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"Extended" radical cholecystectomy for gallbladder cancer:Long-term outcomes, indications and limitations

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World Journal of Gastroenterology 2012年第34期18卷 4736-4743页

作者： Yoshio Shirai Jun Sakata Toshifumi Wakai Taku Ohashi Katsuyoshi Hatakeyama division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental SciencesNiigata City 951-8510Japan

AIM:To delineate indications and limitations for "ex tended" radical cholecystectomy for gallbladder cancer:a procedure which was instituted in our department in 1982. METHODS:Of 145 patients who underwent a radi cal resection for gallbladder cancer from 1982 through 2006, 52 (36%) had an extended radical cholecystec tomy, which involved en bloc resection of the gallblad der, gallbladder fossa, extrahepatic bile duct, and the regional lymph nodes (first-and second-echelon node groups). A retrospective analysis of the 52 patients was conducted including at least 5 years of follow up. Residual tumor status was judged as no residual tumor (R0) or microscopic/macroscopic residual tumor (R1 2). athological findings were documented according tothe American Joint Committee on Cancer Cancer Stag ing anual (7th edition). RESULTS:he primary t mor as classified as patho-logical T1 (pT1) in 3 patients, pT2 in 36, pT3 in 12, and pT4 in 1. Twenty three patients had lymph node metastases; 11 had a single positive node, 4 had two positive nodes, and 8 had three or more positive nodes. None of the three patients with pT1 tumors had nodal disease, whereas 23 of 49 (47%) with pT2 or more advanced tumors had nodal disease. One patient died during the hospital stay for definitive resection, giv ing an in hospital mortality rate of 2%. Overall survival (OS) after extended radical cholecystectomy was 65% at 5 years and 53% at 10 years in all 52 patients. OS differed according to the p classification ( < 0.001) and the nodal status ( = 0.010). All of 3 patients with pT1 tumors and most (29 of 36) patients with pT2 tu mors survived for more than 5 years. Of 12 patients with pT3 tumors, 8 who had an R1 2 resection, distant metastasis, or extensive extrahepatic organ involve ment died soon after resection. Of the remaining four pT3 patients who had localized hepatic spread through the gallbladder fossa and underwent an R0 resection, 2 survived for more than 5 years and another survived for 4

关键词： Gallbladder neoplasms Radical surgery Hepatectomy Bile duct resection Lymph node excision Prognosis

Multicentric occurrence of hepatocellular carcinoma with nonalcoholic steatohepatitis

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World Journal of Hepatology 2011年第1期3卷 15-23页

作者： Hirokazu Kawai Minoru Nomoto Takeshi Suda Kenya Kamimura Atsunori Tsuchiya Yasushi Tamura Masahiko Yano Masaaki Takamura Masato Igarashi Toshifumi Wakai Satoshi Yamagiwa Yasunobu Matsuda Shogo Ohkoshi Isao Kurosaki Yoshio Shirai Masahiko Okada Yutaka Aoyagi Department of Clinical Laboratory Niigata University Medical and Dental Hospital division of Gastroenterology and Hepatology Niigata University Graduate School of Medical and Dental Sciences division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences Department of medical Technology Niigata University Graduate School of Health Sciences division of Preventive Medicine Niigata University Graduate School of Medical and Dental Sciences

AIM:To reveal the manner of hepatocellular carcinoma (HCC) development in patients with nonalcoholic steatohepatitis(NASH) focusing on multicentric occurrence (MO) of ***:We compared clinicopathological characteristics between patients with and without MO of HCC arising from NASH *** clinical features were implicated with reference to the literature ***:MO of HCC was identified with histological proof in 4 out of 12 patients with NASH-related HCC(2 males and 2 females).One patient had synchronous MO;an advanced HCC,two well-differentiated HCCs and a dysplastic nodule,followed by the development of metachronous MO of *** other three patients had multiple advanced HCCs accompanied by a well-differentiated HCC or a dysplastic *** these three patients,one had synchronous MO,one had metachronous MO and the other had both synchronous and metachronous *** were no obvious differences between the patients with or without MO in terms of liver function tests,tumor markers and anatomical extent of *** the other hand,all four patients with MO of HCC were older than 70 years old and had the comorbidities of obesity,type 2 diabetes mellitus(T2DM),hypertension and *** these conditions were not limited to MO of HCC,all the conditions were met in only one of eight patients without MO of ***,concurrence of these conditions may be a predisposing situation to synchronous MO of *** particular,old age,T2DM and cirrhosis were suggested to be prerequisite for MO because these factors were depicted in common among two other cases with MO of HCC under NASH in the ***:The putative predisposing factors and necessary preconditions for synchronous MO of HCC in NASH were suggested in this *** investigations are required to clarify the accurate prevalence and predictors of MO to establish better strategies for treatment and prevention leading to the prognostic improvement in NASH.

