Severe Delayed Gastric Emptying Induces Non-acid Reflux up to Proximal Esophagus in Neurologically Impaired Patients

( Shinji Ishii ),( Suguru Fukahori ),( Kimio Asagiri ),( Yoshiaki Tanaka ),( Nobuyuki Saikusa ),( Naoki Hashizume ),( Motomu Yoshida ),( Daisuke Masui ),( Naoko Komatsuzaki ),( Naruki Higashidate ),( 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2017 Journal of Neurogastroenterology and Motility (JNM Vol.23 No.4

Background/Aims The aim of this study is to investigate the degree of delayed gastric emptying (DGE) and evaluate how the severity of DGE affects gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients utilizing 24-hour multichannel intraluminal impedance pH measurements (pH/MII) and ¹³C-acetate breath test (¹³C-ABT) analyses. Methods ¹³C-ABT and pH/MII were conducted in 26 NI patients who were referred to our institution due to suspected GERD. At first, correlation analyses were performed to investigate the correlation between the ¹³C-ABT parameters and the clinical or pH/MII parameters. Thereafter, all patients were divided into 2 groups (DGE and severe DGE [SDGE] group) according to each cut off half emptying time (t_1/2, 90-170 minutes). Each pH/MII parameter was compared between the 2 groups in each set-up cutoff t_1/2. Results The mean t_1/2 of all patients was 215.5 ± 237.2 minutes and the t_1/2 of 24 (92.3%) patients were > 100 minutes. Significant moderate positive correlations were observed between both t1/2 and lag phase time and the non-acid reflux related parameters. Furthermore, the patients in the SDGE group demonstrated higher non-acid reflux related parameters than those of the DGE groups when the cutoff was t_1/2 ≥ 140 minutes. Conclusion The present study demonstrated that GE with t_1/2 ≥ 140 minutes was related to an increase of non-acid exposure reaching up to the proximal esophagus in NI patients, and indicating that NI patients with SDGE might have a high risk of non-acid GERD. (J Neurogastroenterol Motil 2017;23:533-540)

Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study

Shinji Tanishima,Tokumitsu Mihara,Atsushi Tanida,Chikako Takeda,Masaaki Murata,Toshiaki Takahashi,Koji Yamane,Tsugutake Morishita,Yasuo Morio,Hiroyuki Ishii,Satoru Fukata,Yoshiro Nanjo,Yuki Hamamoto,T 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: Multicenter, prospective study. Purpose: To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. Overview of Literature: To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. Methods: The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. Results: JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. Conclusions: Poor glycemic control might prevent postoperative functional recovery of the spinal cord.

Significance of Stabilometry for Assessing Postoperative Body Sway in Patients with Cervical Myelopathy

Shinji Tanishima,Hideki Nagashima,Hiroyuki Ishii,Satoru Fukata,Toshiyuki Dokai,Taiki Murakami,Yasuo Morio 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.5

Study Design: Prospective study. Purpose: To examine the changes in body sway using stabilometry in patients who underwent cervical laminoplasty for cervical myelopathy. Overview of Literature: Although the patients of cervical myelopathy complain body sway there are few report to examine body sway objectively. Methods: Patients who received treatment for cervical myelopathy between October 2010 and February 2013 were included. Twentyone patients underwent cervical laminoplasty (myelopathy group). Body sway was assessed using stabilometry, wherein patients stood on a stabilometer with their eyes closed for 30 seconds. The Romberg ratio, outer peripheral area (OPA) with eyes closed (cm2), and total locus length per unit area (L/A) with eyes closed (/cm) were examined. Examinations were performed preoperatively (at baseline) and at 8 weeks postoperatively. Examination results of patients in the myelopathy group were compared with those of 17 healthy individuals (control group). Clinical symptoms were evaluated using the Japanese Orthopaedic Association scale score (JOA score) and the timed up and go (TUG) test. Results: In the myelopathy and control groups, the mean baseline Romberg ratio, OPA, and L/A were 2.3±1.2, 8.9±5.5 cm2, and 14.2±5.3/cm and 1.4±1.0, 4.3±2.8 cm2, and 23.7±10.1/cm, respectively. Eight weeks after laminoplasty, only L/A showed significant improvement from baseline in the myelopathy group (23.2±10.1 to 16.8±7.9; p =0.03). The Romberg ratio and OPA showed improvement in the myelopathy group, but the changes were not statistically significant. JOA scores and TUG test results in this group significantly improved from baseline to 8 weeks after laminoplasty (12.7 to 13.4 and 10.8 to 8.0 seconds, respectively; both p <0.05). Conclusions: L/A is a useful parameter for measuring body sway to assess the recovery of body sway after laminoplasty.

