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Pretreatment AKR1B10 expression predicts the risk of hepatocellular carcinoma development after hepatitis C virus eradication

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World Journal of Gastroenterology 2016年第33期22卷 7569-7578页

作者： Ayato Murata Takuya Genda Takafumi Ichida Nozomi Amano Sho Sato Hironori Tsuzura Shunsuke Sato Yutaka Narita yoshio Kanemitsu Yuji Shimada Katsuharu Hirano Katsuyori Iijima Ryo Wada Akihito Nagahara Sumio watanabe Department of Gastroenterology and Hepatology Juntendo University Shizuoka Hospital Department of Hepatology Shonan-East General Hospital Department of Pathology Juntendo University Shizuoka Hospital Department of Gastroenterology Juntendo University School of Medicine

AIM To clarify the association between aldo-keto reductase family 1 member B10(AKR1B10) expression and hepatocarcinogenesis after hepatitis C virus *** In this study,we enrolled 303 chronic hepatitis C patients who had achieved sustained virological response(SVR) through interferon-based antiviral therapy. Pretreatment AKR1B10 expression in the liver was immunohistochemically assessed and quantified as a percentage of positive staining area by using image-analysis software. A multivariate Cox analysis was used to estimate the hazard ratios(HRs) of AKR1B10 expression for hepatocellular carcinoma(HCC) development after achieving SVR. The cumulative incidences of HCC development were evaluated using Kaplan-Meier analysis and the log-rank *** Of the 303 chronic hepatitis C patients,153(50.5%) showed scarce hepatic AKR1B10 expression,quantified as 0%,which was similar to the expression in control normal liver tissues. However,the remaining 150 patients(49.5%) exhibited various degrees of AKR1B10 expression in the liver,with a maximal AKR1B10 expression of 73%. During the median follow-up time of 3.6 years(range 1.0-10.0 years),8/303 patients developed HCC. Multivariate analysis revealed that only high AKR1B10 expression(≥ 8%) was an independent risk factor for HCC development(HR = 15.4,95%CI: 1. 8- 1 3 2. 5,P = 0. 0 1 2). T h e 5- y e a r c u m u l a t i v e incidences of HCC development were 13.7% and 0.5% in patients with high and low AKR1B10 expression,respectively(P < 0.001). During the follow-up period after viral eradication,patients expressing high levels of AKR1B10 expressed markedly higher levels of alanine aminotransferase and α-fetoprotein than did patients exhibiting low AKR1B10 *** Chronic hepatitis C patients expressing high levels of hepatic AKR1B10 had an increased risk of HCC development even after SVR.

关键词： Human AKR1B10 protein Hepatocellular carcinoma Chronic hepatitis C Immunohistochemistry Risk factor Sustained virological response

Diagnosis of small intramucosal signet ring cell carcinoma of the stomach by non-magnifying narrow-band imaging: A pilot study

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World Journal of Gastrointestinal Endoscopy 2015年第12期7卷 1070-1077页

作者： Jiro Watari Toshihiko Tomita Hisatomo Ikehara masato Taki tomohiro Ogawa Takahisa Yamasaki Takashi Kondo Fumihiko Toyoshima Jun Sakurai Tomoaki Kono Katsuyuki Tozawa yoshio Ohda Tadayuki Oshima Hirokazu Fukui Seiichi Hirota Hiroto Miwa Division of Gastroenterology Department of Internal Medicine Hyogo College of Medicine NishinomiyaHyogo 663-8501 Japan Department of Surgical Pathology Hyogo College of Medicine Nishinomiya Hyogo 663-8501 Japan Division of Gastroenterology Department of Internal Medicine Hyogo College of MedicineNishinomiyaHyogo 663-8501 Japan

AIM: To examine the efficacy of non-magnifying narrow-band imaging(NM-NBI) imaging for small signet ring cell carcinoma(SRC).METHODS: We retrospectively analyzed 14 consecutive small intramucosal SRCs that had been treated with endoscopic submucosal dissection(ESD) and 14 randomly selected whitish gastric ulcer scars(control). The strength and shape of the SRCs and whitish scars by NM-NBI and white-light imaging(WLI) were assessed with Image J(NIH, Bethesda).RESULTS: NM-NBI findings of SRC showed a clearly isolated whitish area amid the brown color of the surrounding normal mucosa. The NBI index, which indicates the potency of NBI for visualizing SRC, was significantly higher than the WLI index(P = 0.001), indicating SRC was more clearly identified by NM-NBI. Although the NBI index was not significantly different between SRCs and controls, the circle(C)-index, as an index of circularity of tumor shape, was significantly higher in SRCs(P = 0.001). According to the receiveroperating characteristic analysis, the resulting cut-off value of the circularity index(C-index) for SRC was 0.60(85.7% sensitivity, 85.7% specificity). Thus a lesion with a C-index ≥ 0.6 was significantly more likely to be an SRC than a gastric ulcer scar(OR = 36.0; 95%CI: 4.33-299.09; P = 0.0009).CONCLUSION: Small isolated whitish round area by NM-NBI endoscopy is a useful finding of SRCs which is the indication for ESD.

