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Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

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World Journal of Gastrointestinal Oncology 2018年第11期10卷 381-397页

作者： Yuki Aisu Daiki Yasukawa yusuke kimura Tomohide Hori Department of Digestive Surgery Tenri Hospital Department of Surgery Shiga University of Medical Science Department of Hepato-Biliary-Pancreatic Surgery and Transplantation Graduate School of Medicine Kyoto University Department of Surgery Shiga General Hospital

Laparoscopic and endoscopic cooperative surgery(LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors(GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to av-oid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according tothe concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.

关键词： Minimally invasive surgery Laparoscopic and endoscopic cooperative surgery Facility-based Gastrointestinal stromal tumor Early gastric cancer

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A study on vestibular-evoked myogenic potentials via galvanic vestibular stimulation in normal people

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Journal of Otology 2018年第1期13卷 16-19页

作者： Ying Cheng yusuke kimura Kimitaka Kaga National Institute of Sensory Organs Tokyo Medical Center Japan The Department of Otolaryngology Head and Neck Surgery in the Second Affiliated Hospital of Xi 'an Jiaotong University Shaanxi Province PR China

Objectives: The aim of our study is to examine vestibular-evoked myogenic potentials(VEMPs) elicited by the galvanic vestibular stimulation in the sternocleidomastoid muscle(SCM) in healthy subjects for clinical applications of auditory neuropathy or vestibular neuropathy in the ***: We enrolled sixteen healthy subjects to record the average responses of SCM to galvanic vestibular stimulation(GVS) [current 3 mA;duration 1 ms] by electromyography(EMG). SPSS 18.0 software was used to analyze the obtained data for mean and standard ***: In all healthy subjects mastoid-forehead galvanic vestibular stimulation produced a positive-negative biphasic EMG responses on SCM ipsilateral to the cathodal electrode. The latency of p13 was 11.7 ± 3.0 ms. The latency of n23 was 17.8 ± 3.4 ms. The amplitude of p13-n23 was147.0 ± 69.0 μV. The interaural asymmetry ratio(AR) of p13, n23 latency and the amplitude was respectively 0.12 ± 0.09, 0.08 ± 0.08 and0.16 ± ***: Galvanic vestibular stimulation could elicit biphasic EMG responses from SCM via the vestibular nerve but not from the otolith organs. Galvanic stimulation together with air conducted sound(ACS) or bone conducted vibration(BCV) can elicit VEMPs and may enable the differentiation of retrolabyrinthine lesions from labyrinthine lesions in vestibular system.

关键词： Galvanic vestibular stimulation Vestibular nerve Vestibular-evoked myogenic potentials Sternocleidomastoid muscle Interaural asymmetry ratio (AR)

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A child with severe inner ear malformations with favorable hearing utilization and balance functions after wearing hearing aids

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Journal of Otology 2017年第1期12卷 41-46页

作者： yusuke kimura Takeshi Masuda Akifumi Tomizawa Hideaki Sakata Kimitaka Kaga National Institute of Sensory Organs National Tokyo Medical Center Tokyo Japan Department of OtolaryngologyeHead and Neck Surgery Nihon University School of Medicine Tokyo Japan Department of Speech Language and Hearing Therapy Mejiro University Saitama Japan Kawagoe Otology Institute Saitama Japan

Infants with congenital deafness caused by severe bilateral inner ear malformations frequently suffer from severe hearing loss and poor balance. Unfortunately, the use of hearing aids is usually ineffective in recovering hearing, necessitating cochlear implants. We report a case of a 6-year-old boy with congenital deafness and bilateral inner ear malformations(right side, incomplete partition type I [IP-I]; left side, common cavity deformity). Hearing aids had a remarkable effect in this patient, enabling sufficient and favorable hearing recovery such as to allow the patient to engage in daily conversations. Per-rotatory nystagmus was recorded on an electronystagmogram for both right and left rotations in a damped rotational chair test. It is rare for deaf children with severe bilateral inner ear malformation to demonstrate favorable development in hearing and good equilibrium function. Our findings suggest that auditoryevestibular hair cells in this patient may have been partially preserved despite IP-I in the right ear and common cavity deformity of the left ear.

关键词： Congenital hearing loss Inner ear malformations Rotation chair test

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Performance Improvement by Control of Wingtip Vortices for Vertical Axis Type Wind Turbine

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Open Journal of Fluid Dynamics 2018年第3期8卷 331-342页

作者： Shigeru Ogawa yusuke kimura Department of Mechanical Engineering National Institute of Kure College Kure Japan

The present paper describes control of wingtip vortices generated by vertical type wind turbine. The wind turbine consists of three circular cylinders. Each cylinder rotates on its own vertical axis and moves in orbit. It is known that wingtip vortices give rise to decrease of power generation performance as well as aerodynamic noise. Therefore, the goal of the study is to control wingtip vortices and to improve power generation performance. Numerical study was conducted for 14 models to find out control factors to suppress wingtip vortices. Numerical simulation visualized wingtips by streamlines as well as pressure distribution on the circular cylinder for evaluating Magnus effect. As a result, the following findings were obtained: 1) Installation of fully covered protection plates at both ends of the circular cylinder blades is greatly effective to suppress the wingtip vortices. 2) Curved wings attached to each cylinder are more effective to enhance power generation efficiency than flat ones, due to great increase in Magnus effect caused by large pressure difference on both sides of the curved wing. The power efficiency of the optimized model was improved up to 2.8%, which means 11 times that of the original model.

