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Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy

World Journal of Gastroenterology 2012年第22期18卷 2832-2836页

作者： Shuhei Komatsu Daisuke Ichikawa Kazuma Okamoto Daito Ikoma Masahiro Tsujiura Yukihisa Nishimura yasutoshi murayama Atsushi Shiozaki Hisashi Ikoma Yoshiaki Kuriu Masayoshi Nakanishi Hitoshi Fujiwara Toshiya Ochiai Yukihito Kokuba Eigo Otsuji Division of Digestive Surgery Department of Surgery Kyoto Prefectural University of Medicine 465 Kajii-cho Kawaramachihirokoji Kamigyo-ku Kyoto 602-8566 Japan

AIM: To re-evaluate the recent clinicopathological features of remnant gastric cancer (RGC) and to develop desirable surveillance programs. METHODS: Between 1997 and 2008, 1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Japan. Of these, 33 patients underwent gastrectomy with lymphadenectomy for RGC. Regarding the initial gastric disease, there were 19 patients with benign disease and 14 patients with gastric cancer. The hospital records of these patients were reviewed retrospectively. RESULTS: Concerning the initial gastric disease, the RGC group following gastric cancer had a shorter interval [P < 0.05; gastric cancer vs benign disease: 12 (2-22) vs 30 (4-51) years] and were more frequently reconstructed by Billroth-Ⅰ procedure than those following benign lesions (P < 0.001). Regarding reconstruction, RGC following Billroth-Ⅱ reconstruction showed a longer interval between surgical procedures [P < 0.001; Billroth-Ⅱ vs Billroth-Ⅰ: 32 (5-51) vs 12 (2-36) years] and tumors were more frequently associated with benign disease (P < 0.001) than those following Billroth-Ⅰ reconstruction. In tumor location of RGC, after Billroth-Ⅰ reconstruction, RGC occurred more frequently near the suture line and remnant gastric wall. After Billroth-Ⅱ reconstruction, RGC occurred more frequently at the anastomotic site. The duration of follow-up was significantly associated with the stage of RGC (P < 0.05). Patients diagnosed with early stage RGC such as stage Ⅰ-Ⅱ tended to have been followed up almost every second year. CONCLUSION: Meticulous follow-up examination and early detection of RGC might lead to a better prognosis. Based on the initial gastric disease and the procedure of reconstruction, an appropriate follow-up interval and programs might enable early detection of RGC.

关键词：时间间隔胃癌随访远端早期阶段有限元分析早期检测切除术

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Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

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World Journal of Gastroenterology 2017年第5期23卷 891-898页

作者： Hirotaka Konishi Kazuma Okamoto Katsutoshi Shoda Tomohiro Arita Toshiyuki Kosuga Ryo Morimura Shuhei Komatsu yasutoshi murayama Atsushi Shiozaki Yoshiaki Kuriu Hisashi Ikoma Masayoshi Nakanishi Daisuke Ichikawa Hitoshi Fujiwara Eigo Otsuji Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of MedicineKajii-choKyoto city 6028566Japan

AIM To investigate the efficacy of thrombomodulin(TM)-α for treatment of disseminated intravascular coagulopathy(DIC) in the field of gastrointestinal surgery. METHODS Thirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the ini-tiation of TM-α and patient demographics were also evaluated. RESULTS Abscess formation or bacteremia was the most frequent cause of DIC(33%), followed by digestive tract perforation(31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk(81%). TM-α was most often administered within 1 d of the DIC diagnosis(72%) and was continued for more than 3 d(64%). Although bleeding tendency was observed in 7 patients(19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome(SIRS) scores, quick-sequential organ failure assessment(qS OFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk(P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration(≥ 4, ≤ 6) and improvements in DIC-associated scores(DIC, SIRS and q SOFA) at 1 wk were significantly better prognostic factors for 28-d survival(P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qS OFA scores, sepsis, shock or high lactate values(P < 0.05, for all). CONCLUSION Early administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.

