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Okamura Y, Nishitai R, Sasaki N, Ito H, Sakamoto T, Itokawa Y, Kusumoto M, Nakai Y, Yamaoka T, Manaka D. Neoadjuvant therapy with intensity-modulated radiotherapy combined with S-1 for borderline-resectable pancreatic cancer. Asia Pac J Clin Oncol 2024. [PMID: 38771310 DOI: 10.1111/ajco.14080] [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: 09/21/2023] [Revised: 03/23/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
AIM We evaluated the efficacy of neoadjuvant chemotherapy with intensity-modulated radiotherapy (NAC-IMRT) in patients with borderline-resectable pancreatic cancer (BRPC). METHODS BRPC patients were treated with IMRT (45 Gy/15fr) combined with two courses of S-1 (40 mg/m2 bid) before surgery. Outcomes after NAC-IMRT, surgery, and survival were then evaluated. This single-center retrospective study assessed 26 consecutive patients. RESULTS Twenty-six patients (BR-PV: 7, BR-A: 19) with a median age of 73 years were enrolled from 2016 to 2021. Ten (38%) patients were 75-years-old and above. Twenty-three patients completed NAC-IMRT treatment. The median reductions in tumor size and cancer antigen 19-9 level were 13.6% and 69%, respectively. All 26 patients underwent resection within a median time of 71 days after NAC-IMRT initiation. R0 resection was achieved in 24 patients (92%). The median overall survival (OS) was 28.0 months, and the 1- and 3-year OS rates were 100% and 34%, respectively. The median progression-free survival (PFS) was 12.5 months, and the 1- and 3-year PFS rates were 50% and 32%, respectively. No significant differences were observed in OS between the patients under and over the age of 75 (29 vs. 20 months, p = 0.86). The 12 patients who completed NAC-IMRT, resection, and subsequent adjuvant chemotherapy (AC) exhibited a 3-year survival rate of 73%, which was significantly better than that of the patients who did not receive or complete AC (median OS, not reached vs. 19 months, p < 0.001). CONCLUSION NAC-IMRT showed outstanding clinical efficacy with acceptable tolerability in patients with BRPC, including geriatric patients.
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Affiliation(s)
- Yusuke Okamura
- Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Ryuta Nishitai
- Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Naoya Sasaki
- Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hitoshi Ito
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Takashi Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yoshio Itokawa
- Department of Gastroenterological Medicine, Kyoto Katsura Hospital, Kyoto, Japan
| | - Masanori Kusumoto
- Department of Gastroenterological Medicine, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yoshitaka Nakai
- Department of Gastroenterological Medicine, Kyoto Katsura Hospital, Kyoto, Japan
| | - Toshihide Yamaoka
- Department of Diagnostic Imaging and Interventional Radiology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Dai Manaka
- Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
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Kanazawa H, Shimoda T, Kou N, Okamura Y, Ito H. Optic nerve sheath diameter measurement using ultrasonography: associations with in-hospital mortality in COVID-19 intensive care unit admissions. QJM 2023; 116:617-618. [PMID: 37079750 DOI: 10.1093/qjmed/hcad070] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- H Kanazawa
- The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - T Shimoda
- University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - N Kou
- Chiba University Hospital, Chiba, Chiba, Japan
| | - Y Okamura
- College of Medicine, School of Medicine and Health Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - H Ito
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
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Sasaki N, Okamura Y, Nishitai R. Real-Time Fluorescent Cholangiography by Intrabiliary Indocyanine Green Administration With Near-Infrared Laparoscopy in Major Hepatectomy. Cureus 2023; 15:e40769. [PMID: 37485116 PMCID: PMC10362199 DOI: 10.7759/cureus.40769] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND AND PURPOSE Biliary injury is a severe complication that can be associated with liver surgery. Intrahepatic biliary anatomy can be evaluated using magnetic resonance cholangiopancreatography and X-ray cholangiography; however, an intraoperative real-time bile duct visualization method has not yet been reported. This study aimed to demonstrate the availability of real-time fluorescent cholangiography (FC) by intrabiliary indocyanine green administration with near-infrared laparoscopy in major hepatectomy. METHODS The optimal concentration of indocyanine green (ICG) solution was examined ex vivo. The fluorescence intensity of the ICG solution and its mixture with bile was measured. Using a clinical trial model, ICG solution was injected into the cystic duct, followed by near-infrared laparoscopy performed during hepatectomy. RESULTS The optimal concentration of ICG solution for FC was between 0.01 and 0.05 mg/mL. Three different laparoscopic systems were used in three hepatectomy cases. In all cases, the fluorescence of the intrahepatic bile ducts in the Glissonian sheath was clearly visualized using the near-infrared laparoscopic system. A small piece of tissue prevented the bile glow; thus, exposure of the Glissonian sheath was necessary for clear FC. This procedure also detected bile leakage from the cut surface of the liver. CONCLUSIONS Intrabiliary ICG administration and near-infrared laparoscopy enabled real-time intrahepatic FC during major hepatectomy.
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Affiliation(s)
- Naoya Sasaki
- Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, JPN
| | | | - Ryuta Nishitai
- Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
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Konishi S, Manaka D, Morioka M, Ikeda A, Kudo R, Saito Y, Ota T, Kanaya Y, Okamura Y, Takahashi R, Seo S. Laparoscopic-assisted robotic distal gastrectomy for gastric cancer by Billroth II reconstruction. Langenbecks Arch Surg 2023; 408:179. [PMID: 37145178 DOI: 10.1007/s00423-023-02895-4] [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: 11/04/2022] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND There are several reconstructions in distal gastrectomy for gastric cancer, and there is no clear definition regarding the method selection. The optimal reconstruction is likely to vary according to the surgical setting, and the optimal reconstruction for robotic distal gastrectomy is urgently needed. In addition, as robotic gastrectomy is getting popular, cost and operative time are pressing issues of robotic gastrectomy. METHODS Gastrojejunostomy was planned with Billroth II reconstruction using a linear stapler arranged specifically for a robotic approach. After firing the stapler, the common insertion orifice of the stapler was closed using a 30 cm long non-absorbable barbed suture, and continuously, the afferent loop of the jejunum was lifted to the stomach with the same barbed suture. In addition, we introduced laparoscopic-assisted robotic gastrectomy, using extracorporeally inserted laparoscopic devices from the assistant port. Scissors, clips, and linear staplers were all laparoscopic tools inserted extracorporeally. RESULTS Twenty-one gastric cancer patients underwent laparoscopic-assisted robotic distal gastrectomy by Billroth II reconstruction with our modifications. There were no anastomosis-related complications such as leakage, stenosis, or bleeding. There were 2 cases of aspiration pneumonia (Clavien-Dindo grade 2), 1 case of pancreatic juice leakage (grade 3a), and 1 case of delayed gastric emptying (grade 1). CONCLUSION We successfully arranged Billroth II reconstruction for robotic distal gastrectomy with fewer operative and postoperative complications. Laparoscopic-assisted robotic gastrectomy using extracorporeally inserted devices, and continuous suturing using a barbed suture will reduce the time and cost of robotic gastrectomy.
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Affiliation(s)
- Sayuri Konishi
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan.
| | - Dai Manaka
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Michina Morioka
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Atsushi Ikeda
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Ryo Kudo
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Yasuhiro Saito
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Takano Ota
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Yuri Kanaya
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Yusuke Okamura
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Ryo Takahashi
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Satoru Seo
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
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Yamashita S, Imahori T, Koyama J, Tanaka K, Okamura Y, Arai A, Iwahashi H, Mori T, Onobuchi K, Sasayama T. Endovascular Treatment of Tandem Atherosclerotic Cervical Internal Carotid Artery Occlusion in the Setting of Acute Ischemic Stroke. Vasc Endovascular Surg 2023; 57:137-148. [PMID: 36189731 DOI: 10.1177/15385744221130865] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Among tandem occlusions, atherosclerotic cervical internal carotid artery occlusion (ACICAO) can be technically challenging and associated with its unique complications. We evaluated our experience with endovascular treatment (EVT) of ACICAO in the setting of acute ischemic stroke. METHODS In total, 154 consecutive patients who underwent EVT for acute anterior circulation stroke at our institute were retrospectively reviewed. Patients with tandem ACICAO were analyzed in this study. Procedures, recanalization rates, complications, and prognoses were evaluated. RESULTS Ten patients (6%) of all 154 patients had ACICAO. In nine (90%) of the 10 patients, cervical lesions were successfully crossed and intervened upon. Four patients underwent stenting and five underwent angioplasty alone, followed by intracranial procedure. Eight patients (80%) achieved successful recanalization following mechanical thrombectomy for intracranial occlusion. However, one patient had massive subarachnoid hemorrhage during the procedure and another patient developed massive intracranial hemorrhage after EVT, both after stenting. Four of the five patients who initially underwent angioplasty alone subsequently underwent staged endarterectomy or stenting for residual stenosis on or after the next day. The single patient in whom the cervical lesion could not be crossed and another with reocclusion after EVT underwent a rescue bypass procedure due to persistent ischemic symptoms. After 90 days, four patients (40%) were functionally independent (modified Rankin scale score 0-2). CONCLUSIONS Our experience suggests that EVT for ACICAO is technically feasible; however, it involves the potential risk of several significant complications. To avoid serious hemorrhagic complications, cervical lesions may be better treated with angioplasty alone first.
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Affiliation(s)
- Shunsuke Yamashita
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Hyogo, Japan.,Department of Neurosurgery, 157128Toyooka Hospital, Hyogo, Japan
| | - Taichiro Imahori
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Hyogo, Japan.,Department of Neurosurgery, 157128Toyooka Hospital, Hyogo, Japan
| | - Junji Koyama
- Department of Neurosurgery, 157128Toyooka Hospital, Hyogo, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Hyogo, Japan.,Department of Neurosurgery, 157128Toyooka Hospital, Hyogo, Japan
| | - Yusuke Okamura
- Department of Neurosurgery, 157128Toyooka Hospital, Hyogo, Japan
| | - Atsushi Arai
- Department of Neurosurgery, 157128Toyooka Hospital, Hyogo, Japan
| | | | - Tatsuya Mori
- Department of Neurosurgery, 157128Toyooka Hospital, Hyogo, Japan
| | - Kana Onobuchi
- Department of Neurosurgery, 157128Toyooka Hospital, Hyogo, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, 38303Kobe University Graduate School of Medicine, Hyogo, Japan
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Manaka D, Konishi S, Kawaguchi K, An H, Hamasu S, Yoneda M, Fushitani M, Ota T, Morioka M, Okamura Y, Ikeda A, Sasaki N, Nishitai R. A novel method of anvil placement of circular stapler for esophagojejunostomy in laparoscopic total gastrectomy for gastric cancer: results of consecutive 200 cases. Surg Endosc 2023; 37:1021-1030. [PMID: 36097097 DOI: 10.1007/s00464-022-09566-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic total gastrectomy for gastric cancer is still a demanding operation because of technical difficulties, especially of intracorporeal esophago-jejunal anastomosis. METHODS We introduced a newly designed method of anvil placement of circular stapling devices (CS) for laparoscopic esophagojejunostomy (EJS). A small incision was made on the anterior wall of the stomach, from which the anvil was inserted into the stomach and proceeded to the thoracic esophagus. Then, the abdominal esophagus was transected by a linear stapler, and the anvil into the esophagus was drawn back to the esophageal stump by pulling out the cotton tape pre-attached to the anvil. Intracorporeal EJS by Roux-en-Y reconstruction was performed by CS inserted into the abdominal cavity from the umbilical wound. RESULTS A total of consecutive 200 gastric cancer patients underwent laparoscopic total gastrectomy using this method. There was no operative mortality. Anastomotic complications occurred in 12 cases (6.0%): 9 cases of stenosis (4.5%) and 3 cases of bleedings (1.5%). Anastomotic leakage was not observed. As for non-anastomotic complications, there occurred 2 pulmonary complications (1.0%), 3 pancreatic leakages (1.5%), and 8 bowel obstructions due to internal hernia (4.0%). With a median follow-up period of 47.1 months, 5-year overall survival for assessable patients (n = 193) was 60.3% (95% CI 52.6-67.2). The total rate of peritoneal recurrence was 9.8%. CONCLUSION Our new method of anvil placement for laparoscopic EJS with CS is safe and feasible with favorable survival outcomes. It eliminates the need for suturing, and will promote the clinical application of laparoscopic total gastrectomy for gastric cancer. CLINICAL TRIALS UMIN000046119.
