Fukuoka University

SUZUKI T.

Matsumoto T., Hisamatsu T., Esaki M., Omori T., Sakuraba H., Shinzaki S., Sugimoto K., Takenaka K., Naganuma M., Bamba S., Hisabe T., Hiraoka S., Fujiya M., Matsuura M., Yanai S., et. al.

In recent years, we have seen a considerable increase in the number of patients with inflammatory bowel diseases of unknown etiology, including both Crohn's disease and ulcerative colitis. Inflammatory bowel diseases can cause intestinal lesions throughout the gastrointestinal tract, necessitating gastrointestinal endoscopy for examining all relevant aspects, especially lesion characteristics, for differential diagnosis and histological diagnosis, to select the appropriate treatment options, determine treatment effectiveness, etc. Specific guidelines are necessary to ensure that endoscopy can be performed in a safe and more tailored and efficient manner, especially since gastrointestinal endoscopy, including enteroscopy, is a common procedure worldwide, including in Japan. Within this context, the Japan Gastroenterological Endoscopy Society has formulated the “Guidelines for the Endoscopic Diagnosis and Treatment of Inflammatory Bowel Diseases” to provide detailed guidelines regarding esophagogastroduodenoscopy, enteroscopy, and colonoscopy procedures for definitive diagnosis, as well as determination of treatment effectiveness in clinical cases of inflammatory bowel diseases.

Takata K., Maeda T., Kuno N., Hirai F.

FUJIKAWA T., SATO K., KOGA C., KOZAKAI N., UEDA T., Ota T.

You S., Zheng D., Chen X., Wang X., Ouyang M., Han Q., Cao Y., Delcourt C., Song L., Carcel C., Arima H., Liu C., Lindley R.I., Robinson T., Anderson C.S., et. al.

BACKGROUND: The frequency and prognostic significance of subacute neurological improvement (SNI) on 90-day outcomes after acute intracerebral hemorrhage are unknown. METHODS: Secondary analyses of participant data from the INTERACT2 trial (second Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial). SNI included any, moderate, significant, and substantial neurological improvement defined as ≥1, ≥2, ≥3, and ≥4 points decrease, respectively, on the National Institutes of Health Stroke Scale from 24 hours to 7 days after intracerebral hemorrhage. Logistic regression models were used to assess associations of SNI and death or major disability (modified Rankin Scale score of 3–6), major disability (modified Rankin Scale scores, 3–5), and death alone at 90 days. Data are reported as odds ratios and 95% CIs. RESULTS: Of 2571 patients included in analyses, 1492 (58.0%), 1057 (41.1%), 731 (28.4%), and 490 (19.1%) patients experienced any, moderate, significant, and substantial SNI (24 hours to 7 days) after intracerebral hemorrhage, respectively. After adjustment for key confounders, any SNI was associated with 49%, 25%, and 65% reduced odds of death or major disability (odds ratio, 0.51 [95% CI, 0.42–0.63]), major disability alone (odds ratio, 0.75 [95% CI, 0.63–0.90]), and death (odds ratio, 0.35 [95% CI, 0.24–0.50]), respectively. Moderate, significant, and substantial SNI were also significantly associated with decreased odds of death or major disability at 90 days. The relationship between any SNI and study outcomes was consistent in most subgroups, including age and baseline hematoma volume. Early intensive blood pressure-lowering treatment did not increase the odds of SNI. CONCLUSIONS: SNI from 24 hours to 7 days is common after intracerebral hemorrhage and predicts a lower likelihood of death or major disability. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00716079.

Kurniawaty M., Kuwae K., Tsuchida K.

Matsunaga A., Saito T.

Koyauchi T., Fujisawa T., Miyashita M., Mori M., Morita T., Yazawa S., Akiyama N., Hagimoto S., Matsuda Y., Tachikawa R., Yasui H., Suzuki M., Asai Y., Ono M., Kimura Y., et. al.

Nagai T., Kikkawa N., Jinnouchi R., Kimura M., Okazaki S.

Haga N., Yoshida M., Mitsui T., Sekido N., Masumori N., Omae K., Saito M., Kubota Y., Sakakibara R., Takahashi S.

AbstractObjectivesThe aim of the present epidemiological study was to evaluate the sex‐related prevalence of stress urinary incontinence (SUI) and the associated factors using data from the 2023 Japan Community Health Survey.MethodsWe investigated 3097 males and 3056 females aged 20–99 years. All participants answered web‐based questionnaires on their health status and lower urinary tract symptoms. Data on the frequency of SUI, comorbidities and health‐related behaviour were extracted. The Cochran‐Armitage trend test was used to evaluate the trend between the prevalence of SUI and age. Multivariate analysis was performed using logistic regression analysis to identify factors associated with SUI.ResultsSUI was consistently observed in about 10% of individuals in their 20s and 30s, including in males. There were no age‐related differences in the prevalence of SUI in males (P = 0.55). In females, the prevalence of SUI statistically significantly increased with age (P < 0.0001). The frequency of SUI was, however, low in both sexes. Drinking habits (OR, 1.43; 95% CI, 1.10–1.87) and frequent spicy food intake (OR, 1.55; 95% CI, 1.19–2.01) were associated with SUI only in males. Age (OR, 1.36; 95% CI, 1.13–1.62), BMI (OR, 1.87; 95% CI, 1.50–2.32) and history of vaginal delivery (OR, 2.15; 95% CI, 1.77–2.63) were only associated with SUI in females.ConclusionsAlthough the frequency of SUI was low in both sexes, the correlation between the prevalence of SUI and age was different between both sexes. Female SUI might involve weakness of the pelvic floor muscle, while male SUI might be affected by health‐related behaviours.

