105 results on '"Yoshitomi M"'
Search Results
2. A novel use of indocyanine green to identify the plane of dissection during abdominoperineal resection by the transperineal approach - a video vignette
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Kawada, K., primary, Hida, K., additional, Yoshitomi, M., additional, and Sakai, Y., additional
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- 2018
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3. LB017-SUN: Immunonutrition Suppresses Acute Inflammatory Responses Through Modulation of Resolvin E1 in Patients Undergoing Major Hepatobiliary Resection
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Furukawa, K., primary, Uno, H., additional, Suzuki, D., additional, Miyauchi, Y., additional, Shimizu, H., additional, Ohtsuka, M., additional, Kato, A., additional, Yoshitomi, M., additional, Takayashiki, T., additional, Kuboki, S., additional, Takano, S., additional, Okamura, D, additional, Sakai, N., additional, Kagawa, S., additional, and Miyazaki, M., additional
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- 2014
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4. Contributions of regional and intercontinental transport to surface ozone in the Tokyo area
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Yoshitomi, M., primary, Wild, O., additional, and Akimoto, H., additional
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- 2011
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5. Contributions of regional and intercontinental transport to surface ozone in Tokyo
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Yoshitomi, M., primary, Wild, O., additional, and Akimoto, H., additional
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- 2011
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6. DEVELOPMENT OF OPERATIONAL TOLERANCE AFTER PEDIATRIC LIVER TRANSPLANTATION IS ASSOCIATED WITH THE ABSENCE OF EARLY REJECTION AND THE PRESENCE OF HLA-B MISMATCH BETWEEN DONORS AND RECIPIENTS
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Ohe, H, primary, Yoshitomi, M, additional, Koshiba, T, additional, and Uemoto, S, additional
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- 2008
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7. Efficient Implementation of the Pairing on Mobilephones Using BREW
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YOSHITOMI, M., primary, TAKAGI, T., additional, KIYOMOTO, S., additional, and TANAKA, T., additional
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- 2008
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8. A Graph-Based Differentially Private Algorithm for Mining Frequent Sequential Patterns
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Miguel Nunez-del-Prado, Yoshitomi Maehara-Aliaga, Julián Salas, Hugo Alatrista-Salas, and David Megías
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sequential pattern mining ,differential privacy ,frequent pattern mining ,edge differential privacy ,graph differential privacy ,anonymization of big data ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
Currently, individuals leave a digital trace of their activities when they use their smartphones, social media, mobile apps, credit card payments, Internet surfing profile, etc. These digital activities hide intrinsic usage patterns, which can be extracted using sequential pattern algorithms. Sequential pattern mining is a promising approach for discovering temporal regularities in huge and heterogeneous databases. These sequences represent individuals’ common behavior and could contain sensitive information. Thus, sequential patterns should be sanitized to preserve individuals’ privacy. Hence, many algorithms have been proposed to accomplish this task. However, these techniques add noise to the candidate support before they are validated as, frequently, and thus, they cannot be applied without having access to all the users’ sequences data. In this paper, we propose a differential privacy graph-based technique for publishing frequent sequential patterns. It is applied at the post-processing stage; hence it may be used to protect frequent sequential patterns after they have been extracted, without the need to access all the users’ sequences. To validate our proposal, we performed a detailed assessment of its utility as a pattern mining algorithm and calculated the impact of the sanitization mechanism on a recommender system. We further evaluated its information loss disclosure risk and performed a comparison with the DP-FSM algorithm.
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- 2022
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9. On the changing international competitiveness of Japanese manufacturing since 1985
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Yoshitomi, M, primary
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- 1996
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10. The Accuracy of Calculating Wave Action in Engine Intake Manifolds
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Winterbone, D. E., primary and Yoshitomi, M., additional
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- 1990
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11. An Appraisal of Japanese Financial Policies
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Yoshitomi, M.
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Japan -- Economic policy ,Business, international ,Economics - Published
- 1983
12. The Two-Chip Integration for Color Television Receivers.
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Yoshitomi, M., Yamashita, H., Kojima, K., and Takano, H.