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Affiliation(s)
- Dai Manaka
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan.
| | - Sayuri Konishi
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Kiyotaka Kawaguchi
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Hideo An
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Shinya Hamasu
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Machi Yoneda
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Masashi Fushitani
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Takano Ota
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Michina Morioka
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Yusuke Okamura
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Atsushi Ikeda
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Naoya Sasaki
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Ryuta Nishitai
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
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Harada T, Uozumi Y, Fukuoka H, Miyake S, Yamamoto D, Okamura Y, Ishii T, Tatsumi S, Mizobe T, Aihara H, Tanaka K, Kohmura E, Sasayama T. The impact of hormonal dynamics and serum sodium fluctuations on symptomatic vasospasm after subarachnoid hemorrhage. J Clin Neurosci 2022; 103:131-140. [PMID: 35872447 DOI: 10.1016/j.jocn.2022.07.016] [Citation(s) in RCA: 2] [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: 04/17/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Symptomatic vasospasm (SVS) is a major cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (SAH), and serum sodium frequently decreases before SVS. Serum sodium changes might be regulated by sodium metabolism-related hormones. This multi-institutional prospective cohort study therefore investigated the measurement of sodium metabolism-related hormones to elucidate the pathophysiology of serum sodium changes in SAH. METHODS SAH patients were treated with clipping or coiling from September 2017 to August 2020 at five hospitals. The laboratory data of 133 SAH patients were collected over 14 days and correlations between changes in serum sodium, sodium metabolism-related hormones (plasma adrenocorticotropic hormone (ACTH), serum cortisol, plasma arginine vasopressin (AVP)), and SVS were determined. Serum sodium concentrations were measured every day and serum sodium levels >135 mEq/L were maintained until day 14. RESULTS Of the 133 patients, 18 developed SVS within 14 days of subarachnoid hemorrhage onset (SVS group) and 115 did not suffer from SVS (non-SVS group). Circulating AVP, ACTH, and cortisol concentrations were significantly higher on day 1 in the SVS group compared with the non-SVS group. Fluctuations in serum sodium in the SVS group were significantly higher than those in the non-SVS group. There were antiparallel fluctuations in serum sodium and potassium from days 2 to 14. CONCLUSIONS Elevated levels of ACTH/cortisol and AVP on day 1 may be predictive markers for the occurrence of SVS. Multiple logistic regression analysis showed that serum sodium fluctuations were associated with SVS occurrence. Serum sodium fluctuations were associated with stress-related hormonal dynamics. (249 words).
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Affiliation(s)
- Tomoaki Harada
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan
| | - Yoichi Uozumi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan.
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan
| | - Shigeru Miyake
- Department of Neurosurgery, Kita-Harima Medical Center, 926-250 Ichiba cho, Ono 675-1392, Japan
| | - Daisuke Yamamoto
- Department of Neurosurgery, Kita-Harima Medical Center, 926-250 Ichiba cho, Ono 675-1392, Japan
| | - Yusuke Okamura
- Department of Neurosurgery, Toyooka Hospital, 1094 Tomaki, Toyooka 668-8501, Japan
| | - Taiji Ishii
- Department of Neurosurgery, Toyooka Hospital, 1094 Tomaki, Toyooka 668-8501, Japan
| | - Shotaro Tatsumi
- Department of Neurosurgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki cho, Hirohata ku, Himeji 671-1122, Japan
| | - Takashi Mizobe
- Department of Neurosurgery, Hyogo Brain and Heart Center, 520 Saisho, Himeji 670-981, Japan
| | - Hideo Aihara
- Department of Neurosurgery, Hyogo Brain and Heart Center, 520 Saisho, Himeji 670-981, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan; Department of Neurosurgery, Kinki Central Hospital, 3-1 Kurumazuka Itami, 664-8533, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki cho, Chuo ku, Kobe 650-0017, Japan
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Torres G, Diaz F, Okamura Y, Messori S, Hutchison J. The World Organisation for Animal Health - current and potential roles in safe international trade of bees and other insects. REV SCI TECH OIE 2022; 41:211-218. [PMID: 35925621 DOI: 10.20506/rst.41.1.3318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The World Organisation for Animal Health (WOAH, founded as OIE) is the recognised intergovernmental standard-setting organisation for animal health and welfare. The WOAH mandate is to support its members in the prevention of the spread of animal diseases of concern, as listed in the Terrestrial Animal Health Code (Terrestrial Code). Once a disease, infection or infestation is listed, national Veterinary Authorities have the obligation regularly to notify WOAH of the presence or absence of the listed disease. In regard to insects, the scope of the Terrestrial Code limits its recommendations to preserving the health of bees (species of the genus Apis, extended to the genus Bombus and to the stingless bees for one disease). However, it does not include standards to mitigate the potential animal health risks associated with the international trade of other insects. A description of the standard-setting process and a review of the history of the standards for bee health highlight the resources and requirements to expand the scope of the Terrestrial Code to include recommendations for animal health risk mitigation measures for the safety of international trade in insects. Any initiative to develop guidance on insect trade should include WOAH in its role as the sole global standard-setting organisation on animal health and welfare matters. This aligns with the WOAH commitment to a One Health approach.
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Kusakabe J, Yagi S, Sasaki K, Uozumi R, Abe H, Okamura Y, Taura K, Kaido T, Uemoto S. Is 0.6% Reasonable as the Minimum Requirement of the Graft-to-recipient Weight Ratio Regardless of Lobe Selection in Adult Living-donor Liver Transplantation? Transplantation 2021; 105:2007-2017. [PMID: 33031228 DOI: 10.1097/tp.0000000000003472] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several studies reported favorable outcomes of small-for-size grafts with graft-to-recipient weight ratio (GRWR) <0.8% in living-donor liver transplantation (LDLT). However, their indications should be carefully determined because they must have been indicated for low-risk cases over larger grafts with 0.8% ≤ GRWR. Furthermore, evidence for minimum requirements of GRWR remains inconclusive. We investigated the safety of small-for-size grafts against larger grafts by adjusting for confounding risk factors, and minimum requirement of graft volume in adult LDLT. METHODS We enrolled 417 cases of primary adult-to-adult LDLT in our center between 2006 and 2019. The outcomes of small grafts (0.6% ≤ GRWR < 0.8%, n = 113) and large grafts (0.8% ≤ GRWR, n = 289) were mainly compared using a multivariate analysis and Kaplan-Meier estimates. RESULTS The multivariate analysis showed that small grafts were not a significant risk factor for overall graft survival (GS). In the Kaplan-Meier analysis, small grafts did not significantly affect overall GS regardless of lobe selection (versus large grafts). However, GRWR < 0.6% was associated with poor overall GS. Although there were no significant differences between the 2 groups, unadjusted Kaplan-Meier curves of small grafts were inferior to those of large grafts in subcohorts with ABO incompatibility, and donor age ≥50 years. CONCLUSIONS Similar outcomes were observed for small and large graft use regardless of lobe selection. 0.6% in GRWR was reasonable as the minimum requirement of graft volume in LDLT. However, small grafts should be indicated carefully for high-risk cases.
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Affiliation(s)
- Jiro Kusakabe
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shintaro Yagi
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazunari Sasaki
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroyasu Abe
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Okamura
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshimi Kaido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sugiura T, Uesaka K, Okamura Y, Ito T, Yamamoto Y, Ashida R, Ohgi K, Otsuka S, Nakagawa M, Aramaki T, Asakura K. Major hepatectomy with combined vascular resection for perihilar cholangiocarcinoma. BJS Open 2021; 5:6342603. [PMID: 34355240 PMCID: PMC8342931 DOI: 10.1093/bjsopen/zrab064] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/27/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022] Open
Abstract
Background Hepatectomy with vascular resection (VR) for perihilar cholangiocarcinoma (PHCC) is a challenging procedure. However, only a few reports on this procedure have been published and its clinical significance has not been fully evaluated. Methods Patients undergoing surgical resection for PHCC from 2002–2017 were studied. The surgical outcomes of VR and non-VR groups were compared. Results Some 238 patients were included. VR was performed in 85 patients. The resected vessels were hepatic artery alone (31 patients), portal vein alone (37 patients) or both (17 patients). The morbidity rates were almost the same in the VR (49.4 per cent) and non-VR (43.8 per cent) groups (P = 0.404). The mortality rates of VR (3.5 per cent) and non-VR (3.3 per cent) were also comparable (P > 0.999). The median survival time (MST) was 45 months in the non-VR group and 36 months in VR group (P = 0.124). Among patients in whom tumour involvement was suspected on preoperative imaging and whose carbohydrate antigen 19-9 (CA19-9) value was 37 U/ml or less, MST in the VR group was significantly longer than that in the non-VR group (50 versus 34 months, P = 0.017). In contrast, when the CA19-9 value was greater than 37 U/ml, MST of the VR and non-VR groups was comparable (28 versus 29 months, P = 0.520). Conclusion Hepatectomy with VR for PHCC can be performed in a highly specialized hepatobiliary centre with equivalent short- and long-term outcomes to hepatectomy without VR.
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Affiliation(s)
- T Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery
| | - K Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery
| | - Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery
| | - T Ito
- Division of Hepato-Biliary-Pancreatic Surgery
| | - Y Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery
| | - R Ashida
- Division of Hepato-Biliary-Pancreatic Surgery
| | - K Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery
| | - S Otsuka
- Division of Hepato-Biliary-Pancreatic Surgery
| | - M Nakagawa
- Division of Plastic and Reconstructive Surgery
| | - T Aramaki
- Division of Diagnostic Radiology, Shizuoka Cancer Centre, Shizuoka, Japan
| | - K Asakura
- Division of Diagnostic Radiology, Shizuoka Cancer Centre, Shizuoka, Japan
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11
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Okamura Y, Nishitai R, Sasaki N, An H, Fushitani M, Ota T, Morioka M, Kawaguchi K, Konishi S, Hamasu S, Manaka D. Intrahepatic bile duct rupture associated with IgG4-related sclerosing cholangitis presenting hepatic inflammatory pseudotumor. Clin J Gastroenterol 2021; 14:1530-1535. [PMID: 34312794 DOI: 10.1007/s12328-021-01487-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/21/2021] [Indexed: 12/12/2022]
Abstract
A 67-year-old man with a low-grade fever was found to have a 25-mm diameter tumor of the left hepatic umbilical portion. The tumor was accompanied by occlusion of the left portal vein. Positron emission tomography using fluorodeoxyglucose showed that the tumor had abnormally high metabolic activity. Magnetic resonance imaging revealed the left hepatic duct segmental narrowing. There was a mild elevation in serum IgG4 (206 mg/dL). Intrahepatic cholangiocarcinoma was suspected. Instead of planned hepatectomy, the patient was forced to undergo emergency surgery for biliary panperitonitis caused by intrahepatic bile duct rupture. Intraoperative ultrasonography revealed a hypoechoic tumor-like thickened Glissonean sheath and needle biopsy was performed. Histologic examination confirmed fibrous tissue with IgG4-positive plasma cell infiltration without neoplastic proliferation. He was diagnosed with IgG4-related sclerosing cholangitis (IgG4-SC) presenting hepatic inflammatory pseudotumor. After his general condition improved, he underwent left hepatectomy. Macroscopic findings showed extreme fibrosis of the Glissonean sheath of the umbilical portion, and diffuse granular lesion aggregated in the left lateral segment. Microscopic examination confirmed chronic cholangitis and dense portal fibrosis in the umbilical portion and diffuse xanthogranulomatous inflammation. This is the first case report of spontaneous rupture of the intrahepatic bile duct in patient with IgG4-SC.
