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Primary Small Cell Neuroendocrine Carcinoma of the Endometrium: A Cytologically Diagnosed Case with Immunocytochemical, Immunohistochemical, and Electron Microscopic Features

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Open Journal of Pathology 2020年第4期10卷 113-123页

作者： Kentaro Nagata Kenji niwa Sakae Mori Keigo Kuwabara Motoki Takenaka Yoshio Yamaguchi Kentaro niwa Takuji Tanaka Department of Obstetrics & Gynecology Gujo City Hospital Gujo City Japan Section of Laboratory Medicine Gujo City Hospital Gujo City Japan Department of Obstetrics & Gynecology Gifu University School of Medicine Gifu City Japan Department of Obstetrics & Gynecology Kizawa Memorial Hospital Minokamo City Japan Present Address: Department of Obstetrics & Gynecology University of Fukui Hospital Yoshida-gun Fukui Prefecture Japan Department of Diagnostic Pathology & Research Center of Diagnostic Pathology Gifu Municipal Hospital Gifu City Japan

Endometrial neuroendocrine tumors are rare, accounting less than 1% of endometrial cancers. They include small cell neuroendocrine carcinoma (NEC) and large cell NEC and usually occur in postmenopausal patients. Although common symptoms include postmenopausal bleeding, most patients are diagnosed at an advanced stage. We report an extremely rare case of small cell NEC developed in the endometrium of a 75-year-old Japanese woman. This case was initially suspected based on the findings of endometrial cytology: a number of small round malignant cells were present on the endometrial smear specimens. The immunocytochemical and immunohistochemical examinations revealed diffusely cytoplasmic positive reaction of neuron specific enolase (NSE) and partially membranous positive reaction of CD56 in the small cancer cells. They showed PAX-8-positive reaction, but did not express microsatellite instability high. Electron micrography showed several dense-core secretory granules in the cytoplasm of cancer cells. Despite multiple lung metastases, the patient underwent a hysterectomy and salpingo-oophorectomy in order to control excessive genital bleeding. She received six courses of adjuvant chemotherapy based on etoposide and cisplatin, and survived healthy eight months after the first visit without any viability of lung metastases.

关键词： SCNEC Endometrium NSE Ultrastructure Etoposide and Cisplatin Regimen

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Can mosapride citrate reduce the volume of lavage solution for colonoscopy preparation?

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World Journal of Gastroenterology 2013年第5期19卷 727-735页

作者： Masahiro Tajika Yasumasa niwa Vikram Bhatia shinya Kondo Tsutomu Tanaka Nobumasa Mizuno Kazuo Hara Susumu Hijioka Hiroshi Imaoka Koji Komori Kenji Yamao Department of Endoscopy Aichi Cancer Center HospitalNagoya 464-8681Japan Department of Medical Hepatology Institute of Liver and Biliary SciencesNew Delhi 110070India Department of Gastroenterology Aichi Cancer Center HospitalNagoya 464-8681Japan Department of Gastroenterological surgery Aichi Cancer Center HospitalNagoya 464-8681Japan

AIM:To evaluate the possibility of reducing the volume of polyethylene glycol(PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation. METHODS:This was a single-center,prospective, randomized,investigator-blinded,non-inferiority study involving 252 patients of both sexes,aged from 20 to 80 years,scheduled for screening or diagnostic colonoscopy in our department.A total of 126 patients was randomized to receive 1.5 L PEG-electrolyte solution plus 15 mg of mosapride(1.5 L group),and 126 received 2 L PEG-electrolyte solution plus 15 mg of mosapride(2 L group).Patients completed a questionnaire on the acceptability and tolerability of the bowel preparation *** efficacy of bowel preparation was assessed using a 5-point scale based on the Aronchick *** primary end point was adequate bowel preparation rates(score of excellent/good/fair) vs(poor/inadequate).Acceptability and tolerability,as well as disease detection,were secondary end points. RESULTS:A total of 244 patients was included in the *** were no significant differences between the 2 L and 1.5 L groups in age,sex,body mass index, number of previous colonoscopies,and the preparation method used *** adequate bowel preparation rates were 88.5%in the 2 L group and 82.8%in the 1.5 L group[95%lower confidence limit(LCL)for the difference=-14.5%,non-inferiority P=0.019]in the right *** the left colon,the adequate bowel preparation rates were 89.3%in the 2 L group and 81.1%in the 1.5 L group(95%LCL=-17.0%,non-inferiority P=0.066).Compliance,defined as complete (100%)intake of the PEG solution,was significantly higher in the 1.5 L group than in the 2 L group(96.8% vs 85.7%,P=0.002).The proportion of abdominal distension(none/mild/moderate/severe)was significantly lower in the 1.5 L group than in the 2 L group (36/65/22/3 vs 58/48/18/2,P=0.040).Within the subgroup who had undergone colonoscopy previously, a significantly higher number of patients in t

