Natural History of Chronic Intestinal Pseudo-obstruction and Need for Palliative Care

Kosuke Tanaka,Hidenori Ohkubo,Atsushi Yamamoto,Kota Takahashi,Yuki Kasai,Anna Ozaki,Michihiro Iwaki,Takashi Kobayashi,Tsutomu Yoshihara,Noboru Misawa,Akiko Fuyuki,Shingo Kato,Takuma Higurashi,Kunihiro 대한소화기 기능성질환∙운동학회 2023 Journal of Neurogastroenterology and Motility (JNM Vol.29 No.3

Background/AimsNatural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients. MethodsFrom October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course. ResultsForty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m2, 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care. ConclusionCIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired.

Influences of Channel Size and Operating Conditions on Fluid Behavior in a MHD Micro Pump for Micro Total Analysis System

Ito, Kosuke,Takahashi, Toru,Fujino, Takayasu,Ishikawa, Motoo The Korean Institute of Electrical Engineers 2014 The Journal of International Council on Electrical Vol.4 No.3

The present paper discusses experimental and numerical studies on the fluid behavior in a magnetohydrodynamic(MHD) micro pump for micro total analysis system(${\mu}$-TAS). In the experiment, the MHD micro pump has a length of 26.0 mm, a width and a height of 0.5 mm. As a working fluid, Phosphate Buffered Saline(PBS) solution is used under the assumption of blood analysis using ${\mu}$-TAS. A neodymium permanent magnet with the maximum magnetic flux density of 0.32 T is used for applying a magnetic field to a channel in the MHD pump. Experimental and numerical results show that Hartmann flow is not observed in the channel because the MHD interaction is very weak, so that Poiseuille flow is maintained in the channel. The numerical study also examines the influences of the channel height and the strength of externally applied magnetic flux density on the fluid temperature in the channel. The numerical results indicate that an increase in fluid temperature by operating the MHD pump is less than 1 K when the magnetic flux density and the channel height are more than 0.3 T and 0.3 mm, respectively.

Recent topics on endoscopic ultrasonography-guided celiac plexus neurolysis

Ichiro Yasuda,Tatsuyuki Hanaoka,Kosuke Takahashi,Yasuhiro Araki,Shinpei Doi,Takuji Iwashita,Keisuke Iwata,Tsuyoshi Mukai 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.4

Endoscopic ultrasonography-guided celiac plexus neurolysis (EUS-CPN) is a widely practiced technique. Three sets of guidelines have recently been published and this procedure has become a major EUS technique. However, there are still several unanswered questions. The purpose of this manuscript is to review the recent literature pertaining to EUS-CPN. Currently, the main indication of EUS-CPN is pancreatic cancer pain. It is also performed for patients with chronic pancreatitis, but the indication is controversial due to its limited efficacy and a high incidence of infectious complications. Various techniques, such as central and bilateral EUS-CPN, and EUS-guided direct celiac ganglia neurolysis (EUS-CGN) have been performed. However, the efficacies of these techniques remain controversial. Complications related to the procedures are generally not serious, but major adverse events, such as paraplegia and ischemic complications, have been reported. The impacts of EUS-CPN on survival have also been evaluated. Although increased survival was expected via improvements in the quality of life, data suggests that EUS-CPN related procedures, especially EUS-CGN, might reduce the survival time. However, precise mechanisms have not been elucidated. In addition to conventional techniques, new techniques, such as EUS-guided celiac ganglion radiofrequency ablation (EUS-RFA) and the use of highly viscous phenol-glycerol, dexmedetomidine, and contrast-enhanced agents, have been introduced. However, these techniques are still in experimental stages. Additional studies need to be conducted to address these gaps in the literature.