关键词：快顺序的机关失败评价 Thrombomodulin-α 胃肠的外科全身的煽动性的反应症候群尖锐传播 intravascular coagulopathy

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Laparoscopic transhiatal approach for resection of an adenocarcinoma in long-segment Barrett's esophagus

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World Journal of Gastroenterology 2015年第29期21卷 8974-8980页

作者： Atsushi Shiozaki Hitoshi Fujiwara Hirotaka Konishi Osamu Kinoshita Toshiyuki Kosuga Ryo Morimura yasutoshi murayama Shuhei Komatsu Yoshiaki Kuriu Hisashi Ikoma Masayoshi Nakanishi Daisuke Ichikawa Kazuma Okamoto Chouhei Sakakura Eigo Otsuji Division of Digestive Surgery Department of Surgery Kyoto Prefectural University of Medicine

Barrett's esophagus(BE) is a precursor of esophageal adenocarcinoma and is associated with gastroesophageal reflux disease, which is often preceded by a hiatal hernia. We describe a case of esophageal adenocarcinoma arising in long-segment BE(LSBE) associated with a hiatal hernia that was successfully treated with a laparoscopic transhiatal approach(LTHA) without thoracotomy. The patient was a 42-year-old male who had previously undergone laryngectomy and tracheal separation to avoid repeated aspiration pneumonitis. An ulcerative lesion was found in a hiatal hernia by endoscopy and superficial esophageal cancer was also detected in the lower thoracic esophagus. The histopathological diagnosis of biopsy samples from both lesions was adenocarcinoma. There were difficulties with the thoracic approach because the patient had severe kyphosis and muscular contractures from cerebral palsy. Therefore, we performed subtotal esophagectomy by LTHA without thoracotomy. Using hand-assisted laparoscopic surgery, the esophageal hiatus was divided and carbon dioxide was introduced into the mediastinum. A hernial sac was identified on the cranial side of the right crus of the diaphragm and carefully separated from the surrounding tissues. Abruption of the thoracic esophagus was performed up to the level of thearch of the azygos vein via LTHA. A cervical incision was made in the left side of the permanent tracheal stoma, the cervical esophagus was divided, and gastric tube reconstruction was performed via a posterior mediastinal route. The operative time was 175 min, and there was 61 m L of intra-operative bleeding. A histopathological examination revealed superficial adenocarcinoma in LSBE. Our surgical procedure provided a good surgical view and can be safely applied to patients with a hiatal hernia and kyphosis.

关键词： Laparoscopic transhiatal approach Barrett'sesophageal carcinoma Hiatal hernia

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Optimal duration of the early and late recurrence of hepatocellular carcinoma after hepatectomy

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World Journal of Gastroenterology 2015年第4期21卷 1207-1215页

作者： Yusuke Yamamoto Hisashi Ikoma Ryo Morimura Hirotaka Konishi yasutoshi murayama Shuhei Komatsu Atsushi Shiozaki Yoshiaki Kuriu Takeshi Kubota Masayoshi Nakanishi Daisuke Ichikawa Hitoshi Fujiwara Kazuma Okamoto Chouhei Sakakura Toshiya Ochiai Eigo Otsuji Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of MedicineKyoto 6028566Japan Department of Surgery North Medical CenterKyoto Prefectural University of MedicineKyoto 6028566Japan

AIM: To determine the best cut-off value between the early and late recurrence periods after the initial recurrence of hepatocellular carcinoma(HCC).METHODS: The clinical records of 404 patients who underwent macroscopic curative hepatectomy for HCC between 1980 and 2010 were retrospectively examined. We divided the 252 patients experienced a recurrence of HCC into two groups, the early and late recurrence groups using the "minimum P-value" approach. Factors for early recurrence were investigated using all 404 patients, and factors related to late recurrence were investigated in the patients who were confirmed to be recurrence free at the end of the early recurrence period.RESULTS: For the 252 patients who experienced a recurrence, the optimal cut-off value for differentiating early and late recurrence based on the overall survival after initial recurrence was 17 mo(5-year overall survival after initial recurrence: 15.4% vs 36.3%, P = 0.000018). Cox proportional hazard analysis identified early recurrence(P = 0.003) as one of the independent prognostic factors associated with overall survival after initial recurrence. A logistic regression model showed that an alpha-fetoprotein level > 100 ng/m L(P < 0.001), multiple HCC(P < 0.001), serosal invasion(P = 0.031), and microvascular invasion(P = 0.012) were independent factors associated with early recurrence, whereas the only independent factor related to late recurrence was liver cirrhosis(P = 0.002).CONCLUSION: Seventeen months after hepatectomy is a useful cut-off value between early and late recurrence of HCC based on the prognosis and different etiologies.

