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Regression of hepatocellular carcinoma during vitamin K administration

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World Journal of Gastroenterology 2005年第42期11卷 6722-6724页

作者： Kazuhiro Nouso Shuji Uematsu Kunihiro Shiraga Ryoichi Okamoto Ryo Harada Shoko Takayama Wakako Kawai shigeru kimura Toru Ueki Nobuaki Okano Masahiro Nakagawa Motowo Mizuno Yasuyuki Araki Yasushi Shiratori Department of Internal Medicine Hiroshima City Hospital Hiroshima 730-8518 Japan Department of Medicine and Medical Science Okayama University Graduate School of Medicine and Dentistry Okayama 700-8558 Japan

An 85-year-old man with HCV infection and diabetes mellitus was diagnosed as having hepatocellular carcinoma （HCC, 13 cm in diameter） based on high serum alpha-fetoprotein （AFP）, AFP-L3, and des-y-carboxy prothrombin levels as well as typical enhancement pattern on contrast-enhanced CT. The patient did not receive any interventional treatments because of advanced age and the advanced stage of HCC. He chose to take vitamin K, which was reported to suppress the growth of HCC in vitro. Three months after starting vitamin K, all three tumor markers were normalized and HCC was markedly regressed, showing no enhancement in the early arterial phase on CT. Here we present the report describing the regression of HCC during the administration of vitamin K.

关键词： Hepatocellular carcinoma Vitamin K Regression

Performance Improvement by Control of Wingtip Vortices for Vertical Axis Type Wind Turbine

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Open Journal of Fluid Dynamics 2018年第3期8卷 331-342页

作者： shigeru Ogawa Yusuke kimura Department of Mechanical Engineering National Institute of Kure College Kure Japan

The present paper describes control of wingtip vortices generated by vertical type wind turbine. The wind turbine consists of three circular cylinders. Each cylinder rotates on its own vertical axis and moves in orbit. It is known that wingtip vortices give rise to decrease of power generation performance as well as aerodynamic noise. Therefore, the goal of the study is to control wingtip vortices and to improve power generation performance. Numerical study was conducted for 14 models to find out control factors to suppress wingtip vortices. Numerical simulation visualized wingtips by streamlines as well as pressure distribution on the circular cylinder for evaluating Magnus effect. As a result, the following findings were obtained: 1) Installation of fully covered protection plates at both ends of the circular cylinder blades is greatly effective to suppress the wingtip vortices. 2) Curved wings attached to each cylinder are more effective to enhance power generation efficiency than flat ones, due to great increase in Magnus effect caused by large pressure difference on both sides of the curved wing. The power efficiency of the optimized model was improved up to 2.8%, which means 11 times that of the original model.

关键词： Vertical Axis Type Wind Turbine Wingtip Vortex Magnus Effect

Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

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World Journal of Gastroenterology 2017年第32期23卷 5849-5859页

作者： tomohide hori takafumi machimoto yoshio kadokawa toshiyuki hata tatsuo ito shigeru kato daiki yasukawa yuki aisu yusuke kimura maho sasaki yuichi takamatsu taku kitano shigeo hisamori tsunehiro yoshimura department of gastrointestinal surgery tenriyorodusoudanjyo hospital

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

关键词： Laparoscopic appendectomy Acute appendicitis Interval appendectomy Surgery Delayed appendectomy

Iron Indices and Mortality in Maintenance Hemodialysis Patients

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International Journal of Clinical Medicine 2018年第5期9卷 454-466页

作者： Saeko Kumon Yoichiro Tanaka Kazuo kimura Takako Onuki shigeru Otsubo Kosaku Nitta Department of Medicine Towa Hospital Tokyo Japan Department of Medicine Kidney Center Tokyo Women’s Medical University Tokyo Japan Department of Blood Purification Sangenjaya Hospital Tokyo Japan

Background: The relationship between the iron indices and mortality in maintenance hemodialysis (MHD) patients has remained unclear. We performed a retrospective, observational cohort study to investigate the relationships between serum ferritin levels and mortality in MHD patients. Methods: MHD outpatients (n = 150) were followed up for a median period of 49 months. Their ESA and low-dose iron supplement dosages were adjusted to maintain their hemoglobin (Hb) concentrations in the 10 - 11 g/dl range in accordance with Japanese guidelines. The Kaplan-Meier method, log-rank tests, and Cox proportional hazards models were used to perform the statistical analyses. The patients were divided into 3 groups according to their serum ferritin levels: a serum ferritin 100 ng/ml group. Results: During the median follow-up period of 49 months, there were 55 deaths. The multivariate analysis showed no significant associations between the ferritin level groups and all-cause mortality or cardiovascular (CV) events, and the Kaplan-Meier analysis showed no significant differences among the 3 ferritin level groups in all-cause mortality and CV event rates. However, the multivariate analysis revealed that age, CRP level and a history of previous CV disease were independently associated with all-cause mortality, while diabetes, previous CV disease, and iron administration were independently associated with CV events. Conclusion: The results of this study revealed no significant associations of MHD patients between the ferritin ranges and all-cause mortality or CV events. Thus, the adverse clinical outcomes in these patients were independently associated with other markers and not with their serum ferritin levels.

关键词： Anemia Ferritin Hemodialysis Mortality

Protocol for laparoscopic cholecystectomy: Is it rocket science?

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World Journal of Gastroenterology 2016年第47期22卷 10287-10303页

作者： Tomohide Hori Fumitaka Oike Hiroaki Furuyama Takafumi Machimoto Yoshio Kadokawa Toshiyuki Hata shigeru Kato Daiki Yasukawa Yuki Aisu Maho Sasaki Yusuke kimura Yuichiro Takamatsu Masato Naito Masaya Nakauchi Takahiro Tanaka Daigo Gunji Kiyokuni Nakamura Kiyoko Sato Masahiro Mizuno Taku Iida Shintaro Yagi Shinji Uemoto Tsunehiro Yoshimura Department of Gastrointestinal and General Surgery Tenriyorodusoudanjyo Hospital Department of Gastrointestinal Surgery Mitsubishi Kyoto Hospital Department of Anesthesiology Mitsubishi Kyoto Hospital Department of Gastroenterology and Hepatology Mitsubishi Kyoto Hospital Department of Hepatobiliary Pancreatic Surgery Kyoto University Hospital

Laparoscopic cholecystectomy(LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety(CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon's assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical ***, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC:(1) consideration that a high level of experience alone is not enough;(2) recognition of the plateau involving the common hepatic duct and hepatic hilum;(3) blunt dissection until CVS exposure;(4) Calot's triangle clearance in the overhead view;(5) Calot's triangle clearance in the view from underneath;(6) dissection of the posterior right side of Calot's triangle;(7) removal of the gallbladder body; and(8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.

关键词： Laparoscopic cholecystectomy Gallbladder Critical view of safety biliary injury Protocol