关键词： Gastric cancer Signet ring cell carcinoma Narrow-b

Histological diagnosis of gastric submucosal tumors: A pilot study of endoscopic ultrasonography-guided fine-needle aspiration biopsy vs mucosal cutting biopsy

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World Journal of Gastrointestinal Endoscopy 2015年第14期7卷 1142-1149页

作者： Hisatomo Ikehara Zhaoliang Li Jiro Watari masato Taki tomohiro Ogawa Takahisa Yamasaki Takashi Kondo Fumihiko Toyoshima Tomoaki Kono Katsuyuki Tozawa yoshio Ohda Toshihiko Tomita Tadayuki Oshima Hirokazu Fukui Ikuo Matsuda Seiichi Hirota Hiroto Miwa Division of Gastroenterology Department of Internal Medicine Hyogo College of Medicine Department of Surgical Pathology Hyogo College of Medicine

AIM: To compare the usefulness of endoscopic ultrasonography-guided fine-needle aspiration biopsy(EUS-FNAB) without cytology and mucosal cutting biopsy(MCB) in the histological diagnosis of gastric submucosal tumor(SMT).METHODS: We prospectively compared the diagnostic yield, feasibility, and safety of EUS-FNAB and those of MCB based on endoscopic submucosal dissection. The cases of 20 consecutive patients with gastric SMT ≥1 cm in diameter. who underwent both EUS-FNAB and MCB were ***: The histological diagnoses were gastrointestinal stromal tumors(n = 7), leiomyoma(n =6), schwannoma(n = 2), aberrant pancreas(n = 2), and one case each of glomus tumor, metastatic hepatocellular carcinoma, and no-diagnosis. The tumors' mean size was 23.6 mm. Histological diagnosis was made in 65.0% of the EUS-FNABs and 60.0% of the MCBs, a nonsignificant difference. There were no significant differences in the diagnostic yield concerning the tumor location or tumor size between the two methods. However, diagnostic specimens were significantly more frequently obtained in lesions with intraluminal growth than in those with extraluminal growth by the MCB method(P = 0.01). All four SMTs with extraluminal growth were diagnosed only by EUSFNAB(P = 0.03). No complications were found in either ***: MCB may be chosen as an alternative diagnostic modality in tumors showing the intraluminal growth pattern regardless of tumor size, whereas EUSFNAB should be performed for SMTs with extraluminal growth.

关键词： Submucosal tumor Endoscopic ultrasonography-guided

Current status of preoperative drainage for distal biliary obstruction

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World Journal of Hepatology 2015年第18期7卷 2171-2176页

作者： Harutoshi Sugiyama Toshio Tsuyuguchi Yuji Sakai Rintaro Mikata Shin Yasui Yuto watanabe Dai Sakamoto masato Nakamura Reina Sasaki Jun-ichi Senoo Yuko Kusakabe Masahiro Hayashi Osamu Yokosuka Department of Gastroen- terology and Nephrology Graduate School of Medicine Chiba University

Preoperative biliary drainage(PBD) was developed to improve obstructive jaundice, which affects a number of organs and physiological mechanisms in patients waiting for surgery. However, its role in patients who will undergo pancreaticoduodenectomy for biliary obstruction remains controversial. This article aims to review the current status of the use of preoperative drainage for distal biliary obstruction. Relevant articles published from 1980 to 2015 were identified by searching MEDLINE and Pub Med using the keywords "PBD", "pancreaticoduodenectomy", and "obstructive jaundice". Additional papers were identified by a manual search of the references from key articles. Current studies have demonstrated that PBD should not be routinely performed because of the postoperative complications. PBD should only be considered in carefully selected patients, particularly in cases where surgery had to be delayed. PBD may be needed in patients with severe jaundice, concomitant cholangitis, or severe malnutrition. The optimal method of biliary drainage has yet to be confirmed. PBD should be performed by endoscopic routes rather than by percutaneous routes to avoid metastatic tumor seeding. Endoscopic stenting or nasobiliary drainage can be selected. Although more expensive, the use of metallic stents remains a viable option to achieve effective drainage without cholangitis and reintervention.

关键词： Preoperative drainage Biliary drainage Distal bili