Development of Dilated Esophagus, Sigmoid Esophagus, and Esophageal Diverticulum in Patients With Achalasia: Japan Achalasia Multicenter Study

Hiroki Sato,Yusuke Fujiyoshi,Hirofumi Abe,Hironari Shiwaku,Junya Shiota,Chiaki Sato,Hiroyuki Sakae,Masaki Ominami,Yoshitaka Hata,Hisashi Fukuda,Ryo Ogawa,Jun Nakamura,Tetsuya Tatsuta,Yuichiro Ikebuchi 대한소화기 기능성질환∙운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.2

Background/AimsPatients with achalasia-related esophageal motility disorders (AEMDs) frequently present with dilated and sigmoid esophagus, and develop esophageal diverticulum (ED), although the prevalence and patients characteristics require further elucidation. MethodsWe conducted a multicenter cohort study of 3707 patients with AEMDs from 14 facilities in Japan. Esophagography on 3682 patients were analyzed. ResultsStraight (n = 2798), sigmoid (n = 684), and advanced sigmoid esophagus (n = 200) were diagnosed. Multivariate analysis revealed that long disease duration, advanced age, obesity, and type I achalasia correlate positively, whereas severe symptoms and integrated relaxation pressure correlate negatively with development of sigmoid esophagus. In contrast, Grade II dilation (3.5-6.0 cm) was the most common (52.9%), while grade III dilation (≥ 6 cm) was rare (5.0%). We found early onset, male, obesity, and type I achalasia correlated positively, while advanced age correlated negatively with esophageal dilation. Dilated and sigmoid esophagus were found mostly in types I and II achalasia, but typically not found in spastic disorders. The prevalence of ED was low (n = 63, 1.7%), and non-dilated esophagus and advanced age correlated with ED development. Patients with right-sided ED (n = 35) had a long disease duration (P = 0.005) with low integrated relaxation pressure values (P = 0.008) compared with patients with left-sided ED (n = 22). Patients with multiple EDs (n = 6) had lower symptom severity than patients with a single ED (P = 0.022). ConclusionsThe etiologies of dilated esophagus, sigmoid esophagus, and ED are considered multifactorial and different. Early diagnosis and optimal treatment of AEMDs are necessary to prevent these conditions.

Altered Joint Angle Strategy for Sprinting in Elite Sprinters with Chronic Ankle Instability

Hiroki Arakawa,Masamichi Okudaira,Satoru Tanigawa,Hirohiko Maemura,Takashi Fukuda 대한운동학회 2023 아시아 운동학 학술지 Vol.25 No.3

OBJECTIVES Individuals with chronic ankle instability (CAI) demonstrated altered not only ankle but also lower extremity joint angle during numerous dynamic movements compared to healthy controls. However, little is known about joint angles during sprinting, which is the most essential movement during explosive sports. We, therefore, investigated the lower extremity joint angle during sprinting between elite sprinters with CAI and healthy controls. Met hods Fourteen male college sprinters participated in this study, seven with CAI and seven healthy controls. Five-second steady speed running was performed on a treadmill at 7.5 m/s. Mean lower extremity joint angles were compared applying the statistical parametric mapping method. Results The CAI patients demonstrated significantly higher ankle dorsiflexion and knee flexion angles during the stance phase. Additionally, large between-group effect sizes would demonstrate higher ankle dorsiflexion and knee and hip flexion angle from the late swing phase to the late stance phase. Conclusions The altered lower extremity joint angles from the late swing phase to the late stance phase in CAI patients suggest greater joint stability for large external loads with feed-forward motor control programs.

Subtype of Achalasia and Integrated Relaxation Pressure Measured Using the Starlet High-resolution Manometry System: A Multicenter Study in Japan

Tetsuya Tatsuta,Hiroki Sato,Yusuke Fujiyoshi,Hirofumi Abe,Akio Shiwaku,Junya Shiota,Chiaki Sato,Masaki Ominami,Yoshitaka Hata,Hisashi Fukuda,Ryo Ogawa,Jun Nakamura,Yuichiro Ikebuchi,Hiroshi Yokomichi 대한소화기 기능성질환∙운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.4

