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Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy

World Journal of Gastroenterology 2009年第33期15卷 4111-4115页

作者： hiromichi Maeda Takehiro Okabayashi Tomoaki Yatabe Koichi Yamashita Kazuhiro Hanazaki Department of Surgery Kochi Medical SchoolKochi University Department of Anesthesiology and Critical Care Medicine Kochi Medical SchoolKochi University

Perioperative glycemic control is important for reducing postoperative infectious complications. However, clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead to the destruction of glucose homeostasis, which is termed pancreatogenic diabetes. Pancreatogenic diabetes is characterized by the occurrence of hyperglycemia and iatrogenic severe hypoglycemia, which adversely effects patient recovery. Postoperatively, a variety of factors including surgical stress, inflammatory cytokines, sympathomimetic drug therapy, and aggressive nutritional support can also affect glycemic control. This review discusses the endocrine aspects of pancreatic resection and highlights postoperative glycemic control using a closed-loop system or artificial pancreas. In previous experiments, we have demonstrated the reliability of the artificial pancreas in dogs with total pancreatectomy, and its postoperative clinical use has been shown to be effectiveand safe, without the occurrence of hypoglycemic episodes, even in patients after total pancreatectomy. Considering the increasing requirement for tight perioperative glycemic control and the recognized risk of hypoglycemia, we propose the use of an artificial endocrine pancreas that is able to monitor continuously blood glucose concentrations with proven accuracy, and administer automatically substances to return blood glucose concentration to the optimal narrow range.

关键词： Blood glucose Diabetes mellitus Hyperglycemia Pancreas Artificial Pancreatectomy

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Morphology and gene expression of sex‐determining region Y‐box 9 and runt‐related transcription factor 2 in centrifugally compressed cell collagen‐combined constructs (C^(6))

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Biosurface and Biotribology 2023年第3期9卷 78-83页

作者： Xu Ye Masashi Yamazaki Wataru Ando Norimasa Nakamura hiromichi Fujie Faculty of System Design Tokyo Metropolitan UniversityTokyoJapan Research Center for Medicine‐Engineering Collaboration TokyoJapan Department of Orthopaedic Surgery Kansai Rosai HospitalAmagasakiJapan Department of Orthopaedic Surgery Osaka University Graduate School of MedicineSuitaJapan Institute for Medical Science in Sports Osaka Health Science UniversityOsakaJapan Center for Advanced Medical Engineering and Informatics Osaka UniversitySuitaJapan

The authors previously developed a scaffold‐free tissue‐engineered construct(TEC)from mesenchymal stem cells(MSCs).Although the TEC exhibited even cell distribution and was successfully applied for cartilage repair in animal models,it is unsuitable for relatively large‐scale cartilage defects due to its small *** solve the problem,the authors recently developed a novel biomaterial,a centrifugally compressed cell‐collagen combined construct(C^(6))from a mixture of MSCs and atelocollagen,both of which are subjected to *** results of the previous study indicated that C^(6) exhibited high cell viability(70%)and sufficient cell distribution similar to that of the *** the present study,the morphology and gene expression of C^(6) were *** ex-amination indicated that C6 is six times thicker(approximately 1 mm)than the TEC after a 7‐day *** C^(6) remained unchanged in scale with increased cell density after a 21‐day *** electron microscopic observation indicated that C^(6) exhibited interconnected and porous microstructures,while the TEC had close‐knit *** transcriptase‐polymerase chain reaction analysis indicated that the expression of sex‐determining region Y‐box 9 and runt‐related transcription factor 2 was significantly higher in C^(6) than that in TEC.

