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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 97-100页

作者： Tsukasa Takayashiki Hideyuki Yoshitomi Katsunori Furukawa Satoshi Kuboki masaru miyazaki Masayuki Ohtsuka Department of General Surgery Graduate School of MedicineChiba University Department of Gastroenterological Surgery Mita HospitalInternational University of Health and Welfare

To the Editor:Pancreaticobiliary maljunction(PBM)is a congenital anomaly in which the pancreatic and bile ducts join anatomically outside of the duodenal wall away from the Oddi’s *** condition causes the reflux of pancreatic juice into the bile duct under high pressure,resulting in various pathologic *** features of PBM patients are common bile duct dilatation,long common channel,and high amylase levels in bile *** them,one of the most significant problems is the development of biliary cancer,including extrahepatic bile duct and gallbladder cancers[1].A nationwide survey in Japan reported biliary cancer in 21.6%of adult patients with PBM concomitant with congenital biliary dilatation,32.1%and 62.3%extrahepatic bile duct and gallbladder cancers,respectively[2].

关键词： biliary cancer congenital

Peripheral portal vein-oriented non-dilated bile duct puncture for percutaneous transhepatic biliary drainage

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World Journal of Gastroenterology 2015年第44期21卷 12628-12634页

作者： Hiroaki Shimizu Atsushi Kato Tsukasa Takayashiki Satoshi Kuboki Masayuki Ohtsuka Hideyuki Yoshitomi Katsunori Furukawa masaru miyazaki Department of General Surgery Chiba University Graduate School of Medicine Chiba City

AIM: To evaluate the efficacy of peripheral portal vein(PV)-oriented non-dilated bile duct(BD) puncture for percutaneous transhepatic biliary drainage(PTBD).METHODS: Thirty-five patients with non-dilated BDs underwent PTBD for the management of various biliary disorders, including benign bilioenteric anastomotic stricture(n = 24), BD stricture(n = 5) associated with iatrogenic BD injury, and postoperative biliary leakage(n = 6). Under ultrasonographic guidance, percutaneous transhepatic puncture using a 21-G needle was performed along the running course of the peripheral targeted non-dilated BD(preferably B6 for right-sided approach, and B3 for left-sided approach) or along the accompanying PV when the BD was not well visualized. This technique could provide an appropriate insertion angle of less than 30° between the puncture needle and BD running course. The puncture needle was then advanced slightly beyond the accompanying PV. The needle tip was moved slightly backward while injecting a small amount of contrast agent to obtain the BD image, followed by insertion of a 0.018-inch guide wire(GW). A drainage catheter was then placed usinga two-step GW method. RESULTS: PTBD was successful in 33(94.3%) of the 35 patients with non-dilated intrahepatic BDs. A rightsided approach was performed in 25 cases, while a left-sided approach was performed in 10 cases. In 31 patients, the first PTBD attempt proved successful. Four cases required a second attempt a few days later to place a drainage catheter. PTBD was successful in two cases, but the second attempt also failed in the other two cases, probably due to poor breath-holding ability. Although most patients(n = 26) had been experiencing cholangitis with fever(including septic condition in 8 cases) before PTBD, only 5(14.3%) patients encountered PTBD procedure-related complications, such as transient hemobilia and cholangitis. No major complications such as bilioarterial fistula or portal thrombosis were observed. There was

关键词： Percutaneous transhepatic biliary drainage Cholang

Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by pancreatic duct stenting using a loop-tipped guidewire

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World Journal of Clinical Cases 2016年第8期4卷 213-218页

作者： Yuji Sakai Toshio Tsuyuguchi Harutoshi Sugiyama Masahiro Hayashi Jun-ichi Senoo Reina Sasaki Yuko Kusakabe Masato Nakamura Shin Yasui Rintaro Mikata masaru miyazaki Osamu Yokosuka Department of Gastroenterology and Nephrology Graduate School of Medicine Chiba University Department of General Surgery Graduate School of Medicine Chiba University