No Effect of High Fat Diet-Induced Obesity on Spontaneous Reporter Gene Mutations in gpt Delta Mice

Takasu, Shinji,Ishii, Yuji,Matsushita, Kohei,Kuroda, Ken,Kijima, Aki,Kodama, Yukio,Ogawa, Kumiko,Umemura, Takashi Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.17

A large number of epidemiological studies have demonstrated that obesity is a risk factor for several human cancers. Several animal studies using rodents with diet-induced or genetic obesity have also demonstrated that obesity can promote tumor development. However, the effects of obesity on the early stages of carcinogenesis, and especially on the spontaneous occurrence of somatic gene mutations, remain unclear. To investigate the effects of obesity on the rate of spontaneous gene mutations, we performed reporter gene mutation assays in liver, kidney, and colon, organs in which obesity appears to be associated with cancer development on the basis of epidemiological or animal studies, in mice with high fat diet (HFD)-induced obesity. Six-week-old male and female C57BL/6 gpt delta mice were fed HFD or standard diet (STD) for 13 or 26 weeks. At the end of the experiments, reporter gene mutation assays of liver, kidney, and colon were performed. Final body weights and serum leptin levels of male and female mice fed HFD for 13 or 26 weeks were significantly increased compared with corresponding STD-fed groups. Reporter gene mutation assays of liver, kidney, and colon revealed that there were no significant differences in gpt or $Spi^-$ mutant frequencies between STD- and HFD-fed mice in either the 13-week or 26-week groups. These results indicate that HFD treatment and consequent obesity does not appear to influence the spontaneous occurrence of somatic gene mutations.

Conversion surgical therapy combined with hepatic arterial infusion chemotherapy for initially unresectable advanced hepatocellular carcinoma with tumor thrombus

Etsuro Hatano,Takamichi Ishii,Satoru Seo,Kojiro Taura,Shinji Uemoto 한국간담췌외과학회 2013 한국간담췌외과학회 학술대회지 Vol.2013 No.4

Novel angular evaluation method for radiation field using Lie derivative

Anetai Yusuke,Kinami Shinji,Koike Yuhei,Kamojima Takeo,Yokoi Masanori,Nishikawa Toshiyuki,Hirokawa Keiko,Ishii Yoshie,Takegawa Hideki 한국물리학회 2022 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.81 No.11

In radiotherapy, quality assurance (QA) for beam delivery from linear accelerator (linac) of treatment machine is a highly crucial factor for accurate radiotherapy because of the fuctuations in the conditions of the machine. The radiation feld is one of the important evaluation items, and this has been well-checked by crossline (right-to-left) and inline (caudal-to-cranial) profles. Diagonal or angular profles of the radiation feld are also an important component of irradiation feld; however, these are frequently omitted or not fully taken into account as it requires inefcient measurements. To detect the angular and radial conditions of the radiation feld, we proposed a novel evaluation method using Lie derivative analysis against radiochromic flm dosimetry in this study. This method directly compared the detected dose distributions with the calculations, obtained the discrepancy of the fow feld from the mathematical characteristic of Lie derivative, resulted in a detection of the radial and angular discrepancies that have not been handled by conventional gamma analysis.

