基本情報
- 所属
- 自治医科大学 医学部 医学教育センター 医療人キャリア教育開発部門 教授 (特命教授)東北大学 大学院医学系研究科 消化器病態学分野 准教授
- 学位
- 博士(医学)(2015年3月 東北大学)
- J-GLOBAL ID
- 201801017707199790
- researchmap会員ID
- B000302281
<臨床経験に立脚した、社会の問題を解決するエビデンスの構築と、シミュレータ開発および学習法の開発>
1. 地域医療の経験を背景にし、内科学一般とくに消化器内科学を研究の基盤としています。医学博士は「東日本大震災後の消化性潰瘍の増加とその特徴」に関する臨床研究で取得し、精神的ストレスは、消化性潰瘍の独立した成因であり、災害時潰瘍出血の危険因子となることを報告しました。現在も臨床の課題を克服すべく、コホートを含む臨床研究とCochrane Review memberとしてシステマティックレビューを行っており、エビデンスの実臨床への還元を目指しています。2019年7月よりCochrane Upper GI and Pancreatic diseases(その後Cochrane Gutに名称変更)のEditorとなりました。COVID-19状況下の意思決定支援として、Paul Moayyedi教授の指導下で、免疫不全者や小児におけるワクチン接種の効果に関してのエビデンス集積を行いました。(COVID-END: COVID-19 Evidence Network to support Decision-making in Canada)。
東日本大震災時の出血性潰瘍増加をきっかけとして、出血を伴う観血的内視鏡処置の学習環境の課題を明らかとし、そこから新規シミュレータ開発とそれらを用いた問題解決型シミュレーション教育の推進をしています。
医学教育学会主催の第43回富士研WSにも参加し、医学教育の基本とこれからの在り方に関して学んでおり、2023年4月から自治医科大学医学教育センター医療人キャリア教育開発部門を担当し、卒前卒後をつなぐキャリア教育を模索しています。また2.と関連して災害の経験を通した医療者としてのプロフェッショナリズムに関する講義を継続的に行っております。
<災害時の経験と人脈をきっかけに、領域横断的な災害医療人材の育成>
2. 2008年岩手宮城内陸地震(M7.2)では震源地に近接する栗原中央病院での急性期トリアージと初期治療そしてDMAT受け入れを経験しました。また2011年東日本大震災(M9.0)では、南三陸町公立志津川病院で勤務医として15mを超える地震津波災害に被災、患者・住民避難とその後の災害医療体制構築に関わりTIME誌「世界で最も影響力のある100人」に選出されました。以降、災害医療領域の中でこれまで重視されてこなかった支援を受け止める「受援」の在り方を提言しています。さらに、被災した人間として困難に向き合うレジリエントな社会を目指し、国内外で経験と知見を共有する講演活動・いのちの教育を継続しています。2024年現在で講演はのべ250回を超え、2万3千人超の聴講者へメッセージを伝えています。
2019年10月より文部科学省補助金事業(平成30年度選定)「課題解決型高度医療人材養成プログラム」"コンダクター型災害保健医療人材の養成プログラム"の運営業務に携わり、社会に提案できる医療人材育成を進めています。2024年1月の能登半島地震においても自治医科大学同窓会支援チームの立ち上げおよび事務局を担当し受援体制構築と被災地内医療機関の疲弊を防ぐ取り組みを主導しました。
<クロスアポイントメントを用いた大学×大学連携/臨床×教育連携>
3. 文部科学省が推進するクロスアポイントメント制度の事例として、2023年4月より東北大学大学院医学系研究科消化器病態学分野でのシミュレータ研究開発を准教授として継続しつつ、自治医科大学医学教育センター医療人キャリア教育開発部門の特命教授として両方常勤職を務め、領域横断的かつ大学横断的な活動を実践すべく取り組んでいます。どちらの所属においても周囲の理解と協力の下でいくつものプロジェクトを進めていますので、研究力や医工連携に強い東北大学と、臨床と医療人教育に強みのある自治医科大学の連携構築としても発展できるよう努めています。
産学連携で開発しているシミュレータ Medical Rising STAR シリーズ(動画)https://www.youtube.com/playlist?list=PLYyDSR_h1X0yyqqgRpVUd6erdvJKoXqIA
<リンク先:シミュレータ開発におけるプレスリリース記事>
侵襲的内視鏡手技シミュレータの社会実装 デンカと東北大学の産学連携「Medical Rising STAR®」プロジェクト
https://www.tohoku.ac.jp/japanese/2023/04/press20230425-01-denka.html
出血合併症の再現を含む 胆膵内視鏡シミュレータモデルを開発 産学連携「Medical Rising STAR」プロジェクト第2弾
https://www.tohoku.ac.jp/japanese/2024/02/press20240219-02-mrs.html
<リンク先:TEDxTaipei 2014講演 被災とレジリエンスについて>
http://tedxtaipei.com/talks/2014-takeshi-kanno/
※メディア関連出演の記録は社会貢献活動欄の末尾に、東北大学医学部広報一條様のご助力で一覧を作成し掲載しています。
<リンク先:コンダクター型災害保健医療人材の養成プログラム>
https://www.dcnd.hosp.tohoku.ac.jp/
研究キーワード
5経歴
11-
2023年4月 - 現在
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2023年4月 - 現在
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2019年10月 - 2023年3月
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2020年8月 - 2021年3月
学歴
2-
2011年4月 - 2015年3月
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1999年4月 - 2005年3月
委員歴
9-
2023年10月 - 現在
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2023年3月 - 現在
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2022年7月 - 現在
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2018年8月 - 現在
受賞
6-
2024年10月
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2017年10月
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2013年10月
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2011年5月
論文
100-
月刊薬事 = The pharmaceuticals monthly 63(14) 2792-2796 2021年11月
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Internal Medicine 60(21) 3351-3358 2021年11月1日
