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Clinical significance of hypoechoic submandibular gland lesions in type 1 autoimmune pancreatitis

World Journal of Gastroenterology 2017年第18期23卷 3295-3300页

作者： Shinichi Takano mitsuharu fukasawa Makoto Kadokura Hiroko Shindo Ei Takahashi Sumio Hirose Yoshimitsu fukasawa Satoshi Kawakami Tadashi Sato Nobuyuki Enomoto First Department of Internal Medicine Faculty of Medicine University of Yamanashi

AIM To assess the role of ultrasonography of submandibular glands(SGs) in the diagnosis of type 1 autoimmune pancreatitis(AIP). METHODS Thirty-seven patients who were definitively diagnosed with type 1 AIP according to the international consensus diagnostic criteria(ICDC) for AIP at our institution between December 1990 and April 2016 were retrospectively reviewed. Findings by physical examination, ultrasonography, and scintigraphy of SGs were analyzed to reach a diagnosis based on the ICDC for AIP. The efficacy of corticosteroid treatment in the resolution of hypoechoic lesions in SGs was also evaluated by assessment with ultrasonography before and after treatment in 18 cases.RESULTS The sensitivity of multiple hypoechoic lesions in SGs by ultrasonography for the diagnosis of sialadenitis in type 1 AIP(84%) was higher than that of physical examination(46%), scintigraphy(28%), and SGs thickness(49%). Ultrasonographic evidence of hypoechoic lesions in SGs improved the definitive diagnosis of sialadenitis and type 1 AIP by the ICDCcriteria in 11(30%) and 2(5.4%) cases, respectively. Multiple hypoechoic lesions in SGs were resolved or disappear by corticosteroid administration in 14 of 16 cases with hypoechoic lesions in SGs, whereas the ultrasonographic findings in the remaining 2 cases with hypoechoic lesions in SGs and the 2 cases with homogenous SG parenchyma remained unchanged after corticosteroid administration.CONCLUSION SG ultrasonography to detect multiple hypoechoic lesions might be useful for type 1 AIP diagnosis by improving diagnostic accuracy together with the ICDC sialadenitis criteria.

关键词：自体免疫的胰腺炎 Ultrasonography Submandibular 腺国际一致诊断标准 Sialadenitis

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Risk factors for perforation during endoscopic retrograde cholangiopancreatography in post-reconstruction intestinal tract

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World Journal of Clinical Cases 2019年第1期7卷 10-18页

作者： Shinichi Takano mitsuharu fukasawa Hiroko Shindo Ei Takahashi Sumio Hirose Yoshimitsu fukasawa Satoshi Kawakami Hiroshi Hayakawa Hiroshi Yokomichi Makoto Kadokura Tadashi Sato Nobuyuki Enomoto First Department of Internal Medicine Faculty of Medicine University of Yamanashi Yamanashi 409-3898 Japan Department of Health Sciences Interdisciplinary Graduate School and Engineering University of Yamanashi Yamanashi 409-3898 Japan

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy has been a major challenge to gastrointestinal endoscopists with low success rates for reaching the target site as well as high complication rates. The knowledge of ERCP-related risk factors is important for reducing unexpected complications.AIM To identify ERCP-related risk factors for perforation in patients with surgically altered anatomy.METHODS The medical records of 187 patients with surgically altered anatomy who underwent ERCP at our institution between April 2009 and December 2017 were retrospectively reviewed. An analysis of patient data, including age, sex, type of reconstruction, cause of surgery, aim of ERCP, success rate of reaching target site,success rate of procedure, adverse events, type of scope, time to reach the target site, and duration of procedure, was performed. In patients with Billroth-Ⅱ reconstruction, additional potential risk factors were the shape of the inserted scope and whether the anastomosis was antecolic or retrocolic.RESULTS All patients(n = 187) had surgical anatomy, such as Billroth-Ⅰ(n = 22), Billroth-Ⅱ(n = 33), Roux-en-Y(n = 54), Child, or Whipple reconstruction(n = 75). ERCP was performed for biliary drainage in 43 cases(23%), stone removal in 29 cases(16%),and stricture dilation of anastomosis in 59 cases(32%). The scope was unable to reach the target site in 17 cases(9%), and an aimed procedure could not be accomplished in 54 cases(29%). Adverse events were pancreatitis(3%),hyperamylasemia(10%), cholangitis(6%), cholestasis(4%), excessive sedation(1%), perforation(2%), and others(3%). Perforation occurred in three cases, all of which were in patients with Billroth-Ⅱ reconstruction; in these patients, further analysis revealed loop-shaped insertion of the scope to be a significant risk for perforation(P = 0.01).CONCLUSION Risk factors for perforation during ERCP in patients with surgically altered anatomy were Billroth-Ⅱ reconstruction and looping of the scope dur

