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Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

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World Journal of Clinical Cases 2024年第2期12卷 276-284页

作者： Taiichiro Miyake Hiroaki Yanagimoto Daisuke Tsugawa Masayuki Akita riki Asakura Keisuke Arai Toshihiko Yoshida Shinichi So Jun Ishida Takeshi Urade Yoshihide Nanno Kenji Fukushima Hidetoshi Gon Shohei Komatsu Sadaki Asari Hirochika Toyama Masahiro Kido Tetsuo Ajiki Takumi Fukumoto Division of Hepato-Biliary-Pancreatic Surgery Department of SurgeryKobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding.Therefore,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.AIM To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.METHODS The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities.Clinicopathological factors,including demographic data and perioperative D-dimer values,were compared between the two groups.Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value.Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.RESULTS In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE group.In the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after hepatectomy.CONCLUSION Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

关键词： Hepatectomy Malignant tumor Postoperative complication D-dimer Early diagnosis Venous thromboembolism

Current perspectives of viral

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World Journal of Gastroenterology 2024年第18期30卷 2402-2417页

作者： Daisuke Usuda Yuki Kaneoka Rikuo Ono Masashi Kato Yuto Sugawara Runa Shimizu Tomotari Inami EriNakajima Shiho Tsuge riki Sakurai Kenji Kawai Shun Matsubara Risa Tanaka Makoto Suzuki ShintaroShimozawa Yuta Hotchi Ippei Osugi Risa Katou Sakurako Ito Kentaro Mishima Akihiko Kondo KeikoMizuno Hiroki Takami Takayuki Komatsu Tomohisa Nomura Manabu Sugita Department of Emergency and Critical Care Medicine Juntendo University Nerima HospitalNerima 177-8521TokyoJapan Department of Sports Medicine Faculty of MedicineJuntendo UniversityBunkyo 113-8421TokyoJapan

Viral hepatitis represents a major danger to public health,and is a globally leading cause of death.The five liver-specific viruses:Hepatitis A virus,hepatitis B virus,hepatitis C virus,hepatitis D virus,and hepatitis E virus,each have their own unique epidemiology,structural biology,transmission,endemic patterns,risk of liver complications,and response to antiviral therapies.There remain few options for treatment,in spite of the increasing prevalence of viral-hepatitiscaused liver disease.Furthermore,chronic viral hepatitis is a leading worldwide cause of both liver-related morbidity and mortality,even though effective treatments are available that could reduce or prevent most patients’complications.In 2016,the World Health Organization released its plan to eliminate viral hepatitis as a public health threat by the year 2030,along with a discussion of current gaps and prospects for both regional and global eradication of viral hepatitis.Today,treatment is sufficiently able to prevent the disease from reaching advanced phases.However,future therapies must be extremely safe,and should ideally limit the period of treatment necessary.A better understanding of pathogenesis will prove beneficial in the development of potential treatment strategies targeting infections by viral hepatitis.This review aims to summarize the current state of knowledge on each type of viral hepatitis,together with major innovations.

关键词： Hepatitis A virus Hepatitis B virus Hepatitis C virus Hepatitis D virus Hepatitis E virus Current perspectives

Global prevalence and gender inequalities in at least 60 min of self-reported moderate-to-vigorous physical activity 1 or more days per week:An analysis with 707,616 adolescents

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Journal of Sport and Health Science 2024年第5期13卷 709-716页