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- 1982
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13. Resolution of breakpoints in a complex rearrangement by use of multiple staining techniques: Confirmation of suspected 12p12.3 intraband by deletion dosage effect of LDHB
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Magenis, E., primary, Brown, M. G., additional, Chamberlin, J., additional, Donlon, T., additional, Hepburn, D., additional, Lamvik, N., additional, Lovrien, E., additional, Yoshitomi, M., additional, and Opitz, John M., additional
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- 1981
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14. Synthesis and Biological Properties of Novel Fluoroprostaglandin Derivatives: Highly Selective and Potent Agonists for Prostaglandin Receptors
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Yasushi Matsumuraa, Takashi Nakanob, Nobuaki Moria, and Yoshitomi Morizawab
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Antiplatelet ,Fluorination ,Glaucoma ,Prostaglandin ,Receptor ,Chemistry ,QD1-999 - Abstract
Synthesis of novel 7,7-difluoroprostacyclin and 15-deoxy-15,15-difluoro-PGF2? derivatives will be presented. These compounds show high affinity to prostaglandin receptors and potent biological activities.
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- 2004
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15. Leakage Sign Is a Reliable Predictor of Hematoma Expansion in Acute Epidural Hematoma.
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Sugi K, Kikuchi J, Yoshitomi M, Orito K, Kajiwara S, Nakamura Y, Takeshige N, Takeuchi Y, Abe T, and Morioka M
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- Humans, Male, Female, Middle Aged, Retrospective Studies, Aged, Adult, Predictive Value of Tests, Aged, 80 and over, Disease Progression, Hematoma, Epidural, Cranial surgery, Hematoma, Epidural, Cranial diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Background: Hematoma expansion (H-Ex) in small-/medium-sized acute epidural hematoma (AEDH) cases upon emergency admission is critical. Predicting H-Ex can lead to early surgical interventions, improving outcomes, and eliminating the need to check for expansion via computed tomography (CT). This study aimed to identify the most reliable predictors of AEDH expansion., Methods: We retrospectively collected data from patients with pure AEDH not requiring surgical treatment upon emergency admission from 2012 to 2022. We assessed clinical and laboratory data, time from injury to the first CT, and time to follow-up CT. Factors predictive of H-Ex on the second follow-up CT, including the leakage sign (LS), were analyzed., Results: A total of 23 patients with pure AEDH without surgery at admission were included, and LS was positive in 18. Thirteen patients showed H-Ex. The H-Ex group showed a significantly higher rate of positive LS and a lower mean platelet count than the group without H-Ex. LS's predictive value for AEDH expansion showed 100% sensitivity and 50% specificity. All patients with negative LS and normal platelet counts showed no H-Ex. Analyzing the time from injury to the first CT suggested that LS (+) within 120 minutes strongly predicted H-Ex. Reconstructed three-dimensional images of the leakage point on the skull revealed multiple mottled bleeding points on the dural surface., Conclusions: LS can predict H-Ex in patients with pure AEDH for whom emergency surgery is unnecessary at admission. The time from injury and platelet counts must also be considered., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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16. High DOCK1 expression identifies a distinct prognostic subgroup of pediatric acute myeloid leukemia: Results of the Japanese Pediatric Leukemia/Lymphoma Study Group AML-05 trial.
