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A Scrotal Arteriovenous Malformation: A Case Report

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Modern Plastic Surgery 2014年第1期4卷 16-19页

作者： nobuhiro Sato Tomoaki Kuroki Yasuyoshi Tosa Taro Kusano Shinya Yoshimoto Department of Plastic and Reconstructive Surgery Showa University Hospital Tokyo Japan

Purpose: Haemangiomas and vascular malformations are not easy to differentiate clinically. We describe a patient who was initially thought to have a scrotal venous malformation (VM) but after pathological examination was diagnosed to be afflicted with an arteriovenous malformation (AVM) with a micro-fistula in pathorogical photo. We think that even if there are suspicions of VM before the operation, the importance of resection with an ample margin of safety is indicated. Material and Method: A 38-year-old man who noticed a mass in his scrotum. The patient was seen at our hospital in May 2009 with concern for progression of the scrotal mass. That mass appeared to indicate a simple case of VM of the scrotum. Result and Conclusion: A biopsy of the mass was performed and was diagnosed to be a micro-fistula AVM, with no tumour growth in the vascular endothelial cells. Resection was performed in September 2009. And there is no recurrence. Even if there are suspicions of VM before the operation, the importance of resection with an ample margin of safety is indicated.

关键词： Arteriovenous Malformation Scrotum Resection

A Novel Innovative Sleeping Mattress Could Possibly Save Lives and the National Economy: Small but Solid Evidence from a Medical Perspective

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Health 2020年第7期12卷 811-827页

作者： Masaki Omura nobuhiro Suetake Kenichi Itao Takuji Yamaguchi Ailing Hu Hiroyuki Kobayashi Department of Hospital Administration Juntendo University Graduate School of Medicine Tokyo Japan WINFrontier Co. Ltd. Tokyo Japan Center for Advanced Kampo Medicine and Clinical Research Juntendo University Graduate School of Medicine Tokyo Japan

The RAND Corporation reported that insufficient sleep causes an economic loss of $138 billion (2.92% of GDP) in Japan every year. In this study, we investigated the sleep improvement effect of a novel innovative sleeping mattress called “AiR SI” (Nishikawa Co., Ltd.) to find a simple method to solve the problem of sleep deprivation. We conducted a 2-week randomized, open-label, crossover, self-controlled study in 14 healthy adults in their 30s to 50s (control: 1 week, AiR SI: 1 week), with sleep quality as the primary endpoint as well as salivary components (cortisol, melatonin) and autonomic nervous function (sympathetic nerve, parasympathetic nerve) as secondary endpoints. Trends toward improvement in sleep were suggested for all the endpoints, regardless of differences in the subject background. The results suggested that the use of AiR SI for 1 week not only improved sleep but normalized both the endocrine and autonomic functions as well. We conclude that, by using a sleeping mattress with a high sleep improvement effect, the user may easily achieve higher labor productivity and have a lower mortality risk. Eliminating sleep deprivation with a sleeping mattress may lead to a reduction in national economic losses and ultimately produce significant economic effects.

关键词： Sleeping Mattress Sleep Deprivation Mortality Risk Autonomic Nervous System Medical Economy

Potentiality of immunotherapy against hepatocellular carcinoma

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World Journal of Gastroenterology 2015年第36期21卷 10314-10326页

作者： nobuhiro Tsuchiya Yu Sawada Itaru Endo Yasushi Uemura Tetsuya Nakatsura Division of Cancer Immunotherapy Exploratory Oncology Research and Clinical Trial CenterNational Cancer Center Department of Gastroenterological Surgery Graduate School of MedicineYokohama City University

Hepatocellular carcinoma(HCC),the predominant form of primary liver cancer,is the fifth most common cancer worldwide and the second leading cause of cancer-related death. Despite the high incidence,treatment options remain limited for advanced HCC,and as a result prognosis continues to be poor. Current therapeutic options,surgery,chemotherapy and radiotherapy,have only modest efficacy. New treatment modalities to prolong survival and to minimize the risk of adverse response are desperately needed for patients with advanced HCC. Tumor immunotherapy is a promising,novel treatment strategy that may lead to improvements in both treatment-associated toxicity and outcome. The strategies have developed in part through genomic studies that have yielded candidate target molecules and in part through basic biology studies that have defined the pathways and cell types regulating immune response. Here,we summarize the various types of HCC immunotherapy and argue that the newfound field of HCC immunotherapy might provide critical advantages in the effort to improve prognosis of patients with advanced HCC. Already several immunotherapies,such as tumor-associated antigen therapy,immune checkpoint inhibitors and cell transfer immunotherapy,have demonstrated safety and feasibility in HCC patients. Unfortunately,immunotherapy currently has low efficacy in advanced stage HCC patients; overcoming this chal lenge will place immunotherapy at the forefront of HCC treatment,possibly in the near future.

