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Significance of timing of therapeutic line on effectiveness of nivolumab for metastatic renal cell carcinoma

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Current Urology 2023年第1期17卷 52-57页

作者： Jun Teishima Daiki Murata Kazuma Yukihiro Yohei Sekino Shogo Inoue Tetsutaro Hayashi Koji Mita Yasuhisa Hasegawa Masao Kato Mitsuru Kajiwara Masanobu Shigeta Satoshi Maruyama Hiroyuki Moriyama Seiji Fujiwara Akio Matsubara Department of Urology Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan Department of Urology Hiroshima-City Asa Citizens HospitalHiroshimaJapan Department of Urology Fukuyama Medical CenterFukuyamaJapan Department of Urology Hiroshima General HospitalHatsukaichiJapan Department of Urology Hiroshima Prefectural HospitalHiroshimaJapan Department of Urology Kure Medical Center and Chugoku Cancer CenterKureJapan Department of Urology Miyoshi Central HospitalMiyoshiJapan Department of Urology Onomichi General HospitalOnomichiJapan Department of Urology Higashi-Hiroshima Medical Center Higashi-HiroshimaJapan

Objectives:This study aimed to clarify the significance of therapeutic timing on the effectiveness of nivolumab for treating metastatic renal cell *** and methods:Fifty-eight patients with metastatic renal cell carcinoma treated with nivolumab monotherapy were retrospectively *** who were treated with nivolumab as second-line therapy were included in the second-line group,while the others were included in the later-line *** clinicopathological characteristics,effects of nivolumab,and prognoses of these groups were ***:Twenty and thirty-eight patients were included in the second-line and later-line groups,*** were no significant differences in the distribution of International Metastatic Renal Cell Carcinoma Database Consotium risk and other clinicopathological characteristics between the 2 *** proportion of patients whose objective best response was progressive disease in the second-line group was significantly lower than that in the later-line group(15%vs.50%,p=0.0090).The 50%progression-free survival with nivolumab in the second-line group was significantly better than that in the later-line group(not reached and 5 months,p=0.0018).Multivariate analysis showed that the second-line setting was an independent predictive factor for better progression-free survival(p=0.0028,hazard ratio=0.108).The 50%overall survival after starting nivolumab in the second-line and later-line groups was not reached and 27.8 months,respectively(p=0.2652).Conclusions:The therapeutic efficacy of nivolumab as second-line therapy is expected to be better than that of later therapy.

关键词： Immune checkpoint inhibitor Metastatic renal cell carcinoma Nivolumab Prognostic factor Second-line treatment

Radiofrequency Ablation-Associated Delayed Diaphragmatic Hernia Treated with the Thoracolaparotomy Approach: A Case Report

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Case Reports in Clinical Medicine 2016年第12期5卷 541-547页

作者： Hiroaki Yamane Toshihiko Kohashi Ichiro Omori Akira Nakashima Eisuke Murakami Koji Waki Hidenori Mukaida Naoki Hirabayashi Department of Gastroenterological Surgery Hiroshima City Asa Citizens Hospital Hiroshima Japan Department of Gastroenterological and Transplant Surgery Applied Life Sciences Institute of Biomedical and Health Sciences Hiroshima University Hiroshima Japan Department of Gastroenterology Hiroshima City Asa Citizens Hospital Hiroshima Japan