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Yoshitomi M, Tsujimoto SI, Ikeda J, Kawai T, Ohki K, Hara Y, Yamato G, Tanoshima R, Tomizawa D, Shimada A, Horibe K, Adachi S, Taga T, Tawa A, Hayashi Y, Ito S, and Shiba N
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- Humans, Child, Male, Female, Prognosis, Child, Preschool, Adolescent, Infant, Survival Rate, Follow-Up Studies, East Asian People, rac GTP-Binding Proteins, Leukemia, Myeloid, Acute genetics, Leukemia, Myeloid, Acute drug therapy, Leukemia, Myeloid, Acute mortality, Leukemia, Myeloid, Acute pathology, Biomarkers, Tumor genetics, Biomarkers, Tumor metabolism
- Abstract
Background: The molecular pathogenesis of acute myeloid leukemia (AML) was dramatically clarified over the latest two decades. Several important molecular markers were discovered in patients with AML that have helped to improve the risk stratification. However, developing new treatment strategies for relapsed/refractory acute myeloid leukemia (AML) is crucial due to its poor prognosis., Procedure: To overcome this difficulty, we performed an assay for transposase-accessible chromatin with sequencing (ATAC-seq) in 10 AML patients with various gene alterations. ATAC-seq is based on direct in vitro sequencing adaptor transposition into native chromatin, and is a rapid and sensitive method for integrative epigenomic analysis. ATAC-seq analysis revealed increased accessibility of the DOCK1 gene in patients with AML harboring poor prognostic factors. Following the ATAC-seq results, quantitative reverse transcription polymerase chain reaction was used to measure DOCK1 gene expression levels in 369 pediatric patients with de novo AML., Results: High DOCK1 expression was detected in 132 (37%) patients. The overall survival (OS) and event-free survival (EFS) among patients with high DOCK1 expression were significantly worse than those patients with low DOCK1 expression (3-year EFS: 34% vs. 60%, p < .001 and 3-year OS: 60% vs. 80%, p < .001). To investigate the significance of high DOCK1 gene expression, we transduced DOCK1 into MOLM14 cells, and revealed that cytarabine in combination with DOCK1 inhibitor reduced the viability of these leukemic cells., Conclusions: Our results indicate that a DOCK1 inhibitor might reinforce the effects of cytarabine and other anti-cancer agents in patients with AML with high DOCK1 expression., (© 2024 Wiley Periodicals LLC.)
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- 2024
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17. Extrahepatic Portal Venous Gas Is the Strongest Predictor of Mortality in Patients with Portal Venous Gas and Pneumatosis Intestinalis.
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Yoshida N, Sadakari Y, Nakane H, Yoshitomi M, Tamehiro K, Hirokata G, Aoyagi T, Ogata T, and Taniguchi M
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Background: Very few studies have examined the association between contrast-enhanced computed tomography (CT) findings observed in portal venous gas (PVG) and pneumatosis intestinalis (PI) and the underlying diseases in these conditions., Objectives: In this study, we analyzed this association and report the findings for predicting mortality., Materials and Methods: Overall, 50 patients diagnosed with PVG or PI, observed on contrast-enhanced CT, underwent treatment at our hospital. Based on the underlying disease, we divided the patients into three groups, those with ischemic disease, infectious disease, or gastrointestinal dilatation. Furthermore, cases that underwent surgical treatment or needed surgery but were inoperable were assigned to the high risk group (n=16) and patients who received conservative treatment were assigned to the low risk group (n=34). We reviewed the patients' medical charts, laboratory data, and CT images retrospectively, and analyzed the relationship between CT findings, underlying disease, and association with the high risk or low risk group in each case., Results: Poor enhancement of the intestinal wall, mesenteric fat stranding, extrahepatic PVG, advanced age, and renal disease were significantly associated with ischemic disease (p=0.02, p=0.02, p=0.005, p=0.008 and p=0.049, respectively). PI alone was strongly associated with gastrointestinal dilatation (p=0.009). Patients in the low risk group had more favorable outcomes with conservative treatment. In multivariate analysis, extrahepatic PVG was the only factor associated with the high risk group (p=0.002)., Conclusion: Extrahepatic PVG associated with ischemic disease was the strongest predictive factor of mortality. Other CT findings, though useful in diagnosing the underlying disease, were not significant predictive factors.
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- 2024
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18. Landscape of driver mutations and their clinical effects on Down syndrome-related myeloid neoplasms.
