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Tsukida S, Ishigame T, Nishimagi A, Muto M, Sato N, Kofunato Y, Haga J, Kimura T, Kenjo A, Marubashi S. [A Case of Pancreatic Cancer That Developed Peritoneal Recurrence after Radical Surgery following Neoadjuvant Chemoradiation Therapy(NACRT)with Pathological Complete Response(pCR)]. Gan To Kagaku Ryoho 2023; 50:1311-1313. [PMID: 38247070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
A 71-year-old woman was diagnosed with a tumor in the pancreatic head on CT imaging, which was performed as a close examination of an exacerbation of diabetes mellitus. The pancreatic tumor was diagnosed as resectable pancreatic cancer, and after preoperative adjuvant chemoradiotherapy, pancreatoduodenectomy was performed as a radical surgery. There were no residual tumor cells in the resected specimen histopathologically, and the patient was judged to have a pathological complete response(pCR). Six months of postoperative adjuvant chemotherapy was administered, but peritoneal recurrence was observed at 20 months postoperatively, and the patient is currently undergoing treatment for recurrence. There have been other reports of recurrence even after pCR was achieved with preoperative treatment, so it is important to follow up carefully, keeping in mind that pancreatic cancer is a latent systemic disease.
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Affiliation(s)
- Shigeyuki Tsukida
- Dept. of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
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Nishimagi A, Kobayashi M, Sugimoto K, Kofunato Y, Sato N, Haga J, Ishigame T, Kimura T, Kenjo A, Kobayashi Y, Hashimoto Y, Marubashi S, Chiba H. Aberrant phosphorylation of human LRH1 at serine 510 is predictable of hepatocellular carcinoma recurrence. Clin Exp Med 2023; 23:4985-4995. [PMID: 37285077 PMCID: PMC10725388 DOI: 10.1007/s10238-023-01098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/20/2023] [Indexed: 06/08/2023]
Abstract
We previously identified the AKT-phosphorylation sites in nuclear receptors and showed that phosphorylation of S379 in mouse retinoic acid γ and S518 in human estrogen receptor α regulate their activity independently of the ligands. Since this site is conserved at S510 in human liver receptor homolog 1 (hLRH1), we developed a monoclonal antibody (mAb) that recognized the phosphorylation form of hLRH1S510 (hLRH1pS510) and verified its clinicopathological significance in hepatocellular carcinoma (HCC). We generated the anti-hLRH1pS510 mAb and assessed its selectivity. We then evaluated the hLRH1pS510 signals in 157 cases of HCC tissues by immunohistochemistry because LRH1 contributes to the pathogenesis of diverse cancers. The developed mAb specifically recognized hLRH1pS510 and worked for immunohistochemistry of formalin-fixed paraffin-embedded tissues. hLRH1pS510 was exclusively localized in the nucleus of HCC cells, but the signal intensity and positive rates varied among the subjects. According to the semi-quantification, 45 cases (34.9%) showed hLRH1pS510-high, and the remaining 112 cases (65.1%) exhibited hLRH1pS510-low. There were significant differences in the recurrence-free survival (RFS) between the two groups, and the 5-year RFS rates in the hLRH1pS510-high and hLRH1pS510-low groups were 26.5% and 46.1%, respectively. In addition, high hLRH1pS510 was significantly correlated with portal vein invasion, hepatic vein invasion, and high levels of serum alpha-fetoprotein (AFP). Furthermore, multivariable analysis revealed that hLRH1pS510-high was an independent biomarker for HCC recurrence. We conclude that aberrant phosphorylation of hLRH1S510 is a predictor of poor prognosis for HCC. The anti-hLRH1pS510 mAb could provide a powerful tool to validate the relevance of hLRH1pS510 in pathological processes such as tumor development and progression.
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Affiliation(s)
- Atsushi Nishimagi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Makoto Kobayashi
- Department of Basic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Kotaro Sugimoto
- Department of Basic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan.
| | - Yasuhide Kofunato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Junichiro Haga
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Yasuyuki Kobayashi
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Hideki Chiba
- Department of Basic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan.
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Suzushino S, Sato N, Ishigame T, Okada R, Kofunato Y, Watanabe J, Muto M, Tsukida S, Nishimagi A, Kimura T, Kenjo A, Waguri S, Marubashi S. Tissue-Engineered Hepatocyte Sheets Supplemental with Adipose-derived Stem Cells. Tissue Eng Part A 2023. [PMID: 37058354 DOI: 10.1089/ten.tea.2022.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
The ability to engineer biologically viable hepatocytes and tissue matrices with long-term functional maintenance has attracted considerable interest in the fields of hepatocyte transplantation and liver tissue engineering. Here, newly developed hepatocyte sheets supplemented with adipose-derived stem cells (ADSCs) were evaluated to assess the effects of ADSCs on hepatocyte function and engraftment into the subcutaneous space. Eight-week-old male C57BL/6J mice were used as donors and 6-week-old male C.B-17/Icr-scid/scid mice were used as recipients. Hepatocyte-ADSC composite sheets were developed using temperature-responsive culture dishes. Hepatocyte viability in the hepatocyte-ADSC composite sheets was evaluated in an in vitro assay, and the outcome of subcutaneous transplantation of the sheet was evaluated. Hepatocyte viability was sustained in the hepatocyte-ADSC composite sheets in vitro. Albumin secretion was significantly higher (p = 0.015) in the hepatocytes of the hepatocyte-ADSC composite sheets (70.5 μg/mL) than in hepatocyte-only sheets (24.0 μg/mL). Cytokine assays showed that hepatocyte growth factor and interleukin-6 were contributed by ADSCs and not hepatocytes, which were not capable of constitutively secreting them. Immunohistochemically, phosphorylated STAT3 and c-MET expression in hepatocytes in the hepatocyte-ADSC composite sheets was significantly higher than that in the hepatocyte-only sheets. Engraftment of the transplanted hepatocyte-ADSC composite sheets was significantly enhanced without pretreatment of the subcutaneous tissue to induce a vascular network. In the hepatocyte-ADSC composite sheets, the viability of the hepatocytes was significantly maintained as the co-cultured ADSCs provided cytokines, enhancing pivotal cell signaling necessary for hepatocyte activity.
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Affiliation(s)
- Seiko Suzushino
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Naoya Sato
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Teruhide Ishigame
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Ryo Okada
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Yasuhide Kofunato
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Junichiro Watanabe
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Makoto Muto
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Shigeyuki Tsukida
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Atsushi Nishimagi
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Takashi Kimura
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Akira Kenjo
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
| | - Satoshi Waguri
- Fukushima Medical University, 12775, Department of Anatomy and Histology, Fukushima, Fukushima, Japan;
| | - Shigeru Marubashi
- Fukushima Medical University, 12775, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima, Fukushima, Japan;
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Sato N, Kenjo A, Nishimagi A, Kimura T, Okada R, Ishigame T, Kofunato Y, Yamada S, Hashimoto Y, Marubashi S. Accuracy comparison of MR elastography and biological markers in detecting liver fibrosis and predicting postoperative ascites. HPB (Oxford) 2021; 23:1383-1391. [PMID: 33583734 DOI: 10.1016/j.hpb.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/14/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND This retrospective study aimed to compare the discriminative performance between magnetic resonance elastography (MRE) and biological markers in detecting liver fibrosis and in predicting postoperative ascites (PA). METHODS We enrolled 77 patients consecutively who underwent hepatectomy between March 2017 and June 2019. Liver fibrosis was histopathologically graded using the METAVIR scoring system as reference. Discriminative performance of non-invasive assessments in detecting different stages of liver fibrosis and predicting PA was evaluated by receiver-operator curve analysis. RESULTS The concordance indices (C-indices) for MRE and biological markers for detecting significant fibrosis (≥F2) and cirrhosis (F4) were: MRE, 0.84 and 0.86; Wisteria floribunda agglutinin + Mac-2 binding protein (WM2BP), 0.63 and 0.71; Hyaluronic acid (HA), 0.72 and 0.75; 7 S-type 4 collagen (T4C), 0.61 and 0.66; APRI, 0.76 and 0.83; and Fib-4, 0.75 and 0.76. Univariable logistic analysis for predicting PA showed that C-indices were 0.751 (p = 0.007), 0.798 (p = 0.106), 0.771 (p = 0.050), 0.674 (p = 0.855), 0.655 (p = 0.263), and 0.560 (p = 0.640) for MRE, WM2BP, Fib-4, HA, APRI, and T4C, respectively. CONCLUSION MRE has a higher diagnostic performance than biological markers in detecting the stages of liver fibrosis and is a predictor for PA after hepatectomy.
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Affiliation(s)
- Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikagigaoka-1, Fukushima, Japan.
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikagigaoka-1, Fukushima, Japan
| | - Atsushi Nishimagi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikagigaoka-1, Fukushima, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikagigaoka-1, Fukushima, Japan
| | - Ryo Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikagigaoka-1, Fukushima, Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikagigaoka-1, Fukushima, Japan
| | - Yasuhide Kofunato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikagigaoka-1, Fukushima, Japan
| | - Shoki Yamada
- Department of Diagnostic Pathology, Fukushima Medical University, Hikarigaoka-1, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University, Hikarigaoka-1, Fukushima, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikagigaoka-1, Fukushima, Japan
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Sato N, Kenjo A, Suzushino S, Kimura T, Okada R, Ishigame T, Kofunato Y, Marubashi S. Predicting Post-Hepatectomy Liver Failure Using Intra-Operative Measurement of Indocyanine Green Clearance in Anatomical Hepatectomy. World J Surg 2021; 45:3660-3667. [PMID: 34392399 DOI: 10.1007/s00268-021-06289-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prediction of post-hepatectomy liver failure (PHLF) based on remnant liver function reserve is important for successful hepatectomy. The aim of this study was to investigate whether intraoperative indocyanine green (ICG) clearance in a future remnant liver was a predictor of PHLF. METHODS This prospective study enrolled 31 consecutive patients who underwent anatomical hepatectomy between June 2016 and August 2019. Intraoperative ICG plasma disappearance rate (ICG-PDR) and ICG retention rate at 15 min (ICG-R15) were measured after clamping the selective hepatic inflow to the liver to be resected. The discriminative performance of the ICG-associated variables for the prediction of PHLF grade B/C was evaluated by receiver operator curve (ROC) analysis. RESULTS Of the operations performed, 87.1% were major hepatectomy. PHLF Grade B/C was observed in eight patients (25.8%) with no mortality. The concordance indices of intraoperative ICG-PDR and ICG-PDR for predicting PHLF were 0.834 (95% CI, 0.69-0.98) and 0.834 (95% CI, 0.69-0.98), respectively. A subgroup analysis of patients with preoperative biliary drainage (BD) (n = 17) showed that the concordance indices of intraoperative ICG-PDR increased to 0.923 (95% CI, 0.79-1.00). CONCLUSIONS Intraoperative ICG clearance in the remnant liver was a promising predictor for PHLF in patients undergoing anatomical hepatectomy, especially in patients with BD.