关键词： Early recurrence Late recurrence Hepatocellular ca

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Post-hepatectomy survival in advanced hepatocellular carcinoma with portal vein tumor thrombosis

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World Journal of Gastroenterology 2015年第1期21卷 246-253页

作者： Yusuke Yamamoto Hisashi Ikoma Ryo Morimura Katsutoshi Shoda Hirotaka Konishi yasutoshi murayama Shuhei Komatsu Atsushi Shiozaki Yoshiaki Kuriu Takeshi Kubota Masayoshi Nakanishi Daisuke Ichikawa Hitoshi Fujiwara Kazuma Okamoto Chouhei Sakakura Toshiya Ochiai Eigo Otsuji Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of MedicineKyoto 6028566Japan Department of Surgery North Medical Center Kyoto Prefectural University of MedicineKyoto 6028566Japan

AIM: To analyze hepatocellular carcinoma(HCC) patients with portal vein tumor thrombosis(PVTT) using the tumor-node-metastasis(TNM) staging system.METHODS: We retrospectively analyzed 372 patients with HCC who underwent hepatectomy between 1980 and 2009.We studied the outcomes of HCC patients with PVTT to evaluate the American Joint Committee on Cancer TNM staging system(7th edition) for stratifying and predicting the prognosis of a large cohort of HCC patients after hepatectomy in a single-center.Portal vein invasion(vp) 1 was defined as an invasion or tumor thrombus distal to the second branch of the portal vein,vp2 as an invasion or tumor thrombus in the second branch of the portal vein,vp3 as an invasion or tumor thrombus in the first branch of the portal vein,and vp4 as an invasion or tumor thrombus in the portal trunk or extending to a branch on the contralateral side.RESULTS: The cumulative 5-year overall survival(5yr OS) and 5-year disease-free survival(5yr DFS) rates of the 372 patients were 58.3% and 31.3%,respectively.The 5yr DFS and 5yr OS of vp3-4 patients(n = 10) were 20.0%,and 30.0%,respectively,which was comparable with the corresponding survival rates of vp1-2 patients(P = 0.466 and 0.586,respectively).In the subgroup analysis of patients with macroscopic PVTT(vp2-4),the OS of the patients who underwent preoperative transarterial chemoembolization was comparable to that of patients who did not(P = 0.747).There was a significant difference in the DFS between patients with stage Ⅰ HCC and those with stage Ⅱ HCC(5yr DFS 39.2% vs 23.1%,P 100 mg/dL was independently associated with DFS.CONCLUSION: Hepatectomy for vp3-4 HCC results in a survival rate similar to hepatectomy for vp1-2.AFP stratified the stage Ⅱ-Ⅲ HCC patients according to prognosis.

关键词： Hepatocellular carcinoma Hepatectomy Portal vein t

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Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy:A case report and review of literature

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World Journal of Gastroenterology 2022年第8期28卷 868-877页

作者： Eiji Yoshida yasutoshi Kimura Takuro Kyuno Ryoko Kawagishi Kei Sato Tsuyoshi Kono Takehiro Chiba Toshimoto Kimura Hitoshi Yonezawa Osamu Funato Makoto Kobayashi Kenji Murakami Akinori Takagane Ichiro Takemasa Department of Surgery Hakodate Goryoukaku HospitalHakodate City 040-8611Japan Department of Surgery Surgical Oncology and ScienceSapporo Medical UniversitySapporo City 060-8543HokkaidoJapan Department of Diagnostic Radiology Hakodate Goryoukaku HospitalHakodate City 040-8611Japan

