Postoperative Bleeding Risk after Gastric Endoscopic Submucosal Dissection in Patients Receiving a P2Y12 Receptor Antagonist

Background/Aims@#The safety of gastric endoscopic submucosal dissection (ESD) in users of a P2Y12 receptor antagonist (P2Y12RA) under current guidelines has not been verified. @*Methods@#Patients treated by gastric ESD at Okayama University Hospital between January 2013 and December 2020 were registered. The postoperative bleeding rates of patients (group A) who did not receive any antithrombotic drugs; patients (group B) receiving aspirin or cilostazol monotherapy; and P2Y12RA users (group C) those on including monotherapy or dual antiplatelet therapy were compared. The risk factors for post-ESD bleeding were examined in a multivariate analysis of patient background, tumor factors, and antithrombotic drug management. @*Results@#Ultimately, 1,036 lesions (847 patients) were enrolled. The bleeding rates of group B and C were significantly higher than that of group A (p=0.012 and p<0.001, respectively), but there was no significant difference between group B and C (p=0.11). The postoperative bleeding rate was significantly higher in dual antiplatelet therapy than in P2Y12RA monotherapy (p=0.014). In multivariate analysis, tumor diameter ≥12 mm (odds ratio [OR], 4.30; 95% confidence interval [CI], 1.99 to 9.31), anticoagulant use (OR, 4.03; 95% CI, 1.64 to 9.86), and P2Y12RA use (OR, 3.40; 95% CI, 1.07 to 10.70) were significant risk factors for postoperative bleeding. @*Conclusions@#P2Y12RA use is a risk factor for postoperative bleeding in patients who undergo ESD even if receiving drug management according to guidelines. Dual antiplatelet therapy carries a higher risk of bleeding than monotherapy.

Experiencing Patient-Centered Medicine through the Practice of Inter-Professional Education (IPE) in Undergraduate Medical Education / 医学教育

This study examined whether medical students were able to consider themselves to have practiced patient-centered team medicine through the practice of small group IPE. Undergraduate medical, pharmacy, and nursing students during Clinical Clerkship were asked to complete case-based clinical reasoning and treatment/nursing planning in small groups, and a questionnaire was administered to the IPE. The medical students felt that they were able to practice clinical reasoning and treatment planning, the pharmacy students felt that they were able to propose countermeasures against side effects of treatment, and the nursing students felt that they were able to provide necessary information to the medical team and practice patient-centered medicine with the medical team.　Each department had different objectives they considered when practicing team-based medicine. It is important to incorporate each of these elements in IPE.

Generation of hepatocyte-like cells from human induced pluripotent stem [iPS] cells by co-culturing embryoid body cells with liver non-parenchymal cell line TWNT-1

To generate a homogeneous population of patient-specific hepatocyte-like cells [HLCs] from human iPS cells those show the morphologic and phenotypic properties of primary human hepatocytes. An experimental study. Department of Surgery, Okayama University, Graduate School of Medicine, Japan, from April to December 2011. Human iPS cells were generated and maintained on ES qualified matrigel coated plates supplemented with mTeSR medium or alternatively on mitotically inactivated MEF feeder layer in DMEM/F12 medium containing 20% KOSR, 4ng/ml bFGF-2, 1 x 10-4 M 2-mercaptoethanol, 1 mmol/L NEAA, 2mM L-glutamine and 1% penicillin-streptomycin. iPS cells were differentiated to HLCs by sequential culture using a four step differentiation protocol: [I] Generation of embryoid bodies [EBs] in suspension culture; [II] Induction of definitive endoderm [DE] from 2 days old EBs by growth in human activin-A [100 ng/ml] and basic fibroblasts growth factor [bFGF2] [100 ng/ml] on matrigel coated plates; [III] Induction of hepatic progenitors by co-culture with non-parenchymal human hepatic stellate cell line [TWNT-1]; and [IV] Maturation by culture in dexamethasone. Characterization was performed by RT-PCR and functional assays. The generated HLCs showed microscopically morphological phenotype of human hepatocytes, expressed liverspecific genes [ASGPR, Albumin, AFP, Sox17, Fox A2], secreted human liver-specific proteins such as albumin, synthesized urea and metabolized ammonia. Functional HLCs were generated from human iPS cells, which could be used for autologus hepatocyte transplantation for liver failure and as in vitro model for determining the metabolic and toxicological properties of drug compounds

Magnifying Endoscopy for Intestinal Follicular Lymphoma Is Helpful for Prompt Diagnosis

The representative endoscopic features of primary intestinal follicular lymphoma are well known as small whitish polypoid nodules, but a magnified view has only been described in a few case reports. Herein, we report a case with intestinal follicular lymphoma in which magnifying endoscopy with narrow band imaging was helpful for prompt diagnosis. A 57-year-old Japanese woman underwent surveillance esophagogastroduodenoscopy. The endoscopic examination revealed confluent whitish granules in the duodenum, distinct from the nodules or polyps that are typical findings of intestinal follicular lymphoma. Magnifying endoscopy visualized whitish enlarged villi, and narrow band imaging emphasized an elongated and coiled vascular pattern. Based on these features, intestinal follicular lymphoma was highly suspected, and subsequent histological study confirmed the diagnosis. This case demonstrates that magnifying endoscopy with narrow band imaging was useful for the detection and prompt diagnosis of intestinal follicular lymphoma. The pathological features of intestinal follicular lymphoma are also discussed.