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Clinical benefit of radiation therapy and metallic stenting for unresectable hilar cholangiocarcinoma

World Journal of Gastroenterology 2012年第19期18卷 2364-2370页

作者： Hiroyuki Isayama Takeshi Tsujino Yousuke Nakai Takashi Sasaki Keiichi Nakagawa Hideomi yamashita Taku Aoki kazuhiko Koike Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Radiology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Division of Hepato-Biliary-Pancreatic and Transplantation Surgery Department of SurgeryGraduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

AIM:To determine the efficacy of external beam radiotherapy(EBRT),with or without intraluminal brachytherapy(ILBT),in patients with non-resected locally advanced hilar cholangiocarcinoma.METHODS:We analyzed 64 patients with locally advanced hilar cholangiocarcinoma,including 25 who underwent resection(17 curative and 8 non-curative),28 treated with radiotherapy,and 11 who received best supportive care(BSC).The radiotherapy group received EBRT(50 Gy,30 fractions),with 11 receiving an additional 24 Gy(4 fractions) ILBT by iridium-192 with remote after loading.ILBT was performed using percutaneous transhepatic biliary drainage(PTBD) route.Uncovered metallic stents(UMS) were inserted into nonresected patients with obstructive jaundice,with the exception of four patients who received percutaneous transhepatic biliary drainage only.UMS were placed endoscopically or percutaneously,depending on the initial drainage procedure.The primary endpoints were patient death or stent occlusion.Survival time of patients in the radiotherapy group was compared with that of patients in the resection and BSC groups.Stent patency was compared in the radiotherapy and BSC groups.RESULTS:No statistically significant differences in patient characteristics were found among the resection,radiotherapy,and BSC groups.Three patients in the radiotherapy group and one in the BSC group did not receive UMS insertion but received PTBD alone;cholangitis occurred after endoscopic stenting,and patients were treated with PTBD.A total of 16 patients were administered additional systemic chemotherapy(5-fluorouracil-based regimen in 9,S-1 in 6,and gemcitabine in 1).Overall survival varied significantly among groups,with median survival times of 48.7 mo in the surgery group,22.1 mo in the radiotherapy group,and 5.7 mo in the BSC group.Patients who underwent curative resection survived significantly longer than those who were not candidates for surgery(P = 0.0076).Cumulative survival in the radiotherapy group was significantly longer than in the BSC group(P =

关键词：金属支架放射治疗手术切除胆管平均存活时间肝临床癌

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Factors associated with residual gastroesophageal reflux disease symptoms in patients receiving proton pump inhibitor maintenance therapy

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World Journal of Gastroenterology 2017年第11期23卷 2060-2067页

作者： Fumiaki Kawara Tsuyoshi Fujita Yoshinori Morita Atsushi Uda Atsuhiro Masuda Masaya Saito Makoto Ooi Tsukasa Ishida Yasuyuki Kondo Shiei Yoshida Tatsuya Okuno Yoshihiko Yano Masaru Yoshida Hiromu Kutsumi Takanobu Hayakumo Kazuhiko Yamashita Takeshi Hirano Midori Hirai Takeshi Azuma Division of Gastroenterology Department of Internal MedicineKobe University Graduate School of Medicine Department of Pharmacy Kobe University Hospital

AIM To elucidate the factors associated with residual gastroesophageal reflux disease(GERD) symptoms in patients receiving proton pump inhibitor(PPI) maintenance therapy in clinical practice.METHODS The study included 39 GERD patients receiving maintenance PPI therapy. Residual symptoms were assessed using the Frequency Scale for Symptoms of GERD(FSSG) questionnaire and the Gastrointestinal Symptom Rating Scale(GSRS). The relationships between the FSSG score and patient background factors, including the CYP2C19 genotype, were analyzed.RESULTS The FSSG scores ranged from 1 to 28 points(median score: 7.5 points), and 19 patients(48.7%) had a score of 8 points or more. The patients' GSRS scores were significantly correlated with their FSSG scores(correlation coefficient = 0.47, P < 0.005). In erosive esophagitis patients, the FSSG scores of the CYP2C19 rapid metabolizers(RMs) were significantly higher than the scores of the poor metabolizers and intermediate metabolizers(total scores: 16.7 ± 8.6 vs 7.8 ± 5.4, P < 0.05; acid reflux-related symptom scores: 12 ± 1.9 vs 2.5 ± 0.8, P < 0.005). In contrast, the FSSG scores of the CYP2C19 RMs in the non-erosive reflux disease patients were significantly lower than those of the other patients(total scores: 5.5 ± 1.0 vs 11.8 ± 6.3, P < 0.05; dysmotility symptom-related scores: 1.0 ± 0.4 vs 6.0 ± 0.8, P < 0.01). CONCLUSION Approximately half of the GERD patients receiving maintenance PPI therapy had residual symptoms associated with a lower quality of life, and the CYP2C19 genotype appeared to be associated with these residual symptoms.