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Affiliation(s)
- Yusuke Okamura
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan.
| | - Ryuta Nishitai
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Naoya Sasaki
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Hideo An
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Masashi Fushitani
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Takano Ota
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Michina Morioka
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Kiyotaka Kawaguchi
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Sayuri Konishi
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Shinya Hamasu
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Dai Manaka
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
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12
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Yamamoto R, Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, Ohgi K, Otsuka S, Uesaka K. Utility of remnant liver volume for predicting posthepatectomy liver failure after hepatectomy with extrahepatic bile duct resection. BJS Open 2021; 5:6137383. [PMID: 33609394 PMCID: PMC7893452 DOI: 10.1093/bjsopen/zraa049] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatectomy with extrahepatic bile duct resection is associated with a high risk of posthepatectomy liver failure (PHLF). However, the utility of the remnant liver volume (RLV) in cholangiocarcinoma has not been studied intensively. METHODS Patients who underwent major hepatectomy with extrahepatic bile duct resection between 2002 and 2018 were reviewed. The RLV was divided by body surface area (BSA) to normalize individual physical differences. Risk factors for clinically relevant PHLF were evaluated with special reference to the RLV/BSA. RESULTS A total of 289 patients were included. The optimal cut-off value for RLV/BSA was determined to be 300 ml/m2. Thirty-two patients (11.1 per cent) developed PHLF. PHLF was more frequent in patients with an RLV/BSA below 300 ml/m2 than in those with a value of 300 ml/m2 or greater: 19 of 87 (22 per cent) versus 13 of 202 (6.4 per cent) (P < 0.001). In multivariable analysis, RLV/BSA below 300 ml/m2 (P = 0.013), future liver remnant plasma clearance rate of indocyanine green less than 0.075 (P = 0.031), and serum albumin level below 3.5 g/dl (P = 0.015) were identified as independent risk factors for PHLF. Based on these risk factors, patients were classified into three subgroups with low (no factors), moderate (1-2 factors), and high (3 factors) risk of PHLF, with PHLF rates of 1.8, 14.8 and 63 per cent respectively (P < 0.001). CONCLUSION An RLV/BSA of 300 ml/m2 is a simple predictor of PHLF in patients undergoing hepatectomy with extrahepatic bile duct resection.
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Affiliation(s)
- R Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - T Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - T Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - Y Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - R Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - K Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - S Otsuka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - K Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
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13
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Nakahara M, Imahori T, Tanaka K, Okamura Y, Arai A, Yamashita S, Iwahashi H, Mori T, Sasayama T, Kohmura E. Iatrogenic intracranial vessel dissection during mechanical thrombectomy rescued by emergent stenting: 2 case reports. Radiol Case Rep 2021; 16:835-842. [PMID: 33552335 PMCID: PMC7847827 DOI: 10.1016/j.radcr.2021.01.040] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/27/2022] Open
Abstract
Intracranial vessel dissection is a procedural complication associated with endovascular treatment. However, there have been few reports on its potential causes and management during mechanical thrombectomy. In approximately 250 cases of mechanical thrombectomy over the past 5 years at our institution, iatrogenic intracranial dissection occurred in 2 patients (0.8%). In this report, we described these 2 cases that were rescued through emergent stenting. Mechanical thrombectomy, using both a stent retriever and an aspiration catheter, was performed for acute middle cerebral artery M2 occlusion in Patient 1 (a 69-year-old man) and for distal M1 occlusion in Patient 2 (an 83-year-old woman). In both cases, recanalization was achieved with the procedure, but irregular stenosis developed at the initially nonoccluded, but mildly arteriosclerotic, M1, after recanalization. During the thrombectomy procedure, the aspiration catheter sifted up to the arteriosclerotic M1. In both cases, the lesions were considered vessel dissection, due to a shift of the aspiration catheter tip into the arteriosclerotic vessel wall. Repeated percutaneous angiography with antithrombotic therapy failed to improve the lesions and to maintain the antegrade blood flow. Finally, lesions in each patient were successfully rescued through the use of emergent stenting. A drug-eluting stent for coronary use was deployed in Patient 1, and an Enterprise stent was applied in Patient 2. Inadvertent shift of the aspiration catheter into arteriosclerotic vessels can cause a serious intracranial vessel dissection. When performing mechanical thrombectomy, intracranial stents need to be available as rescue treatment devices to manage refractory iatrogenic intracranial vessel dissection.
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Key Words
- Acute ischemic stroke
- Aspiration catheter
- BGC, balloon-guide catheter
- CT, computed tomography
- DES, drug-eluting stent
- DWI, diffusion-weighted imaging
- Dissection
- ICA, internal carotid artery
- Large vessel occlusion
- MCA, middle cerebral artery
- MRA, magnetic resonance angiography
- MT, mechanical thrombectomy
- Mechanical thrombectomy
- NIHSS, National Institutes of Health Stroke Scale
- PCI, percutaneous coronary intervention
- PTA, percutaneous transluminal angioplasty
- SR, stent retriever
- Stent retriever
- TICI, thrombolysis in cerebral infarction
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Affiliation(s)
- Masahiro Nakahara
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
| | - Taichiro Imahori
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan.,Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan.,Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Yusuke Okamura
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Atsushi Arai
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Shunsuke Yamashita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
| | - Hirofumi Iwahashi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
| | - Tatsuya Mori
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo 650-0017, Japan
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14
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Okamura Y, Minami S, Kato Y, Fujishiro Y, Kaneko Y, Ikeda J, Muramoto J, Kaneko R, Ueda K, Kocsis V, Kanazawa N, Taguchi Y, Koretsune T, Fujiwara K, Tsukazaki A, Arita R, Tokura Y, Takahashi Y. Giant magneto-optical responses in magnetic Weyl semimetal Co 3Sn 2S 2. Nat Commun 2020; 11:4619. [PMID: 32934234 PMCID: PMC7492236 DOI: 10.1038/s41467-020-18470-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/29/2020] [Accepted: 08/25/2020] [Indexed: 11/09/2022] Open
Abstract
The Weyl semimetal (WSM), which hosts pairs of Weyl points and accompanying Berry curvature in momentum space near Fermi level, is expected to exhibit novel electromagnetic phenomena. Although the large optical/electronic responses such as nonlinear optical effects and intrinsic anomalous Hall effect (AHE) have recently been demonstrated indeed, the conclusive evidence for their topological origins has remained elusive. Here, we report the gigantic magneto-optical (MO) response arising from the topological electronic structure with intense Berry curvature in magnetic WSM Co3Sn2S2. The low-energy MO spectroscopy and the first-principles calculation reveal that the interband transitions on the nodal rings connected to the Weyl points show the resonance of the optical Hall conductivity and give rise to the giant intrinsic AHE in dc limit. The terahertz Faraday and infrared Kerr rotations are found to be remarkably enhanced by these resonances with topological electronic structures, demonstrating the novel low-energy optical response inherent to the magnetic WSM.
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Affiliation(s)
- Y Okamura
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan.
| | - S Minami
- Nanomaterials Research Institute, Kanazawa University, Ishikawa, 920-1192, Japan.,RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
| | - Y Kato
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan
| | - Y Fujishiro
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan
| | - Y Kaneko
- RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
| | - J Ikeda
- Institute for Materials Research, Tohoku University, Sendai, 980-8577, Japan
| | - J Muramoto
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan
| | - R Kaneko
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan
| | - K Ueda
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan
| | - V Kocsis
- RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
| | - N Kanazawa
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan
| | - Y Taguchi
- RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
| | - T Koretsune
- Deparment of Physics, Tohoku University, Sendai, 980-8578, Japan
| | - K Fujiwara
- Institute for Materials Research, Tohoku University, Sendai, 980-8577, Japan
| | - A Tsukazaki
- Institute for Materials Research, Tohoku University, Sendai, 980-8577, Japan
| | - R Arita
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan.,RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
| | - Y Tokura
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan.,RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan.,Tokyo College, University of Tokyo, Tokyo, 113-8656, Japan
| | - Y Takahashi
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo, 113-8656, Japan. .,RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan.
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15
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Kusakabe J, Hata K, Tanaka S, Omae K, Okamura Y, Tajima T, Tamaki I, Miyauchi H, Kubota T, Tanaka H, Uemoto S. Prognostic index consisting of early post-transplant variables <2 weeks in adult living-donor liver transplantation. Hepatol Res 2020; 50:741-753. [PMID: 32012392 PMCID: PMC7317571 DOI: 10.1111/hepr.13489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 12/11/2022]
Abstract
AIM Six-month recipient mortality after adult-to-adult living-donor liver transplantation (LDLT) remains high. Early and accurate prediction of recipient outcome and continuous monitoring of recipient severity after surgery are both essential for guiding appropriate care. This study was designed to identify early post-transplant parameters associated with 6-month mortality, and thereby to construct a discriminatory prognostic index (PI). METHODS We retrospectively analyzed 400 consecutive primary adult-to-adult LDLTs in our center (2006-2017). Perioperative variables were comprehensively analyzed for their accuracy in predicting recipient mortality by comparing the area under the receiver operating characteristic (AUROC) of each factor. RESULTS The AUROCs of preoperative predictive factors, for example, Model for End-stage Liver Disease (MELD) score and donor age, were 0.56 and 0.64, respectively, whereas those of post-transplant platelet count (PLT), total bilirubin (T-BIL), and prothrombin time - international normalized ratio (INR) on postoperative day (POD)-7-14 were 0.71/0.84, 0.68/0.82, and 0.71/0.78, respectively. Logistic regression analysis provided a formula: PIPOD-14 = 3.39 + 0.12 × PLTPOD-14 - 0.09 × T-BILPOD-14 - 1.23 × INRPOD-14 , indicating a high AUROC of 0.87. Recipient 6-month survival with PIPOD-14 < 2.38 (n = 173) was 71.7%, whereas that with PIPOD-14 ≥ 2.38 (n = 222) was 97.7% (P < 0.001). The AUROCs of PIPOD-7 were as high as 0.8 in the subgroups with younger donors (<50 years of age), right lobe grafts, ABO-identical/compatible combinations, or low MELD score (<20), indicating usefulness of PI to identify unexpectedly complicated cases within the first week. CONCLUSIONS A novel, post-transplant survival estimator, PI, accurately predicts recipient 6-month mortality within 1-2 weeks after adult LDLT. Daily monitoring of PI could facilitate early interventions including retransplantation in critically ill patients.
