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

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

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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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Pancreatic cancer secondary to intraductal papillary mucinous neoplasm with collision between gastric cancer and B-cell lymphoma: A case report

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World Journal of Clinical Cases 2021年第10期9卷 2400-2408页

作者： Yu-Hong Ma Tatsuya Yamaguchi Tomoki Yasumura Toru Kuno Shoji Kobayashi Takashi Yoshida Takeshi Ishida Yasuaki Ishida Shinya Takaoka Jiang-Lin Fan Nobuyuki Enomoto Department of Gastroenterology Ningxia Hui Autonomous Region People’s HospitalYinchuan 750021Ningxia Hui Autonomous RegionChina Department of the First Internal Medicine Faculty of MedicineUniversity of YamanashiChuo 409-3898YamanashiJapan Department of Molecular Pathology Interdisciplinary Graduate School of Medicine and EngineeringUniversity of YamanashiChuo 409-3898YamanashiJapan

BACKGROUND Patients with intraductal papillary mucinous neoplasm(IPMN)have an increased risk of pancreatic and extrapancreatic malignancies.Lymphomas are rare extrapancreatic malignancies,and in situ collisions of early gastric cancer and diffuse large B-cell lymphoma(DLBCL)are even rarer.Here,we report the first case of pancreatic cancer comorbid with in situ collision of extrapancreatic malignancies(early gastric cancer and DLBCL)in a follow-up IPMN patient.Furthermore,we have made innovations in the treatment of such cases.CASE SUMMARY An 81-year-old Japanese female diagnosed with IPMN developed elevated carbohydrate antigen(CA)19-9 levels during follow-up.Because her CA19-9 levels continued to rise,endoscopic ultrasound(EUS)was performed and revealed a suspicious lesion at the pancreatic tail.However,lesions in the pancreas were not found by computed tomography,magnetic resonance imaging,or endoscopic retrograde cholangiopancreatography.To make an exact pathological diagnosis,EUS-guided fine needle aspiration was performed.To our supprise,early gastric cancer was found in preoperative gastroscopy.The gastric cancer was completely resected through endoscopic submucosal dissection before postoperative pathology identified early adenocarcinoma collided with DLBCL.Subsequent EUS-guided fine needle aspiration provided pathological support forthe pancreatic cancer diagnosis, and then laparoscopic distal pancreatectomy andsplenectomy were performed. CA19-9 levels returned to normal postoperatively.CONCLUSION Endoscopic submucosal dissection is appropriate for submucosal lymphomas inpatients intoleratant of chemotherapy. EUS can detect small IPMN-relatedpancreatic tumors.

关键词： Stomach neoplasms Pancreatic intraductal neoplasms Pancreatic neoplasms B-cell lymphoma Treatment Case report

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Liquefaction and post-liquefaction behaviors of sands affected by immersion-induced degradation of crushed mudstone

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Journal of Rock Mechanics and Geotechnical Engineering 2024年第5期16卷 1799-1812页

作者： Tadao enomoto Graduate School of Science and Engineering Ibaraki University4-12-1Naka-narusawa-choHitachiIbaraki316-8511Japan

A series of undrained triaxial tests was conducted to investigate the effect of crushed mudstone with the immersion-induced degradation on the liquefaction and post-liquefaction properties,and the undrained shearing behavior without precedent cyclic-loading histories of sands containing crushed mudstone.The tested materials with a main particle diameter of 2-0.85 mm were prepared by mixing sands and crushed mudstone to reach the prescribed mudstone content defined by dry mass ranging from 0% to 50%.The mixtures were subjected to immersion under a certain stress level and were subsequently tested.In addition,one-dimensional compression tests were also supplementally performed to visually observe the immersion-induced degradation of crushed mudstone.The test results mainly showed that: (1) the liquefaction resistance,the post-liquefaction undrained strength,and the undrained strength without a precedent cyclic-loading history decreased significantly with increasing mudstone content,M c ,up to 20%;(2) even a small amount of crushed mudstone affected these strengths;(3) the above-mentioned large reductions in the strengths were attributed to the immersion-induced degradation of crushed mudstone;(4) at M_(c) >20%,the liquefaction resistance increased while the significant increase in the undrained static strengths with and without precedent cyclic-loading histories was not observed;and (5) the increase in the liquefaction resistance at M_(c) >20% may have been attributed to both the gradual increase in the plasticity and the formation of the soil aggregates among deteriorated crushed mudstone,while the increase in the specimen density did not play an important role in such behavior.