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Affiliation(s)
- Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Seiko Suzushino
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Ryo Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Yasuhide Kofunato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan.
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Haga J, Sato N, Anazawa T, Kimura T, Kenjo A, Gotoh M, Marubashi S. Comprehensive analysis of gene expression of isolated pancreatic islets during pretransplant culture. Fukushima J Med Sci 2021; 67:17-26. [PMID: 33597316 PMCID: PMC8075558 DOI: 10.5387/fms.2020-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to investigate the effect of pretransplant culture on the survival of pancreatic islet grafts, and to determine the biological characteristics of isolated islets during pretransplant culture. Methods: The survival of islets from Wistar rats, transplanted to diabetic C57BL/B6 mice, was compared between fresh islets and cultured islets. A comprehensive gene expression analysis was employed to investigate biological processes during pretransplant culture, and in vitro validation studies were performed. Results: Survival of cultured xenografts was significantly prolonged as compared to that of fresh islets (fresh: 12.5 ± 1.9 days, 1-day cultured: 16.0 ± 1.3 days (p= 0.017), 3-day cultured: 17.0 ± 2.6 days (p= 0.014)). Comprehensive gene expression analysis identified significant upregulation of annotated functions associated with inflammation in cultured groups. Six proinflammatory genes, including heme oxygenase 1 (HO-1) and IL-6, were significantly upregulated during culture. Validation studies revealed significantly higher levels of IL-6 in the supernatant of cultured islets and HO-1 in the cultured islets when compared with fresh islets. Conclusion: Transplantation of cultured islets induced significant but minimal prolongation of graft survival in xenogeneic combinations. Comprehensive analysis of gene expression in cultured islets showed biological processes associated with proinflammation during culture.
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Affiliation(s)
- Junichiro Haga
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Takayuki Anazawa
- Department of Surgery, Graduate School of Medicine, Kyoto University
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Mitsukazu Gotoh
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
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Sato N, Kimura T, Kenjo A, Kofunato Y, Okada R, Ishigame T, Watanabe J, Marubashi S. Early intra-abdominal infection following pancreaticoduodenectomy:associated factors and clinical impact on surgical outcome. Fukushima J Med Sci 2020; 66:124-132. [PMID: 32963204 PMCID: PMC7790468 DOI: 10.5387/fms.2020-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Early intra-abdominal infection (IAI) following pancreaticoduodenectomy (PD) is an initial event relating to morbidities caused by postoperative pancreatic fistula (POPF). The aims of this study were to determine factors associated with IAI, and to investigate its impact on postoperative outcome. Consecutive patients, 113 in total, who underwent PD at Fukushima Medical University Hospital between January 2012 and September 2017 were included in this retrospective study. IAI was defined by positive bacterial culture from intra-abdominal drainage fluid any time through postoperative day 3 (POD3). Logistic regression analysis was used to identify the relevant factors associated with IAI. The clinical impact of the POD3 infection indicators related to POPF were assessed by multivariate analysis. The incidence of IAI, POPF, and mortality were 36.1%, 36.1%, and 0%, respectively. Independent factors associated with IAI were preoperative biliary drainage (PBD) (OR = 2.91, CI = 1.16-7.33, p = 0.023) and soft pancreas (OR = 8.67, CI = 2.37-31.77, p = 0.001). Among infection markers on POD3, the significant factors for POPF were CRP (OR = 1.18, CI = 1.08-1.30, p < 0.001), IAI (OR = 7,37, CI = 2.53-21.5, p < 0.001), and drain amylase (OR = 1.00, CI = 1.00-1.01, p = 0.001). In conclusion, PBD, soft pancreas, and higher age were associated with IAI. IAI has a significantly negative impact on postoperative outcome.
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Affiliation(s)
- Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Yasuhide Kofunato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Ryo Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Junichiro Watanabe
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
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Fujita M, Okai K, Hayashi M, Abe K, Takahashi A, Kimura T, Kenjo A, Marubashi S, Hashimoto Y, Ohira H. Huge Hepatocellular Carcinoma Treated with Radical Hepatectomy after Drug-eluting Bead Transarterial Chemoembolization. Intern Med 2019; 58:1103-1110. [PMID: 30626806 PMCID: PMC6522415 DOI: 10.2169/internalmedicine.1214-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We performed split drug-eluting bead transarterial chemoembolization (DEB-TACE) in a patient with huge unresectable hepatocellular carcinoma and multiple intrahepatic metastases. However, TACE was discontinued at the fourth application because the tumor was fed by the cholecystic artery. As most intrahepatic metastases disappeared following DEB-TACE, the patient was able to undergo radical hepatectomy, and has maintained a complete response. DEB-TACE enables cancer treatment without reducing the liver or renal function. However, it is associated with a risk of ischemia in other organs in patients whose arteries feed both tumors and other organs; thus appropriate selection is required.
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Affiliation(s)
- Masashi Fujita
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Ken Okai
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Manabu Hayashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Kazumichi Abe
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
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Ishigame T, Kimura T, Tsukida S, Suzushino S, Muto M, Sato N, Kofunato Y, Okada R, Kenjo A, Shimura T, Marubashi S. [FOLFIRINOX for Locally Advanced and Recurrent Pancreatic Cancer with UGT1A1 *6 and or UGT1A1*28 Polymorphisms-A Report of Two Cases]. Gan To Kagaku Ryoho 2019; 46:754-756. [PMID: 31164525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Treatment containing FOLFIRINOX was planned to be administered to a 51-year-old man with locally advanced pancreatic cancer as second-line chemotherapy and to a 66-year-old woman with recurrent pancreatic cancer as third-line chemotherapy in their treatments. Since both patients were revealed to harbor UGT1A1 polymorphisms, which were highly associated with irinotecan-induced toxicity(the former: UGT1A1 *6/*28, the latter: UGT1A1*6/*6), there was no alternative hopeful treatment other than FOLFIRINOX for them. Therefore, FOLFIRINOX was administered very carefully. Although both patients showed Grade 4 neutropenia during the initial course, it was controllable with G-CSF administration and following stepwise reduction of the irinotecan dose. Severe diarrhea and other adverse events were not observed in both cases. Since the determined regimen of FOLFIRINOX for patients with high-risk UGT1A1 polymorphisms has not been developed yet, it would be critical to accumulate and review an experience of FOLFIRINOX administration for these patients.
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Affiliation(s)
- Teruhide Ishigame
- Dept. of Surgery, Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
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Sato N, Shimura T, Kenjo A, Kimura T, Watanabe J, Muto M, Marubashi S. Pancreaticobiliary maljunction diagnosed long after laparotomy in the neonatal period for annular pancreas: report of a case. Surg Case Rep 2019; 5:16. [PMID: 30707318 PMCID: PMC6361191 DOI: 10.1186/s40792-019-0572-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although annular pancreas concurrent with pancreaticobiliary maljunction has rarely been reported, some reports have pointed out a possibility that both anomalies have a common pathogenesis in pancreatic development. We herein report a case with pancreaticobiliary maljunction diagnosed long after surgical treatment for annular pancreas. CASE PRESENTATION A 34-year-old female, with a surgical history of duodenal obstruction due to annular pancreas in the neonatal period, was referred to our hospital for further examination of chronic pancreatitis. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed choledocholithiasis, pancreatic lithiasis, and pancreaticobiliary maljunction without biliary dilatation. Choledocholithotomy and cholecystectomy were performed, and highly elevated levels of amylase in bile from the common bile duct were found intraoperatively. CONCLUSION The present case highlights a possible association of pancreaticobiliary maljunction in a patient with annular pancreas.
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Affiliation(s)
- Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Tatsuo Shimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Junichiro Watanabe
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Makoto Muto
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
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11
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Watanabe K, Hikichi T, Nakamura J, Hashimoto M, Takagi T, Suzuki R, Sugimoto M, Konno N, Takasumi M, Sato Y, Irie H, Kimura T, Kenjo A, Marubashi S, Obara K, Ohira H. Successful Endoscopic Closure Using Polyglycolic Acid Sheets with Fibrin Glue for Nonhealing Duodenal Ulcer with Perforation after Proton Beam Therapy of Liver Tumor. Case Rep Gastroenterol 2019; 12:679-685. [PMID: 30631252 PMCID: PMC6323404 DOI: 10.1159/000494918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022] Open
Abstract
We describe the first case of a nonhealing duodenal ulcer with perforation after proton beam therapy (PBT) of a liver tumor that was successfully treated endoscopically using polyglycolic acid (PGA) sheets with fibrin glue. A 69-year-old man received PBT for a liver tumor. Esophagogastroduodenoscopy (EGD) 3 months after PBT revealed a duodenal ulcer. A proton pump inhibitor was administered for 7 weeks, and the ulcer healed. Six months after the EGD, recurrence of the duodenal ulcer with perforation occurred. An emergency open surgery with placement of the omental patch was performed. However, 5 days after the surgery, because the EGD revealed a perforation site in the duodenal ulcer that was not closed, the conservative treatment was continued. Twenty-eight days after the surgery, EGD revealed that the perforation size had increased. Therefore, we conducted endoscopic closure therapy using PGA sheets with fibrin glue. Eleven days after the closure procedure, the EGD showed that the perforation site was filled with granulation tissue and was closed. Forty-nine days after the procedure, EGD revealed that the ulcer had healed. This endoscopic closure treatment was effective for a nonhealing duodenal ulcer with perforation after PBT of a liver tumor.
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Affiliation(s)
- Ko Watanabe
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naoki Konno
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Katsutoshi Obara
- Department of Advanced Gastrointestinal Endoscopy, Fukushima Medical University, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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12
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Shimura T, Shibata M, Gonda K, Kofunato Y, Ishigame T, Okada R, Sato N, Kimura T, Kenjo A, Marubashi S. Prognostic impact of soluble intercellular adhesion molecule-1 in hepatocellular carcinoma. Oncol Lett 2018; 16:6013-6018. [PMID: 30333872 DOI: 10.3892/ol.2018.9367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/22/2018] [Indexed: 12/24/2022] Open
Abstract
The identification of novel biomarkers for hepatocellular carcinoma (HCC) is of great importance in improving the outcome of patients with HCC. The present study aimed to determine the prognostic significance of the soluble intercellular adhesion molecule (sICAM)-1 in patients with HCC. The present study prospectively collected clinicopathological data from 36 patients with HCC who had undergone successful hepatectomy. An analysis using a receiver operating characteristic (ROC) curve was performed to determine the cut-off value for predicting prognosis. Overall survival (OS), recurrence-free survival (RFS) and potential prognostic factors were analyzed. The ROC curve analysis revealed a sICAM-1 cut-off value of 440 ng/ml. HCC patients with sICAM-1 ≥440 ng/ml exhibited a poorer OS and RFS than those with sICAM-1 <440 ng/ml (P=0.002). sICAM-1 ≥440 ng/ml (hazard ratio=3.623; 95% confidence interval: 1.145-11.458; P=0.028) and Child B (hazard ratio=1.514; 95% confidence interval: 1.066-2.150; P=0.021) were independent prognostic factors for OS, and sICAM-1 ≥440 ng/ml was an independent prognostic factor for RFS (hazard ratio=3.625; 95% confidence interval: 1.233-10.659; P=0.019). Serum sICAM-1 may be a promising predictor for the overall and recurrence-free survival of patients with HCC.