关键词： biomaterials cartilage microstructures

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Rikkunshito increases peripheral incretin-hormone levels in humans and rats

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World Journal of Methodology 2024年第1期14卷 102-113页

作者： Hiroshi Kono Shinji Furuya Hidenori Akaike Katsutoshi Shoda Yoshihiko Kawaguchi Hidetake Amemiya hiromichi Kawaida Daisuke Ichikawa The First Department of Surgery University of YamanashiChuoYamanashi 409-3898Japan

BACKGROUND It was reported that rikkunshito(TJ-43)improved the cisplatin-induced decreases in the active form of ghrelin in plasma;however,other effects on gastrointestinal hormones have not been *** To investigate the effects of TJ-43 on peripheral levels of incretin hormones,including gastric inhibitory polypeptide(GIP)and glucagon-like polypeptide-1(GLP-1),in humans and *** Patients were divided into two groups,namely patients who received TJ-43 immediately following surgery[TJ-43(+)group]and those who received TJ-43 on postoperative day 21[TJ-43(-)group],and the plasma levels of active GIP and active GLP-1 were *** animal experiments,rats were treated with TJ-43[rat(r)TJ-43(+)group]or without[rTJ-43(−)group]by gavage for 4 wk,and the plasma active GIP and active GLP-1 levels were *** expression of incretin hormones in the gastrointestinal tract and insulin in the pancreas were investigated by ***,the cyclic adenosine monophosphate activities were assessed in pancreatic tissues from rats treated with or without TJ-43 in vivo,and the blood glucose levels and plasma insulin levels were measured in rats treated with or without TJ-43 in oral glucose tolerance *** In humans,the active incretin hormone levels increased,and values were significantly greater in the TJ-43(+)group compared those in the TJ-43(-)*** rats,the plasma active incretin levels significantly increased in the rTJ-43(+)group compared with those in the rTJ-43(-)*** and GLP-1 expressions were enhanced by TJ-43 ***,plasma insulin levels increased and blood glucose levels were blunted in the rTJ-43(+)*** The results show that TJ-43 may be beneficial for patients who undergo pancreatic surgery.

关键词： Incretin hormone Japanese traditional herbal medicine Gastric inhibitory polypeptide Glucagon-like polypeptide-1 Islet cells Insulin

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Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection

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World Journal of Gastroenterology 2009年第33期15卷 4116-4121页

作者： Takehiro Okabayashi hiromichi Maeda Zhao-Li Sun Robert A Montgomery Isao Nishimori Kazuhiro Hanazaki Department of Surgery Kochi Medical School Kohasu- Okocho Nankoku-City Kochi 783-8505 Japan Department of Surgery Johns Hopkins University School of Medicine 720 Rutland Ave. Ross 771E Baltimore MD 21205 United States Department of Gastroenterology and Hepatology at Kochi Medical School Kohasu-Okocho Nankoku- City Kochi 783-8505 Japan

Postoperative hyperglycemia is common in critically ill patients, even in those without a prior history of diabetes mellitus. It is well known that hyperglycemia induced by surgical stress often results in dysregulation of liver metabolism and immune function, impairing postoperative recovery. Current evidence suggests that maintaining normoglycemia postoperatively improves surgical outcome and reduces the mortality and morbidity of critically ill patients. On the basis of these observations, several large randomized controlled studies were designed to evaluate the benefit of postoperative tight glycemic control with intensive insulin therapy. However, intensive insulin therapy carries the risk of hypoglycemia, which is linked to serious neurological events. Recently, we demonstrated that perioperative tight glycemic control in surgical patients could be achieved safely using a closed-loop glycemic control system and that this decreased both the incidence of infection at the site of the surgical incision, without the appearance of hypoglycemia, and actual hospital costs. Here, we review the benefits and requirements of perioperative intensive insulin therapy using a dosed-loop artificial endocrine pancreas system in hepatectomized patients. This novel intensive insulin therapy is safe and effectively improves surgical outcome after hepatic resection.

