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Wong P, Wisneski AD, Tsai KK, Chang TT, Hirose K, Nakakura EK, Daud AI, Maker AV, Corvera CU. Metastatic melanoma to small bowel: metastasectomy is supported in the era of immunotherapy and checkpoint inhibitors. World J Surg Oncol 2024; 22:77. [PMID: 38468341 PMCID: PMC10926580 DOI: 10.1186/s12957-024-03335-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Metastatic melanoma to the small bowel is an aggressive disease often accompanied by obstruction, abdominal pain, and gastrointestinal bleeding. With advancements in melanoma treatment, the role for metastasectomy continues to evolve. Inclusion of novel immunotherapeutic agents, such as checkpoint inhibitors, into standard treatment regimens presents potential survival benefits for patients receiving metastasectomy. CASE PRESENTATION We report an institutional experience of 15 patients (12 male, 3 female) between 2014-2022 that underwent small bowel metastasectomy for metastatic melanoma and received perioperative systemic treatment. Median age of patients was 64 years (range: 35-83 years). No patients died within 30 days of their surgery, and the median hospital length of stay was 5 days. Median overall survival in these patients was 30.1 months (range: 2-115 months). Five patients died from disease (67 days, 252 days, 426 days, 572 days, 692 days postoperatively), one patient died of non-disease related causes (1312 days postoperatively), six patients are alive with disease, and three remain disease free. CONCLUSIONS This case series presents an updated perspective of the utility of metastasectomy for small bowel metastasis in the age of novel immunotherapeutic agents as standard systemic treatment. Small bowel metastasectomy for advanced melanoma performed in conjunction with perioperative systemic therapy is safe and appears to promote long-term survival and enhanced quality of life.
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Affiliation(s)
- Paul Wong
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, 505 Parnassus Ave, S549, Box 1932, San Francisco, California, 94143-1932, USA
| | - Andrew D Wisneski
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, 505 Parnassus Ave, S549, Box 1932, San Francisco, California, 94143-1932, USA
| | - Katy K Tsai
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Tammy T Chang
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, 505 Parnassus Ave, S549, Box 1932, San Francisco, California, 94143-1932, USA
| | - Kenzo Hirose
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, 505 Parnassus Ave, S549, Box 1932, San Francisco, California, 94143-1932, USA
| | - Eric K Nakakura
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, 505 Parnassus Ave, S549, Box 1932, San Francisco, California, 94143-1932, USA
| | - Adil I Daud
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, 505 Parnassus Ave, S549, Box 1932, San Francisco, California, 94143-1932, USA
| | - Carlos U Corvera
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, 505 Parnassus Ave, S549, Box 1932, San Francisco, California, 94143-1932, USA.
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Pollini T, Tran T, Wong P, Adam MA, Alseidi A, Corvera C, Hirose K, Nakakura E, Warren R, Maker VK, Maker AV. Improved survival of patients receiving immunotherapy and chemotherapy following curative-intent resection of colorectal liver metastases. J Gastrointest Surg 2024; 28:246-251. [PMID: 38445916 DOI: 10.1016/j.gassur.2023.12.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/25/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Despite significant advancements in the treatment of patients with colorectal liver metastases (CRLMs), only a minority will experience long-term survival. This study aimed to determine the effect of chemotherapy (CT) and immunotherapy (IT) compared with that of CT alone on patient survival after surgical resection. METHODS Patients undergoing curative-intent liver resection followed by adjuvant systemic therapy for stage IV colon cancer were identified using the National Cancer Database. Patients were stratified into type of therapy (CT alone vs CT + IT) and microsatellite status. Propensity score-weighted analysis was performed through 1:1 matching based on the nearest neighbor method. RESULTS Of 9943 patients who underwent resection of CRLMs, 7971 (80%) received systemic adjuvant therapy. Of 7971 patients, 1432 (18%) received a combination of CT and IT. Microsatellite status was not associated with overall survival (OS). Adjuvant CT + IT was associated with increased 3-year OS compared with that of CT alone in both the unmatched cohort (55% vs 48%, respectively; P < .001) and matched cohort (52% vs 48%, respectively; P = .050). On multivariate analysis, older age, positive resection margins, and KRAS mutation were independent predictors of poor survival, whereas the administration of adjuvant CT + IT was an independent predictor of improved survival. CONCLUSION IT combined with CT was associated with improved survival compared with that of CT alone after curative-intent resection of CRLMs, regardless of microsatellite instability status. Clinical trials to determine optimal patient selection, IT regimen, and long-term efficacy to improve outcomes of patients with CRLMs are warranted.
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Affiliation(s)
- Tommaso Pollini
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Thuy Tran
- Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, United States; Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Paul Wong
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Mohamed A Adam
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Adnan Alseidi
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Carlos Corvera
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Kenzo Hirose
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Eric Nakakura
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Robert Warren
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Vijay K Maker
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States.
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Miyano R, Sakamoto H, Hirose K, Sakaba T. RIM-BP2 regulates Ca 2+ channel abundance and neurotransmitter release at hippocampal mossy fiber terminals. eLife 2024; 12:RP90799. [PMID: 38329474 PMCID: PMC10945523 DOI: 10.7554/elife.90799] [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] [Indexed: 02/09/2024] Open
Abstract
Synaptic vesicles dock and fuse at the presynaptic active zone (AZ), the specialized site for transmitter release. AZ proteins play multiple roles such as recruitment of Ca2+ channels as well as synaptic vesicle docking, priming, and fusion. However, the precise role of each AZ protein type remains unknown. In order to dissect the role of RIM-BP2 at mammalian cortical synapses having low release probability, we applied direct electrophysiological recording and super-resolution imaging to hippocampal mossy fiber terminals of RIM-BP2 knockout (KO) mice. By using direct presynaptic recording, we found the reduced Ca2+ currents. The measurements of excitatory postsynaptic currents (EPSCs) and presynaptic capacitance suggested that the initial release probability was lowered because of the reduced Ca2+ influx and impaired fusion competence in RIM-BP2 KO. Nevertheless, larger Ca2+ influx restored release partially. Consistent with presynaptic recording, STED microscopy suggested less abundance of P/Q-type Ca2+ channels at AZs deficient in RIM-BP2. Our results suggest that the RIM-BP2 regulates both Ca2+ channel abundance and transmitter release at mossy fiber synapses.
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Affiliation(s)
- Rinako Miyano
- Graduate School of Brain Science, Doshisha UniversityKyotoJapan
| | - Hirokazu Sakamoto
- Department of Pharmacology, Graduate School of Medicine, The University of TokyoBunkyo-kuJapan
| | - Kenzo Hirose
- Department of Pharmacology, Graduate School of Medicine, The University of TokyoBunkyo-kuJapan
- International Research Center for Neurointelligence (WPI-IRCN), The University of TokyoBunkyo-kuJapan
| | - Takeshi Sakaba
- Graduate School of Brain Science, Doshisha UniversityKyotoJapan
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Ashraf Ganjouei A, Romero-Hernandez F, Wang JJ, Casey M, Frye W, Hoffman D, Hirose K, Nakakura E, Corvera C, Maker AV, Kirkwood KS, Alseidi A, Adam MA. A Machine Learning Approach to Predict Postoperative Pancreatic Fistula After Pancreaticoduodenectomy Using Only Preoperatively Known Data. Ann Surg Oncol 2023; 30:7738-7747. [PMID: 37550449 DOI: 10.1245/s10434-023-14041-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Clinically-relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) is a major postoperative complication and the primary determinant of surgical outcomes. However, the majority of current risk calculators utilize intraoperative and postoperative variables, limiting their utility in the preoperative setting. Therefore, we aimed to develop a user-friendly risk calculator to predict CR-POPF following PD using state-of-the-art machine learning (ML) algorithms and only preoperatively known variables. METHODS Adult patients undergoing elective PD for non-metastatic pancreatic cancer were identified from the ACS-NSQIP targeted pancreatectomy dataset (2014-2019). The primary endpoint was development of CR-POPF (grade B or C). Secondary endpoints included discharge to facility, 30-day mortality, and a composite of overall and significant complications. Four models (logistic regression, neural network, random forest, and XGBoost) were trained, validated and a user-friendly risk calculator was then developed. RESULTS Of the 8666 patients who underwent elective PD, 13% (n = 1160) developed CR-POPF. XGBoost was the best performing model (AUC = 0.72), and the top five preoperative variables associated with CR-POPF were non-adenocarcinoma histology, lack of neoadjuvant chemotherapy, pancreatic duct size less than 3 mm, higher BMI, and higher preoperative serum creatinine. Model performance for 30-day mortality, discharge to a facility, and overall and significant complications ranged from AUC 0.62-0.78. CONCLUSIONS In this study, we developed and validated an ML model using only preoperatively known variables to predict CR-POPF following PD. The risk calculator can be used in the preoperative setting to inform clinical decision-making and patient counseling.
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Affiliation(s)
| | | | - Jaeyun Jane Wang
- Department of Surgery, University of California, San Francisco, USA
| | - Megan Casey
- School of Medicine, University of California, San Francisco, USA
| | - Willow Frye
- School of Medicine, University of California, San Francisco, USA
| | - Daniel Hoffman
- Department of Surgery, University of California, San Francisco, USA
| | - Kenzo Hirose
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA
| | - Eric Nakakura
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA
| | - Carlos Corvera
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA
| | - Kimberly S Kirkwood
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA
| | - Adnan Alseidi
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA
| | - Mohamed A Adam
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, USA.
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Ashraf Ganjouei A, Romero-Hernandez F, Wang JJ, Casey M, Frye W, Hoffman D, Hirose K, Nakakura E, Corvera C, Maker AV, Kirkwood KS, Alseidi A, Adam MA. ASO Visual Abstract: A Machine-Learning Approach to Predict Postoperative Pancreatic Fistula after Pancreaticoduodenectomy Using only Preoperatively Known Data. Ann Surg Oncol 2023; 30:7776-7777. [PMID: 37648889 DOI: 10.1245/s10434-023-14186-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
| | | | - Jaeyun Jane Wang
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Megan Casey
- School of Medicine, University of California, San Francisco, CA, USA
| | - Willow Frye
- School of Medicine, University of California, San Francisco, CA, USA
| | - Daniel Hoffman
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Kenzo Hirose
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Eric Nakakura
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Carlos Corvera
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Ajay V Maker
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Kimberly S Kirkwood
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Adnan Alseidi
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Mohamed A Adam
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA.
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Calthorpe L, Romero-Hernandez F, Casey M, Nunez M, Conroy PC, Hirose K, Kim A, Kirkwood K, Maker AV, Corvera C, Nakakura E, Alseidi A, Adam MA. National Practice Patterns in Malignant Peritoneal Mesothelioma: Updates in Management and Survival. Ann Surg Oncol 2023; 30:5119-5129. [PMID: 37140748 DOI: 10.1245/s10434-023-13528-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare malignancy with a historically poor prognosis. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an effective therapy for patients with peritoneal malignancies. A contemporary analysis of trends in management of and survival from MPM is warranted. METHODS Patients with MPM were identified from the National Cancer Database (2004-2018). Patients were categorized by treatment (CRS-HIPEC, CRS-chemotherapy, CRS only, chemotherapy only, no treatment), and joinpoint regression was employed to compute the annual percent change (APC) in treatment over time. Multivariable Cox proportional hazards models were used to analyze factors associated with survival. RESULTS Of 2683 patients with MPM, 19.1% underwent CRS-HIPEC, and 21.1% received no treatment. Joinpoint regression revealed a statistically significant increase in the proportion of patients undergoing CRS-HIPEC over time (APC 3.21, p = 0.01), and a concurrent decrease in the proportion of patients who underwent no treatment (APC - 2.21, p = 0.02). Median overall survival was 19.5 months. Factors independently associated with survival included CRS-HIPEC, CRS, histology, sex, age, race, Charlson Comorbidity Index, insurance, and hospital type. Although there was a strong association between year of diagnosis and survival on univariate analysis (2016-2018 HR 0.67, p < 0.001), this association was attenuated after adjustment for treatment. CONCLUSIONS CRS-HIPEC is increasingly employed as a treatment for MPM. In parallel, there has been a decrease in patients receiving no treatment with an increase in overall survival. These findings suggest that patients with MPM may be receiving more appropriate therapy; however, a substantial proportion of patients may remain undertreated.