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Affiliation(s)
- Tatsuo Shimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
| | - Masahiko Shibata
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
| | - Kenji Gonda
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
| | - Yasuhide Kofunato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
| | - Ryo Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
| | - Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1259, Japan
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13
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Sato N, Haga J, Anazawa T, Kenjo A, Kimura T, Wada I, Mori T, Marubashi S, Gotoh M. Ex vivo Pretreatment of Islets with Mitomycin C: Reduction in Immunogenic Potential of Islets by Suppressing Secretion of Multiple Chemotactic Factors. Cell Transplant 2018; 26:1392-1404. [PMID: 28901184 PMCID: PMC5680981 DOI: 10.1177/0963689717721233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Strategies to reduce the immunogenicity of pancreatic islets and to prevent the activation of proinflammatory events are essential for successful islet engraftment. Pretransplant islet culture presents an opportunity for preconditioning to improve outcomes of islet transplantation. We previously demonstrated that ex vivo mitomycin C (MMC) pretreatment and subsequent culture significantly prolonged graft survival. Fully understanding the biological process of pretreatment could result in the development of a protocol to improve the survival of islet grafts. Microarrays were employed to conduct a comprehensive analysis of genes expressed in untreated or MMC-treated rat islets that were subsequently cultured for 3 d. A bioinformatics software was used to identify biological processes that were most affected by MMC pretreatment, and validation studies, including in vivo and in vitro assay, were performed. The gene expression analysis identified significant downregulation of annotated functions associated with cellular movement and revealed significant downregulation of multiple genes encoding proinflammatory mediators with chemotactic activity. Validation studies revealed significantly decreased levels of interleukin 6 (IL-6), monocyte chemoattractant protein 3 (MCP-3), and matrix metallopeptidase 2 (MMP2) in culture supernatants of MMC-treated islets compared with controls. Moreover, we showed the suppression of leukocyte chemotactic activity of MMC-treated islets in vitro. We also showed that MMC-treated islets secreted lower levels of chemoattractants that synergistically reduced the immunogenic potential of islets. Histological and immunohistochemical analyses of the implant site revealed that infiltration of monocytes, CD3-positive T cells, and B cells was decreased in MMC-treated islets. In conclusion, the ex vivo pretreatment of islets with MMC and subsequent culture can reduce the immunogenic potential and prolong the survival of islet grafts by inducing the suppression of multiple leukocyte chemotactic factors.
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Affiliation(s)
- Naoya Sato
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Junichiro Haga
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Takayuki Anazawa
- 2 Department of Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Akira Kenjo
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Takashi Kimura
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Ikuo Wada
- 3 Department of Cell Science, Institute of Biomedical Sciences, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Tsutomu Mori
- 4 Department of Human Lifesciences, School of Nursing, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Shigeru Marubashi
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Mitsukazu Gotoh
- 1 Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
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14
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Sato N, Kenjo A, Kimura T, Okada R, Ishigame T, Kofunato Y, Shimura T, Abe K, Ohira H, Marubashi S. Prediction of major complications after hepatectomy using liver stiffness values determined by magnetic resonance elastography. Br J Surg 2018; 105:1192-1199. [PMID: 29683188 DOI: 10.1002/bjs.10831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Liver fibrosis is a risk factor for hepatectomy but cannot be determined accurately before hepatectomy because diagnostic procedures are too invasive. Magnetic resonance elastography (MRE) can determine liver stiffness (LS), a surrogate marker for assessing liver fibrosis, non-invasively. The aim of this study was to investigate whether the LS value determined by MRE is predictive of major complications after hepatectomy. METHODS This prospective study enrolled consecutive patients who underwent hepatic resection between April 2013 and August 2016. LS values were measured by imaging shear waves by MRE in the liver before hepatectomy. The primary endpoint was major complications, defined as Clavien-Dindo grade IIIa or above. Logistic regression analysis identified independent predictive factors, from which a logistic model to estimate the probability of major complications was constructed. RESULTS A total of 96 patients were included in the study. Major complications were observed in 15 patients (16 per cent). Multivariable logistic analysis confirmed that higher LS value (P = 0·021) and serum albumin level (P = 0·009) were independent predictive factors for major complications after hepatectomy. Receiver operating characteristic (ROC) analysis showed that the best LS cut-off value was 4·3 kPa for detecting major complications, comparable to liver fibrosis grade F4, with a sensitivity of 80 per cent and specificity of 82 per cent. A logistic model using the LS value and serum albumin level to estimate the probability of major complications was constructed; the area under the ROC curve for predicting major complications was 0·84. CONCLUSION The LS value determined by MRE in patients undergoing hepatectomy was an independent predictive factor for major complications.
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Affiliation(s)
- N Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - A Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - T Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - R Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - T Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Y Kofunato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - T Shimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - K Abe
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - H Ohira
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - S Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
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15
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Shimura T, Shibata M, Kofunato Y, Okada R, Ishigame T, Kimura T, Kenjo A, Marubashi S. Clinical significance of serum transthyretin level in patients with hepatocellular carcinoma. ANZ J Surg 2018. [DOI: 10.1111/ans.14458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Tatsuo Shimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery; Fukushima Medical University; Fukushima Japan
| | - Masahiko Shibata
- Department of Gastrointestinal Tract Surgery; Fukushima Medical University; Fukushima Japan
| | - Yasuhide Kofunato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery; Fukushima Medical University; Fukushima Japan
| | - Ryo Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery; Fukushima Medical University; Fukushima Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery; Fukushima Medical University; Fukushima Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery; Fukushima Medical University; Fukushima Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery; Fukushima Medical University; Fukushima Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery; Fukushima Medical University; Fukushima Japan
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16
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Ishigame T, Kimura T, Kase K, Muto M, Watanabe J, Sato N, Kofunato Y, Okada R, Kenjo A, Shimura T, Marubashi S. [A Case of Long-Term Survival of Metastatic and Recurrent Duodenal Gastrointestinal Stromal Tumor Treated with Multimodality Managements]. Gan To Kagaku Ryoho 2018; 45:527-529. [PMID: 29650927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We hereby report a case of long-term survival of metastatic and recurrent duodenal gastrointestinal stromal tumor(GIST) treated with multimodality managements. A 59-year-old man was diagnosed with duodenal GIST and underwent surgical resection of a primary lesion of the duodenum. Since the pathological findings on mitotic rate indicated its high risk of recurrence, the systemic treatment by imatinib mesylate was given shortly after the surgery. Six months later, metastatic lesions being considered to be imatinib-resistant were observed in the remnant liver. Since there were no other drugs available for GISTs in clinic at that time, surgery of central bisegmentectomy with partial resection of the liver was performed to eliminate all metastatic lesions. However, recurrences had been repeatedly diagnosed afterward. In response to them, four more surgery for recurrent liver or peritoneal tumors, two transcatheter arterial chemoembolizations(TACE)and one radiofrequency ablation(RFA)were performed on the basis of its resectability. Sunitinib malate had been given since it was approved for imatinib-resistant GISTs in clinic. Eventually, as long as 99 months had passed since we observed the first evidence of the resistance to imatinib mesylate when he died from the GIST.
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Affiliation(s)
- Teruhide Ishigame
- Dept. of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
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17
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Abe K, Takahashi A, Imaizumi H, Hayashi M, Okai K, Kanno Y, Sato N, Kenjo A, Marubashi S, Ohira H. Utility of magnetic resonance elastography for predicting ascites in patients with chronic liver disease. J Gastroenterol Hepatol 2018; 33:733-740. [PMID: 28834565 DOI: 10.1111/jgh.13927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/20/2017] [Accepted: 08/21/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate the utility of magnetic resonance elastography (MRE) as a non-invasive method for predicting ascites in patients with chronic liver disease (CLD). METHODS A total of 208 CLD patients underwent MRE to measure liver stiffness (LS) at our institution from March 2013 to June 2015. We evaluated the diagnostic performance of MRE for predicting the presence of ascites using receiver-operating characteristic (ROC) curve analysis and compared the performance with that of serum fibrosis markers. Multivariate logistic regression analysis was performed to identify factors associated with the presence of ascites. The cumulative incidence of ascites was examined in patients without ascites at baseline. The pathological stage of liver fibrosis was evaluated in 81 CLD patients using histopathologic diagnosis. RESULTS Of the 208 patients, 41 had ascites. The optimal cut-off LS value for the presence of ascites was 6.0 kPa (area under the ROC curve = 0.87). The area under the ROC curve for the presence of ascites was significantly higher for MRE than that for fibrosis markers. Multivariate analysis revealed that LS >6.0 kPa is an independent risk factor for the presence of ascites. The cumulative incidence of ascites was significantly higher among those with LS values >6.0 kPa. There was significantly greater diagnostic accuracy for liver fibrosis stage ≥4 with MRE than that with fibrosis markers. CONCLUSIONS Compared with serum fibrosis markers, MRE has higher diagnostic performance in predicting the presence of ascites. MRE-based LS has the potential to predict the presence of ascites in CLD patients.
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Affiliation(s)
- Kazumichi Abe
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Hiromichi Imaizumi
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Manabu Hayashi
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Ken Okai
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Yukiko Kanno
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
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18
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Kase K, Okada R, Muto M, Watanabe J, Sato N, Kofunato Y, Ishigame T, Kimura T, Kenjo A, Shimura T, Marubashi S. [A Case of Long-Term Survival of the Pancreatic Tail Cancer with the Concomitant Small Liver Metastasis]. Gan To Kagaku Ryoho 2018; 45:387-389. [PMID: 29483456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We hereby report a case of long-term survival of the pancreatic tail cancer with a synchronous small liver metastasis. A 62- year-old male with pancreatic tail cancer was incidentally diagnosed with single tiny metastasis in the left medial section of the liver duringthe distal pancreatectomy. The lesion was also resected together with primary lesion. Since then, systemic chemotherapies such as gemcitabine(GEM)plus S-1 combination therapy, GEM alone therapy and S-1 alone therapy had been given to escape from recurrence. However, the recurrences were found in the liver at 21 months after surgery. Left hepatectomy was performed for metastatic lesions. Afterwards, proton radiation therapy was twice performed for the metastatic lesions in the liver which were unable to be removed by surgery alone. Partial resection of transverse colon was also needed to be performed for the bowel obstruction caused by recurrence on the surgical margin of the liver. Systemic chemotherapies includingS -1 therapy, FOLFIRINOX therapy and GEM plus nab-paclitaxel therapy have been continued throughout his entire treatment history after recurrence. He has been keepingin good physical condition with these multidisciplinary therapies, even though 51 months have passed since the first evidence of liver metastasis was diagnosed.