손상 감지 모니터링을 위한 탄소섬유 복합재료와 인쇄된 은 전극 사이의 접촉저항 평가

전은범(Eun-Beom Jeon),Kosuke Takahashi,김학성(Hak-Sung Kim) 한국비파괴검사학회 2014 한국비파괴검사학회지 Vol.34 No.5

위치 감응형 전극 네트워크(addressable conducting network, ACN)는 탄소섬유 복합재료와 전극 사이의 접촉저항을 통해 구조물의 손상 감지가 가능하다. 손상 감지를 위한 위치 감응형 전극 네트워크의 신뢰성을 향상시키기 위해서는 전극과 복합재료 사이의 접촉저항이 최소화되어야 한다. 본 연구에서는 은 나노 전극을 탄소섬유 복합재료 위에 인쇄전자기술을 이용하여 제작하였다. 은 전극이 형성된 복합재료는 은 나노잉크의 소결온도와 복합재료의 표면거칠기에 따라 제작되었으며, 이에 따른 접촉저항을 측정하였다. 또한, 전자주사현미경(scanning electron microscope, SEM)을 통해 전극과 복합재료 사이의 계면을 관찰하였다. 본 연구를 통해, 은 나노 잉크의 소결온도가 120℃, 복합재료의 표면거칠기가 0.230a일 때, 0.3664Ω의 최소 접촉저항을 나타냈다. An addressable conducting network (ACN) makes it possible to monitor the condition of a structure using the electrical resistance between electrodes on the surface of a carbon fiber reinforced plastics (CFRP) structure. To improve the damage detection reliability of the ACN, the contact resistances between the electrodes and CFRP laminates needs to be minimized. In this study, silver nanoparticle electrodes were fabricated via printed electronics techniques on a CFRP composite. The contact resistance between the silver electrodes and CFRP were measured with respect to various fabrication conditions such as the sintering temperature of the silver nano-ink and the surface roughness of the CFRP laminates. The interfaces between the silver electrode and carbon fibers were observed using a scanning electron microscope (SEM). Based on this study, it was found that the lowest contact resistance of 0.3664 Ω could be achieved when the sintering temperature of the silver nano-ink and surface roughness were 120°C and 0.230 a, respectively.

Recent topics on endoscopic ultrasonography-guided celiac plexus neurolysis

Ichiro Yasuda,Tatsuyuki Hanaoka,Kosuke Takahashi,Yasuhiro Araki,Shinpei Doi,Takuji Iwashita,Keisuke Iwata,Tsuyoshi Mukai 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.4

Endoscopic ultrasonography-guided celiac plexus neurolysis (EUS-CPN) is a widely practiced technique. Three sets of guidelines have recently been published and this procedure has become a major EUS technique. However, there are still several unanswered questions. The purpose of this manuscript is to review the recent literature pertaining to EUS-CPN. Currently, the main indication of EUS-CPN is pancreatic cancer pain. It is also performed for patients with chronic pancreatitis, but the indication is controversial due to its limited efficacy and a high incidence of infectious complications. Various techniques, such as central and bilateral EUS-CPN, and EUS-guided direct celiac ganglia neurolysis (EUS-CGN) have been performed. However, the efficacies of these techniques remain controversial. Complications related to the procedures are generally not serious, but major adverse events, such as paraplegia and ischemic complications, have been reported. The impacts of EUS-CPN on survival have also been evaluated. Although increased survival was expected via improvements in the quality of life, data suggests that EUS-CPN related procedures, especially EUS-CGN, might reduce the survival time. However, precise mechanisms have not been elucidated. In addition to conventional techniques, new techniques, such as EUS-guided celiac ganglion radiofrequency ablation (EUS-RFA) and the use of highly viscous phenol-glycerol, dexmedetomidine, and contrast-enhanced agents, have been introduced. However, these techniques are still in experimental stages. Additional studies need to be conducted to address these gaps in the literature.