Background/Aims ManoScan and Sandhill high-resolution manometry (HRM) systems are used worldwide; however, the diagnosis of achalasia on the Starlet HRM system is not fully characterized. Furthermore, the impact of calcium channel blockers and nitrites in treating achalasia has not been investigated using HRM. Management of recurrent cases is a priority issue, although few studies have examined patient characteristics. Methods We conducted a multicenter, large-scale database analysis. First, the diagnosis of treatment-naive achalasia in each HRM system was investigated. Next, patient characteristics were compared between type I-III achalasia, and the impact of patient characteristics, including calcium channel blocker and nitrite use for integrated relaxation pressure (IRP) values, were analyzed. Finally, patient characteristics with recurrent achalasia were elucidated. Results The frequency of type I achalasia with Starlet was significantly higher than that with ManoScan and Sandhill HRM systems. In achalasia, multivariate analysis identified male sex, advanced age, long disease duration, obesity, type I achalasia, and sigmoid type as risk factors related to normal IRP values (< 26 mmHg). Calcium channel blockers and nitrites use had no significant impact on the IRP values, although achalasia symptoms were indicated to be alleviated. In recurrent cases, the IRP value was significantly lower, and advanced age, long disease duration, and sigmoid type were more common than in treatment-naive patients. Conclusions We should cautiously interpret the type of achalasia and IRP values in the Starlet HRM system. Symptoms of recurrent cases are related to disease progression rather than IRP values, which should be considered in decision making.

Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair

Takaki Imai,Masafumi Gotoh,Keiji Fukuda,Misa Ogino,Hidehiro Nakamura,Hiroki Ohzono,Naoto Shiba,Takahiro Okawa 대한견주관절의학회 2021 대한견주관절의학회지 Vol.24 No.2

Background: Complex regional pain syndrome (CRPS)-related hand lesions are one of the complications following arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the clinical outcomes of patients with CRPS-related hand lesions following ARCR. Methods: Altogether, 103 patients with ARCR were included in this study (mean age, 63.6±8.2 years; 66 males and 37 females; follow-up period, preoperative to 12 months postoperative). Clinical assessment included the Japanese Orthopaedic Association (JOA) score, University of California, Los Angeles (UCLA) score, Constant score, 36-item short form health survey (SF-36) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score from preoperative to 12 months postoperatively. The patients were either assigned to the CRPS group or non-CRPS group depending on CRPS diagnosis until the final follow-up, and clinical outcomes were then compared between the groups. Results: Of 103 patients, 20 (19.4%) had CRPS-related hand lesions that developed entirely within 2 months postoperatively. Both groups showed significant improvement in JOA, UCLA, and Constant scores preoperatively to 12 months postoperatively (p<001). Comparisons between the two groups were not significantly different, except for SF-36 “general health perception” (p<0.05) at 12 months postoperatively. At final follow-up, three patients had residual CRPS-related hand lesions with limited range of motion and finger edema. Conclusions: CRPS-related hand lesions developed in 19.4% of patients following ARCR. Shoulder or upper-limb function improved in most cases at 12 months, with satisfactory SF-36 patient-based evaluation results. Patients with residual CRPS-related hand lesions at the last follow-up require long-term follow-up.

Fecal microbiota transplantation for recurrent Clostridium difficile infection in a patient with ulcerative colitis

Kosaku Nanki,Shinta Mizuno,Katsuyoshi Matsuoka,Keiko Ono,Shinya Sugimoto,Hiroki Kiyohara,Mari Arai,Moeko Nakashima,Kozue Takeshita,Keiichiro Saigusa,Mitsutoshi Senoh,Tadashi Fukuda,Makoto Naganuma,Har 대한장연구학회 2018 Intestinal Research Vol.16 No.1

Fecal microbiota transplantation (FMT) has been reported as a safe and effective therapy in patients with refractory and recurrentClostridium difficile infection (CDI). FMT has also been reported as a promising therapy in patients with ulcerative colitis(UC). Both, CDI and UC, are believed to be caused by dysbiosis, such as altered compositions or decreased diversity of the intestinal microbiota. This report describes a patient with UC in remission with a second recurrent episode of CDI, who was treated with FMT. A single FMT performed via colonoscopy completely resolved the patient’s diarrhea and eradicated C. difficilebacteriologically without any severe complications. Molecular biological analysis of the patient’s fecal microbiota showedthat FMT could dramatically change the altered composition of intestinal microbiota and restore its diversity. Despite the restoration of the intestinal microbiota, FMT could not prevent a relapse of UC in this patient. However, it improved the intestinalsymptoms of CDI and could prevent further recurrences of CDI.

