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Usefulness of the clip-flap method of endoscopic submucosal dissection: A randomized controlled trial

World Journal of Gastroenterology 2018年第35期24卷 4077-4085页

作者： Hiromitsu Ban Mitsushige Sugimoto Taketo Otsuka Masaki Murata toshiro nakata Hiroshi Hasegawa Osamu Inatomi Shigeki Bamba Akira Andoh Division of Digestive Endoscopy Shiga University of Medical Science Hospital Department of Gastroenterology Shiga University of Medical Science Hospital Division of Clinical Nutrition Shiga University of Medical Science Hospital

AIM To prospectively investigate the efficacy and safety of clipflap assisted endoscopic submucosal dissection(ESD) for gastric tumors.METHODS From May 2015 to October 2016, we enrolled 104 patients with gastric cancer or adenoma scheduled for ESD at Shiga University of Medical Science Hospital. We randomized patients into two subgroups using the minimization method based on location of the tumor(upper, middle or lower third of the stomach), tumor size( 20 mm) and ulcer status: ESD using an endoclip(the clip-flap group) and ESD without an endoclip(the conventional group). Therapeutic efficacy(procedure time) and safety(complication: Gastrointestinal bleeding and perforation) were assessed. RESULTS En bloc resection was performed in all patients. Four patients had delayed bleeding(3.8%) and two had perforation(1.9%). No significant differences in en bloc resection rate(conventional group: 100%, clip flap group: 100%), curative endoscopic resection rate(conventional group: 90.9%, clip flap group: 89.8%, P = 0.85), procedure time(conventional group: 70.8 ± 46.2 min, clip flap group: 74.7 ± 53.3 min, P = 0.69), area of resected specimen(conventional group: 884.6 ± 792.1 mm^2, clip flap group: 1006.4 ± 1004.8 mm^2, P = 0.49), delayed bleeding rate(conventional group: 5.5%, clip flap group: 2.0%, P = 0.49), or perforation rate(conventional group: 1.8%, clip flap group: 2.0%, P = 0.93) were found between the two groups. Lessexperienced endoscopists did not show any differences in procedure time between the two groups.CONCLUSION For patients with early-stage gastric tumors, the clipflap method has no advantage in efficacy or safety compared with the conventional method.

关键词： Gastric cancer Clip flap method Endoscopic submucosal dissection Procedure time Complication Randomized clinical trial

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Severity of gastric mucosal atrophy affects the healing speed of post-endoscopic submucosal dissection ulcers

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World Journal of Gastrointestinal Endoscopy 2018年第5期10卷 83-92页

作者： Taketo Otsuka Mitsushige Sugimoto Hiromitsu Ban toshiro nakata Masaki Murata Atsushi Nishida Osamu Inatomi Shigeki Bamba Akira Andoh Division of Digestive Endoscopy Shiga University of Medical Science Hospital Department of Gastroenterology Shiga University of Medical Science Hospital

AIM To investigate factors associated with the healing of endoscopic submucosal dissection(ESD)-induced ulcers.METHODS We enrolled 132 patients with gastric tumors scheduled for ESD. Following ESD, patients were treated with daily lansoprazole 30 mg or vonoprazan 20 mg. Ulcer size was endoscopically measured on the day after ESD and at 4 and 8 wk. The gastric mucosa was endoscopically graded according to the Kyoto gastritis scoring system. We assessed the number of patients with and without a 90% reduction in ulcer area at 4 wk post-ESD and scar formation at 8 wk, and looked for risk factors for slower healing.RESULTS The mean size of gastric tumors and post-ESD ulcers was 17.4 ± 12.1 mm and 32.9 ± 13.0 mm. The meanreduction rates in ulcer area were 90.4% ± 0.8% at 4 wk and 99.8% ± 0.1% at 8 wk. The reduction rate was associated with the Kyoto grade of gastric atrophy at 4 wk(A0: 97.9% ± 0.6%, A1: 93.4% ± 4.1%, and A2: 89.7% ± 1.0%, respectively). In multivariate analysis, the factor predicting 90% reduction at 4 wk was gastric atrophy(Odds ratio: 5.678, 95%CI: 1.190-27.085, P = 0.029).CONCLUSION The healing speed of post-ESD ulcers was associated with the degree of gastric mucosal atrophy, and Helicobacter pylori eradication therapy is required to perform at younger age.