关键词： Surgically altered anatomy Billroth-Ⅱ Endoscopic retrograde cholangiopancreatography Perforation

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Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

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World Journal of Gastroenterology 2015年第16期21卷 4946-4953页

作者： Ei Takahashi mitsuharu fukasawa Tadashi Sato Shinichi Takano Makoto Kadokura Hiroko Shindo Yudai Yokota Nobuyuki Enomoto First Department of Internal Medicine Faculty of MedicineUniversity of Yamanashi

AIM:To identify criteria for predicting successful drainage of unresectable malignant hilar biliary strictures(UMHBS) because no ideal strategy currently exists.METHODS:We examined 78 patients with UMHBS who underwent biliary drainage.Drainage was considered effective when the serum bilirubin level decreased by ≥ 50% from the value before stent placement within 2 wk after drainage, without additional intervention.Complications that occurred within 7 d after stent placement were considered as early complications.Before drainage, the liver volume of each section(lateral and medial sections of the left liver and anterior and posterior sections of the right liver) was measured using computed tomography(CT) volumetry.Drained liver volume was calculated based on the volume of each liver section and the type of bile duct stricture(according to the Bismuth classification).Tumor volume, which was calculated by using CT volumetry, was excluded from the volume of each section.Receiver operating characteristic(ROC) analysis was performed to identify the optimal cutoff values for drained liver volume.In addition, factors associated with the effectiveness of drainage and early complications were evaluated.RESULTS:Multivariate analysis showed that drained liver volume [odds ratio(OR) = 2.92, 95%CI:1.648-5.197; P < 0.001] and impaired liver function(with decompensated liver cirrhosis)(OR = 0.06, 95%CI:0.009-0.426; P = 0.005) were independent factors contributing to the effectiveness of drainage.ROC analysis for effective drainage showed cutoff values of 33% of liver volume for patients with preserved liver function(with normal liver or compensated livercirrhosis)and 50%for patients with impaired liver function(with decompensated liver cirrhosis).The sensitivity and specificity of these cutoff values were82%and 80%for preserved liver function,and 100%and 67%for impaired liver function,respectively.Among patients who met these criteria,the rate of effective drainage among those with preserved liver function and impaired liver func

关键词： Biliary drainage Computed tomographyvolumetry Hilar biliary stricture Cholangiocarcinoma Liver function Cholangitis

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Efficacy and Tolerability of Second-Line Metronidazole Triple Therapy Using Vonoprazan for Helicobacter pylori Eradication in Japan—Comparative Study: Vonoprazan vs. Proton Pump Inhibitors

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Open Journal of Gastroenterology 2018年第1期8卷 27-38页

作者： Masahiko Ohtaka Mika Miura Mitsuhiko Hanawa Yuichi Hirose Atsuko Kitahashi Naoki Imamura Ikko Watanabe Kazuhiko Takaso Naoki Shimura Yoshioki Yoda Ichiro Takayama mitsuharu fukasawa Nobuyuki Enomoto Yamanashi Koseiren Health Care Center Yamanashi Japan First Department of Internal Medicine Graduate School of Medical and Engineering Science University of Yamanashi Yamanashi Japan Health Care Center University of Yamanashi Yamanashi Japan

Aim: To investigate the efficacy and tolerability of second-line metronidazole triple therapy with vonoprazan (VPZ) for Helicobacter pylori (H. pylori). Methods: We retrospectively reviewed medical records of patients who experienced clarithromycin triple therapy failure and were treated with second-line (20 mg VPZ (n = 274)/30 mg lansoprazole (n = 323) or 10 mg rabeprazole (n = 141) twice daily, 750 mg amoxicillin twice daily, 250 mg metronidazole twice daily for 7 days) eradication therapies. Successful eradication rates were compared between two groups: those receiving VPZ and those receiving a proton pump inhibitor (PPI). Adverse events were also investigated. Results: Successful second-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.9% and 92.4% for VPZ therapy and 83.6% and 93.3% for PPI therapy. There were no significant differences between treatment groups. The eradication rates in those who had received first-line VPZ therapy previously according to ITT and PP analysis were 75.2% and 88.1%, respectively;in contrast, values were 82.5% and 95.4%, respectively, for those who had received first-line PPI therapy previously. In second-line therapy, the overall adverse event rate for VPZ therapy was the same as for PPI therapy. Conclusions: The efficacy and tolerability of metronidazole-containing second-line triple therapy with VPZ or a PPI were equivalent.