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Sato T, Yoshida K, Toki T, Kanezaki R, Terui K, Saiki R, Ojima M, Ochi Y, Mizuno S, Yoshihara M, Uechi T, Kenmochi N, Tanaka S, Matsubayashi J, Kisai K, Kudo K, Yuzawa K, Takahashi Y, Tanaka T, Yamamoto Y, Kobayashi A, Kamio T, Sasaki S, Shiraishi Y, Chiba K, Tanaka H, Muramatsu H, Hama A, Hasegawa D, Sato A, Koh K, Karakawa S, Kobayashi M, Hara J, Taneyama Y, Imai C, Hasegawa D, Fujita N, Yoshitomi M, Iwamoto S, Yamato G, Saida S, Kiyokawa N, Deguchi T, Ito M, Matsuo H, Adachi S, Hayashi Y, Taga T, Saito AM, Horibe K, Watanabe K, Tomizawa D, Miyano S, Takahashi S, Ogawa S, and Ito E
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- Humans, Male, Female, Leukemoid Reaction genetics, Infant, Child, Preschool, Exome Sequencing, Prognosis, Leukemia, Myeloid genetics, Infant, Newborn, Child, Core Binding Factor Alpha 2 Subunit genetics, Down Syndrome genetics, Down Syndrome complications, Mutation
- Abstract
Abstract: Transient abnormal myelopoiesis (TAM) is a common complication in newborns with Down syndrome (DS). It commonly progresses to myeloid leukemia (ML-DS) after spontaneous regression. In contrast to the favorable prognosis of primary ML-DS, patients with refractory/relapsed ML-DS have poor outcomes. However, the molecular basis for refractoriness and relapse and the full spectrum of driver mutations in ML-DS remain largely unknown. We conducted a genomic profiling study of 143 TAM, 204 ML-DS, and 34 non-DS acute megakaryoblastic leukemia cases, including 39 ML-DS cases analyzed by exome sequencing. Sixteen novel mutational targets were identified in ML-DS samples. Of these, inactivations of IRX1 (16.2%) and ZBTB7A (13.2%) were commonly implicated in the upregulation of the MYC pathway and were potential targets for ML-DS treatment with bromodomain-containing protein 4 inhibitors. Partial tandem duplications of RUNX1 on chromosome 21 were also found, specifically in ML-DS samples (13.7%), presenting its essential role in DS leukemia progression. Finally, in 177 patients with ML-DS treated following the same ML-DS protocol (the Japanese Pediatric Leukemia and Lymphoma Study Group acute myeloid leukemia -D05/D11), CDKN2A, TP53, ZBTB7A, and JAK2 alterations were associated with a poor prognosis. Patients with CDKN2A deletions (n = 7) or TP53 mutations (n = 4) had substantially lower 3-year event-free survival (28.6% vs 90.5%; P < .001; 25.0% vs 89.5%; P < .001) than those without these mutations. These findings considerably change the mutational landscape of ML-DS, provide new insights into the mechanisms of progression from TAM to ML-DS, and help identify new therapeutic targets and strategies for ML-DS., (© 2024 American Society of Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)
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- 2024
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19. Impact of the coronavirus disease 2019 pandemic on gastric and colorectal cancer surgeries: a multicenter epidemiologic study from the Kinki region of Japan.
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Jikihara S, Hoshino N, Hida K, Inamoto S, Tanaka E, Matsusue R, Hamasu S, Matsuo K, Hashida H, Shiota T, Yamada M, Yamashita Y, Nakamura Y, Yoshitomi M, Murakami T, Itatani Y, Hisamori S, Tsunoda S, and Obama K
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- Humans, Japan epidemiology, Pandemics, Epidemiologic Studies, COVID-19 epidemiology, Colorectal Neoplasms epidemiology, Colorectal Neoplasms surgery
- Abstract
The coronavirus disease 2019 pandemic affected cancer surgeries and advanced cancer diagnoses; however, the trends in patient characteristics in medical institutions during this time, and the surgical approaches used are unclear. We investigated the impact of the pandemic on gastric and colorectal cancer surgeries in the Kinki region of Japan. We grouped 1688 gastric and 3493 colorectal cancer surgeries into three periods: "pre-pandemic" (April 2019-March 2020), "pandemic 1" (April 2020-March 2021), and "pandemic 2" (April 2021-September 2021), to investigate changes in the number of surgeries, patient characteristics, surgical approaches, and cancer progression after surgery. Gastric and colorectal cancer surgeries decreased from the pre-pandemic levels, by 20% and 4%, respectively, in pandemic 1, and by 31% and 19%, respectively, in pandemic 2. This decrease had not recovered to pre-pandemic levels by September, 2021. Patient characteristics, surgical approaches, and cancer progression of gastric and colorectal surgeries did not change remarkably as a result of the coronavirus disease 2019 pandemic., (© 2023. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)
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- 2024
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20. Intraventricular hemorrhage volume and younger age at surgery may be risk factors for postoperative hydrocephalus after hemispherotomy in children.