Background: Radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma (HCC). However, rare but serious complications may occur after RFA. We describe a case of diaphragmatic hernia associated with RFA. Case Presentation: A 68-year-old man with a history of hepatitis C-related liver cirrhosis was admitted to our hospital because of lower abdominal pain. Three years earlier, he underwent RFA for HCC in segment 8. Computed tomography revealed that the intestine was intruding into the right thoracic cavity through a diaphragmatic hernia. On the basis of the diagnosis of right diaphragmatic hernia with a strangulated ileus, an emergency operation was performed. Perforation of the strangulated transverse colon into the right thoracic cavity was suspected, and a combined approach of laparotomy and thoracotomy was utilized. The operative findings showed that the diaphragmatic hernia was 3.5 × 2.0 cm in diameter, and it was simply sutured with a nonabsorbable suture material. Resection of the intruded ischemic transverse colon was completed, and a covering ileostomy was performed. The patient was discharged without any complications. Conclusions: RFA is widely used for the treatment of HCC. Reports of early- and late-phase complications indicate that heat damage contributes to the fragility of neighboring organs. The occurrence of diaphragmatic hernia after RFA is one of the delayed complications. Although it rarely occurs, this complication requires emergency surgery. In conclusion, if perforation of the intestine into the thoracic cavity is suspected, thoracolaparotomy should be considered as a treatment option to prevent postoperative massive empyema.

关键词： Diaphragmatic Hernia Hepatocellular Carcinoma Radiofrequency Ablation

Kinematically Aligned Total Knee Arthroplasty for Valgus Osteoarthritis of More than 10°―Is It Still a “Challenging Surgery”?

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Open Journal of Orthopedics 2023年第9期13卷 355-369页

作者： Yoshinori Soda Toshiya Kano Mitsuhiro Nakamura Midorii Orthopaedics Joint Reconstruction & Arthroscopy Center Hiroshima Japan Department of Orthopaedic Surgery Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan Department of Orthopaedic Surgery Hiroshima Prefectural Hospital Hiroshima Japan

Mechanically aligned total knee arthroplasty (TKA) for valgus knee is considered a “challenging surgery.” Recently, the kinematic alignment (KA) method has gained attention. This study aimed to present objective clinical data, such as intraoperative balance assessment and radiographic evaluation of postoperative lower extremity alignment after TKA using the KA method for valgus deformity. Twenty-one TKA knees (mean age, 74 years;2 males, 19 females) with KA for severe valgus deformity (hip-knee-ankle-angle ≥ 10°) performed at our department in the past 3 years were included in this study. Intraoperative gap and balance measurements and postoperative radiographic evaluation were performed. A total arc of range of motion was achieved up to 98% of preoperative values at 3 weeks postoperatively. Intraoperative gap and balance were stable throughout the entire range of motion. In addition, there were no statistically significant differences in either balance or gap values at each flexion angle. KA TKA is a “simple surgery” rather than a “challenging surgery” because additional soft tissue procedures are not required, operative time is short, intraoperative and postoperative balance is very stable, and a good alignment is achieved. This procedure may relieve surgeons of the stress of TKA for valgus deformities.

关键词： Total Knee Arthroplasty Kinematic Alignment Valgus Deformity Calipered Technique

Regression of hepatocellular carcinoma during vitamin K administration

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World Journal of Gastroenterology 2005年第42期11卷 6722-6724页

作者： Kazuhiro Nouso Shuji Uematsu Kunihiro Shiraga Ryoichi Okamoto Ryo Harada Shoko Takayama Wakako Kawai Shigeru Kimura Toru Ueki Nobuaki Okano Masahiro Nakagawa Motowo Mizuno Yasuyuki Araki Yasushi Shiratori Department of Internal Medicine hiroshima city hospital Hiroshima 730-8518 Japan Department of Medicine and Medical Science Okayama University Graduate School of Medicine and Dentistry Okayama 700-8558 Japan

An 85-year-old man with HCV infection and diabetes mellitus was diagnosed as having hepatocellular carcinoma （HCC, 13 cm in diameter） based on high serum alpha-fetoprotein （AFP）, AFP-L3, and des-y-carboxy prothrombin levels as well as typical enhancement pattern on contrast-enhanced CT. The patient did not receive any interventional treatments because of advanced age and the advanced stage of HCC. He chose to take vitamin K, which was reported to suppress the growth of HCC in vitro. Three months after starting vitamin K, all three tumor markers were normalized and HCC was markedly regressed, showing no enhancement in the early arterial phase on CT. Here we present the report describing the regression of HCC during the administration of vitamin K.