关键词： Mosapride citrate Bowel preparation Polyethylene glycol-electrolyte solution Prokinetics Colonoscopy

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Cytology and Genetic Analysis of Liver Echinococcosis in a Woman Came from Bolivia

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Case Reports in Clinical Medicine 2022年第9期11卷 399-407页

作者： Naoki Futamra Kenji niwa Masato Ohta Sakae Mori Ayumi Hara Yuzo niwa Yoshifumi Katagiri Takuji Tanaka Kentaro Nakamoto Department of Surgery Gujo City Hospital Gifu Japan Section of Laboratory Medicine and Obstetrics & Gynecology Gifu Japan Department of Surgery Gifu University School of Medicine Gifu Japan Department of Internal Medicine Gifu University Hospital Gifu Japan Department of Diagnostic Pathology & Research Center of Diagnostic Pathology Gifu Municipal Hospital Gifu Japan Department of Cellular and Molecular Biology Fujita Health University Aichi Japan

Echinococcosis is a global and zoonotic helminthic disease caused by Echinococcus sp. A 24-year-old woman, coming from Bolivia two years before, was diagnosed as cystic echinococcosis (CE) by unstained wet mount and cytological findings through aspiration cytology from the liver, suggested as liver abscess by diagnostic images. The patient was classified as CE1, smaller than 5 cm, and was diagnosed as P1N0M0, stage I. The phylogenetic trees of Echinococcus spp., based on cox1 genes showed that the isolates on the patient belonged to E. ortleppi. The patient was conservatively treated with two courses of albendazole therapy. E. ortleppi has been reported to be in regions including Latin America, except with Japan. Although the patient came from Bolivia before two years, this is the first case report of E. ortleppi from liver echinococcosis in Japan.

关键词： Echinococcosis Liver Aspiration Cytology Genetic Analysis E. ortleppi

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Primary Ovarian Carcinosarcoma: Cytological, Pathological, Immunocytochemical, and Immunohistochemical Features

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Open Journal of Pathology 2021年第1期11卷 22-31页

作者： Kenji niwa Sakae Mori Keigo Kuwabara Kentaro Nagata Motoki Takenaka Tomomi Shiga Yoshio Yamaguchi Kentaro niwa Takuji Tanaka Department of Obstetrics & Gynecology Gujo City Hospital Gujo City Japan Section of Laboratory Medicine Gujo City Hospital Gujo City Japan Department of Obstetrics & Gynecology Gifu University School of Medicine Gifu City Japan Department of Obstetrics & Gynecology University of Fukui Hospital Eiheiji-cho Fukui Prefecture Japan Department of Diagnostic Pathology & Research Center of Diagnostic Pathology Gifu Municipal Hospital Gifu City Japan

Ovarian carcinosarcoma composed of high-grade carcinoma and sarcoma is an extremely rare neoplasm and typically occurs in postmenopausal women aged over 60 years. A 73-year-old female, gravida three para three, presented to our hospital with right lower abdominal pain. Right pelvic solid tumor with ascites was detected on pelvic ultrasound examination. She underwent hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy, but the tumor had invaded to the right ureter, and some fragile tumor could not be taken (sub-optimal surgery). On the imprint and ascitic cytology specimens during operation, atypical cells suggestive of adenocarcinoma and spindle atypical cells with immunocytochemically vimentin positive were found. The resected tumor was histopathologically carcinosarcoma consisted of serous adenocarcinoma, chondrosarcoma and fibrosarcoma. Immunohistochemical analysis revealed that adenocarcinoma cells were positive for AE1/AE3 and fibrosarcoma cells stained with vimentin. The final diagnosis was the right ovarian carcinosarcoma (stage pT3CNxMx). Microsatellite instability was stable and BRCA1/2 mutations could not be found in the carcinosarcoma cells. The patient was given four cycles of chemotherapy with paclitaxel, carboplatin and bevacizumab regimen, and thereafter she was treated with the ifosfamide and cisplatin because of slight elevation of serum CA125.

关键词： Ovary Carcinosarcoma Immunocytochemistry Immunohistochemistry Ifosfamide Cisplatin

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Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy

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World Journal of Gastroenterology 2015年第41期21卷 11832-11841页

作者： Shigetsugu Tsuji Hisashi Doyama Kunihiro Tsuji Sho Tsuyama Kei Tominaga Naohiro Yoshida Kenichi Takemura shinya Yamada Hideki niwa Kazuyoshi Katayanagi Hiroshi Kurumaya Toshihide Okada Department of Gastroenterology Ishikawa Prefectural Central Hospital Kanazawa Department of Diagnostic Pathology Ishikawa Prefectural Central Hospital Kanazawa

Superficial non-ampullary duodenal epithelial tumor(SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater's papilla, and it includes adenoma a n d a d e n o c a r c i n o m a. R e c e n t d e v e l o p m e n t s i n endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for realtime diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues.