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Yoshitomi M, Iijima K, Kosugi K, Takayama Y, Kimura Y, Kaneko Y, Kawashima T, Tachimori H, Sumitomo N, Baba S, Saito T, Nakagawa E, Morioka M, and Iwasaki M
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- Child, Humans, Bayes Theorem, Risk Factors, Cerebral Hemorrhage, Drug Resistant Epilepsy diagnostic imaging, Drug Resistant Epilepsy etiology, Drug Resistant Epilepsy surgery, Hydrocephalus diagnostic imaging, Hydrocephalus etiology, Hydrocephalus surgery
- Abstract
Objective: Hemispherotomy is an effective treatment for intractable hemispheric epilepsy; however, hydrocephalus remains a common complication of the procedure. The causes of hydrocephalus following hemispherotomy have not been fully elucidated; therefore, the purpose of this study was to identify the risk factors associated with the condition., Methods: The authors investigated the records of all patients aged < 18 years who underwent hemispherotomy at their institution between 2003 and 2020 and were monitored for hydrocephalus for at least 1 year after the procedure. To identify the risk factors for hydrocephalus, the following information about each patient was collected: sex, corrected age at surgery, body weight at surgery, previous intracranial surgery, etiology of epilepsy, results of PET for hypermetabolism, side of surgery, type of operation (vertical or horizontal approach), operation time, blood loss during surgery, use of intraventricular drainage, occurrence of intraventricular hemorrhage (IVH) on the 1st postoperative day, duration of postoperative fever of > 38°C, and maximum C-reactive protein level after the operation. Multivariate logistic regression analyses were performed., Results: This study included 51 children who underwent hemispherotomies for drug-resistant epilepsy at our hospital. Seven patients (13.7%) experienced hydrocephalus and were treated with ventricular or subdural peritoneal shunts or fenestration. Multivariate logistic analysis using the Bayesian information criterion revealed that 3 factors were associated with the occurrence of hydrocephalus: age at surgery, postoperative IVH volume, and duration of postoperative fever of > 38°C., Conclusions: This study showed that younger age at surgery, postoperative IVH volume, and duration of postoperative fever of > 38°C might be risk factors for hydrocephalus after hemispherotomy. The risk of hydrocephalus should be considered in cases of early surgical indication in children. Intraoperative hemostasis and postoperative use of anti-inflammatory measures may reduce the risk of hydrocephalus.
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- 2023
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21. Severe RAS-Associated Lymphoproliferative Disease Case with Increasing αβ Double-Negative T Cells with Atypical Features.