关键词： Nonalcoholic steatohepatitis Hepatocellular carcinoma Multicentric occurrence

Microbial community functional structure in response to micro-aerobic conditions in sulfate-reducing sulfur-producing bioreactor

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Journal of Environmental sciences 2014年第5期26卷 1099-1107页

作者： Hao Yu Chuan Chen Jincai Ma Xijun Xu Ronggui Fan Aijie Wang State Key Laboratory of Urban Water Resource and Environment Harbin Institute of Technology school of Environmental Science and Engineering Liaoning Technical University biosciences and Biotechnology division Lawrence Livermore National Laboratory Research Center for Eco-Environmental sciences Chinese Academy of Sciences

Limited oxygen supply to anaerobic wastewater treatment systems had been demonstrated as an effective strategy to improve elemental sulfur （So） recovery, coupling sulfate reduction and sulfide oxidation. However, little is known about the impact of dissolved oxygen （DO） on the microbial functional structures in these systems. We used a high throughput tool （GeoChip） to evaluate the microbial community structures in a biological desulfurization reactor under micro-aerobic conditions （DO： 0.02-0.33 rag/L）. The results indicated that the microbial community functional compositions and structures were dramatically altered with elevated DO levels. The abundances of dsrA/B genes involved in sulfate reduction processes significantly decreased （p 〈 0.05, LSD test） at relatively high DO concentration （DO： 0.33 mg/L）. The abundances of sox and fccA/B genes involved in sulfur/sulfide oxidation processes significantly increased （p 〈 0.05, LSD test） in low DO concentration conditions （DO： 0.09 mg/L） and then gradually decreased with continuously elevated DO levels. Their abundances coincided with the change of sulfate removal efliciencies and elemental sulfur （S^0） conversion efficiencies in the bioreactor. In addition, the abundance of carbon degradation genes increased with the raising of DO levels, showing that the heterotrophic microorganisms （e.g., fermentative microorganisms） were thriving under micro-aerobic condition. This study provides new insights into the impacts of micro-aerobic conditions on the microbial functional structure of sulfate- reducing sulfur-producing bioreactors, and revealed the potential linkage between functional microbial communities and reactor performance.

关键词： micro-aerobic condition elemental sulfur recovery microbial community functional gene array

Cytapheresis for pyoderma gangrenosum associated with inflammatory bowel disease:A review of current status

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World Journal of Clinical Cases 2020年第11期8卷 2092-2101页

作者： Kentaro Tominaga Kenya Kamimura Hiroki Sato Masayoshi Ko Yuzo Kawata Takeshi Mizusawa Junji Yokoyama Shuji Terai division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata UniversityNiigata 951-8510Japan

Pyoderma gangrenosum(PG)is a neutrophilic dermatosis clinically characterized by the presence of painful skin ulcerations with *** it is frequently associated with inflammatory bowel diseases,including ulcerative colitis,gastroenterologists should be familiar with the disease including therapeutic ***,we have conducted a review focusing on the cytapheresis for PG in cases of inflammatory bowel diseases.A literature search was conducted to extract studies published in the last 20 years,with information on demographics,clinical symptoms,treatment,and the clinical course from a total of 22 cases reported and our recent *** most patients,cytapheresis was associated with improvement or resolution of PG after failure of conventional therapeutic options such as corticosteroids,antibiotics,immunosuppressive agents and *** on the information summarized,cytapheresis is helpful in the majority of patients with PG refractory to medical treatment associated with inflammatory bowel diseases and could be further studied in a multicenter,randomized trial.

关键词： Granulocytapheresis Leucocytapheresis Cytapheresis Inflammatory bowel diseases Pyoderma gangrenosum Complications

Perimuscular connective tissue contains more and larger lymphatic vessels than the shallower layers in human gallbladders

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World Journal of Gastroenterology 2007年第33期13卷 4480-4483页

作者： Masayuki Nagahashi Yoshio Shirai Toshifumi Wakai Jun Sakata Yoichi Ajioka Katsuyoshi Hatakeyama division of Digestive and General Surgery Niigata University Graduate School of Medicaland Dental Sciences Niigata Japan division of Molecular and Diagnostic Pathology Niigata University Graduate School of Medical and Dental Sciences Asahimachi-dori Niigata City Japan

