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Role of phosphorylated Smad3 signal components in intraductal papillary mucinous neoplasm of pancreas

Hepatobiliary & Pancreatic Diseases International 2020年第6期19卷 581-589页

作者： Yuichi Hori tsukasa Ikeura Takashi Yamaguchi Katsunori Yoshida Koichi Matsuzaki Mitsuaki ishida Sohei Satoi Kazuichi Okazaki Department of Gastroenterology and Hepatology Kansai Medical University2-5-1 ShinmachiHirakataOsaka 5731191Japan Department of Pathology Kansai Medical University2-5-1 ShinmachiHirakataOsaka 5731191Japan Department of Surgery Kansai Medical University2-5-1 ShinmachiHirakataOsaka 5731191Japan

Background:Malignant intraductal papillary mucinous neoplasm(IPMN)has poor prognosis.The carcinogenesis of IPMN is not clear.The aim of this study was to clarify transitions in phosphorylated Smad3 signaling during IPMN carcinogenesis.Methods:By using immunohistochemistry,we examined the expression of pSmad3C and pSmad3L from 51 IPMN surgical specimens resected at our institution between 2010 and 2013.We also examined the expression of Ki-67,c-Myc and p-JNK.Results:The median immunostaining index of pSmad3C was 79.2%in low-grade dysplasia,74.9%in highgrade dysplasia,and 42.0%in invasive carcinoma(P<0.01),whereas that of pSmad3L was 3.4%,4.3%,and 42.4%,respectively(P<0.01).There was a negative relationship between the expression of pSmad3C and c-Myc(P<0.001,r=-0.615)and a positive relationship between the expression of pSmad3L and c-Myc(P<0.001,r=0.696).Negative relationship between the expression of pSmad3C and Ki-67(P<0.01,r=-0.610)and positive relationship between the expression of pSmad3L and Ki-67(P<0.01,r=0.731)were confirmed.p-JNK-positive cells were frequently observed among pSmad3L-positive cancer cells.The median of pSmad3L/pSmad3C ratio in the non-recurrence group and the recurrence group were 0.58(range,0.05–0.93),3.83(range,0.85–5.96),respectively(P=0.02).The median immunostaining index of c-Myc in the non-recurrence group and the recurrence group were 2.91(range,0–36.9)and 82.1(range,46.2–97.1),respectively(P=0.02).The median immunostaining index of Ki-67 in the non-recurrence group and the recurrence group were 12.9(range 5.7–30.8)and 90.9(range 52.9–98.5),respectively(P=0.02).Conclusions:pSmad3L was upregulated in malignant IPMN.pSmad3L/pSmad3C ratio may be a useful prognostic factor in IPMN.

关键词： Intraductal papillary mucinous neoplasms of the pancreas Immunohistochemistry Phosphorylated Smad Carcinogenesis Prognosis

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Esophageal diverticulum exposed during endoscopic submucosal dissection of superficial cancer

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World Journal of Gastroenterology 2015年第10期21卷 3121-3126页

作者： Shinwa Tanaka Takashi Toyonaga Yoshiko Ohara Tetsuya Yoshizaki Fumiaki Kawara Tsukasa Ishida Namiko Hoshi Yoshinori Morita Takeshi Azuma Department of Endoscopy Kobe University Division of Gastroenterology Department of Internal MedicineGraduate School of MedicineKobe University

Endoscopic submucosal dissection(ESD) is now widely accepted as a strategy to treat superficial esophageal neoplasms.The rate of adverse events,such as perforation,has been decreasing with the improvement of devices and techniques.In this paper,we report a case of esophageal cancer that had a diverticulum under cancerous epithelium.The diverticulum was not detected during preoperative examination,and led to perforation during the ESD procedure.Our case shows that,although rare,some diverticula can exist underneath the mucosal surface without obvious depression.If there is any sign of hidden diverticula during ESD,surgeons should proceed with caution or,depending on the case,the procedure should be discontinued to avoid adverse events.

