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Anaplastic carcinoma associated with a mucinous cystic neoplasm of the pancreas during pregnancy:Report of a case and a review of the literature

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World Journal of Gastroenterology 2008年第1期14卷 132-135页

作者： Kenichi Hakamada takuya miura Akitoshi Kimura Masaki Nara Yoshikazu Toyoki Shunij Narumi Mutsuo Sasak Department of Gastroenterological Surgery Hirosaki University Graduate School of Medicine Hirosaki 036-8562 Japan

Oncogenesis of anaplastic carcinoma of the pancreas is a subject of controversy, because it shows sarcomatous nature with extremely poor prognosis. We herein report an unusual case of anaplastic carcinoma occurring with a recurrent mucinous cystic neoplasm in a 38-year-old female. A 10-cm retroperitoneal cystic mass was pointed out in the first pregnancy and a probable diagnosis of mucinous cystic neoplasm was made in October 2000. She refused surgery first and delivered her baby uneventfully. During her second pregnancy in 2002, however, she presented hematemesis and underwent urgent distal pancreatectomy, splenectomy and partial resection of the gastric wall where the tumor perforated. A diagnosis of borderline-type mucinous cystic neoplasm with ovarian-like stroma was made. Nine months later, CT visualized a recurrent cystic tumor near the pancreatic stump, which was subsequently resected. Pathology revealed that the tumor was composed of two different components of borderline-type mucinous cystic neoplasm and anaplastic carcinoma. The latter was intensely positive for vimentin, CD68, p53 and focally for cytokeratin, suggesting both sarcomatous and carcinomatous differentiation. She survived four years after the second surgery without tumor recurrence. Although the origin of anaplastic carcinoma has not been determined yet, it should be remembered that anaplastic carcinoma can occur in association with mucinous cystic neoplasm of more benign histology.

关键词： Mucinous cystic neoplasm Anaplastic carcinoma Pancreatic tumor Ovarian-like stroma Pregnancy

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An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture

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World Journal of Gastroenterology 2008年第7期14卷 1091-1096页

作者： Kenichi Hakamada Shunji Narumi Yoshikazu Toyoki Masaki Nara Kenosuke Ishido takuya miura Norihito Kubo Mutsuo Sasaki Gastroenterological Surgery Hirosaki University Graduate School of Medicine5 Zaifu-choHirosaki 036-8562Japan

AIM: To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fast-absorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic ***: Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fast-absorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa ***: The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely ***: A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas.

关键词： Pancreaticojejunostomy Duct-to-mucosa contact method Fast-absorbable suture Irradiated polyglactin 910 Pancreatic fistula

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Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma

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World Journal of Gastroenterology 2008年第9期14卷 1370-1377页

作者： Kenichi Hakamada Norihisa Kimura takuya miura Hajime Morohashi Keinosuke Ishido Masaki Nara Yoshikazu Toyoki Shunji Narumi Mutsuo Sasaki Department of Gastroenterological Surgery Hirosaki University Graduate School of MedicineJapan

AIM:To clarify the effect of a high des-gamma-carboxy prothrombin (DCP) level on the invasiveness and prognosis of small hepatocellular carcinoma. METHODS: Among 142 consecutive patients with known DCP levels, who underwent hepatectomy because of hepatocellular carcinoma, 85 patients met the criteria for small hepatocellular carcinoma, i.e. one ≤ 5 cm sized single tumor or no more than three ≤ 3 cm sized tumors. RESULTS: The overall survival rate of the 142 patients was 92.1% for 1 year, 69.6% for 3 years, and 56.9% for 5 years. Multivariate analysis showed that microscopic vascular invasion (P = 0.03) and serum DCP ≥ 400 mAU/mL (P = 0.02) were independent prognostic factors. In the group of patients who met the criteria for small hepatocellular carcinoma, DCP ≥ 400 mAU/mL was found to be an independent prognostic factor for recurrence-free (P = 0.02) and overall survival (P = 0.0005). In patients who did not meet the criteria, the presence of vascular invasion was an independent factor for recurrence-free (P = 0.02) and overall survivals (P = 0.01). In 75% of patients with small hepatocellular carcinoma and high DCP levels, recurrence occurred extrahepatically. CONCLUSION: For small hepatocellular carcinoma, a high preoperative DCP level appears indicative fortumor recurrence. Because many patients with a high preoperative DCP level develop extrahepatic recurrence, it is necessary to screen the whole body.

