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One-day seminar for residents for implementing abdominal pocketsized ultrasound

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World Journal of Methodology 2021年第4期11卷 208-221页

作者： Hiroko Naganuma hideaki ishida Department of Gastroenterology Yokote Municipal HospitalYokote 0138602AkitaJapan Department of Gastroenterology Akita Red Cross HospitalAkita-City 010-1495Japan

Despite its proven high utility,integration of pocked-sized portable ultrasound(US)into internal medicine residency training remains inconsistent.For 10 years,we have held a 1-d seminar biannually,consisting of lecture(half-day)and handson training(half-day)on pocket-sized US of the abdomen and lungs.The lecture consists of training on US physics and clinical applications of pocket-sized US,followed by a lecture covering the basic anatomy of the abdomen and lungs and introducing the systemic scanning method.Given the simple structure of pocketsized US devices,understanding the basic physics is sufficient yet necessary to operate the pocket-sized US device.It is important to understand the selection of probes,adjustment of B mode gain,adjustment of color gain,and acoustic impedance.Basic comprehension may have a significant positive impact on the overall utilization of pocket-sized US devices.The easiest and most reliable way to observe the whole abdomen and lungs is a combination of transverse,sagittal,and oblique scanning,pursuing the main vascular system from the center to the periphery of the organ in the abdomen and systemic scanning of the pleura.There is usually a marked change in knowledge and attitudes among the program participants,although skill gaps remain among them.We discuss the limitations and problems to this education system as well.

关键词： Pocket-sized ultrasound Abdomen Lung Medical education Resident Ultrasound physics

Diagnostic problems in two-dimensional shear wave elastography of the liver

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World Journal of Radiology 2020年第5期12卷 76-86页

作者： Hiroko Naganuma hideaki ishida Atsushi Uno Hiroshi Nagai Hidekatsu Kuroda Masahiro Ogawa Department of Gastroenterology Yokote Municipal HospitalYokote 0138602AkitaJapan Department of Gastroenterology Akita Red Cross HospitalKamikitatesaruta 0101495AkitaJapan Department of Gastroenterology Oomori Municipal HospitalYokote 0130525AkitaJapan New Generation Imaging Laboratory Tokyo 1680065Japan Division of Gastroenterology and Hepatology Iwate Medical UniversityMorioka 0200023IwateJapan Department of Gastroenterology and Hepatology Nihon University HospitalChiyoda 1018309TokyoJapan

Two-dimensional shear wave elastography(2D-SWE)is used in the clinical setting for observation of the liver.Unfortunately,a wide spectrum of artifactual images are frequently encountered in 2D-SWE,the precise mechanisms of which remain incompletely understood.This review was designed to present many of the artifactual images seen in 2D-SWE of the liver and to analyze them by computer simulation models that support clinical observations.Our computer simulations yielded the following suggestions:(1)When performing 2D-SWE in patients with chronic hepatic disease,especially liver cirrhosis,it is recommended to measure shear wave values through the least irregular hepatic surface;(2)The most useful 2D-SWE in patients with focal lesion will detect lesions that are poorly visible on B-mode ultrasound and will differentiate true tumors from pseudo-tumors(e.g.,irregular fatty change);and(3)Measurement of shear wave values in the area posterior to a focal lesion must be avoided.

关键词： Two-dimensional shear wave elastography Ultrasound Artifacts Liver cirrhosis Liver tumor Computer simulation model

Visualizing the hepatic vascular architecture using superb microvascular imaging in patients with hepatitis C virus: A novel technique

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World Journal of Gastroenterology 2016年第26期22卷 6057-6064页

作者： Hidekatsu Kuroda Tamami Abe Keisuke Kakisaka Yudai Fujiwara Yuichi Yoshida Akio Miyasaka Kazuyuki ishida hideaki ishida Tamotsu Sugai Yasuhiro Takikawa Division of Hepatology Department of Internal Medicine Iwate Medical University School of Medicine Department of Molecular Diagnostic Pathology Iwate Medical University Center of Diagnostic Ultrasound Akita Red Cross Hospital

AIM: To identify the hepatic vascular architecture of patients with hepatitis C virus(HCV) using superb microvascular imaging(SMI) and investigate the use of SMI in the evaluation of liver fibrosis.METHODS: SMI was performed in 100 HCV patients. SMI images were classified into five types according to the vascular pattern, and these patterns were compared with the fibrosis stage. Moreover, the images were analyzed to examine vascularity by integrating the number of SMI signals in the region of interest ROI [number of vascular trees(VT)]. The number of VT, fibrosis stage, serum parameters of liver function, and CD34 expression were investigated.RESULTS: There was a significant difference between SMI distribution pattern and fibrosis stage(P < 0.001). The mean VT values in each of the fibrosis stages were as follows: 26.69 ± 7.08 in F0, 27.72 ± 9.32 in F1, 36.74 ± 9.23 in F2, 37.36 ± 5.32 in F3, and 58.14 ± 14.08 in F4. The VT showed excellent diagnostic ability for F4 [area under the receiver operator characteristic(AUROC): 0.911]. The VT was significantly correlated with the CD34 labeling index(r = 0.617, P < 0.0001).CONCLUSION: SMI permitted the detailed delineation of the vascular architecture in chronic liver disease. SMI appears to be a reliable tool for noninvasively detecting significant fibrosis or cirrhosis in HCV patients.