关键词： Helicobacter pylori Gastric mucosal/AB Endoscopic submucosal dissection Gastric ulcer

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Cap polyposis refractory to Helicobacter pylori eradication treated with endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2017年第10期9卷 529-534页

作者： Masaki Murata Mitsushige Sugimoto Hiromitsu Ban Taketo Otsuka toshiro nakata Masahide Fukuda Osamu Inatomi Shigeki Bamba Ryoji Kushima Akira Andoh Department of Gastroenterology Shiga University of Medical Science Hospital Division of Digestive Endoscopy Shiga University of Medical Science Hospital Department of Clinical Laboratory Medicine Shiga University of Medical Science Hospital

Cap polyposis is a rare intestinal disorder. Characteristic endoscopic findings are multiple inflammatory polypoid lesions covered by caps of fibrous purulent exudate. Although a specific treatment has not been established, some studies have suggested that eradication therapy for Helicobacter pylori(H. pylori) is effective. We report a case of a 20-year-old man with cap polyposis presenting with hematochezia. Colonoscopy showed the erythematous polyps with white caps from the sigmoid colon to rectum. Histopathological findings revealed elongated, tortuous, branched crypts lined by hyperplastic epithelium with a mild degree of fibromusculosis in the lamina propria. Although H. pylori eradication was instituted, there was no improvement over six months. We then performed en bloc excision of the polyps by endoscopic submucosal dissection(ESD), which resulted in complete resolution of symptoms. ESD may be a treatment option for cap polyposis refractory to conservative treatments. We review the literature concerning treatment for cap polyposis and clinical outcomes.

关键词： Endoscopic submucosal dissection Cap polyposis Eradication therapy Helicobacter pylori

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Optimization of fuel consumption and NO_(x) emission for mild HEV via hierarchical model predictive control

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Control Theory and Technology 2022年第2期20卷 221-234页

作者： Yuka Umezawa Ken Yamauchi Hiroki Seto toshiro Imamura Toru Namerikawa Graduate School of Science and Technology Keio University3-14-1 HiyoshiKohoku-ku.YokohamaKanagawa 223-8522Japan Isuzu Advanced Engineering Center Ltd 8 TsuchidanaFujisawa.Kanagawa 252-0881.Japan

In this paper,we consider the fuel economy optimization problem for a mild hybrid electric vehicle(HEV)using hierarchical model predictive control.In the proposed algorithm,two problems are addressed:eco-driving and torque distribution.In the eco-driving problem,vehicle speed was controlled.Considering the reduction in fuel consumption and NOx emissions,the torque required to follow the target speed was calculated.Subsequently,in the torque distribution problem,the distribution between the engine and motor torques were calculated.In this phase,engine characteristics were considered.These problems differ in terms of time scales;therefore,a hierarchical model predictive control is proposed.Lastly,the numerical simulation results demonstrated the efficacy of this research.

关键词： Mild HEV Energy management Model predictive control Hierarchical control

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Importance of an appropriate number of examined lymph nodes in patients with pancreatic cancer-the more the better?

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Hepatobiliary Surgery and Nutrition 2022年第4期11卷 605-607页

作者： toshiro Ogura Hiroyuki Ishida Amane Takahashi Yoshiyuki Kawashima Department of Gastroenterological Surgery Saitama Cancer CenterSaitamaJapan

Pancreatic cancer is a highly aggressive malignant cancer with a 5-year survival rate of approximately 10%.The outcome of patients diagnosed with resectable pancreatic cancer as per the National Comprehensive Cancer Network(NCCN)classification and those who underwent resection was not satisfactory.Similar to other abdominal malignant tumors,the stages of pancreatic cancer are defined by local extension,lymph node metastasis,and distant metastasis.The presence or absence of lymph node metastasis is diagnosed by pathological examination of the retrieved lymph,the quality of the diagnosis based on lymph node(N)staging depends on the surgical and pathological aspects(1).