关键词： Small hepatocellular carcinoma Hepatic resection Des-gamma-carboxy prothrombin Vascular invasion Prognostic factor

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Intraoperative ultrasound as an educational guide for laparoscopic biliary surgery

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World Journal of Gastroenterology 2008年第15期14卷 2370-2376页

作者： Kenichi Hakamada Shunji Narumi Yoshikazu Toyoki Masaki Nara Motonari Oohashi takuya miura Hiroyuki Jin Syuichi Yoshihara Michihiro Sugai Mutsuo Sasaki Department of Gastroenterological Surgery Hirosaki University Graduate School of Medicine5 Zaifu-choHirosaki 036-8562Japan

AIM: To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burden during the learning period. METHODS: A retrospective analysis was performed using 644 consecutive patients who underwent LC from 1991 to 2006. An educational program with the use of IOUS as an operative guide has been used in 276 cases since 1998. RESULTS: IOUS was highly feasible even in patients with high-grade cholecystitis. No BDI was observed after the introduction of the educational program, despite 72% of operations being performed by inexperienced surgeons. Incidences of other morbidity, mortality, and late complications were comparable before and after the introduction of routine IOUS. However, the operation time was significantly extended after the educational program began (P < 0.001), and the grade of laparoscopic cholecystitis (P = 0.002), use of IOUS (P = 0.01), and the experience of the surgeons (P = 0.05) were significant factors for extending the length of operation. CONCLUSION: IOUS during LC was found to be a highly feasible modality, which provided accurate, real- time information about the biliary structures. Theeducational program using IOUS is expected to minimize the incidence of BDI following LC, especially when performed by less-skilled surgeons.

关键词： Intraoperative ultrasound Cholecystolithiasis Laparoscopic cholecystectomy Bile duct injury Education program

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Resection of a locally advanced hilar tumor and the hepatic artery after stepwise hepatic arterial embolization: A case report

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World Journal of Gastroenterology 2008年第22期14卷 3587-3590页

作者： takuya miura Kenichi Hakamada Takashi Ohata Shunji Narumi Yoshikazu Toyoki Masaki Nara Keinosuke Ishido Motonari Ohashi Harue Akasaka Hiroyuki Jin Norihito Kubo Shuichi Ono Hiroshi Kijima Mutsuo Sasaki Department of Gastroenterological Surgery Hirosaki University Graduate School of Medicine Hirosaki 036-8562 Japan Department of Radiology and Radiation Oncology Hirosaki University Graduate School of Medicine Hirosaki 036-8562 Japan Department of Gastroenterological Surgery Hirosaki University Graduate School of Medicine Hirosaki 036-8562 Japan Department of Pathology and Bioscience Hirosaki University Graduate School of Medicine Hirosaki 036-8562 Japan Department of Pathology and Bioscience Hirosaki University Graduate School of Medicine Hirosaki 036-8562 Japan

We herein report a case of a hilar tumor with extensive invasion to the proper hepatic artery, which was successfully treated with a radical resection in a 57-year-old female patient after a stepwise hepatic arterial embolization. She underwent right colectomy and partial hepatectomy for advanced colon cancer two years ago and radiofrequency ablation therapy for a liver metastasis one year ago, respectively. A recurrent tumor was noted around the proper hepatic artery with invasion to the left hepatic duct and right hepatic artery 7 mo previously. We planned a radical resection for the patient 5 mo after the absence of tumor progression was confirmed while he was undergoing chemotherapy. To avoid surgery-related liver failure, we tried to promote the formation of collateral hepatic arteries after stepwise arterial embolizationof the posterior and anterior hepatic arteries two weeks apart. Finally, the proper hepatic artery was occluded after formation of collateral flow from the inferior phrenic and superior mesenteric arteries was confirmed. One month later, a left hepatectomy with hepatic arterial resection was successfully performed without any major complications.

关键词： Hepatic arterial embolization Stepwise Hilar tumor Arterial resection Collateral artery

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Recent advances in treatment of follicular lymphoma: efficacy of PI3Kα/δ inhibitor (TQ-B3525)

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Signal Transduction and Targeted Therapy 2024年第6期9卷 2341-2343页

作者： takuya Watanabe Department of Internal Medicine and Gastroenterology Watanabe Internal Medicine Aoyama ClinicNiigata-city 9502002Japan

The commented study reports the results of monotherapy using TQ-B3525,a novel phosphatidylinositol-3 kinase(PI3K)inhibitor developed in China,in patients with refractory/relapsed follicular lymphoma(r/r FL).

关键词： PI3K lymphoma treatment

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Gene targeted and immune therapies for nodal and gastrointestinal follicular lymphomas

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World Journal of Gastroenterology 2023年第48期29卷 6179-6197页

作者： takuya Watanabe Department of Internal Medicine and Gastroenterology Watanabe Internal Medicine Aoyama ClinicNiigata 9502002Japan

Follicular lymphoma(FL)is the most common indolent B-cell lymphoma(BCL)***,its incidence has increased in Europe,the United States,and Asia,with the number of gastrointestinal FL cases expected to *** abnormalities related to t(14;18)translocation,BCL2 overexpression,NF-κB pathway-related factors,histone acetylases,and histone methyltransferases cause FL and enhance its ***,microRNAs are commonly used in diagnosing FL and predicting patient *** clinical trials on novel therapeutics targeting these genetic abnormalities and immunomodulatory mechanisms have been conducted,resulting in a marked improvement in therapeutic outcomes for *** developing these innovative therapeutic agents targeting specific genetic mutations and immune pathways has provided hope for curative options,FL treatment has become more complex,requiring combinatorial therapeutic ***,optimal treatment combinations have not yet been achieved,highlighting the importance of a complete understanding regarding the pathogenesis of gastrointestinal ***,this article reviews key research on the molecular pathogenesis of nodal FL and novel therapies targeting the causative genetic ***,the results of clinical trials are summarized,with a particular focus on treating nodal and gastrointestinal FLs.