关键词： Superb microvascular imaging Number of vascular trees Chronic liver disease Ultrasound Liver fibrosi

Gravitational wave footprints from Higgs-portal scalegenesis with multiple dark chiral scalars

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Chinese Physics C 2024年第4期48卷 209-221页

作者： He-Xu Zhang Shinya Matsuzaki Hiroyuki ishida Center for Theoretical Physics and College of Physics Jilin UniversityChangchun 130012China Center for Liberal Arts and Sciences Toyama Prefectural UniversityToyama 939-0398Japan

We discuss the gravitational wave(GW)spectra predicted from the electroweak scalegenesis of the Higgs portal type with a large number of dark chiral flavors,which many flavor QCD would underlie and give the dynamical explanation of the negative Higgs portal coupling required to trigger the electroweak symmetry breaking.We employ the linear-sigma model as the low-energy description of dark many flavor QCD and show that the model undergoes ultra-supercooling due to the produced strong first-order thermal phase transition along the(approximately realized)flat direction based on the Gildener-Weinberg mechanism.Passing through evaluation of the bubble nucleation/percolation,we address the reheating and relaxation processes,which are generically non-thermal and nonadiabatic.Parametrizing the reheating epoch in terms of the e-folding number,we propose proper formulae for the redshift effects on the GW frequencies and signal spectra.It then turns out that the ultra-supercooling predicted from the Higgs-portal scalegenesis generically yields none of GW signals with the frequencies as low as nano Hz,unless the released latent heat is transported into another sector other than reheating the universe.Instead,models of this class prefer to give the higher frequency signals and still keeps the future prospected detection sensitivity,like at LISA,BBO,and DECIGO,etc.We also find that with large flavors in the dark sector,the GW signals are made further smaller and the peak frequencies higher.Characteristic phenomenological consequences related to the multiple chiral scalars include the prediction of dark pions with the mass much less than TeV scale,which is also briefly addressed.

关键词： gravitational wave electroweak scalegenesis many flavor QCD

Z-shaped incision without epithelial resection in pterygium surgery

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International Journal of Ophthalmology(English edition) 2024年第7期17卷 1262-1266页

作者： Satoru Kase Shinki Chin Susumu ishida Department of Ophthalmology Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporo 060-8638Japan

AIM:To introduce a novel surgical technique using a Z-shaped incision without epithelial resection in ophthalmic pterygia.METHODS:This was a prospective study.During pterygium surgery,all proliferative tissues were separated from the cornea and conjunctiva without resection of the tissues.The unaffected conjunctiva was incised in a Z-shape.The upper(or lower)conjunctival flap was sutured to the lower(or upper)normal conjunctiva on the limbal sclera,while the proliferative tissue was sutured to the upper conjunctiva(or lower)near the fornix.RESULTS:Ten patients with pterygia were eligible for this study.Eight patients with primary pterygia and 2 with recurrent pterygia were included.The age of patients at surgery ranged from 47 to 90y(average:71.9y).Five patients each showed right and left-sided pterygia.The postoperative follow-up periods were from 8 to 78mo(average:25.0mo).The surgery was successfully conducted and wounds were favorably reconstructed in all patients.The proliferative tissues sutured to the normal conjunctiva showed palor and attenuated neovessles,and never showed re-growth after surgery.Nine patients did not show recerrence.Recerrent pterygium was noted in 1 patient,but additional treatments were not required.CONCLUSION:The procedure involves the reconstruction of pterygial tissue and normal conjunctiva using a Z-shaped incision.The scleral limbal wound can be covered with nonaffected conjunctiva without any excision of conjunctival epithelia in patients with primary or recurrent pterygia.

关键词： pterygium surgery Z-shape non-resection

Gravitational wave footprints from Higgs-portal scalegenesis with multiple dark chiral scalars

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Chinese Physics C 2024年第4期 213-225页

作者：张贺旭 Shinya Matsuzaki Hiroyuki ishida Center for Theoretical Physics and College of Physics Jilin University Center for Liberal Arts and Sciences Toyama Prefectural University

We discuss the gravitational wave(GW) spectra predicted from the electroweak scalegenesis of the Higgs portal type with a large number of dark chiral flavors, which many flavor QCD would underlie and give the dynamical explanation of the negative Higgs portal coupling required to trigger the electroweak symmetry breaking.We employ the linear-sigma model as the low-energy description of dark many flavor QCD and show that the model undergoes ultra-supercooling due to the produced strong first-order thermal phase transition along the(approximately realized) flat direction based on the Gildener-Weinberg mechanism. Passing through evaluation of the bubble nucleation/percolation, we address the reheating and relaxation processes, which are generically non-thermal and nonadiabatic. Parametrizing the reheating epoch in terms of the e-folding number, we propose proper formulae for the redshift effects on the GW frequencies and signal spectra. It then turns out that the ultra-supercooling predicted from the Higgs-portal scalegenesis generically yields none of GW signals with the frequencies as low as nano Hz,unless the released latent heat is transported into another sector other than reheating the universe. Instead, models of this class prefer to give the higher frequency signals and still keeps the future prospected detection sensitivity, like at LISA, BBO, and DECIGO, etc. We also find that with large flavors in the dark sector, the GW signals are made further smaller and the peak frequencies higher. Characteristic phenomenological consequences related to the multiple chiral scalars include the prediction of dark pions with the mass much less than Te V scale, which is also briefly addressed.