关键词： Endoscopy Duodenoscopy Duodenal neoplasms Narrow b

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The Influential Features of an Effective Model of AnchoringTraining in Maritime Education

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Psychology Research 2020年第3期10卷 106-117页

作者： Yoshiaki Kunieda Hideyuki Kashima Koji Murai Shojiro niwa Tokyo University of Marine Science and Technology TokyoJapan Japan Agency of Maritime Education and Training for Seafarers YokohamaJapan

Ship-handling significantly improves when anchoring exercises are practiced on training ships were proved by Kashima *** *** *** *** that practicing on training ships also develops critical thinking and problem-solving *** order to perform more effective maritime education and training,we analyzed the feature of the training effect of the anchoring training considered to be effective *** a result of the questionnaire about the anchoring training,95%or more of trainees have answered“the anchoring training was helpful”.The trainees’comments about the anchoring training were analyzed,affinity diagram as well as the Steps for Coding and Theorization(SCAT).The affinity diagram was able to group and integrate comments written by the trainees into five distinct *** theorization attempted via the SCAT analysis demonstrated the influential features of the anchoring *** investigation aimed to ameliorate the training model proposed by the authors of the current study,intending to ensure safety through automation to eliminate human *** conception of more efficacious manpower education and training programs is critical because the advancement of automation also escalates the need for talented human resources to manage seafaring vessels.

关键词： anchoring training Plan-Do-Check-Act(PDCA)cycle dialog active thinking

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endoscopic ultrasonography-guided biliary drainage:Who,when,which,and how?

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World Journal of Gastroenterology 2016年第3期22卷 1297-1303页

作者： Kazuo Hara Kenji Yamao Nobumasa Mizuno Susumu Hijioka Hiroshi Imaoka Masahiro Tajika Tutomu Tanaka Makoto Ishihara Nozomi Okuno Nobuhiro Hieda Tukasa Yoshida Yasumasa niwa Department of Gastroenterology Aichi Cancer Center HospitalNagoya 464-8681Japan Department of Endoscopy Aichi Cancer Center HospitalNagoya 464-8681Japan

Both endoscopic ultrasonography(EUS)-guided choledochoduodenostomy( EUS- CDS) and EUS-guided hepaticogastrostomy(EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage(PTBD). Both EUSCDS and EUS-HGS have high technical and clinical success rates(more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUSguided biliary drainage(EUS-BD), we recommend a mentor's supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique(EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUSBD will potentially become a first-line biliary drainage procedure in the near future.

关键词： endoscopic ultrasonography endoscopicultrasonography-guided biliary drainage Interventionalendoscopic ultrasonography endoscopic ultrasonography-guided choledochoduodenostomy endoscopicultrasonography-guided rendezvous technique

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No-touch isolation technique in emergency pancreaticoduodenectomy for neoplastic hemorrhage: Two case reports and review of literature

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1910-1917页

作者： Akihiro Cho Satoshi Katagiri Masao Ota Shunsuke Onizawa Ryota Higuchi Toshiya Sugishita Yukiko niwa Takeshi Ishita Toshihiko Mouri Akita Kato Moe Iwata Division of Gastroenterological Surgery Tokyo Women’s Medical UniversityYachiyo Medical CenterChiba 276-8524Japan

BACKGROUND Emergency pancreaticoduodenectomy(EPD)is a rare event for complex periam-pullary *** intraoperative blood loss is correlated with poor post-operative *** SUMMARY Two patients underwent EPD using a no-touch isolation technique,in which all arteries supplying the pancreatic head region were ligated and divided before manipulation of the pancreatic head and *** operative times were 220 and 239 min,and the blood loss was 70 and 270 g,*** patients were discharged on the 14^(th) and 10^(th) postoperative day,***-two patients underwent EPD for the treatment of neoplastic *** mean operative time was 361.6 min,and the mean blood loss was 747.3 *** comp-lication rate was 37.5%.The in-hospital mortality rate was 9.38%.CONCLUSION The no-touch isolation technique is feasible,safe,and effective for reducing intraoperative blood loss in EPD.