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Kurita D, Shiba N, Ohya T, Murase A, Shimosato Y, Yoshitomi M, Hattori S, Sasaki K, Nishimura K, Tsujimoto SI, Takeuchi M, Tanoshima R, Kanegane H, Kitagawa N, and Ito S
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- Female, Humans, Child, CD4-Positive T-Lymphocytes, Receptors, Antigen, T-Cell, alpha-beta genetics, Lymphoproliferative Disorders, Autoimmune Lymphoproliferative Syndrome diagnosis, Autoimmune Lymphoproliferative Syndrome genetics, Lupus Erythematosus, Systemic
- Abstract
Autoimmune lymphoproliferative syndrome (ALPS) is a disease of lymphocyte homeostasis caused by FAS-mediated apoptotic pathway dysfunction and is characterized by non-malignant lymphoproliferation with an increased number of TCRαβ+CD4-CD8- double-negative T cells (αβDNTs). Conversely, RAS-associated leukoproliferative disease (RALD), which is caused by gain-of-functional somatic variants in KRAS or NRAS, is considered a group of diseases with a similar course. Herein, we present a 7-year-old Japanese female of RALD harboring NRAS variant that aggressively progressed to juvenile myelomonocytic leukemia (JMML) with increased αβDNTs. She eventually underwent hematopoietic cell transplantation due to acute respiratory distress which was caused by pulmonary infiltration of JMML blasts. In general, αβDNTs have been remarkably increased in ALPS; however, FAS pathway gene abnormalities were not observed in this case. This case with RALD had repeated shock/pre-shock episodes as the condition progressed. This shock was thought to be caused by the presence of a high number of αβDNTs. The αβDNTs observed in this case revealed high CCR4, CCR6, and CD45RO expressions, which were similar to Th17. These increased Th17-like αβDNTs have triggered the inflammation, resulting in the pathogenesis of shock, because Th17 secretes pro-inflammatory cytokines such as interleukin (IL)-17A and granulocyte-macrophage colony-stimulating factor. The presence of IL-17A-secreting αβDNTs has been reported in systemic lupus erythematosus (SLE) and Sjögren's syndrome. The present case is complicated with SLE, suggesting the involvement of Th17-like αβDNTs in the disease pathogenesis. Examining the characteristics of αβDNTs in RALD, JMML, and ALPS may reveal the pathologies in these cases., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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22. Preoperative Chemotherapy Followed by Hepatectomy for Potentially Resectable UICC7 Stage IIIA, IIIB Hepatocellular Carcinoma; A Phase II Clinical Trial.
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Goto Y, Niizeki T, Fukutomi S, Shirono T, Shimose S, Iwamoto H, Kojima S, Kanno H, Uchino Y, Sasaki S, Shirahama N, Muroya D, Nomura Y, Akashi M, Nakayama G, Hirakawa Y, Sato T, Yoshitomi M, Sakai H, Hisaka T, Kakuma T, Koga H, Torimura T, Akagi Y, and Okuda K
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- Humans, Hepatectomy, Neoplasm Staging, Carcinoma, Hepatocellular drug therapy, Carcinoma, Hepatocellular surgery, Chemoembolization, Therapeutic, Liver Neoplasms drug therapy, Liver Neoplasms surgery
- Abstract
Background: The Japanese guideline for therapeutic strategy in HCC does not recognize any benefit of preoperative chemotherapy for potentially resectable hepatocellular carcinoma (HCC), and only upfront resec tion is recommended even for an advanced HCC. Data on preoperative chemotherapy for advanced HCC is still limited. Poor prognostic factors of HCC after resection are tumor more than 5 cm in diameter, multiple lesions, and gross tumor thrombosis, which constitute UICC7 Stage IIIA and IIIB HCC. There are no prospective studies about preoperative chemotherapy in these patients., Aim: To evaluate the benefit of preoperative chemotherapy for UICC7 Stage IIIA and IIIB potentially resectable HCC., Discussion: Our recent study demonstrated that the 5-year overall survival rate (OS) of patients diagnosed as UICC7 Stage IIIA and IIIB who had received upfront resection was only 16.5%. In contrast, the 5-year OS of UICC7 Stage IIIA and IIIB initially unresectable patients who had achieved conversion from unresectable to resect able status under successful hepatic infusion chemotherapy prior to resection was as high as 61.3%. Additionally, recent studies reported transarterial chemoembolization achieved outcomes comparable with those of resection. Therefore, we believe that patients with UICC7 Stage IIIA and IIIB should be considered borderline resectable. To evaluate this hypothesis we registered the present phase II clinical trial to assess the benefit of preoperative chemo therapy followed by hepatectomy in potentially resectable UICC7 Stage IIIA and IIIB HCC patients.
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- 2023
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23. Prognostic Factors for Distal Bile Duct Carcinoma After Surgery.