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Journal of gastroenterology 56(7) 640-650 2021年7月BACKGROUND: Delayed bleeding is the major adverse event in upper gastrointestinal endoscopic treatment (UGET). We aimed to investigate the efficacy of vonoprazan, which is the novel strong antisecretory agent, to reduce the risk for delayed bleeding in comparison with proton pump inhibitors (PPIs) in UGET. METHODS: This retrospective population-based cohort study used the Diagnosis Procedure Combination database in Japan. We included patients on vonoprazan or PPI in UGET between 2014 and 2019. The primary outcome was delayed bleeding. We conducted propensity score matching to balance the comparison groups, and logistic regression analyses to compare the bleeding outcomes. RESULTS: We enrolled 124,422 patients, in which 34,822 and 89,600 were prescribed with vonoprazan and PPI, respectively. After propensity score matching, the risk for delayed bleeding was lower in vonoprazan than in PPI (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71-0.80), consistent with sensitivity analysis results. In the subgroup analyses of seven UGET procedures, vonoprazan was significantly advantageous in esophageal endoscopic submucosal dissection (E-ESD) (OR, 0.71; 95% CI, 0.54-0.94) and gastroduodenal endoscopic submucosal dissection (GD-ESD) (OR, 0.70; 95% CI, 0.65-0.75), although correction for multiple testing of the outcome data removed the significance in E-ESD. These results were also consistent with sensitivity analysis results. In the five other procedures, no significant advantage was found. CONCLUSIONS: This nationwide study found that, compared with PPI, vonoprazan can reduce delayed bleeding with approximately 30% in GD-ESD. Vonoprazan has the possibility to become a new treatment method for preventing delayed bleeding in this procedure.
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The Tohoku Journal of Experimental Medicine 254(2) 71-80 2021年6月 査読有りOlfactory disorders are one of the characteristic symptoms of the coronavirus disease of 2019 (COVID-19), which causes infection and inflammation of the upper and lower respiratory tract. To our knowledge, there are no treatments for COVID-19-related olfactory disorder. Here, we report five olfactory disorder cases in COVID-19, treated using the Japanese traditional (Kampo) medicine, kakkontokasenkyushin'i. We treated five patients with mild COVID-19 at an isolation facility using Kampo medicine, depending on their symptoms. Patients with the olfactory disorder presented with a blocked nose, nasal discharge or taste impairment. Physical examination using Kampo medicine showed similar findings, such as a red tongue with red spots and sublingual vein congestion, which presented as blood stasis and inflammation; thus, we prescribed the Kampo medicine, kakkontokasenkyushin'i. After administration, the numeric rating scale scores of the smell impairment improved within 3 days from 9 to 3 in case 1, from 10 to 0 in case 2, from 9 to 0 in case 3, from 5 to 0 in case 4, and from 9 to 0 within 5 days in case 5. Following the treatment, other common cold symptoms were also alleviated. Kakkontokasenkyushin'i can be used for treating nasal congestion, rhinitis, and inflammation in the nasal mucosa. The olfactory disorder in COVID-19 has been reportedly associated with inflammation and congestion, especially in the olfactory bulb and olfactory cleft. Kakkontokasenkyushin'i may be one of the treatment alternatives for the olfactory disorder with rhinitis in patients with COVID-19.
