Static model simulation for routine mumps vaccination in Japan: with a result of mumps-related complications in a Japanese community hospital

Taito Kitano,Masayuki Onaka,Mariko Ishihara,Atsuko Nishiyama,Naoki Hashimoto,Sayaka Yoshida 대한백신학회 2017 Clinical and Experimental Vaccine Research Vol.6 No.2

Purpose: Mumps vaccine has not been included in the routine national immunization program in Japan, leading to low vaccine coverage rates and periodic epidemics approximately every 5 years. Our hospital (a secondary community hospital in Japan) experienced an increased number of mumps-related complications with a nationwide epidemic in 2016. Using previously reported data and mumps-related cases in our hospital, we estimated the cost-effectiveness of routine mumps vaccination in Japan with a static model using current epidemiologic data. Materials and Methods: With a decision tree flowchart of mumps infection and adverse events, we estimated the burden of mumps-related complications in our hospital for 5 years, and calculated the current annual national burden. Finally, we compared the current burden and assumptive burden of the stable state after routine vaccination in Japan using a static model. Results: The cost-benefit ratios with sensitivity analysis were 3.69 (1.08-9.52) and 6.84 (1.51-23.73) in independent inoculation and simultaneous inoculation, respectively, from a social perspective in addition to an annual gain of 9,487 (3,227-14,659) quality adjusted life years. Conclusion: We contributed additional evidence in terms of cost-effectiveness that routine mumps vaccination should be introduced in Japan with simultaneous inoculation.

New endoscopic ultrasonography techniques for pancreaticobiliary diseases

Ken Kamata,Masayuki Kitano,Shunsuke Omoto,Kumpei Kadosaka,Takeshi Miyata,Kosuke Minaga,Kentaro Yamao,Hajime Imai,Masatoshi Kudo 대한초음파의학회 2016 ULTRASONOGRAPHY Vol.35 No.3

Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases,especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it isnot sufficient for the differential diagnosis of various types of lesions. In order to address thelimitations of EUS, new techniques have been developed to improve the characterization ofthe lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used fordiagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNAneedle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a newimaging modality that uses an ultrasonographic contrast agent to visualize blood flow in finevessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirmingthe presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes severaldifferent variables to measure tissue elasticity, color patterns, and strain ratio, using analyticaltechniques such as hue-histogram analysis, and artificial neural networks, which are useful forthe diagnosis of chronic pancreatitis and pancreatic cancer.

Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors

Takashi Tamura,Masayuki Kitano 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.4

Subepithelial tumors are divided into benign subepithelial and potentially malignant gastrointestinal stromal tumors. It is difficultto distinguish between these tumor types. Contrast-enhanced harmonic endoscopic ultrasound is reportedly useful for diagnosingsubepithelial tumors, can be safely and easily performed by understanding the principle and method, and can be used to distinguishbetween tumor types with high sensitivity on the basis of differences in contrast effect. The generated image shows a hyperenhancementpattern in gastrointestinal stromal tumors (sensitivity, 78%–100%; specificity, 60%–100%; accuracy, 60%–100%) and hypoenhancementpattern in benign subepithelial tumors. Contrast-enhanced harmonic endoscopic ultrasound can be used to estimatethe malignancy potential of gastrointestinal stromal tumors by evaluating the uniformity of the contrast and the blood vessels insidethe tumor, with abnormal intra-tumor blood vessels, heterogeneous enhancement, and non-enhancing spots suggesting malignancy. Contrast-enhanced harmonic endoscopic ultrasound has a higher sensitivity than other imaging modalities for the detection ofvascularity within gastrointestinal stromal tumors. Additionally, it has been reported that treatment effects can be estimated byevaluating the blood flow in the gastrointestinal stromal tumor before and after treatment with tyrosine kinase inhibitors using contrastenhancedultrasound. However, there will be subjective-bias and the results depends on the performer’s skill.

Role of contrast-enhanced harmonic endoscopic ultrasonography (EUS) and EUS elastography in pancreatic lesions

Yasunobu Yamashita,Masayuki Kitano 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.2

Pancreatic cancers have a poor prognosis, and their incident rates have risen. Endoscopic ultrasonography (EUS) is an efficient and reliable diagnostic modality for pancreatic lesions, providing high spatial resolution. However, while EUS helps to detect minor pancreatic lesions, nearly all solid pancreatic lesions are hypoechoic, which creates difficulty in making differential diagnoses of pancreatic lesions. When diagnosing pancreatic lesions, the performance of image-enhanced EUS techniques is essential, such as EUS elastography or contrast-enhanced harmonic EUS (CH-EUS). CH-EUS diagnosis is based on assessing the vascularity of lesions, whereas tissue elasticity is measured via EUS elastography. Elastography is either strain or shear-wave, depending on the different mechanical properties being evaluated. The usefulness of enhanced EUS techniques is demonstrated in this review for the differential diagnosis of pancreatic lesions, including solid and cystic lesions, and pancreatic cancer staging.