作者： Raphael H.O.Araujo AndrúO.Werneck Clarice L.Martins Luciana L.Barboza Rafael M.Tassitano Nicolas Aguilar-Farias Gilmar M.Jesus Robinson Ramírez-Véelez riki Tesler Adewale L.Oyeyemi Ellen C.M.Silva Robert G.Weaver Mark S.Tremblay Javier Brazo-Sayavera Grégore I.Mielke Danilo R.P.Silva Graduation Program in Health Sciences Londrina State University(UEL)Londrina 86057-970Brazil Center for Epidemiological Research in Nutrition and Health Department of NutritionSchool of Public HealthUniversidade de Sao Paulo(USP)Sao Paulo 01246-904Brazil Department of Physical Education Federal University of ParaıbaParaıba 58051-900Brazil Research Centre of Physical Activity Health and LeisureFaculty of SportsLaboratory for Integrative and Translational Research in Population Health(ITR)University of PortoPorto 4500Portugal Postgraduate Program in Physical Education University of BrasıliaBrasılia 70910-900Brazil Department of Kinesiology and Community Health University of Illinois at Urbana-ChampaignChampaignIL 61801-3841USA Department of Physical Education Sports and RecreationUniversidad de La FronteraTemuco 4680000Chile Department of Health State University of Feira de SantanaFeira de Santana 44036-900Brazil Navarrabiomed Hospital Universitario de Navarra(HUN)Navarra Institute for Health Research(IdiSNA)Universidad Publica de Navarra(UPNA)Pamplona 31006Spain Facultad de Ciencias de la Educacion Unidad Central del Valle del Cauca(UCEVA)TuluaValle del Cauca 763022Colombia Health Management Department Faculty of Heath sciencesAriel UniversityAriel 40700Israel College of Health Solutions Arizona State UniversityPhoenixAZ 85004USA Arnold School of Public Health University of South CarolinaColumbiaSC 29208USA Healthy Active Living and Obesity Research Group Children’s Hospital of Eastern Ontario Research InstituteOttawaON K1H 8L1Canada Department of Pediatrics University of OttawaOttawaON K1H 8L1Canada Department of Health Sciences Carleton UniversityOttawaON K1S 5B6Canada Department of Sports and Computer Science Universidad Pablo de Olavide(UPO)Seville 41013Spain Centro Universitario Regional Noreste Universidad de la RepublicaRivera 40000Uruguay School of Public Health The University of QueenslandBrisbaneQLD 4006Australia Department of Physical Education

Background:Guidelines recommend that adolescents should accumulate an average of 60 min per day of moderate-to-vigorous physical activity(MVPA).However,using only this cut-off could hide important information.For instance,from a population-level point of view,increasing physical activity for those with no or low physical activity could provide more health benefits than increasing physical activity for those with intermediate levels.Also,including a more sensitive cut-point of≥1 days per week could be an additional strategy for identifying those with low access/opportunities for physical activity practice.Thus,the current study aims to estimate the prevalence of≥60 min of MVPA≥1 days per week among adolescents globally,and to describe any relevant gender inequalities.Methods:We used representative datasets from 146 countries/territories collected between 2003 and 2019.MVPA was self-reported.Participants were grouped into younger(≤14 years old)and older(>14 years old)adolescents.Crude Poisson regression models were used to identify the relative differences in≥60 min of MVPA≥1 days per week between boys and girls,and random-effects meta-analysis models were used to identify the pooled estimates.Analyses were stratified by country and region.Results:Approximately 80%of both younger and older adolescents reported≥60 min of MVPA≥1 days per week.This prevalence was≥94%in Europe and Central Asia and North America,while the estimates for the other regions were14y)=1.09(95%CI:1.08-1.10)).Conclusion:Approximately 8 out of 10 adolescents reported accumulating≥60 min of MVPA≥1 days per week,with notable differences between regions.Gender differences were observed in several countries,especially among the oldest adolescents.Priorities for physical activity promotion among adolescents

关键词： Global School-based Student Health Survey Health Behaviour Among School-aged Children survey Inequality Surveillance Youth

Reachability-Based Packet Scheduler of Multipath QUIC for Heterogeneous Mobile Networks

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Communications and Network 2022年第4期14卷 200-209页

作者： riki Okunishi Rui Teng Kenya Sato Graduate School of Science and Engineering Doshisha University Kyoto Japan Mobility Research Center Doshisha University Kyoto Japan