关键词： lymph metastasis patients

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A hybrid chemical modification strategy for monocrystalline silicon micro-grinding:Experimental investigation and synergistic mechanism

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Chinese Journal of Aeronautics 2023年第7期36卷 147-159页

作者： Yinghui REN Kexin LI Wei LI Xiangming HUANG Xiaoman LIU Genyu CHEN toshiro DOI College of Mechanical and Vehicle Engineering Hunan UniversityChangsha 410082China Laser Research Institute Hunan UniversityChangsha 410082China Kyushu University Fukuoka 814-0001Japan

For high performance manufacturing of micro parts and features,a hybrid chemical modification strategy is proposed to decrease critical energy barrier of mechanical removal of hard and brittle crystal material by refining localized machining condition.The strategy,namely UVlight and IR-laser hybrid chemical modification(UVIR-CM)strategy,includes two steps,an ultraviolet light(UV-light)catalytic advanced oxidation and an infrared laser(IR-laser)assisted selective modification based on Fenton liquid–solid reaction for monocrystalline silicon.The modification effects of UVIR-CM strategy were investigated by surface morphology micro-observation,crosssection transmission electron microscopy(TEM)observation,Raman spectroscopy analysis and nanoindentation test.Experimental results demonstrated that varied degrees of laser texturing appeared on different strategy samples’IR-laser scanned area.And the IR-laser thermal damage has been successfully inhibited due to the refraction and reflection of energy by bubbles in liquid medium.But for the UVIR-CM strategy,a uniform and amorphous silicate layer is detected in a certain boundary.The UV-light promotes oxidation cycle ability of the chemical solution and ensures sufficient oxide modified layer for subsequent step.Attributing to synergism of photochemical,photothermal and kinetic effects induced by IR-laser,the modified layer displays layered structure with about 600 nm thickness,(2.7±0.60)GPa nanohardness,and(93.7±22.9)GPa indentation modulus.And the layered structure is amorphous layer,nanocrystal and micro-twins layer from the surface to the interior of sample.Consequently,it reveals that the subsequent mechanical removal will become easy due to decreasing energy barrier of monocrystalline silicon in selective area.Meanwhile,its original excellent mechanical properties also are maintained under a certain depth.The results contribute to develop a novel combined micro-machining technology to achieve collaborative manufacturing of structure shape and surface integrity for m

关键词： Modification strategy Monocrystalline silicon Multi-energy fields Selective surface modification

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Distribution of splenic artery lymph nodes and splenic hilar lymph nodes

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World Journal of Gastrointestinal Surgery 2023年第5期15卷 812-824页

作者： Yuya Umebayashi Satoru Muro Masanori Tokunaga Toshifumi Saito Yuya Sato toshiro Tanioka Yusuke Kinugasa Keiichi Akita Department of Gastrointestinal Surgery Tokyo Medical and Dental UniversityTokyo 113-8519Japan Department of Clinical Anatomy Tokyo Medical and Dental UniversityTokyo 113-8519Japan

BACKGROUND Total gastrectomy with splenectomy is the standard treatment for advanced proximal gastric cancer with greater-curvature invasion.As an alternative to splenectomy,laparoscopic spleen-preserving splenic hilar lymph node(LN)dissection(SPSHLD)has been developed.With SPSHLD,the posterior splenic hilar LNs are left behind.AIM To clarify the distribution of splenic hilar(No.10)and splenic artery(No.11p and 11d)LNs and to verify the possibility of omitting posterior LN dissection in laparoscopic SPSHLD from an anatomical standpoint.METHODS Hematoxylin&eosin-stained specimens were prepared from six cadavers,and the distribution of LN No.10,11p,and 11d was evaluated.In addition,heatmaps were constructed and three-dimensional reconstructions were created to visualize the LN distribution for qualitative evaluation.RESULTS There was little difference in the number of No.10 LNs between the anterior and posterior sides.For LN No.11p and 11d,the anterior LNs were more numerous than the posterior LNs in all cases.The number of posterior LNs increased toward the hilar side.Heatmaps and three-dimensional reconstructions showed that LN No.11p was more abundant in the superficial area,while LN No.11d and 10 were more abundant in the deep intervascular area.CONCLUSION The number of posterior LNs increased toward the hilum and was not neglectable.Thus,surgeons should consider that some posterior No.10 and No.11d LNs may remain after SPSHLD.

