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Kidney structure and function in dilating vesicoureteral reflux patients with anorectal malformation

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World Journal of Pediatric Surgery 2020年第2期3卷 1-5页

作者： Yuichiro Miyake hiroyuki koga Geoffrey J Lane Atsuyuki Yamataka Department of Pediatirc General and Urogenital Surgery Juntendo University School of MedicineBunkyo-kuTokyoJapan

Background We assessed the impact of anorectal malformation(ARM)on the kidneys of children with dilating vesicoureteral reflux(D-VUR)≥grade III using a simple dimercaptosuccinic acid(DMSA)scintigraphy scan based renal dysfunction score(RDS).Methods The medical records of 121 patients with D-VUR treated between 2000 and 2014 were reviewed *** excluding patients with secondary D-VUR(n=18),presence of ARM was used to create two groups:ARM+(n=12 cases;15 ureters)and ARM-(n=91 cases;131 ureters).Types of ARM,grades of D-VUR,bladder and bowel dysfunction(BBD)and RDS were *** Patient demographics,mean follow-up,grades of D-VUR and history of urinary tract infections were not significantly *** was significantly higher in ARM+(41.7%versus 7.7%,p=0.0006).RDS was significantly higher in ARM+(p=0.036).Grades of D-VUR were significantly lower in ARM-with low RDS(p=0.008).During follow-up,changes in DMSA uptake over time were not observed in ARM+.Conclusions While renal cortical lesions were correlated with grade of D-VUR in ARM-and RDS was significantly higher in ARM+,BBD did not appear to contribute to progressive renal dysfunction as is commonly *** fact,no progression in renal cortical lesions was observed in ARM+based on RDS *** cortical lesions may possibly be a feature of ARM,a topic that warrants further study.

关键词： patients Kidney malformation

Pulmonary artery diameter ratio as a prognostic indicator of congenital diaphragmatic hernia

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World Journal of Pediatric Surgery 2024年第1期7卷 20-25页

作者： Yuichiro Miyake hiroyuki koga Shuko Nojiri Shunsuke Yamada Takanori Ochi Go Miyano Geoffrey J Lane Atsuyuki Yamataka Tadaharu Okazaki Department of Pediatric General and Urogenital Surgery Juntendo University School of MedicineBunkyo-kuTokyoJapan Department of Medical Technology Innovation Center Juntendo UniversityBunkyo-ku TokyoJapan Department of Pediatric Surgery Juntendo University Urayasu HospitalUrayasuChibaJapan

Background Following on from an earlier study published in 2008 about left pulmonary artery(LPA)flow measured on serial echocardiography being strongly prognostic in left-sided congenital diaphragmatic hernia(CDH)and the ratio of LPA to right pulmonary artery(RPA)diameters being a simple and reliable indicator for commencing nitric oxide(NO)therapy,the ratio of LPA:RPA diameters(PA ratio orPAR)was hypothesized to possibly reflect cardiopulmonary stresses accompanying CDH *** Subjects with isolated left-sided CDH treated between 2007 and 2020 at a single pediatric surgical center were recruited and classified according to *** obtained retrospectively for subject demographics,clinical course,LPA/RPA diameters,and PAR were compared between survivors and *** value of PAR for optimizing the prognostic value of PA diameter data in CDH were analyzed with receiver operating characteristic(ROC)curve *** Of 65 subjects,there were 54 survivors(82.3%)and 11 non-survivors(17.7%);7 of 11 non-survivors died before surgical repair could be *** PAR for survivors(0.851±0.152)was significantly higher than for non-survivors(0.672±0.108)(p=0.0003).Mean PAR for non-survivors was not affected by surgical *** of survivors were:LPA≥2 mm(n=52 of 54;mean PAR=0.866±0.146)and RPA≥3mm(n=46 of 54;mean PAR=0.857±0.152).Non-survivors with similar LPA and RPA diameters to survivors had significantly lower mean *** curve cut-off for PAR was *** with high PAR(≥0.762)required high-frequency oscillatory ventilation/NO less than subjects with low PAR(<0.762)(p=0.0244 and p=0.0485,respectively)and subjects with high PAR stabilized significantly earlier than subjects with low PAR(1.71±0.68 days vs 3.20±0.87 days)(p<0.0001).Conclusions PAR would appear to be strongly correlated with clinical outcome in CDH and be useful for planning management of cardiopulmonary instability in CDH.

