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Surgical treatment of gallbladder cancer:An eight-year experience in a single center

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World Journal of Hepatology 2020年第9期12卷 641-660页

作者： Yasuyuki Kamada Tomohide Hori Hidekazu Yamamoto Hideki Harada Michihiro Yamamoto MasahiroYamada Takefumi Yazawa Masaki Tani Asahi Sato Ryotaro Tani Ryuhei Aoyama Yudai Sasaki MasazumiZaima Department of Surgery Shiga General HospitalMoriyama 524-8524ShigaJapan

BACKGROUND Gallbladder cancer(GBC)is the most common biliary malignancy and has the worst prognosis,but aggressive surgeries[e.g.,resection of the extrahepatic bile duct(EHBD),major hepatectomy and lymph node(LN)dissection]may improve long-term survival.GBC may be suspected preoperatively,identified intraoperatively,or discovered incidentally on histopathology.AIM To present our data together with a discussion of the therapeutic strategies for GBC.METHODS We retrospectively investigated nineteen GBC patients who underwent surgical treatment.RESULTS Nearly all symptomatic patients had poor outcomes,while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery.Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs.Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus.All patients with positive surgical margins(e.g.,the biliary cut surface)showed poor outcomes.Hepatectomies were performed in sixteen patients,nearly all of which were minor hepatectomies.Metastases were observed in the left-sided liver but not in the caudate lobe.We may need to reconsider the indications for major hepatectomy,minimizing its use except when it is required to accomplish negative bile duct margins.Only a few patients received neoadjuvant or adjuvant chemoradiation.There were significant differences in overall and disease-free survival between patients with stages≤IIB and≥IIIA disease.The median overall survival and disease-free survival were 1.66 and 0.79 years,respectively.CONCLUSION Outcomes for GBC patients remain unacceptable,and improved therapeutic strategies,including neoadjuvant chemotherapy,optimal surgery and adjuvant chemotherapy,should be considered for patients with advanced GBCs.

关键词： Gallbladder cancer Surgery Prognosis Outcome Metastasis Lymph node Extrahepatic bile duct

Impact of continuous local lavage on pancreatic juice-related postoperative complications: Three case reports

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World Journal of Clinical Cases 2019年第17期7卷 2526-2535页

作者： Tomohide Hori Kohei Ogawa Hidekazu Yamamoto Hideki Harada Kazuyoshi Matsumura Michihiro Yamamoto Masahiro Yamada Takefumi Yazawa Katsutoshi Kuriyama Masaki Tani Daiki Yasukawa Yasuyuki Kamada Yuki Aisu Ryotaro Tani Ryuhei Aoyama Shinnosuke Nakayama Yudai Sasaki Koki Nishimoto Masazumi Zaima Department of Surgery Shiga General HospitalMoriyama 524-8524Japan Department of Hepatobiliary Pancreatic and Breast Surgery Ehime UniversityToon 791-0295Japan Department of Gastroenterology and Hepatology Shiga General HospitalMoriyama 524- 8524Japan Department of Surgery Shiga University of Medical ScienceOtsu 520-2192Japan Department of Surgery Kyoto University Graduate School of MedicineKyoto 606- 8507Japan

BACKGROUND Postoperative pancreatic leakage readily results in intractable pancreatic fistula and subsequent intraperitoneal abscess.This refractory complication can be fatal;therefore,intensive treatment is important.Continuous local lavage (CLL) has recently been reevaluated as effective treatment for severe infected pancreatitis,and we report three patients with postoperative intractable pancreatic fistula successfully treated by CLL.We also discuss our institutional protocol for CLL for postoperative pancreatic fistula.CASE SUMMARY The first patient underwent subtotal stomach-preserving pancreaticoduodenectomy,and pancreatic leakage was observed postoperatively.Intractable pancreatic fistula led to intraperitoneal abscess,and CLL near the pancreaticojejunostomy site was instituted from postoperative day (POD) 8.The abscess resolved after 7 d of CLL.The second patient underwent distal pancreatectomy.Pancreatic leakage was observed,and intractable pancreatic fistula led to intraperitoneal abscess near the pancreatic stump.CLL was instituted from POD 9,and the abscess resolved after 4 d of CLL.The third patient underwent aneurysmectomy and splenectomy with wide exposure of the pancreatic parenchyma.Endoscopic retrograde pancreatic drainage was performed on POD 15 to treat pancreatic fistula;however,intraperitoneal abscess was detected on POD 59.We performed CLL endoscopically via the transgastric route because the percutaneous approach was difficult.CLL was instituted from POD 63,and the abscess resolved after 1 wk of CLL.CONCLUSION CLL has therapeutic potential for postoperative pancreatic fistula.