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Kawahara R, Midorikawa R, Taniwaki S, Kojima S, Kanno H, Yoshitomi M, Nomura Y, Goto Y, Satou T, Sakai H, Ishikawa H, Hisaka T, Yasunaga M, Sakaue T, Ushijima T, Yasumoto M, Okabe Y, Tanigawa M, Naitou Y, Yano H, and Okuda K
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- Humans, Aged, Prognosis, Lymphatic Metastasis, Treatment Outcome, Pancreaticoduodenectomy, Bile Ducts pathology, Bile Ducts surgery, Survival Rate, Retrospective Studies, Bile Duct Neoplasms surgery, Bile Duct Neoplasms pathology, Carcinoma secondary, Carcinoma surgery
- Abstract
Background: Distal bile duct carcinoma continues to be one of the most difficult cancers to manage in terms of staging and radical resection. Pancreaticoduodenectomy (PD) with regional lymph node dissection has become the standard treatment of distal bile duct carcinoma. We evaluated treatment outcomes and histological factors in patients with distal bile duct carcinoma., Methods: Seventy-four cases of resection of carcinoma of the distal bile ducts treated at our department during the period from January 2002 and December 2016 using PD and regional lymph node dissection as the standard surgical procedure were investigated. Survival rates of factors were analyzed using uni- and multivariate analyses., Results: The median survival time was 47.8 months. On univariate analysis, age of 70 years or older, histologically pap, pPanc2,3, pN1, pEM0, v2,3, ly2,3, ne2,3 and postoperative adjuvant chemotherapy were statistically significant factors. On multivariate analysis, histologically pap was identified as a significant independent prognostic factor. The multivariate analysis identified age of 70 years or older, pEM0, ne2,3 and postoperative adjuvant chemotherapy as showing a significant trend towards independent prognostic relevance., Conclusion: The good news about resected distal bile duct carcinoma is that the percentage of those who achieved R0 resection has risen to 89.1%. Our multivariate analysis identified age of 70 years or older, pEM0, ne2,3 and postoperative adjuvant chemotherapy as prognostic factors. In order to improve the outcome of treatment, it is necessary to improve preoperative diagnostic imaging of pancreatic invasion and lymph node metastasis, establish the optimal operation range and clarify whether aortic lymph node dissection is needed to control lymph node metastasis, and establish effective regimens of chemotherapy.
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- 2023
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24. Ability of minimally invasive surgery to decrease incisional surgical site infection occurrence in patients with colorectal cancer and other gastroenterological malignancies.
- Author
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Yamamoto T, Yoshitomi M, Oshimo Y, Nishikawa Y, Hisano K, Nakano K, Kawai T, Okuchi Y, Iguchi K, Tanaka E, Fukuda M, Taura K, and Terajima H
- Abstract
Background: Surgical site infection (SSI) is one of the most important complications of surgery for gastroenterological malignancies because it leads to a prolonged postoperative hospital stay and increased inpatient costs. Furthermore, SSI can delay the initiation of postoperative treatments, including adjuvant chemotherapy, negatively affecting patient prognosis. Identifying the risk factors for SSI is important to improving intra- and postoperative wound management for at-risk patients., Methods: Patients with gastroenterological malignancies who underwent surgery at our institution were retrospectively reviewed and categorized according to the presence or absence of incisional SSI. Clinicopathological characteristics such as age, sex, body mass index, malignancy location, postoperative blood examination results, operation time, and blood loss volume were compared between groups. The same analysis was repeated of only patients with colorectal malignancies., Results: A total of 528 patients (330 men, 198 women; mean age, 68 ± 11 years at surgery) were enrolled. The number of patients with diseases of the esophagus, stomach, small intestine, colon and rectum, liver, gallbladder, and pancreas were 25, 150, seven, 255, 51, five, and 35, respectively. Open surgery was performed in 303 patients vs. laparoscopic surgery in 225 patients. An incisional SSI occurred in 46 patients (8.7%). Multivariate logistic regression analysis showed that postoperative hyperglycemia (serum glucose level ≥140 mg/dl within 24 h after surgery), colorectal malignancy, and open surgery were independent risk factors for incisional SSI. In a subgroup analysis of patients with colorectal malignancy, incisional SSI occurred in 27 (11%) patients. Open surgery was significantly correlated with the occurrence of incisional SSI ( P = 0.024)., Conclusions: Postoperative hyperglycemia and open surgery were significant risk factors for SSI in patients with gastroenterological malignancies. Minimally invasive surgery could reduce the occurrence of incisional SSI., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Yamamoto, Yoshitomi, Oshimo, Nishikawa, Hisano, Nakano, Kawai, Okuchi, Iguchi, Tanaka, Fukuda, Taura and Terajima.)