关键词： hernia congenital diameters

From text to image:challenges in integrating vision into ChatGPT for medical image interpretation

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Neural Regeneration Research 2025年第2期20卷 487-488页

作者： Shunsuke koga Wei Du Department of Pathology and Laboratory Medicine Hospital of the University of PennsylvaniaPhiladelphiaPAUSA

Large language models(LLMs),such as ChatGPT developed by OpenAI,represent a significant advancement in artificial intelligence(AI),designed to understand,generate,and interpret human language by analyzing extensive text *** potential integration into clinical settings offers a promising avenue that could transform clinical diagnosis and decision-making processes in the future(Thirunavukarasu et al.,2023).This article aims to provide an in-depth analysis of LLMs’current and potential impact on clinical *** ability to generate differential diagnosis lists underscores their potential as invaluable tools in medical practice and education(Hirosawa et al.,2023;koga et al.,2023).

关键词： image diagnosis text

Treatment of a densely fused fissure during thoracoscopic right middle lobectomy

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Open Journal of Pediatrics 2013年第2期3卷 105-107页

作者： hiroyuki koga Kenji Suzuki Tadaharu Okazaki Kinya Nishimura Geoffrey J. Lane Atsuyuki Yamataka Department of Anesthesiology Juntendo University School of Medicine Tokyo Japan Department of Pediatric General and Urogenital Surgery Juntendo University School of Medicine Tokyo Japan Department of Thoracic General Surgery Juntendo University School of Medicine Tokyo Japan

Aim: To report a case of fused fissure between the right upper and middle lobes that we treated using a surgical stapler rather than a Ligasure device for the benefit of creating a better division between the right upper and middle lobes and to effectively seal the lung parenchyma. Case: A 2-year-old girl with congenital cystic adenomatoid malformation of the right middle lobe (RML) was referred to our institution for further management after a series of infections. The vein of the RML, which drains into the superior pulmonary vein, was isolated and divided using endoclips. The bronchus was then exposed and divided using endo-clips. The arteries of the RML could be identified and ligated, allowing a line demarcating the major fissure to be identified and dissected. A stapler device was then used to seal the lung parenchyma and create a division between the right upper and middle lobes. She is currently well after follow-up of 16 months, with no episodes of respiratory distress or recurrence of symptoms. Conclusion: Our technique for dividing the pulmonary vein, then the bronchus, then the pulmonary artery and finally the fused fissure is safe and could be applied whenever fused fissures are encountered during thoracoscopic pulmonary lobectomy.

关键词： Thoracoscopic Surgery Pulmonary Lobectomy Fused Fissure Surgical Stapler

HYDRATION AND PHASE SEPARATION OF TEMPERATURE-SENSITIVE WATER-SOLUBLE POLYMERS

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Chinese Journal of Polymer Science 2011年第1期29卷 13-21页

作者： Fumihiko Tanaka Tsuyoshi koga hiroyuki Kojima Francoise M.Winnik Department of Polymer Chemistry Graduate School of EngineeringKyoto University Department of Chemistry and Faculty of Pharmacy University of Montréal

Collapse of a poly（N-isopropylacrylamide）（PNIPAM） chain upon heating and phase diagrams of aqueous PNIPAM solutions with very fiat LCST phase separation line are theoretically studied on the basis of cooperative dehydration （simultaneous dissociation of bound water molecules in a group of correlated sequence）, and compared with the experimental observation of temperature-induced coil-globule transition by light scattering methods. The transition becomes sharper with the cooperativity parameter σ of hydration. Reentrant coil-globule-coil transition in mixed solvent of water and methanol is also studied from the viewpoint of competitive hydrogen bonds between polymer-water and polymer-methanol. The downward shift of the cloud-point curves （LCST cononsolvency） with the mole fraction of methanol due to the competition is calculated and compared with the experimental data. Aqueous solutions of hydophobically-modified PNIPAM carrying short alkyl chains at both chain ends （telechelic PNIPAM） are theoretically and experimentally studied. The LCST of these solutions is found to shift downward along the sol-gel transition curve as a result of end-chain association （association-induced phase separation）, and separate from the coil-globule transition line. Associated structures in the solution, such as flower micelles, mesoglobules and higher fractal assembly, are studied by USANS with theoretical modeling of the scattering function.

关键词： Cooperative dehydration LCST phase separation Poly(N-isopropylacrylamide) Cononsolvency Coil-globule transition Flower micelle.