关键词： Endoscopic submucosal dissection Eso-phageal cance

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Usefulness of a novel slim type Flush Knife-BT over conventional Flush Knife-BT in esophageal endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第9期23卷 1657-1665页

作者： Yoshiko Ohara Takashi Toyonaga Namiko Hoshi Shinwa Tanaka Shinichi Baba Hiroshi Takihara Fumiaki Kawara Tsukasa Ishida Yoshinori Morita Eiji Umegaki Takeshi Azuma Division of Gastroenterology Department of Internal MedicineGraduate School of MedicineKobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

AIM To investigated the usefulness of a novel slim type balltipped Flush Knife (Flush Knife-BTS) over ball-tipped Flush Knife (Flush Knife-BT) in functional experiments and clinical practice.METHODS In order to evaluate the functionality of Flush KnifeBTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between Flush Knife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using Flush Knife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were analyzed.RESULTS Functional experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with Flush Knife-BTS was 7.7-fold faster than that with conventional Flush Knife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushK nife-BTS. The waterjet flushing speed was faster with the use of Flush Knife-BT. In clinical practice, a comparison of 6 and 7 ESD using Flush Knife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min(range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with Flush Knife-BTS when the resection size was larger than 1000 m2(n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15)(P = 0.0065).CONCLUSION Our results indicate that FlushK nife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspiration and knife insertion during ESD and reducing the frequency of knife removal and rein

关键词：内视镜的 submucosal 解剖新奇细长的类型付小费给球的 FlushKnife 付小费给球的 FlushKnife 抵抗到刀插入浇渴望速度

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Efficacy of forced coagulation with low high-frequency power setting during endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第29期23卷 5422-5430页

作者： Tsukasa Ishida Takashi Toyonaga Yoshiko Ohara Tadao Nakashige Yasuaki Kitamura Ryusuke Ariyoshi Hiroshi Takihara Shinichi Baba Tetsuya Yoshizaki Fumiaki Kawara Shinwa Tanaka Yoshinori Morita Eiji Umegaki Namiko Hoshi Takeshi Azuma Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

AIM To investigated the hemostatic ability of the S and F1-10 methods in clinical and ex vivo studies.METHODS The hemostatic abilities of the two methods were analyzed retrospectively in all six gastric endoscopic submucosal dissection cases. The treated vessel diameter, compressed vessel frequency, and bleeding frequency after cutting the vessels were noted by therecorded videos. The coagulation mechanism of the two power settings was evaluated using the data recording program and histological examination on macro-and microscopic levels in the ex vivo experiments using porcine tissues.RESULTS F1-10 method showed a significantly better hemostatic ability for vessels ≥ 2 mm in diameter and a trend of overall better coagulation effect, evaluated by the bleeding rate after cutting the vessels. F1-10 method could sustain electrical current longer and effectively coagulate the tissue wider and deeper than the S method in the porcine model.CONCLUSION F1-10 method is suggested to achieve a stronger hemostatic effect than the S method in clinical procedures and ex vivo models.

关键词：内视镜的 submucosal 解剖电外科学 Endoknife 止血效果强迫的凝结模式

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Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids

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World Journal of Gastroenterology 2016年第27期22卷 6268-6275页

作者： Shinwa Tanaka Takashi Toyonaga Yoshinori Morita Namiko Hoshi Tsukasa Ishida Yoshiko Ohara Tetsuya Yoshizaki Fumiaki Kawara Eiji Umegaki Takeshi Azuma Department of Endoscopy Kobe University Hospital Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University

AIM: To evaluate the feasibility and safety of endoscopic submucosal dissection(ESD) for lower rectal lesions with hemorrhoids.METHODS: The outcome of ESD for 23 lesions with hemorrhoids(hemorrhoid group) was compared with that of 48 lesions without hemorrhoids extending to the dentate line(non-hemorrhoid group) during the same study period. RESULTS: Median operation times(ranges) in the hemorrhoid and non-hemorrhoid groups were 121(51-390) and 130(28-540) min. The en bloc resection rate and the curative resection rate in the hemorrhoid group were 96% and 83%, and they were 100% and 90% in the non-hemorrhoid group, respectively. In terms of adverse events, perforation and postoperative bleeding did not occur in both groups. In terms of the clinical course of hemorrhoids after ESD, the rate of complete recovery of hemorrhoids after ESD in lesions with resection of more than 90% was significantly higher than that in lesions with resection of less than 90%.CONCLUSION: ESD on lower rectal lesions with hemorrhoids could be performed safely, similarly to that on rectal lesions extending to the dentate line without hemorrhoids. In addition, all hemorrhoids after ESD improved to various degrees, depending on the resection range.