关键词： Vonoprazan Metronidazole Proton Pump Inhibitor Second-Line Eradication Helicobacter pylori

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Effects of General Anesthesia on the Results of Cardiac Catheterization in Pediatric Patients with Ventricular Septal Defect

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Congenital Heart Disease 2023年第2期18卷 235-243页

作者： Kiyotaka Go Taichi Kato Machiko Kito Yoshihito Morimoto Satoru Kawai Hidenori Yamamoto Yoshie fukasawa Kazushi Yasuda Department of Pediatric Cardiology Aichi Children’s Health and Medical CenterObu474-8710Japan Department of Pediatrics Nagoya University Graduate School of MedicineNagoya466-8560Japan

Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics,although few studies have examined these effects.The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters.Methods:This study retrospectively evaluated consecutive patients with ventricular septal defect(VSD)below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center,who were divided into age-and VSD diameter-matched general anesthesia(GA)and monitored anesthesia care(MAC)under the natural airway groups(n=40 each),for comparison of hemodynamic parameters.Results:In the GA group,arterial blood pH and arterial partial pressure of oxygen were significantly higher(p<0.01),whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group(p<0.01).Mean pulmonary artery pressure(p<0.05)and systemic blood pressure(p<0.01)were lower in the GA group.Pulmonary vascular resistance index(p<0.01)and systemic vascular resistance index(p<0.01)were also significantly lower in the GA group than the MAC group.There were no significant differences in pulmonary blood flow index,systemic blood flow index,and pulmonary/systemic blood flow ratio between the two groups.Conclusions:Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC.In particular,when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management,consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.

关键词： Ventricular septal defect cardiac catheterization general anesthesia monitored anesthesia care

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Recent advances in transthyretin amyloidosis therapy

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Translational Neurodegeneration 2014年第1期3卷 131-140页

作者： mitsuharu Ueda Yukio Ando Department of Diagnostic Medicine Graduate School of Medical SciencesKumamoto University1-1-1 Honjo860-0811 KumamotoJapan Department of Neurology Graduate School of Medical SciencesKumamoto University1-1-1 Honjo860-0811 KumamotoJapan

Mutant(MT)forms of transthyretin(TTR)cause the most common type of autosomal-dominant hereditary systemic amyloidosis—familial amyloidotic polyneuropathy(FAP).Until 20 years ago,FAP was thought to be an endemic disease,but FAP is known to occur worldwide.To date,more than 130 mutations in the TTR gene have been reported.Genotype-phenotype correlations are seen in FAP,and some variation in clinical presentation is often observed in individual kindreds with the same mutation and even among family members.Of the pathogenic TTR mutations,Val30Met was the first to be identified and is the most frequent known mutation found throughout the world.Studies of patients with FAP amyloidogenic TTR(ATTR)Val30Met documented sensorimotor polyneuropathy,autonomic dysfunction,heart and kidney failure,gastrointestinal tract(GI)disorders,and other symptoms leading to death,usually within 10 years of the onset of disease.Diagnosis is sometimes delayed,especially in patients without a clear family history and typical clinical manifestations,since diagnosis requires various studies and techniques such as histopathology,genetic testing,and mass spectrometry.For treatment of FAP,liver transplantation(LT)reportedly halts the progression of clinical manifestations.Exchange of an FAP patient’s diseased liver with a healthy liver causes MT TTR in the body to be replaced by wild-type(WT)TTR.Although clinical evaluations indicated that progression of other clinical symptoms such as peripheral neuropathy,GI symptoms,and renal involvement usually halted after LT in FAP ATTR Val30Met patients,recent studies suggested that LT failed to prevent progression of cardiac amyloidosis in FAP ATTR Val30Met patients after LT,with this failure reportedly being due to continued formation of amyloid that derived mainly from WT TTR secreted from the transplanted non-mutant liver graft.In recent years,many therapeutic strategies have been proposed,and several ongoing therapeutic trials involve,for example,stabilizers of TTR tetramers(tafamidis and diflunisal)an

关键词： Transthyretin Amyloidosis Familial amyloidotic polyneuropathy Senile systemic amyloidosis,Immunotherapy Gene therapy

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

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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 factors.METHODS:Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined retrospectively.Using 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 analysis.RESULTS: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 analysis.In preoperatively evaluable factors excluding LVI,sm and > 2 cm were independent factors.According 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 groups.CONCLUSION:LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size postoperatively.Among these factors,LI was the most significantly correlated factor.

关键词： Undifferentiated-type early gastric cancer Lymph n

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PREPARATION OF PHOTOFUNCTIONAL POLYMER THIN FILMS BY LANGMUIR-BLODGETT TECHNIQUE

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Chinese Journal of Polymer Science 1999年第1期17卷 75-79页

作者： Tokuji Miyashita Tatsuo Taniguchi Yoshihito fukasawa Institute for Chemical Reaction Science Tohoku University Sendai 980-8577 JapanInstitute for Chemical Reaction Science Tohoku University Sendai 980-8577 JapanInstitute for Chemical Reaction Science Tohoku University Sendai 980-8577 Japan

Polymer LB films containing photofuntional groups were prepared by the copolymerization of N-dodecylacrylamide (DDA), which has an excellent property to form a stable monolayer and LB multilayerswith photofunctional monomers. Tris(2, 2'-bipyridine) ruthenium complex, Ru(bpy)_3^(2+), one of the most well-known redox-active sensitizer, was incorporated into the DDA copolymer. The photogalvanic effect based onthe photoinduced electron transfer using the ruthenium complex in the polymer LB monolayer was discussed.