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Affiliation(s)
- Lucia Calthorpe
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Megan Casey
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Miguel Nunez
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Patricia C Conroy
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Kenzo Hirose
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alex Kim
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Kimberly Kirkwood
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Carlos Corvera
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Nakakura
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Adnan Alseidi
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mohamed Abdelgadir Adam
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Calthorpe L, Romero-Hernandez F, Casey M, Nunez M, Conroy PC, Hirose K, Kim A, Kirkwood K, Maker AV, Corvera C, Nakakura E, Alseidi A, Adam MA. ASO Visual Abstract: National Practice Patterns in Malignant Peritoneal Mesothelioma-Updates in Management and Survival. Ann Surg Oncol 2023; 30:5131. [PMID: 37221399 DOI: 10.1245/s10434-023-13615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Lucia Calthorpe
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Megan Casey
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Miguel Nunez
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Patricia C Conroy
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Kenzo Hirose
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alex Kim
- Division of Surgical Oncology, Department of Surgery , The Ohio State University, Columbus, OH, USA
| | - Kimberly Kirkwood
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Carlos Corvera
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Nakakura
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Adnan Alseidi
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mohamed Abdelgadir Adam
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Yoshida T, Takenaka KI, Sakamoto H, Kojima Y, Sakano T, Shibayama K, Nakamura K, Hanawa-Suetsugu K, Mori Y, Hirabayashi Y, Hirose K, Takamori S. Compartmentalization of soluble endocytic proteins in synaptic vesicle clusters by phase separation. iScience 2023; 26:106826. [PMID: 37250768 PMCID: PMC10209458 DOI: 10.1016/j.isci.2023.106826] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/10/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Synaptic vesicle (SV) clusters, which reportedly result from synapsin's capacity to undergo liquid-liquid phase separation (LLPS), constitute the structural basis for neurotransmission. Although these clusters contain various endocytic accessory proteins, how endocytic proteins accumulate in SV clusters remains unknown. Here, we report that endophilin A1 (EndoA1), the endocytic scaffold protein, undergoes LLPS under physiologically relevant concentrations at presynaptic terminals. On heterologous expression, EndoA1 facilitates the formation of synapsin condensates and accumulates in SV-like vesicle clusters via synapsin. Moreover, EndoA1 condensates recruit endocytic proteins such as dynamin 1, amphiphysin, and intersectin 1, none of which are recruited in vesicle clusters by synapsin. In cultured neurons, like synapsin, EndoA1 is compartmentalized in SV clusters through LLPS, exhibiting activity-dependent dispersion/reassembly cycles. Thus, beyond its essential function in SV endocytosis, EndoA1 serves an additional structural function by undergoing LLPS, thereby accumulating various endocytic proteins in dynamic SV clusters in concert with synapsin.
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Affiliation(s)
- Tomofumi Yoshida
- Laboratory of Neural Membrane Biology, Graduate School of Brain Science, Doshisha University, Kyoto 610-0394, Japan
| | - Koh-ichiro Takenaka
- Laboratory of Neural Membrane Biology, Graduate School of Brain Science, Doshisha University, Kyoto 610-0394, Japan
| | - Hirokazu Sakamoto
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Yusuke Kojima
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Takumi Sakano
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-0033, Japan
| | - Koyo Shibayama
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-0033, Japan
| | - Koki Nakamura
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-0033, Japan
| | - Kyoko Hanawa-Suetsugu
- Laboratory of Neural Membrane Biology, Graduate School of Brain Science, Doshisha University, Kyoto 610-0394, Japan
| | - Yasunori Mori
- Laboratory of Neural Membrane Biology, Graduate School of Brain Science, Doshisha University, Kyoto 610-0394, Japan
| | - Yusuke Hirabayashi
- Department of Chemistry and Biotechnology, School of Engineering, The University of Tokyo, Tokyo 113-0033, Japan
| | - Kenzo Hirose
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo, Tokyo 113-0033, Japan
| | - Shigeo Takamori
- Laboratory of Neural Membrane Biology, Graduate School of Brain Science, Doshisha University, Kyoto 610-0394, Japan
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Miller PN, Romero-Hernandez F, Conroy P, Calthorpe L, Yilma M, Mohamedaly S, Kelly YM, Feng J, Hirose K, Kirkwood K, Maker AV, Corvera C, Nakakura E, Alseidi A, Adam MA. Hand-Assisted Versus Pure Minimally-Invasive Distal Pancreatectomy: Is There a Downside to Lending a Hand? World J Surg 2023; 47:750-758. [PMID: 36402918 DOI: 10.1007/s00268-022-06835-z] [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] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hand-assisted laparoscopic distal pancreatectomy (HALDP) is suggested to offer similar outcomes to pure laparoscopic distal pancreatectomy (LDP). However, given the longer midline incision, it is unclear whether HALDP increases the risk of postoperative hernia. Our aim was to determine the risk of postoperative incisional hernia development after HALDP. METHODS We retrospectively collected data from patients undergoing HALDP or LDP at a single center (2012-2020). Primary endpoints were postoperative incisional hernia and operative time. All patients had at minimum six months of follow-up. Outcomes were compared using unadjusted and multivariable regression analyses. RESULTS Ninety-five patients who underwent laparoscopic distal pancreatectomy were retrospectively identified. Forty-one patients (43%) underwent HALDP. Patients with HALDP were older (median, 67 vs. 61 years, p = 0.02). Sex, race, Body Mass Index (median, 27 vs. 26), receipt of neoadjuvant chemotherapy, gland texture, wound infection rates, postoperative pancreatic fistula, overall complications, and hospital length-of-stay were similar between HALDP and LDP (all p > 0.05). In unadjusted analysis, operative times were shorter for HALDP (164 vs. 276 min, p < 0.001), but after adjustment, did not differ significantly (MR 0.73; 0.49-1.07, p = 0.1). Unadjusted incidence of hernia was higher in HALDP versus LDP (60% vs. 24%, p = 0.004). After adjustment, HALDP was associated with an increased odds of developing hernia (OR 7.52; 95% CI 1.54-36.8, p = 0.014). After propensity score matching, odds of hernia development remained higher for HALDP (OR 4.62; 95% CI 1.28-16.65, p = 0.031) p = 0.03). CONCLUSIONS Compared with LDP, HALDP was associated with increased likelihood of postoperative hernia with insufficient evidence that HALDP shortens operative times. Our results suggest that HALDP may not be equivalent to LDP.
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Affiliation(s)
- Phoebe N Miller
- Department of Surgery, University of California, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Fernanda Romero-Hernandez
- Department of Surgery, University of California, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Patricia Conroy
- Department of Surgery, University of California, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Lucia Calthorpe
- Department of Surgery, University of California, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Mignote Yilma
- Department of Surgery, University of California, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Sarah Mohamedaly
- Department of Surgery, University of California, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Yvonne M Kelly
- Department of Surgery, University of California, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Jean Feng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kenzo Hirose
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly Kirkwood
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Ajay V Maker
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Carlos Corvera
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Nakakura
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Adnan Alseidi
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Mohamed A Adam
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA.
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Fukaya R, Hirai H, Sakamoto H, Hashimotodani Y, Hirose K, Sakaba T. Increased vesicle fusion competence underlies long-term potentiation at hippocampal mossy fiber synapses. Sci Adv 2023; 9:eadd3616. [PMID: 36812326 PMCID: PMC9946361 DOI: 10.1126/sciadv.add3616] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
Presynaptic long-term potentiation (LTP) is thought to play an important role in learning and memory. However, the underlying mechanism remains elusive because of the difficulty of direct recording during LTP. Hippocampal mossy fiber synapses exhibit pronounced LTP of transmitter release after tetanic stimulation and have been used as a model of presynaptic LTP. Here, we induced LTP by optogenetic tools and applied direct presynaptic patch-clamp recordings. The action potential waveform and evoked presynaptic Ca2+ currents remained unchanged after LTP induction. Membrane capacitance measurements suggested higher release probability of synaptic vesicles without changing the number of release-ready vesicles after LTP induction. Synaptic vesicle replenishment was also enhanced. Furthermore, stimulated emission depletion microscopy suggested an increase in the numbers of Munc13-1 and RIM1 molecules within active zones. We propose that dynamic changes in the active zone components may be relevant for the increased fusion competence and synaptic vesicle replenishment during LTP.
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Affiliation(s)
- Ryota Fukaya
- Graduate School of Brain Science, Doshisha University, Kyotanabe, Kyoto 610-0394, Japan
- Institute of Biology/Genetics, Freie Universität Berlin, 14195 Berlin, Germany
| | - Himawari Hirai
- Graduate School of Brain Science, Doshisha University, Kyotanabe, Kyoto 610-0394, Japan
| | - Hirokazu Sakamoto
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yuki Hashimotodani
- Graduate School of Brain Science, Doshisha University, Kyotanabe, Kyoto 610-0394, Japan
| | - Kenzo Hirose
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
- International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takeshi Sakaba
- Graduate School of Brain Science, Doshisha University, Kyotanabe, Kyoto 610-0394, Japan
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11
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Lin JJ, Conroy PC, Romero-Hernandez F, Yilma M, Feng J, Hirose K, Nakakura E, Maker AV, Corvera C, Kirkwood K, Alseidi A, Adam MA. Hypertension Requiring Medication Use: a Silent Predictor of Poor Outcomes After Pancreaticoduodenectomy. J Gastrointest Surg 2023; 27:328-336. [PMID: 36624324 DOI: 10.1007/s11605-022-05577-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although hypertension requiring medication (HTNm) is a well-known cardiovascular comorbidity, its association with postoperative outcomes is understudied. This study aimed to evaluate whether preoperative HTNm is independently associated with specific complications after pancreaticoduodenectomy. STUDY DESIGN Adults undergoing elective pancreaticoduodenectomy were included from the 2014-2019 NSQIP-targeted pancreatectomy dataset. Multivariable regression models compared outcomes between patients with and without HTNm. Endpoints included significant complications, any complication, unplanned readmissions, length of stay (LOS), clinically relevant postoperative pancreatic fistula (CR-POPF), and cardiovascular and renal complications. A subgroup analysis excluded patients with diabetes, heart failure, chronic obstructive pulmonary disease, estimated glomerular filtration rate from serum creatinine (eGFRCr) < 60 ml/min per 1.73 m2, bleeding disorder, or steroid use. RESULTS Among 14,806 patients, 52% had HTNm. HTNm was more common among older male patients with obesity, diabetes, congestive heart failure, chronic obstructive pulmonary disease, functional dependency, hard pancreatic glands, and cancer. After adjusting for demographics, preoperative comorbidities, and laboratory values, HTNm was independently associated with higher odds of significant complications (aOR 1.12, p = 0.020), any complication (aOR 1.11, p = 0.030), cardiovascular (aOR 1.78, p = 0.002) and renal (aOR 1.60, p = 0.020) complications, and unplanned readmissions (aOR 1.14, p = 0.040). In a subgroup analysis of patients without major preoperative comorbidity, HTNm remained associated with higher odds of significant complications (aOR 1.14, p = 0.030) and cardiovascular complications (aOR 1.76, p = 0.033). CONCLUSIONS HTNm is independently associated with cardiovascular and renal complications after pancreaticoduodenectomy and may need to be considered in preoperative risk stratification. Future studies are necessary to explore associations among underlying hypertension, specific antihypertensive medications, and postoperative outcomes to investigate potential risk mitigation strategies.
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Affiliation(s)
- Jackie J Lin
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Patricia C Conroy
- Department of Surgery, University of California, San Francisco, San Francisco, USA
| | | | - Mignote Yilma
- Department of Surgery, University of California, San Francisco, San Francisco, USA
- National Clinician Scholars Program, University of California, San Francisco, San Francisco, USA
| | - Jean Feng
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Kenzo Hirose
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Eric Nakakura
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Ajay V Maker
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Carlos Corvera
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Kimberly Kirkwood
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Adnan Alseidi
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA
| | - Mohamed A Adam
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0790, USA.