关键词： Endoscopic submucosal dissection Rectum Hemorrhoid Outcome Bleeding

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Factors associated with residual gastroesophageal reflux disease symptoms in patients receiving proton pump inhibitor maintenance therapy

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World Journal of Gastroenterology 2017年第11期23卷 2060-2067页

作者： Fumiaki Kawara Tsuyoshi Fujita Yoshinori Morita Atsushi Uda Atsuhiro Masuda Masaya Saito Makoto Ooi Tsukasa Ishida Yasuyuki Kondo Shiei Yoshida Tatsuya Okuno Yoshihiko Yano Masaru Yoshida Hiromu Kutsumi Takanobu Hayakumo Kazuhiko Yamashita Takeshi Hirano Midori Hirai Takeshi Azuma Division of Gastroenterology Department of Internal MedicineKobe University Graduate School of Medicine Department of Pharmacy Kobe University Hospital

AIM To elucidate the factors associated with residual gastroesophageal reflux disease(GERD) symptoms in patients receiving proton pump inhibitor(PPI) maintenance therapy in clinical practice.METHODS The study included 39 GERD patients receiving maintenance PPI therapy. Residual symptoms were assessed using the Frequency Scale for Symptoms of GERD(FSSG) questionnaire and the Gastrointestinal Symptom Rating Scale(GSRS). The relationships between the FSSG score and patient background factors, including the CYP2C19 genotype, were analyzed.RESULTS The FSSG scores ranged from 1 to 28 points(median score: 7.5 points), and 19 patients(48.7%) had a score of 8 points or more. The patients' GSRS scores were significantly correlated with their FSSG scores(correlation coefficient = 0.47, P < 0.005). In erosive esophagitis patients, the FSSG scores of the CYP2C19 rapid metabolizers(RMs) were significantly higher than the scores of the poor metabolizers and intermediate metabolizers(total scores: 16.7 ± 8.6 vs 7.8 ± 5.4, P < 0.05; acid reflux-related symptom scores: 12 ± 1.9 vs 2.5 ± 0.8, P < 0.005). In contrast, the FSSG scores of the CYP2C19 RMs in the non-erosive reflux disease patients were significantly lower than those of the other patients(total scores: 5.5 ± 1.0 vs 11.8 ± 6.3, P < 0.05; dysmotility symptom-related scores: 1.0 ± 0.4 vs 6.0 ± 0.8, P < 0.01). CONCLUSION Approximately half of the GERD patients receiving maintenance PPI therapy had residual symptoms associated with a lower quality of life, and the CYP2C19 genotype appeared to be associated with these residual symptoms.

关键词： Gastroesophageal reflux disease CYP2C19 FSSG Residual symptoms Proton pump inhibitor

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Commentary on transplant outcomes of 100 cases of living-donor ABO-incompatible kidney transplantation

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Chinese Medical Journal 2022年第19期135卷 2301-2302页

作者： Hideki ishida Department of Organ Transplant Medicine Tokyo Women's Medical University HospitalShinjuku-kuTokyo 162-8666Japan.

By the end of 1980,Japanese groups had started programs with ABO-incomparible kidney transplantation as a consequence of the very limited supply of cadaveric organs for transplantation.Since then,they have done successful transplantations across the blood type barrier in combina-tion with plasmapheresis and splenectomy.In Japan,the strategy for ABO-incompatible transplantation has changed with the development of the tacrolimus(FK)/mycophenolate mofetil(MMF)combination in 2000 and rituximab in 2005.1 In addition,preoperative 1-week administration of FK/MMF produced much more excellent results.Current graft survival(2005-2013)was almost over 90%in both ABO-incompatible at 9-year follow-up,which was comparable to ABO-compatible kidney trans-plantations.