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Internal medicine (Tokyo, Japan) 60(10) 1529-1532 2021年5月15日A 72-year-old man without any symptoms was referred to our hospital. Esophagogastroduodenoscopy revealed an elevated esophageal lesion that was covered with normal mucosa. The examination of biopsy specimens from the lesion revealed amyloid light-chain (AL) (λ) type amyloid deposits, but there were no amyloid deposits elsewhere in the gastrointestinal tract. Further examinations did not indicate systemic amyloidosis. Thus, this case was diagnosed as a localized esophageal amyloidosis. As the clinical outcome of localized amyloidosis is favorable, this case was scheduled for close follow-up. Localized amyloidosis should be considered in the differential diagnosis of esophageal submucosal tumors.
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Heliyon 7(5) e07044-e07044 2021年5月After a massive disaster, many residents in affected areas are forced to temporarily stay in evacuation shelters. The exact impact of the state of resource supply and infrastructure in evacuation shelters on the health status of evacuees has not been sufficiently studied. Two weeks after the 2011 Great East Japan Earthquake (GEJE), comprehensive surveillance related to the health status and hygiene level was performed for all evacuation shelters (328 shelters with 46,480 evacuees at the peak) in one of the most devastating medical zones after the tsunami hit the area (Ishinomaki City). The joint relief team regularly visited all evacuation shelters across the area to assess the situation of resource supply levels, infrastructural damage, rapid need of resources, and the health status of the evacuees. In this cross-sectional observational study, we evaluated the relationship between the resource supply levels and health status among evacuees in two time periods (days 14-19 and 20-25). Among the evaluated vital resources, clean tap water supply was among the most disrupted by the disaster, and was not fully restored in most shelters during the assessment period. The cross-sectional relationship between resource supplies and morbidity was inconsistent between the two assessment periods, reflecting the multifactorial nature of health status in evacuation shelters. The clean tap water supply level at the first assessment showed a strong negative correlation with the subsequent prevalence of respiratory or gastrointestinal infectious conditions at the second assessment. Restorations in the clean tap water supply and toilet hygiene correlated each other, and both correlated with a decrease in the prevalence of gastrointestinal infectious conditions. In conclusion, disrupted clean tap water supply and inadequate toilet hygiene after a massive disaster would jointly harm the health status of those in shelters. Prompt assessments using quick visual assessment and restorations of these key resources have validity with suppressed environmental health risks among evacuees.
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Digestive Endoscopy 33(4) 538-548 2021年5月OBJECTIVES: There are two major methods for local anesthesia by lidocaine before upper gastrointestinal endoscopy: simple spray and viscous solution. We aimed to assess the efficacy and safety by meta-analysis between these two methods. METHODS: We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases through October 2019 to perform meta-analyses using random-effects models. The primary outcomes were participants' pain/discomfort, satisfaction, and anaphylactic shock. Three reviewers independently searched for articles, extracted data, and assessed the risk of bias. We evaluated the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach. This study was registered in PROSPERO (CRD42020155611). RESULTS: We included seven randomized controlled trials (2667 participants). The participants' pain/discomfort may be similar between the lidocaine spray and viscous solution [standardized mean difference 0.03, 95% confidence intervals (CI) -0.37 to 0.42; I2 = 93%; low certainty of evidence]. The lidocaine spray probably increased participants' satisfaction compared with the viscous solution (relative risk 1.22; 95% CI, 1.02 to 1.47; I2 = 47%; moderate certainty of evidence). No anaphylactic shock occurred in four studies (low certainty of evidence). Four studies had high risks of selection bias. CONCLUSION: The use of lidocaine spray for local anesthesia provided better satisfaction scores than the viscous solution, and both methods have the same effect with regards to the control of discomfort and pain. Further studies in large multicenter randomized controlled trials with a pre-registration protocol are needed.