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12
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Tbeileh N, Timmerman L, Mattis AN, Toriguchi K, Kasai Y, Corvera C, Nakakura E, Hirose K, Donner DB, Warren RS, Karelehto E. Metastatic colorectal adenocarcinoma tumor purity assessment from whole exome sequencing data. PLoS One 2023; 18:e0271354. [PMID: 37022995 PMCID: PMC10079084 DOI: 10.1371/journal.pone.0271354] [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] [Received: 12/21/2021] [Accepted: 06/28/2022] [Indexed: 04/07/2023] Open
Abstract
Tumors rich in stroma are associated with advanced stage and poor prognosis in colorectal adenocarcinoma (CRC). Abundance of stromal cells also has implications for genomic analysis of patient tumors as it may prevent detection of somatic mutations. As part of our efforts to interrogate stroma-cancer cell interactions and to identify actionable therapeutic targets in metastatic CRC, we aimed to determine the proportion of stroma embedded in hepatic CRC metastases by performing computational tumor purity analysis based on whole exome sequencing data (WES). Unlike previous studies focusing on histopathologically prescreened samples, we used an unbiased in-house collection of tumor specimens. WES from CRC liver metastasis samples were utilized to evaluate stromal content and to assess the performance of three in silico tumor purity tools, ABSOLUTE, Sequenza and PureCN. Matching tumor derived organoids were analyzed as a high purity control as they are enriched in cancer cells. Computational purity estimates were compared to those from a histopathological assessment conducted by a board-certified pathologist. According to all computational methods, metastatic specimens had a median tumor purity of 30% whereas the organoids were enriched for cancer cells with a median purity estimate of 94%. In line with this, variant allele frequencies (VAFs) of oncogenes and tumor suppressor genes were undetectable or low in most patient tumors, but higher in matching organoid cultures. Positive correlation was observed between VAFs and in silico tumor purity estimates. Sequenza and PureCN produced concordant results whereas ABSOLUTE yielded lower purity estimates for all samples. Our data shows that unbiased sample selection combined with molecular, computational, and histopathological tumor purity assessment is critical to determine the level of stroma embedded in metastatic colorectal adenocarcinoma.
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Affiliation(s)
- Noura Tbeileh
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Luika Timmerman
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Aras N Mattis
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
- Department of Pathology, University of California, San Francisco, San Francisco, California, United States of America
- Liver Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Kan Toriguchi
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Yosuke Kasai
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Carlos Corvera
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Eric Nakakura
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Kenzo Hirose
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
| | - David B Donner
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Robert S Warren
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Eveliina Karelehto
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America
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13
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Trang K, Pierce L, Wick EC, Hirose K. Using Electronic Health Record Meta-Data to Identify Variation in Trainee Progress Note Writing Patterns: Opportunity to Enhance Systems-Based Care. J Surg Educ 2022; 79:e257-e262. [PMID: 36096881 DOI: 10.1016/j.jsurg.2022.08.011] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/28/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Daily progress notes are the backbone of all inpatient hospitalizations. Progress notes serve as a lasting record of a patient's diagnoses, condition, and planned interventions and are essential communication tools. We designed a study to identify patterns in progress note filing and use on general surgical services. METHODS The electronic health record (EHR) data warehouse was queried for general surgical progress notes signed between July 1, 2020, and July 1, 2021. Only notes authored by resident physicians or advanced practice providers (APPs) were included, and those filed on the day of a surgery were excluded. 10 am was identified as a target for note completion as it coincided with multidisciplinary discharge rounds. Physician, case managers pharmacist, physical therapist, dietician, nurse (and collaborating disciplines) progress note views were measured using EHR access log data. RESULTS A total of 8384 progress notes were analyzed; 4146 notes (49%) were authored by 81 trainees. A total of 4433 (53%) progress notes were filed before 10 am, 3673 (44%) were filed between 10 am and 6 pm, and 278 (3%) were filed after 6 pm. Variation in progress note file time was observed and associated with individual habits, residents vs APPs, day-of-week, and service structure. Surgery progress notes are viewed by collaborating disciplines throughout the workday, with high-volume viewership occurring by mid-morning. Each individual progress note received an average of 17.6 lifetime views with a range of 1 to 76. An average of 10.2 of those views occurred on the same day that the note was written. Notes that were filed after 10 am received a significantly lower number of same-day views compared to notes filed before 10am (8.4 vs 11.8, p < 0.0001). CONCLUSIONS Progress notes are identified as a significant burden by trainees and even considered to contribute to duty hour violations, yet they are used regularly as a source of information for collaborating disciplines. Progress notes filed earlier are viewed more frequently. Efforts to identify barriers to timeliness may help communication and efficiency of inpatient surgical care.
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Affiliation(s)
- Karen Trang
- Department of Surgery, University of California San Francisco, San Francisco, California.
| | - Logan Pierce
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California
| | - Elizabeth C Wick
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, San Francisco, California
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14
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Suetani Y, Iida Y, Hirose K, Shichijo K, Yamamoto S, Fukui T, Kuramoto M, Arita Y, Saeki H, Miyoshi M, Okada M, Ogasawara N. Urine osmolality predicts worsening renal function and poor prognosis in acute decompensated heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1088] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Purpose
Worsening renal function (WRF) can sometimes occur in the patients with acute decompensated heart failure (ADHF) and increase the risk of morbidity and mortality (1). In a previous study, it was reported that fractional excretion of sodium (FENa) reflects net sodium reabsorption from nephron segments and predicts WRF during treating ADHF (2). On the other hand, recently the new drugs which approach urine concentration mechanism and affect urine osmolality (U-OSM), such as tolvaptan and sodium-glucose cotransporter-2 inhibitor, have begun to be widely used as treatment of heart failure. Thus, we focused on U-OSM, which reflects not only sodium handling but also water excretion controlled by the collecting duct, and evaluated the association between WRF and U-OSM. Moreover, previous studies have demonstrated that FENa, fractional excretion of urea nitrogen and transtubular potassium concentration gradient are markers for long-term prognosis in patients with ADHF (3–5). Therefore, we also studied whether U-OSM can predict prognosis in ADHF.
Methods
A total of 157 patients admitted to our hospital because of a primary diagnosis of ADHF from February 2020 through July 2021 were retrospectively reviewed. U-OSM in the spot urinary samples were examined within 72 hours after admission. U-OSM was calculated based on the following validated formula (6): U-OSM = 1.07 × {2 × [urine sodium (mEq/L)] + [urine urea nitrogen (mg/dL)]/2.8 + [urine creatinine (mg/dl)] × 2/3} + 16.2. The primary outcome was the occurrence of WRF during hospitalization. WRF was defined as increased serum creatinine ≥0.3 mg/dL from baseline (7). The secondary outcome was the occurrence of ADHF readmission and all-cause death within 180 days after discharge.
Results
Primary Outcome. WRF developed in 46% of all patients. In the patients that developed WRF during hospitalization, U-OSM was significantly lower than in the patients without WRF (366±106 mOsm/L versus 430±128 mOsm/L; P<0.001). Receiver operating characteristic curve analysis revealed the optimal cutoff values of U-OSM was 403 mOsm/L (AUC 0.64; 95% CI: 0.56–0.72; P<0.001) to predict the WRF (Figure 1). On multivariable logistic regression analysis, U-OSM (OR, 1.99, 95% CI: 1.27–3.12; p=0.003) and serum creatinine (OR, 1.00, 95% CI: 0.99–1.00; P=0.009) were independent predictors of WRF.
Secondary Outcome. There were 34 patients (22%) readmitted and 9 patients (6%) died within 180 days after discharge. ROC curve analysis revealed the optimal cutoff values of U-OSM as 349 mOsm/L (C-statistic 0.74; 95% CI: 0.65–0.83; P<0.001) to predict ADHF readmission and all-cause death within 180 days (Figure 2A). On Kaplan-Meier analysis, the secondary outcome was significantly higher in patients with U-OSM<349 mOsm/L (u-OSM≥349, 57%, U-OSM<349, 43%; HR, 0.99; 95% CI: 0.99–1.00, P<0.001) (Figure 2B).
Conclusion
U-OSM on admission may be a predictor of WRF and a prognostic marker in ADHF patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Suetani
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - Y Iida
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - K Hirose
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - K Shichijo
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - S Yamamoto
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - T Fukui
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - M Kuramoto
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - Y Arita
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - H Saeki
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - M Miyoshi
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - M Okada
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
| | - N Ogasawara
- Japan Community Healthcare Organization Osaka Hospital , Osaka , Japan
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15
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Conroy PC, Calthorpe L, Lin JA, Mohamedaly S, Kim A, Hirose K, Nakakura E, Corvera C, Sosa JA, Sarin A, Kirkwood KS, Alseidi A, Adam MA. Determining Hospital Volume Threshold for Safety of Minimally Invasive Pancreaticoduodenectomy: A Contemporary Cutpoint Analysis. Ann Surg Oncol 2022; 29:1566-1574. [PMID: 34724124 PMCID: PMC9289437 DOI: 10.1245/s10434-021-10984-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 06/11/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Guidelines recommend limiting minimally invasive pancreaticoduodenectomy (MIPD) to high-volume centers. However, the definition of high-volume care remains unclear. We aimed to objectively define a minimum number of MIPD performed annually per hospital associated with improved outcomes in a contemporary patient cohort. PATIENTS AND METHODS Resectable pancreatic adenocarcinoma patients undergoing MIPD were included from the National Cancer Database (2010-2017). Multivariable modeling with restricted cubic splines was employed to identify an MIPD annual hospital volume threshold associated with lower 90-day mortality. Outcomes were compared between patients treated at low-volume (≤ model-identified cutoff) and high-volume (> cutoff) centers. RESULTS Among 3079 patients, 141 (5%) died within 90 days. Median hospital volume was 6 (range 1-73) cases/year. After adjustment, increasing hospital volume was associated with decreasing 90-day mortality for up to 19 (95% CI 16-25) cases/year, indicating a threshold of 20 cases/year. Most cases (82%) were done at low-volume (< 20 cases/year) centers. With adjustment, MIPD at low-volume centers was associated with increased 90-day mortality (OR 2.7; p = 0.002). Length of stay, positive surgical margins, 30-day readmission, and overall survival were similar. On analysis of the most recent two years (n = 1031), patients at low-volume centers (78.2%) were younger and had less advanced tumors but had longer length of stay (8 versus 7 days; p < 0.001) and increased 90-day mortality (7% versus 2%; p = 0.009). CONCLUSIONS The cutpoint analysis identified a threshold of at least 20 MIPD cases/year associated with lower postoperative mortality. This threshold should inform national guidelines and institution-level protocols aimed at facilitating the safe implementation of this complex procedure.
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Affiliation(s)
- Patricia C. Conroy
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Lucia Calthorpe
- School of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Joseph A. Lin
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Mohamedaly
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alex Kim
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA
| | - Kenzo Hirose
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Nakakura
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Carlos Corvera
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Julie Ann Sosa
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Ankit Sarin
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly S. Kirkwood
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Adnan Alseidi
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Mohamed A. Adam
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA
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Ishikawa Y, Uehara S, Ishihara K, Hirose K, Soma T, Fujiwara M, Kobayashi M, Fan B, Nakamura Y, Uchida Y, Fukuda S, Tanaka H, Yoshida S, Yokoyama M, Matsuoka Y, Fujii Y. Variability in diagnostic performance of non-muscle invasive bladder cancer for each region using fluorescence cystoscopy with orally administered 5-aminolevulinic acid. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00317-7] [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: 11/30/2022]
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17
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Ishikawa Y, Sho U, Ishihara K, Hirose K, Soma T, Fujiwara M, Kobayashi M, Fan B, Nakamura Y, Uchida Y, Fukuda S, Tanaka H, Yoshida S, Yokoyama M, Matsuoka Y, Fujii Y. Orally administered 5-aminolevulinic acid can cause intraoperative hypotension in patients with bladder cancer undergoing transurethral resection. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00332-3] [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: 11/28/2022]
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18
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Conroy PC, Calthorpe L, Lin JA, Mohamedaly S, Kim A, Hirose K, Nakakura E, Corvera C, Sosa JA, Sarin A, Kirkwood KS, Alseidi A, Adam MA. ASO Visual Abstract: Determining Hospital Volume Threshold for the Safety of Minimally Invasive Pancreaticoduodenectomy: A Contemporary Cutpoint Analysis. Ann Surg Oncol 2022. [PMID: 35031919 DOI: 10.1245/s10434-021-11075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Patricia C Conroy
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Lucia Calthorpe
- School of Medicine, University of California, San Francisco, CA, USA
| | - Joseph A Lin
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Sarah Mohamedaly
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Alex Kim
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA
| | - Kenzo Hirose
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Eric Nakakura
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Carlos Corvera
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Julie Ann Sosa
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Ankit Sarin
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Kimberly S Kirkwood
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Adnan Alseidi
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA
| | - Mohamed A Adam
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, USA.