关键词： Surgery Pancreas Pancreatic fistula Pancreatic juice Postoperative complications Case report

Do liver metastases from gastric cancer contraindicate aggressive surgical resection?A 14-year single-center experience

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2020年第5期11卷 110-122页

作者： Takefumi Yazawa Tomohide Hori Hidekazu Yamamoto Hideki Harada Michihiro Yamamoto MasahiroYamada Masaki Tani Asahi Sato Yasuyuki Kamada Ryotaro Tani Ryuhei Aoyama Yudai Sasaki MasazumiZaima Department of Surgery Shiga General HospitalMoriyama 524-8524ShigaJapan

BACKGROUND Advanced gastric cancer(GC)with liver metastasis is often characterized by multiple and bilobular metastases and may also be associated with extrahepatic metastatic lesions.Hence,many physicians consider that radical surgeries are contraindicated for liver metastases from GC(LMGC).According to the 2017 Japanese treatment guideline for GC,a smaller number of liver metastases without unresectable factors may be an indication for liver resection(LR)with curability.The actual 5-year overall survival(OS)rate ranges from 0 to 0.37.AIM To present the institutional indications for LR for LMGC and identify important factors for prognostic outcomes.METHODS In total,30 patients underwent LR for LMGC during a 14-year period,and we evaluated the clinical,surgical,and oncological findings.In all patients,radical surgery with intentional lymphadenectomy was performed for the primary GC.The median follow-up duration after the initial LR was 33.7 mo,and three patients with no recurrence died of causes unrelated to the LMGC.The OS and recurrence-free survival rates after the initial LR were assessed.RESULTS Seventeen patients had metachronous LMGC.The initial LR achieved curability in 29 patients.Perioperative chemotherapy was introduced in 23 patients.The median greatest LMGC dimension was 30 mm,and the median number of LMGC was two.Twenty-two patients had unilobular LMGC.The 5-year OS and recurrence-free survival rates were 0.48 and 0.28,respectively.The median survival duration and recurrence-free duration after the initial LR were 16.8 and 8.6 mo,respectively.Twenty-one patients developed recurrence after the initial LR.Additional surgeries for recurrence were performed in nine patients,and these surgeries clearly prolonged the patients’survival.Pathological serosal invasion was an independent predictor of a poor prognostic outcome after the initial LR.Aggressive LR may be indicated for carefully selected patients with LMGC.CONCLUSION Our results of LR for LMGC seem acceptable.Additional surgeries for recurrence aft

关键词： Liver metastasis Metastatic tumor Gastric cancer Hepatectomy Liver resection Surgery

Successful treatment of warfarin-induced skin necrosis using oral rivaroxaban: A case report

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World Journal of Clinical Cases 2019年第24期7卷 4285-4291页

作者： Momoka kamada Tsuneaki Kenzaka Department of Internal Medicine Hyogo Prefectural Tamba Medical CenterTamba 669-3395Japan Division of Community Medicine and Career Development Kobe University Graduate School of MedicineKobe 652-0032Japan

BACKGROUND Heparin is commonly recommended for warfarin-induced skin necrosis;however, there is currently no established therapy for this disease. We present a serious case of warfarin-induced skin necrosis that was successfully treated with oral rivaroxaban, a factor Xa inhibitor.CASE SUMMARY A 48-year-old woman was admitted to the hospital for cellulitis of the right lower extremity. After antibiotic treatment, she developed pain and swelling of the left lower extremity, and deep vein thrombosis of both lower extremities was diagnosed. She was treated with a continuous heparin injection;subsequently,oral warfarin was concomitantly administered. Heparin was terminated after the therapeutic range was reached. On the following day, the patient had swelling and pain in the left lower extremity. In addition to decrease in protein S activity due to systemic lupus erythematosus, warfarin also reduced protein C activity,resulting in further hypercoagulation and skin necrosis. Warfarin was discontinued, and continuous heparin injection was resumed. Although the patient had to undergo amputation of the distal end of her left foot, continuous heparin injection was switched to oral rivaroxaban, and she was eventually discharged from the hospital in remission.CONCLUSION Administration of direct oral anticoagulants instead of warfarin is important in patients with decreased protein S and C activity.

关键词： Skin necrosis Warfarin Heparin Rivaroxaban Systemic lupus erythematosus Case report

Fatal arterial hemorrhage after pancreaticoduodenectomy:How do we simultaneously accomplish complete hemostasis and hepatic arterial flow?