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Affiliation(s)
- Koji Kase
- Dept. of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
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19
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Shimura T, Shibata M, Gonda K, Kofunato Y, Okada R, Ishigame T, Kimura T, Kenjo A, Kono K, Marubashi S. Significance of Circulating Galectin-3 in Patients with Pancreatobiliary Cancer. Anticancer Res 2017; 37:4979-4986. [PMID: 28870921 DOI: 10.21873/anticanres.11909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Pancreatobiliary cancer is a disease associated with a dismal prognosis and limited treatment options. The aim of the present study was to clarify the usefulness of circulating galectin-3 in pancreatobiliary cancer. PATIENTS AND METHODS We examined serum galectin-3 concentrations in 45 patients with pancreatobiliary cancer. Receiver operating characteristic curves were utilized to evaluate the accuracy of circulating galectin-3 to discriminate pancreatobiliary cancer patients from controls and predict the prognostic outcomes. RESULTS Circulating galectin-3 had diagnostic value at the cut-off level of 6.2 ng/ml, and the patients' overall survival was predictable at the cut-off level of 10.3 ng/ml. Furthermore, circulating galectin-3 ≥10.3 ng/ml was an independent prognostic marker in pancreatobiliary cancer. Regarding biliary cancer, higher galectin-3 was associated with malnutrition. On the other hand, regarding pancreatic cancer, higher galectin-3 levels were associated with higher inflammatory parameters. CONCLUSION Galectin-3 can be a useful biomarker in patients with pancreatobiliary cancer.
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Affiliation(s)
- Tatsuo Shimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Masahiko Shibata
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Japan
| | - Kenji Gonda
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yasuhide Kofunato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Ryo Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Koji Kono
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
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Shimura T, Shibata M, Gonda K, Kofunato Y, Okada R, Ishigame T, Kimura T, Kenjo A, Marubashi S, Kono K, Takenoshita S. Clinical Significance of Soluble Intercellular Adhesion Molecule-1 and Interleukin-6 in Patients with Extrahepatic Cholangiocarcinoma. J INVEST SURG 2017; 31:475-482. [PMID: 28925763 DOI: 10.1080/08941939.2017.1358310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose/Aim: Although several prognostic factors for extrahepatic cholangiocarcinoma (EHC) have been reported, preoperative prognostic factors have yet to be established. We investigated the serum concentration of angiogenic, inflammatory, and nutritional parameters. MATERIALS AND METHODS Twenty-five patients with EHC were enrolled before starting treatment. Preoperative prognostic factors were identified using multivariate analyses. RESULTS The serum soluble intercellular adhesion molecule-1 (sICAM-1) levels were significantly higher in the patients with EHC (436.0 ± 43.2 ng/ml) than in the healthy volunteers (228.6 ± 22.0 ng/ml) (p <.001). In addition, the serum IL-6 levels were significantly higher in the patients (18.0 ± 5.6 pg/ml) than in the healthy volunteers (5.7 ± 0.8 pg/ml) (p <.05). The serum IL-6 and sICAM-1 showed a strong correlation (r = 0.559) in the patients with EHC (p <.01). The serum IL-6 (area under the curve = 0.764, p =.030, cut-off level = 11.6) and sICAM-1 (area under the curve = 0.818, p =.007, cutoff level = 322.6) were revealed to be useful as prognostic factors by the receiver operating characteristic curves. The high IL-6 group and the high sICAM-1 group showed poorer DSS than those of the respective low groups. In the multivariate analysis, IL-6 (hazard ratio: 1.050, 95% confidence interval: 1.002-1.100, p =.043) and sICAM-1 (hazard ratio: 1.009, 95% confidence interval: 1.002-1.015, p =.009) were independent prognostic factors for DSS. CONCLUSIONS IL-6 and sICAM-1 were independent preoperative prognostic factors in EHC patients, causing continuous inflammation and malnutrition in collaboration with other pro-angiogenic factors.
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Affiliation(s)
- Tatsuo Shimura
- a Department of Organ Regulatory Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Masahiko Shibata
- a Department of Organ Regulatory Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Kenji Gonda
- a Department of Organ Regulatory Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Yasuhide Kofunato
- a Department of Organ Regulatory Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Ryo Okada
- a Department of Organ Regulatory Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Teruhide Ishigame
- a Department of Organ Regulatory Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Takashi Kimura
- b Department of Organ Regenerative Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Akira Kenjo
- b Department of Organ Regenerative Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Shigeru Marubashi
- b Department of Organ Regenerative Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Koji Kono
- a Department of Organ Regulatory Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
| | - Seiichi Takenoshita
- a Department of Organ Regulatory Surgery , Fukushima Medical University , 1 Hikarigaoka, Fukushima, Fukushima , Japan
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Takada Y, Kaido T, Shirabe K, Nagano H, Egawa H, Sugawara Y, Taketomi A, Takahara T, Wakabayashi G, Nakanishi C, Kawagishi N, Kenjo A, Gotoh M, Toyoki Y, Hakamada K, Ohtsuka M, Akamatsu N, Kokudo N, Takeda K, Endo I, Takamura H, Okajima H, Wada H, Kubo S, Kuramitsu K, Ku Y, Ishiyama K, Ohdan H, Ito E, Maehara Y, Honda M, Inomata Y, Furukawa H, Uemoto S, Yamaue H, Miyazaki M, Takada T. Significance of preoperative fluorodeoxyglucose-positron emission tomography in prediction of tumor recurrence after liver transplantation for hepatocellular carcinoma patients: a Japanese multicenter study. J Hepatobiliary Pancreat Sci 2017; 24:49-57. [PMID: 27806426 DOI: 10.1002/jhbp.412] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the present study, we conducted a multicenter nationwide survey to investigate the effects of preoperative fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). METHODS From 16 Japanese LT centers, data were collected on 182 recipients with HCC who underwent living donor liver transplantation (LDLT) between February 2005 and November 2013. PET-positive status was defined as increased uptake of FDG in the tumor compared to the surrounding non-tumor liver tissue. The median follow-up after LDLT was 54.5 months (range 1-125 months). RESULTS Postoperative HCC recurrence occurred in 23 patients. Multivariate analysis revealed that exceeding the Milan criteria (MC), alpha-fetoprotein (AFP) level ≥115 ng/ml, and PET-positive status were significant and independent risk factors for recurrence. In the over-MC group, a subgroup of patients with AFP level <115 ng/ml and PET-negative status (n = 22) had a significantly lower 5-year recurrence rate than the other patients (n = 27, 19% vs. 53%, P = 0.019). CONCLUSIONS These results suggest that preoperative FDG-PET status offers additional information on HCC recurrence risk after LT. Over-MC patients with PET-negative status and lower AFP level may achieve successful outcome comparable to that of within-MC patients.
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Affiliation(s)
- Yasutsugu Takada
- Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Toshimi Kaido
- Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Gunma, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroto Egawa
- Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuhiko Sugawara
- Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Surgical Services, Ageo Central General Hospital, Saitama, Japan
| | - Chikashi Nakanishi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Miyagi, Japan
| | - Naoki Kawagishi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Miyagi, Japan
| | - Akira Kenjo
- Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan
| | - Mitsukazu Gotoh
- Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yoshikazu Toyoki
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhisa Akamatsu
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Kazuhisa Takeda
- National Hospital Organization Yokohama Medical Center, Kanagawa, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Hiroyuki Takamura
- Department of Gastroenterological Surgery, Kanazawa University, Ishikawa, Japan
| | - Hideaki Okajima
- Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kaoru Kuramitsu
- Hepato-Biliary-Pancreatic Surgery, Kobe University Hospital, Hyogo, Japan
| | - Yonson Ku
- Hepato-Biliary-Pancreatic Surgery, Kobe University Hospital, Hyogo, Japan
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Eitaro Ito
- Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Honda
- Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Yukihiro Inomata
- Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Furukawa
- Division of Gastroenterologic Surgery, Department of Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Shinji Uemoto
- Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Masaru Miyazaki
- International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Tadahiro Takada
- Japanese Society of Hepato-biliary-Pancreatic Surgery, Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Suzuki Y, Kenjo A, Togano T, Yamamoto N, Ohto H, Kume H. Infectious diseases in solid organ transplant recipients: Analysis of autopsied cases in Japan. J Infect Chemother 2017. [PMID: 28647177 DOI: 10.1016/j.jiac.2017.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the improvements in immunosuppressive agents and graft survival, infections such as mycoses have become major complications after solid organ transplantation (SOT). METHODS Our group has continuously updated an epidemiological database of visceral mycoses (VM) among autopsy cases in Japan since 1989. Data on infectious agents and clinical information were complied using similar procedures. RESULTS Among the all autopsied cases studied, 356 undergone SOT. Of these, 214 (60.1%) suffered from one or more types of infections, including 51 (14.3%) with VM. Thus, the incidence of VM was higher in SOT recipients than in non-transplanted cases (P < 0.0001). Aspergillus spp. (Asp) was the most predominant agent and Candida spp. was second. Specifically, among SOT recipients, Asp was the most predominant in liver and lung transplant recipients. Among the 217 autopsied liver transplants cases, the incidence of VM was highest in those with fulminant hepatitis (FH, P = 0.01). The incidence of cytomegalovirus infection tended to be higher in cases with mycosis (P = 0.06). Multivariate logistic regression analysis identified FH (odds ratio, 3.61, 95% confidence interval 1.34-9.75; P = 0.03) as an independent risk factor for mycosis in liver transplant recipients. CONCLUSION This epidemiological analysis of autopsied cases provides a strong incentive to intensify efforts to diagnose and treat post-SOT infectious diseases.
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Affiliation(s)
- Yuhko Suzuki
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Fukushima, Japan.
| | - Akira Kenjo
- Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Tomiteru Togano
- Department of Hematology, National Center for Global Health and Medicine, Shinjyuku, Tokyo, Japan
| | - Natsuo Yamamoto
- Department of Infection Control, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Hikaru Kume
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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23
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Watanabe J, Kenjo A, Saze Z, Kimura T, Sato N, Osuka F, Endo H, Hanayama H, Tada T, Kikuchi T, Muto M, Kaneta A, Nishimagi A, Marubashi S, Gotoh M. [A Case of AFP and PIVKA- II Producing Gastric Cancer Presenting with Metachronous Multiple Liver Metastases]. Gan To Kagaku Ryoho 2016; 43:1788-1790. [PMID: 28133132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 55-year old man underwent distal gastrectomy with lymphadenectomy for gastric cancer(T1N0M0, Stage I A). Six months after the radical operation, he presented with multiple liver metastases. Based on immunohistochemical examination, he was diagnosed with AFP-producing gastric cancer and metachronous liver metastases. He underwent a surgery to remove the liver metastases. Two months after the surgery, recurrent tumors were found in the lung and remnant liver. He received chemotherapy(S-1/CDDP and CPT-11/CDDP)for the recurrent tumor and lived for 15 months after the surgical intervention.