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19
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Endo Y, Asanuma D, Namiki S, Sugihara K, Hirose K, Uemura A, Kubota Y, Miura T. Quantitative modeling of regular retinal microglia distribution. Sci Rep 2021; 11:22671. [PMID: 34811401 PMCID: PMC8608893 DOI: 10.1038/s41598-021-01820-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/03/2021] [Indexed: 12/16/2022] Open
Abstract
Microglia are resident immune cells in the central nervous system, showing a regular distribution. Advancing microscopy and image processing techniques have contributed to elucidating microglia’s morphology, dynamics, and distribution. However, the mechanism underlying the regular distribution of microglia remains to be elucidated. First, we quantitatively confirmed the regularity of the distribution pattern of microglial soma in the retina. Second, we formulated a mathematical model that includes factors that may influence regular distribution. Next, we experimentally quantified the model parameters (cell movement, process formation, and ATP dynamics). The resulting model simulation from the measured parameters showed that direct cell–cell contact is most important in generating regular cell spacing. Finally, we tried to specify the molecular pathway responsible for the repulsion between neighboring microglia.
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Affiliation(s)
- Yoshie Endo
- Department of Anatomy and Cell Biology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Asanuma
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeyuki Namiki
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kei Sugihara
- Department of Anatomy and Cell Biology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenzo Hirose
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiyoshi Uemura
- Department of Retinal Vascular Biology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Yoshiaki Kubota
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Miura
- Department of Anatomy and Cell Biology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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20
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Takagi T, Ueno T, Ikawa K, Asanuma D, Nomura Y, Uno SN, Komatsu T, Kamiya M, Hanaoka K, Okimura C, Iwadate Y, Hirose K, Nagano T, Sugimura K, Urano Y. Discovery of an F-actin-binding small molecule serving as a fluorescent probe and a scaffold for functional probes. Sci Adv 2021; 7:eabg8585. [PMID: 34797716 PMCID: PMC8604405 DOI: 10.1126/sciadv.abg8585] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/30/2021] [Indexed: 06/10/2023]
Abstract
Actin is a ubiquitous cytoskeletal protein, forming a dynamic network that generates mechanical forces in the cell. There is a growing demand for practical and accessible tools for dissecting the role of the actin cytoskeleton in cellular function, and the discovery of a new actin-binding small molecule is an important advance in the field, offering the opportunity to design and synthesize of new class of functional molecules. Here, we found an F-actin–binding small molecule and introduced two powerful tools based on a new class of actin-binding small molecule: One enables visualization of the actin cytoskeleton, including super-resolution imaging, and the other enables highly specific green light–controlled fragmentation of actin filaments, affording unprecedented control of the actin cytoskeleton and its force network in living cells.
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Affiliation(s)
- Takeru Takagi
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tasuku Ueno
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Keisuke Ikawa
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Yayoi 2-11-16, Bunkyo-ku, Tokyo 113-0032, Japan
- Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto University, Yoshida-Ushinomiya-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Daisuke Asanuma
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- PRESTO, Japan Science and Technology Agency (JST), 4-1-8 Honcho, Kawaguchi-shi, Saitama 332-0012, Japan
| | - Yusuke Nomura
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shin-nosuke Uno
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Toru Komatsu
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Mako Kamiya
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kenjiro Hanaoka
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Chika Okimura
- Faculty of Science, Yamaguchi University, 1677-1 Yoshida, Yamaguchi-shi, Yamaguchi 753-8512, Japan
| | - Yoshiaki Iwadate
- Faculty of Science, Yamaguchi University, 1677-1 Yoshida, Yamaguchi-shi, Yamaguchi 753-8512, Japan
| | - Kenzo Hirose
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- International Research Center for Neurointelligence, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tetsuo Nagano
- Drug Discovery Initiative, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kaoru Sugimura
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Yayoi 2-11-16, Bunkyo-ku, Tokyo 113-0032, Japan
- Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto University, Yoshida-Ushinomiya-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yasuteru Urano
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Core Research for Evolutional Science and Technology (CREST) Investigator, Japan Agency for Medical Research and Development (AMED), 1-7-1 Otemachi, Chiyoda-ku, Tokyo 100-0004, Japan
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21
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Homma C, Hirose K, Ito T, Kamikawa M, Toma S, Nikaido S, Satoh M, Uemoto Y. Estimation of genetic parameter for feed efficiency and resilience traits in three pig breeds. Animal 2021; 15:100384. [PMID: 34757251 DOI: 10.1016/j.animal.2021.100384] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/16/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
Recently, automatic feeders have become popular for collecting daily feed intake data in the pig industry, making it possible to evaluate genetic effects on feed efficiency and resilience traits, expressed as day-to-day fluctuations in feeding records. This study aimed to understand the influence of genetic factors on feed efficiency traits, including residual intake and BW gain (RIG), and resilience traits, as well as to compare the differences in genetic parameter estimates among three purebred pig breeds. A total of 6 103 pigs from three breeds (Large White: 1 193 pigs, Landrace: 3 010 pigs, and Duroc: 1 900 pigs) were raised in a specific pathogen-free environment. The growth and feed intake records during the testing period were obtained using automatic feeders, and the average daily gain (ADG) and average feed intake (AFI) were calculated. Feed conversion ratio (FCR), residual feed intake (RFI), residual gain, and RIG were calculated as feed efficiency traits, and the log-transformed variance of deviation for the daily feed intake (LnVar_FI), daily occupation time (LnVar_OC), and the daily number of visits to the feeder (LnVar_VT) was calculated as resilience traits. After estimating the genetic parameters for each breed, a meta-analysis was performed to obtain the weighted mean of heritability estimates (hm2) and genetic correlation estimates (GCm) for the three breeds. The hm2 were moderate and ranged from 0.31 to 0.39 for feed efficiency traits and 0.31 to 0.40 for resilience traits, and there were no significant differences in heritability estimates among the three breeds except for AFI, RFI, and RIG. For feed efficiency traits, the FCR and RIG showed favourably moderate GCm with AFI (0.29 and -0.33, respectively) and ADG (-0.39 and 0.31, respectively). For resilience traits, the LnVar_FI and LnVar_VT showed favourably low to moderate GCm with FCR (0.33 and 0.28, respectively) and RIG (-0.37 and 0.28, respectively), and there were no genetic relationships of LnVar_OC with FCR and RIG (the absolute value of GCm was 0.01). There was no significant difference in the genetic correlation estimates among the three breeds for feed efficiency and resilience traits. Our results suggest that feed efficiency and resilience traits were heritable, and resilience traits showed favourable or no genetic correlation with feed efficiency traits. In addition, the influence of genetic factors on feed efficiency and resilience traits could be the same among breeds.
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Affiliation(s)
- C Homma
- Graduate School of Agricultural Science, Tohoku University, Sendai, Miyagi 980-8572, Japan
| | - K Hirose
- Central Research Institute for Feed and Livestock, ZEN-NOH (National Federation of Agricultural Cooperative Associations), Kamishihoro, Hokkaido 080-1406, Japan
| | - T Ito
- Central Research Institute for Feed and Livestock, ZEN-NOH (National Federation of Agricultural Cooperative Associations), Kamishihoro, Hokkaido 080-1406, Japan
| | - M Kamikawa
- Central Research Institute for Feed and Livestock, ZEN-NOH (National Federation of Agricultural Cooperative Associations), Kamishihoro, Hokkaido 080-1406, Japan
| | - S Toma
- Central Research Institute for Feed and Livestock, ZEN-NOH (National Federation of Agricultural Cooperative Associations), Kamishihoro, Hokkaido 080-1406, Japan
| | - S Nikaido
- ZEN-NOH LIVESTOCK CO., LTD, 11-17, Fuyuki, Koto-ku, Tokyo 135-0041, Japan
| | - M Satoh
- Graduate School of Agricultural Science, Tohoku University, Sendai, Miyagi 980-8572, Japan
| | - Y Uemoto
- Graduate School of Agricultural Science, Tohoku University, Sendai, Miyagi 980-8572, Japan.
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22
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Conroy PC, Mohamedaly S, Calthorpe L, Glencer A, Hirose K, Nakakura EK, Corvera CU, Kirkwood K, Alseidi A, Adam M. Which Pancreaticoduodenectomy Dunking Conduit Is Optimal in the Setting of Very Small Pancreatic Ducts? J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.310] [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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23
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Lin JA, Pierce L, Murray SG, Soleimani H, Wick EC, Sosa JA, Hirose K. Estimation of Surgical Resident Duty Hours and Workload in Real Time Using Electronic Health Record Data. J Surg Educ 2021; 78:e232-e238. [PMID: 34507910 PMCID: PMC9335013 DOI: 10.1016/j.jsurg.2021.08.011] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the use of electronic health record (EHR) data to estimate surgery resident duty hours and monitor real time workload. DESIGN Retrospective analysis of resident duty hours logged using a voluntary global positioning system (GPS)-based smartphone application compared to duty hour estimates by an EHR-based algorithm. The algorithm estimated duty hours using EHR activity data and operating room logs. A dashboard was developed through Plan-Do-Study-Act cycles for real-time monitoring of workload. SETTING Single tertiary/quaternary medical center general surgery residency program with approximately 90 categorical, preliminary, and integrated residents at eight clinical sites. PARTICIPANTS Categorical, preliminary, and integrated surgery residents of all clinical years who volunteered to pilot a GPS application to track duty hours. RESULTS Of 2,623 work periods by 59 residents were logged with both methods. EHR-estimated work periods started later than GPS logs (median 0.3 hours, interquartile range [IQR] -0.1 - 0.3); EHR-estimated work periods ended earlier than GPS logs (median 0.1 hours, IQR -0.7 - 0.3); and EHR-estimated duty hour totals were less than totals logged by GPS (median -0.3 hours, IQR -0.8 - +0.1). Overall correlation between weekly duty hours logged by EHR and GPS was 0.79. Correlations between the 2 systems stratified from PGY-1 through PGY-5 were 0.76, 0.64, 0.82, 0.87, and 0.83, respectively. The algorithm identified six 80-hour workweek violations (averaged over 4 weeks), while GPS logs identified 8. EHR-based duty hours and operational data were integrated into a dashboard to enable real time monitoring of resident workloads. CONCLUSIONS EHR-based estimation of surgical resident duty hours has good correlation with GPS-based assessment of duty hours and identifies most workweek duty hour violations. This approach allows for dynamic workload monitoring and may be combined with operational data to anticipate and prevent duty hour violations, thereby optimizing learning.
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Affiliation(s)
- Joseph A Lin
- Department of Surgery, University of California San Francisco, San Francisco, California.
| | - Logan Pierce
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sara G Murray
- Department of Medicine, University of California San Francisco, San Francisco, California; Health Informatics, University of California San Francisco, San Francisco, California
| | - Hossein Soleimani
- Health Informatics, University of California San Francisco, San Francisco, California
| | - Elizabeth C Wick
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California; Department of Medicine, University of California San Francisco, San Francisco, California
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, San Francisco, California
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24
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Kitajima N, Takikawa K, Sekiya H, Asanuma D, Sakamoto H, Namiki S, Iino M, Hirose K. In vivo Fluorescence Imaging of Extracellular ATP in the Mouse Cerebral Cortex with a Hybrid-type Optical Sensor. Bio Protoc 2021; 11:e4046. [PMID: 34250212 DOI: 10.21769/bioprotoc.4046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/04/2021] [Revised: 03/16/2021] [Accepted: 04/25/2021] [Indexed: 12/26/2022] Open
Abstract
Adenosine 5'-triphosphate (ATP) works as an extracellular signaling molecule for cells in the brain, such as neurons and glia. Cellular communication via release of ATP is involved in a range of processes required for normal brain functions, and aberrant communication is associated with brain disorders. To investigate the mechanisms underlying these cellular processes, various techniques have been developed for the measurement of extracellular ATP. To monitor the dynamics of extracellular ATP signaling with high spatiotemporal resolution, we recently developed a hybrid-type ATP optical sensor (ATPOS) that enables in vivo fluorescence imaging of extracellular ATP dynamics in the brain. ATPOS is synthesized by labeling an ATP-binding protein, Bacillus FoF1-ATP synthase ε subunit, with a small-molecular fluorescent dye Cy3. Injection of ATPOS into the cerebral cortex of living mice enables visualization of the wave-like propagation of extracellular ATP release in response to electrical stimulation. The protocol described here should be useful for visualizing ATP signaling in diverse processes involved in intercellular communication in the brain.