关键词： Artificial pancreas Hepatic resection Hyperglycemia Intensive insulin therapy Surgical site infection

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Three cases of Solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum

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World Journal of Gastroenterology 2008年第6期14卷 944-947页

作者： Seiyuu Suzuki Shoji Hirasaki Fusao Ikeda Eiichiro Yumoto hiromichi Yamane Minoru Matsubara Department of Internal Medicine Sumitomo Besshi Hospital Niihama Japan

A solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum is rare, and few reports have described its characteristic endoscopic features. We describe three cases of solitary Peutz-Jeghers-type hamartomatous polyp and their endoscopic findings in detail. The polyp in all of our three cases showed an irregularly lobular or nodular surface, whereas adenomas often show a regularly nodular or granular surface. The color of the polyp was whitish in all of our cases. In the present cases, close observation by endoscopy revealed that the solitary Peutz-Jeghers-type hamartomatous polyps looked whitish because of the presence of diffusely scattered white spots on the surface of the polyps. Duodenal polyps that exhibit the aforementioned endoscopic characteristics may be diagnosed as Peutz-Jeghers-type hamartomatous polyps and treated by polypectomy because of the malignant potential.

关键词： Duodenal polyp Hamartoma Peutz-Jeghers polyp

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Carbon nanotube-dependent synthesis of armchair graphene nanoribbons

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Nano Research 2022年第3期15卷 1709-1714页

作者： Yifan Zhang Kecheng Cao Takeshi Saito hiromichi Kataura Hans Kuzmany Thomas Pichler Ute Kaiser Guowei Yang Lei Shi State Key Laboratory of Optoelectronic Materials and Technologies Nanotechnology Research CenterGuangzhou Key Laboratory of Flexible Electronic Materials and Wearable DevicesSchool of Materials Science and EngineeringSun Yat-sen UniversityGuangzhou 510275China Central Facility for Electron Microscopy Electron Microscopy Group of Materials ScienceUlm UniversityUlm 89081Germany School of Physical Science and Technology Shanghai Tech UniversityShanghai 201210China Nanomaterials Research Institute National Institute of Advanced Industrial Science and TechnologyTsukuba 305-8565Japan Faculty of Physics University of ViennaVienna 1090-AAustria

Sub-nanometer armchair graphene nanoribbons(GNRs)with moderate band gap have great potential towards novel *** can be synthesized in the confined tubular space of single-walled carbon nanotubes(SWCNTs),in which precursor molecules have been specifically designed to form the GNRs with certain width and ***,it is still unexplored how the diameter and metallicity of SWCNTs influence the synthesis of the ***,we applied a series of SWCNTs with different average diameters to study the diameter-dependent synthesis of *** using Raman spectroscopy and transmission electron microscopy,we found that the width of the GNRs can be tailored by the diameter of the ***,the SWCNTs with average diameter of 1.3 nm produced 6 and 7 armchair GNRs with the highest yield,which can be well explained by considering the width of the GNRs and van der Waals radius of hydrogen and carbon *** addition,semiconducting and metallic SWCNTs produced GNRs with different yields,which could attribute to different diameter distributions and density of *** results enable the possibility of a high-yield production of certain armchair graphene nanoribbons in large scale,which would benefit future applications as semiconductor with sub-nanometer in width.

关键词： armchair graphene nanoribbons single-walled carbon nanotubes Raman spectroscopy diameter dependence metallicity dependence

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Quantitative analysis of the intertube coupling effect on the photoluminescence characteristics of distinct(n,m)carbon nanotubes dispersed in solution

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Nano Research 2020年第4期13卷 1149-1155页

作者： Shilong Li Dehua Yang Jiaming Cui Yanchun Wang Xiaojun Wei Weiya Zhou hiromichi Kataura Sishen Xie Huaping Liu Beijing National Laboratory for Condensed Matter Physics Institute of PhysicsChinese Academy of SciencesBeijing 100190China Center of Materials Science and Optoelectronics Engineering College of Materials Science and Opto-Electronic TechnologyUniversity of Chinese Academy of SciencesBeijing 100049China Department of Physical Science University of Chinese Academy of SciencesBeijing 100049China Beijing Key Laboratory for Advanced Functional Materials and Structure Research Beijing 100190China Songshan Lake Materials Laboratory Dongguan 523808China Nanomaterials Research Institute National Institute of Advanced Industrial Science and Technology(AIST)Tsukuba 305-8565Japan

