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Stratifying the risk of lymph node metastasis in undifferentiated-type early gastric cancer

World Journal of Gastroenterology 2015年第9期21卷 2683-2692页

作者： Yukiko Asakawa Masahiko Ohtaka Shinya Maekawa Mitsuharu Fukasawa Yasuhiro Nakayama Tatsuya Yamaguchi Taisuke Inoue Tomoyoshi Uetake Minoru Sakamoto Tadashi Sato Yoshihiko Kawaguchi Hideki Fujii Kunio Mochizuki masao hada Toshio Oyama Tomotaka Yasumura Kosaku Omata Atsushi Nishiyama Keiichi Naito Hideo Hata Yoshiaki Haba Kazuyuki Miyata Haruhisa Saitoh Yoichi Yamadera Kazuo Miura Akira Kawaoi Tohru Abe Hajime Tsunoda Yuji Honda Masayuki Kurosaki Nobuyuki Enomoto First Department of Internal Medicine Faculty of MedicineUniversity of YamanashiYamanashi 409-3898Japan First Department of Surgery Faculty of MedicineUniversity of YamanashiYamanashi 409-3898Japan Department of Pathology Faculty of MedicineUniversity of YamanashiYamanashi 409-3898Japan Department of Surgery Yamanashi Prefectural Central HospitalYamanashi 400-8506Japan Department of Pathology Yamanashi Prefectural Central HospitalYamanashi 400-8506Japan Department of Surgery Social Insurance Yamanashi HospitalYamanashi 400-0025Japan Department of Pathology Social Insurance Yamanashi HospitalYamanashi 400-0025Japan Department of General Surgery Kofu Kyoritsu HospitalYamanashi 400-0034Japan Department of Pathology Kofu Kyoritsu HospitalYamanashi 400-0034Japan Department of Surgery Kofu Municipal HospitalYamanashi 400-0832Japan Department of Pathology Kofu Municipal HospitalYamanashi 400-0832Japan Department of Surgery Yamanashi Kosei HospitalYamanashi 405-0033Japan Department of Surgery Kanoiwa General HospitalYamanashi 405-0018Japan Department of Pathology Kanoiwa General HospitalYamanashi 405-0018Japan Department of Surgery Social Insurance Kajikazawa HospitalYamanashi 400-0601Japan Department of Surgery Kofu National HospitalYamanashi 400-0006Japan Department of Surgery Fujiyoshida Municipal Medical CenterYamanashi 403-0005Japan Division of Gastroenterology and Hepatology Musashino Red Cross HospitalTokyo 180-0023Japan

AIM:To study how lymph node metastasis(LNM) risk is stratified in undifferentiated-type early gastric cancer(undiff-EGC) dependent on combinations of risk ***:Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined *** clinicopathological factors of patient age,location,size,an endoscopic macroscopic tumor form,ulceration,depth,histology,lymphatic involvement(LI) and venous involvement(VI),LNM risk was examined and stratified by conventional statistical analysis and datamining ***:LNM was positive in 44 of 567 cases(7.8%).Univariate analysis revealed > 2 cm,protrusion,submucosal(sm),mixed type,LI and VI as significant prognostic factors and > 2 cm and LI-positive were independent factors by multivariate *** preoperatively evaluable factors excluding LVI,sm and > 2 cm were independent *** to the depth and size,cases were categorized into the low-risk group [m and ≤ 2 cm,0%(LNM incidence)],the moderaterisk group(m and > 2 cm,5.6%; and sm and ≤ 2 cm,6.0%),and the high-risk group(sm and > 2 cm,19.3%).On the other hand,LNM occurred in 1.4% in all LI-negative cases,greatly lower than 28.2% in all LI-positive cases,and LNM incidence was low in LInegative cases even in the moderate- and high-risk ***:LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size *** these factors,LI was the most significantly correlated factor.

关键词： Undifferentiated-type early gastric cancer Lymph n

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Low-molecular-weight dextran for optical coherence tomography may not be protective against kidney injury in patients with renal insufficiency

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World Journal of Nephrology 2021年第2期10卷 8-20页

作者： Toru Misawa Tomoyo Sugiyama Yoshihisa Kanaji Masahiro Hoshino masao Yamaguchi Masahiro hada Tatsuhiro Nagamine Kai Nogami Yumi Yasui Eisuke Usui Tetsumin Lee Taishi Yonetsu Tetsuo Sasano Tsunekazu Kakuta Department of Cardiovascular Medicine Tsuchiura Kyodo General HospitalIbaraki 300-0028Japan Department of Interventional Cardiology Tokyo Medical and Dental UniversityTokyo 113-8519Japan Department of Cardiovascular Medicine Tokyo Medical and Dental UniversityTokyo 113-8519Japan

BACKGROUND Low-molecular-weight dextran(LMWD)is considered a safe alternative to contrast media for blood displacement during optical coherence tomography(OCT)*** To investigate whether the use of LMWD for OCT is protective against kidney injury in patients with advanced renal *** In this retrospective cohort study,we identified 421 patients with advanced renal insufficiency(estimated glomerular filtration rate<45 mL/min/1.73 m2)who underwent coronary angiography or percutaneous coronary intervention;79 patients who used additional LMWD for OCT imaging(LMWD group)and 342 patients who used contrast medium exclusively(control group).We evaluated the differences between these two groups and performed a propensity score-matched subgroup *** The median total volume of contrast medium was 133.0 mL in the control group vs 140.0 mL in the LMWD *** baseline renal function was not statistically different between these two groups,the LMWD group demonstrated a strong trend toward the progression of renal insufficiency as indicated by the greater change in serum creatinine level during the 1-year follow-up compared with the control *** in the LMWD group experienced worsening renal function more frequently than patients in the control *** score matching adjusted for total contrast media volume consistently indicated a trend toward worsening renal function in the LMWD group at the 1-year *** serum creatinine at 1-year follow-up was significantly greater in the LMWD group than that in the control group[0.06(-0.06,0.29)vs-0.04(-0.23,0.08)mg/dL,P=0.001],despite using similar contrast *** OCT using LMWD may not be protective against worsening renal function in patients with advanced renal insufficiency.

关键词： Coronary artery disease Kidney injury Contrast media Dextran Optical coherence tomography Renal insufficiency

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