Characteristic Analysis of Visual Evoked Potentials and Posterior Dominant Rhythm by Use of EEG Model

Kazuhiko Goto,Takenao Sugi,Yoshitaka Matsuda,Satoru Goto,Hiroki Fukuda,Yoshinobu Goto,Takao Yamasaki,Shozo Tobimatsu 제어로봇시스템학회 2013 제어로봇시스템학회 국제학술대회 논문집 Vol.2013 No.10

Visual evoked potentials (VEPs) are the electrical responses from the brain concerned with visual information processing. Amplitude of VEPs is smaller than that of background EEG activity, and the stimulus-locked averaging method is usually used for obtained the waveform. VEP response to each stimulus is not completely the same however it is varying with its amplitude and duration. Therefore, amplitude of averaged VEP waveform deteriorates due to their variability in raw data. Feature extraction of background EEG activity during visual stimulation is also a one of significant items in VEP analysis. In that case, separation of VEP component and background EEG component (mainly posterior dominant rhythm) is crucial. In the past, we proposed the method of estimating both amplitude of VEP and dominant rhythm by use of EEG model. This present study, the proposed method was applied to actual recorded VEP data and its effectiveness was evaluated. EEGs with visual stimulus were recorded from nine healthy young adults. Usefulness of the proposed method was investigated by comparing the conventional power spectrum averaging method. The proposed method will be applicable to show an accurate VEP analysis and characteristic analysis of background activity under visual stimulus.

Efficacy and Safety of Trastuzumab Deruxtecan and Nivolumab as Third- or Later-Line Treatment for HER2-Positive Advanced Gastric Cancer: A Single-Institution Retrospective Study

Daisuke Takahari,Keitaro Shimozaki,Izuma Nakayama,Kengo Nagashima,Koichiro Yoshino,Koshiro Fukuda,Shota Fukuoka,Hiroki Osumi,Mariko Ogura,Takeru Wakatsuki,Akira Ooki,Eiji Shinozaki,Keisho Chin,Kensei 대한위암학회 2023 Journal of gastric cancer Vol.23 No.4

Purpose: Determination of optimal treatment strategies for HER2-positive advanced gastric cancer (AGC) in randomized trials is necessary despite difficulties in direct comparison between trastuzumab deruxtecan (T-DXd) and nivolumab as third or later-line treatments. Materials and Methods: This single-institution, retrospective study aimed to describe the real-world efficacy and safety of T-DXd and nivolumab as ≥ third line treatments for HER2-positive AGC between March 2016 and May 2022. Overall, 58 patients (median age, 64 years; 69% male) were eligible for the study (T-DXd group, n=20; nivolumab group, n=38). Results: Most patients exhibited a HER2 3+ status (72%) and presented metastatic disease at diagnosis (66%). The response rates of 41 patients with measurable lesions in the T-DXd and nivolumab groups were 50% and 15%, respectively. The T-DXd and nivolumab groups had a median progression-free survival of 4.8 months (95% confidence interval [CI], 3.3, 7.0) and 2.3 months (95% CI, 1.5, 3.5), median overall survival (OS) of 10.8 months (95% CI, 6.9, 23.8) and 11.7 months (95% CI, 7.6, 17.1), and grade 3 or greater adverse event rates of 50% and 2%, respectively. Overall, 64% patients received subsequent treatment. Among 23 patients who received both regimens, the T-DXd–nivolumab and nivolumab–T-DXd groups had a median OS of 14.0 months (95% CI, 5.0, not reached) and 19.3 months (95% CI, 9.5, 25.1), respectively. Conclusions: T-DXd and nivolumab showed distinct efficacy and toxicity profiles as ≥ third line treatments for HER2-positive AGC. Considering the distinct features of each regimen, they may help clinicians personalize optimal treatment approaches for these patients.

Malnutrition and inflammation status in nonobese patients with inflammatory bowel disease are associated with nonalcoholic fatty liver disease: a retrospective study

Takahiro Nagata,Sadahiro Funakoshi,Daisuke Morihara,Satoshi Shakado,Keiji Yokoyama,Kazuhide Takata,Takashi Tanaka,Atsushi Fukunaga,Ryo Yamauchi,Hiromi Fukuda,Hiroki Matsuoka,So Imakiire,Hideto Sakisak 대한장연구학회 2023 Intestinal Research Vol.21 No.4

Background/Aims: The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD.Methods: We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters.Results: Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m²), C-reactive protein (CRP; <i>P</i><0.001) and alanine aminotransferase (<i>P</i>=0.018) levels were higher and the albumin level (<i>P</i>=0.005) and prognostic nutritional index (PNI; <i>P</i>=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (<i>P</i><0.001) and the CRP level was negatively correlated (<i>P</i>=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (<i>P</i><0.05) and CRP values (<i>P</i><0.001) were improved over time after CT imaging by continuing IBD treatment.Conclusions: Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.