关键词： Cell transfer immunotherapy Cytokine therapy Hepat

Nasogastric tube syndrome induced by an indwelling long intestinal tube

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World Journal of Gastroenterology 2016年第15期22卷 4057-4061页

作者： Naoki Sano Masayoshi Yamamoto Kentaro Nagai Keiichi Yamada nobuhiro Ohkohchi Department of Surgery Tsukuba Medical Center Hospital Department of Surgery and Organ Transplantation Faculty of Medicine University of Tsukuba

The nasogastric tube(NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome(NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.

关键词： Nasogastric tube syndrome Nasogastric tube Long intestinal tube Acute upper airway obstruction Trach

Clinical trial of chemotherapy by superselective intra-arterial infusion of nedaplatin （CDGP） and 5-Fu with concurrent radiotherapy for advanced oral cancer

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中国口腔颌面外科杂志 2008年第B5期6卷 171-172页

作者： Kumiko Aoki Yuichiro Imai nobuhiro Yamakawa Yasutugu Yamakawa Tadaaki Kirita The Department of Oral and Maxillofacoal Surgery Nara Medical University. Nara 634-0813 Japan

Purpose: Nedaplatin (CDGP) is the one of the platinum-derivatives to further improve the anti-tumor effect and to reduce adverse effects of cisplatin, such as renal toxicity。The present study evaluated the efficacy and adverse events of chemotherapy by superselective intra-arterial infusion of CDGP and 5-Fu combined with concurrent radiotherapy in patients with advanced squamous cell carcinoma of the oral cavity。Methods- Eighteen patients were treated with CDGP plus 5Fu in combination with concurrent irradiation of 40-60Gy。Twelve patients were treated as a preoperative therapy and 6 patients were as a definitive therapy。Eleven patients had stage III carcinomas and 7 patients had stage IV。Results: The overall clinical response rates were 88.9% and histological effects according to the grading system of Shimosato et al。were seen in 83.3%。Adverse events were observed in all patients。Mucositis, leucopenia and thrombocytopenia (>Grade 2 )were seen in 15 (83.3%), 12(66.7%) and 8(44.4%) of 18 patients, respectively。With a follow-up ranging from 8-45 months, 3 years overall survival rates are 69.9% for all patients, and 81.5% as a preoperative therapy, 50.0% as a definitive therapy。Conclusion: Concurrent chemoradiotherapy using CDGP plus 5-Fu was tolerated with good clinical and histological effects, resulting in good local control for advanced oral carcinoma。

关键词：口腔癌治疗方法动脉输液放射线疗法

Fibrosis in nonalcoholic fatty liver disease: Noninvasive assessment using computed tomography volumetry

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World Journal of Gastroenterology 2016年第40期22卷 8949-8955页

作者： nobuhiro Fujita Akihiro Nishie Yoshiki Asayama Kousei Ishigami Yasuhiro Ushijima Yukihisa Takayama Daisuke Okamoto Ken Shirabe Tomoharu Yoshizumi Kazuhiro Kotoh Norihiro Furusyo Tomoyuki Hida Yoshinao Oda Taisuke Fujioka Hiroshi Honda Department of Clinical Radiology Graduate School of Medical Sciences Kyushu University Department of Advanced Imaging and Interventional Radiology Graduate School of Medical Sciences Kyushu University Department of Radiology Informatics and Network Graduate School of Medical Sciences Kyushu University Department of Surgery and Sciences Graduate School of Medical Sciences Kyushu University Department of Medicine and Bioregulatory Science Graduate School of Medical Sciences Kyushu University Department of General Internal Medicine Graduate School of Medical Sciences Kyushu University Department of Anatomic Pathology Graduate School of Medical Sciences Kyushu University CT Application Philips Electronics Japan Medical Systems

AIM To evaluate the diagnostic performance of computed tomography(CT) volumetry for discriminating the fibrosis stage in patients with nonalcoholic fatty liver disease(NAFLD).METHODS A total of 38 NAFLD patients were enrolled. On the basis of CT imaging, the volumes of total, left lateral segment(LLS), left medial segment, caudate lobe, and right lobe(RL) of the liver were calculated with a dedicated liver application. The relationship between the volume percentage of each area and fibrosis stage was analyzed using Spearman's rank correlation coefficient. A receiver operating characteristic(ROC) curve analysis was performed to determine the accuracy of CT volumetry for discriminating fibrosis *** The volume percentages of the caudate lobe and the LLS significantly increased with the fibrosis stage(r = 0.815, P < 0.001; and r = 0.465, P = 0.003, respectively). Contrarily, the volume percentage of the RL significantly decreased with fibrosis stage(r =-0.563, P < 0.001). The volume percentage of the caudate lobe had the best diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating fibrosis stage were as follows: ≥ F1, 0.896; ≥ F2, 0.929; ≥ F3, 0.955; and ≥ F4, 0.923. The best cut-off for advanced fibrosis(F3-F4) was 4.789%, 85.7% sensitivity and 94.1% *** The volume percentage of the caudate lobe calculated by CT volumetry is a useful diagnostic parameter for staging fibrosis in NAFLD patients.