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24
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Muto M, Kimura T, Sato N, Watanabe J, Endo K, Marubashi S, Kenjo A, Gotoh M. [A Case of Axillary Lymph Node Metastases from Distal Bile Duct Cancer]. Gan To Kagaku Ryoho 2016; 43:2410-2412. [PMID: 28133338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 67-year-old man suffered from obstructive jaundice due to distal bile duct cancer. He underwent surgery after percutaneous biliary drainage and did not received adjuvant chemotherapy afterwards. Two years after surgery, some subcutaneous nodules were detected in the left axilla and the lateral chest on enhanced CT imaging. The nodules were diagnosed as metachronous distant metastases from bile duct cancer based on pathological findings. He was treated postoperatively with S-1 and new lesions have not been detected during the 3 months after the surgery. Surgical intervention in combination with chemotherapy might be beneficial in selected patients with recurrent bile duct cancer.
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Affiliation(s)
- Makoto Muto
- Dept. of Regenerative Surgery, Fukushima Medical University
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25
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Okochi M, Kenjo A, Asai E, Ueda K, Gotoh M. Two-step hepatic artery reconstruction for a hepatic artery lacking in length for the use of a microclamp in living donor liver transplantation. Int J Surg Case Rep 2016; 24:70-2. [PMID: 27203819 PMCID: PMC4885017 DOI: 10.1016/j.ijscr.2016.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/24/2016] [Accepted: 04/16/2016] [Indexed: 11/29/2022] Open
Abstract
A graft hepatic artery we experienced too short to rotate a microclamp in living donor liver transplantation. We performed two-step hepatic artery reconstruction. In the first step, we cut the recipient right hepatic artery and used it as an arterial graft. The graft hepatic artery was coapted to the distal stump of the arterial graft without a microclamp. In the second step, the proximal stump of the arterial graft was coapted to the recipient right hepatic artery.
Introduction We describe successful two-step hepatic artery reconstruction in a patient whose graft site hepatic artery was too short for the use of a microclamp in living donor liver transplantation. Presentation of case A 57-year-old woman was diagnosed as having hepatitis C and liver cirrhosis. Her 26-year-old son was the living liver donor. The living donor underwent right lobectomy. The dissected graft hepatic artery was too short for the use of a microclamp. The recipient right hepatic artery was cut and used as an arterial graft. The graft right hepatic artery was sutured to the right hepatic artery of the arterial graft and the graft posterior branch of the right hepatic artery was sutured to the middle hepatic artery of the arterial graft. After reconstruction of the portal vein and hepatic vein was completed, anastomosis was performed between the graft right hepatic artery and right hepatic artery. The patency of the vessels was checked using color Doppler ultrasonography for 1 week postoperatively. No postoperative complications involving blood flow of the hepatic artery were observed. Discussion In our case, the recipient hepatic artery was cut and used as an arterial graft. Although the number of anastomotic sites of the hepatic artery increased, we could perform hepatic artery reconstruction safely and easily. Conclusion Two-step hepatic artery reconstruction is a useful method in cases where the recipient hepatic artery does not have enough length.
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Affiliation(s)
- Masayuki Okochi
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, Japan.
| | - Akira Kenjo
- Department of Regenerative Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, Japan
| | - Emiko Asai
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, Japan
| | - Kazuki Ueda
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, Japan
| | - Mitsukazu Gotoh
- Department of Regenerative Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, Japan
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26
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Kenjo A, Sato T, Marubashi S, Saito T, Tsuchiya T, Kimura T, Sato N, Takahashi A, Ohira H, Gotoh M. Role of intratumoral infiltrating macrophages after transarterial immunoembolization for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 2016; 23:298-304. [DOI: 10.1002/jhbp.342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/01/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Akira Kenjo
- Department of Regenerative Surgery; Fukushima Medical University, 1 Hikariga-oka; Fukushima 960-1295 Japan
| | - Tetsu Sato
- Department of Regenerative Surgery; Fukushima Medical University, 1 Hikariga-oka; Fukushima 960-1295 Japan
| | - Shigeru Marubashi
- Department of Regenerative Surgery; Fukushima Medical University, 1 Hikariga-oka; Fukushima 960-1295 Japan
| | - Takuro Saito
- Department of Regenerative Surgery; Fukushima Medical University, 1 Hikariga-oka; Fukushima 960-1295 Japan
| | - Takao Tsuchiya
- Department of Regenerative Surgery; Fukushima Medical University, 1 Hikariga-oka; Fukushima 960-1295 Japan
| | - Takashi Kimura
- Department of Regenerative Surgery; Fukushima Medical University, 1 Hikariga-oka; Fukushima 960-1295 Japan
| | - Naoya Sato
- Department of Regenerative Surgery; Fukushima Medical University, 1 Hikariga-oka; Fukushima 960-1295 Japan
| | - Atsushi Takahashi
- Department of Gastroenterology; Fukushima Medical University; Fukushima Japan
| | - Hiromasa Ohira
- Department of Gastroenterology; Fukushima Medical University; Fukushima Japan
| | - Mitsukazu Gotoh
- Department of Regenerative Surgery; Fukushima Medical University, 1 Hikariga-oka; Fukushima 960-1295 Japan
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27
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Tada T, Kikuchi T, Watanabe J, Sato N, Hanayama H, Endo H, Anazawa T, Saze Z, Kimura T, Osuka F, Kenjo A, Kawana S, Tasaki K, Hashimoto Y, Gotoh M. [Surgical Resection for a Metachronous Liver Metastasis of an Esophagogastric Junction Adenocarcinoma]. Gan To Kagaku Ryoho 2015; 42:1617-1619. [PMID: 26805115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The patient was a 56-year-old man with advanced esophagogastric junction cancer. He received neoadjuvant chemotherapy with 5-FU plus CDDP followed by lower esophagectomy and total gastrectomy via the left thoracoabdominal approach in October 2011. Pathological examination revealed EGJ adenocarcinoma (ypT4aN1M0, Stage ⅢA, Japanese Classification of Gastric Carcinoma ver.14), and histological analysis indicated Grade 0 (no change). Adjuvant chemotherapy with S-1 was administered. Nevertheless, 6 months after the operation, a solitary hepatic metastasis (f: 32 mm) was detected in S7 of the liver. The patient underwent proton beam irradiation of the liver metastasis, resulting in a complete response, and he was followed up without any chemotherapy. However, 21 months after the irradiation, regrowth of the previous lesion with FDG re-accumulation was noted. Given the absence of any neoplasms other than the liver metastasis, right hepatic lobectomy was performed. Pathological examination revealed a small cluster of viable tumor cells surrounded by extensive fibrotic tissue (Grade 2). At 45 months after the initial operation (10 months after the liver lobectomy), the patient is living without any signs of recurrence. Surgical resection for liver metastasis of EGJ cancer may be feasible after careful selection.
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Affiliation(s)
- Takeshi Tada
- Dept. of Regenerative Surgery, Fukushima Medical Universitye
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Okochi M, Ueda K, Sakaba T, Kenjo A, Gotoh M. Right gastro-omental artery reconstruction after pancreaticoduodenectomy for subtotal esophagectomy and gastric pull-up. Int J Surg Case Rep 2015; 15:42-5. [PMID: 26313336 PMCID: PMC4601963 DOI: 10.1016/j.ijscr.2015.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/12/2015] [Accepted: 08/12/2015] [Indexed: 01/18/2023] Open
Abstract
Pancreaticoduodenectomy is a difficult and challenging operation, and a gastric tube is frequently used for reconstruction after subtotal esophagectomy for esophageal cancer. The right gastro-omental artery is important for supplying blood flow to the gastric tube. Surgeries for pancreatic head tumors become incredibly difficult in patients who have undergone esophageal reconstruction with a gastric tube. We describe successful arterial reconstruction using the middle colic artery in a patient who had undergone esophageal reconstruction with a gastric tube and whose right gastro-omental artery had been resected.
Introduction There are no reports on vessel reconstruction of right gastro-omental artery deficits due to pancreatic tumor resection. Here, we describe successful arterial reconstruction using the middle colic artery in a patient who had undergone esophageal reconstruction with a gastric tube and whose right gastro-omental artery had been resected. Presentation of case A 70-year-old man underwent subtotal esophagectomy and reconstructive surgery with a retrosternal gastric tube for esophageal cancer. A follow-up computed tomography (CT) scan revealed a tumor on the pancreatic head that was adjacent to the right gastro-omental artery. Pancreaticoduodenectomy (PD) was subsequently performed. The gastro-omental artery was resected along with the tumor, creating a 7-cm deficit. The anastomosis was performed between the right branch of the middle colic artery and the distal end of the right gastro-omental artery. No complications that involved blood flow to the reconstructed esophagus were postoperatively observed. Four months after surgery, the blood flow to the gastric tube was confirmed by a contrast CT scan. Discussion We reconstructed the right gastro-omental artery using the middle colic artery, and not a vein graft, as that would have required vessel anastomosis at two locations. The middle colic artery branches on the posterior surface of the pancreas, which is located close to the right gastro-omental artery. Conclusion The middle colic artery provides sufficient blood supply to the pulled-up gastric tube. PD can be performed even in patients who have undergone esophageal reconstruction.
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Affiliation(s)
- Masayuki Okochi
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Kazuki Ueda
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Takao Sakaba
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Akira Kenjo
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Mitsukazu Gotoh
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
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29
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Kikuchi T, Kenjo A, Kimura T, Anazawa T, Sato T, Sato N, Haga J, Watanabe J, Tsuchiya T, Saito T, Gotoh M. [A case of two re-resections for peritoneal recurrence of pancreatic cancer]. Gan To Kagaku Ryoho 2014; 41:2166-2168. [PMID: 25731458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 63-year-old man underwent subtotal stomach-preserving pancreaticoduodenectomy and intraoperative radiation therapy for pancreatic head cancer (Stage IVa, JPS). Subsequently, he received adjuvant chemotherapy including gemcitabine (GEM). A peritoneal recurrence appeared adjacent to the right colon and the lower pole of the right kidney. He received chemotherapy including S-1 and GEM+S-1. Since the recurrent lesions were localized, he underwent resection for the recurrence lesions 2 years and 9 months after surgery. The resection was R1, and re-recurrence appeared in the lower pole of the right kidney. After chemotherapy and chemoradiotherapy, he underwent re-resection for the recurrence 4 years and 3 months after the first surgery. Three months after re-resection, multiple liver metastases appeared in the bilateral lobes. Reoperation can be one of the multidisciplinary management options for local recurrence of pancreatic cancer under specific conditions.