In this work,we quantitatively studied the intertube coupling of different(n,m)-sorted semiconducting single-wall carbon nanotubes(SWCNTs)on their photoluminescence(PL)efficiencies by precisely tuning the ratio of(9,4)and(6,5)SWCNTs in the mixture.A significant decrease in the PL intensity of(9,4)SWCNTs was observed after mixing with(6,5)species when fixing the(9,4)concentration,which was confirmed to be caused by the absorption of incident photons and reabsorption of the emitted photons by the added(6,5)*** contrast,a similar decrease in the PL intensity of(6,5)SWCNTs was also observed after mixing with the larger-diameter(9,4)*** from that of(9,4)SWCNTs,the PL decrease of(6,5)SWCNTs was found to originate not only from photon absorption and reabsorption by the(9,4)species but also from one-way exciton energy transfer(EET)from the(6,5)SWCNTs to the larger-diameter(9,4)*** the experimental results and numerical simulations further demonstrated that increasing the concentration of mixed(9,4)SWCNTs would enhance the effects of photon absorption and reabsorption and EET on the PL intensity of(6,5)SWCNTs quantified by the decrease ratio of the(6,5)PL ***,the influence of EET was found to be always weaker than that of photon absorption and *** proposed that the observed EET between isolated SWCNTs in a surfactant solution is derived from their proximity due to Brownian motion.

关键词： single-wall carbon nanotubes photoluminescence intertube coupling quantitative analysis

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Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery

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World Journal of Gastroenterology 2019年第28期25卷 3722-3737页

作者： hiromichi Kawaida Hiroshi Kono Naohiro Hosomura Hidetake Amemiya Jun Itakura Hideki Fujii Daisuke Ichikawa First Department of Surgery Faculty of Medicine University of Yamanashi Yamanashi 409-3898 Japan Department of Surgery Kofu Manicipal Hospital Yamanashi 400-0832 Japan

Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.

关键词： Postoperative pancreatic fistula Pancreaticoduodenectomy Pancreatojejunostomy Pancreatogastrostomy Distal pancreatectomy Prophylactic drainage Somatostatin analogs

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Plasma MMP-2 and MMP-7 levels are elevated first month after surgery and may promote growth of residual metastases

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World Journal of Gastrointestinal Oncology 2021年第8期13卷 879-892页

作者： HMC Shantha Kumara hiromichi Miyagaki Sajith A Herath Erica Pettke Xiaohong Yan Vesna Cekic Richard L Whelan Division of Colon and Rectal Surgery Department of SurgeryLenox Hill HospitalNorthwell HealthNew YorkNY 10028United States Department of Gastroenterological Surgery Osaka UniversitySuita 565-0862OsakaJapan Analytic Department NovartisMorris PlainsNJ 07905United States Department of Surgery Swedish Medical CenterSeattleWA 98122United States Department of Surgery Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNY 11549United States

BACKGROUND MMP-2 also known as gelatinase A and MMP-7(matrilysin)are members of the zinc-dependent family of MMPs(Matrix metalloproteinase).MMP-2 and MMP-7 are remodeling enzymes that digest extracellular matrix;MMP-2 is extensively expressed during development and is upregulated at sites of tissue damage,inflammation,and in stromal cells of metastatic ***-7 is expressed in the epithelial cells and in a variety of cancers including colon *** MMP-2 and MMP-7 levels were assessed before and after minimally invasive colorectal resection for cancer *** To determine plasma MMP-2 and MMP-7 levels before and after minimally invasive colorectal resection for cancer *** Patients enrolled in a plasma bank for whom plasma was available were *** obtained from preoperative(Preop)and postoperative blood samples was *** colorectal cancer(CRC)patients who underwent elective minimally invasive cancer resection with preop,post-operative day(POD)1,3 and at least 1 late postop sample(POD 7-34)were *** samples were bundled into 7 d blocks(POD 7-13,14-20,etc.)and treated as single time *** MMP-2 and MMP-7 levels were determined via enzyme-linked immunosorbent assay in *** Total 88 minimally invasive CRC resection CRC patients were studied(right colectomy,37%;sigmoid,24%;and LAR/AR 18%).Cancer stages were:1,31%;2,30%;3,34%;and 4,5%.Mean Preop MMP-2 plasma level(ng/mL)was 179.3±40.9(n=88).Elevated mean levels were noted on POD1(214.3±51.2,n=87,P<0.001),POD3(258.0±63.9,n=80,P<0.001),POD7-13(229.9±62.3,n=65,P<0.001),POD 14-20(234.9±47.5,n=25,P<0.001),POD 21-27(237.0±63.5,n=17,P<0.001,)and POD 28-34(255.4±59.7,n=15,P<0.001).Mean Preop MMP-7 level was 3.9±1.9(n=88).No significant differences were noted on POD 1 or 3,however,significantly elevated levels were noted on POD 7-13(5.7±2.5,n=65,P<0.001),POD 14-20(5.9±2.5,n=25,P<0.001),POD 21-27(6.1±3.6,n=17,P=0.002)and on POD 28-34(6.8±3.3,n=15 P<0.001,)vs p