BACKGROUND During pancreaticoduodenectomy in patients with celiac axis(CA)stenosis due to compression by the median arcuate ligament(MAL),the MAL has to be divided to maintain hepatic blood flow in many cases.However,MAL division often fails,and success can only be determined intraoperatively.To overcome this problem,we performed endovascular CA stenting preoperatively,and thereafter safely performed pancreaticoduodenectomy.We present this case as a new preoperative treatment strategy that was successful.CASE SUMMARY A 77-year-old man with a diagnosis of pancreatic head cancer presented to our department for surgery.Preoperative assessment revealed CA stenosis caused by MAL.We performed endovascular stenting in the CA preoperatively because we knew that going into the operation without a strategy could lead to ischemic complications.Double-antiplatelet therapy(DAPT)–which is needed when a stent is inserted–was then administered in parallel with neoadjuvant chemotherapy(NAC).This allowed us to administer DAPT for a sufficient period before the main pancreaticoduodenectomy procedure while obtaining therapeutic effects from NAC.Subtotal stomach-preserving pancreaticoduodenectomy was thenperformed.The operation did not require any unusual techniques and was performed safely.Postoperatively,the patient progressed well,without any ischemic complications.Histopathologically,curative resection was confirmed,and the patient had no recurrence or complications due to ischemia up to six months postoperatively.CONCLUSION Preoperative endovascular stenting,with NAC and DAPT,is effective and safe prior to pancreaticoduodenectomy in potentially resectable pancreatic cancer.

关键词： Pancreaticoduodenectomy Celiac axis stenosis Median arcuate ligament Endovascular stenting Pancreatic head cancer Case report

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Effects of soil profile and characteristic of exciting force on propagation of ground vibrations

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Journal of Modern Transportation 2012年第3期20卷 129-137页

作者： Sunao KUNIMATSU Yoshihiro HIRAO yasutoshi KITAMURA Institute for Geo-Resources and Environment National Institute of Advanced Industrial Science and Technology1-1-1 Higashi Tsukuba Ibaraki 305-8567 Japan Kobayashi Institute of Physical Research 3-20-41 Higashi-Motomachi Kokubunji Tokyo 185-0020 Japan Construction Engineering Research Institute Foundation 1-3-10 Turukabuto Nada-ku Kobe Hyogo 657-0011 Japan

Ground-borne vibrations caused by vibration sources such as road traffic and construction exhibit complicated properties during propagation from the vibration source to the inside of a building. In the present paper, a numerical analysis technique for the system of vibration source and propagation path of ground vibration is developed in order to systematically determine the propagation properties of the vibration as part of developing a predictive technique for exposure evaluations by vibrations in three directions at receiving points of vibration in the human body. First, the exciting forces in three directions for input into the numerical computation are inversely-estimated by using the measured acceleration rec- ords of the measurement points, which are near the vibration source. The thin-layered element method is used for numerical computation of the ground vibration. Then, the calculation results for the ground vibration obtained by using the estimated exciting force are compared with the measured results, and the influence of the stratified structure of the ground on the exciting force and the propagation properties of the ground vibration are studied. From these results, in a prediction of the ground vibration in three directions, it is emphasized that it is necessary to consider the influence of horizontal exciting force, although attention has been paid to only the vertical exciting force for simulating ground vibration.

关键词： ground-borne vibration vibration source exciting force stratified structure soil profile

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Vascular endothelial growth factor 165b expression in stromal cells and colorectal cancer

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World Journal of Gastroenterology 2011年第44期17卷 4867-4874页

作者： Makoto Tayama Tomohisa Furuhata Yoshiko Inafuku Kenji Okita Toshihiko Nishidate Toru Mizuguchi yasutoshi Kimura Koichi Hirata the First Department of Surgery Sapporo Medical University