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Affiliation(s)
- Tomohiro Kikuchi
- Dept. of Organ Regenerative Surgery, Fukushima Medical University
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30
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Anazawa T, Saito T, Goto M, Kenmochi T, Uemoto S, Itoh T, Yasunami Y, Kenjo A, Kimura T, Ise K, Tsuchiya T, Gotoh M. Long-Term Outcomes of Clinical Transplantation of Pancreatic Islets With Uncontrolled Donors After Cardiac Death: A Multicenter Experience in Japan. Transplant Proc 2014; 46:1980-4. [DOI: 10.1016/j.transproceed.2014.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yazawa T, Shibata M, Gonda K, Machida T, Suzuki S, Kenjo A, Nakamura I, Tsuchiya T, Koyama Y, Sakurai K, Shimura T, Tomita R, Ohto H, Gotoh M, Takenoshita S. Increased IL-17 production correlates with immunosuppression involving myeloid-derived suppressor cells and nutritional impairment in patients with various gastrointestinal cancers. Mol Clin Oncol 2013; 1:675-679. [PMID: 24649227 PMCID: PMC3916208 DOI: 10.3892/mco.2013.134] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 04/23/2013] [Indexed: 12/30/2022] Open
Abstract
Although a causal relationship between inflammation and innate immunity of cancer is more widely accepted today, many of the precise cell mechanisms mediating this relationship have not been elucidated. Th17 cells, which produce the proinflammatory cytokine interleukin 17 (IL-17), have been recognized as one of the key factors in the regulation of inflammatory bowel disease and rheumatoid arthritis. This study demonstrated that, in patients with various types of gastrointestinal cancer, IL-17 production was correlated with myeloid-derived suppressor cell (MDSC) levels and with markers for nutritional impairment, immune suppression and chronic inflammation. IL-17 was significantly higher in patients with various types of gastrointestinal cancer compared to normal volunteers. In addition, IL-17 levels were significantly correlated with neutrophil counts and the neutrophil/lymphocyte ratio (NLR) and significantly inversely correlated with cell-mediated immune response indicators [lymphocyte phytohemagglutinin (PHA)-blastogenesis and IL-12 induction] and patient nutritional status (prealbumin levels). Circulating MDSC levels were significantly correlated with IL-17 production. These results suggest that, in human gastrointestinal cancers, chronic inflammation involving IL-17 may be an important mechanism contributing to disease progression through enhancement of immune suppression or cachexia. Controlling the activation of Th17 cells may prove to be a valuable strategy for the treatment of gastrointestinal cancer patients.
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Affiliation(s)
- Takashi Yazawa
- Departments of Organ Regulatory Surgery, Fukushima 960-1295
| | - Masahiko Shibata
- Departments of Organ Regulatory Surgery, Fukushima 960-1295; ; Tumor and Host Bioscience, Fukushima 960-1295
| | - Kenji Gonda
- Departments of Organ Regulatory Surgery, Fukushima 960-1295; ; Blood Transfusion and Transplantation Immunology, Fukushima 960-1295
| | | | - Satoshi Suzuki
- Departments of Organ Regulatory Surgery, Fukushima 960-1295
| | | | - Izumi Nakamura
- Departments of Organ Regulatory Surgery, Fukushima 960-1295
| | | | | | - Kenichi Sakurai
- Department of Surgery, Nihon University School of Medicine, Itabashi, Tokyo 173-8610
| | - Tatsuo Shimura
- Departments of Organ Regulatory Surgery, Fukushima 960-1295; ; Tumor and Host Bioscience, Fukushima 960-1295
| | - Ryouichi Tomita
- Department of Surgery, Nippon Dental University, Chiyoda, Tokyo 102-8158, Japan
| | - Hitoshi Ohto
- Blood Transfusion and Transplantation Immunology, Fukushima 960-1295
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Gonda K, Shibata M, Yazawa T, Yashima R, Kimura T, Kenjo A, Nakamura I, Ohki S, Anazawa T, Tsuchiya T, Shimura T, Koyama Y, Gotoh M, Takenoshita S. Correlation of production of IL-17 with immune suppression relating myeloid-derived suppressor cells (MDSC) and nutritional damages in patients with digestive system cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
437 Background: Although a causal relationship between inflammation and innate immunity of cancer is more widely accepted today, many of the precise cellular mechanisms mediating this relationship remain unclear. Th17 cells, which produce the proinflammatory cytokine IL-17, have been recognized as one of the key factors in regulation of inflammatory bowel disease and rheumatoid arthritis. Methods: This study demonstrated that, in patients with digestive system cancers including 7 patients with esophageal, 14 with gastric, 20 with colorectal, 5 with hepatocellular, 7 with cholangiocellular, and 7 with pancreatic carcinomas, IL-17 production was correlated with MDSC level and with markers for nutritional impairment, immune suppression and chronic inflammation. Results: IL-17 production was significantly higher in patients with all types of digestive cancer than in normal volunteers. In addition, IL-17 production levels were significantly correlated with neutrophil counts and the neutrophil/lymphocyte ratio, and significantly inversely correlated with cell mediated immune response indicators (lymphocyte PHA-blastogenesis and IL-12 production) and patients’ nutritional status (prealbumin levels). Circulating MDSC levels were significantly correlated with IL-17 production. Conclusions: These results suggest that, in human gastrointestinal cancers, chronic inflammation involving IL-17 may be an important mechanism for disease progression through enhancement of immune suppression or cachexia. Controlling activation of Th17 cells may prove to be a valuable strategy for treatment of patients with gastrointestinal cancer.
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Affiliation(s)
- Kenji Gonda
- Fukushima Medical University, Fukushima, Japan
| | | | | | - Rei Yashima
- Fukushima Medical University, Fukushima, Japan
| | | | - Akira Kenjo
- Fukushima Medical University, Fukushima, Japan
| | | | - Shinji Ohki
- Fukushima Medical University, Fukushima, Japan
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Endo H, Saito T, Kenjo A, Hoshino M, Terashima M, Sato T, Anazawa T, Kimura T, Tsuchiya T, Irisawa A, Ohira H, Hikichi T, Takagi T, Gotoh M. Phase I trial of preoperative intratumoral injection of immature dendritic cells and OK-432 for resectable pancreatic cancer patients. J Hepatobiliary Pancreat Sci 2013; 19:465-75. [PMID: 21983893 DOI: 10.1007/s00534-011-0457-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the feasibility, safety and histological change of preoperative endoscopic ultrasound-guided fine-needle injection (PEU-FNI) of immature DCs (iDCs) with OK-432 in pancreatic cancer patients. METHODS Nine patients enrolled in the trial (DC group) and were compared with 15 patients operated on without iDC injection (non-DC group). Adverse events of PEU-FNI and postoperative complications were evaluated according to CTC-AE ver.3.0 and the Clavien-Dindo classification/ISGPF definition, respectively. Histological changes within the tumor and lymph nodes were evaluated by immunohistochemical examination of infiltrating inflammatory cells (CD4+, CD8+, Foxp3+ and CD83+). RESULTS There were no severe toxicities following PEU-FNI, except for one transient grade 3 fever, and there were no significant differences in the incidence of postoperative complications between the two groups. Colliquative necrosis and diffusely scattered TUNEL-positive cells were observed at the injection sites. CD83+ cells significantly accumulated in the regional lymph nodes of the DC group as well as Foxp3+ cells in the regional and distant lymph nodes. The two DC group patients, one of which was stage IV with distant lymph node metastasis, survived more than 5 years without requiring adjuvant theraphy. CONCLUSION PEU-FNI was feasible and safe, and further study needs to confirm and enhance antitumor responses.
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Affiliation(s)
- Hisahito Endo
- Department of Regenerative Surgery, Fukushima Medical University, 1 Hikariga-oka, Fukushima 960-1295, Japan
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Yamashita M, Saito T, Ise K, Ishii S, Satoh Y, Saito T, Oshibe I, Shimizu H, Kenjo A, Kimura T, Gotoh M. Mizoribine as sole immunosuppressive agent in islet xenotransplantation models: a candidate immunosuppressant causing no adverse effects on islets. Cell Transplant 2012; 21:535-45. [PMID: 22793062 DOI: 10.3727/096368911x605457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Mizoribine (MZ) inhibits the differentiation and proliferation of helper T and B cells after antigen recognition by suppressing the purine biosynthesis pathway and nucleic acid synthesis. MZ has been used in kidney transplantation, but distinct data are unavailable for islet transplantation. The present study investigated the efficacy of MZ for islet xenotransplantation. Immunosuppressive effects of MZ were determined by mixed lymphocyte reaction (MLR) assay in vitro. Toxicities for Wistar rat islets were determined by adenosine triphosphate (ATP) contents of islets during 3-day culture and stimulation index in response to glucose after culture. Immunosuppressive effects in vivo were tested in a Wistar-to-B6 islet xenotransplantation model. MZ was administered continuously for 28 days subcutaneously or intramuscularly. MZ inhibited MLR response by approximately 50% at 0.1 μg/ml. ATP contents decreased with MZ >100 μg/ml, while stimulation index was maintained. Continuous infusion of MZ at 10 mg/kg maintained blood concentrations at 0.13-0.19 μg/ml, while intramuscular injection of MZ at 100 mg/kg/day (peak 520 μg/ml at 1 h postinjection) resulted in below measurable levels (<0.03 μg/ml) within 24 h. Graft survival was significantly prolonged following continuous infusion of 10 mg/kg/day compared to controls (31.0 ± 9.5 vs. 13.2 ± 5.2 days; p = 0.002). Furthermore, animals with intramuscular injection at doses of 3.2, 10, or 100 mg/kg/day showed significantly longer graft survival (20.0 ± 7.5, 22.0 ± 7.31, and 24.5 ± 8.1 days, respectively; p < 0.05 each). Histological examination showed significant suppression of lymphocyte infiltration by MZ administration. MZ showed immunosuppressive effects in an experimental islet xenotransplantation model without adverse effects on endocrine function of islet grafts.
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Affiliation(s)
- Michitoshi Yamashita
- Department of Surgery I, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Tsukada M, Saito T, Ise K, Kenjo A, Kimura T, Satoh Y, Saito T, Anazawa T, Oshibe I, Suzuki S, Hashimoto Y, Gotoh M. A model to evaluate toxic factors influencing islets during collagenase digestion: the role of serine protease inhibitor in the protection of islets. Cell Transplant 2012; 21:473-82. [PMID: 22793055 DOI: 10.3727/096368911x605385] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The recovery of all of the islets contained in a pancreas is the goal of islet isolation for transplantation. This study reveals an environment that injures the isolated islets during digestion and proposes a new model for optimal islet isolation. Islets were isolated from Wistar rat pancreases by stationary collagenase digestion while the digestion time was varied at 15, 30, 60, and 120 min. The digested pancreas and islets were analyzed histologically and adenosine nucleotides were measured. Overnight cultured islets (40 islets) were cocultured for 30 min with the supernatants obtained from pancreatic collagenase digestion at different digestion periods in order to assess the toxic environment. The peak yields of islets were obtained at 30 min of digestion. The histological study of digested pancreas showed that the exocrine cells lost their cellular integrity at 120 min of digestion, but the islet cells were left intact. Accordingly, the ATP levels of the pancreatic tissue decreased during the digestion period. The coculture experiment demonstrated that the islets cultured with the supernatants from the collagenase digestion showed digestion time-dependent disruption of the cellular integrity of islets in accordance with a rapid decrease of ATP levels in the islets. The addition of serine protease inhibitors into this coculture clearly showed protection of islets, which maintained high ATP levels in association with intact membrane integrity as assessed by AO/PI staining. Morphological deterioration of islets as well as a marked ATP decrease was evident in the entire digested pancreas as well as in islets cocultured in the supernatants from the collagenase digestion. Various factors toxic to the islets can therefore be analyzed in future experiments using this coculture model for obtaining a good yield of viable islets.