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Affiliation(s)
- Jiro Kusakabe
- Department of Surgery, Division of Hepato‐Biliary‐Pancreatic Surgery and TransplantationKyoto University Graduate School of MedicineKyotoJapan
| | - Koichiro Hata
- Department of Surgery, Division of Hepato‐Biliary‐Pancreatic Surgery and TransplantationKyoto University Graduate School of MedicineKyotoJapan
| | - Shiro Tanaka
- Department of Clinical BiostatisticsKyoto University Graduate School of MedicineKyotoJapan
| | - Katsuhiro Omae
- Department of Clinical BiostatisticsKyoto University Graduate School of MedicineKyotoJapan
| | - Yusuke Okamura
- Department of Surgery, Division of Hepato‐Biliary‐Pancreatic Surgery and TransplantationKyoto University Graduate School of MedicineKyotoJapan
| | - Tetsuya Tajima
- Department of Surgery, Division of Hepato‐Biliary‐Pancreatic Surgery and TransplantationKyoto University Graduate School of MedicineKyotoJapan
| | - Ichiro Tamaki
- Department of Surgery, Division of Hepato‐Biliary‐Pancreatic Surgery and TransplantationKyoto University Graduate School of MedicineKyotoJapan
| | - Hidetaka Miyauchi
- Department of Surgery, Division of Hepato‐Biliary‐Pancreatic Surgery and TransplantationKyoto University Graduate School of MedicineKyotoJapan
| | - Toyonari Kubota
- Department of Surgery, Division of Hepato‐Biliary‐Pancreatic Surgery and TransplantationKyoto University Graduate School of MedicineKyotoJapan
| | - Hirokazu Tanaka
- Department of Surgery, Division of Hepato‐Biliary‐Pancreatic Surgery and TransplantationKyoto University Graduate School of MedicineKyotoJapan
| | - Shinji Uemoto
- Department of Surgery, Division of Hepato‐Biliary‐Pancreatic Surgery and TransplantationKyoto University Graduate School of MedicineKyotoJapan
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16
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Imahori T, Koyama J, Tanaka K, Okamura Y, Arai A, Iwahashi H, Mori T, Yokote A, Matsushima K, Matsui D, Kobayashi M, Hosoda K, Kohmura E. Impact of introducing endovascular treatment on acute ischemic stroke outcomes: A shift from an era of medical management to thrombectomy in Japan. Heliyon 2020; 6:e03945. [PMID: 32426544 PMCID: PMC7226659 DOI: 10.1016/j.heliyon.2020.e03945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/24/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
Background Endovascular treatment (EVT) has increasingly become the standard treatment of acute cerebral large vessel occlusion (LVO). We evaluated the impact of introducing EVT on LVO therapy in a single center where intravenous thrombolysis (IVT) had been the only recanalization therapy. Materials and methods Between April 2013 and March 2017, 354 consecutive patients with LVO admitted to our institution were analyzed. We compared outcomes between two chronological groups before (Pre-EVT group) and after (Post-EVT group) introducing EVT in April 2015. We assessed prognostic factors for favorable outcomes (modified Rankin scale score ≤2 at 90 days). Results In the Pre-EVT group, all 140 patients were treated medically, including 30 patients (21%) undergoing IVT. In the Post-EVT group, 118 patients (55%) underwent EVT, and the remaining 96 patients treated medically, including six patients (3%) undergoing IVT. The proportion undergoing recanalization therapy with IVT or EVT significantly increased after introducing EVT (21% versus 58%, p < 0.001). The rate of patients achieving favorable outcomes also significantly increased (14% versus 31%, p < 0.001). In multivariate regression analysis, introducing EVT was an independent predictive factor after adjusting for age, stroke severity and extent, and time (p = 0.005). The arrival time in patients with helicopter transport was significantly shorter than that with ground ambulance for a distance of more than 10 km (p < 0.001). Conclusions This study demonstrated that the introduction of EVT improved outcomes of acute LVO patients, increasing the opportunity to receive recanalization therapy. Further efforts to establish medical systems to provide EVT are required throughout the country.
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Affiliation(s)
| | - Junji Koyama
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | | | - Yusuke Okamura
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Atsushi Arai
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | | | - Tatsuya Mori
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | | | | | - Daisaku Matsui
- Tajima Emergency & Critical Care Medical Center, Toyooka Hospital, Hyogo, Japan
| | - Makoto Kobayashi
- Tajima Emergency & Critical Care Medical Center, Toyooka Hospital, Hyogo, Japan
| | - Kohkichi Hosoda
- Department of Neurosurgery, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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17
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Kusakabe J, Yagi S, Okamura Y, Iida T, Ogawa E, Ito T, Hata K, Taura K, Okajima H, Kaido T, Uemoto S. Anatomical Pitfall in Right Posterior Sector Graft Procurement in Living Donor Liver Transplantation. Liver Transpl 2020; 26:299-303. [PMID: 31563152 DOI: 10.1002/lt.25648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/23/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Jiro Kusakabe
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shintaro Yagi
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Okamura
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Taku Iida
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eri Ogawa
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Ito
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koichiro Hata
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideaki Okajima
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshimi Kaido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
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18
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Seki S, Garst M, Waizner J, Takagi R, Khanh ND, Okamura Y, Kondou K, Kagawa F, Otani Y, Tokura Y. Propagation dynamics of spin excitations along skyrmion strings. Nat Commun 2020; 11:256. [PMID: 31937762 PMCID: PMC6959257 DOI: 10.1038/s41467-019-14095-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 03/25/2019] [Accepted: 12/10/2019] [Indexed: 11/09/2022] Open
Abstract
Magnetic skyrmions, topological solitons characterized by a two-dimensional swirling spin texture, have recently attracted attention as stable particle-like objects. In a three-dimensional system, a skyrmion can extend in the third dimension forming a robust and flexible string structure, whose unique topology and symmetry are anticipated to host nontrivial functional responses. Here we experimentally demonstrate the coherent propagation of spin excitations along skyrmion strings for the chiral-lattice magnet Cu2OSeO3. We find that this propagation is directionally non-reciprocal and the degree of non-reciprocity, as well as group velocity and decay length, are strongly dependent on the character of the excitation modes. These spin excitations can propagate over a distance exceeding 50 μm, demonstrating the excellent long-range ordered nature of the skyrmion-string structure. Our combined experimental and theoretical analyses offer a comprehensive account of the propagation dynamics of skyrmion-string excitations and suggest the possibility of unidirectional information transfer along such topologically protected strings.
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Affiliation(s)
- S Seki
- Department of Applied Physics, University of Tokyo, Tokyo, 113-8656, Japan. .,Institute of Engineering Innovation, University of Tokyo, Tokyo, 113-8656, Japan. .,RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan. .,PRESTO, Japan Science and Technology Agency (JST), Kawaguchi, 332-0012, Japan.
| | - M Garst
- Institut für Theoretische Physik, Technische Universität Dresden, 01062, Dresden, Germany.,Institut für Theoretische Festkörperphysik, Karlsruher Institut für Technologie, 76131, Karlsruhe, Germany
| | - J Waizner
- Institut für Theoretische Physik, Universität zu Köln, Zülpicher Str. 77a, 50937, Köln, Germany
| | - R Takagi
- Department of Applied Physics, University of Tokyo, Tokyo, 113-8656, Japan.,Institute of Engineering Innovation, University of Tokyo, Tokyo, 113-8656, Japan.,RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
| | - N D Khanh
- RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
| | - Y Okamura
- Department of Applied Physics, University of Tokyo, Tokyo, 113-8656, Japan
| | - K Kondou
- RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
| | - F Kagawa
- Department of Applied Physics, University of Tokyo, Tokyo, 113-8656, Japan.,RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
| | - Y Otani
- RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan.,Institute for Solid State Physics, University of Tokyo, Kashiwa, 277-8581, Japan
| | - Y Tokura
- Department of Applied Physics, University of Tokyo, Tokyo, 113-8656, Japan.,RIKEN Center for Emergent Matter Science (CEMS), Wako, 351-0198, Japan
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Hashimoto H, Nakanishi R, Mizumura S, Hashimoto Y, Okamura Y, Yamanaka K, Ikeda T. P175 Prognostic value of 99mTc-ECD brain perfusion SPECT in patients with atrial fibrillation and dementia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.056] [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
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and those afflicted have reduced quality of life, functional status, and cardiac performance. The patients with AF have a high risk of coronary heart disease and cardiovascular disease. Although the prevalence of AF is increasing, cognitive disorders are also on the rise in tandem with the aging of the population. The patients with dementia have also experienced lower the quality of life and have increased mortality. Technetium 99m ECD brain perfusion single photon emission computed tomography (99mTc-ECD brain perfusion SPECT) is a useful modality for diagnosing dementia and identifying high risk patients with mild cognitive impairment. However, there are few reports about the relationship between the value of Z score calculated by 99mTc-ECD brain perfusion SPECT and prognosis of patients with AF and dementia.
Purpose
The aim of this study was to evaluate the prognostic values of brain perfusion using 99mTc-ECD SPECT in patients with AF and dementia.
Methods
Among 405 consecutive patients who were diagnosed as AF in cardiac outpatients and subsequently diagnosed as dementia using Mini-Mental State Examination by neurologists or psychiatrists, we identified 170 patients (81 ± 10 years) who underwent 99mTc-ECD brain perfusion SPECT for the current study. Of those, 73, 73, and 24 were diagnosed as Alzheimer’s dementia (AD), vascular dementia (VD), and non-specified dementia respectively. Multivariate Cox model was used to assess if higher Z score by 99mTc-ECD brain perfusion SPECT and clinical parameters were associated with major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, hospitalization for heart failure, and stroke. Sub-analyses of multivariate Cox models by AD or VD were also assessed. The cut-off values of Z score were determined using area under the curve by a receiver operating characteristic analysis based on MACE occurrences.
Results
During a mean follow-up of 1258 ± 1044 days, 62 MACE occurred. There was not significant difference of MACE between AD and VD (33%, vs. 44%, p = 0.153). By multivariable Cox model, the higher Z score of temporal-occipital-pariental lobe was associated with increased MACE compared to the lower group (HR 2.521, 95% CI 1.465–4.337, p < 0.001). In a sub-analysis of patients with AD, Z score was the most significant prognostic factor for MACE (HR 3.969, 95% CI 1.374–11.468, p = 0.011). The similar trend was observed in those with VD (HR 2.247, 95% CI 1.028–4.913, p = 0.043). Conclusion: This study demonstrated that the Z score of temporal-occipital-pariental lobe by 99mTc-ECD brain perfusion SPECT could be a potential prognostic value among patients with AF and dementia, regardless of type of dementia.
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Affiliation(s)
- H Hashimoto
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - R Nakanishi
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - S Mizumura
- Toho University Faculty of Medicine, Radiology, Tokyo, Japan
| | - Y Hashimoto
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - Y Okamura
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - K Yamanaka
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
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20
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Imamura T, Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Ohgi K, Todaka A, Fukutomi A, Aramaki T, Uesaka K. Prognostic role of the length of tumour-vein contact at the portal-superior mesenteric vein in patients having surgery for pancreatic cancer. Br J Surg 2019; 106:1649-1656. [PMID: 31626342 DOI: 10.1002/bjs.11328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/15/2019] [Accepted: 07/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The length of tumour-vein contact between the portal-superior mesenteric vein (PV/SMV) and pancreatic head cancer, and its relationship to prognosis in patients undergoing pancreatic surgery, remains controversial. METHODS Patients diagnosed with pancreatic head cancer who were eligible for pancreatoduodenectomy between October 2002 and December 2016 were analysed. The PV/SMV contact was assessed retrospectively on CT. Using the minimum P value approach based on overall survival after surgery, the optimal cut-off value for tumour-vein contact length was identified. RESULTS Among 491 patients included, 462 underwent pancreatoduodenectomy for pancreatic head cancer. PV/SMV contact with the tumour was detected on preoperative CT in 248 patients (53·7 per cent). Overall survival of patients with PV/SMV contact exceeding 20 mm was significantly worse than that of patients with a contact length of 20 mm or less (median survival time (MST) 23·3 versus 39·3 months; P = 0·012). Multivariable analysis identified PV/SMV contact longer than 20 mm as an independent predictor of poor survival, whereas PV/SMV contact greater than 180° was not a predictive factor. Among patients with a PV/SMV contact length exceeding 20 mm on pretreatment CT, those receiving neoadjuvant therapy had significantly better overall survival than patients who had upfront surgery (MST not reached versus 21·6 months; P = 0·002). CONCLUSION The length of PV/SMV contact predicts survival, and may be used to suggest a role for neoadjuvant therapy to improve prognosis.