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World Journal of Hepatology 2021年第4期13卷 483-503页

作者： Yasuyuki Kamada Tomohide Hori Hidekazu Yamamoto Hideki Harada Michihiro Yamamoto MasahiroYamada Takefumi Yazawa Ben Sasaki Masaki Tani Asahi Sato Hikotaro Katsura Ryotaro Tani RyuheiAoyama Yudai Sasaki Masaharu Okada Masazumi Zaima Department of Surgery Shiga General HospitalMoriyama 524-8524ShigaJapan Department of Cardiovascular Medicine Shiga General HospitalMoriyama 524-8524ShigaJapan

BACKGROUND Although arterial hemorrhage after pancreaticoduodenectomy(PD)is not frequent,it is fatal.Arterial hemorrhage is caused by pseudoaneurysm rupture,and the gastroduodenal artery stump and hepatic artery(HA)are frequent culprit vessels.Diagnostic procedures and imaging modalities are associated with certain difficulties.Simultaneous accomplishment of complete hemostasis and HA flow preservation is difficult after PD.Although complete hemostasis may be obtained by endovascular treatment(EVT)or surgery,liver infarction caused by hepatic ischemia and/or liver abscesses caused by biliary ischemia may occur.We herein discuss therapeutic options for fatal arterial hemorrhage after PD.AIM To present our data here along with a discussion of therapeutic strategies for fatal arterial hemorrhage after PD.METHODS We retrospectively investigated 16 patients who developed arterial hemorrhage after PD.The patients’clinical characteristics,diagnostic procedures,actual treatments[transcatheter arterial embolization(TAE),stent-graft placement,or surgery],clinical courses,and outcomes were evaluated.RESULTS The frequency of arterial hemorrhage after PD was 5.5%.Pancreatic leakage was observed in 12 patients.The onset of hemorrhage occurred at a median of 18 d after PD.Sentinel bleeding was observed in five patients.The initial EVT procedures were stent-graft placement in seven patients,TAE in six patients,and combined therapy in two patients.The rate of technical success of the initial EVT was 75.0%,and additional EVTs were performed in four patients.Surgical approaches including arterioportal shunting were performed in eight patients.Liver infarction was observed in two patients after TAE.Two patients showed a poor outcome even after successful EVT.These four patients with poor clinical courses and outcomes had a poor clinical condition before EVT.Fourteen patients were successfully treated.CONCLUSION Transcatheter placement of a covered stent may be useful for simultaneous accomplishment of complete hemostasis and HA flow

关键词： Pancreaticoduodenectomy Endovascular treatment Stent-graft Covered stent Transcatheter arterial embolization Arterioportal shunting

Improving conditional random field model for prediction of protein-RNA residue-base contacts

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Frontiers of Electrical and Electronic Engineering in China 2018年第2期6卷 155-162页

作者： Morihiro Hayashida Noriyuki Okada Mayumi kamada Hitoshi Koyano Department of Electrical Engineering and Computer Science National Institute of Technology Matsue College Shimane 690- 8518 Japan Graduate School of Medicine Kyoto University Kyoto 606-8507 Japan Riken Quantitative Biology Center Hyogo 650-0047 Japan

Background： For understanding biological cellular systems, it is important to analyze interactions between protein residues and RNA bases. A method based on conditional random fields （CRFs） was developed for predicting contacts between residues and bases, which receives multiple sequence alignments for given protein and RNA sequences, respectively, and learns the model with many parameters involved in relationships between neighboring residue-base pairs by maximizing the pseudo likelihood function. Methods： In this paper, we proposed a novel CRF-based model with more complicated dependency relationships between random variables than the previous model, but which takes less parameters for the sake of avoidance of overfitting to training data. Results： We performed cross-validation experiments for evaluating the proposed model, and took the average of AUC （area under receiver operating characteristic curve） scores. The result suggests that the proposed CRF-based model without using Ll-norm regularization （lasso） outperforms the existing model with and without the lasso under several input observations to CRFs. Conclusions： We proposed a novel stochastic model for predicting protein-RNA residue-base contacts, and improved the prediction accuracy in terms of the AUC score. It implies that more dependency relationships in a CRF could be controlled by less parameters.