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Journal of Gastroenterology 56(4) 303-322 2021年2月23日 査読有り<title>Abstract</title>The Japanese Society of Gastroenterology (JSGE) revised the third edition of evidence-based clinical practice guidelines for peptic ulcer disease in 2020 and created an English version. The revised guidelines consist of nine items: epidemiology, hemorrhagic gastric and duodenal ulcers, <italic>Helicobacter pylori</italic> (<italic>H. pylori</italic>) eradication therapy, non-eradication therapy, drug-induced ulcers, non<italic>-H. pylori,</italic> and nonsteroidal anti-inflammatory drug (NSAID) ulcers, remnant gastric ulcers, surgical treatment, and conservative therapy for perforation and stenosis. Therapeutic algorithms for the treatment of peptic ulcers differ based on ulcer complications. In patients with NSAID-induced ulcers, NSAIDs are discontinued and anti-ulcer therapy is administered. If NSAIDs cannot be discontinued, the ulcer is treated with proton pump inhibitors (PPIs). Vonoprazan (VPZ) with antibiotics is recommended as the first-line treatment for <italic>H. pylori</italic> eradication, and PPIs or VPZ with antibiotics is recommended as a second-line therapy. Patients who do not use NSAIDs and are <italic>H. pylori</italic> negative are considered to have idiopathic peptic ulcers. Algorithms for the prevention of NSAID- and low-dose aspirin (LDA)-related ulcers are presented in this guideline. These algorithms differ based on the concomitant use of LDA or NSAIDs and ulcer history or hemorrhagic ulcer history. In patients with a history of ulcers receiving NSAID therapy, PPIs with or without celecoxib are recommended and the administration of VPZ is suggested for the prevention of ulcer recurrence. In patients with a history of ulcers receiving LDA therapy, PPIs or VPZ are recommended and the administration of a histamine 2-receptor antagonist is suggested for the prevention of ulcer recurrence.
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月刊薬事 2021年2月臨時増刊号【どんな薬剤・合併症・病態・患者背景にも対応できる 周術期の薬の使い方パーフェクトガイド】 63(3) 495-500 2021年2月
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Journal of Family Medicine and Primary Care 10(2) 1021-1021 2021年2月 査読有り
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Internal Medicine 60(3) 391-396 2021年2月1日
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The Tohoku journal of experimental medicine 253(1) 29-39 2021年1月 査読有りIn esophageal squamous cell carcinoma (ESCC) comprising 90% of cases with esophageal cancer, endoscopic resection (ER) is recommended for patients with negligible risk of ESCC-related mortality. In fact, a main cause of death in patients underwent ER is not ESCC. We thus aimed to clarify the predictors for early and late mortality among patients underwent ER of ESCC between 2005 and 2018 at our institution. In this retrospective cohort study, we investigated the prognosis and predictors of early and late mortality with the cut-off value of 3 years. We enrolled 407 patients with a median 69 months follow-up. The 5-year overall survival and disease-specific survival, an indicator of ESCC-related mortality, were 83.4% and 98.4%, respectively. In multivariate Cox analyses, Eastern Cooperative Oncology Group performance status (ECOG-PS), consisting of six grades by a patient's level of activity, ≥ 2 was a predictor for early and late morality [hazard ratio (HR), 7.21 (P = 0.007) and 15.62 (P = 0.021), respectively]. Charlson comorbidity index (CCI), which is an index for predicting mortality by comorbid conditions, ≥ 2 was also a predictor for both mortality [HR, 2.97 (P = 0.017) and 1.90 (P = 0.019), respectively]. However, age was a predictor only for late mortality [HR, 3.08 (P = 0.010) in 80-84 years and 8.38 (P < 0.001) in ≥ 85 years]. Considering the predictive ability for early mortality, we propose that ECOG-PS and/or CCI are better indices compared with age in deciding treatment strategy after ER for ESCC.