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Affiliation(s)
- T Imamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - Y Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - T Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - T Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - R Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - K Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - A Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Centre, Shizuoka, Japan
| | - A Fukutomi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Centre, Shizuoka, Japan
| | - T Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Centre, Shizuoka, Japan
| | - K Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
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Okada M, Uyama A, Okamura Y, Miyake S, Terazono T, Yamamoto K, Takaishi Y, Kondoh T. [Pseudoaneurysm of Neck External Carotid Artery Related to Chiropractic Manipulation]. No Shinkei Geka 2019; 47:799-804. [PMID: 31358700 DOI: 10.11477/mf.1436204026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 55-year-old man presented with progressive pain and expanding swelling in his right neck. He had no history of trauma or infectious disease. The patient had undergone chiropractic manipulations once in a month and the last manipulation was done one day before the admission to our hospital. On examination by laryngeal endoscopy, a swelling was found on the posterior wall of the pharynx on the right side. The right piriform fossa was invisible. CT revealed hematoma in the posterior wall of the right oropharynx compressing the airway tract. Aneurysm-like enhanced lesion was also seen near the right common carotid artery. Ultrasound imaging revealed a fistula of approximately 1.2 mm at the posterior wall of the external carotid artery and inflow image of blood to the aneurysm of a diameter of approximately 12 mm. No dissection or stenosis of the artery was found. Jet inflow of blood into the aneurysm was confirmed by angiography. T1-weighted MR imaging revealed presence of hematoma on the posterior wall of the pharynx and the aneurysm was recognized by gadolinium-enhancement. We performed emergency surgery to remove the aneurysm while preserving the patency of the external carotid artery. The pin-hole fistula was sutured and the wall of the aneurysm was removed. Histopathological assessment of the rissue revealed pseudoaneurysm. The patient was discharged after 12 days without deficit. Progressively growing aneurysm of the external carotid artery is caused by various factors and early intervention is recommended. Although, currently, intravascular surgery is commonly indicated, direct surgery is also feasible and has advantages with regard to pathological diagnosis and complete repair of the parent artery.
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Imahori T, Okamura Y, Sakata J, Shose H, Yamanishi S, Kohmura E. Delayed Rebleeding from Pseudoaneurysm After Mechanical Thrombectomy Using Stent Retriever Due to Small Artery Avulsion Confirmed by Open Surgery. World Neurosurg 2019; 133:150-154. [PMID: 31589986 DOI: 10.1016/j.wneu.2019.09.141] [Citation(s) in RCA: 10] [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: 09/06/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pseudoaneurysm after mechanical thrombectomy (MT) is rare but is one of the potential complications associated with endovascular procedures. There is limited information regarding its mechanism of formation and the potential risk of delayed bleeding. CASE DESCRIPTION An 84-year-old woman was admitted to our institution with right hemiplegia and global aphasia. Magnetic resonance imaging and angiography revealed occlusion of the M2 segment of the left middle cerebral artery with subtle acute ischemic change in this territory. After initiating intravenous thrombolysis, MT was performed for persistent occlusion of the M2. Successful revascularization was finally achieved with a single pass of a Trevo XP 3 mm × 20 mm stent retriever; significant deviation of the vessel occurred during withdrawal of the stent retriever. Anticoagulation was initiated after confirming resolution of a small amount of postprocedural subarachnoid hemorrhage 1 day after the procedure. However, 4 days after the procedure, computed tomography and angiography revealed a massive sylvian hematoma with de novo formation of a small pseudoaneurysm at the site where the stent retriever was deployed. Open surgery revealed a small artery avulsion at this site. The lesion was closed by microsurgical suturing. CONCLUSIONS Angiographic and intraoperative findings showed that the mechanism of formation of the pseudoaneurysm was small artery avulsion resulting from deviation of the vessel during withdrawal of the stent retriever. When performing MT in a tortuous distal vessel, the possibility of small artery avulsion should be kept in mind to both prevent and manage critical hemorrhagic complications.
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Affiliation(s)
| | - Yusuke Okamura
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Junichi Sakata
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Hiroyasu Shose
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | | | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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Imahori T, Shose H, Okamura Y, Kohmura E. Deploying 5 Overlapping Enterprise Stents and Coiling for Treating Hemorrhagic Vertebral Artery Dissecting Aneurysm. World Neurosurg 2019; 132:177-181. [PMID: 31505281 DOI: 10.1016/j.wneu.2019.08.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Reconstructive endovascular treatment is a method that can ameliorate vertebral artery dissecting aneurysm (VADA) and preserve the parent artery. Recently, 2 or 3 overlapping stents have been used to treat VADAs through the flow-diversion effect. However, little is known about the use of >3 overlapping stents for acute treatment of hemorrhagic VADA. CASE DESCRIPTION A 69-year-old woman was admitted to our institute with the sudden onset of a headache. Brain computed tomography revealed a subarachnoid hemorrhage. Cerebral angiography revealed a VADA in the right intracranial vertebral artery. The contralateral vertebral artery was hypoplastic; thus we performed a reconstructive endovascular procedure using multiple overlapping stents combined with coiling. We used 5 overlapping stents with the aim of preventing coil herniation, fixing the jailed microcatheter, and reinforcing flow diversion and achieved immediate occlusion of the aneurysmal component. Postoperative imaging showed no apparent infarction in the brainstem. Six months after the treatment, angiography revealed complete occlusion of the aneurysm. Therefore in this case, hemorrhagic VADA was successfully treated in the acute setting by 5 overlapping Enterprise stents and coiling, which also preserved the parent artery. CONCLUSIONS Reconstructive endovascular treatment using multiple overlapping stents and coiling may be a beneficial therapy for hemorrhagic VADA, especially when the contralateral vertebral artery is aplastic or hypoplastic. Using >3 overlapping stents may represent a promising, feasible technique for achieving immediate occlusion by increasing flow diversion.
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Affiliation(s)
- Taichiro Imahori
- Department of Neurosurgery, Toyooka Hospital, Kobe University Graduate School of Medicine, Toyooka, Hyogo, Japan.
| | - Hiroyasu Shose
- Department of Neurosurgery, Toyooka Hospital, Kobe University Graduate School of Medicine, Toyooka, Hyogo, Japan
| | - Yusuke Okamura
- Department of Neurosurgery, Toyooka Hospital, Kobe University Graduate School of Medicine, Toyooka, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Ohgi K, Uesaka K. Surgical Indication for advanced gallbladder cancer considering the optimal preoperative carbohydrate antigen 19-9 cut-off value. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.006] [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: 11/13/2022] Open
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25
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Okamura Y, Sugiura T, Ito T, Yamamoto Y, Ashida R, Aramaki T, Uesaka K. The tumor diameter cut-off for predicting microscopic intrahepatic metastasis of hepatocellular carcinoma patients without treatment history differs from that of hepatocellular carcinoma patients with a treatment history. Clin Transl Oncol 2019; 22:319-329. [PMID: 31041718 DOI: 10.1007/s12094-019-02120-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Intrahepatic metastasis (IM) of hepatocellular carcinoma (HCC) occurs via vascular invasion; the tumor diameter that affects the risk of micro intra-hepatic metastasis (MIM) should be larger than that which affects the risk of micro vessel invasion (MVI). The aim of the present study was to determine the optimum tumor diameter cut-off value for predicting the presence of MIM in HCC patients without treatment history and HCC patients with a treatment history and to compare these diameters between cases of MVI and MIM. METHODS This retrospective study included 621 patients without macroscopic vessel invasion or intrahepatic metastasis on preoperative imaging who underwent hepatectomy. The cut-off tumor diameter for predicting the presence of MIM was determined by a receiver operating characteristic curves analysis. RESULTS The optimum cut-off value for predicting the presence of MIM in HCC patients without treatment history was 43 mm. In contrast, the optimum cut-off value for predicting the presence of MIM in HCC patients with a treatment history was 20 mm. Among 46 HCC patients with MIM without treatment history, there were 20 patients with MIM without MVI who were considered to have potential multi-centric (MC) tumors rather than IM. The cumulative overall survival rates in patients with MIM without MVI (potential MC) was significantly better than that in patients with both MIM and MVI (P = 0.022). CONCLUSIONS The tumor diameter cut-off value for predicting MIM differed between HCC patients without treatment history and with a treatment history and slightly smaller than those for predicting MVI beyond our expectation.
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Affiliation(s)
- Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
| | - T Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
| | - T Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
| | - Y Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
| | - R Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
| | - T Aramaki
- Division of Diagnostic Radiology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - K Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
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Okamura Y, Seki S, Bordács S, Butykai Á, Tsurkan V, Kézsmárki I, Tokura Y. Microwave Directional Dichroism Resonant with Spin Excitations in the Polar Ferromagnet GaV_{4}S_{8}. Phys Rev Lett 2019; 122:057202. [PMID: 30822005 DOI: 10.1103/physrevlett.122.057202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Indexed: 06/09/2023]
Abstract
We have investigated the directional dichroism of magnetic resonance spectra in the polar ferromagnet GaV_{4}S_{8}. While four types of structural domains are energetically degenerated under a zero field, the magnetic resonance for each domain is well separated by applying magnetic fields due to uniaxial magnetic anisotropy. Consequently, a directional dichroism as large as 20% is clearly observed without domain cancellation. The present observation therefore demonstrates that not only magnetoelectric monodomain crystals but also magnetoelectric multidomain specimens can be used to realize microwave (optical) diodes owing to the lack of inversion domains.
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Affiliation(s)
- Y Okamura
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo 113-8656, Japan
| | - S Seki
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
| | - S Bordács
- Department of Physics, Budapest University of Technology and Economics and MTA-BME Lendulet Magneto-optical Spectroscopy Research Group, 1111 Budapest, Hungary
- Hungarian Academy of Sciences, Premium Postdoctor Program, 1051 Budapest, Hungary
| | - Á Butykai
- Department of Physics, Budapest University of Technology and Economics and MTA-BME Lendulet Magneto-optical Spectroscopy Research Group, 1111 Budapest, Hungary
| | - V Tsurkan
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - I Kézsmárki
- Department of Physics, Budapest University of Technology and Economics and MTA-BME Lendulet Magneto-optical Spectroscopy Research Group, 1111 Budapest, Hungary
| | - Y Tokura
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo 113-8656, Japan
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
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Imahori T, Okamura Y, Sakata J, Shose H, Yokote A, Matsushima K, Matsui D, Kobayashi M, Hosoda K, Tanaka K, Fujita A, Kohmura E. Stent Expansion and In-Stent Thrombus Sign in the Trevo Stent Retriever Predict Recanalization and Possible Etiology During Mechanical Thrombectomy: A Case Series of 50 Patients with Acute Middle Cerebral Artery Occlusion. World Neurosurg 2018; 124:S1878-8750(18)32910-3. [PMID: 30597281 DOI: 10.1016/j.wneu.2018.12.087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 08/31/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Interaction between the stent retriever and clot is a key factor for recanalization during mechanical thrombectomy. The aim of this study was to evaluate the association between radiographically apparent features during thrombectomy and angiographic outcomes using the Trevo stent retriever with a fully radiopaque strut. METHODS We retrospectively reviewed 50 patients with acute middle cerebral artery occlusion who were treated with the Trevo. Patients were divided into groups that achieved (first-pass recanalization group, n = 21) or did not achieve (non-first-pass recanalization group, n = 29) a modified Thrombolysis in Cerebral Ischemia score of 2b or 3 with the first-pass procedure. Patients were also divided into a thromboembolic (n = 39) and atherosclerotic (n = 11) group by occlusion etiology. We evaluated radiographic findings of the Trevo's strut (e.g., degree of stent expansion and filling defect of the thrombus in the strut [in-stent thrombus sign]) during the first-pass procedure. RESULTS Median stent expansion was significantly greater in the first-pass recanalization group than in the non-first-pass recanalization group (60% vs. 34%; P < 0.01) and in the thromboembolic group than in the atherosclerotic group (45% vs. 31%; P < 0.01). The receiver operator characteristic curve showed moderate capacity for prediction of recanalization and etiology, with an area under the curve of 0.83 and 0.73, respectively. In-stent thrombus sign was significantly more common in the thromboembolic group than in the atherosclerotic group (86% vs. 10%; P < 0.01). CONCLUSIONS Greater stent expansion was associated with recanalization after thrombectomy. The in-stent thrombus sign may be useful for etiology prediction. These radiographic findings could provide useful real-time feedback during procedures, reflecting clot-stent interaction.
