whether the lymphocyte-to-monocyte ratio(L/M ratio)could predict the failure of advanced therapies....Advanced therapies for patients with mild-to-severe ulcerative colitis(UC)may result in treatment failure.We examined whether the lymphocyte-to-monocyte ratio(L/M ratio)could predict the failure of advanced therapies.This retrospective,observational,cohort study included 73 patients who were treated with advanced therapies at the Hamamatsu University School of Medicine(Shizuoka,Japan)between February 2011 and November 2020.The patients were divided into the nonfailure and failure groups,and their leukocyte counts and ratios before induction were examined.Univariate and multivariate analyses were performed to identify the prognostic factors.Advanced therapies failed within 3 months in 15(20.5%)patients.Only the L/M ratio was significantly lower in the failure group than in the non-failure group(P=0.004).Receiveroperating characteristic(ROC)curve analysis revealed that an L/M ratio of ≤3.417 was predictive of treatment failure;the area under the curve(AUC)was 0.747(95%CI,0.620–0.874).Kaplan–Meier analysis revealed that the failure-free rate was significantly lower in the group with an L/M ratio of≤3.417 than in the group with an L/M ratio of>3.417(log-rank test P=0.002).Cox proportional hazard regression analysis identified an L/M ratio of≤3.417 as an independent risk factor for failure within 3 months after the induction of advanced therapies.Furthermore,ROC analysis of patients who did not receive immunomodulators also revealed that the cut-off L/M ratio was 3.417 and the AUC was 0.796(95%CI,0.666–0.925).In patients receiving advanced therapies for active UC,the L/M ratio can predict treatment failure within 3 months.L/M ratios could facilitate the transition from advanced therapies to subsequent treatments.展开更多
文摘BACKGROUND Although the usefulness of endoscopic scores,such as the Mayo Endoscopic Subscore(MES),Ulcerative Colitis Endoscopic Index of Severity(UCEIS),and Ulcerative Colitis Colonoscopic Index of Severity(UCCIS),and biomarkers such as fecal calprotectin(FC)for predicting relapse in ulcerative colitis(UC)has been reported,few studies have included endoscopic scores for evaluating the entire colon.AIM To compare the usefulness of FC value and MES,UCEIS,and UCCIS for predicting relapse in patients with UC in clinical remission.METHODS In total,75 patients with UC in clinical and endoscopic remission who visited our institution between February 2019 and March 2022 were enrolled.The diagnosis of UC was confirmed based on the clinical presentation,endoscopic findings,and histology,according to the current established criteria for UC.Fecal samples were collected the day before or after the colonoscopy for measurement of FC.Endoscopic evaluations were performed using MES,UCEIS,and UCCIS.The primary outcome measure of this study was the assessment of the association between relapse within 12 mo and MES,UCEIS,UCCIS,and FC.The secondary outcome was the comparison between endoscopic scores and biomarkers in en-rolled patients with UC with mucosal healing.RESULTSFC and UCCIS showed a significant correlation with UCEIS (r = 0.537, P < 0.001 and r = 0.957, P < 0.001, respectively).Receiver-operating characteristic analysis for predicting MES 0 showed that the area under the curve ofUCCIS was significantly higher than that of FC (P < 0.01). During the 1-year observation period, 18 (24%) patientsexperienced a relapse, and both the FC and UCCIS of the relapse group were significantly higher than that of theremission group. The cut-off values for predicting relapse were set at FC = 323 mg/kg and UCCIS = 10.2. The areaunder the curve of the receiver-operating characteristic analysis for predicting relapse did not show a significantdifference between FC and UCCIS. The accuracy of the endoscopic scores and biomarkers in predicting relapse was86.7% for UCCIS, 85.3% for UCEIS, 76.0% for FC, and 73.3% for MES.CONCLUSIONThe three endoscopic scores and FC may predict UC relapse during clinical remission. Among these scores, UCEISmay be the most useful in terms of ease of evaluation and accuracy.
文摘BACKGROUND Primary sclerosing cholangitis(PSC)is an extraintestinal manifestation of ulcerative colitis(UC).PSC is a well-known risk factor for intrahepatic cholangiocarcinoma(ICC),and ICC is known to have a poor prognosis.CASE SUMMARY We present two cases of ICC in patients with PSC associated with UC.In the first case,a tumor was found by magnetic resonance imaging(MRI)in the liver of a patient with PSC and UC who presented to our hospital with right-sided rib pain.The second patient was asymptomatic,but we unexpectedly detected two liver tumors in an MRI performed to evaluate bile duct stenosis associated with PSC.ICC was strongly suspected by computed tomography and MRI in both cases,and surgery was performed,but unfortunately,the first patient died of ICC recurrence 16 mo postoperatively,and the second patient died of liver failure 14 mo postoperatively.CONCLUSION Careful follow-up of patients with UC and PSC with imaging and blood tests is necessary for early detection of ICC.