AIM: To examine whether it is possible to prevent the occurrence of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis in patients experiencing difficulties with selective biliary duct cannulation by pancreatic duct stenting using a looptipped ***: Procedure success rate, frequency of unintended insertion of the guidewire into side branches of the pancreatic duct, and incidence of procedural accidents were examined using a loop-tipped guidewire(Group A, 20 patients), and a conventional straighttype guidewire(Group B, 20 patients).RESULTS: The success rate of the procedure was 100% in both groups. Unintended insertion of the guidewire into a side branch of the pancreatic duct occurred 0.056 ± 0.23(0-1) times in Group A and 2.3 ±1.84(0-5) times in Group B; thus, unintended insertion of the guidewire into a side branch of the pancreatic duct was seen significantly less frequently in Group A. There were no procedural accidents in Group A, whereas pancreatitis occurred in one Group B patient; however, the difference between the two groups was not statistically significant. The serum amylase level after ERCP was 257.15 ± 136.4(88-628) IU/L in Group A, and 552.05 ± 534.57(101-2389) IU/L in Group B, showing a significantly lower value in Group A. Hyperamylasemia was found in two patients(10%) in Group A, and nine(45%) in Group B, showing a significantly lower value in Group ***: The results suggest that in patients who experience difficulties with biliary cannulation, the use of a loop-tipped guidewire for pancreatic duct stenting may assist with the prevention of post-ERCP pancreatitis, and thereby to a reduction of the risk of post-ERCP pancreatitis or hyperamylasemia.

关键词： Hyperamylasemia Post-endoscopic retrograde cholangiopancreatography pancreatitis Guidewire

Postoperative recurrence of an IPMN of the pancreas with a fistula to the stomach

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World Journal of Gastrointestinal Endoscopy 2010年第10期2卷 349-351页

作者： Masaya Uesato Yoshihiro Nabeya Shinichi miyazaki Taito Aoki Takashi Akai Kiyohiko Shuto Tohru Tanizawa masaru miyazaki Hisahiro Matsubara Department of Frontier Surgery Chiba University Graduate School of MedicineChiba 260-8677Japan Makuhari Gastrointestinal Clinic Chiba 262-0033Japan Department of Pathology Chiba University HospitalChiba 260-8677Japan Department of General Surgery Chiba University Graduate School of MedicineChiba 260-8677Japan

We report on a case of a 74 year old man who was diagnosed with a recurrence of non-invasive carcinoma of intraductal papillary mucinous neoplasm (non-invasive IPMN) by postoperative gastroscopy (GS). A pylorus preserving pancreatico duodenectomy for IPMN in the pancreatic head was performed. A histopathological study revealed non-invasive adenocarcinoma. At first,the local recurrence of the tumor around the superior mesenteric artery circumference was diagnosed and disappeared with gemcitabine. Later,the GS showed the elevated lesion with mucin hypersecretion in the remnant stomach. The lesion had a central dip and a fistula common to the pancreas was confirmed on fisterography. We diagnosed a recurrence of IPMN and administered chemotherapy again. However,he died of his original illness. There are no reports of postoperative recurrence of IPMN checked by GS. It should be remembered that the elevated lesion of the remnant stomach is considered as one of the recurrent patterns of IPMN.

关键词： Intraductal papillary mucinous neoplasm Recurrence Fistula Stomach Endoscopy

Utility of endoscopic retrograde cholangiopancreatography on biliopancreatic diseases in patients with Billroth Ⅱ-reconstructed stomach

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World Journal of Gastrointestinal Endoscopy 2017年第3期9卷 127-132页

作者： Yuji Sakai Toshio Tsuyuguchi Rintaro Mikata Harutoshi Sugiyama Shin Yasui masaru miyazaki Osamu Yokosuka Department of Gastroenterology and Nephrology Graduate School of MedicineChiba University Department of General Surgery Graduate School of MedicineChiba University

AIM To examine the utility of endoscopic retrograde cholangiopancreatography(ERCP) on biliopancreatic diseases in the patients with Billroth II-reconstructed *** For 26 cases of biliopancreatic diseases in patients with Billroth Ⅱ-reconstructed stomach,ERCP was conducted using a straight-view scope or a retrograde obliqueviewing *** the cases were patients aiming at selective insertion into the bile *** patient aimed at diagnosis,and 25 patients aimed at *** cases in which the endoscope reached the duodenal papilla and anastomosis,and insertion into the bile duct became possible,were considered *** The rate of reaching the duodenal papilla and anastomosis was 84.7%(22/26 patients).Among the cases without reaching the duodenal papilla and anastomosis,there were 2 in which the endoscope did not pass due to tumor-induced duodenal *** 1 case,the fiber did not reach the duodenal papilla due to long afferent *** success rate of insertion into the bile duct in patients in which the endoscope reached the duodenal papilla and anastomosis was 90.9%(20/22 patients),and the success rate of procedures including treatment was 86.3%(19/22 patients).After treatment,mild cholangitis was observed in 1 patient(4.5%,1/22 patients) but relieved *** other accidental symptom was *** It was considered that the ERCP for biliopancreatic diseases in patients with Billroth II-reconstructed stomach will become a less invasive,safe and useful examination and treatment approach.