关键词： Gastroesophageal reflux disease CYP2C19 FSSG Residual symptoms Proton pump inhibitor

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使用蒙特卡罗模型分析^111In对^90Y韧致辐射SPECT显像的影响

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中华核医学与分子影像杂志 2017年第8期37卷 522-522页

作者：唐军 Hiroaki Shiba Akihiko Takahashi Shingo Baba kazuhiko Himuro Yasuo yamashita Masayuki Sasaki 苏州大学附属第二医院核医学科 215004 Division of Medical Quantum Science Department of Health Sciences Graduate School of Medical Sciences Kyushu University Fukuoka Japan

【摘要】目的用于治疗恶性淋巴瘤的^90Y-替伊莫单克隆抗体（^90Y—Zevalin，^90Y-泽娃灵）由于^90Y衰变放出的β粒子具有韧致辐射，故可用于SPECT显像。但使用如Y-泽娃灵前，会行^111In-泽娃灵显像以判断是否为^90Y-泽娃灵治疗的适应证... 详细信息

【摘要】目的用于治疗恶性淋巴瘤的^90Y-替伊莫单克隆抗体（^90Y—Zevalin，^90Y-泽娃灵）由于^90Y衰变放出的β粒子具有韧致辐射，故可用于SPECT显像。但使用如Y-泽娃灵前，会行^111In-泽娃灵显像以判断是否为^90Y-泽娃灵治疗的适应证，而^111In-泽娃灵发出的γ射线会干扰^90Y的韧致辐射显像。

关键词： ^90Y ^111In 单光子发射计算机断层(SPECT) 蒙特卡罗模型替伊莫单克隆抗体

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Copper Accumulates in Hemosiderins in Livers of Patients with Iron Overload Syndromes

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Journal of Clinical and Translational Hepatology 2015年第2期3卷 85-92页

作者： Yukiya Ono Masatoshi Ishigami kazuhiko Hayashi Shinya Wakusawa Hisao Hayashi Kotaro Kumagai Natsuko Morotomi Tetsuji yamashita Miwa Kawanaka Minemori Watanabe Hiroaki Ozawa Mayumi Tai Hiroaki Miyajima Kentarou Yoshioka Yoshiki Hirooka Hidemi Goto Department of Gastroenterology Nagoya University Graduate School of Medicine Nagoya Japan Department of Medical Laboratory Sciences Nagoya University Graduate School of Medicine Nagoya Japan Department of Medicine Aichi Gakuin University School of Pharmacy Nagoya Japan Digestive Disease and Lifestyle Related Disease Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan Department of Internal Medicine Moji Hospital Kitakyushu Japan Department of Medicine Yoshida Hospital Matsuyama Japan General Internal Medicine 2 Kawasaki Hospital Kawasaki Medical School Okayama Japan Department of Endocrinology and Diabetes Okazaki City Hospital Okazaki Japan Department of Pathology Okazaki City Hospital Okazaki Japan Department of Gastroenterology Fukushima Rohsai Hospital Fukushima Japan First Department of Medicine Hamamatsu University School of Medicine Hamamatsu Japan Department of Liver Biliary Tract and Pancreas Diseases Fujita Health University Toyoake Japan

In biology,redox reactions are essential and sometimes harmful,and therefore,iron metabolism is tightly regulated by cuproproteins.Since the state of copper in iron overload syndromes remains unclear,we investigated whether copper metabolism is altered in these syndromes.Eleven patients with iron overload syndromes participated in this study.The clinical diagnoses were aceruloplasminemia (n=2),hemochromatosis (n=5),ferroportin disease (n=2),and receiving excess intravenous iron supplementation (n=2).Liver specimens were analyzed using a light microscope and transmission electron microscope equipped with an X-ray analyzer.In addition to a large amount of iron associated with oxygen and phosphorus,the iron-rich hemosiderins of hepatocytes and Kupffer cells contained small amounts of copper and sulfur,regardless of disease etiology.Two-dimensional imaging clearly showed that cuproproteins were distributed homogenously with iron complexes within hemosiderins.Copper stasis was unlikely in noncirrhotic patients.The enhanced induction of cuproproteins by excess iron may contribute to copper accumulation in hemosiderins.In conclusion,we have demonstrated that copper accumulates in hemosiderins in iron overload conditions,perhaps due to alterations in copper metabolism.

关键词： Aceruloplasminemia Cuproprotein induction Ferroportin disease Hemochromatosis Hemosiderin Iron copper interaction Iron overload syndromes

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