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Affiliation(s)
- Nami Kitajima
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Takikawa
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Sekiya
- Department of Physiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Asanuma
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirokazu Sakamoto
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeyuki Namiki
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masamitsu Iino
- Department of Cellular and Molecular Pharmacology, Nihon University School of Medicine, Tokyo, Japan
| | - Kenzo Hirose
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,International Research Center for Neurointelligence, The University of Tokyo, Tokyo, Japan
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25
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Chee B, Ibrahim F, Esquivel M, Van Seventer EE, Jarnagin JX, Zhang L, Ju JH, Price KS, Raymond VM, Corvera CU, Hirose K, Nakakura EK, Van Loon K, Corcoran RB, Parikh AR, Atreya CE. Circulating tumor derived cell-free DNA (ctDNA) to predict recurrence of metastatic colorectal cancer (mCRC) following curative intent surgery or radiation. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3565] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3565 Background: Over half of patients (pts) with oligometastatic CRC treated with curative intent surgery or radiotherapy experience cancer recurrence with or without adjuvant chemotherapy. ctDNA detection post-definitive treatment could identify high risk pts for additional intervention to eliminate molecular residual disease. Here we report results of a prospective observational study aiming to determine ctDNA detection rates using a sensitive liquid biopsy and to correlate post-procedure ctDNA detection (post-ctDNA (+)) with radiographic mCRC recurrence. Methods: Pts with mCRC intending to undergo a curative intent procedure were prospectively recruited at two US sites. ctDNA was collected pre-procedure, 3 weeks post-procedure, and at multiple structured follow-up timepoints. The presence of ctDNA was evaluated using a plasma-only integrated genomic and epigenomic assay (Guardant Reveal, Guardant Health). A bioinformatic classifier was applied to differentiate tumor derived versus non-tumor derived cell-free DNA. Results: Among 52 enrolled pts, post-ctDNA data is available for 45 pts (87%), with a median of 4 (range 1-10) timepoints per pt. The sample analysis failure rate was 1% (2/217). As of 1/1/2021, the radiographic recurrence rate was 60% with a median follow-up time of 50 (range 4-192) weeks. 23 of 25 pts with post-ctDNA(+) have had recurrence (Positive Predictive Value [PPV], 92%). On average, ctDNA was detected 28 weeks before radiographic recurrence (mean 12 vs. 40 weeks, respectively). The two pts with post-ctDNA(+) but no recurrence have > 3 years follow-up; one pt received adjuvant chemotherapy and cleared ctDNA. With a median event-free follow-up time of 97 (range 4-192) weeks, 4 of 20 pts with no post-ctDNA detection (-) have recurred (Negative Predictive Value, 80%). 3 of 4 pts with recurrence despite post-ctDNA(-) also were pre-ctDNA(-). We observed a sensitivity of 85% and a specificity of 89% for the ctDNA assay. The median time to radiographic recurrence was 36 wks for ctDNA(+) vs. not reached for ctDNA(-) (Hazard Ratio, 7.7; 95% CI, 2.6-22.5; P <.001). Conclusions: In mCRC pts undergoing curative intent surgery or radiotherapy, detection of ctDNA post-procedure had a high PPV for cancer recurrence, with a median lead time of 6 months compared to surveillance imaging. Thus, ctDNA holds promise as a biomarker for pt enrollment on clinical trials and as an endpoint for monitoring of response to experimental therapies in this oligometastatic CRC population.
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Affiliation(s)
- Bryant Chee
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Faaiz Ibrahim
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Mikaela Esquivel
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | - Li Zhang
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | | | - Carlos U. Corvera
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Kenzo Hirose
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Eric K. Nakakura
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Katherine Van Loon
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | - Chloe Evelyn Atreya
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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26
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Thiruvengadam NR, Miranda J, Kim C, Behr S, Corvera C, Dai SC, Kirkwood K, Harris HW, Hirose K, Nakakura E, Ostroff JW, Kochman ML, Arain MA. Burden of Ionizing Radiation in the Diagnosis and Management of Necrotizing Pancreatitis. Clin Transl Gastroenterol 2021; 12:e00347. [PMID: 33904509 PMCID: PMC8081480 DOI: 10.14309/ctg.0000000000000347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION A step-up endoscopic or percutaneous approach improves outcomes in necrotizing pancreatitis (NP). However, these require multiple radiographic studies and fluoroscopic procedures, which use low-dose ionizing radiation. The cumulative radiation exposure for treatment of NP has not been well defined. METHODS We conducted a retrospective study of consecutive patients with NP admitted to University of California San Francisco Medical Center from January 2011 to June 2019. We calculated effective doses for fluoroscopic procedures using the dose area product and used the National Cancer Institute tool for computed tomography studies. The primary outcome was the cumulative effective dose (CED). Multivariable logistic regression was used to evaluate risk factors of high exposure (CED > 500 mSv). RESULTS One hundred seventy-one patients with NP (mean follow-up 40 ± 18 months) underwent a median of 7 (interquartile range [IQR] 5-11) computed tomography scans and 7 (IQR 5-12) fluoroscopic procedures. The median CED was 274 mSv (IQR 177-245) and 30% (51) of patients received high exposure. Risk factors of high exposure include multiorgan failure (aOR 3.47, 95%-CI: 1.53-9.88, P = 0.003), infected necrosis (adjusted odds ratio [aOR] 3.89 95%-CI:1.53-9.88, P = 0.005), and step-up endoscopic approach (aOR 1.86, 95%-CI: 1.41-1.84, P = 0.001) when compared with step-up percutaneous approach. DISCUSSION Patients with NP were exposed to a substantial amount of ionizing radiation (257 mSv) as a part of their treatment, and 30% received more than 500 mSv, which corresponds with a 5% increase in lifetime cancer risk. Severity of NP and a step-up endoscopic approach were associated with CED > 500 mSv. Further studies are needed to help develop low-radiation treatment protocols for NP, particularly in patients receiving endoscopic therapy.
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Affiliation(s)
- Nikhil R. Thiruvengadam
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Endoscopic Innovation, Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Janille Miranda
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Christopher Kim
- Abdominal Imaging Section, Department of Radiology, University of California San Francisco, San Francisco, California, USA
| | - Spencer Behr
- Abdominal Imaging Section, Department of Radiology, University of California San Francisco, San Francisco, California, USA
| | - Carlos Corvera
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Sun-Chuan Dai
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Kimberly Kirkwood
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Hobart W. Harris
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Eric Nakakura
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - James W. Ostroff
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Michael L. Kochman
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Endoscopic Innovation, Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mustafa A. Arain
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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27
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Sato M, Hirose K, Ichise K, Yoshino H, Harada T, Hatayama Y, Kawaguchi H, Tanaka M, Fujioka I, Takai Y, Aoki M. Not Only Hypoxia- but Radiation-Induced Epithelial-Mesenchymal Transition Is Modulated by Hypoxia-Inducible Factor 1 in A549 Lung Cancer Cells. Folia Biol (Praha) 2021; 67:62-69. [PMID: 34624938] [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: 06/13/2023]
Abstract
Hypoxia leads to post-treatment metastasis and recurrences of cancer via the epithelial-mesenchymal transition (EMT). Radiotherapy itself may also contribute to the acquisition of EMT phenotypes. Despite extensive studies on the EMT driven by either hypoxia or radiation stimuli, the molecular mechanisms characterizing these EMT events remain unclear. Thus, we aimed to evaluate the differences in the molecular pathways between hypoxia-induced EMT (Hypo-EMT) and radiation-induced EMT (R-EMT). Further, we investigated the therapeutic effects of HIF-1α inhibitor (LW6) on Hypo-EMT and R-EMT cells. A549 cells, lung adenocarcinoma cell line, acquired enhanced wound-healing activity under both hypoxia and irradiation. Localization of E-cadherin was altered from the cell membrane to the cytoplasm in both hypoxia and irradiated conditions. Of note, the expression levels of vimentin, one of the major EMT markers, was enhanced in irradiated cells, while it decreased under hypoxia condition. Importantly, LW6 significantly blocked EMT-related malignant phenotypes in both Hypo-EMT cells and R-EMT cells with concomitant re-location of E-cadherin onto the cell membrane. Moreover, LW6 deflected stress responsive signalling, JNK, activated sustainably under hypoxic condition, and the blockage of JNK impaired EMT phenotypes. Together, this work demonstrated the molecular events underlying Hypo-EMT and R-EMT, and highlighted HIF-1α as a therapeutic target not only in Hypo- EMT, but also in R-EMT.
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Affiliation(s)
- M Sato
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan
- Southern Tohoku BNCT Research Center, Yatsuyamada, Koriyama, Japan
- Department of Radiation Oncology, Southern Tohoku General Hospital, Yatsuyamada, Koriyama, Japan
| | - K Hirose
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan
- Southern Tohoku BNCT Research Center, Yatsuyamada, Koriyama, Japan
- Department of Radiation Oncology, Southern Tohoku General Hospital, Yatsuyamada, Koriyama, Japan
| | - K Ichise
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan
| | - H Yoshino
- Department of Radiation Science, Hirosaki University Graduate School of Health Sciences, Hon-cho, Hirosaki, Japan
| | - T Harada
- Southern Tohoku BNCT Research Center, Yatsuyamada, Koriyama, Japan
| | - Y Hatayama
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan
| | - H Kawaguchi
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan
| | - M Tanaka
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan
| | - I Fujioka
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan
| | - Y Takai
- Southern Tohoku BNCT Research Center, Yatsuyamada, Koriyama, Japan
- Department of Radiation Oncology, Southern Tohoku General Hospital, Yatsuyamada, Koriyama, Japan
| | - M Aoki
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan
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28
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Gomez A, Wisneski AD, Luu HY, Hirose K, Roberts JP, Hirose R, Freise CE, Nakakura EK, Corvera CU. Contemporary Management of Hepatic Cyst Disease: Techniques and Outcomes at a Tertiary Hepatobiliary Center. J Gastrointest Surg 2021; 25:77-84. [PMID: 33083858 PMCID: PMC7850990 DOI: 10.1007/s11605-020-04821-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 06/07/2020] [Accepted: 10/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatic cyst disease is often asymptomatic, but treatment is warranted if patients experience symptoms. We describe our management approach to these patients and review the technical nuances of the laparoscopic approach. METHODS Medical records were reviewed for operative management of hepatic cysts from 2012 to 2019 at a single, tertiary academic medical center. RESULTS Fifty-three patients (39 female) met the inclusion criteria with median age at presentation of 65 years. Fifty cases (94.3%) were performed laparoscopically. Fourteen patients carried diagnosis of polycystic liver disease. Dominant cyst diameter was median 129 mm and located within the right lobe (30), left lobe (17), caudate (2), or was bilobar (4). Pre-operative concern for biliary cystadenoma/cystadenocarcinoma existed for 7 patients. Operative techniques included fenestration (40), fenestration with decapitation (7), decapitation alone (3), and excision (2). Partial hepatectomy was performed in conjunction with fenestration/decapitation for 15 cases: right sided (7), left sided (7), and central (1). One formal left hepatectomy was performed in a polycystic liver disease patient. Final pathology yielded simple cyst (52) and one biliary cystadenoma. Post-operative complications included bile leak (2), perihepatic fluid collection (1), pleural effusion (1), and ascites (1). At median 7.1-month follow-up, complete resolution of symptoms occurred for 34/49 patients (69.4%) who had symptoms preoperatively. Reintervention for cyst recurrence occurred for 5 cases (9.4%). CONCLUSIONS Outcomes for hepatic cyst disease are described with predominantly laparoscopic approach, approach with minimal morbidity, and excellent clinical results.
