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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 fea- tures of remnant gastric cancer （RGC） and to develop desirable surveillance ***： Between 1997 and 2008, 1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural Uni- versity of Medicine, Japan. Of these, 33 patients un- derwent gastrectomy with lymphadenectomy for RGC. Regarding the initial gastric disease, there were 19 patients with benign disease and 14 patients with gas- tric 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 in- terval [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 fol- lowing benign lesions （P 〈 0.001）. Regarding recon- struction, RGC following Billroth-]_l reconstruction showed a longer interval between surgical procedures [P 〈 0.001; Billroth-11 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 fre- quently near the suture line and remnant gastric wall. After Billroth- 1I reconstruction, RGC occurred more fre- quently 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： Remnant gastric cancer Surveillance Fol-low-up Reconstruction Distal gastrectomy

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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

AIMTo investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal ***-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 initiation of TM-α and patient demographics were also *** 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 (qSOFA) 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 qSOFA) 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 qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all).CONCLUSIONEarly 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： Quick-sequential organ failure assessment Thrombomodulin-α Gastrointestinal surgery Systemic inflammatory response syndrome Acute disseminated 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 ***: 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 ***: We retrospectively analyzed 372 patients with HCC who underwent hepatectomy between 1980 and *** 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 *** 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 ***: 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%,*** 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 ***: Hepatectomy for vp3-4 HCC results in a survival rate similar to hepatectomy for *** stratified the stage Ⅱ-Ⅲ HCC patients according to prognosis.

关键词： Hepatocellular carcinoma Hepatectomy Portal vein t

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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 ***:VEGF-A expression in tumor and stromal cells from 165 consecutive patients with colorectal cancer was examined by *** association between VEGF-A expression status and clinicopathological factors was *** freshfrozen samples were obtained for laser capture microdissection to analyze the splice variants of ***:VEGF-A was expressed in 53.9% and 42.4% of tumor and stromal cells,***-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%,*** was no significant difference in t-VEGF-A expression *** 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 *** 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 ***:s-VEGF-A appears be a good prognostic factor for colorectal cancer and includes VEGF165 and VEGF165b.

关键词： Colorectal cancer Vascular endothelial growth factor-A Vascular endothelial growth factor 165 Microvascular density Stromal cell

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Assessment of liver fibrosis by a noninvasive method of transient elastography and biochemical markers

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World Journal of Gastroenterology 2006年第27期12卷 4325-4330页

作者： Masaki Kawamoto Toru Mizuguchi Tadashi Katsuramaki Minoru Nagayama Hideki Oshima Hiroyuki Kawasaki Takayuki Nobuoka yasutoshi Kimura Koichi Hirata Department of Surgery Ⅰ Sapporo Medical University HospitalSapporo Medical University School of MedicineS-1W-16Chuo-KuSapporoHokkaido 060-8543Japan

AIM： To assess the correlation between the fibrotic area （FA） as calculated by a digital image analysis （DIA）, and to compare the diagnostic accuracy of FibroScan to the other existing Liver fibrosis （LF） markers using the receiver operating curve analysis.METHODS： We recruited 30 patients who underwent a liver resection for three different etiologies including normal liver, hepatitis B, and hepatitis C. Liver stiffness was measured by using a FibroScan. The FA was then calculated by DIA to evaluate LF in order to avoid any sampling bias. RESULTS： The FA negatively correlated with Prothrombin time （PT）, platelet count, lecithin-cholesterol acyltransferase （LCAT）, and pre-albumin （ALB）. On the other hand, the findings of FibroScan correlated with similar markers. The FA positively correlated with FibroScan, serum hyaluronate level, and type Ⅳ collagen level, and aspartate transaminase to platelet ratio index （APRI）. The area under the receiver operating curve for FibroScan was higher than that for the other markers, even though the statistical significance was minimal. CONCLUSION： Our findings suggest that FibroScan can initially be used to assess LF as an alternative to a liver biopsy （LB） and serum diagnosis, because it is a safe method with comparable diagnostic accuracy regarding the existing LF markers.

关键词： Cirrhosis Digital image analysis Fibro-Scan Fibrotic area Hyaluronate Lecithin-cholesterol acyltransferase Liver fibrosis Pre-albumin

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Targeting tight junctions during epithelial to mesenchymal transition in human pancreatic cancer

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World Journal of Gastroenterology 2014年第31期20卷 10813-10824页

作者： Daisuke Kyuno Hiroshi Yamaguchi Tatsuya Ito Tsuyoshi Kono yasutoshi Kimura Masafumi Imamura Takumi Konno Koichi Hirata Norimasa Sawada Takashi Kojima Department of Surgery Sapporo Medical University School of Medicine Department of Cell Science Research Institute for Frontier Medicine Sapporo Medical University School of Medicine Department of Pathology Sapporo Medical University School of Medicine

Pancreatic cancer continues to be a leading cause of cancer-related death worldwide and there is an urgent need to develop novel diagnostic and therapeutic strategies to reduce the mortality of patients with this disease. In pancreatic cancer, some tight junction proteins, including claudins, are abnormally regulated and therefore are promising molecular targets for diagnosis, prognosis and therapy. Claudin-4 and-18 are overexpressed in human pancreatic cancer and its precursor lesions. Claudin-4 is a high affinity receptor of Clostridium perfringens enterotoxin(CPE). The cytotoxic effects of CPE and monoclonal antibodies against claudin-4 are useful as novel therapeutic tools for pancreatic cancer. Claudin-18 could be a putative marker and therapeutic target with prognostic implications for patients with pancreatic cancer. Claudin-1,-7, tricellulin and marvelD3 are involved in epithelial to mesenchymal transition(EMT) of pancreatic cancer cells and thus might be useful as biomarkers during disease. Protein kinase C is closely related to EMT of pancreatic cancer and regulates tight junctions of normal human pancreatic duct epithelial cells and the cancer cells. This review focuses on the regulation of tight junctions via protein kinase C during EMT in human pancreatic cancer for the purpose of developing new diagnostic and therapeutic modalities for pancreatic cancer.

关键词： Tight junctions Claudins Tricellulin MarvelD3 Normal human pancreatic duct epithelial cells Pancreatic cancer Protein kinase C Epithelial to mesenchymal transition

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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

The braking behavior of drivers when a pedestrian comes out from the sidewalk to the road was analyzed using a driving simulator. Based on drivers＇ braking behavior, the braking control timing of the system for avoiding the collision with pedestrians was proposed. In this study, the subject drivers started braking at almost the same time in terms of TTC （Time to Collision）, regardless of the velocity of a subject vehicle and crossing velocity of pedestrians. This experimental result showed that brake timing of the system which can minimize the interference for braking between drivers and the system is 1.3 s of TTC. Next, the drivers＇ braking behavior was investigated when the system controlled braking to avoid collision at this timing. As a result, drivers did not show any change of braking behavior with no excessive interference between braking control by the system and braking operation by drivers for avoiding collisions with pedestrians which is equivalent to the excessive dependence on the system.

关键词： Active safety collision avoidance pedestrian brake timing TTC driving simulator.

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