关键词：不含酒精的脂肪肝疾病计算断层摄影术容量测定纤维变性舞台不含酒精的 steatohepatitis

Gastric submucosa-invasive carcinoma associated with EpsteinBarr virus and endoscopic submucosal dissection: A case report

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World Journal of Gastrointestinal Oncology 2019年第10期11卷 925-932页

作者： Yu Kobayashi Takehito Kunogi Hiroki Tanabe Yuki Murakami Takuya Iwama Takahiro Sasaki Keitaro Takahashi Katsuyoshi Ando Yoshiki Nomura nobuhiro Ueno Shin Kashima Kentaro Moriichi Hidehiro Takei Mikihiro Fujiya Toshikatsu Okumura Division of Gastroenterology and Hematology/Oncology Department of Medicine Asahikawa Medical UniversityAsahikawa 078-8510Japan Pathological Department of Asahikawa Medical University Hospital Asahikawa Medical UniversityAsahikawa 078-8510Japan

BACKGROUND Epstein-Barr virus(EBV)-associated carcinoma is a gastric cancer subtype with a morphology characterized by gastric carcinoma with lymphoid stroma(GCLS).Clinicopathological studies have indicated a better prognosis for GCLS than for common gastric *** previous cases of early gastric cancer associated with EBV had been diagnosed by endoscopic *** SUMMARY We present two GCLS cases subjected to endoscopic submucosal dissection(ESD)for a definitive diagnosis.A protruded gastric lesion was identified by routine endoscopic examination,but forceps biopsy showed no atypical cells before *** resected specimen showed a poorly differentiated adenocarcinoma with lymphoid cells involving the mucosa and *** final diagnosis was submucosa-invasive poorly differentiated gastric ***,additional gastrectomy was recommended to obtain a complete *** patient underwent additional distal gastrectomy with lymph node dissection,but the other was refused because of cardiovascular *** patients remained in remission for more than half a *** positivity was determined by EBV-encoded RNA in situ *** also conducted a literature review of cases of early gastric cancer associated with EBV that had been diagnosed by *** Submucosa-invasive GCLS could be dissected using ESD,and EBV positivity should be subsequently assessed to determine whether or not any additional curative surgery is *** prospective investigations on the prevalence of lymph node metastasis in EBV-associated carcinoma should be performed to expand the indications for endoscopic resection.

关键词： Herpesvirus 4 Human Stomach neoplasms Gastric carcinoma with lymphoid stroma Epstein-Barr virus-associated gastric carcinoma Case report

Complete response to multidisciplinary therapy in a patient with primary gastric choriocarcinoma

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World Journal of Gastroenterology 2013年第31期19卷 5187-5194页

作者： Kazuhiro Takahashi Shigeki Tsukamoto Ken Saito nobuhiro Ohkohchi Katsu Hirayama Division of Gastro-enterological and Hepatobiliary Surgery and Organ Transplantation Department of Surgery University of Tsukuba Tsukuba 3058575 Japan Department of Surgery Hiraka General Hospital Yokote 0138610 Japan

Primary gastric choriocarcinoma is a rapidly growing neoplasm with an average survival of several months in untreated *** with lymph node dissection followed by chemotherapy is the treatment of *** used for gastric adenocarcinoma are usually ***,median survival remains less than six *** this case report,we describe a case of primary gastric choriocarcinoma with a clinical complete response to multidisciplinary treatment including surgery,chemotherapy,and radiofrequency ablation(RFA).The patient was originally referred for general *** demonstrated a large tumor occupying the fornix,and total gastrectomy with lymph node dissection was *** days later,multiple liver metastatic recurrences with high serum levels of beta-human chorionic gonadotropin(β-hCG) were *** with a gonadal choriocarcinoma regimen consisting of etoposide,methotrexate,actinomycin D,cyclophosphamide,and vincristine(EMA/CO),was *** three cycles,serum β-hCG decreased markedly and the tumors *** months later,multiple lung metastatic recurrences were *** one cycle of EMA/CO,only one nodule *** tomography-guided RFA was performed for this oligometastatic *** patient has been alive with no evidence of disease for 10 years after the initial *** the best of our knowledge,this patient with recurrent primary gastric choriocarcinoma has achieved the longest *** present case is the first report of choriocarcinoma metastatic to the lung successfully treated with *** our retrospective analysis of recurrent or unresectable primary gastric choriocarcinoma,we propose that gonadal choriocarcinoma regimens can be considered as first-line for primary gastric choriocarcinoma.

关键词： Primary gastric choriocarcinoma Betahuman chorionic gonadotropin Etoposide,methotrexate,actinomycin D,cyclophosphamide,and vincristine Oligometastatic Radiofrequency ablation

Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

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Health 2017年第8期9卷 1159-1175页

作者： nobuhiro Sato Kohei Akazawa Yuji Mitadera Tsubasa Suzuki Nahoko Ibe Yasuo Hirose Department of Medical Informatics and Statistics Niigata University Graduate School of Medicine Niigata Japan Department of Emergency and Critical Care Medicine Niigata City General Hospital Niigata Japan Development Center of Medical Professionals for Next-Generation Niigata University Hospital Niigata Japan Patient and Family Support Center Niigata City General Hospital Niigata Japan

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

关键词： Older People Emergency Healthcare System Japan Long-Term Care Staffing Problems