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Affiliation(s)
- Axel Gomez
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Andrew D Wisneski
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Hubert Y Luu
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - John P Roberts
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Ryutaro Hirose
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Christopher E Freise
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Eric K Nakakura
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Carlos U Corvera
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA.
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Wisneski AD, Carter J, Nakakura EK, Posselt A, Rogers SJ, Cello JP, Arain M, Kirkwood KS, Hirose K, Stewart L, Corvera CU. Ampullary stenosis and choledocholithiasis post Roux-En-Y gastric bypass: challenges of biliary access and intervention. HPB (Oxford) 2020; 22:1496-1503. [PMID: 32340857 DOI: 10.1016/j.hpb.2020.02.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/13/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ampullary stenosis following Roux-en-Y gastric bypass (RYGB) is increasingly encountered. We describe cases of biliary obstruction from ampullary stenosis and choledocholithiasis to illustrate the associated diagnostic and interventional challenges with this condition. METHODS We reviewed medical records of patients with prior RYGB who underwent a biliary access procedure or surgery for non-malignant disease from January 2012-December 2018. RESULTS We identified 15 patients (4 male, 11 female; mean age 53.7 years) who had RYGB on average 11.7 years (range 1-32) years before diagnosis of biliary obstruction. Fourteen patients reported abdominal pain, 5 had nausea/emesis, 12 had elevated liver function tests, and 6 had ascending cholangitis. Mean common bile duct (CBD) diameter at presentation was 16.9 mm (range 4.0-25.0 mm). Operations included 3 transduodenal ampullectomies (2 with biliary bypass), 2 CBD explorations with stone extraction, 1 laparoscopic cholecystectomy alone, 1 Whipple procedure, 1 balloon enteroscopy with sphincterotomy, and 7 transgastric endoscopic retrograde cholangiopancreatography. All ampulla pathology was benign in patients who underwent resection. At follow-up (mean 15.4 months; range 0.23-44.5 months), 12/15 (80%) reported symptom resolution or improvement. DISCUSSION Ampullary stenosis after RYGB presents challenges for diagnostic evaluation and intervention, often requiring multi-disciplinary expertise. The underlying pathology remains to be elucidated.
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Affiliation(s)
- Andrew D Wisneski
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Jonathan Carter
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Eric K Nakakura
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Andrew Posselt
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Stanley J Rogers
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - John P Cello
- University of California San Francisco, Department of Medicine, Division of Gastroenterology, 513 Parnassus Avenue, S-357, San Francisco, CA, 94143-0538, United States
| | - Mustafa Arain
- University of California San Francisco, Department of Medicine, Division of Gastroenterology, 513 Parnassus Avenue, S-357, San Francisco, CA, 94143-0538, United States
| | - Kimberly S Kirkwood
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Kenzo Hirose
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States
| | - Lygia Stewart
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States; San Francisco Veterans Affairs Medical Center, Department of Surgery, 4150 Clement Street, Box 112, San Francisco, CA, 94121, United States
| | - Carlos U Corvera
- University of California San Francisco, Department of Surgery, 513 Parnassus Avenue S-321, San Francisco, CA, 94143-0470, United States; San Francisco Veterans Affairs Medical Center, Department of Surgery, 4150 Clement Street, Box 112, San Francisco, CA, 94121, United States.
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Wisneski AD, Jin C, Huang CY, Warren R, Hirose K, Nakakura EK, Corvera CU. Synchronous Versus Metachronous Colorectal Liver Metastasis Yields Similar Survival in Modern Era. J Surg Res 2020; 256:476-485. [PMID: 32798995 DOI: 10.1016/j.jss.2020.06.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/27/2020] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Synchronous colorectal cancer liver metastasis (CRLM) has been viewed as being more aggressive and having shorter survival than metachronous disease. Advances in CRLM management led us to examine differences in treatment characteristics of synchronous versus metachronous CRLM patients along with survival and recurrence. MATERIALS AND METHODS A retrospective review of hepatic resection for CRLM at a tertiary academic medical center was performed for two periods: a historic cohort from 1992 to 2010 (n = 121), and a modern cohort (n = 179) from 2012 to 2018. Clinical variables were compared between the patient groups, and survival outcomes were characterized. RESULTS Five-year disease-specific survival for the modern synchronous group compared to the historic synchronous group was 71.7% versus 44.3% (P = 0.02). Modern metachronous versus modern synchronous 5-y disease-specific survival rates were 49.8% versus 71.7% (P = 0.31). Compared to the historic cohort, the modern one had significantly different timing of hepatic resection (P < 0.01) with increased use of liver-first (30.1% versus 7.5%) and simultaneous liver-colon resections (24.1% versus 10.4%), along with greater use of neoadjuvant chemotherapy (96.4% versus 65.6%; P < 0.01). Significantly more patients in the modern synchronous cohort had disease-free or alive-with-disease status at last follow-up, compared to the historic group (P < 0.01), and experienced less disease recurrence (62.7% versus 77.6%; P < 0.05). CONCLUSIONS Modern synchronous CRLM patients who underwent hepatic resection experienced significantly improved survival compared to a historic cohort. We postulate that increased use of neoadjuvant chemotherapy and liver-first/simultaneous liver-colon resections in the modern synchronous cohort contributed to improved survival.
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Affiliation(s)
- Andrew D Wisneski
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Robert Warren
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Eric K Nakakura
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Carlos U Corvera
- Department of Surgery, University of California San Francisco, San Francisco, California.
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Lancaster E, Inglis-Arkell C, Hirose K, Seib CD, Wick E, Sosa JA, Duh QY. Variability in Opioid-Prescribing Patterns in Endocrine Surgery and Discordance With Patient Use. JAMA Surg 2020; 154:1069-1070. [PMID: 31411647 DOI: 10.1001/jamasurg.2019.2518] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Christina Inglis-Arkell
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco
| | - Kenzo Hirose
- Department of Surgery, University of California, San Francisco
| | - Carolyn D Seib
- Department of Surgery, University of California, San Francisco
| | - Elizabeth Wick
- Department of Surgery, University of California, San Francisco
| | - Julie A Sosa
- Department of Surgery, University of California, San Francisco
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco
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Kitajima N, Takikawa K, Sekiya H, Satoh K, Asanuma D, Sakamoto H, Takahashi S, Hanaoka K, Urano Y, Namiki S, Iino M, Hirose K. Real-time in vivo imaging of extracellular ATP in the brain with a hybrid-type fluorescent sensor. eLife 2020; 9:57544. [PMID: 32648544 PMCID: PMC7398694 DOI: 10.7554/elife.57544] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 04/03/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
Adenosine 5' triphosphate (ATP) is a ubiquitous extracellular signaling messenger. Here, we describe a method for in-vivo imaging of extracellular ATP with high spatiotemporal resolution. We prepared a comprehensive set of cysteine-substitution mutants of ATP-binding protein, Bacillus FoF1-ATP synthase ε subunit, labeled with small-molecule fluorophores at the introduced cysteine residue. Screening revealed that the Cy3-labeled glutamine-105 mutant (Q105C-Cy3; designated ATPOS) shows a large fluorescence change in the presence of ATP, with submicromolar affinity, pH-independence, and high selectivity for ATP over ATP metabolites and other nucleotides. To enable in-vivo validation, we introduced BoNT/C-Hc for binding to neuronal plasma membrane and Alexa Fluor 488 for ratiometric measurement. The resulting ATPOS complex binds to neurons in cerebral cortex of living mice, and clearly visualized a concentrically propagating wave of extracellular ATP release in response to electrical stimulation. ATPOS should be useful to probe the extracellular ATP dynamics of diverse biological processes in vivo.
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Affiliation(s)
- Nami Kitajima
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Takikawa
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Sekiya
- Department of Physiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaname Satoh
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Asanuma
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirokazu Sakamoto
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shodai Takahashi
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Kenjiro Hanaoka
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Yasuteru Urano
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.,Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeyuki Namiki
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masamitsu Iino
- Department of Cellular and Molecular Pharmacology, Nihon University School of Medicine, Tokyo, Japan
| | - Kenzo Hirose
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,International Research Center for Neurointelligence, The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Tokyo, Japan
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Kasai Y, Mahuron K, Hirose K, Corvera CU, Kim GE, Hope TA, Shih BE, Warren RS, Bergsland EK, Nakakura EK. A novel stratification of mesenteric mass involvement as a predictor of challenging mesenteric lymph node dissection by minimally invasive approach for ileal neuroendocrine tumors. J Surg Oncol 2020; 122:204-211. [PMID: 32291778 DOI: 10.1002/jso.25930] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/09/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES We classified the extent of mesenteric mass (MM) involvement that predicts challenging mesenteric lymph node dissection (mLND) by minimally invasive surgery (MIS) for ileal neuroendocrine tumors (i-NETs). METHODS Patients who underwent surgery for i-NETs were retrospectively reviewed. MM involvement was classified as region-0: no MM; region-1: >2 cm from the origins of the ileocolic artery/vein; region-2: ≤2 cm from the origins; and region-3: more proximal superior mesenteric artery/vein. Logistic regression analysis was used to evaluate the predictive value of MM regions for gross positive mesenteric margin (mR2) and/or conversion among the MIS cohort. The open surgery cohort was used as a reference for mR2 rates. RESULTS Of 108 patients, 83 patients (77%) underwent MIS. MMs in region-2 and region-3 were independent risk factors for mR2 and/or conversion (odds ratio [95% confidence interval]: 4.25 [1.17-16.4] and 8.51 × 107 [11.0-], respectively, against regions-0 and 1]. mR2 rates of MIS and open surgery cohorts per region did not differ significantly (4% and 7% for regions-0 and 1; 17% and 25% for region-2; and 100% and 83% for region-3). CONCLUSIONS The novel stratification of MM regions was predictive of challenging mLND by MIS. Surgeons should have a low threshold for conversion for MMs in proximal regions.
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Affiliation(s)
- Yosuke Kasai
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Kelly Mahuron
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Kenzo Hirose
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Carlos U Corvera
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Grace E Kim
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Thomas A Hope
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Brandon E Shih
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Robert S Warren
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Emily K Bergsland
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Medicine, University of CFACS, California, San Francisco, San Francisco, California
| | - Eric K Nakakura
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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Ichikawa N, Homma S, Funakoshi T, Ohshima T, Hirose K, Yamada K, Nakamoto H, Kazui K, Yokota R, Honma T, Maeda Y, Yoshida T, Ishikawa T, Iijima H, Aiyama T, Taketomi A. Impact of technically qualified surgeons on laparoscopic colorectal resection outcomes: results of a propensity score-matching analysis. BJS Open 2020; 4:486-498. [PMID: 32207580 PMCID: PMC7260420 DOI: 10.1002/bjs5.50263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/21/2019] [Indexed: 02/06/2023] Open
Abstract
Background The Endoscopic Surgical Skill Qualification System (ESSQS) was introduced in Japan to improve the quality of laparoscopic surgery. This cohort study investigated the short‐ and long‐term postoperative outcomes of colorectal cancer laparoscopic procedures performed by or with qualified surgeons compared with outcomes for unqualified surgeons. Methods All laparoscopic colorectal resections performed from 2010 to 2013 in 11 Japanese hospitals were reviewed retrospectively. The procedures were categorized as performed by surgeons with or without the ESSQS qualification and patients' clinical, pathological and surgical features were used to match subgroups using propensity scoring. Outcome measures included postoperative and long‐term results. Results Overall, 1428 procedures were analysed; 586 procedures were performed with ESSQS‐qualified surgeons and 842 were done by ESSQS‐unqualified surgeons. Upon matching, two cohorts of 426 patients were selected for comparison of short‐term results. A prevalence of rectal resection (50·3 versus 40·5 per cent; P < 0·001) and shorter duration of surgery (230 versus 238 min; P = 0·045) was reported for the ESSQS group. Intraoperative and postoperative complication and reoperation rates were significantly lower in the ESSQS group than in the non‐ESSQS group (1·2 versus 3·6 per cent, P = 0·014; 4·6 versus 7·5 per cent, P = 0·025; 1·9 versus 3·9 per cent, P = 0·023, respectively). These findings were confirmed after propensity score matching. Cox regression analysis found that non‐attendance of ESSQS‐qualified surgeons (hazard ratio 12·30, 95 per cent c.i. 1·28 to 119·10; P = 0·038) was independently associated with local recurrence in patients with stage II disease. Conclusion Laparoscopic colorectal procedures performed with ESSQS‐qualified surgeons showed improved postoperative results. Further studies are needed to investigate the impact of the qualification on long‐term oncological outcomes.