Yamato I., Kansui Y., Matsumura K., Inoue M., Ibaraki A., Sakata S., Arima H., Goto K., Kitazono T.

UCHIDA Y., TAKAMARU K., OTOTAKE H., KIMURA Y.

Yokoya M., Takata F., Iwao T., Matsumoto J., Tanaka Y., Aridome H., Yasunaga M., Mizoguchi J., Sano K., Dohgu S.

Parkinson’s disease (PD) is characterized by widespread distribution of Lewy bodies, which are composed of phosphorylated and aggregated forms of α-Synuclein (α-Syn), in the brain. Although the accumulation and propagation of α-Syn contribute to the development of PD, the involvement of the blood–brain barrier (BBB) in these processes remains unknown. Pericytes, one of the cell types that constitute the BBB, degrade various forms of α-Syn. However, the detailed mechanisms involved in α-Syn degradation by pericytes remain poorly understood. Therefore, in this study, we aimed to determine the ability of the BBB-constituting cells, particularly primary cultures of rat pericytes, brain endothelial cells, and astrocytes, to degrade α-Syn. After α-Syn uptake by the cells, intracellular α-Syn decreased only in pericytes. This pericyte-specific α-Syn decrease was inhibited by an autophagy inhibitor, bafilomycin A1, and a proteasome inhibitor, MG132. siRNA-mediated knockdown of degradation enzymes or familial PD-associated genes, including cathepsin D, DJ-1, and LRRK2, did not affect α-Syn clearance in pericytes. However, pharmacological inhibitors of Akt, ERK, and p38 MAPK inhibited α-Syn degradation by pericytes. In conclusion, our results suggest that α-Syn degradation by pericytes is mediated by an autophagy–lysosome system and a ubiquitin–proteasome system via α-Syn-activated Akt, ERK, and p38 MAPK signaling pathways.

Ichikawa D., Kawarazaki W., Saka S., Kanaoka T., Ohnishi H., Arima H., Shibata S.

In hypertensive patients with diabetes, the effectiveness of renin-angiotensin system (RAS) inhibitors in improving mortality, cardiovascular events, and renal outcomes, compared to other antihypertensive drugs such as calcium channel blockers (CCBs) and diuretics, remains uncertain, particularly in the context of albuminuria. A comprehensive literature search was conducted using PubMed, the Cochrane Library, and the Japan Medical Abstracts Society databases up to October 2024. A meta-analysis of 12 randomized controlled trials, including 14,163 patients, was performed. RAS inhibitors showed no significant advantage over CCBs or diuretics for all-cause mortality (relative risk [RR]: 1.00, 95% confidence interval [CI]: 0.92–1.08, p = 0.98), myocardial infarction (RR: 0.64, 95% CI: 0.32–1.31, p = 0.22), stroke (RR: 1.14, 95% CI: 1.00–1.31, p = 0.05), composite cardiovascular events (RR: 0.93, 95% CI: 0.81–1.07, p = 0.45), or end-stage renal disease (RR: 0.88, 95% CI: 0.72–1.08, p = 0.21). Subgroup analyses stratified by albuminuria status revealed no significant benefits of RAS inhibitors, regardless of albuminuria presence. The findings emphasize the need for cautious interpretation due to limited sample sizes, wide confidence intervals, and low precision. These results highlight the importance of considering not only RAS inhibitors but also other antihypertensive drugs as the first-line choice for blood pressure control in diabetic patients, with careful attention to side effects and other relevant factors.

Okita M., Takenaka K., Hirai F., Ashizuka S., Iijima H., Bamba S., Fujii T., Watanabe K., Shimodaira Y., Shiga H., Hiraoka S., Inokuchi T., Yamamura T., Emoto R., Matsui S.

Abstract Background Small bowel (SB) lesions in Crohn’s disease (CD) are often asymptomatic despite being highly active. Fecal calprotectin (FC) is the most widely used biomarker of CD activity, but its drawbacks include a large intra-individual sample variability and the burden of collecting stool samples. Meanwhile, serum leucine-rich alpha-2 glycoprotein (LRG) has recently attracted attention as a biomarker that can address the limitations of FC. This study determined the diagnostic accuracy of LRG and its cut-off values for diagnosing CD activity in SB. Methods This was a retrospective, multi-center study of CD patients undergoing retrograde balloon-assisted endoscopy. For ileal- and ileocolonic-type patients with a colon SES-CD score of 0, we estimated the receiver operating characteristic curve of LRG and determined the cut-off value to achieve a target sensitivity level of 80%. Results Among 285 patients with SB lesions, LRG had an area under the curve (AUC) of 0.72 (95% CI 0.67–0.78) with a sensitivity of 80.2% and specificity of 47.2% for a cut-off value of 10.5 when diagnosing endoscopic remission (modified SES-CD ≤ 3), while it had an AUC of 0.72 (95% CI 0.65–0.78) with a sensitivity of 81.2% and specificity of 46.2% for a cut-off value of 10.1 when diagnosing complete ulcer healing (modified SES-CD ≤ 1). Conclusion LRG was effective for diagnosing CD activity in SB, specifically with cut-off values of 10.5 and 10.1 for endoscopic remission and complete ulcer healing, respectively. A future prospective validation study will assess its clinical utility. Graphical abstract