关键词： Vertical Axis Type Wind Turbine Wingtip Vortex Magnus Effect

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Coexistence of esophageal superficial carcinoma and multiple leiomyomas:A case report

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World Journal of Gastroenterology 2006年第28期12卷 4588-4592页

作者： Takeshi Iwaya Chihaya Maesawa Noriyuki Uesugi Toshimoto kimura Kenichiro Ikeda yusuke kimura Shingo Mitomo Kaoru Ishida Nobuhiro Sato Go Wakabayashi Departments of Surgery Ⅰ Iwate Medical University School of MedicineUchimaru 19-1Morioka 020-8505Japan Departments of Pathology Iwate Medical University School of MedicineUchimaru 19-1Morioka 020-8505Japan Division of Pathology Central Clinical LaboratoryIwate Medical University School of MedicineUchimaru 19-1Morioka 020-8505Japan Critical Care Medicine Iwate Medical University School of MedicineUchimaru 19-1Morioka 020-8505Japan

Leiomyomas are the most common benign tumors of the esophagus. They usually occur as a single lesion or as two or three nodules. Only two cases of esophageal multiple leiomyomas comprising more than 10 nodules have been reported previously. Moreover, there have been few reports of esophageal squamous cell carcinoma overlying submucosal tumors. We describe a 71-yearold man who was diagnosed as having a superficial esophageal cancer coexisting with two or three leiomyoma nodules. During surgery, 10 or more nodules that had not been evident preoperatively were palpable in the submucosal and muscular layers throughout the esophagus. As intramural metastasis of the esophageal cancer was suspected, we considered additional lymphadenectomy, but had to rule out this option because of the patient＇s severe anoxemia. Microscopic examination revealed that all the nodules were leiomyomas （20 lesions, up to 3 cm in diameter）, and that invasion of the carcinoma cells was limited to the submucosal layer overlying a relatively large leiomyoma. This is the first report of superficial esophageal cancer coexisting with numerous solitary leiomyomas. Multiple minute leiomyomas are often misdiagnosed as intramural metastasis, and a leiomyoma at the base of a carcinoma lesion can also be rnisdiagnosed as tumor invasion. The present case shows that accurate diagnosis is required for the management of patients with coexisting superficial esophageal cancer and multiple leiomyomas.

关键词： Multiple leiomyomas Squamous cell carcinoma Esophagus Coexistence

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Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

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World Journal of Gastroenterology 2017年第32期23卷 5849-5859页

作者： tomohide hori takafumi machimoto yoshio kadokawa toshiyuki hata tatsuo ito shigeru kato daiki yasukawa yuki aisu yusuke kimura maho sasaki yuichi takamatsu taku kitano shigeo hisamori tsunehiro yoshimura department of gastrointestinal surgery tenriyorodusoudanjyo hospital

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

关键词： Laparoscopic appendectomy Acute appendicitis Interval appendectomy Surgery Delayed appendectomy

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Protocol for laparoscopic cholecystectomy: Is it rocket science?

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World Journal of Gastroenterology 2016年第47期22卷 10287-10303页

作者： Tomohide Hori Fumitaka Oike Hiroaki Furuyama Takafumi Machimoto Yoshio Kadokawa Toshiyuki Hata Shigeru Kato Daiki Yasukawa Yuki Aisu Maho Sasaki yusuke kimura Yuichiro Takamatsu Masato Naito Masaya Nakauchi Takahiro Tanaka Daigo Gunji Kiyokuni Nakamura Kiyoko Sato Masahiro Mizuno Taku Iida Shintaro Yagi Shinji Uemoto Tsunehiro Yoshimura Department of Gastrointestinal and General Surgery Tenriyorodusoudanjyo Hospital Department of Gastrointestinal Surgery Mitsubishi Kyoto Hospital Department of Anesthesiology Mitsubishi Kyoto Hospital Department of Gastroenterology and Hepatology Mitsubishi Kyoto Hospital Department of Hepatobiliary Pancreatic Surgery Kyoto University Hospital

Laparoscopic cholecystectomy(LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety(CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon's assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical ***, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC:(1) consideration that a high level of experience alone is not enough;(2) recognition of the plateau involving the common hepatic duct and hepatic hilum;(3) blunt dissection until CVS exposure;(4) Calot's triangle clearance in the overhead view;(5) Calot's triangle clearance in the view from underneath;(6) dissection of the posterior right side of Calot's triangle;(7) removal of the gallbladder body; and(8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.