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Affiliation(s)
- N Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
| | - S Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
| | - T Funakoshi
- Department of Surgery, Sapporo-Kosei General Hospital, Sapporo
| | - T Ohshima
- Department of Surgery, Sapporo City General Hospital, Sapporo
| | - K Hirose
- Department of Surgery, Tomakomai City Hospital, Tomakomai
| | - K Yamada
- Department of Surgery, Asahikawa-Kosei General Hospital, Asahikawa
| | - H Nakamoto
- Department of Surgery, KKR Sapporo Medical Centre, Sapporo
| | - K Kazui
- Department of Surgery, Hokkaido Hospital, Japan Community Healthcare Organization, Sapporo
| | - R Yokota
- Department of Surgery, Sunagawa City Medical Centre, Sunagawa
| | - T Honma
- Department of Surgery, Obihiro Kyokai Hospital, Obihiro
| | - Y Maeda
- Department of Gastroenterological Surgery, Hokkaido Cancer Centre, Sapporo
| | - T Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
| | - T Ishikawa
- Department of Surgery, Kushiro Rosai Hospital, Japan Labour Health and Welfare Organization, Kushiro
| | - H Iijima
- Clinical Research and Medical Innovation Centre, Hokkaido University Hospital, Sapporo
| | - T Aiyama
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
| | - A Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo
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Takaki H, Kobayashi N, Hirose K. SAKE: first-principles electron transport calculation code. J Phys Condens Matter 2020; 32:325901. [PMID: 32191926 DOI: 10.1088/1361-648x/ab8153] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We developed and implemented a numerical code called SAKE, which stands for (simulation code for atomistic Kohn-Sham equation). We developed it for first-principle electron transport calculations based on density-functional theory and non-equilibrium Green's function formalism. First, we present the central calculation parts of the formalism of the electronic states and transport properties for open and non-equilibrium systems. We show specific computational techniques, such as the use of a complex contour integration for charge density from the density matrix, which is compared with the calculation method of summing the residues of the Fermi-Dirac distribution, as well as the efficient achievement of the self-consistent procedures. Thereafter, for applications of the present computation code, SAKE, we present first-principle calculation results of three different systems. We first analyze electronic structures of polythiophene molecular wires, compare summation techniques for the density matrix. We show thermoelectric properties of an n-type antiferromagnetic semiconductor CuFeS2 as a second application. The electrical conductance, electrical thermal conductance, and the Seebeck coefficients with carrier doping are examined, and the analytical form of the Seebeck coefficient is briefly described. For the third application, we analyze the electron transport properties of polyaniline molecular wires under structural deformations, i.e. rotations around the transport direction. The thermally averaged current-voltage characteristics are also analyzed. The results show that the current decreases as the temperature increases which are determined based on the competition between the thermal energy and the electronic energy, which increases with the rotation angle.
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Affiliation(s)
- H Takaki
- Faculty of Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Japan
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Kasai Y, Hirose K, Corvera CU, Kim GE, Hope TA, Shih BE, Harun N, Kim MO, Warren RS, Bergsland EK, Nakakura EK. Residual tumor volume discriminates prognosis after surgery for neuroendocrine liver metastasis. J Surg Oncol 2020; 121:330-336. [PMID: 31828813 DOI: 10.1002/jso.25811] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/05/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES We developed objective measurements of preoperative and residual tumor volume, and debulking rate, to evaluate their prognostic value for neuroendocrine liver metastasis (NELM). METHODS Seventy-three patients who underwent surgery for NELM were analyzed retrospectively. Indices of preoperative and postoperative residual tumor volume (pre-volume index [VI] and post-VI) were calculated as the sum of the cubes of individual tumor diameters on preoperative and postoperative imaging, respectively. The debulking rate (%) was calculated as 100 - 100 × post-VI/pre-VI. The classification and regression trees method was used to classify pre-VI and post-VI. RESULTS Overall survival (OS) was discriminated by preoperative tumor volume (5-year OS rates, 87.8% for low pre-VI and 60.1% for high pre-VI; P = .037) and residual tumor volume (5-year OS rates, 88.1% for low post-VI and 24.8% for high post-VI; P < .001). In contrast, debulking rates of 100%, ≥90%, and <90% did not discriminate OS (5-year OS rates, 88.0%, 61.9%, and 58.9%, respectively, not significant). In multivariate analysis, residual tumor volume (high post-VI, hazard ratio, 6.40; 95% confidence interval, 1.45-32.3) was an independent prognostic factor for OS. CONCLUSIONS Objective measurement of tumor volume demonstrates that residual tumor volume is prognostic after surgery for NELM.
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Affiliation(s)
- Yosuke Kasai
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Kenzo Hirose
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Carlos U Corvera
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Grace E Kim
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Thomas A Hope
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Brandon E Shih
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Nusrat Harun
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Mi-Ok Kim
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Robert S Warren
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Emily K Bergsland
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Eric K Nakakura
- Department of Surgery, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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Bongiovanni T, Hansen K, Lancaster E, O’Sullivan P, Hirose K, Wick E. Adopting best practices in post-operative analgesia prescribing in a safety-net hospital: Residents as a conduit to change. Am J Surg 2020; 219:299-303. [DOI: 10.1016/j.amjsurg.2019.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
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Antonia RJ, Toriguchi K, Karelehto E, Annuar D, Timmerman L, Tbeileh N, Mattis AN, Corvera CU, Hirose K, Nakakura EK, Donner DB, Warren RS. Patient-derived organoids for personalized drug screening in intrahepatic cholangiocarcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.581] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
Abstract
581 Background: Despite standard treatment with gemcitabine and cisplatin, median survival for unresectable Intrahepatic Cholangiocarcinoma (ICC) is < 1 year. Clearly, novel therapeutic strategies are urgently needed. The paucity of targetable mutations in ICC and the as yet unproven benefit of genetically targeted drugs led us to ask whether a reliable clinical benefit may be revealed by patient-specific therapeutic testing in novel models of ICC. Here we describe our ability to establish patient-derived three-dimensional organoid cultures (PDO) that enable individualized identification of active single agents or drug combinations in surrogate models of ICC. Methods: To model patient-specific drug responses, we used the freshly resected ICCs from small samples of single patient tumors to generate PDXs and PDOs, small spheroidal clusters of tumor cells grown in vitro. We have employed a high-throughput drug screening platform using AI-enhanced robotics (Yamaha Motor Corporation) to identify and distribute single, uniformly sized PDOs into 384-well ultra-low adherent plates. This is coupled with a TECAN D300e drug dispenser that rapidly delivers nanoliter volumes of a 34-drug panel, thereby facilitating rapid, reliable drug response analyses. Results: Our data show that PDOs retain characteristic genomic and histological features of the patients’ tumors. Drug responses were specific to each patient tumor, but PDOs from all patients responded to a greater or lesser degree to mTOR inhibition, suggesting that this pathway is important in ICC. The responses of PDO to the mTOR inhibitor Sapanisertib (INK128), was recapitulated in the same patient’s PDX. Further, INK128 was synergistic with gemcitabine in patient 970 PDOs as well as in vivo in PDX also from patient 970. Conclusions: As it is believed that PDX can predict patient responses to drugs, our results suggest that PDO may also predict patient drug responses. The establishment of PDO may allow economical patient-specific, high throughput drug screens that could ultimately inform clinical practice. [Table: see text]
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Affiliation(s)
| | - Kan Toriguchi
- University of California San Francisco, San Francisco, CA
| | | | - Dania Annuar
- University of California San Francisco, San Francisco, CA
| | | | - Noura Tbeileh
- University of California San Francisco, San Francisco, CA
| | - Aras N. Mattis
- University of California San Francisco, San Francisco, CA
| | - Carlos U. Corvera
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Kenzo Hirose
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Eric K. Nakakura
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Takahashi S, Hanaoka K, Okubo Y, Echizen H, Ikeno T, Komatsu T, Ueno T, Hirose K, Iino M, Nagano T, Urano Y. Rational Design of a Near-infrared Fluorescence Probe for Ca 2+ Based on Phosphorus-substituted Rhodamines Utilizing Photoinduced Electron Transfer. Chem Asian J 2020; 15:524-530. [PMID: 31909880 DOI: 10.1002/asia.201901689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/05/2019] [Indexed: 12/12/2022]
Abstract
Fluorescence imaging in the near-infrared (NIR) region (650-900 nm) is useful for bioimaging because background autofluorescence is low and tissue penetration is high in this range. In addition, NIR fluorescence is useful as a complementary color window to green and red for multicolor imaging. Here, we compared the photoinduced electron transfer (PeT)-mediated fluorescence quenching of silicon- and phosphorus-substituted rhodamines (SiRs and PRs) in order to guide the development of improved far-red to NIR fluorescent dyes. The results of density functional theory calculations and photophysical evaluation of a series of newly synthesized PRs confirmed that the fluorescence of PRs was more susceptible than that of SiRs to quenching via PeT. Based on this, we designed and synthesized a NIR fluorescence probe for Ca2+ , CaPR-1, and its membrane-permeable acetoxymethyl derivative, CaPR-1 AM, which is distributed to the cytosol, in marked contrast to our previously reported Ca2+ far-red to NIR fluorescence probe based on the SiR scaffold, CaSiR-1 AM, which is mainly localized in lysosomes as well as cytosol in living cells. CaPR-1 showed longer-wavelength absorption and emission (up to 712 nm) than CaSiR-1. The new probe was able to image Ca2+ at dendrites and spines in brain slices, and should be a useful tool in neuroscience research.
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Affiliation(s)
- Shodai Takahashi
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenjiro Hanaoka
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yohei Okubo
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Honami Echizen
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takayuki Ikeno
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Toru Komatsu
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tasuku Ueno
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenzo Hirose
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masamitsu Iino
- Division of Cellular and Molecular Pharmacology, Nihon University School of Medicine, 30-1 Oyaguchi kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tetsuo Nagano
- Drug Discovery Initiative, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasuteru Urano
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,AMED-CREST, Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
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40
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Okubo Y, Iino M, Hirose K. Store-operated Ca 2+ entry-dependent Ca 2+ refilling in the endoplasmic reticulum in astrocytes. Biochem Biophys Res Commun 2019; 522:1003-1008. [PMID: 31812243 DOI: 10.1016/j.bbrc.2019.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 12/11/2022]
Abstract
Astrocytes regulate various brain functions, for which Ca2+ release from the endoplasmic reticulum (ER) often play crucial roles. Because astrocytic ER Ca2+ release is robust and frequent, the ER Ca2+ refilling mechanism should be critical for ongoing Ca2+ signaling in astrocytes. In this study, we focused on the putative functional significance of store-operated Ca2+ entry (SOCE) in ER Ca2+ refilling. We expressed the ER luminal Ca2+ indicator G-CEPIA1er in astrocytes in acute cortical slices to directly monitor the decrease and recovery of ER Ca2+ concentration upon spontaneous or norepinephrine-induced Ca2+ release. Inhibition of SOCE significantly slowed the recovery of ER Ca2+ concentration after Ca2+ release in astrocytes. This delayed recovery resulted in a prolonged decrease in the ER Ca2+ content in astrocytes with periodic spontaneous Ca2+ release, followed by the attenuation of cytosolic Ca2+ responses upon Ca2+ release. Therefore, our results provide direct evidence for the physiological significance of SOCE in ER Ca2+ refilling after ER Ca2+ release.