关键词： Photofunctional polymer Polymer LB film, N-Dodecylacrylamide Ruthenium complex

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Distribution and Possible Function of Cannabinoid Receptor Subtype 1 in the Human Prostate

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Open Journal of Urology 2013年第2期3卷 102-109页

作者： Manabu Kamiyama Mizuya fukasawa Yoshio Takihana Norifumi Sawada Hiroshi Nakagomi mitsuharu Yoshiyama Isao Araki Masayuki Takeda Department of Urology Interdisciplinary Graduate School of Medicine and Engineering University of Yamanashi Chuo City Japan Department of Urology Shiga University of Medical Science Ohtsu City Japan

Background: Cannabinoid receptor subtype 1 (CB1) has a relationship to the proliferation of various cells including malignant tumoral cells. We investigated and compared the expression of CB1 in benign and malignant human prostate tissues and in benign and malignant human prostate cell lines, as well as its function for the proliferation of human prostate cancer cells. Methods: Real-time quantitative PCR was performed to compare its expressions in human prostate tissues (normal, benign hyperplasia, and cancer) and prostate cell lines (3 normal and 3 malignant). For localization of CB1, immunofluorescent staining with rabbit anti-CB1 polyclonal antibodies and tetramethyl isothiocyanate (TRITC)-labeled swine anti-rabbit immunoglobulin (DAKO) were used under fluorescence microscope. To further analyze whether cell death was induced by anandamide (non-selective agonist for CB1/CB2) via a receptor dependent mechanism, the viability of DU145 cells, which is known as androgen-insensitive prostate cancer cell, was measured using MTT assay. Results: CB1mRNA was found to be expressed in the all 3 human prostate tissues, however, CB1 protein was expressed in BPH and low grade malignant PC tissues, but not in high grade malignant PC tissues. CB1 as for cell lines, the expression of CB1 was low in malignant cell lines except for DU145. Anandamide elicited cell death, which was significantly inhibited by AM251 (selective antagonist for CB1), indicating that cell death induced by anandamide in DU145 cells was mediated by CB1. Anandamide time-dependently elicits up-regulation of CB1 in DU145 cells. Conclusions: CB1 may be an inhibitory regulator of androgen-insensitive human prostate cancer epithelial cell growth.

关键词： Prostate Cancer Prostate Cell Cannabinoid Receptor CB1

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Configuration of Shock Waves in Two-Dimensional Overexpanded Jets

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Journal of Thermal Science 2003年第4期12卷 294-298页

作者： Masashi Kashitani Yutaka Yamaguchi Yoshiaki Miyazato mitsuharu Masuda Kazuyasu Matsuo Department of Aerospace Engineering National Defense Academy 1-10-20 Hashirimizu Yokosuka Kanagawa 239-8686 JapanDepartment of Aerospace Engineering National Defense Academy 1-10-20 Hashirimizu Yokosuka Kanagawa 239-8686 JapanDepartment of Energy and Environmental Engineering Kyushu University 6-1 Kasuga-Kouen Kasuga Fukuoka 816-8580 JapanDepartment of Energy and Environmental Engineering Kyushu University 6-1 Kasuga-Kouen Kasuga Fukuoka 816-8580 JapanDepartment of Mechanical Systems and Environmental Engineering The University of Kitakyushu 1-1 Hibikino Wakamatsu-ku Kitakyushu Fukuoka 808-0315 Japan

An experimental and analytical study has been carried out to obtain the clear understanding of a shock wave transition associated with a steady two-dimensional overexpanded flow. Two-dimensional inviscid theory with respect to a shock wave reflection is used in the present study on the characteristic of shock waves. The results obtained from the flow analysis are compared with those obtained from flow visualizations. It is shown that in the region of regular reflection, the angle of an incident shock wave becomes lower than that calculated by two shock theory with an increment in the ratio PJPb of the nozzle exit pressure Pc to the back pressure Pb. It is indicated that the configuration of shock waves in overexpanded jets is influenced by the divergent angle at the nozzle exit. Also it is shown from the flow visualization that a series of shock waves move into the nozzle inside with a decrease in pressure ratio Pc/Pb, even if the Pc/Pb is under overexpanded conditions.

关键词：振动波超声喷管可压缩流体膨胀喷射空气动力学

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