AIM： To clarify whether perimuscular connective tissue contains more lymphatic vessels than the shallower layers in human gallbladders. METHODS： Lymphatic vessels were stained immunohistochemically with monoclonal antibody D2-40, which is a specific marker of lymphatic endothelium, in representative sections of 12 normal human gallbladders obtained at the time of resection for colorectal carcinoma liver metastases. In individual gallbladder specimens, nine high-power （×200） fields with the highest lymphatic vessel density （LVD）, termed ＂hot spots＂; were identified for each layer （mucosa, muscle layer, and perimuscular connective tissue）. In individual hot spots, the LVD and relative lymphatic vessel area （LVA） were measured microscopically using a computer-aided image analysis system. The mean LVD and LVA values for the nine hot spots in each layer were used for statistical analyses. RESULTS： In the mucosa, muscle layer, and perimuscular connective tissue, the LVD was 16.1 ± 9.2, 35.4 ± 15.7, and 65.5 ± 12.2, respectively, and the LVA was 0.4 ± 0.4, 2.1 ± 1.1, and 9.4 ± 2.6, respectively. Thus, both the LVD and LVA differed significantly （P 〈 0.001 and P 〈 0.001, respectively; KruskaI-Wallis test） among the individual layers of the wall of the gallbladder, with the highest LVD and LVA values in the perimuscular connective tissue. Most （98 of 108） of the hot spots within the perimuscular connective tissue were located within 500 μm of the lower border of the muscle layer. CONCLUSION： The perimuscular connective tissue contains more and larger lymphatic vessels than the shallower layers in the human gallbladder. This observation partly explains why the incidence of lymph node metastasis is high in T2 （tumor invading the perimuscular connective tissue） or more advanced gallbladder carcinoma.

关键词： Gallbladder Lymphatic vessels Monoclonal antibody D2-40 Gallbladder neoplasms Lymphaticmetastasis

Autoantibodies in primary biliary cirrhosis:Recent progress in research on the pathogenetic and clinical significance

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World Journal of Gastroenterology 2014年第10期20卷 2606-2612页

作者： Satoshi Yamagiwa Hiroteru Kamimura Masaaki Takamura Yutaka Aoyagi division of Gastroenterology and Hepatology Niigata University Graduate School of Medical and Dental Sciences Niigata 951-8510 Japan

Primary biliary cirrhosis(PBC)is a chronic progressive cholestatic liver disease characterized by immunemediated destruction of the small-and medium-sized intrahepatic bile ducts and the presence of antimitochondrial antibodies(AMA)in the *** are detected in over 90%of patients with PBC,whereas their prevalence in the general population is extremely low,varying from 0.16%to 1%.Previous studies have shown that the unique characteristics of biliary epithelial cells undergoing apoptosis may result in a highly direct and very specific immune response to mitochondrial ***,recent studies have demonstrated that serum from AMA-positive PBC patients is reactive with a number of xenobiotic modified E2 subunits of the pyruvate dehydrogenase complex,which is not observed in the serum of normal *** findings indicate that chemicals originating from the environment may be associated with a breakdown in the tolerance to mitochondrial *** it is currently generally accepted that AMA are the most specific serological markers of PBC,more than 60 au-toantibodies have been investigated in patients with PBC,and some have previously been considered specific to other autoimmune *** review covers the recent progress in research on the pathogenetic and clinical significance of important autoantibodies in *** the pathogenic role of those autoantibodies in PBC remains a priority of basic and clinical research.

关键词： Primary biliary cirrhosis Autoantibodies Anti-mitochondrial antibodies Anticentromere antibodies Anti-gp210 antibodies

Advances in understanding and treating liver diseases during pregnancy:A review

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World Journal of Gastroenterology 2015年第17期21卷 5183-5190页

作者： Kenya Kamimura Hiroyuki Abe Hirokazu Kawai Hiroteru Kamimura Yuji Kobayashi Minoru Nomoto Yutaka Aoyagi Shuji Terai division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata UniversityNiigata 951-8510Japan

Liver disease in pregnancy is rare but pregnancyrelated liver diseases may cause threat to fetal and maternal *** includes pre-eclampsia;eclampsia;haemolysis,elevated liver enzymes,and low platelets syndrome;acute fatty liver of pregnancy;hyperemesis gravidarum;and intrahepatic cholestasis of *** basic researches have shown the various etiologies involved in this disease *** these advances,rapid diagnosis is essential for severe cases since the decision of immediate delivery is important for maternal and fetal *** other therapeutic options have also been shown in recent reports based on the clinical trials and cooperation and information sharing between hepatologist and gynecologist is important for timely therapeutic ***,correct understandings of diseases and differential diagnosis from the pre-existing and co-incidental liver diseases during the pregnancy will help to achieve better ***,here we review and summarized recent advances in understanding the etiologies,clinical courses and management of liver disease in *** information will contribute to physicians for diagnosis of disease and optimum management of patients.