关键词： Gastrointestinal follicular lymphoma Genetic mutation analysis using nextgeneration sequencing MicroRNA Gene targeted therapy Immune therapy

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Recent advances in treatment of nodal and gastrointestinal follicular lymphoma

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World Journal of Gastroenterology 2023年第23期29卷 3574-3594页

作者： takuya Watanabe Department of Internal Medicine and Gastroenterology Watanabe Internal Medicine Aoyama ClinicNiigata-city 9502002Japan

Follicular lymphoma(FL)is the most common low-grade lymphoma,and although nodal FL is highly responsive to treatment,the majority of patients relapse repeatedly,and the disease has been incurable with a poor ***,primary FL of the gastrointestinal tract has been increasingly detected in Japan,especially due to recent advances in small bowel endoscopy and increased opportunities for endoscopic examinations and endoscopic ***,many cases are detected at an early stage,and the prognosis is good in many *** contrast,in Europe and the United States,gastrointestinal FL has long been considered to be present in 12%-24%of Stage-IV patients,and the number of advanced gastrointestinal cases is expected to *** editorial provides an overview of the recent therapeutic advances in nodal FL,including antibody-targeted therapy,bispecific antibody therapy,epigenetic modulation,and chimeric antigen receptor T-cell therapy,and reviews the latest therapeutic manuscripts published in the past *** on an understanding of the therapeutic advances in nodal FL,we also discuss future possibilities for gastroenterologists to treat gastrointestinal FL,especially in advanced cases.

关键词： Nodal and gastrointestinal follicular lymphoma Antibody-based therapy Bispecific antibody therapy Phosphatidylinositol-3 kinase inhibitor Epigenetic modulator Chimeric antigen receptor-T cell therapy

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Docking and Molecular Dynamics Study of the Carbohydrate Binding Module from Trichoderma reesei Cel7A on the Surfaces of the Cellulose Ⅲ_(1) Crystal

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Journal of Renewable Materials 2020年第8期8卷 863-878页

作者： Toshifumi Yui takuya Uto Faculty of Engineering University of MiyazakiMiyazaki889-2192Japan Organization for Promotion of Tenure Track University of MiyazakiMiyazaki889-2192Japan

We report the systematic survey of the binding free energies at the interface between a carbohydrate binding module(CBM)of Cel7A and the celluloseⅢ_(1)crystal model using grid docking searches and molecular dynamics *** two hydrophobic crystal surfaces were involved in the distinct energy minima of the binding free *** complex models,each with the CBM at the minimum energy position,stably formed in the solution *** binding free energies of the celluloseⅢ_(1)complex models,based on both static and dynamics states,were comparable to those of the native cellulose complex ***,the celluloseⅢ_(1)crystal had a larger binding surface,which is compatible with the observed high enzymatic activity of Cel7A for the celluloseⅢ_(1)substrate.

关键词： Carbohydrate binding module Cel7A celluloseⅢ_(1) docking analysis

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Experimental and numerical study on hydrodynamics of riparian vegetation

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Journal of Hydrodynamics 2014年第5期26卷 796-806页

作者： UOTANI takuya KANDA Keiichi MICHIOKU Kohji Kobe City Bureau KobeJapan Department of Civil Engineering Akashi National College of TechnologyAkashiJapan Department of Civil and Environmental Engineering Hosei UniversityShinjukuTokyoJapan

Recently, many channelized rivers tend to be heavily vegetated due to regime shifts in hydrological, fluvial and ecological processes. Dense vegetation in a river frequently obstructs a flood flow and reduces conveyance capacity of channels. On the other hand, river vegetation provides various ecological services such as habitats for various species and life, natural cycle of organic and inorganic substances, etc.. It is of engineering importance to understand vegetation hydrodynamics in order to preserve vegetation nature and keep a certain level of flow conveyance capacity. In view that willows tend to be densely vegetated along the shoreline of floodplains or sandbars, a field measurement, a physical model experiment and a numerical analysis were carried out for investigating hydrodynamics in an open channel with riparian vegetation. Discussion was made focusing on flow and shear layer structures developed around the vegetation canopy.

关键词： open channel riparian vegetation drag force velocity profile laboratory experiment hydrodynamic model

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