In recent years, we need more bandwidth to enjoy entertainment contents such as video streaming, music and online gaming. To gain enough bandwidth, technologies that combine bandwidth by using multiple interfaces at same time are desired. Multipath transport protocols which combine multiple paths for packet delivery at the transport layer are a promising technology. Such protocols have a mechanism, called “packet scheduler”, to select the interface to send a packet. However, existing studies of the packet scheduler have not explicitly considered the compatibility of mobility with bonding of bandwidth. Therefore, when smartphone users move out of coverage of communication networks such as wireless Local Area Network (LAN) and Long Term Evolution (LTE) by vehicle, packet loss occurs, leading to a decrease of throughput. In this study, we propose a packet scheduler that selects an appropriate communication path so that packets can reach the peer before it moves out of the coverage. Based on routes of a vehicle and the position and communication range of the access point, the time at which a communication path will be lost is predicted. In addition, we employ MPQUIC (Multipath QUIC (Quick UDP Internet Connections)), which is a multipath transport protocol proposed as the extension of QUIC protocol, to reduce the ACK packet loss in multipath communication, and to reduce the time until the starts of retransmission. We evaluated the number of packet losses, the throughput and the time until starts of retransmission using a simulator and show the superiority of proposed method.

关键词： Mobility Multipath Transport Protocol Multipath QUIC

Invasive ductal carcinoma of the pancreas showing exophytic growth

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Hepatobiliary & Pancreatic Diseases International 2009年第1期8卷 97-102页

作者： Yuichi Sanada Kazuhiro Yoshida Masaoki Itoh riki Okita Morihito Okada Department of Surgical Oncology Research Institution for Radiation Biology and MedicineHiroshima University

BACKGROUND:Invasive pancreatic carcinoma generally appears as poorly defined mass reflecting the infiltrative growth.We aimed to identify the histological and immunohistochemical features in a rare case of pancreatic carcinoma showing exophytic growth. METHODS:A 67-year-old woman presented with a mass of 5.0 cm in diameter in the pancreatic head.Preoperative computed tomography revealed a well-demarcated, primarily solid mass with a central low-density area. Magnetic resonance cholangiopancreatography revealed neither encasement nor dilation of the main pancreatic duct.An incorrect preoperative diagnosis was made of solid pseudopapillary tumor of the pancreas.Elevated serum carcinoembryonic antigen(CEA)levels and abnormal FDG positron emmission tomography accumulation suggested that the tumor had malignant potential requiring a pancreatoduodenectomy. RESULTS:The head of the pancreas contained a well- circumscribed encapsulated mass of 5.0 cm in diameter, comprising 50%adenocarcinoma,with mucinous carci- noma in the center and anaplastic carcinoma at the periphery.The anaplastic carcinoma comprised pleo- morphic cells(PCs)and pleomorphic giant cells(PGCs). The PGCs phagocytozed mononuclear PCs and lymphocytes adjacent to the capsule without infiltrating the capsule itself.Immunohistochemistry revealed that the anaplastic carcinoma cells including PGCs were positive for the tumor antigen Mucin 1 and CEA but negative for vimentin. CONCLUSION:Our observations suggest anaplastic carcinoma components in the present tumor have a ductal origin and that the exophytic tumor growth is associated with the phagocytotic activity of PGCs.

关键词： pancreatic carcinoma anaplastic carcinoma mucinous carcinoma Mucin 1 carcinoembryonic antigen

Hemorrhagic shock due to submucosal esophageal hematoma along with mallory-weiss syndrome:A case report

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World Journal of Clinical Cases 2022年第27期10卷 9911-9920页

作者： Jiro Oba Daisuke Usuda Shiho Tsuge riki Sakurai Kenji Kawai Shun Matsubara Risa Tanaka Makoto Suzuki Hayabusa Takano Shintaro Shimozawa Yuta Hotchi Kenki Usami Shungo Tokunaga Ippei Osugi Risa Katou Sakurako Ito Kentaro Mishima Akihiko Kondo Keiko Mizuno Hiroki Takami Takayuki Komatsu Tomohisa Nomura Manabu Sugita Department of Emergency and Critical Care Medicine Juntendo University Nerima HospitalNerima-ku 177-8521TokyoJapan Faculty of Medicine Juntendo UniversityBunkyo-ku 113-8421TokyoJapan