关键词： Hepatocellular carcinoma Vitamin K Regression

Coronal Alignment of Three Different Types of Implants in Kinematically Aligned Total Knee Arthroplasty: A Comparative Study

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Open Journal of Orthopedics 2021年第6期11卷 183-198页

作者： Yoshinori Soda Mitsuhiro Nakamura Nobuo Adachi Department of Orthopaedic Surgery Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan Department of Orthopaedic Surgery Integrated Health Sciences Institute of Biomedical and Health Sciences Hiroshima University Hiroshima Japan

Background: The number of total knee arthroplasty (TKA) surgeries performed each year is increasing worldwide and mechanical alignment (MA) is currently seen as the gold standard procedure. However, taking neutral alignment as the universal goal may be mistaken. In our hospital, we currently conduct kinematically aligned TKA (KA-TKA). Three different types of implants are used: the cruciate-retaining (CR) type, cruciate-sacrificing (CS) type, or bi-cruciate-retained (BCR) type. We aimed to compare the coronal alignment observed following KA-TKA and MA-TKA and in normal knees, as well as that achieved with different types of implants. Methods: The study comprised 206 knees of Japanese patients who underwent KA-TKA using varying implants in our Hospital between May 2019 and April 2020. Measurements of pre- and postoperative coronal alignment were determined from weight-bearing full-leg standing radiographs. The postoperative results were compared to measurements taken from patients who underwent MA-TKA (N = 96) and normal knees (N = 60). Results: No significant differences between the KA-TKA group and normal knees were found for the medial proximal tibial angle (MPTA) (–4.2° ± 2.6° vs –3.8° ±

Efficacy and safety of endoscopic submucosal dissection for gastric tube cancer:A multicenter retrospective study

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World Journal of Gastroenterology 2021年第11期27卷 1043-1054页

作者： Takuya Satomi Seiji Kawano Tomoki Inaba Masahiro Nakagawa Hirokazu Mouri Masao Yoshioka Shoichi Tanaka Tatsuya Toyokawa Sayo Kobayashi Takehiro Tanaka Hiromitsu Kanzaki Masaya Iwamuro Yoshiro Kawahara Hiroyuki OkadaDepartment of Gastroenterology and Hepatology Department of Gastroenterology and Hepatology Okayama University Graduate School of MedicineDentistryand Pharmaceutical SciencesOkayama 700-8558OkayamaJapan Department of Gastroenterology Kagawa Prefectural Central HospitalTakamatsu 760-8557KagawaJapan Department of Endoscopy Hiroshima City Hiroshima Citizens HospitalHiroshima 730-8518HiroshimaJapan Department of Gastroenterology and Hepatology Kurashiki Central HospitalKurashiki 710-8602OkayamaJapan Department of Gastroenterology and Hepatology Okayama Saiseikai General HospitalOkayama 700-8511OkayamaJapan Department of Gastroenterology National Hospital Organization Iwakuni Clinical CenterIwakuni 740-8510YamaguchiJapan Department of Gastroenterology National Hospital Organization Fukuyama Medical CenterFukuyama 720-8521HiroshimaJapan Department of Internal Medicine Fukuyama City HospitalFukuyama 721-8511HiroshimaJapan Department of Pathology Okayama University HospitalOkayama 700-8558OkayamaJapan Department of Practical Gastrointestinal Endoscopy Okayama University Graduate School of MedicineDentistry and Pharmaceutical SciencesOkayama 700-8558OkayamaJapan