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Internal Medicine 60(4) 539-543 2021年 査読有りWe herein report an extremely rare case of localized gastric amyloidosis (LGA) with morphological changes during the follow-up. A 71-year-old woman who had a depressed lesion with central elevation in the gastric lower body was diagnosed with LGA. Esophagogastroduodenoscopy at 10 years after the initial examination showed that the lesion had grown and changed morphologically, exhibiting a submucosal tumor-like appearance. Since the lesion was confined to the submucosa, the patient underwent endoscopic submucosal dissection. The final pathological diagnosis was amyloid light-chain (AL)-type LGA. This case may provide useful information regarding the natural history of AL-type LGA.
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Current Treatment Options in Gastroenterology 18 557-573 2020年11月11日 査読有り筆頭著者
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Journal of gastroenterology 55(8) 742-753 2020年4月10日 査読有りBACKGROUND: Additional surgery for all patients with noncurative resection after endoscopic resection (ER) for early gastric cancer (EGC) may be excessive due to the relatively low rate of lymph node metastasis (LNM) in such patients. However, the prevalence and risk factors for LNM after noncurative ER have not been consistent across studies. METHODS: We performed a systematic review of electronic databases through August 10, 2018 to identify cohort studies with patients who underwent additional surgery after noncurative ER for EGC. The prevalence of LNM in such patients was extracted for all studies. Odds ratios (ORs) were combined using random-effects meta-analyses to assess the risk of LNM, when possible. RESULTS: We identified 24 studies comprising 3877 patients with 311 having LNM (pooled prevalence, 8.1%). The risk of LNM was significantly increased in lymphatic invasion (OR [95% confidence interval] = 4.22 [2.88-6.19]), lymphovascular invasion (LVI) (4.17 [2.90-5.99]), vascular invasion (2.38 [1.65-3.44]), positive vertical margin (2.16 [1.59-2.93]), submucosal invasion depth of ≥ 500 μm (2.14 [1.48-3.09]), and tumor size > 30 mm (1.77 [1.31-2.40]). In contrast, there was no significant association between undifferentiated-type or ulceration (scar) and LNM. When studies were restricted to those that evaluated the adjusted OR, the risk of vascular invasion for LNM did not reach statistical significance. CONCLUSIONS: Several pathological factors, most notably lymphatic invasion and LVI, were associated with LNM in patients with noncurative resection after ER for EGC. Lymphatic and vascular invasion should be assessed separately instead of LVI (PROSPERO CRD42018109996).
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Journal of clinical medicine 9(2) 2020年2月17日 査読有りBACKGROUND: International treatment guidelines for Helicobacter pylori infection recommend a proton pump inhibitor (PPI)/amoxicillin/clarithromycin (CAM) regimen (PAC) or PPI/amoxicillin/metronidazole (MNZ) regimen (PAM) as first-line therapy based on culture and sensitivity testing. As incidence rates of antimicrobial agent-resistant strains are changing year by year, it is important to reevaluate the efficacy of eradication regimens. We performed a meta-analysis to evaluate the efficacy and safety of PAC and PAM based on different locations categorized by the reported incidence of CAM- and MNZ-resistant strains. METHODS: Randomized control trials (RCTs) comparing eradication rates between PAC and PAM first-line treatment up to December 2018 were included. We divided RCTs into four groups based on resistance to CAM (< 15% or ≥ 15%) and MNZ (< 15% or ≥ 15%). RESULTS: A total of 27 studies (4825 patients) were included. Overall eradication rates between PAC and PAM were similar (74.8% and 72.5%, relative risk (RR): 1.13, 95% confidence interval (CI): 0.91-1.39, P = 0.27) in the intention-to-treat analysis. In areas with low MNZ- and high CAM-resistance rates, PAM had a significantly higher eradication rate than PAC (92.5% vs. 70.8%, RR: 0.29, 95% CI: 0.13-0.68). In areas with high MNZ- and low CAM-resistance rates, the eradication rate with PAC was only 72.9%. CONCLUSIONS: Overall eradication rates with PAC and PAM were equivalent worldwide. In low MNZ-resistance areas, PAM may be recommended as first-line therapy. However, the efficacy of PAC may be insufficient, irrespective of susceptibility to CAM.