BACKGROUND Esophageal submucosal hematoma is a rare condition.Although the exact etiology remains uncertain,vessel fragility with external factors is believed to have led to submucosal bleeding and hematoma formation;the vessel was ruptured by a sudden increase in pressure due to nausea,and the hematoma was enlarged by antiplatelet or anticoagulant therapy.Serious conditions are rare,with a better prognosis.We present the first known case of submucosal esophageal hematoma-subsequent hemorrhagic shock due to Mallory-Weiss syndrome.CASE SUMMARY A 73-year-old female underwent endovascular treatment for an unruptured cerebral aneurysm.The patient received aspirin and clopidogrel before surgery and heparin during surgery,and was well during the surgery.Several hours after returning to the ICU,she complained of chest discomfort,vomited 500 m L of fresh blood,and entered hemorrhagic shock.Esophageal submucosal hematoma with Mallory-Weiss syndrome was diagnosed through an endoscopic examination and computed tomography.In addition to a massive fluid and erythrocyte transfusion,we performed a temporary compression for hemostasis with a Sengstaken-Blakemore(S-B)tube.Afterwards,she became hemodynamically stable.On postoperative day 1,we performed an upper gastrointestinal endoscopy and confirmed no expansion of the hematoma nor any recurring bleeding;therefore,we removed the S-B tube and clipped the gastric mucosal laceration at the esophagogastric junction.We started oral intake on postoperative day 10.The patient made steady progress,and was discharged on postoperative day 33.CONCLUSION We present the first known case of submucosal esophageal hematoma subsequent hemorrhagic shock due to Mallory-Weiss syndrome.

关键词： Esophageal submucosal hematoma Hemorrhagic shock Mallory-Weiss syndrome Antithrombotic therapy Anticoagulant therapy Case report

Nationalist-Religious Ideology and Civic Education:The Israeli Case

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International Relations and Diplomacy 2021年第2期9卷 51-68页

作者： riki Tesler The Hebrew University JerusalemIsrael

Are we riding the fourth wave of democracy,as predicted by Toffler(1984)and Huntington(1991),a post-capitalist,post-global wave?Western liberal democracy is currently responding to the dramatic change in the economic system after capitalism,the coronavirus pandemic,and the growing power of nationalist and fundamentalist ideologies.Does this process indicates a change in Western democracy or is it the end of democracy and what is the role of civic education within it?In Israel,as in other Western countries,the nationalist and fundamentalist ideologies(gained strength,undermining liberalism)threaten the conception of global citizenship and strive to shape a model of an illiberal democracy.In Israel,contrary to other Western countries,they also threaten civic equality and the very existence of the democratic rule.In the absence of a constitution and consensus,Israel is experiencing culture and religious war over values,identity and the concept of“citizenship”as a legal,political,and social framework.Thus,the struggle over civic education reflects the struggle over educational hegemony,as well as over national hegemony.In this process,nationalists and fundamentalists initiate anti-democratic legislation,violate human rights,obstruct government supervisory mechanisms,and expand ideological education in order to change Israel‟s character to a Jewish state rather than a Jewish and democratic state.

关键词： Liberalism Nationalism Fundamentalism Civic Education.Ideological Education Global Citizen Digital Citizen

High doses of dextromethorphan induced shock and convulsions in a 19-year-old female:A case report

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World Journal of Clinical Cases 2023年第16期11卷 3870-3876页

作者： Shintaro Shimozawa Daisuke Usuda Toru Sasaki Shiho Tsuge riki Sakurai Kenji Kawai Shun Matsubara Risa Tanaka Makoto Suzuki Yuta Hotchi Shungo Tokunaga Ippei Osugi Risa Katou Sakurako Ito Suguru Asako Kentaro Mishima Akihiko Kondo Keiko Mizuno Hiroki Takami Takayuki Komatsu Jiro Oba Tomohisa Nomura Manabu Sugita Department of Emergency and Critical Care Medicine Juntendo University Nerima HospitalNerima-city 177-8521TokyoJapan Clinical Training Center Juntendo University Nerima HospitalNerima-city 177-8521TokyoJapan Department of Sports Medicine Faculty of MedicineJuntendo UniversityBunkyo-city 113-8421TokyoJapan