AIM:To characterize the implications of vascular endothelial growth factor(VEGF)-A in stromal cells and colorectal cancer and the expression of VEGF-A splice variants.METHODS:VEGF-A expression in tumor and stromal cells from 165 consecutive patients with colorectal cancer was examined by immunohistochemistry.The association between VEGF-A expression status and clinicopathological factors was investigated.Twenty freshfrozen samples were obtained for laser capture microdissection to analyze the splice variants of VEGF-A.RESULTS:VEGF-A was expressed in 53.9% and 42.4% of tumor and stromal cells,respectively.VEGF-A expression in tumor cells(t-VEGF-A) was associated with advanced clinical stage(stage 0,1/9;stage 1,2/16;stage 2,32/55;stage 3,38/66;stage 4,16/19,P < 0.0001).VEGF-A expression in stromal cells(s-VEGF-A) increased in the earlier clinical stage(stage 0,7/9;stage 1,6/16;stage 2,33/55;stage 3,22/66;stage 4,5/19;P = 0.004).Multivariate analyses for risk factors of recurrence showed that only s-VEGF-A expression was an independent risk factor for recurrence(relative risk 0.309,95% confidence interval 0.141-0.676,P = 0.0033).The five-year disease-free survival(DFS) rates of t-VEGF-A-positive and-negative cases were 51.4% and 62.9%,respectively.There was no significant difference in t-VEGF-A expression status.The five-year DFS rates of s-VEGF-A-positive and-negative cases were 73.8% and 39.9%,respectively.s-VEGFA-positive cases had significantly better survival than s-VEGF-A-negative cases(P = 0.0005).Splice variant analysis revealed that t-VEGF-A was mainly composed of VEGF165 and that s-VEGF-A included both VEGF165 and VEGF165b.In cases with no venous invasion(v0),the level of VEGF165b mRNA was significantly higher(v0 204.5 ± 122.7,v1 32.5 ± 36.7,v2 2.1 ± 1.7,P = 0.03).The microvessel density tended to be lower in cases with higher VEGF165b mRNA levels.CONCLUSION:s-VEGF-A appears be a good prognostic factor for colorectal cancer and includes VEGF165 and VEGF165b.

关键词：血管内皮生长因子基质细胞大肠癌激光捕获显微切割 mRNA水平免疫组化检测肿瘤细胞危险因素

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Re-emerging threat of Trypanosoma cruzi vector transmission in El Salvador, update from 2018 to 2020

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Infectious Diseases of Poverty 2022年第4期11卷 101-102页

作者： Marvin Stanley Rodriguez Yuko Nitahara Michelle Cornejo Kevin Siliezar Rafael Grande Ana Gonzalez Kotaro Tasaki Yu Nakagama Yu Michimuko Yoko Onizuka Junko Nakajima-Shimada Jose Eduardo Romero Jose Ricardo Palacios Carmen Elena Arias Wilam Mejia yasutoshi Kido Ricardo Cardona Alvarenga Department of Virology and Parasitology Graduate School of MedicineOsaka Metropolitan University1-4-3 Asahi-machiAbeno-kuOsaka 545-8585 Japan 不详

Background:Since the late twentieth century,Chagas disease gained global attention to suppress the vector burden as a main control strategy in endemic countries.In Central America,multi-national initiative successfully achieved significant reduction in the estimated disease prevalence as well as elimination of the region's principal vector species at the time in 2012.While the last decade has witnessed significant changes in ecosystem-such as urbanization and replacement of the main vector species-that can possibly affect the vector's habitation and residual transmission,the up-to-date vector burden in the region has not been evaluated thoroughly due to the cessation of active vector surveillance.The aim of this study was to update the risk of vector-borne Trypanosoma cruzi infection in El Salvador,the top Chagas disease-endemic country in Central America.Methods:A nationwide vector survey was conducted in the domestic environment of El Salvador from September 2018 to November 2020.The selection of the houses for inspection was based on expert purposeful sampling.Infection for T.cruzi was examined by microscopic observation of the insects'feces,followed by a species confrmation using PCR.The data were analyzed using R software version 4.1.3.Proportion estimates with 95%confidence intervals were inferred using the Jeffrey's method provided under the epiR package.Results:A total of 1529 Triatoma dimidiata was captured from 107 houses(infestation rate,34.4%;107/311)in all the fourteen departments of the country visited within the period;prevalence of T.cruzi infection was as high as 10%(153/1529).In the country,domestic T.dimidiata infestation was distributed ubiquitously,while T.cruzi infection rates varied across the departments.Five out of fourteen departments showed higher infection rates than the average,suggesting sporadic high-risk areas in the country.Conclusions:Our comprehensive study revealed substantial T.cruzi infection of T.dimidiata across the country,indicating potential active transmission of the di

关键词： Chagas disease Vector transmission Triatomine Trypanosoma cruzi Triatoma dimidiata

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Investigation of Braking Timing of Drivers for Design of Pedestrian Collision Avoidance System

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Journal of Mechanics Engineering and Automation 2016年第3期6卷 118-127页

作者： Keisuke Suzuki Takuya Kakihara yasutoshi Horii Faculty of Engineering Kagawa University Takamatsu 761-0396 Japan DENSO SALES SWEDEN AB Goteborg 417 55 Sweden

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