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Affiliation(s)
| | - Yusuke Okamura
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Junichi Sakata
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Hiroyasu Shose
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | | | | | - Daisaku Matsui
- Tajima Emergency and Critical Care Medical Center, Toyooka Hospital, Hyogo, Japan
| | - Makoto Kobayashi
- Tajima Emergency and Critical Care Medical Center, Toyooka Hospital, Hyogo, Japan
| | - Kohkichi Hosoda
- Department of Neurosurgery, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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Tamaki I, Hata K, Okamura Y, Nigmet Y, Hirao H, Kubota T, Inamoto O, Kusakabe J, Goto T, Tajima T, Yoshikawa J, Tanaka H, Tsuruyama T, Tolba RH, Uemoto S. Hydrogen Flush After Cold Storage as a New End-Ischemic Ex Vivo Treatment for Liver Grafts Against Ischemia/Reperfusion Injury. Liver Transpl 2018; 24:1589-1602. [PMID: 30120877 PMCID: PMC6686173 DOI: 10.1002/lt.25326] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 07/16/2018] [Accepted: 08/01/2018] [Indexed: 01/13/2023]
Abstract
Cold storage (CS) remains the gold standard for organ preservation worldwide, although it is inevitably associated with ischemia/reperfusion injury (IRI). Molecular hydrogen (H2 ) is well known to have antioxidative properties. However, its unfavorable features, ie, inflammability, low solubility, and high tissue/substance permeability, have hampered its clinical application. To overcome such obstacles, we developed a novel reconditioning method for donor organs named hydrogen flush after cold storage (HyFACS), which is just an end-ischemic H2 flush directly to donor organs ex vivo, and, herein, we report its therapeutic impact against hepatic IRI. Whole liver grafts were retrieved from Wistar rats. After 24-hour CS in UW solution, livers were cold-flushed with H2 solution (1.0 ppm) via the portal vein (PV), the hepatic artery (HA), or both (PV + HA). Functional integrity and morphological damages were then evaluated by 2-hour oxygenated reperfusion at 37°C. HyFACS significantly lowered portal venous pressure, transaminase, and high mobility group box protein 1 release compared with vehicle-treated controls (P < 0.01). Hyaluronic acid clearance was significantly higher in the HyFACS-PV and -PV + HA groups when compared with the others (P < 0.01), demonstrating the efficacy of the PV route to maintain the sinusoidal endothelia. In contrast, bile production and lactate dehydrogenase leakage therein were both significantly improved in HyFACS-HA and -PV + HA (P < 0.01), representing the superiority of the arterial route to attenuate biliary damage. Electron microscopy consistently revealed that sinusoidal ultrastructures were well maintained by portal HyFACS, while microvilli in bile canaliculi were well preserved by arterial flush. As an underlying mechanism, HyFACS significantly lowered oxidative damages, thus improving the glutathione/glutathione disulfide ratio in liver tissue. In conclusion, HyFACS significantly protected liver grafts from IRI by ameliorating oxidative damage upon reperfusion in the characteristic manner with its route of administration. Given its safety, simplicity, and cost-effectiveness, end-ischemic HyFACS may be a novel pretransplant conditioning for cold-stored donor organs.
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Affiliation(s)
- Ichiro Tamaki
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Koichiro Hata
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Yusuke Okamura
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Yermek Nigmet
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Hirofumi Hirao
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Toyonari Kubota
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Osamu Inamoto
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Jiro Kusakabe
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Toru Goto
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Tetsuya Tajima
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Junichi Yoshikawa
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Hirokazu Tanaka
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
| | - Tatsuaki Tsuruyama
- Center for Anatomical, Pathological and Forensic Medical ResearchKyoto University Graduate School of MedicineKyotoJapan
| | - Rene H. Tolba
- Institute for Laboratory Animal Science and Experimental SurgeryRheinisch‐Westfälische Technische Hochschule Aachen UniversityAachenGermany
| | - Shinji Uemoto
- Department of SurgeryDivision of Hepato‐Biliary‐Pancreatic Surgery and Transplantation
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Kato Y, Okamura Y, Omae K, Sugiura T, Ito T, Yamamoto Y, Ashida R, Sato R, Aramaki T, Uesaka K. Propensity score-matched comparison of non-anatomical resection and radiofrequency ablation for hepatocellular carcinoma in patients with up to three tumours, each measuring up to 3 cm in diameter. BJS Open 2018; 2:213-219. [PMID: 30079390 PMCID: PMC6069355 DOI: 10.1002/bjs5.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/23/2018] [Accepted: 02/22/2018] [Indexed: 12/17/2022] Open
Abstract
Background Non‐anatomical liver resection (NAR) and radiofrequency ablation (RFA) are treatment options for early‐stage hepatocellular carcinoma (HCC). The aim was to compare the outcomes of NAR and RFA for HCC in patients with three or fewer tumour nodules, each measuring not more than 3 cm in maximum diameter. Methods Eligible patients undergoing NAR or RFA with curative intent between September 2002 and December 2014 were identified. A propensity score‐matching analysis was performed to reduce bias, and outcomes in these patients were analysed. Results From a total of 199 patients, 1:1 propensity score matching identified 70 matched pairs. Patients having NAR had a longer hospital stay (median 10 days versus 4 days for those who had RFA; P < 0·001) and a higher morbidity rate (24 versus 10 per cent respectively; P = 0·042). Patients who had NAR had slightly better recurrence‐free survival but this failed to reach statistical significance in univariable analysis (P = 0·064). There was no significant difference in overall survival between the two groups (P = 0·475). RFA was identified as an independent risk factor for recurrence‐free survival (hazard ratio (HR) 1·57; P = 0·041) in multivariable analysis. Local recurrence was significantly more common in patients receiving RFA (23 versus 1 per cent; P < 0·001). Conclusion RFA was an independent risk factor for shorter recurrence‐free survival, with a significantly higher local recurrence rate than NAR. Despite these differences, overall survival was not affected.
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Affiliation(s)
- Y Kato
- Division of Hepato-Biliary-Pancreatic Surgery Shizuoka Cancer Centre Hospital Shizuoka Japan
| | - Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery Shizuoka Cancer Centre Hospital Shizuoka Japan
| | - K Omae
- Clinical Trial Coordination Office Shizuoka Cancer Centre Hospital Shizuoka Japan
| | - T Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery Shizuoka Cancer Centre Hospital Shizuoka Japan
| | - T Ito
- Division of Hepato-Biliary-Pancreatic Surgery Shizuoka Cancer Centre Hospital Shizuoka Japan
| | - Y Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery Shizuoka Cancer Centre Hospital Shizuoka Japan
| | - R Ashida
- Division of Hepato-Biliary-Pancreatic Surgery Shizuoka Cancer Centre Hospital Shizuoka Japan
| | - R Sato
- Division of Intervention Radiology Shizuoka Cancer Centre Hospital Shizuoka Japan
| | - T Aramaki
- Clinical Trial Coordination Office Shizuoka Cancer Centre Hospital Shizuoka Japan
| | - K Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery Shizuoka Cancer Centre Hospital Shizuoka Japan
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Yamaguchi M, Honda R, Erdenebaatar C, Monsur M, Honda T, Sakaguchi I, Okamura Y, Ohba T, Katabuchi H. Treatment of cervical pregnancy with ultrasound-guided local methotrexate injection. Ultrasound Obstet Gynecol 2017; 50:781-787. [PMID: 27943496 DOI: 10.1002/uog.17384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/24/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Cervical pregnancy (CP) is a rare type of ectopic pregnancy. While methotrexate (MTX) is generally the first-line method of choice for clinically stable women, there is still no consensus on the most appropriate treatment for this abnormal pregnancy. The aim of this study was to investigate the efficacy of a single local MTX injection under transvaginal ultrasound guidance for the initial treatment of CP and to assess post-treatment fertility. METHODS We reviewed retrospectively 15 patients with CP treated with local MTX injection under transvaginal ultrasound guidance. In all patients, the serum human chorionic gonadotropin (hCG) levels were monitored and the gestational sac was evaluated using ultrasonography after treatment. Magnetic resonance imaging (MRI) was performed as necessary. We evaluated the patients' clinical characteristics and clinical course after treatment, the efficacy of the treatment and the post-treatment fertility in patients desiring subsequent pregnancy. RESULTS The median estimated gestational age at the time of MTX injection was 6 + 2 (range, 5 + 2 to 11 + 0) weeks. All 15 patients were treated successfully, without the need for blood transfusion or surgical procedures; however, three patients required an additional local MTX injection due to a poor decline in serum hCG level following the initial injection, while one patient required uterine artery embolization due to persistent vaginal bleeding and an enlarging gestational sac with blood vessels visible on contrast-enhanced MRI. The mean time following initial MTX injection for hCG normalization was 43.8 (95% CI, 33.3-54.3) days and for resumption of menses was 68.4 (95% CI, 51.9-84.9) days. Seven of the 10 women desiring subsequent pregnancy following treatment had uneventful pregnancy, one became pregnant but miscarried spontaneously at 8 weeks of gestation, one was treated by laparoscopic surgery after diagnosis of a tubal pregnancy and one did not conceive. CONCLUSIONS A single, ultrasound-guided, local MTX injection is apparently effective for the treatment of CP without the need for concomitant procedures or surgical intervention. Furthermore, this conservative technique both preserves fertility and allows for the possibility of subsequent uneventful pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Yamaguchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Chuo-Ku, Kumamoto-City, Kumamoto, Japan
| | - R Honda
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Chuo-Ku, Kumamoto-City, Kumamoto, Japan
| | - C Erdenebaatar
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Chuo-Ku, Kumamoto-City, Kumamoto, Japan
| | - M Monsur
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Chuo-Ku, Kumamoto-City, Kumamoto, Japan
| | - T Honda
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Chuo-Ku, Kumamoto-City, Kumamoto, Japan
| | - I Sakaguchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Chuo-Ku, Kumamoto-City, Kumamoto, Japan
| | - Y Okamura
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Chuo-Ku, Kumamoto-City, Kumamoto, Japan
| | - T Ohba
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Chuo-Ku, Kumamoto-City, Kumamoto, Japan
| | - H Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Chuo-Ku, Kumamoto-City, Kumamoto, Japan
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Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Uesaka K. Surgical indication for advanced intrahepatic cholangiocarcinoma according to the optimal preoperative carbohydrate antigen 19-9 cut-off value. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.105] [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: 11/14/2022] Open
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Hashimoto H, Nakanishi R, Mizumura S, Hashimoto Y, Okamura Y, Kiuchi S, Yamazaki J, Ikeda T. 4782Prognostic value of 123I-betamethyl-p-iodophenyl-pentadecanoic acid single-photon emission computed tomography in patients with non-ischemic heart failure with preserved ejection fraction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4782] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, Uesaka K. Impact of Patient Age on the Postoperative Survival in Pancreatic Head Cancer. Ann Surg Oncol 2017; 24:3220-3228. [PMID: 28695390 DOI: 10.1245/s10434-017-5994-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Some reports have stated that pancreatoduodenectomy for elderly patients have comparable morbidity and mortality to that of young patients. However, the long-term outcomes of these patients have not been fully evaluated, especially for pancreatic head cancer. METHODS A total of 227 patients who underwent pancreatoduodenectomy for pancreatic head cancer between 2007 and 2014 were included. They were stratified according to age: young (<70 years), elderly (70 to <80 years), and very elderly (≥80 years). The short- and long-term outcomes were evaluated. RESULTS There were no significant differences in terms of morbidity among the three groups. The median disease-free survival times were 15 months in the young, 11 months in the elderly, and 7 months in the very elderly. The disease-free survival of the young patients was significantly better than that in both the elderly and the very elderly (p = 0.012 and p = 0.016). The median overall survival times were 30 months in the young, 20 months in the elderly, and 14 months in the very elderly. The overall survival of the young patients was significantly better than that in both the elderly and the very elderly (p = 0.007 and p < 0.001). The difference was marginal between the elderly and the very elderly (p = 0.053). Multivariate analysis revealed that lymph node metastasis (p < 0.001), age ≥80 years (p = 0.013), lack of adjuvant chemotherapy (p = 0.003), blood transfusion (p = 0.015), and CA 19-9 ≥300 U/ml (p = 0.040) were significant prognostic factors. CONCLUSIONS Patient age influenced the survival after pancreatoduodenectomy for pancreatic cancer.