BACKGROUND Recent improvements in the prognosis of patients with esophageal cancer have led to the increased occurrence of gastric tube cancer(GTC)in the reconstructed gastric ***,there are few reports on the treatment results of endoscopic submucosal dissection(ESD)for *** To evaluate the efficacy and safety of ESD for GTC after esophagectomy in a multicenter *** We retrospectively investigated 48 GTC lesions in 38 consecutive patients with GTC in the reconstructed gastric tube after esophagectomy who had undergone ESD between January 2005 and December 2019 at 8 institutions participating in the Okayama Gut Study *** clinical indications of ESD for early gastric cancer were similarly applied for GTC after *** specimens were evaluated in 2-mm slices according to the Japanese Classification of Gastric Carcinoma with curability assessments divided into curative and non-curative resection based on the Gastric Cancer Treatment *** characteristics,treatment results,clinical course,and treatment outcomes were *** The median age of patients was 71.5 years(range,57-84years),and there were 34 men and 4 *** median observation period after ESD was 884 d(range,8-4040 d).The median procedure time was 81 min(range,29-334 min),the en bloc resection rate was 91.7%(44/48),and the curative resection rate was 79%(38/48).Complications during ESD were seen in 4%(2/48)of case,and those after ESD were seen in 10%(5/48)of *** survival rate at 5 years was 59.5%.During the observation period after ESD,10 patients died of other *** there were differences in the procedure time between institutions,a multivariate analysis showed that tumor size was the only factor associated with prolonged procedure *** ESD for GTC after esophagectomy was shown to be safe and effective.

关键词： Endoscopic submucosal dissection Gastric tube Gastric cancer Esophagectomy Multicenter study Retrospective study

Non-Mass Forming Isolated Omental Panniculitis: A Case Report

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Case Reports in Clinical Medicine 2017年第7期6卷 211-216页

作者： Keishi Hakoda Masanori Yoshimitsu Ichiro Omori Masashi Miguchi Toshihiko Kohashi Hideki Ohdan Naoki Hirabayashi Department of Surgery Hiroshima City Asa Citizens Hospital Hiroshima Japan Department of Gastroenterological and Transplant Surgery Applied Life Sciences Institute of Biomedical & Health Sciences Hiroshima University Hiroshima Japan

A 61-year-old man presenting with abdominal pain and fever refractory to antibiotics underwent diagnostic laparoscopy and non-mass-forming isolated omental panniculitis was identified. He presented with left-upper-quadrant abdominal pain. Laboratory data and the CT findings suggested intraabdominal bacterial disease in the splenic flexure, which we treated with antibiotics and fasting. He clinically improved once, but later relapsed with abdominal pain migration to the left-lower-quadrant. CT re-examination revealed no inflammation in the splenic flexure, but attenuation of adipose tissue in the greater omentum. We partially extracted the greater omentum during diagnostic laparoscopy and diagnosed omental panniculitis and administered steroids. He improved and was discharged three days after starting oral prednisone and is recurrence-free with a close follow-up. The characteristic CT feature of omentum panniculitis is a high-density fatty mass, but we noted only an attenuation of adipose tissue in the greater omentum. Diagnositic laparoscopy is useful for diagnosing this condition.

关键词： Omental Panniculitis Computed Tomography Laparoscopy

Randomized study of lafutidine vs lansoprazole in patients with mild gastroesophageal reflux disease

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World Journal of Gastroenterology 2016年第23期22卷 5430-5435页

作者： Ryuta Takenaka Hiroyuki Okada Seiji Kawano Yoshinori Komazawa Fumiya Yoshinaga Shinji Nagata Masafumi Inoue Hirohisa Komatsu Seiji Onogawa Yoshinori Kushiyama Shinichi Mukai Hiroko Todo Hideharu Okanobu Noriaki Manabe Shinji Tanaka Ken Haruma Yoshikazu Kinoshita Department of Gastroenterology Tsuyama Chuo Hospital Tsuyama 708-0841 Japan Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama 708-0841 Japan Division of Internal Medicine Izumo City General Medical Center Izumo 691-0003 Japan Department of Gastroenterology Mihara Red Cross Hospital Mihara 723-0011 Japan Department of Endoscopy Hiroshima City Asa Citizens Hospital Hiroshima 731-0293 Japan Department of Gastroenterology Okayama Red Cross Hospital Okayama 700-0941 Japan Department of Gastroenterology Hiroshima General Hospital Hiroshima 734-8551 Japan Department of Gastroenterology Onomichi General Hospital Onomichi 722-8508 Japan Department of Gastroenterology Matsue Red Cross Hospital Matsue 690-8506 Japan Department of Gastroenterology Miyoshi Central Hospital Miyoshi 728-0023 Japan Department of Gastroenterology Hiroshima-Nishi Medical Center Hiroshima 739-0651 Japan Department of Gastroenterology Chugoku Rosai Hospital Kure 737-0134 Japan Department of Gastroenterology Kawasaki Medical School Hospital Kurashiki 701-0192 Japan Department of Endoscopy Hiroshima University Hospital Hiroshima 734-8551 Japan Department of General Internal Medicine 2 Kawasaki Hospital Kawasaki Medical School Okayama 708-0841 Japan Department of Gastroenterology and Hepatology Shimane University Hospital Izumo 693-0021 Japan