关键词： Gastric cancer Laparoscopic gastrectomy Anatomy Splenic hilar lymph node Laparoscopic spleen-preserving splenic hilar lymph node dissection

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Effects of bottom bracings on torsional dynamic characteristics of horizontally curved twin I-girder bridges with different curvatures

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Earthquake Engineering and Engineering Vibration 2012年第2期11卷 149-162页

作者： Robiul Awall toshiro Hayashikawa Takashi Matsumoto Graduate School of Engineering Hokkaido University Faculty of Engineering Hokkaido University

Curved twin I-girder bridges (CTIGBs) have low torsional stiffness that makes them vulnerable to dynamic loads. This study investigates the effects of bottom bracings on the torsional dynamic characteristics of CTIGBs. Five types of bottom bracings are designed to investigate their effects on the dynamic characteristics of CTIGBs with different curvatures under free and forced vibrations. To perform numerical investigations, three-dimensional (3-D) finite element (FE) bridge and vehicle models are established using commercial ANSYS code, and then a vehicle-bridge interaction analysis approach is proposed. Road roughness profiles generated from power spectral density and cross spectral functions are also taken into account in the analyses. The numerical results show that torsional frequencies increase significantly after providing bottom bracings, and the increasing rate depends on the type of bottom bracings and their locations of installation. Bottom bracings can act as load transmitting members from one main girder to the others. Large negative bearing forces that have occurred in bridges with small radii of curvatures can be remarkably reduced by providing bottom bracing systems. It is found that the performances of several bottom bracing systems are effective in improving the torsional dynamic characteristics of the bridges in this study.

关键词： bottom bracing CTIGB FE model torsional stiffness dynamic response negative bearing force

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Improvement in growth yield of single-walled carbon nanotubes with narrow chirality distribution by pulse plasma CVD

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Frontiers of Chemical Science and Engineering 2019年第3期13卷 485-492页

作者： Bin Xu toshiro Kaneko Toshiaki Kato Department o f Electronic Engineering Tohoku UniversitySendai 980-8579Japan Japan Science and Technology Agency (JST)-PRESTO Sendai 980-8579Japan

A pulse plasma chemical vapor deposition (CVD) technique was developed for improving the growth yield of single-walled carbon nanotubes (SWNTs) with a narrow chirality distribution. The growth yield of the SWNTs could be improved by repetitive short duration pulse plasma CVD, while maintaining the initial narrow chirality distribution. Detailed growth dynamics is discussed based on a systematic investigation by changing the pulse parameters. The growth of SWNTs with a narrow chirality distribution could be controlled by the difference in the nucleation time required using catalysts comprising relatively small or large particles as the key factor. The nucleation can be controlled by adjusting the pulse on/ofF time ratio and the total processing time.

关键词： single-walled carbon nanotubes chiralitycontrolled synthesis pulse plasma chemical vapor deposition

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Numerical analysis on seismic response of Shinkansen bridge-train interaction system under moderate earthquakes

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Earthquake Engineering and Engineering Vibration 2011年第1期10卷 85-97页

作者： Xingwen He Mitsuo Kawatani toshiro Hayashikawa Takashi Matsumoto Faculty of Engineering Hokkaido University Sapporo 060-8628 Japan Graduate School of Engineering Kobe University Kobe 657-8501 Japan

This study is intended to evaluate the influence of dynamic bridge-train interaction （BTI） on the seismic response of the Shinkansen system in Japan under moderate earthquakes. An analytical approach to simulate the seismic response of the BTI system is developed. In this approach, the behavior of the bridge structure is assumed to be within the elastic range under moderate ground motions. A bullet train car model idealized as a sprung-mass system is established. The viaduct is modeled with 3D finite elements. The BTI analysis algorithm is verified by comparing the analytical and experimental results. The seismic analysis is validated through comparison with a general program. Then, the seismic responses of the BTI system are simulated and evaluated. Some useful conclusions are drawn, indicating the importance of a proper consideration of the dynamic BTI in seismic design.

关键词： seismic analysis train-bridge interaction seismic design Shinkansen

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