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Affiliation(s)
- Manabu Tsukada
- Department of Surgery, Fukushima Medical University, Fukushima City, Fukushima, Japan
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36
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Oshibe I, Saito T, Sato Y, Saito T, Tsukada M, Ise K, Kenjo A, Kimura T, Anazawa T, Suzuki S, Hashimoto Y, Gotoh M. Adenine nucleotide levels in a closed enzymatic digestion system for porcine islet isolation. Cell Transplant 2012; 21:483-91. [PMID: 22793056 DOI: 10.3727/096368911x605394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Obtaining viable islets is a crucial step for successful islet transplantation. Adenosine triphosphate (ATP) is a marker of cell viability. However, little is known about any changes in the energy status of the tissues that are being digested during the digestion phase. We herein examined whether the ATP content in serially digested pancreatic tissue samples could be specific objective parameters that signal the optimal point to stop the digestion process. We obtained partial pancreata (body to tail) from 4- to 5-year-old pigs from a slaughterhouse. The tissue samples were preserved in M-Kyoto solution for less than 3 h. They were digested using an automated enzymatic and mechanical dissociation system at 37°C for 90 min following intraductal injection of Liberase HI. Samples were collected from the digestive circuit every 5 or 10 min to determine the ATP level, total adenine nucleotide (TAN) level, islet count (count/g), and yield of islet equivalent (IEQ) in the serial digestive fluids. The ATP and TAN levels, IEQ and islet count were increased and then decreased during digestion process. The profile of these parameters differed from case to case. However, when ATP changing ratio (respective value/precedent value) was compared with IEQ changing ratio, a greater than threefold increase in the ATP changing ratio followed by an increase in the islet count changing ratio within 5 min was consistently observed, indicating the optimal time to stop the digestion. The ATP levels of the handpicked islets in the digested samples were lower in the overdigested phase in comparison to those in the earlier digested phase. These results indicate that the ATP level in digested fluid could be an effective indicator to estimate the viability of cells as well as determine the optimal time to terminate the digestion process in order to obtain viable islets.
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Affiliation(s)
- Ikuro Oshibe
- Department of Surgery I, Fukushima Medical University, Fukushima City, Japan
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37
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Gonda K, Shibata M, Nakamura I, Kenjo A, Ohtake T, Yasuda M, Suzuki S, Suzuki H, Watanabe T, Fujimori K, Gotoh M, Takenoshita S. [Myeloid-derived suppressor cells in cancer patients]. Gan To Kagaku Ryoho 2012; 39:1797-1799. [PMID: 23267890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Myeloid-derived suppressor cells (MDSCs) are one of the major cell populations responsible for regulating immune responses. MDSCs have been reported to accumulate in the blood, lymph nodes, and at tumor sites in most patients during tumor progression and chronic infection, where they potentially suppress T cell functions. We analyzed MDSCs (CD11b+ CD14- CD33+) in peripheral blood mononuclear cells by flow cytometry in 222 patients with esophageal, gastric, colorectal, hepatocellular, cholangiocellular, pancreatic, breast, ovarian, thyroid, and lung cancer, and 18 healthy volunteers. MDSCs were significantly higher in patients with esophageal, gastric, colorectal, hepatocellular, pancreatic, and breast cancer than in healthy volunteers, and the differences were not significant in patients with cholangiocellular, ovarian, thyroid, and lung cancer. Production of the cytokines IFN-γ and IL-6 in response to phytohemagglutinin was assayed using enzyme-linked immunosorbent assay (ELISA) test kits. Serum concentrations of sIL-2R were measured by ELISA. The percentages of MDSCs in patients with colorectal cancer positively correlated with neutrophil counts and the concentration of sIL-2R(both p<0.05), and inversely correlated with the production of IFN-γ( p<0.0001), serum albumin concentration(p<0.005), and lymphocyte counts (p<0.05). These data suggested that MDSCs are strongly related to chronic inflammation and nutritional impairment.
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Affiliation(s)
- Kenji Gonda
- Dept. of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Japan
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38
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Ishii S, Saito T, Ise K, Yamashita M, Sato Y, Saito T, Tsukada M, Oshibe I, Kenjo A, Kimura T, Anazawa T, Suzuki S, Gotoh M. Preservation of pancreatic islets in cold UW solution before transplantation. Islets 2012; 4:32-9. [PMID: 22504908 DOI: 10.4161/isl.18607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Culture of islets prior to transplantation needs to be revisited for maintaining functional islet capacity. This study was conducted to compare cold UW (University of Wisconsin) preservation with conventional culture based on insulin secretory capacity in vitro and in vivo. Islets isolated from Wistar rats were either cultured for 24 h at 37°C in RPMI1640 medium or DMEM containing various concentrations of glucose or preserved for the same period in UW solution or in DMEM solution at 4°C. The islet yield in UW group, but not in other groups, was maintained as comparable with that of fresh islets. Insulin secretory capacity in response to glucose was maintained only in the islets of UW group, but not in other groups. SCID mice given 300 IEQ islets of UW group showed gradual restoration of normoglycemia as found in the mice given freshly isolated islets. Meanwhile, those mice given cultured islets for 24 h at 37°C in RPMI1640 medium showed rapid decrease of blood glucose levels on day 1 followed by relatively elevated levels on day 2, suggesting unstable insulin secretory capacity of islets. Morphological staining with anti-HMGB1 (high mobility group B1) antibody revealed central damage of islets in all culture groups regardless of glucose concentration and in islets of cold DMEM group, whereas those in the UW group were quite intact. These results suggest that cold preservation in UW solution is simple and beneficial in protecting islets morphologically and functionally before transplantation.
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Affiliation(s)
- Show Ishii
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Takuro Saito
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Kazuya Ise
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Michitoshi Yamashita
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Yoshihiro Sato
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Takaharu Saito
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Manabu Tsukada
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Ikuro Oshibe
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Akira Kenjo
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Takashi Kimura
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Takayuki Anazawa
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
| | - Shigeya Suzuki
- Research and Development Division; Kikkoman Co., Ltd; Noda City, Chiba, Japan
| | - Mitsukazu Gotoh
- Department of Surgery; Fukushima Medical University; Fukushima City, Fukushima, Japan
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Kanno Y, Takahashi A, Abe K, Takagi T, Okai K, Katsushima F, Saito H, Anazawa T, Kimura T, Kenjo A, Tsuchiya T, Saito T, Gotoh M, Ohira H. Hepatocellular carcinoma that relapsed 54 months after living donor liver transplantation. Intern Med 2012; 51:2325-8. [PMID: 22975542 DOI: 10.2169/internalmedicine.51.7620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report the case of a 41-year-old woman with hepatocellular carcinoma (HCC). She received living donor liver transplantation (LDLT) from her husband for HCC at 36 years of age. She had few risk factors for HCC recurrence, such as elevated alpha-fetoprotein (AFP), protein induced by vitamin K absence (PIVKA) II, vascular invasion, and number, size of tumors. However, recurrent tumors were found in the graft at 54 months after LDLT. Although we examined the sex chromosomes of the HCC by fluorescence in situ hybridization (FISH) methods, the origin of the HCC was unclear. This is a very rare case of recurrent HCC appearing more than 4 years after LDLT in the absence of risk factors for recurrence.
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Affiliation(s)
- Yukiko Kanno
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Japan
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Sato J, Kimura T, Saito T, Anazawa T, Kenjo A, Sato Y, Tsuchiya T, Gotoh M. Gene expression analysis for predicting gemcitabine resistance in human cholangiocarcinoma. Journal of Hepato-Biliary-Pancreatic Sciences 2011; 18:700-11. [DOI: 10.1007/s00534-011-0376-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jun Sato
- Department of Organ Regenerative Surgery; Fukushima Medical University; 1 Hikarigaoka Fukushima 960-1295 Japan
| | - Takashi Kimura
- Department of Organ Regenerative Surgery; Fukushima Medical University; 1 Hikarigaoka Fukushima 960-1295 Japan
| | - Takuro Saito
- Department of Organ Regenerative Surgery; Fukushima Medical University; 1 Hikarigaoka Fukushima 960-1295 Japan
| | - Takayuki Anazawa
- Department of Organ Regenerative Surgery; Fukushima Medical University; 1 Hikarigaoka Fukushima 960-1295 Japan
| | - Akira Kenjo
- Department of Organ Regenerative Surgery; Fukushima Medical University; 1 Hikarigaoka Fukushima 960-1295 Japan
| | - Yoshihiro Sato
- Department of Organ Regenerative Surgery; Fukushima Medical University; 1 Hikarigaoka Fukushima 960-1295 Japan
| | - Takao Tsuchiya
- Department of Organ Regenerative Surgery; Fukushima Medical University; 1 Hikarigaoka Fukushima 960-1295 Japan
| | - Mitsukazu Gotoh
- Department of Organ Regenerative Surgery; Fukushima Medical University; 1 Hikarigaoka Fukushima 960-1295 Japan
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41
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Saito T, Tsuchiya T, Sato Y, Kenjo A, Kimura T, Anazawa T, Terashima M, Takahashi A, Ohira H, Gotoh M. Effect of Transarterial Immunoembolization as Preoperative Treatment for Hepatocellular Carcinoma. ACTA ACUST UNITED AC 2011. [DOI: 10.4993/acrt.19.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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42
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Satoh A, Saito T, Sato Y, Tsuchiya T, Kenjo A, Kimura T, Kanno R, Suzuki H, Kogure M, Hoshino Y, Gotoh M. Traffic of infused bone marrow cells after genetically-labeled syngeneic bone marrow transplantation following lethal irradiation in mice. Fukushima J Med Sci 2008; 54:11-24. [PMID: 18924549 DOI: 10.5387/fms.54.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED Bone marrow (BM) cells are considered the source of stem cells for various organs. However, how quickly BM cells can penetrate and constitute lymphoid organs remains elusive. In the present study, we addressed this issue in a model using genetically-labeled syngeneic BM transplantation (BMT). METHODS Donor BM cells were obtained from "green mice", transgenic mice with enhanced GFP. Lethally irradiated C57BL/6 mice were infused with 1 x 10(6) BM cells from the green mice through the tail vein. BM chimerism was analyzed by FACS and the presence of donor BM cells in thoracoabdominal organs was assessed by fluorescence microscopy. The commitment of BM cells was examined by immunohistochemical staining using epithelium-, macrophage-, B and T-lymphocyte, and endothelium-specific antibodies. RESULTS BM chimerism reached 40+/- 18.5%, 82.6 +/- 23.4%, and 72 +/- 18% (mean +/- SD) at 1, 4, and 12 wks after BMT, respectively. GFP-positive cells were detected in all organs in the course of chimeric formation. Most GFP-positive cells were T and B lymphocytes in lymphoid systems including spleen, thymus, mesenteric lymph nodes and microvilli, and some were positive for macrophage and endothelial cell markers. CONCLUSIONS Our results indicate that BM-derived cells migrate rapidly into various thoracoabdominal organs after BMT, and that lymphoid tissues are predominantly replaced with infused BM in lethally-irradiated mice. This confirmed the previous finding by others and suggests high interest of this model for further studies to characterize kinetics and roles of infused cells.