Management of Remnant or Recurrent Lesions after Endoscopic Papillectomy

Ichiro Yasuda,Saito Kobayashi,Kosuke Takahashi,Sohachi Nanjo,Hiroshi Mihara,Shinya Kajiura,Takayuki Ando,Kazuto Tajiri,Haruka Fujinami 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.6

Endoscopic papillectomy (EP) for ampullary adenomas achieves cure rates ranging from 76% to 90%, and recurrence rates are as high as 33%. If remnant or recurrent lesions after prior EP are endoscopically visible and are not suspected of intraductal extension into the biliary or pancreatic duct, repeated snaring and cutting can be performed until all visible lesions are completely resected. However, endoscopic ablative therapies, particularly argon plasma coagulation, can be attempted for tiny or uncertain remnant and recurrent lesions. In addition, intraductal radiofrequency ablation has recently been attempted for residual intraductal lesions after EP at several institutions. Although still under investigation, it has shown some promise. It might be offered as an alternative to surgery, particularly in patients who are unfit for surgery or those who refuse to undergo surgery

Effectiveness of Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid as a Non-Surgical Treatment for Internal Hemorrhoids

Yuichi Tomiki,Jun Aoki,Shunsuke Motegi,Rina Takahashi,Toshiaki Hagiwara,Yu Okazawa,Kosuke Mizukoshi,Masaya Kawai,Shinya Munakata,Shun Ishiyama,Kiichi Sugimoto,Kazuhiro Sakamoto 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.6

Background/Aims: Sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) has a potent effect on internalhemorrhoids. In this retrospective study, we compared the effects of endoscopic ALTA therapy and standard ALTA therapy. Methods: We investigated patients who underwent treatment for internal hemorrhoids at our institution between 2014 and 2016. Theywere divided into a standard ALTA group (n=33, treated using proctoscopy) and an endoscopic ALTA group (n=48). We compared theclinical findings between the 2 groups. Results: There were no intergroup differences in background factors. The mean ALTA dose was 21.9±7.2 mL and 17.8±3.4 mL inthe standard and endoscopic ALTA groups, respectively (p<0.01). Adverse events occurred in 4 patients (12.1%) from the standardALTA group and 6 patients (12.5%) from the endoscopic ALTA group. In both groups, the patients reported good satisfaction withthe therapeutic effect at 1 month after the procedure. Hemorrhoids recurred in 2 patients (6.3%) from the standard ALTA group and 4patients (8.3%) from the endoscopic ALTA group. Conclusions: Endoscopic ALTA sclerotherapy is equivalent to standard ALTA therapy in terms of efficacy, adverse events, andrecurrence. Therefore, it is a useful non-surgical option for patients with internal hemorrhoids who prefer a less invasive treatment.

Optimal silkworm larva host for high-level production of Mus musculus IL-4 using a baculovirus expression vector system

Masahiko Kobayashi,Jian Xu,Kohei Kakino,Akitsu Masuda,Masato Hino,Naoki Fujimoto,Kosuke Minamihata,Noriho Kamiya,Hiroaki Mon,Hiroshi Iida,Masateru Takahashi,Takahiro Kusakabe,이재만 한국응용곤충학회 2020 Journal of Asia-Pacific Entomology Vol.23 No.1

Interleukine-4 (IL-4) is a cytokine that plays an important role in the immune system and recognized as a biological medicine. Therefore, there is a demand for the production of IL-4 with high performance. The expression of a recombinant IL-4 protein in the prokaryotic system usually results in the formation of an inclusion body. To date, the solution to obtain those active products without the refolding process remains to be established. In this study, we tried to acquire a biologically active recombinant Mus musculus IL-4 (rMmIL-4) using a silkworm-baculovirus expression vector system (silkworm-BEVS). We constructed two recombinant baculoviruses coding rMmIL-4 with the distinct location of affinity purification tags and succeeded in the expression and purification of rMmIL-4 proteins directly without the refolding process. Both purified proteins displayed comparable biological activity to the commercial proteins produced by the E. coli expression system. Besides, we performed screening of silkworm strains to seek optimal hosts for the mass-production of rMmIL-4. Intriguingly, we found that some silkworm strains showed significantly higher secretion levels of rMmIL-4 in silkworm sera. Our study provides meaningful insights into the industrial-scale production of rMmIL-4 with high productivity for pharmaceutical applications in the future.