Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration

Yuki Fujii,Yoshihide Kanno,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Keisuke Yonamine,Yujiro Kawakami,Toji Murabayashi,Fumisato Kozakai,Yutaka Noda,Hiroyuki Okada,Kei 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.2

Background/Aims: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needleaspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation. Methods: Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity,specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis(lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparisonbetween accurately diagnosed cases and others. Results: The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignantlymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, andaccuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor forinaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015). Conclusions: The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis ofswollen lymph nodes.

Diagnostic Ability of Convex-Arrayed Endoscopic Ultrasonography for Major Vascular Invasion in Pancreatic Cancer

Yuki Fujii,Kazuyuki Matsumoto,Hironari Kato,Yosuke Saragai,Saimon Takada,Sho Mizukawa,Shinichiro Muro,Daisuke Uchida,Takeshi Tomoda,Shigeru Horiguchi,Noriyuki Tanaka,Hiroyuki Okada 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.5

Background/Aims: This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascularinvasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance. Methods: In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUSimage findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion,types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors andevaluated vessels. Results: The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in theveins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings weresignificantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0–742] µmvs. 2,833 [1,076–5,694] µm, p=0.012) and arteries (623 [0–854] µm vs. 3,097 [1,396–6,000] µm, p=0.0061). All cases with a distance of≥1,000 µm between the tumors and main vessels were correctly diagnosed. Conclusions: Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.

유유아 신체발달의 시대적 변동을 제어하는 고도 경제 성장의 요인 분석

藤井勝紀(Fujii, Katsunori),可兒勇樹(Kani, Yuki),糟谷浩輔(Kasuya, Kosuke),김준동(Kim, Jun-Dong) 한국체육과학회 2017 한국체육과학회지 Vol.26 No.5

The Ministry of Health, Labor and Welfare has published measurement records on height, weight, chest circumference, and head circumference in 0 to 6 year-old children from 1960 to 2010 as indicators of physical development in early childhood in Japan. Physical development evaluation charts have been developed from these records using percentile methods, but reports on the trends in physical development over time are limited. This is because no method has been established to scientifically analyze physical growth. Even more difficult is investigating secular trends in physical growth and linking those trends to economic growth. In this study, we identified the first largest peak velocity (FLPV) during the year after birth in infant physical growth records (height, weight, chest circumference, head circumference), and applied the wavelet interpolation model to the variations over time in the identified FLPV. Next, we applied the wavelet interpolation model to the secular variations in GDP for the same years. We then applied a cross correlation function to the relationship between the curves of FLPV and GDP variations over time, and investigated how high economic growth acts as a controlling factor variations in physical development of young children over time. The speed of variation in the physical development of children over time was the greatest around 1980. By synchronizing GDP to that time, the results suggest that high economic growth is a controlling factor in the physical development of young children.

연령증가에 따른 유아 골밀도의 평가차트 구축

藤井勝紀(Fujii, Katsunori),可兒勇樹(Kani, Yuki),糟谷浩輔(Kasuya, Kosuke),김준동(Kim, Jun-Dong) 한국체육과학회 2018 한국체육과학회지 Vol.27 No.2

A clear method for evaluating bone density findings in young children has not been established. One reason behind this is that the changes with age in bone density during early childhood have not been clarified. In this study, a mixed cohort method was adopted and a least squares approximation polynomial was applied to bone density indices (stiffness, BUA, SOS) of children from 3 to 5 years old. We then attempted to construct a bone density evaluation chart for early childhood by clarifying the changes in bone density with age. The method was to measure bone density in 3, 4, and 5 year-old children, and then analyze the age-related changes in the bone density index data obtained in a mixed cohort. The results showed changes with age in the values for stiffness and SOS. The optimal polynomial obtained with least squares approximation was shown to be a third order polynomial for boys and a fourth order polynomial for girls. Therefore, in the standard regression evaluation chart for stiffness values a third order polynomial was applied for boys and a fourth order polynomial was applied for girls. An evaluation chart was constructed from a 5-grade regression evaluation. Normalization was then seen in the frequency distribution, and the bone density evaluation constructed in this study for young children was seen to be effective. The mixed cohort in this study did not provide fundamentally simple cross-sectional data but rather semi-longitudinal data that included almost all tracking data from the same subjects. Therefore, clarification of the trends in changes with age in stiffness has great significance.

GDPの成長から判断される地域的インフラ格差の社会学的構図

可兒勇樹(Kani, Yuki),藤井勝紀(Fujii, Katsunori),백승희(Baek, Seung-Hui) 한국체육과학회 2018 한국체육과학회지 Vol.27 No.5

The Japanese economy experienced an unprecedented period of high economic growth for almost 20 years from 1955 to 1973. During this time, regional economic policies including infrastructure development and small business measures were implemented in outlying regions to reduce regional disparities. However, during the economic bubble that arrived in the 1980s, the economic gap between Japan’s three major metropolitan regions and the other regions of Japan widened, and the nation entered an urban-centered economy. Afterward, the three major metropolitan areas suffered a major shock when the economic bubble burst, compared to which the economic slowdown in the outlying regions was mild. However, these phenomena have not been analyzed scientifically. This study analyzed the factors in the economic gap due to the currently ongoing urban-centered economy for phenomena from fluctuations in the rate of GDP growth. The fluctuations in the rate of GDP growth were examined by applying wavelet interpolation to GDP data for each region from 1955 to 2010. The results, judging from the behavior of the maximum peak velocity (MPV) of GDP in urban and rural regions, showed that the MPV of GDP was clearly larger in the bubble period than in the period of high economic growth in urban areas, and this social phenomenon is conjectured to have produced the continuation of the urban-centered economy and the disparities with rural regions.