关键词： Billroth Ⅱ-reconstructed stomach Endoscopic retrograde cholangiopancreatography Endoscopic papillary balloon dilatation

Vascular endothelial growth factor and angiopoietins regulate sinusoidal regeneration and remodeling after partial hepatectomy in rats

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World Journal of Gastroenterology 2005年第46期11卷 7254-7260页

作者： Hiroaki Shimizu Noboru Mitsuhashi Masayuki Ohtsuka Hiroshi Ito Fumio Kimura Satoshi Ambiru Akira Togawa Hiroyuki Yoshidome Atsushi Kato masaru miyazaki Department of General Surgery Graduate School of Medicine Chiba University Chiba 260-0856 Japan

AIM： To study the regulatory mechanisms of sinusoida regeneration after partial hepatectomy. METHODS： We invesldgated the expression of angiopoietin （Ang）-1, Ang-2, Tie-2, and vascular endothelial growth factor （VEGF） in regenerating liver tissue by quantitative reverse-transcription polymerase chain reaction （RT- PCR） using a LightCycler （Roche Diagnostics） and also immunohistochemical staining after 70% hepatectomy in rats. In the next step, we isolated liver cells （hepatocytes, sinusoidal endothelial cell （SEC）, Kupffer cell, and hepatic stellate cells （HSC）） from regenerating liver tissue by in situ collagenase perfusion and counterflow elutriation, to determine potential cellular sources of these angiogenic factors after hepatectomy. Proliferation and apoptosis of SECs were also evaluated by proliferating cell nuclear antigen （PCNA） staining and the terminal deoxynucleotidyl transferase d-uridine triphosphate nick end labeling （TUNEL） assay, respectively. RESULTS： VEGF mRNA expression increased with a peak at 72 h after hepatectomy, decreasing thereafter. The expression of Ang-1 mRNA was present at detectable levels before hepatectomy and increased slowly with a peak at 96 h. Meanwhile, Ang-2 mRNA was hardly detected before hepatectomy, but was remarkably induced at 120 and 144 h. In isolated cells, VEGF mRNA expression was found mainly in the hepatocyte fraction. Meanwhile, mRNA for Ang-1 and Ang-2 was found in the SEC and HSC fractions, but was more prominent in the latter. The PCNA labeling index of SECs increased slowly, reaching a peak at 72 h, whereas apoptotic SECs were detected between 120 h and 144 h. CONCLUSION： Ang-Tie system, together with VEGF, plays a critical role in regulating balance between SEC proliferation and apoptosis during sinusoidal regeneration after hepatectomy. However, the VEGF system plays a more important role in the early phase of sinusoidal regeneration than angiopoietin/Tie system.

关键词： Vascular endothelial cell growth factor Angiopoietin Sinusoidal endothelial cell Hepatectomy Liver regeneration

Is ERCP really necessary in case of suspected spontaneous passage of bile duct stones?

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World Journal of Gastroenterology 2009年第26期15卷 3283-3287页

作者： Yuji Sakai Toshio Tsuyuguchi Takeshi Ishihara Seigo Yukisawa Tadashi Ohara masaru Tsuboi Yoshihiko Ooka Kazuki Kato Kiyotake Katsuura Michio Kimura Makoto Takahashi Kazuhisa Nemoto masaru miyazaki Osamu Yokosuka Department of Medicine and Clinical Oncology Graduate School of MedicineChiba University Department of Internal Medicine Funabashi Central Hospital Department of Surgery Funabashi Central Hospital Department of Radiology Funabashi Central Hospital Department of General Surgery Graduate School of MedicineChiba University

AIM:To investigate the usefulness of magnetic resonance cholangiopancreatography (MRCP) and the need for endoscopic retrograde cholangiopancreatography (ERCP) in cases of suspected spontaneous passage of stones into the common bile ***:Thirty-six patients with gallbladder stones were clinically suspected of spontaneous passage of stones into the common bile duct because they presented with clinical symptoms such as abdominal pain and fever,and showed signs of inflammatory reaction and marked rise of hepatobiliary *** symptoms resolved and they showed normalized values of blood biochemical parameters after conservative treatment without evidence of stones in the common bile duct on *** these patients were subjected to ERCP within 3 d of MRCP to check for the presence of ***:No stones were detected by ERCP in any patient,confi rming the results of ***:When clinical symptoms improve,blood biochemical parameters have normalized,and MRCP shows there are no stones in the common bile duct,it can be considered the stone has spontaneously passed and thus ERCP is not necessary.