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Affiliation(s)
- Yohei Okubo
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 133-0033, Japan.
| | - Masamitsu Iino
- Division of Cellular and Molecular Pharmacology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kenzo Hirose
- Department of Pharmacology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 133-0033, Japan
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41
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Lancaster E, Bongiovanni T, Lin J, Croci R, Wick E, Hirose K. Residents as Key Effectors of Change in Improving Opioid Prescribing Behavior. J Surg Educ 2019; 76:e167-e172. [PMID: 31155453 DOI: 10.1016/j.jsurg.2019.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 05/05/2023]
Abstract
OBJECTIVE There is a national imperative to curb the flow of opioids into our communities. In academic medical centers, the majority of discharge opioid prescriptions are written by residents who receive predominantly ad hoc, peer-to-peer education on perioperative analgesia. We aimed to reduce opioid overprescribing after common general surgical operations through a resident led quality improvement project that involved formal educational interventions and feedback on prescribing habits. DESIGN A transdisciplinary team was formed to identify how current prescribing habits differed from best practices, and to identify the educational needs to bridge this gap. We then focused on multiple educational interventions, including department-wide grand rounds, case-based conferences with residents, and dedicated didactic sessions on opioid prescribing. Feedback reports of opioid prescribing habits of the residents were developed. Residents' attitudes toward opioid prescribing were assessed using an anonymous survey before and after our interventions. Actual opioid prescribing data were abstracted from the electronic health record. SETTING A single academic medical center. PARTICIPANTS A surgical resident led a transdisciplinary team consisting of faculty, anesthesiologists, pharmacists, advanced practice providers, and health informaticians within the Department of Surgery. RESULTS After our educational intervention, residents' impression of the appropriate number of opioid pills necessary after common general surgical operations decreased significantly, as measured by surveys pre- and postintervention. Electronic health record data regarding actual opioid prescribing behavior show significant discrepancy from the survey responses, but does show a significant decrease in the quantity of opioids prescribed for most evaluated operations following the educational intervention. CONCLUSIONS Opioid prescribing is an ideal target for resident led education and quality improvement. Residents' attitudes toward appropriate opioid prescribing tend to differ from actual prescribing habits. Our results demonstrate that a well-scoped, resident-driven quality improvement program can lead to change in both attitudes and practice surrounding opioid prescribing.
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Affiliation(s)
- Elizabeth Lancaster
- University of California San Francisco, Department of Surgery, San Francisco, California.
| | - Tasce Bongiovanni
- Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Joseph Lin
- University of California San Francisco, Department of Surgery, San Francisco, California
| | - Rhiannon Croci
- University of California San Francisco, Department of Health Informatics, San Francisco, California
| | - Elizabeth Wick
- University of California San Francisco, Department of Surgery, San Francisco, California
| | - Kenzo Hirose
- University of California San Francisco, Department of Surgery, San Francisco, California
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Kasai Y, Mahuron K, Hirose K, Corvera CU, Kim GE, Hope TA, Shih BE, Warren RS, Bergsland EK, Nakakura EK. Prognostic impact of a large mesenteric mass >2 cm in ileal neuroendocrine tumors. J Surg Oncol 2019; 120:1311-1317. [DOI: 10.1002/jso.25727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/14/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Yosuke Kasai
- Department of SurgeryUniversity of California San Francisco California
- UCSF Helen Diller Family Comprehensive Cancer Center San Francisco California
| | - Kelly Mahuron
- Department of SurgeryUniversity of California San Francisco California
| | - Kenzo Hirose
- Department of SurgeryUniversity of California San Francisco California
- UCSF Helen Diller Family Comprehensive Cancer Center San Francisco California
| | - Carlos U. Corvera
- Department of SurgeryUniversity of California San Francisco California
- UCSF Helen Diller Family Comprehensive Cancer Center San Francisco California
| | - Grace E. Kim
- UCSF Helen Diller Family Comprehensive Cancer Center San Francisco California
- Department of PathologyUniversity of California San Francisco California
| | - Thomas A. Hope
- UCSF Helen Diller Family Comprehensive Cancer Center San Francisco California
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California
| | - Brandon E. Shih
- UCSF Helen Diller Family Comprehensive Cancer Center San Francisco California
| | - Robert S. Warren
- Department of SurgeryUniversity of California San Francisco California
- UCSF Helen Diller Family Comprehensive Cancer Center San Francisco California
| | - Emily K. Bergsland
- UCSF Helen Diller Family Comprehensive Cancer Center San Francisco California
- Department of MedicineUniversity of California San Francisco California
| | - Eric K. Nakakura
- Department of SurgeryUniversity of California San Francisco California
- UCSF Helen Diller Family Comprehensive Cancer Center San Francisco California
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Lancaster E, Bongiovanni T, Wick E, Hirose K. Postoperative Pain Control: Barriers to Quality Improvement. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.163] [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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44
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Kasai Y, Mahuron KM, Hirose K, Corvera CU, Kim GE, Shih BE, Warren RS, Bergsland EK, Nakakura EK. Prognostic Impact of Desmoplastic Lymphadenopathy on Preoperative Imaging in Ileum Neuroendocrine Tumors. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.775] [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: 11/30/2022]
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45
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Hirose K, Konno A, Yoshimoto S, Ono K, Otsuki N, Hatazawa J, Hiratsuka J, Takai Y. Updated results of a phase II study evaluating accelerator-based boron neutron capture therapy (AB-BNCT) with borofalan(10B) (SPM-011) in recurrent squamous cell carcinoma (R-SCC-HN) and recurrent and locally advanced non-SCC (R/LA-nSCC-HN) of the head and neck. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fukunaga M, Hirose K, Isotani A, Morinaga T, Ando K. P6355The behavior of atrial fibrillation in patients with heart failure hospitalization. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0951] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Relationship between atrial fibrillation (AF) and heart failure (HF) is often compared with proverbial question of which came first, the chicken or the egg. Some patients showing AF at the HF admission result in restoration of sinus rhythm (SR) at discharge. It is not well elucidated that the restoration into SR during hospitalization can render the preventive effect for rehospitalization.
Purpose
To investigate the impact of restoration into SR during hospitalization for readmission rate of the HF patients showing AF.
Methods
We enrolled consecutive 640 HF patients hospitalized from January 2015 to December 2015. Patients data were retrospectively investigated from medical record. Patients showing atrial fibrillation on admission but unrecognized ever were defined as “incident AF”; patients with AF diagnosed before admission were defined as “prevalent AF”. Primary endpoint was a composite of death from cardiovascular disease or hospitalization for worsening heart failure. Secondary endpoints were death from cardiovascular disease, unplanned hospitalization related to heart failure, and any hospitalization.
Results
During mean follow up of 19 months, 139 patients (22%) were categorized as incident AF and 145 patients (23%) were categorized as prevalent AF. Among 239 patients showing AF on admission, 44 patients were discharged in SR (39 patients in incident AF and 5 patients in prevalent AF). Among incident AF patients, the primary composite end point occurred in significantly fewer in those who discharged in SR (19% vs. 42% at 1-year; 23% vs. 53% at 2-year follow-up, p=0.005). To compare the risk factors related to readmission due to HF with the cox proportional-hazards model, AF only during hospitalization [Hazard Ratio (HR)=0.37, p<0.01] and prevalent AF (HR=1.67, p=0.04) was significantly associated. There was no significant difference depending on LVEF.
Conclusion
Newly diagnosed AF with restoration to SR during hospitalization was a good marker to forecast future prognosis.
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Affiliation(s)
- M Fukunaga
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - K Hirose
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - A Isotani
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - T Morinaga
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - K Ando
- Kokura Memorial Hospital, Kitakyushu, Japan
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47
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Esquivel M, Chee B, Shih B, Zhang L, Corvera CU, Hirose K, Nakakura EK, Van Loon K, Raymond VM, Dix D, Odegaard J, Atreya CE. Circulating tumor derived cell-free DNA (ctDNA) to predict recurrence of metastatic colorectal cancer (mCRC) following curative intent surgery or radiation: Interim results. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.552] [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
552 Background: Over half of patients (pts) with oligometastatic CRC treated with definitive surgery or radiotherapy experience cancer recurrence. Early detection of ctDNA could identify high risk pts for additional intervention to eliminate micrometastatic disease. Here we report interim results of a prospective study aiming to determine ctDNA detection rates using a sensitive multigene assay and to correlate post-procedure ctDNA detection with radiographic mCRC recurrence. Methods: Pts with mCRC intending to undergo a curative intent procedure were prospectively recruited at a single site. ctDNA was collected pre-procedure, 3 weeks (wks) post-procedure, and at multiple follow-up timepoints. ctDNA detection utilizing a multi-gene sequencing panel (Guardant Health) included somatic variant and epigenetic assessments. A novel variant classifier was applied to differentiate tumor derived versus non-tumor derived alterations. A Simon’s two-stage design with planned interim analysis to assess 3wk post-procedure ctDNA detection rate was employed. Results: Of 25 pts enrolled, 21 (84%) had evaluable paired pre- and post-procedure samples. In these 21 pts, the 3 wks post-procedure sample was collected after surgery (N = 20) or radiation (N = 1) to address liver (N = 17), lung (N = 3), or ovarian (N = 1) metastases ± colon resection (N = 6). ctDNA was detected (+) in 15/21 (71%) pre- and 11/21 (52%) post-procedure samples. ctDNA was (+) in 8/12 (67%) pre- and 8/17 (47%) post-procedure samples with carcinoembryonic antigen < 5 ng/ml. Conclusions: In this interim analysis of pts with mCRC undergoing curative intent procedures, the post-procedure ctDNA detection rate was 52%. The similarity between the observed post-procedure ctDNA detection and expected recurrence rate suggests promise for recurrence prediction using this approach. Given post-procedure ctDNA was (+) in > 3 pts, the study will continue to enroll, and pts are being followed for future correlation of ctDNA with radiographic recurrence. [Table: see text]
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Affiliation(s)
- Mikaela Esquivel
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Bryant Chee
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Brandon Shih
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Li Zhang
- UC San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Carlos U. Corvera
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Kenzo Hirose
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Eric K. Nakakura
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Katherine Van Loon
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | | | - Chloe Evelyn Atreya
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Okubo Y, Kanemaru K, Suzuki J, Kobayashi K, Hirose K, Iino M. Inositol 1,4,5-trisphosphate receptor type 2-independent Ca2+
release from the endoplasmic reticulum in astrocytes. Glia 2018; 67:113-124. [DOI: 10.1002/glia.23531] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Yohei Okubo
- Department of Pharmacology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Kazunori Kanemaru
- Department of Pharmacology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
- Department of Cellular and Molecular Pharmacology; Nihon University School of Medicine; Tokyo Japan
| | - Junji Suzuki
- Department of Physiology; University of California San Francisco; San Francisco California
| | - Kenta Kobayashi
- Section of Viral Vector Development; National Institute for Physiological Sciences; Okazaki Japan
- The Graduate University for Advanced Studies (SOKENDAI); Hayama Japan
| | - Kenzo Hirose
- Department of Neurobiology; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Masamitsu Iino
- Department of Cellular and Molecular Pharmacology; Nihon University School of Medicine; Tokyo Japan
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Hida S, Igarashi Y, Hirose K, Saitoh T, Hatano T, Morishima T, Yamashita J, Murata N, Goto M, Itoh R, Chikamori T. 2459Diagnostic value of simultaneous dual-isotope imaging with 99mTc-sestamibi and 123I-BMIPP using cadmium-zinc-telluride SPECT system in patients with acute myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Hida
- Tokyo Medical University, Tokyo, Japan
| | | | - K Hirose
- Tokyo Medical University, Tokyo, Japan
| | - T Saitoh
- Tokyo Medical University, Tokyo, Japan
| | - T Hatano
- Tokyo Medical University, Tokyo, Japan
| | | | | | - N Murata
- Tokyo Medical University, Tokyo, Japan
| | - M Goto
- Tokyo Medical University, Tokyo, Japan
| | - R Itoh
- Tokyo Medical University, Tokyo, Japan
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50
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Hiramori S, Soga Y, Tomoi Y, Ito N, Hirose K, Shirai S, Ando K. P3566Impact of baseline characteristics on efficacy of cilostazol for patients performing endovascular therapy for femoropopliteal lesions. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Hiramori
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - Y Soga
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - Y Tomoi
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - N Ito
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - K Hirose
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - S Shirai
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - K Ando
- Kokura Memorial Hospital, Kitakyushu, Japan
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