A Rare Case of a White-Furred Ileocecal Valve

Shinya Taki,Takao Maekita,Masayuki Kitano 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4

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Patient self-reported symptoms using visual analog scales are useful to estimate endoscopic activity in ulcerative colitis

( Saya Tsuda ),( Reiko Kunisaki ),( Jun Kato ),( Mayu Murakami ),( Masafumi Nishio ),( Tsuyoshi Ogashiwa ),( Takeichi Yoshida ),( Hideaki Kimura ),( Masayuki Kitano ) 대한장연구학회 2018 Intestinal Research Vol.16 No.4

Background/Aims: In clinical practice, colonoscopy has been regarded as the gold standard for the evaluation of disease severity as well as mucosal healing in ulcerative colitis (UC). Some activity indices incorporating patient symptoms as parameters have been shown to reflect the endoscopic activity of UC. The aim of this study was to examine whether self-reported symptoms with visual analog scales (VAS) can predict endoscopic activity. Methods: A cross-sectional study of 150 UC patients who underwent colonoscopy with submission of VAS scores of 4 symptoms: general condition, bloody stools, stool form, and abdominal pain (0: no symptoms, 10: the most severe symptoms). Each VAS score was compared with colonoscopic activity assessed with the Mayo endoscopic subscore (MES). Results: All VAS scores were significantly correlated with the endoscopic severity (Spearman correlation coefficients of general condition, bloody stools, stool form, and abdominal pain: 0.63, 0.64, 0.58, and 0.43, respectively). Mucosal healing defined as MES 0 alone was predicted by VAS score <1.5 on general condition or 0 on bloody stools with sensitivity of 0.84 and 0.76 and specificity of 0.66 and 0.76, respectively. Additionally, VAS score <2.5 on stool form predicted active lesions in distal colorectum alone with sensitivity of 0.67 and specificity of 0.66, suggesting that this item could predict the indication of topical therapy. Conclusions: Self-reported VAS scores on symptoms were correlated with endoscopic activity of UC. To clarify the relationship between VAS and mucosal healing, further validation studies are needed. (Intest Res 2018;16:579-587)

Migration of a Percutaneous Endoscopic Gastrojejunostomy Tube into the Colon with Small Intestinal Telescoping

Shinya Taki,Takao Maekita,Mayumi Sakata,Kazuhiro Fukatsu,Yoshimasa Maeda,Mikitaka Iguchi,Hidefumi Ito,Masayuki Kitano 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.6

Continuous duodenal levodopa/carbidopa intestinal gel delivery by a gastrostomy infusion system improves control of Parkinson’sdisease. The overall complication rates of percutaneous endoscopic gastrojejunostomy were reported to be 41% and 59% for immediateand delayed adverse events, respectively. A 72-year-old woman underwent percutaneous endoscopic gastrojejunostomy using thedelivery system noted above. Abdominal pain and vomiting occurred 3 months later. Esophagogastroduodenoscopy showed alongitudinal ulcer extending from the lower gastric body to the ileum end, with small intestinal telescoping. Colonoscopy showed alarge bezoar of food residue that was attached around the tip of the tube, reaching the ascending colon, which may have acted as ananchor. Thus, the gastric antrum and small intestine were shortened with telescoping. This complication was resolved by crushing thebezoar with forceps during colonoscopy and can be prevented by consuming a fiber-free diet and periodic exchanges of the tube usingesophagogastroduodenoscopy.

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid

이재영,Minami Yasunori,최병인,이원재,Chou Yi-Hong,정우경,박미숙,Kudo Nobuki,이민우,Kamata Ken,Iijima Hiroko,김소연,Numata Kazushi,Sugimoto Katsutoshi,Maruyama Hitoshi,Sumino Yasukiyo,Ogawa Chikara,Kitano Masayuki,주이진,Arit 대한초음파의학회 2020 ULTRASONOGRAPHY Vol.39 No.3

The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology�European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.

Utility of Elastography with Endoscopic Ultrasonography Shear-Wave Measurement for Diagnosing Chronic Pancreatitis

Yasunobu Yamashita,Kensuke Tanioka,Yuki Kawaji,Takashi Tamura,Junya Nuta,Keiichi Hatamaru,Masahiro Itonaga,Takeichi Yoshida,Yoshiyuki Ida,Takao Maekita,Mikitaka Iguchi,Masayuki Kitano 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.5

Background/Aims: Rosemont classification (RC) with endoscopic ultrasonography (EUS) is important for diagnosing chronic pancreatitis (CP) but is based only on subjective judgement. EUS shear wave measurement (EUS-SWM) is a precise modality based on objective judgment, but its usefulness has not been extensively studied yet. This study evaluated the utility of EUS-SWM for diagnosing CP and estimating CP severity by determining the presence of endocrine dysfunction along with diabetes mellitus (DM). Methods: Between June 2018 and December 2018, 52 patients who underwent EUS and EUS-SWM were classified into two groups according to RC: non-CP (indeterminate CP and normal) and CP (consistent and suggestive of CP). The EUSSWM value by shear wave velocity was evaluated with a median value. The EUS-SWM value was compared with RC and the number of EUS features. The diagnostic accuracy and cutoff value of EUS-SWM for CP and DM and its sensitivity and specificity were calculated. Results: The EUS-SWM value significantly positively correlated with the RC and the number of EUS features. The EUS-SWM values that were consistent and suggestive of CP were significantly higher than that of normal. The area under the receiver operating characteristic (AUROC) curve for the diagnostic accuracy of EUS-SWM for CP was 0.97. The cutoff value of 2.19 had 100% sensitivity and 94% specificity. For endocrine dysfunction in CP, the AUROC was 0.75. The cutoff value of 2.78 had 70% sensitivity and 56% specificity. Conclusions: EUS-SWM provides an objective assessment and can be an alternative diagnostic tool for diagnosing CP. EUS-SWM may also be useful for predicting the presence of endocrine dysfunction.