关键词： Magnetic resonance cholangiopancreatography Endoscopic retrograde cholangiopancreatography Spontaneous passage of bile duct stones Bile duct stones Pancreatitis

Changes in growth factor and cytokine expression in biliary obstructed rat liver and their relationship with delayed liver regeneration after partial hepatectomy

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World Journal of Gastroenterology 2006年第13期12卷 2053-2059页

作者： Hironobu Makino Hiroaki Shimizu Hiroshi Ito Fumio Kimura Satoshi Ambiru Akira Togawa Masayuki Ohtsuka Hiroyuki Yoshidome Atsushi Kato Hideyuki Yoshitomi Shigeaki Sawada masaru miyazaki Department of General Surgery Graduate School of Medicine Chiba UniversityChibaJapan

AIM： To study the effects of obstructive jaundice on liver regeneration after partial hepatectomy. METHODS： Hepatocyte growth factor （HGF）, its receptor, c-Met, vascular endothelial growth factor （VEGF） and transforming growth factor-β1 （TGF-β1） mRNA expression in both liver tissue and isolated liver cells were investigated after biliary obstruction （BO） by quantitative reverse-transcription polymerase chain reaction （RT-PCR） using a LightCycler. Immunohistochemical staining for desmin and e-smooth muscle actin （α-SNA） was also studied. Regenerating liver weight and proliferating cell nuclear antigen （PCNA） labeling index, and growth factor expression were then evaluated after 70% hepatectomy with concomitant internal bUiary drainage in BO rats or sham-operated rats. RESULTS： Hepatic TGF-β1 mRNA levels increased significantly 14 days after BO, and further increased with duration of cholestasis. Meanwhile, HGF and VEGF tended to increase, but was not significant. In cell isolates, TGF-β1 mRNA was found mainly in the hepatic stellate cell （HSC） fraction. Immunohistochemical studies revealed an increased number of HSCs （desmin-positive cells） and activated HSCs （α-SMA-positive cells） in portal areas after BO. In a hepatectomy model, liver regeneration was delayed in BO rats, as compared to sham-operated rats. TGF-β1 mRNA was significantly up-regulated up to 48 h after hepatectomy, and the earlier HGF mRNA peak was lost in BO rats. CONCLUSION： BO induces HSCs proliferation and activation, leading to up-regulation of TGF-β1 mRNA and suppression of HGF mRNA in livers. These altered expression patterns may be strongly involved in delayed liver regeneration after hepatectomy with obstructive jaundice.

关键词： Biliary obstruction Liver regeneration Hepatocyte growth factor Transforming growth factor-β Hepatic stellate cells Hepatectomy

Impact of Socioeconomic Status and Demographic Composition on Disaster Mortality: Community‑Level Analysis for the 2011 Tohoku Tsunami

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International Journal of Disaster Risk Science 2022年第6期13卷 913-924页

作者： Takeshi miyazaki School of Economics Kyushu UniversityFukuoka 819-0395Japan

On 11 March 2011, the Tohoku tsunami hit the northeastern region of Japan, causing massive damage to people and property. The tsunami was bigger than any other in Japan’s recorded history, but the damage varied by community. This research addressed the effects of socioeconomic status and demographic composition on mortality in the 2011 Tohoku tsunami using community-level *** effects were estimated using regression analysis, taking into account a variety of potential contributing aspects at the community level, including strength of the tsunami,population characteristics, gender, age, education, household composition, evacuation methods, and occupation. It was found that the height of the tsunami and the shares of threegeneration households and employees in the manufacturing industry are all positively correlated with tsunami *** impacts of these factors on mortality are particularly large for the older adults.

关键词： 2011 Tohoku tsunami Community-level analysis Demographic composition Disaster risk reduction Mortality Socioeconomic status

A Remark on Jesmanowicz' Conjecture for the Non-coprimality Case

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Acta Mathematica Sinica,English Series 2015年第8期31卷 1255-1260页

作者： Takafumi miyazaki Department of Mathematics College of Science and Technology Nihon University 1-8-14Kanda-SurugadaiChiyoda-kuTokyo 101-8308Japan

Let a, b, c be relatively prime positive integers such that a^2＋ b^2= c^2. Jesmanowicz＇conjecture on Pythagorean numbers states that for any positive integer N, the Diophantine equation（aN）x＋（b N）y=（cN）zhas no positive solution（x, y, z） other than x = y = z = 2. In this paper, we prove this conjecture for the case that a or b is a power of 2.

关键词： Diophantine equation Pythagorean numbers Jesmanowicz' conjecture