关键词： protein-RNA interaction residue-base contact conditional random field

Optical nature of non-substituted triphenylmethyl cation:Crystalline state emission,thermochromism,and phosphorescence

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Aggregate

Aggregate 2021年第6期2卷 99-108页

作者： Tomohiko Nishiuchi Hikaru Sotome Risa Fukuuchi Kenji kamada Hiroshi Miyasaka Takashi Kubo Department of Chemistry Graduate School of ScienceOsaka UniversityToyonakaOsakaJapan Innovative Catalysis Science Division Institute for Open and Transdisciplinary Research Initiatives(ICS-OTRI)Osaka UniversitySuitaOsakaJapan Division of Frontier Materials Science and Center for Advanced Interdisciplinary Research Graduate School of Engineering ScienceOsaka UniversityToyonakaOsakaJapan Nanomaterial Research Institute(NMRI) National Institute of Advanced Industrial Science and Technology(AIST)IkedaOsakaJapan Department of Chemistry Graduate School of Science and TechnologyKwansei Gakuin UniversitySandaHyogoJapan

Since the discovery of the triphenylmethyl(trityl)cation 120 years ago,a variety of aromatic cations having various colors and luminescence properties have been rigorously studied.Many,differently substituted trityl cations have been synthesized,and their optical properties have been elucidated.However,the optical properties of the parent,non-substituted and highly reactive trityl cation,which was observed to be very weakly luminescent,have not been subjected to detailed investigation.In the effort described herein,we explored the optical nature of non-substituted trityl hexafluorophosphate(PF_(6))in the crystalline state.Trityl PF_(6) was found to exist as two crystal polymorphs including a yellow(Y)and an orange(O)form.Moreover,we observed that these crystalline forms display crystalline-state emission with different colors.The results of X-ray crystallographic analysis showed that the two polymorphs have totally different molecular packing arrangements.Furthermore,an investigation of their optical properties revealed that the O-crystal undergoes a distinct color change to yellow upon cooling as a consequence of a change in the nature of the charge transfer interaction between the cation and PF6 anion,and that both the Y-and O-crystal exhibit phosphorescence.

关键词： aggregation induced emission carbocation phosphorescence crystal phase transition thermochromism

Evaluation of changes of intracranial blood flow after carotid artery stenting using digital subtraction angiography flow assessment

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World Journal of Radiology 2015年第2期7卷 45-51页

作者： Hajime Wada Masato Saito Kyousuke kamada Department of Neurosurgery Asahikawa Medical University

AIM: To evaluate the changes of intracranial blood flow after carotid artery stenting(CAS), using the flow assessment application "Flow-Insight", which was developed in our department.METHODS: Twenty patients treated by CAS participated in this study. We analyzed the change in concentration of the contrast media at the anterior-posterior and profile view image with the flow assessment application "Flow-Insight". And we compared the results with N-isopropyl-p-[123I] iodoamphetamine-single-photon emission computed tomography(IMP SPECT) performed before and after the treatment. RESULTS: From this study, 200% of the parameter "blood flow" change in the post/pre-treatment is suggested as the critical line of the hyperperfusion syndrome arise. Although the observed blood flow increase in the digital subtraction angiography system did not strongly correlate with the rate of increase of SPECT, the "Flow-Insight" reflected the rate of change of the vessels well. However, for patients with reduced reserve blood flow before CAS, a highly elevated site was in agreement with the site analysis results. CONCLUSION: We concluded that the cerebral angiography flow assessment application was able to more finely reveal hyperperfusion regions in the brain after CAS compared to SPECT.

关键词： Intracranial blood flow Cerebral angiography Carotid artery stenting Single-photon emission computed tomography

A New Epi‑neoverrucosane‑type Diterpenoid from the Liverwort Pleurozia subinfata in Borneo

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Natural Products and Bioprospecting 2020年第1期10卷 51-56页

作者： Takashi kamada Mary Lyn Johanis Shean-Yeaw Ng Chin-Soon Phan Monica Suleiman Charles SVairappan Department of Materials and Life Science Faculty of Science and TechnologyShizuoka Institute of Science and Technology2200-2 ToyosawaFukuroiShizuoka 437-8555Japan Institute for Tropical Biology and Conservation Universiti Malaysia Sabah88400 Kota KinabaluSabahMalaysia

New bioactive 13-epi-neoverrucosane diterpenoid,5β-acetoxy-13-epi-neoverrucosanic acid(1)along with three known secondary metabolites,13-epi-neoverrucosan-5β-ol(2),chelodane(3)and(E)-β-farnesene(4)were isolated from the MeOH extract of east Malaysia’s liverwort Pleurozia subinfata.The chemical structure of new compound was elucidated by the analyses of its spectroscopic data(FTIR,NMR and HR-ESI-MS).These epi-neoverrucosane-type compounds seem to be notable chemosystematic markers for P.subinfata in Borneo.Compound 3 was widespread in marine sponges however this is the frst record for 3 to be found in liverwort.These metabolites were tested for their antifungal potentials against selected fungi from the marine environment.Compound 1 exhibited efective antifungal activity against Lagenidium thermophilum.

关键词： Epi-neoverrucosane Diterpenoid Pleurozia subinfata Liverwort Borneo