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Digestion 101(6) 752-760 2020年<b><i>Background:</i></b> There has been no study that has directly measured the esophageal reflux factors in Barrett’s adenocarcinoma (BA) using 24-h multichannel intraluminal impedance-pH monitoring (24-h MII-pH). We aimed to clarify the esophageal reflux factors in Barrett’s esophagus (BE) and BA and the factors that determine the location of BA with 24-h MII-pH. <b><i>Methods:</i></b> We performed 24-h MII-pH in 26 patients with superficial BA treated endoscopically (BA group) and 13 patients with BE (BE group) and examined the esophageal reflux factors (esophageal acid exposure time [AET], bolus exposure (acid, weakly acid, and alkaline), and number of reflux episodes. In the BA group, there were 16 cases in which the lesions were localized in an area in contact with the esophagogastric junction (EGJ; EGJ group), and 10 cases in which the lesions were proximal to the BE and separated from the EGJ (non-EGJ group). <b><i>Results:</i></b> Total reflux in the bolus exposure in the BA group showed higher values compared to that in the BE group. The total of acid and weakly acid reflux of bolus exposure was significantly higher in the BA group than that in the BE group. The BA group also had greater numbers of total reflux episodes than the BE group. As for the cancer locations in BE, the cases in which the lesions were located proximally and separated from the EGJ had more AET and total reflux and acid reflux indicated by bolus exposure compared to the lesions adjacent to the EGJ. <b><i>Conclusions:</i></b> Stronger gastro-esophageal reflux appeared to be an important factor in the development of adenocarcinoma from BE. In addition, the cancer location in BE may be related to the intensity of esophageal reflux.
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Curr Gastroenterol Rep. 2019 Dec 5;21(12):65. 21(12) 2019年12月 査読有り筆頭著者
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Aliment Pharmacol Ther. 2019 Aug;50(4):454-455. 50(4) 2019年8月 査読有り筆頭著者
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Lancet Gastroenterol Hepatol. 2018 Dec;3(12):815-817. 3(12) 2018年12月 査読有り筆頭著者
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Dig Dis Sci. 2018 Nov;63(11):3033-3040. 63(11) 3033-3040 2018年11月 査読有り
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救急医学 42(8) 931‐940 2018年8月
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Clin J Gastroenterol. 2017 Oct;10(5):469-473. 10(5) 469-473 2017年10月 査読有り
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ONCOTARGET 7(35) 56598-56607 2016年8月 査読有り
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DIGESTIVE ENDOSCOPY 28(5) 556-563 2016年7月 査読有り筆頭著者責任著者
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SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY 51(7) 782-787 2016年 査読有り
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Nihon rinsho. Japanese journal of clinical medicine 73(7) 1209-1214 2015年7月
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J Gastroenterol Hepatol. 2015 May;30(5):842-8. 30(5) 842-848 2015年5月 査読有り筆頭著者
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J Gastroenterol. 2015 Jan;50(1):31-40 50(1) 31-40 2015年1月 査読有り筆頭著者
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Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 103(3) 557-560 2014年3月
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WORLD JOURNAL OF GASTROENTEROLOGY 20(3) 706-713 2014年1月 査読有り
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JOURNAL OF GASTROENTEROLOGY 48(4) 483-490 2013年4月 査読有り筆頭著者
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Digestion. 2013;87(1):40-6. 87(1) 40-46 2013年1月 査読有り筆頭著者
MISC
89書籍等出版物
13講演・口頭発表等
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第52回日本小児内視鏡研究会 教育講演 2025年7月6日 招待有り
共同研究・競争的資金等の研究課題
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日本学術振興会 科学研究費助成事業 基盤研究(C) 2025年4月 - 2028年3月
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日本学術振興会 科学研究費助成事業 2025年4月 - 2028年3月
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日本学術振興会 科学研究費助成事業 2023年4月 - 2028年3月
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日本学術振興会 科学研究費助成事業 2023年4月 - 2027年3月
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文部科学省 科学研究費助成事業 基盤研究(C) 2022年4月 - 2025年3月