关键词： ABO kidney organs

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Factors other than fibrosis that increase measured shear wave velocity

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World Journal of Gastroenterology 2022年第46期28卷 6512-6521页

作者： Hiroko Naganuma Hideaki ishida Department of Gastroenterology Yokote Municipal HospitalYokote 013-8602Japan Department of Gastroenterology Akita Red Cross HospitalAkita 010-1495Japan

Shear wave elastography(SWE)is now becoming an indispensable diagnostic tool in the routine examination of liver diseases.In particular,accuracy is required for shear wave propagation velocity measurement,which is directly related to diagnostic accuracy.It is generally accepted that the liver shear wave propagation velocity reflects the degree of fibrosis,but there are still few reports on other factors that increase the shear wave propagation velocity.In this study,we reviewed such factors in the literature and examined their mechanisms.Current SWE measures propagation velocity based on the assumption that the medium has a homogeneous structure,uniform density,and is purely elastic.Otherwise,the measurement is subject to error.The other(confounding)factors that we routinely experience are primarily:(1)Conditions that appear to increase the viscous component;and(2)Conditions that appear to increase tissue density.Clinically,the former includes acute hepatitis,congested liver,biliary obstruction,etc,and the latter includes diffuse infiltration of malignant cells,various storage diseases,tissue necrosis,etc.In any case,it is important to evaluate SWE in the context of the entire clinical picture.

关键词： Liver Shear wave elastography Propagation velocity Viscoelasticity Artifact Ultrasound

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Linear nonadiabatic pulsation models of the double-mode Cepheid V371 Per

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Research in Astronomy and Astrophysics 2017年第6期17卷 11-16页

作者： Toshihito ishida Center for Astronomy Institute of Natural and Environmental Science University of Hyogo Sayo-cho Hyogo 679-5313 Japan

A recently found double-mode Cepheid with the shortest known period in our Galaxy and abnormal period ratio, V371 Per, is investigated by linear nonadiabatic pulsation models. V371 Per is likely to be crossing the instability strip for the first time, because the mass derived from pulsation models is larger than the evolution mass for the second or higher crossing objects. This result seems to support the conclusion obtained from spectroscopic observation. We also found that models with observed period and period ratio of V371 Per need to have mass and Teff in a narrow range which shifts as heavy element abundance Z changes. We have checked the agreement between Teffranges estimated observationally and derived from pulsation models using observational Z. We found that those ranges overlap marginally. We need more spectroscopic estimations of Teff and [Fe/H], and more photometric monitoring to estimate the evolutional period change for confirmation of our result.

关键词： stars： oscillations （including pulsations） - stars variables Cepheids - stars individual （V371 Per）

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Verification of modified sum-peak method in Monte Carlo simulation of full energy peak and sum-peak efficiencies of a HPGe detector

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辐射防护 2020年第6期40卷 527-532页

作者： tsukasa Aso Yoshimune Ogata Hidesuke Itadzu College 1-2 Ebie NeriyaImizu 9330293Japan Radioisotope Research Center Medical Division Nagoya University65 Tsurumai-choShowa-kuNagoya 4668550Japan SEIKO EG&G Co.Ltd 1-9 NakaseMihama-kuChiba 2618507Japan

The modified sum-peak method estimates radioactivity by using only the peak and the sum-peak count rates.To verify the modified sum-peak method,the dependence of the full energy peak efficiency on the source-to-detector distance in a high-purity germanium detector system was studied using a Geant4 Monte Carlo simulation.The effect of the deadlayer in the germanium crystal was estimated by reference to experiments on 241 Am and the relative efficiency of the detector.The peak efficiency dependence on the source-to-detector distance was compared between the simulation and measurements.The modified sum-peak method is discussed with respect to these peak efficiencies.

关键词： Geant4 Monte Carlo simulation sum-peak method peak efficiency HPGe 60Co

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