关键词： Effects of surgery Colorectal resection Colorectal cancer Plasma MMP-2 and MMP-7 levels Angiogenesis

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Ultrastructural changes in porcine liver sinusoidal endothelial cells of machine perfused liver donated after cardiac death

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World Journal of Gastroenterology 2022年第19期28卷 2100-2111页

作者： Hiroki Bochimoto Yo Ishihara Nur Khatijah Mohd Zin Hiroyoshi Iwata Daisuke Kondoh hiromichi Obara Naoto Matsuno Department of Cell Physiology The Jikei University School of MedicineMinato-ku 105-8461TokyoJapan Department of Transplantation Technology and Therapeutic Development Asahikawa Medical UniversityAsahikawa 078-8510HokkaidoJapan Department of Surgery Asahikawa Medical UniversityAsahikawa 078-8510HokkaidoJapan Laboratory of Veterinary Anatomy Obihiro University of Agriculture and Veterinary MedicineObihiro 080-8555HokkaidoJapan Department of Mechanical Engineering Tokyo Metropolitan UniversityHachioji 192-0397TokyoJapan

BACKGROUND The machine perfusion(MP)preservation including hypothermic MP(HMP)and midthermic MP(MMP)has been considered as a promising strategy to preserve the functions of liver donated after cardiac *** importance of understanding liver sinusoidal endothelial cells(LSEC)damage in regulating liver injury during MP has been ***,the ultrastructural changes in the LSEC and sinusoids around them after MP are *** To investigate the ultrastructural changes in the LSEC and sinusoids around them after *** Porcine liver grafts undergo a warm ischemia time of 60 minutes perfused for 4 h with modified University of Wisconsin gluconate *** A grafts were preserved with HMP at 8℃ constantly for 4 *** B grafts were preserved with a rewarming solution at 22℃ by MMP for 4 *** the ultrastructural changes in the LSEC and sinusoids in Group A and B were comparatively analyzed by using osmium-maceration scanning electron microscopy with complementary transmission electron microscopy *** An analysis of the LSEC after warm ischemia revealed that mitochondria with condensed-shaped cristae,abnormal vesicles,reduction of ribosomes and the endoplasmic reticulum(ER)surround the mitochondria *** MP subsequent after warm ischemia alleviate the abnormal vesicles and reduction of ribosomes in LSEC,which indicated the reduction of the ER ***,MMP could restore the tubular mitochondrial cristae,while after HMP the condensed and narrow mitochondrial cristae *** addition,the volume of the sinusoidal space in the liver grafts after MMP were restored,which indicated a lower risk of pressure injury than *** MMP alleviates the ER damage of LSEC by warm ischemia,additionally restore the metabolism of LSEC via the normalization of mitochondria and prevent the share stress damage of liver grafts.

关键词： Liver Sinusoidal endothelial cells Warm ischemia Machine perfusion preservation Transplantation Ultrastructure

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