关键词： Pregnancy Liver injury Low platelets Haemolysis elevated liver enzymes Acute fatty liverof pregnancy Hyperemesis gravidarum Intrahepaticcholestasis of pregnancy

Incidence and risk factors for infantile colic in Iranian infants

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World Journal of Gastroenterology 2008年第29期14卷 4662-4666页

作者： Elham Talachian Ali Bidari Mohammad Hossein Rezaie division of Pediatric Gastroenterology Ali-Asghar Children's HospitalTehran *** Iran medical school Iran University of Medical SciencesTehran 158756177 Iran

AIM: To assess the incidence of infantile colic and its association with variable predictors in infants born in a community maternity hospital, Tehran, Iran. METHODS: In this prospective cohort study, mothers who gave birth to live newborns between February 21 and March 20, 2003 at the hospital were invited to join to the study. For every infant-mother dyad data were collected on infant gender, type of delivery, gestational age at birth, birth weight, birth order, and mother's reproductive history. Then mothers were given a diary to document the duration of crying/fussiness behav-iors of their infants for the next 12 wk. We scheduled home visits at the time the infants were 3 mo of age to collect the completed diaries and obtain additional information on infants' nutritional sources and identify if medications were used for colic relief. Cases of colic were identifi ed by applying Wessel criteria to recorded data. Chi-square and Mann-whitney U tests were used to compare proportions for non-parametric and para-metric variables, respectively. RESULTS: From 413 infants, follow-up was completed for 321 infants. In total, 65 infants (20.24%) satisfi ed the Wessel criteria for infantile colic. No statistical sig-nifi cance was found between colicky and non-colicky infants according to gender, gestational age at birth, birth weight, type of delivery, and, infant's feeding pattern. However, fi rstborn infants had higher rate for developing colic (P = 0.03). CONCLUSION: Colic incidence was 20% in this popu-lation of Iranian infants. Except for birth order status, no other variable was signifi cantly associated with in-fantile colic.

关键词： Infantile colic Incidence Iran, Risk factors

Self-reported risk of stroke and factors associated with underestimation of stroke risk among older adults with atrial fibrillation: the SAGE-AF study

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Journal of Geriatric Cardiology 2020年第8期17卷 502-509页

作者： Jordy Mehawej Jane Saczynski Jerry H.Gurwitz Hawa O.Abu Benita A.Bamgbade Wei-Jia WANG Tenes Paul Katherine Trymbulak Connor Saleeba Zi-Yue WANG Catarina I.Kiefe Robert J.Goldberg David D.Mc Manus division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health Systems sciences School of PharmacyNortheastern UniversityBostonMAUSA Department of Population and Quantitative Health sciences University of Massachusetts Medical SchoolWorcesterMAUSA division of Geriatric Medicine and Meyers Primary Care Institute University of Massachusetts Medical SchoolWorcesterMAUSA

Background Though engaging patients with atrial fibrillation(AF) in understanding their stroke risk is encouraged by guidelines, little is known regarding AF patients' perceived stroke risk or its relationship with oral anticoagulation(OAC) use. We aim to identify factors associated with underestimation of stroke risk among older patients with AF and relate this to OAC use. Methods Data are from the ongoing SAGE(Systematic Assessment of Geriatric Elements)-AF study, which included older patients(> 65 years) with non-valvular AF and a CHA2 DS2-VASc score of ≥ 2. Participants reported their perceived risk of having a stroke without OAC. We compared the perceived risk to CHA2 DS2-VASc predicted stroke risk and classified participants as "over" or "under" estimators, and identified factors associated with underestimation of risk using multiple logistic regression. Results The average CHA2 DS2-VASc score of 915 participants(average age: 75 years, 47% female, 86% white) was 4.3 ± 1.6, 43% of participants had discordant predicted and self-reported stroke risks. Among the 376 participants at highest risk(CHA2 DS2-VASc score ≥ 5), 46% of participants underestimated their risk. Older participants(≥ 85 years) were more likely and OAC treated patients less likely to underestimate their risk of developing a future stroke than respective comparison groups. Conclusions A significant proportion of study participants misperceived their stroke risk, mostly by overestimating. Almost half of participants at high risk of stroke underestimated their risk, with older patients more likely to do so. Patients on OAC were less likely to underestimate their risk, suggesting that successful efforts to educate patients about their stroke risk may influence treatment choices.

关键词： Anticoagulation Atrial fibrillation Stroke