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Affiliation(s)
- Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - T Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Y Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - R Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - K Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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Okamura Y, Hata K, Tanaka H, Hirao H, Kubota T, Inamoto O, Kageyama S, Tamaki I, Yermek N, Yoshikawa J, Uemoto S. Impact of Subnormothermic Machine Perfusion Preservation in Severely Steatotic Rat Livers: A Detailed Assessment in an Isolated Setting. Am J Transplant 2017; 17:1204-1215. [PMID: 27860296 DOI: 10.1111/ajt.14110] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 06/14/2016] [Revised: 10/09/2016] [Accepted: 10/30/2016] [Indexed: 01/25/2023]
Abstract
The current drastic shortage of donor organs has led to acceptance of extended-criteria donors for transplantation, despite higher risk of primary nonfunction. Here, we report the impact of subnormothermic machine perfusion (SMP) preservation on the protection of >50% macrosteatotic livers. Dietary hepatic steatosis was induced in Wistar rats via 2-day fasting and subsequent 3-day re-feeding with a fat-free, carbohydrate-rich diet. This protocol induces 50-60% macrovesicular steatosis, which should be discarded when preserved via cold storage (CS). The fatty livers were retrieved and preserved for 4 h using either CS in histidine-tryptophan-ketoglutarate or SMP in polysol solution. Graft functional integrity was evaluated via oxygenated ex vivo reperfusion for 2 h at 37°C. SMP resulted in significant reductions in not only parenchymal alanine aminotransferase (p < 0.001), but also mitochondrial glutamate dehydrogenase (p < 0.001) enzyme release. Moreover, portal venous pressure (p = 0.047), tissue adenosine triphosphate (p = 0.001), bile production (p < 0.001), high-mobility group box protein-1 (p < 0.001), lipid peroxidation, and tissue glutathione were all significantly improved by SMP. Electron microscopy revealed that SMP alleviated deleterious alterations of sinusoidal microvasculature and hepatocellular mitochondria, both of which are characteristic disadvantages associated with steatosis. SMP could protect 50-60% macrosteatotic livers from preservation/reperfusion injury, and may thus represent a new means for expanding available donor pools.
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Affiliation(s)
- Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - K Hata
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - H Tanaka
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - H Hirao
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Kubota
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - O Inamoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Kageyama
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - I Tamaki
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - N Yermek
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - J Yoshikawa
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Okamura Y, Hata K, Uemoto S. Reply to "Representing Subnormothermic Machine Perfusion in Fatty Livers: The Complete Picture?". Am J Transplant 2017; 17:1423-1424. [PMID: 28251800 DOI: 10.1111/ajt.14254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - K Hata
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Okamura Y, Hata K, Inamoto O, Kubota T, Hirao H, Tanaka H, Fujimoto Y, Ogawa K, Mori A, Okajima H, Kaido T, Uemoto S. Influence of hepatorenal syndrome on outcome of living donor liver transplantation: A single-center experience in 357 patients. Hepatol Res 2017; 47:425-434. [PMID: 27323334 DOI: 10.1111/hepr.12764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 12/13/2022]
Abstract
AIM Liver transplantation is the only curative treatment for hepatorenal syndrome (HRS); however, the influence of HRS on the patient and renal outcome after living donor liver transplantation (LDLT) is still unclear. The aim of the present study was to evaluate the influence of HRS on the outcome of LDLT. METHODS We retrospectively analyzed 357 consecutive adult patients who underwent primary LDLT between January 2005 and March 2013 at Kyoto University Hospital. The outcome of the patients with HRS was compared with those without HRS. RESULTS A total of 29 patients (8%) were diagnosed as HRS (Group-HRS) preoperatively, and the other 328 patients (92%) were not diagnosed as HRS (Group-Non-HRS). Group-HRS showed a significantly lower preoperative estimated glomerular filtration rate (22.1 vs 78.3 mL/min/1.73m2 , P < 0.001) and higher Child-Pugh-Turcotte score (13 vs 10, P < 0.001) than Group-non-HRS. After a median follow up of 60 months, the 1-, 3- and 5-year recipients' survival were 60.7%, 57.1% and 57.1% in Group-HRS, and 83.7%, 79.4% and 76.2% in Group-Non-HRS, respectively (P = 0.030). Concomitant HRS significantly elongated postoperative hospital stays (75 vs 50 days, P = 0.003), as well as predisposed patients to higher in-hospital mortality (41% vs 18%, P = 0.005). Multivariate analysis showed that preoperative renal dysfunction (estimated glomerular filtration rate on admission <40 mL/min/1.73m2 , OR 2.106, P = 0.03) was an independent risk factor for 1-year recipients' survival after LDLT, in addition to donor age ≥38 years (OR 3.114, P < 0.001), Child-Pugh-Turcotte score ≥13 (OR 2.929, P < 0.001) and left lobe graft (OR 2.225, P = 0.004). CONCLUSION Coincidence of HRS is associated with significantly worse outcome after LDLT, especially in the early post-transplant period.
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Affiliation(s)
- Yusuke Okamura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichiro Hata
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Osamu Inamoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyonari Kubota
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirofumi Hirao
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirokazu Tanaka
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhiro Fujimoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kohei Ogawa
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Mori
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideaki Okajima
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ashida R, Okamura Y, Nakao K, Mizuno T, Aoki S, Kiuchi R, Sugiura T, Ito T, Yamamoto Y, Mochizuki T, Uesaka K. MON-P241: The Impact of Preoperative Enteral Nutrition Enriched Administration with Eicosapentaenoic Acid (EPA) on Postoperative Hypercytokinemia after Pancreatoduodenectomy: Results of a Double-Blinded Randomized Controlled Trial. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30875-5] [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: 11/24/2022]
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Okamura Y, Sugiura T, Ito T, Yamamoto Y, Ashida R, Mori K, Uesaka K. Neutrophil to lymphocyte ratio as an indicator of the malignant behaviour of hepatocellular carcinoma. Br J Surg 2016; 103:891-8. [DOI: 10.1002/bjs.10123] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 12/13/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023]
Abstract
Abstract
Background
The preoperative serum neutrophil to lymphocyte ratio (NLR) has been associated with survival in patients with hepatocellular carcinoma (HCC). However, it is still unclear what the NLR reflects precisely. This study aimed to elucidate the relationship between the NLR and TNM stage, and the role of NLR as a prognostic factor after liver resection for HCC.
Methods
This retrospective study enrolled patients who underwent liver resection as initial treatment for HCC. The best cut-off value of serum NLR was determined, and overall survival was compared among patients grouped according to TNM stage (I, II and III).
Results
The best cut-off value for NLR was 2·8. A high preoperative NLR was more frequently associated with poor overall survival than a low preoperative NLR after resection for TNM stage I tumours (5-year survival 45·0 versus 76·4 per cent, P < 0·001), but not stage II (P = 0·283) or stage III (P = 0·155) tumours. Among patients with TNM stage I disease, the proportion of patients with extrahepatic recurrence was greater in the group with a high preoperative NLR than in the low-NLR group (P = 0·006). In multivariable analysis, preoperative NLR was the strongest independent prognostic risk factor for overall survival in TNM stage I (hazard ratio 2·69, 95 per cent c.i. 1·57 to 4·59; P < 0·001).
Conclusion
Preoperative NLR was an important prognostic factor for TNM stage I HCC after liver resection with curative intent. These results suggest that the NLR may reflect the malignant potential of HCC.
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Affiliation(s)
- Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
| | - T Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
| | - T Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
| | - Y Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
| | - R Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
| | - K Mori
- Clinical Research Centre, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
| | - K Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre Hospital, Shizuoka, Japan
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Nagashima H, Tanaka K, Sasayama T, Okamura Y, Taniguchi M, Otani K, Yamasaki T, Itoh T, Kohmura E. A large cavernous malformation of the third ventricle floor: A case report. Neurol Neurochir Pol 2015; 49:446-50. [DOI: 10.1016/j.pjnns.2015.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 05/25/2015] [Accepted: 08/13/2015] [Indexed: 11/28/2022]
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Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, Uesaka K. 1309 Pancreaticoduodenectomy for high-elderly patients with pancreatic adenocarcinoma. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30554-8] [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: 11/29/2022]
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Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Miyata T, Uemura S, Kinugasa Y, Bando E, Terashima M, Uesaka K. 2277 Is combined pancreatoduodenectomy for advanced gallbladder cancer justifiled? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31193-5] [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: 11/27/2022]
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Sugiura T, Mizuno T, Okamura Y, Ito T, Yamamoto Y, Kawamura I, Kurai H, Uesaka K. Impact of bacterial contamination of the abdominal cavity during pancreaticoduodenectomy on surgical-site infection. Br J Surg 2015. [DOI: 10.1002/bjs.9899] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract
Background
Several risk factors for complications after pancreaticoduodenectomy have been reported. However, the impact of intraoperative bacterial contamination on surgical outcome after pancreaticoduodenectomy has not been examined in depth.
Methods
This retrospective study included patients who underwent pancreaticoduodenectomy and peritoneal lavage using 7000 ml saline between July 2012 and May 2014. The lavage fluid was subjected to bacterial culture examination. The influence of a positive bacterial culture on surgical-site infection (SSI) and postoperative course was evaluated. Risk factors for positive bacterial cultures were also evaluated.
Results
Forty-six (21·1 per cent) of 218 enrolled patients had a positive bacterial culture of the lavage fluid. Incisional SSI developed in 26 (57 per cent) of these 46 patients and in 13 (7·6 per cent) of 172 patients with a negative lavage culture (P < 0·001). Organ/space SSI developed in 32 patients with a positive lavage culture (70 per cent) and in 43 of those with a negative culture (25·0 per cent) (P < 0·001). Grade B/C pancreatic fistula was observed in 22 (48 per cent) and 48 (27·9 per cent) respectively of patients with positive and negative lavage cultures (P = 0·010). Postoperative hospital stay was longer in patients with a positive lavage culture (28 days versus 21 days in patients with a negative culture; P = 0·028). Multivariable analysis revealed that internal biliary drainage, combined colectomy and a longer duration of surgery were significant risk factors for positive bacterial culture of the lavage fluid.