Microbiota in the stomach and application of probiotics to gastroduodenal diseases

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World Journal of Gastroenterology 2022年第47期28卷 6702-6715页

作者： Yasuhiro koga Japanese Society for Probiotic Science Isehara 259-1143Japan

The stomach is a hostile environment for most microbes because strong gastric acid kills indigenous ***,the mass of indigenous microbes detected by traditional culturing method in a highly acidic stomach is reported to be very ***,in a stomach with less acidity due to atrophic changes of the gastric mucosa,the number of live gastric microbiota dramatically increases and their composition changes.A probiotic is defined as a live microorganism that,when administered in adequate amounts,confers a health benefit on the *** administration of probiotics to the stomach has thus far been considered impractical,mainly due to the strong acidity in the *** identification of candidate probiotic strains with sufficient resistance to acidity and the ability to achieve close proximity to the gastric mucosa could enable the application of probiotics to the *** utilization of probiotics alone for Helicobacter pylori(***)infection significantly improves gastric mucosal inflammation and decreases the density of *** on the mucosa,although complete eradication of *** has not yet been *** use of probiotics in combination with antimicrobial agents significantly increases the *** eradication rate,especially when the *** strains are resistant to antimicrobial *** *** has been considered the most important pathogenic bacterium for the development of gastric cancer,bacteria other than *** are also suggested to be causative pathogens that promote the development of gastric cancer,even after the eradication of *** *** Gram-negative bacteria in the stomach with weak acidity accompanying atrophic gastritis may perpetuate gastric mucosal inflammation and accelerate carcinogenic progression,even after *** *** restore the acidity in this stomach environment and may therefore prevent the development of gastric cancer by termination of Gram-negative ba

关键词： Stomach Microbiota Probiotics Helicobacter pylori Post-eradication gastric cancers Functional dyspepsia

Beyond management to conquer life-threatening tumor thrombosis in hepatocellular carcinoma

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Hepatobiliary Surgery and Nutrition 2022年第5期11卷 773-774页

作者： Hironori koga Division of Gastroenterology Department of MedicineKurume University School of MedicineKurumeJapan

Hepatic vein tumor thrombus(HVTT),together with portal vein tumor thrombus(PVTT),is a major determinant of survival outcome in patients with advanced hepatocellular carcinoma(HCC).HVTT can be an oncologic emergency,especially when it invades beyond IVC into the right atrium,where it can cause sudden death from pulmonary *** studies using large numbers of patients are generally difficult in this relatively rare and urgent *** this context,the multicenter study conducted by Chen et *** significant,albeit retrospective(1).

关键词： hepatocellular thrombus al.

Spin Interference in Rectangle Loop Based on Rashba and Dresselhaus Spin-Orbit Interactions

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Chinese Physics Letters 2009年第12期26卷 210-212页

作者：倪佳婷梁小婉陈斌 T.koga Department of Physics Hangzhou Normal University Hangzhou 310018 Department of Physics Oklahoma State University Stillwater 74075 USA Zhejiang Economic and Trade Polytechnic Hangzhou 310036 Division of Electronics for Informatics Graduate School of Information Science and Technology Hokkaido University N-14 W-9 Kita-ku Sapporo Hokkaido 060-0814 Japan CREST Japan Science and Technology Agency 4-1-8 Honchou Kawaguchi Saitama 332-0012 Japan

We demonstrate the amplitude and spin polarization of AAS oscillation changing with Rashba spin-orbit interaction （SOI） and Dresselhaus SOI. The amplitude and spin polarization of AB oscillation changing with Rashba SOI and Dresselhaus SOI are demonstrated as well. The ideal quasi-one-dimensional square loop does not exist in reality, therefore to match the experiment better we should consider the shape of the rectangle loop in theory.

关键词： Chinese climate network complex systems small world community

Current clinical management of gastrointestinal stromal tumor

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World Journal of Gastroenterology 2018年第26期24卷 2806-2817页

作者： Kazuya Akahoshi Masafumi Oya Tadashi koga Yuki Shiratsuchi Department of Gastroenterology Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Department of Surgery Aso Iizuka Hospital

Gastrointestinal stromal tumors(GISTs) are the most common malignant subepithelial lesions(SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1(DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography(EUS) and EUS-guided fine needle aspiration(EUSFNA) are critical for an accurate diagnosis of SELs. EUSFNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.

关键词： Gastrointestinal stromal tumor Endoscopic ultrasonography-guided fine needle aspiration Endoscopic ultrasonography Diagnosis Therapy