Simultaneous Evaluation of Laryngopharyngeal Reflux and Swallowing Function Using Hypopharyngeal Multichannel Intraluminal Impedance Measurements in Neurologically Impaired Patients

( Daisuke Masui ),( Suguru Fukahori ),( Naoki Hashizume ),( Shinji Ishii ),( Naruki Higashidate ),( Saki Sakamoto ),( Shiori Tsuruhisa ),( Hirotomo Nakahara ),( Nobuyuki Saikusa ),( Yoshiaki Tanaka ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.2

Background/Aims This study aims to evaluate the presence of laryngopharyngeal reflux (LPR) and to investigate the use of hypopharyngeal baseline impedance (BI) for assessing swallowing dysfunction and gastroesophageal reflux disease (GERD) using hypopharyngeal multichannel intraluminal impedance and pH (HMII-pH) monitoring in neurologically impaired patients (NIPs). Methods The study population in this retrospective study comprised 20 NIPs (mean age, 36.1 ± 15.0 years; age range, 13-64 years) who underwent multichannel intraluminal impedance and pH (MII-pH), HMII-pH, and laryngoscopy using the Hyodo scoring method from December 2016 to April 2019. The MII-pH and HMM-pH parameters were compared in the NIPs, whereas hypopharyngeal BI values were compared between NIPs with ≥ 5 and < 5 in Hyodo scores. Correlations between the hypopharyngeal BI values and the Hyodo score were analyzed using Spearman’s correlation coefficient. A receiver operator characteristic curve was created to determine the optimum cut-off of hypopharyngeal BI value to discriminate SD. Results Three NIPs were diagnosed with pathological LPR and GERD by the HMII-pH monitoring. No significant differences in parameters were observed between MII-pH and HMII-pH monitoring. The correlation analysis demonstrated a significant negative correlation between the hypopharyngeal BI values and Hyodo scores. The optimal cutoff value for hypopharyngeal BI was 1552 Ω. Conclusions This study demonstrated the usefulness of HMII-pH monitoring in identifying NIP with pathological LPR. Considering the difficulties in performing examinations in NIPs, HMII-pH monitoring may be a potentially useful technique for the simultaneous evaluation of swallowing dysfunction, LPR, and GERD in NIP. (J Neurogastroenterol Motil 2021;27:198-204)

Approximation of bicarbonate concentration using serum total carbon dioxide concentration in patients with non-dialysis chronic kidney disease

Keiji Hirai,Saori Minato,Shohei Kaneko,Katsunori Yanai,Hiroki Ishii,Taisuke Kitano,Mitsutoshi Shindo,Haruhisa Miyazawa,Kiyonori Ito,Yuichirou Ueda,Yoshio Kaku,Taro Hoshino,Tatsuro Watano,Shinji Fujino 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.3

Background: We investigated the relationship between serum total carbon dioxide (CO2) and bicarbonate ion (HCO3 -) concentrations in pre-dialysis chronic kidney disease (CKD) patients and devised a formula for predicting low bicarbonate (HCO3 - < 24 mmol/L) and high bicarbonate (HCO3 - ≥ 24 mmol/L) using clinical parameters. Methods: In total, 305 samples of venous blood collected from 207 pre-dialysis patients assessed by CKD stage (G1 + G2, 46; G3, 50; G4, 51; G5, 60) were investigated. The relationship between serum total CO2 and HCO3 - concentrations was analyzed using Pearson’s correlation coefficient. An approximation formula was developed using clinical parameters correlated independently with HCO3 - concentration. Diagnostic accuracy of serum total CO2 and the approximation formula was evaluated by receiver operating characteristic curve analysis and a 2 × 2 table. Results: Serum total CO2 correlated strongly with HCO3 - concentration (r = 0.91; P < 0.001). The following approximation formula was obtained by a multiple linear regression analysis: HCO3 - (mmol/L) = total CO2 - 0.5 × albumin - 0.1 × chloride - 0.01 × (estimated glomerular filtration rate + blood glucose) + 15. The areas under the curves of serum total CO2 and the approximation formula for detection of low bicarbonate and high bicarbonate were 0.981, 0.996, 0.993, and 1.000, respectively. This formula had superior diagnostic accuracy compared with that of serum total CO2 (86.6% vs. 81.3%). Conclusion: Serum total CO2 correlated strongly with HCO3 - concentration in pre-dialysis CKD patients. An approximation formula including serum total CO2 showed superior diagnostic accuracy for low and high bicarbonate compared with serum total CO2.