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Affiliation(s)
- Atai Satoh
- Department of Surgery I, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
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43
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Saito T, Tsuchiya T, Kenjo A, Kimura T, Sato Y, Saito T, Anazawa T, Takase S, Satokawa H, Satoh Y, Yokoyama H, Ohira H, Rai T, Gotoh M. Successful treatment of pseudoaneurysms of celiac and superior mesenteric arteries by combined endovascular and surgical approach. ACTA ACUST UNITED AC 2008; 15:444-8. [DOI: 10.1007/s00534-007-1238-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 04/16/2007] [Indexed: 10/21/2022]
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44
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Kenjo A, Saito T, Tsuchiya T, Sato Y, Kimura T, Ogata T, Ohto H, Yasuda H, Kawabata K, Gotoh M. PLATELET-TRANSFUSION REFRACTORINESS FOLLOWING LIVING RELATED LIVER TRANSPLANTATION. Transplantation 2008. [DOI: 10.1097/01.tp.0000330716.08578.d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Ohtake K, Saito T, Satoh Y, Kenjo A, Kimura T, Asawa S, Anazawa T, Gotoh M. Bone marrow traffic to regenerating islets induced by streptozotocin injection and partial pancreatectomy in mice. Transplant Proc 2008; 40:449-51. [PMID: 18374097 DOI: 10.1016/j.transproceed.2008.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The role of bone marrow (BM)-derived cells in the process of pancreatic islet regeneration remains unclear. The purpose of this study was to determine the role of BM cells in the repair process or regeneration of pancreatic islets in mice using chimeric green fluorescent protein (GFP) expressing BM cells. BM-infused chimeric mice were made diabetic by streptozotocin (STZ) injection or 60% partial pancreatectomy. GFP-positive cells within the islets and pancreas were studied immunohistologically. STZ treatment induced a 10-fold increase in PCNA-positive cells within the islets on day 7 posttreatment. GFP-positive cells increased in number within the islets as well as in the pancreatic parenchyma immediately after STZ injection. The partial pancreatectomy induced 2- to 3-fold increases on day 7 to 28 posttreatment. GFP-positive cells increased in number in pancreatic parenchyma but not within the islets. BM traffic to the pancreas significantly increased in the 2 models inducing islet regeneration. In both models, GFP-positive cells were not positive for antibodies against insulin, glucagon, or somatostatin, but were positive for markers of macrophages or fibroblasts, suggesting their involvement in the initiation of islet regeneration.
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Affiliation(s)
- K Ohtake
- Department of Surgery 1, Fukushima Medical University, Fukushima, Japan
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Saito T, Abe T, Tsuchiya T, Satoh Y, Kenjo A, Kimura T, Gotoh M. Sequential magnetic resonance imaging for evaluation of Kupffer cell function. Hepatogastroenterology 2008; 55:596-599. [PMID: 18613415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND/AIMS Kupffer cells play an important role in liver regeneration and depression of their function is associated with poor outcome. However, there is no clinically safe and reliable method for evaluating Kupffer cell function. METHODOLOGY We used magnetic resonance imaging following injection of superparamagnetic iron oxide, which is trapped by Kupffer cells, to evaluate Kupffer cell function in 14 patients, including 6 with normal liver and 8 with obstructive jaundice T1-weighed signal intensity of the liver parenchyma was examined every 4 minutes for 60 min after superparamagnetic iron oxide injection. RESULTS Signal intensity values gradually decreased in both groups after accumulation of iron in the liver. Serum iron levels equally and significantly increased in both groups. In contrast, the values of relative enhancement, percentage of signal intensity of precontrast to postcontrast, between 8-20 minutes after superparamagnetic iron oxide injection were significantly higher in obstructive jaundice group than in the control, indicating Kupffer cell dysfunction in obstructive jaundiced liver. CONCLUSIONS These results indicate that chronological magnetic resonance imaging with superparamagnetic iron oxide is a suitable method for assessment of Kupffer cell function in patients with obstructive jaundice.
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Affiliation(s)
- Takuro Saito
- Department of Surgery I, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Takahashi A, Saito H, Kanno Y, Abe K, Yokokawa J, Irisawa A, Kenjo A, Saito T, Gotoh M, Ohira H. Case of clear-cell hepatocellular carcinoma that developed in the normal liver of a middle-aged woman. World J Gastroenterol 2008; 14:129-31. [PMID: 18176975 PMCID: PMC2673377 DOI: 10.3748/wjg.14.129] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 36-year-old woman was admitted to our department for close examination of a liver tumor that was found during a medical checkup. Abdominal US, CT and MRI showed a tumor in segment 7 (S7) of the liver. Although imaging suggested hepatocellular carcinoma, laboratory tests showed no abnormality in liver function, hepatitis virus markers were negative, and tumor markers including protein induced by vitamin K absence or antagonist II (PIVKA-II), α-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) were all within normal ranges. Upon aspiration biopsy of the liver, the histopathological diagnosis was moderately differentiated hepatocellular carcinoma. Therefore, right hepatectomy was performed. Although a part of the tumor was necrotic, about 60% of the viable part showed a clear-cell variant. Consequently, it was diagnosed as clear-cell hepatocellular carcinoma. It was noted that the background liver tissue was normal. This case is worthy of reporting because development of clear-cell hepatocellular carcinoma in the normal liver of a middle-aged woman is rarely seen.
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Yamada F, Saito T, Abe T, Tsuchiya T, Sato Y, Kenjo A, Kimura T, Gotoh M. Ischemic preconditioning enhances regenerative capacity of hepatocytes in long-term ischemically damaged rat livers. J Gastroenterol Hepatol 2007; 22:1971-7. [PMID: 17914979 DOI: 10.1111/j.1440-1746.2006.04711.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Ischemic preconditioning (IPC) protects tissues against ischemia and reperfusion (I/R) injury. The aim of this study was to examine the impact of IPC on protection and regeneration of hepatocytes after prolonged I/R injury. METHODS A rat model of segmental (70%) hepatic ischemia was used to determine the effect of 10-min IPC preceding 40, 60, 90, or 120 min of liver ischemia. The effect was assessed by comparing cytolysis markers and necrotic areas of the liver, as well as the regenerative capacity of hepatocytes using the proliferating cell nuclear antigen labeling index (PCNA-LI) and weight of the ischemic liver lobe. Protein kinase B/Akt (Akt) and caspase-9 were investigated immunohistochemically to determine the effect of IPC on activation of survival and anti-apoptotic signals. RESULTS In the model of 40 min I/R, which resulted in focal necrosis of the liver, IPC significantly protected against I/R injury by reducing the area of focal necrosis, level of PCNA-LI and immunoreactivities to Akt and caspase-9. In contrast, IPC did not prevent ischemic damage in the 90- and 120-min ischemic model with massive liver necrosis. However, IPC enhanced the regenerative capacity of the remaining hepatocytes with higher levels of PCNA-LI, number of Akt-positive cells and mean weight of the liver lobe postoperatively than in the controls. CONCLUSIONS In a model of focal necrosis of the liver, IPC protected hepatocytes against I/R injury. In addition, in a model of massive necrosis, IPC maintained the regenerative capacity of the remaining hepatocytes by enhancing the survival signals.
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Affiliation(s)
- Fumihiko Yamada
- First Department of Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Kimura T, Saito T, Tsuchiya T, Kenjo A, Anazawa T, Abè T, Gotoh M. Treatment of external iliac artery dissection with endovascular stent placement in a patient with simultaneous pancreas and kidney transplantation. Transplant Proc 2006; 37:3572-3. [PMID: 16298665 DOI: 10.1016/j.transproceed.2005.09.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Dissection of the external iliac artery is a rare but serious complication after transplantation, leading to graft loss. Stent angioplasty has been accepted for iliac artery dissection, but the safety and benefits of this procedure in transplantation are unclear. We report a case of right external iliac artery dissection with simultaneous kidney and pancreas transplantation, which was noticed during the operation. A self-expandable metallic stent was inserted from the right femoral artery to the dissected area and arterial blood flow was immediately restored. The postoperative clinical course was uneventful and soon after transplantation both the kidney and pancreas graft functioned well. Together with a previously reported six cases of stent replacement with transplantation and our case, no complication related to this procedure was reported, and in six cases the arterial flow was restored and graft function was improved. Endovascular stent replacement may be a safe and effective procedure for iliac artery dissection in transplantation.
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Affiliation(s)
- T Kimura
- Department of Surgery I, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
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Ishii S, Saito T, Ise K, Sato Y, Tsutiya T, Kenjo A, Kimura T, Anazawa T, Suzuki S, Terashima M, Gotoh M. Evaluation of energy state of islet independent of size using a newly developed ATP bioluminescence assay. Transplant Proc 2006; 37:3499-500. [PMID: 16298641 DOI: 10.1016/j.transproceed.2005.09.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ATP content or energy charge (EC) of islets may be a good parameter to assess viability. In this study, we examined adenine nucleotides and EC of freshly isolated or 24-hour cultured rat islets of various diameters using a novel bioluminescent enzymatic cycling assay system. For freshly isolated islets, ATP content and islet diameter showed a high correlation (r = 0.842, P < .001), but a significant correlation was not observed for cultured islets (r = 0.284) when all islets were included for the analysis. When only the cultured islets with a diameter <350 microm were included for analysis, a significant correlation was observed (r = 0.719). EC of freshly isolated islets fluctuated widely irrespective of diameter, in contrast with results of 24-hour cultured islets, which showed a stable, high EC, regardless of diameter. These data suggest that the ATP content of islets correlates with the islet size and that EC of islets widely fluctuates following isolation, indicating a significant role of monitoring ATP and EC of islets before transplantation.
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Affiliation(s)
- S Ishii
- Department of Surgery I, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
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