关键词： No-touch isolation technique Pancreaticoduodenectomy Emergency pancre-aticoduodenectomy Neoplastic bleeding Superior mesenteric artery first approach Case report

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Asymptomatic Anisakiasis of the Colon Diagnosed and Treated by Colonoscopy

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Case Reports in Clinical Medicine 2020年第9期9卷 288-294页

作者： Tomoshi Takeda Kenji niwa Akie Sano Atsunori Kodama Kuninori Hatasa Yasunari Matsuno Masao Kagami Motoki Takenaka Kohjiro niwa Takuji Tanaka Department of Internal Medicine Gujo City Hospital Shimadani Gujo City Gifu Japan Section of Laboratory Medicine and Obstetrics & Gynecology Gujo City Hospital Shimadani Gujo City Gifu Japan Sano Internal Medicine Clinic Naka-fukuno-cho Seki City Gifu Japan Department of Obstetrics & Gynecology Gifu University School of Medicine Yanagido Gifu City Japan Department of Internal Medicine Kizawa Memorial Hospital Shimokobi Kobicho Minokamo City Japan Department of Diagnostic Pathology & Research Center of Diagnostic Pathology Gifu Municipal Hospital Gifu City Japan

Anisakiasis can involve any part of the digestive tract, but most cases reported have involved the stomach;few reports have described colonic anisakiasis. Furthermore, asymptomatic colonic anisakiasis has been reported to be very rare. A 58-year-old Japanese male asymptomatically received colonoscopy due to a fecal occult blood testing positive, and an Anisakis larva was removed in the ascending colon. After colonoscopy, an detailed questionings concerning eating raw fish revealed that the patient ate the liver of raw filefish 21 days before the colonoscopy. Thus, questionings concerning eating the raw fish were very important and helpful for correct diagnosis. This case report demonstrated that colonic anisakiasis can be diagnosed by colonoscopy before severe complications (intestinal obstruction, perforation, and cancer development) occur. Also, biopsy forceps could be used to remove the Anisakis worms, demonstrating that diagnosis and treatment can be simultaneously performed.

关键词： Asymptomatic Anisakiasis Ascending Colon Colonoscopy Risk Factor for Cancer

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Prospective Cohort Research of Aortic Root Dilatation after Surgical Repair in Adults with Tetralogy of Fallot(TRANSIT)

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Congenital Heart Disease 2024年第4期19卷 351-362页

作者： Hiroki Nagamine Masaru Miura Jun Maeda Takumi Nishiki Maasa Sato Fumie Takechi Shigeru Tateno Tomoko Ishizu Yumi Shiina Ken Kato Hiroshi Ono Hiroyuki Yamagishi Koichiro niwa Department of Cardiology Tokyo Metropolitan Children’s Medical CenterTokyo183-8561Japan Department of Pediatric Cardiology Sakakibara Heart InstituteTokyo183-0003Japan Department of Adult Congenital Heart Disease Chiba Cerebral and Cardiovascular CenterChiba305-8576Japan Department of Adult Congenital Heart Disease Chiba Kaihin Municipal HospitalChiba261-0003Japan Department of Cardiology Faculty of MedicineUniversity of TsukubaTsukuba305-8576Japan Cardiovascular Center St.Luke’s International HospitalTokyo104-8560Japan Department of Cardiology Tokyo Metropolitan Tama Medical CenterTokyo183-8524Japan Division of Cardiology National Center for Child Health and DevelopmentTokyo158-8531Japan Center for Preventive Medicine Keio University School of MedicineTokyo160-0016Japan

Background:Aortic root dilatation occurs in adults with tetralogy of Fallot(TOF)after surgical repair,but the longitudinal changes are *** main research aim is to determine the annual dilatation rate of aorta in adults with repaired ***:The present,multicentric,prospective cohort study assessed the rate of aortic diameter change in adults aged 20 years or older with TOF,including pulmonary artery atresia,who underwent surgical *** data,focusing on echocardiograms,were collected at three-year intervals from seven ***:In total,104 patients(58 males;median age:29 years)were *** actual Valsalva sinus(VS)diameter was 34.3±5.8(mean±standard deviation)and 36.1±6.0 mm at the initial andﬁnal examinations,respectively,and the annual dilatation rate was 0.64(0.07,1.33)(median,interquartile)mm/*** corrected diameter at the respective examination was 21.3±3.8 and 22.2±3.7 mm/m^(2),and the annual dilation rate was 0.28(-0.21,0.76)mm/m^(2)/*** regression analysis showed that factors signiﬁcant associated with dila-tation rate of actual VS diameter were the diastolic blood pressure(standardized coefﬁcient-0.22;p=0.04),cardiothoracic ratio(0.28;0.02),and the ratio of early mitral valve inﬂow velocity to early diastolic annular velocity(E/e′)ratio(0.31;0.004).Factors signiﬁcantly associated with corrected VS diameter were diastolic blood pressure(-0.25;0.02)and the E/e′ratio(0.34;0.001).Conclusions:In adults with repaired TOF,the rate of dilatation of the aortic diameter was associated with decreased diastolic blood pressure and left ventricular diastolic dysfunction,possibly reﬂecting decreased aortic wall elasticity.

关键词： Adults aortic dilatation prospective cohort research tetralogy of Fallot

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