关键词： Liquefaction Post-liquefaction behavior Triaxial test Sands containing crushed mudstone

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The future of bone marrow stromal cell transplantation for the treatment of spinal cord injury

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Neural Regeneration Research 2015年第3期10卷 383-384页

作者： Mitsuhiro enomoto Department of Orthopaedic and Spinal Surgery Graduate SchoolTokyo Medical and Dental University Hyperbaric Medical Center Tokyo Medical and Dental University

Bone marrow stromal cell （BMSC） transplantation therapy is a promising approach for treating spinal cord injury （SCI）, based on a number of experimental and clinical reports （Wright et al., 2011）. BMSCs are a source of neuroregenerative somatic stem cells that are without the potential for tumorigenicity. Although clinical studies of autologous BMSC transplantation have been reported in Asia （fiang et al., 2013; Yoon et al., 2007）, in Japan, it is currently an uncommon procedure and highly controversial as well. This perspective paper provides an overview of the clinical effectiveness of BMSC trans- 191antation and a proposal to enhance its use as a viable therapy.

关键词： BMSCs The future of bone marrow stromal cell transplantation for the treatment of spinal cord injury SCI bone cell

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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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Nonlinear Activation Functions in CNN Based on Fluid Dynamics and Its Applications

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Computer Modeling in Engineering & Sciences 2019年第1期118卷 1-14页

作者： Kazuhiko Kakuda Tomoyuki enomoto Shinichiro Miura Department of Mathematical Information Engineering College of Industrial TechnologyNihon UniversityChiba 275-8575Japan Department of Liberal Arts and Basic Sciences College of Industrial TechnologyNihon UniversityChiba

The nonlinear activation functions in the deep CNN(Convolutional Neural Network)based on fluid dynamics are presented.We propose two types of activation functions by applying the so-called parametric softsign to the negative region.We use significantly the well-known TensorFlow as the deep learning framework.The CNN architecture consists of three convolutional layers with the max-pooling and one fullyconnected softmax layer.The CNN approaches are applied to three benchmark datasets,namely,MNIST,CIFAR-10,and CIFAR-100.Numerical results demonstrate the workability and the validity of the present approach through comparison with other numerical performances.

关键词： Deep learning CNN activation function fluid dynamics MNIST CIFAR-10 CIFAR-100.

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Deciphering tumor-suppressor signaling in flies:Genetic link between Scribble/Dlg/Lgl and the Hippo pathways

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Journal of Genetics and Genomics 2011年第10期38卷 461-470页

作者： Masato enomoto Tatsushi Igaki Department of Cell Biology G-COEKobe University Graduate School of Medicine7-5-1 Kusunoki-choChuo-kuKobe 650-0017Japan Japan Science and Technology Agency PRESTO4-1-8 HonchoKawaguchiSaitama 332-0012Japan

Loss of apico-basal polarity is one of the crucial factors that drives epithelial tumor progression, scribbleldiscs largellethal giant larvae （scrib/dlg/lgl）, a group of apico-basal polarity genes, were initially identified as members of ＂neoplastic＂ tumor-suppressors in flies. The components of the Hippo signaling pathway, which is crucial for organ size control and cancer development, were also identified through Drosophila genetic screens as members of ＂hyperplastic＂ tumor-suppressors. Accumulating evidence in recent studies implies that these two tumor-suppressor signaling pathways are not mutually exclusive but rather cooperatively act to give rise to highly malignant tumors. The interaction of these tumor-suppressor pathways could include deregulations of actin cytoskeleton, cell-cell contact, and apical-domain size of

关键词： Cell polarity Hippo pathway Drosophila scribble dlg lgl Tumor-suppressor Tumor progression

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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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