关键词： Laparoscopic cholecystectomy Gallbladder Critical view of safety biliary injury Protocol

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Endoscopic submucosal dissection of gastric adenomas using the clutch cutter

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World Journal of Gastrointestinal Endoscopy 2017年第7期9卷 334-340页

作者： Kazuya Akahoshi Masaru Kubokawa Junya Gibo Shigeki Osada Kayo Tokumaru Eriko Yamaguchi Hiroko Ikeda Takao Sato Kazuaki Miyamoto yusuke kimura Yuki Shiratsuchi Kazuaki Akahoshi Masafumi Oya Hidenobu Koga Eikichi Ihara Kazuhiko Nakamura Department of Gastroenterology Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Clinical Research Support Office Aso Iizuka Hospital Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu University

To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) using the clutch cutter (CC) (ESD-CC) for gastric adenoma (GA). METHODSFrom June 2007 to August 2015, 122 consecutive patients with histological diagnoses of GA from specimens resected by ESD-CC were enrolled in this prospective study. The CC was used for all ESD steps (marking, mucosal incision, submucosal dissection, and hemostatic treatment), and its therapeutic efficacy and safety were assessed. RESULTSBoth the en-bloc resection rate and the R0 resection rate were 100% (122/122). The mean surgical time was 77.4 min, but the time varied significantly according to tumor size and location. No patients suffered perforation. Post-ESD-CC bleeding occurred in six cases (4.9%) that were successfully resolved by endoscopic hemostatic treatment. CONCLUSIONESD-CC is a technically efficient, safe, and easy method for resecting GA.

关键词： Endoscopic submucosal dissection Clutch cutter Gastric adenoma

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Active Air Venting of Mold Cavity to Improve Performance of Injection Molded Direct Joining

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Nanomanufacturing and Metrology 2021年第2期4卷 109-117页

作者： Fuminobu kimura Shotaro Kadoya yusuke Kajihara Institute of Industrial Science The University of Tokyo4-6-1KomabaMeguro-kuTokyoJapan

A surface micro-/nano-structured metal plate can be joined with an injection molded plastic piece in a mold,which has been named injection molded direct joining(IMDJ).The injected plastic melt infiltrates the micro-/nano-structure,e.g.,a porous structure with micro/nano pores,on the metal plate while flowing in the mold cavity where the metal plate is *** solidification of the plastic,the metal and plastic materials are directly joined via the micro-/nano-structured metal *** air is trapped by the plastic melt,it is easily imagined that the air in the mold cavity prevents the melt plastic from contacting the metal surface and infiltrating the micro-/nano-structure,which could result in poorer joining *** avoid the prevention of the air for the better joining performance,the present study proposes a system actively venting the mold cavity during injection *** apply the active venting to IMDJ,venting and sealing systems were newly *** addition,a system measuring air pressure of the mold cavity was *** proposed system was evaluated by a measurement of joining strengths of IMDJ specimens that were produced under various *** the results,it is concluded that the active venting does not necessarily have a positive effect in any cases:the effect depends on the type of surface micro-/nano-structure.

关键词： Metal-plastic direct joining Micro-/nano-structured surface Injection molding Active venting Mold cavity pressure measurement

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Surface treatment of titanium dioxide nanopowder using rotary electrode dielectric barrier discharge reactor

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Plasma Science and Technology 2021年第10期23卷 197-203页

作者： Naw Rutha PAW Takuma kimura Tatsuo ISHIJIMA Yasunori TANAKA yusuke NAKANO Yoshihiko UESUGI Shiori SUEYASU Shu WATANABE Keitaro NAKAMURA Faculty of Electrical Engineering and Computer Science Kanazawa UniversityKanazawa 920-1192Japan Research Center for Production&Technology Nisshin Seifun Group Inc.Fujimino 356-8511Japan

Titanium dioxide(Ti O_(2))nanopowder(P-25;Degussa AG)was treated using dielectric barrier discharge(DBD)in a rotary electrode DBD(RE-DBD)*** electrical and optical characteristics were investigated during RE-DBD *** treated TiO_(2)nanopowder properties and structures were analyzed using x-ray diffraction(XRD)and Fourier-transform infrared spectroscopy(FTIR).After RE-DBD treatment,XRD measurements indicated that the anatase peak theta positions shifted from 25.3°to 25.1°,which can be attributed to the substitution of new functional groups in the TiO_(2)*** FTIR results show that hydroxyl groups(OH)at 3400 cm-1 increased *** mechanism used to modify the TiO_(2)nanopowder surface by air DBD treatment was confirmed from optical emission spectrum *** species,such as OH radical,ozone and atomic oxygen can play key roles in hydroxyl formation on the TiO_(2)nanopowder surface.

关键词： dielectric barrier discharge nanopowder reactive species rotary electrodes surface treatment titanium dioxide

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