BACKGROUND Dextromethorphan is a prevalent antitussive agent that can be easily obtained as an over-the-counter medication.There has been a growing number of reported cases of toxicity in recent years.Generally,there are numerous instances of mild symptoms,with only a limited number of reports of severe cases necessitating intensive care.We presented the case of a female who ingested 111 tablets of dextromethorphan,leading to shock and convulsions and requiring intensive care that ultimately saved her life.CASE SUMMARY A 19-year-old female was admitted to our hospital via ambulance,having overdosed on 111 tablets of dextromethorphan(15 mg)obtained through an online importer in a suicide attempt.The patient had a history of drug abuse and multiple self-inflicted injuries.At the time of admission,she exhibited symptoms of shock and altered consciousness.However,upon arrival at the hospital,the patient experienced recurrent generalized clonic convulsions and status epilepticus,necessitating tracheal intubation.The convulsions were determined to have been caused by decreased cerebral perfusion pressure secondary to shock,and noradrenaline was administered as a vasopressor.Gastric lavage and activated charcoal were also administered after intubation.Through systemic management in the intensive care unit,the patient’s condition stabilized,and the need for vasopressors ceased.The patient regained consciousness and was extubated.The patient was subsequently transferred to a psychiatric facility,as suicidal ideation persisted.CONCLUSION We report the first case of shock caused by an overdose of dextromethorphan.

关键词： Dextromethorphan Drug overdose Shock Symptom Treatment Case report

Penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive man: A case report

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世界临床病例杂志 2023年第24期11卷 5811-5816页

作者： Daisuke Usuda Nobuyoshi Kaminishi Masashi Kato Yuto Sugawara Runa Shimizu Tomotari Inami Shiho Tsuge riki Sakurai Kenji Kawai Shun Matsubara Risa Tanaka Makoto Suzuki Shintaro Shimozawa Yuta Hotchi Ippei Osugi Risa Katou Sakurako Ito Kentaro Mishima Akihiko Kondo Keiko Mizuno Hiroki Takami Takayuki Komatsu Jiro Oba Tomohisa Nomura Manabu Sugita Emergency and Critical Care Medicine Juntendo University Nerima HospitalNerima 177-8521TokyoJapan Clinical Training Center Juntendo University Nerima HospitalNerima 177-8521TokyoJapan Sports Medicine Juntendo UniversityBunkyo 113-8421TokyoJapan

BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic objects are used.On the other hand,penile strangulation is a rare urologic emergency that requires prompt evaluation and intervention to prevent long-term complications.The goal of treating penile incarceration is to remove the foreign object as soon as possible.On the other hand,removal can be very challenging,and often requires resourcefulness and a multidisciplinary approach.CASE SUMMARY A 47-year-old man who has sex with men was transferred to our hospital for persistent phallodynia and scrotal pain,accompanying swelling due to strangulation by stainless steel rings.His medical history included acquired immunodeficiency syndrome.One day prior,he had put three stainless steel rings on his penis and scrotum before sexual intercourse.After sexual intercourse,he was unable to remove them,due to swelling of his penis and scrotum.The swelling persisted,and he felt pain in the affected area the next day,then he was transferred to our hospital by ambulance.The emergency department found that his penis and scrotum were markedly engorged and swollen.We established a diagnosis of penile and scrotal strangulation by stainless steel rings.We unsuccessfully attempted to cut the rings using a cutter,then requested a rescue team via emergency medical service.They cut through each ring in two places,using an electric-powered angle grinder,and successfully removed all of the pieces.Finally,he was discharged and went home.CONCLUSION We report the first case of penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive person.

关键词： Penile strangulation Stainless steel ring Human immunodeficiency virus Urologic emergency Management Case report