Unveiling the Impact of Outpatient Physiotherapy on Specific Motor Symptoms in Parkinson’s Disease: A Prospective Cohort Study

Terasawa Yuta,Ikuno Koki,Fujii Shintaro,Nishi Yuki,Tanizawa Emi,Nabeshima Sachio,Okada Yohei 대한뇌신경재활학회 2023 뇌신경재활 Vol.16 No.3

Understanding how outpatient physiotherapy impacts on specific motor symptoms in Parkinson's disease (PD) is important for multidisciplinary care, but these points have not been clarified. We investigated the impact of outpatient physiotherapy on individual motor symptoms in PD patients. Fifty-five PD patients participated in the prospective cohort study, which examined the changes in motor symptoms after 90 min of outpatient physiotherapy program (1×/week for 10 weeks) and at 3 months follow-up. Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score and tremor, rigidity, bradykinesia, and axial scores were assessed and compared pre-intervention, post-intervention, and at follow-up. Significant level was set at 0.05. Their MDS-UPDRS motor score and axial score significantly decreased post-intervention and at the follow-up. In the analysis differentiating effects based on the severity of motor symptoms according to the MDS-UPDRS motor score, only the moderate-severe group showed significant decreases in their MDS-UPDRS motor score, bradykinesia, and axial scores post-intervention, as well as in their MDS-UPDRS motor score, rigidity, bradykinesia, and axial scores at the follow-up. These findings suggest the outpatient physiotherapy might provide benefits, particularly in managing axial symptoms and bradykinesia, for community dwelling PD patients with moderate-severe motor symptoms within a multidisciplinary care framework.

A matrix reverse Hölder inequality

Bourin, Jean-Christophe,Lee, Eun-Young,Fujii, Masatoshi,Seo, Yuki Elsevier 2009 Linear algebra and its applications Vol.431 No.11

<P><B>Abstract</B></P><P>A matrix reverse Hölder inequality is given. This result is a counterpart to the concavity property of matrix weighted geometric means. It extends a scalar inequality due to Gheorghiu and contains several Kantorovich type inequalities.</P>

Predictive Value of Localized Stenosis of the Main Pancreatic Duct for Early Detection of Pancreatic Cancer

Yoshihide Kanno,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Keisuke Yonamine,Yujiro Kawakami,Yuki Fujii,Kazuaki Miyamoto,Toji Murabayashi,Fumisato Kozakai,Jun Horaguchi 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.6

Background/Aims: In this study, we aimed to evaluate the predictive value of localized stenosis of the main pancreatic duct (MPD) forearly detection of pancreatic cancer. Methods: Among 689 patients who underwent endoscopic retrograde pancreatography from January 2008 to September 2018, 19patients with MPD findings were enrolled. These patients showed findings for indicating suspicious pancreatic cancer at an early stage(FiCE); FiCE was defined as a single, localized stenosis in the MPD without a detectable mass (using any other imaging methods) andwithout other pancreatic diseases, such as definite chronic pancreatitis, intraductal papillary mucinous neoplasm, and autoimmunepancreatitis. Final diagnoses were established by examining resected specimens or through follow-up examinations after an interval of>5 years. Results: Among 19 patients with FiCE, 11 underwent surgical resection and 8 were evaluated after a >5-year observation period. Thefinal diagnosis of the MPD stenosis was judged to be pancreatic cancer in 9 patients (47%), including 3 with intraepithelial cancer, andto be a non-neoplastic change in 10. The sensitivity, specificity, and accuracy of preoperative pancreatic juice cytology were 75%, 100%,and 88%, respectively. Conclusions: The predictive value of FiCE for pancreatic cancer prevalence was 47%. Histological confirmation with pancreatic juicecytology is necessary before surgical resection.

Capability of Radial- and Convex-Arrayed Echoendoscopes for Visualization of the Pancreatobiliary Junction

Yoshihide Kanno,Kei Ito,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Toji Murabayashi,Sho Hasegawa,Fumisato Kozakai,Yujiro Kawakami,Yuki Fujii,Yutaka Noda 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.3

Background/Aims: Although both radial- and convex-arrayed endoscopic ultrasonography (EUS) scopes are widely used forobservational EUS examinations, there have been few comparative studies on their power of visualization. The aim of this study was toevaluate the capability of these EUS scopes for observation of the pancreatobiliary junction. Methods: The rate of successful visualization of the pancreatobiliary junction was retrospectively compared between a radial-arrayedand a convex-arrayed echoendoscope, from a prospectively maintained database. Study periods were defined as January 2010 toDecember 2012 for the radial group, and February 2015 to October 2016 for the convex group because the respective scope wasmainly used during those periods. Results: During the study period, 1,660 cases with radial EUS and 1,984 cases with convex EUS were recruited. The success rates ofobservation of the pancreatobiliary junction were 80.0% and 89.5%, respectively (p<0.0001). Conclusions: The capability of visualization of the pancreatobiliary junction in observational EUS was found to be better with aconvex-arrayed than with a radial-arrayed echoendoscope

Endoscopic Ultrasonography-Guided Gallbladder Drainage as a Treatment Option for Acute Cholecystitis after Metal Stent Placement in Malignant Biliary Strictures

Fumisato Kozakai,Yoshihide Kanno,Kei Ito,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Toji Murabayashi,Keisuke Yonamine,Yujiro Kawakami,Yuki Fujii,Kazuaki Miyamoto,Yutak 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3

Background/Aims: It is often diffcult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliarystrictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD)for acute cholecystitis. Methods: The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage(PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference. Results: The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bileleakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of thecases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and63% of the cases, respectively. Conclusions: EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue techniquefollowing the established percutaneous intervention in the current setting because of the immature technical methodology, includingdedicated devices, which need further development.