AIM: To compare the clinical efficacy of the secondgeneration H2 RA lafutidine with that of lansoprazole in Japanese patients with mild gastroesophageal reflux disease(GERD). METHODS: Patients with symptoms of GERD and a diagnosis of grade A reflux esophagitis(according to the Los Angeles classification) were randomized to receive lafutidine(10 mg, twice daily) or lansoprazole(30 mg, once daily) for an initial 8 wk, followed by maintenance treatment comprising half-doses of the assigned drug for 24 wk. The primary endpoint was the frequency and severity of heartburn during initial and maintenance treatment. The secondary endpoints were the sum score of questions 2 and 3 in the Gastrointestinal Symptom Rating Scale(GSRS), and the satisfaction ***: Between April 2012 and March 2013, a total of 53 patients were enrolled, of whom 24 and 29 received lafutidine and lansoprazole, respectively. After 8 wk, the frequency and severity of heartburn was significantly reduced in both groups. However, lafutidine was significantly inferior to lansoprazole with regard to the severity of heartburn during initial and maintenance treatment(P = 0.016). The sum score of questions 2 and 3 in the GSRS, and satisfaction scores were also significantly worse in the lafutidine group than the lansoprazole group(P = 0.0068 and P = 0.0048, respectively).CONCLUSION: The clinical efficacy of lafutidine was inferior to that of lansoprazole, even in Japanese patients with mild GERD.

关键词： Gastroesophageal reflux disease Proton pump inhibitors Histamine receptor-2 antagonists Los Angeles classification

Benefit of Using Sick Child Care Facilities to the Children and Their Parents

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Health 2016年第11期8卷 1128-1141页

作者： Kyoko Fukumoto Mao Kawamura Mayu Yoshitsugu Ikuko Sobue Mazda hospital Hiroshima Japan hiroshima University hospital Hiroshima Japan Division of Nursing Science Graduate School of Biomedical & Health Sciences Hiroshima University Hiroshima Japan

Introduction: Sick child care is a form of nursing care provided temporarily for sick children when they cannot be cared for by their parents at home. To clarify the benefits of using sick child care facilities for children and their parents, we surveyed these parents about the benefits of such care and their needs. Method: Study design: Descriptive research. We studied parents whose children had used one of the 11 sick child care facilities for sick children in hiroshima city in 2014. A total of 156 parents consented to participate in the study. We investigated their usage situation of sick child care, perceived benefits of such care, and care-related requests in a quantitative and qualitative manner. Results: Both nuclear families consisting of the dual income parents and their children and single-mother households reported that their children (mean age: 2.46 years [SD: 1.77 years]) had used sick child care because of infectious diseases. Approximately 10% of the parents were using the fee reduction systems of sick child care intended for people with a low income. Parents viewed sick child care as beneficial both in early the health recovery of children, and as support for child raising and working. On the other hand, some parents left their children at home alone when sick child care was not available due to the limited number of sick child care facilities and an insufficient capacity to accept children. Some parents desired an increased number of care facilities, as well as a reduction in or subsidies for care fees. Conclusion: The results of this study suggest that, to ensure children’s health and safety, and support their parents for working and child raising, there is a need to increase the number of sick child care facilities along with expanding care services.

关键词： Benefits Child Raising Support Sick Child Care