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Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

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World Journal of Clinical Cases 2024年第2期12卷 276-284页

作者： Taiichiro Miyake Hiroaki Yanagimoto Daisuke Tsugawa Masayuki Akita Riki Asakura Keisuke Arai Toshihiko Yoshida Shinichi So Jun ishida Takeshi Urade Yoshihide Nanno Kenji Fukushima Hidetoshi Gon Shohei Komatsu Sadaki Asari Hirochika Toyama Masahiro Kido Tetsuo Ajiki Takumi Fukumoto Division of Hepato-Biliary-Pancreatic Surgery Department of SurgeryKobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding.Therefore,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.AIM To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.METHODS The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities.Clinicopathological factors,including demographic data and perioperative D-dimer values,were compared between the two groups.Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value.Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.RESULTS In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE group.In the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after hepatectomy.CONCLUSION Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

关键词： Hepatectomy Malignant tumor Postoperative complication D-dimer Early diagnosis Venous thromboembolism

Commentary on transplant outcomes of 100 cases of living-donor ABO-incompatible kidney transplantation

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Chinese Medical Journal 2022年第19期135卷 2301-2302页

作者： Hideki ishida Department of Organ Transplant Medicine Tokyo Women's Medical University HospitalShinjuku-kuTokyo 162-8666Japan.

By the end of 1980,Japanese groups had started programs with ABO-incomparible kidney transplantation as a consequence of the very limited supply of cadaveric organs for transplantation.Since then,they have done successful transplantations across the blood type barrier in combina-tion with plasmapheresis and splenectomy.In Japan,the strategy for ABO-incompatible transplantation has changed with the development of the tacrolimus(FK)/mycophenolate mofetil(MMF)combination in 2000 and rituximab in 2005.1 In addition,preoperative 1-week administration of FK/MMF produced much more excellent results.Current graft survival(2005-2013)was almost over 90%in both ABO-incompatible at 9-year follow-up,which was comparable to ABO-compatible kidney trans-plantations.

关键词： ABO kidney organs

Pneumonia and seizures due to hypereosinophilic syndrome—organ damage and eosinophilia without synchronisation:A case report

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World Journal of Clinical Cases 2022年第18期10卷 6325-6332页

作者： Tetsuro ishida Tomonori Murayama Seiju Kobayashi Department of Psychiatry Hokujinkai Ishibashi HospitalOtaru 047-8585Japan Department of Psychiatry Kushiro Red Cross HospitalKushiro 085-8512Japan Department of Psychiatry Shinyukai Nakae HospitalSapporo 001-0022Japan

BACKGROUND Hypereosinophilic syndrome(HES)is a condition characterized by increased eosinophil proliferation in the bone marrow,as well as tissue eosinophilia,often causing organ damage.The cause of the disease is unknown.Initial symptoms include fatigue,cough,shortness of breath,myalgia,angioedema,fever,and pneumonia.In addition to the respiratory symptoms,damage to the central nervous system can lead to severe seizures.Here,we report a case with pneumonia and complex partial seizures secondary to HES.CASE SUMMARY A 94-year-old woman was admitted to our hospital for heart failure and bloody stools.After admission,she also showed symptoms of pneumonia.Non-contrast computed tomography of the chest showed pleural effusion and infiltrative shadows.Lower gastrointestinal endoscopy showed multiple ulcers in the sigmoid colon.Blood analyses showed marked eosinophilia(eosinophils 1760/mm3,total leukocytes 6850/mm3).Initial treatment with furosemide 20 mg/d and prednisolone 25 mg/d relieved these symptoms.However,the patient subsequently experienced localised epileptic seizures characterized by bilateral eyelid twitching and eyes rolling upwards,without generalized convulsions,and respiratory arrest occurred.Electroencephalography showed spikes and waves.Non-contrast magnetic resonance imaging of the brain showed extensive periventricular hyperintensity.With administration of levetiracetam 1000 mg/d the epileptic seizures disappeared.However,the patient’s consciousness remained impaired,and her pneumonia worsened again.Two weeks later,she died of pneumonia.CONCLUSION HES symptoms are variable and atypical,and the level and timing of eosinophilia and organ damage are often discordant.

关键词： Case report Hypereosinophilic syndrome Pneumonia Seizures Prednisolone Levetiracetam