基金funding from the Japan Society for the Promotion of Science(JSPS)KAKENHI(grant numbers 17KT0119,18K17371,21K17321,and 21H04595).
文摘Public health measures to control the international spread of infectious diseases include strengthening quarantines and sealing borders.Although these measures are effective in delaying the importation of infectious diseases,they also have a significant economic impact by stopping the flow of people and goods.The arrival time of infectious diseases is often used to assess quarantine effectiveness.Although the arrival time is highly dependent on the number of infected cases in the endemic country,direct comparisons have not yet been made.Therefore,this study derives an explicit relationship between the number of infected cases and arrival time.Transmission behavior is stochastic,and deterministic models are not always realistic.In this study,random differential equations,which are differential equations with stochastic processes,were used to describe the dynamics of infection in an endemic country.Furthermore,the flow of travelers from the endemic country was described in terms of survival time,and the arrival time in each country was calculated.A scenario in which PCR kits were distributed between endemic and diseasefree countries was also considered,and the impact of different distribution rates on arrival time was evaluated.The simulation results showed that increasing the distribution of PCR kits in the endemic country was more effective in delaying arrival times than using PCR kits in quarantine in disease-free countries.It was also found that increasing the proportion of identified infected persons in the endemic country,leading to isolation,was more important and effective in delaying arrival times than increasing the number of PCR tests.
基金This study was supported by the Health and Labour Sciences Research Grant,“Research on Emerging and Re-emerging Infectious Diseases and Immunization”Program(19HA1003).
文摘With the rapid increase in the number of COVID-19 patients in Japan,the number of patients receiving oxygen at home has also increased rapidly,and some of these patients have died.An efficient approach to identify high-risk patients with slowly progressing and rapidly worsening COVID-19,and to avoid missing the timing of therapeutic intervention will improve patient prognosis and prevent medical complications.Patients admitted to medical institutions in Japan from November 14,2020 to April 11,2021 and registered in the COVID-19 Registry Japan were included.Risk factors for patients with High Flow Nasal Cannula invasive respiratory management or higher were comprehensively explored using machine learning.Age-specific cohorts were created,and severity prediction was performed for the patient surge period.We were able to obtain a model that was able to predict severe disease with a sensitivity of 57%when the specificity was set at 90%for those aged 40e59 years,and with a specificity of 50%and 43%when the sensitivity was set at 90%for those aged 60e79 years and 80 years and older,respectively.We were able to identify lactate dehydrogenase level(LDH)as an important factor in predicting the severity of illness in all age groups.Using machine learning,we were able to identify risk factors with high accuracy,and predict the severity of the disease.We plan to develop a tool that will be useful in determining the indications for hospitalisation for patients undergoing home care and early hospitalisation.
文摘Advanced therapies for patients with mild-to-severe ulcerative colitis(UC)may result in treatment failure.We examined whether the lymphocyte-to-monocyte ratio(L/M ratio)could predict the failure of advanced therapies.This retrospective,observational,cohort study included 73 patients who were treated with advanced therapies at the Hamamatsu University School of Medicine(Shizuoka,Japan)between February 2011 and November 2020.The patients were divided into the nonfailure and failure groups,and their leukocyte counts and ratios before induction were examined.Univariate and multivariate analyses were performed to identify the prognostic factors.Advanced therapies failed within 3 months in 15(20.5%)patients.Only the L/M ratio was significantly lower in the failure group than in the non-failure group(P=0.004).Receiveroperating characteristic(ROC)curve analysis revealed that an L/M ratio of ≤3.417 was predictive of treatment failure;the area under the curve(AUC)was 0.747(95%CI,0.620–0.874).Kaplan–Meier analysis revealed that the failure-free rate was significantly lower in the group with an L/M ratio of≤3.417 than in the group with an L/M ratio of>3.417(log-rank test P=0.002).Cox proportional hazard regression analysis identified an L/M ratio of≤3.417 as an independent risk factor for failure within 3 months after the induction of advanced therapies.Furthermore,ROC analysis of patients who did not receive immunomodulators also revealed that the cut-off L/M ratio was 3.417 and the AUC was 0.796(95%CI,0.666–0.925).In patients receiving advanced therapies for active UC,the L/M ratio can predict treatment failure within 3 months.L/M ratios could facilitate the transition from advanced therapies to subsequent treatments.