Conclusion
Intraoperative bacterial contamination has an adverse impact on the development of SSI and grade B/C pancreatic fistula following pancreaticoduodenectomy.
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Affiliation(s)
- T Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - T Mizuno
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - Y Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - T Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - Y Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
| | - I Kawamura
- Division of Infectious Disease, Shizuoka Cancer Centre, Shizuoka, Japan
| | - H Kurai
- Division of Infectious Disease, Shizuoka Cancer Centre, Shizuoka, Japan
| | - K Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan
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Okamura Y, Kagawa F, Seki S, Kubota M, Kawasaki M, Tokura Y. Microwave Magnetochiral Dichroism in the Chiral-Lattice Magnet Cu_{2}OSeO_{3}. Phys Rev Lett 2015; 114:197202. [PMID: 26024193 DOI: 10.1103/physrevlett.114.197202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Indexed: 06/04/2023]
Abstract
Through broadband microwave spectroscopy in Faraday geometry, we observe distinct absorption spectra accompanying magnetoelectric (ME) resonance for oppositely propagating microwaves, i.e., directional dichroism, in the multiferroic chiral-lattice magnet Cu_{2}OSeO_{3}. The magnitude of the directional dichroism critically depends on the magnetic-field direction. Such behavior is well accounted for by considering the relative direction of the oscillating electric polarizations induced via the ME effect with respect to microwave electric fields. Directional dichroism in a system with an arbitrary form of ME coupling can be also discussed in the same manner.
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Affiliation(s)
- Y Okamura
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo 113-8656, Japan
| | - F Kagawa
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
| | - S Seki
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
- PRESTO, Japan Science and Technology Agency, Bunkyo, Tokyo 113-8656, Japan
| | - M Kubota
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
- Research and Development Headquarters, ROHM Co., Ltd., Kyoto 615-8585, Japan
| | - M Kawasaki
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo 113-8656, Japan
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
| | - Y Tokura
- Department of Applied Physics and Quantum Phase Electronics Center, University of Tokyo, Tokyo 113-8656, Japan
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
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Kimura H, Okamura Y, Chiba Y, Shigeru M, Ishii T, Hori T, Shiomi R, Yamamoto Y, Fujimoto Y, Maeyama M, Kohmura E. Cilostazol administration with combination enteral and parenteral nutrition therapy remarkably improves outcome after subarachnoid hemorrhage. Acta Neurochir Suppl 2015; 120:147-52. [PMID: 25366615 DOI: 10.1007/978-3-319-04981-6_25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE In order to prevent cerebral vasospasm (VS) following aneurysmal subarachnoid hemorrhage (SAH), we introduced combined enteral nutrition (EN) and parenteral nutrition (PN) with oral cilostazol administration to the postoperative patient after SAH and investigated the effect on VS. METHODS After aneurysmal SAH, 130 postoperative patients were enrolled in this study between April 2008 and March 2012. The patients enrolled before April 2010 were treated by conventional therapy (control group). The patients enrolled after April 2010 were administrated cilostazol 200 mg/day and received EN and PN simultaneously (combined group). RESULTS The combined group consisted of 62 patients and the control group of 68 patients. Angiographic VS occurred in 33.9 % (n = 21) of the combined group and in 51.5 % (n = 35) of the control group (p = 0.051, Fisher exact test). The incidence of symptomatic VS was significantly lower in the combined group (p = 0.001). The incidence of new cerebral infarctions was also significantly lower in the combined group (p = 0.0006). Clinical outcome at discharge was also significantly better in the combined group than in control group (p = 0.031). CONCLUSIONS Cilostazol administration with combination EN and PN is remarkably effective in preventing cerebral VS after aneurysmal SAH.
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Affiliation(s)
- Hidehito Kimura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusuniki-cho, Chuo-ku, Kobe, 650-0017, Japan,
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Kageyama S, Hata K, Tanaka H, Hirao H, Kubota T, Okamura Y, Iwaisako K, Takada Y, Uemoto S. Intestinal ischemic preconditioning ameliorates hepatic ischemia/reperfusion injury in rats: role of heme oxygenase 1 in the second window of protection. Liver Transpl 2015; 21:112-22. [PMID: 25234134 DOI: 10.1002/lt.24006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 02/24/2014] [Revised: 08/29/2014] [Accepted: 09/17/2014] [Indexed: 01/12/2023]
Abstract
Preconditioning by brief ischemia protects not only the concerned organ but also other distant organs against subsequent lethal damage; this is called remote ischemic preconditioning (RIPC). This study was designed to investigate the impact of intestinal RIPC on hepatic ischemia/reperfusion injury (IRI) with a special interest in heme oxygenase 1 (HO-1) induction in the second window of protection (SWOP). Male Wistar rats were randomly assigned to 1 of 2 groups: an RIPC group or a sham group. Before hepatic IRI, either intestinal RIPC, consisting of 2 cycles of 4-minute superior mesenteric artery clamping separated by 11 minutes of declamping (RIPC group), or a sham procedure (sham group) was performed. After 48 hours of recovery, the rats were exposed to 30 minutes of total hepatic IRI. Transaminase releases and proinflammatory cytokines were determined at several time points after reperfusion. Histopathological analysis and animal survival were also investigated. Intestinal RIPC significantly lowered transaminase release (alanine aminotransferase at 2 hours: 873.3 ± 176.4 IU/L for the RIPC group versus 3378.7 ± 871.1 IU/L for the sham group, P < .001) as well as proinflammatory cytokine production (tumor necrosis factor α at 2 hours: 930 ± 42 versus 387 ± 17 pg/μL, P < .001). The morphological integrity of the liver and the ileum was maintained significantly better with intestinal RIPC; this reached statistical significance not only in Suzuki's liver injury score (3.5 ± 0.2 versus 0.7 ± 0.5, P = .007) but also in Park's score for intestinal damage (4.0 ± 0.4 versus 2.0 ± 0.2, P = .007). Animal survival was also markedly improved (83.1% versus 15.4%, P < .001). As a mechanism underlying this protection, HO-1 was substantially induced in liver tissue, especially in hepatocytes, with remarkable up-regulation of bradykinin in the portal blood, whereas HO-1 protein induction in enterocytes was not significant. In conclusion, intestinal RIPC remarkably attenuates hepatic IRI in the SWOP, presumably by HO-1 induction in hepatocytes.
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Affiliation(s)
- Shoichi Kageyama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
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Kanda M, Shimizu D, Sugimoto H, Oya H, Hibino S, Takami H, Hashimoto R, Okamura Y, Yamada S, Fujii T, Nakayama G, Koike M, Nomoto S, Fujiwara M, Kodera Y. B-Cell Translocation Gene 1 Serves As a Novel Prognostic Indicator of Hepatocellular Carcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.120] [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: 11/13/2022] Open
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Shimizu D, Kanda M, Sugimoto H, Oya H, Takami H, Hibino S, Hashimoto R, Okamura Y, Yamada S, Fujii T, Nakayama G, Koike M, Nomoto S, Fujiwara M, Kodera Y. Identification of Intragenic Methylation in the Tusc1 Gene As a Novel Prognostic Marker of Hepatocellular Carcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.121] [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: 11/14/2022] Open
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48
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Tolba RH, Fet N, Yonezawa K, Taura K, Nakajima A, Hata K, Okamura Y, Uchinami H, Klinge U, Minor T, Yamaoka Y, Yamamoto Y. Role of preferential cyclooxygenase-2 inhibition by meloxicam in ischemia/reperfusion injury of the rat liver. Eur Surg Res 2014; 53:11-24. [PMID: 24854565 DOI: 10.1159/000362411] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ischemia/reperfusion injury (IRI) is one of the major clinical problems in liver and transplant surgery. Livers subjected to warm ischemia in vivo often show a severe dysfunction and the release of numerous inflammatory cytokines and arachidonic acid metabolites. Cyclooxygenase (COX)-2 is the inducible isoform of an intracellular enzyme that converts arachidonic acid into prostaglandins. The aim of the study was to evaluate the effect of COX-2 inhibition and the role of Kupffer cells in IRI of the liver. METHODS Male Wistar rats [250- 280 g body weight (BW)] were anesthetized and subjected to 30-min warm ischemia of the liver (Pringle's maneuver) and 60-min reperfusion after median laparotomy. The I/R group received no additional treatment. In the COX-2 inhibitor (COX-2I) group, the animals received 1 mg/kg BW meloxicam prior to operation. Gadolinium chloride (GdCl3) (10 mg/kg BW) was given 24 h prior to operation in the GdCl3 and GdCl3 + COX-2I groups for the selective depletion of Kupffer cells. The GdCl3 + COX-2I group received both GdCl3 and meloxicam treatment prior to operation. Blood and liver samples were obtained at the end of the experiments for further investigations. RESULTS After 30 min of warm ischemia in vivo, severe hepatocellular damage was observed in the I/R group. These impairments could be significantly prevented by the selective COX-2 inhibition and the depletion of Kupffer cells. Alanine aminotransferase was significantly reduced upon meloxicam and GdCl3 treatment compared to the I/R group: I/R, 3,240 ± 1,262 U/l versus COX-2I, 973 ± 649 U/l, p < 0.001; I/R versus GdCl3, 1,611 ± 600 U/l, p < 0.05, and I/R versus GdCl3 + COX-2I, 1,511 ± 575 U/l, p < 0.01. Plasma levels of tumor necrosis factor alpha (TNF-α) were significantly reduced in the COX-2I treatment group compared to I/R (3.5 ± 1.5 vs. 16.3 ± 11.7 pg/ml, respectively; p < 0.05). Similarly, the amount of TxB2, a marker for COX-2 metabolism, was significantly reduced in the meloxicam treatment groups compared to the I/R group: I/R, 22,500 ± 5,210 pg/ml versus COX-2I, 1,822 ± 938 pg/ml, p < 0.001, and I/R versus GdCl3 + COX-2I, 1,530 ± 907 pg/ml, p < 0.001. All values are given as mean ± SD (n = 6). CONCLUSION These results suggest that the inhibition of COX-2 suppressed the initiation of an inflammatory cascade by attenuating the release of TNF-α, which is an initiator of the inflammatory reaction in hepatic IRI. Therefore, we conclude that preferential inhibition of COX-2 is a possible therapeutic approach against warm IRI of the liver.
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Affiliation(s)
- René H Tolba
- Division of Surgical Research, University Hospital Bonn, Bonn, Germany
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Kokunai Y, Nakata T, Furuta M, Sakata S, Kimura H, Aiba T, Yoshinaga M, Osaki Y, Nakamori M, Itoh H, Sato T, Kubota T, Kadota K, Shindo K, Mochizuki H, Shimizu W, Horie M, Okamura Y, Ohno K, Takahashi MP. A Kir3.4 mutation causes Andersen-Tawil syndrome by an inhibitory effect on Kir2.1. Neurology 2014; 82:1058-64. [DOI: 10.1212/wnl.0000000000000239] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Okamura Y, Fujiwara K, Ishihara R, Sugo T, Kojima T, Umeno D, Saito K. Cesium removal in freshwater using potassium cobalt hexacyanoferrate-impregnated fibers. Radiat Phys Chem Oxf Engl 1993 2014. [DOI: 10.1016/j.radphyschem.2013.04.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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