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- 2023
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25. Safety, Feasibility, and Efficacy of Additional Extraventricular Anterior Commissurotomy With Corpus Callosotomy.
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Kosugi K, Yoshitomi M, Takayama Y, Iijima K, Kimura Y, Kaneko Y, Toda M, and Iwasaki M
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- Humans, Retrospective Studies, Feasibility Studies, Seizures surgery, Blood Loss, Surgical, Corpus Callosum surgery, Epilepsy surgery
- Abstract
Background: Corpus callosotomy (CC) is a palliative neurosurgical procedure for patients with intractable epilepsy and without resectable focal epileptogenic lesions. Anterior commissurotomy (AC) has been historically performed with CC. However, the efficacy and safety of adding AC to CC remain unknown., Objective: To describe the surgical technique of extraventricular AC and retrospectively investigate its clinical efficacy and safety by assessing patients who underwent CC with and without AC., Methods: AC has been added to CC at our institution since 2018. Fifty-five consecutive patients who received total callosotomy from 2016 to 2020 were included and categorized into 2 groups: 26 patients with additional AC and 29 patients without additional AC. Seizure outcome 1 year after surgery were compared between groups for assessing the efficacy of adding AC. The perioperative factors were compared for assessing the safety and feasibility., Results: Seizure reduction rate (50% and 60%; P = .60) and disappearance of drop attacks (42% and 58%; P = .25) were not significantly different between CC and CC + AC groups. No statistical group differences were found in intraoperative estimated blood loss, number of days to first oral intake, duration of postoperative intravenous hydration, and length of hospital stay., Conclusion: Disconnection of the anterior commissure is a feasible and relatively safe procedure. This study failed to show the significant efficacy of adding AC to CC. However, further investigation is needed to prove its efficacy in ameliorating epilepsy., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)
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- 2023
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26. Salvage PTBD With Chemotherapy Improves Survival in Patients With Unresectable Malignant Biliary Obstruction - A Single Center Retrospective Study.
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Muroya D, Tsuru H, Shimokobe H, Nagao Y, Yoshimoto Y, Wada Y, Hayashi K, Taniwaki S, Midorikawa R, Taniwaki S, Kojima S, Arai S, Shirahama T, Goto Y, Sakai H, Yoshitomi M, Hisaka T, Akagi Y, and Okuda K
- Subjects
- Aged, Female, Humans, Male, Drainage adverse effects, Retrospective Studies, Treatment Outcome, Cholestasis drug therapy, Cholestasis etiology, Neoplasms etiology
- Abstract
Background/aim: Malignant biliary obstruction (MBO) is a life-threatening condition. We aimed to investigate the outcome of salvage percutaneous transhepatic biliary drainage (PTBD) in patients with unresectable MBO due to failure of management by endoscopic retrograde cholangiopancreatography (ERCP) and/or prior surgical bypass., Patients and Methods: Fifty-two consecutive patients (mean age, 69 years; 44.2% women) underwent salvage PTBD between 2013 and 2020., Results: The median overall survival rate was 4.2 months, with a 95% confidence interval (CI) of 1.9-5.7. The median overall survival (OS) were 11.1 months and 1.9 months for patients who underwent chemotherapy (n=17) and best supportive care (n=35), respectively (p=0.0005). Independent factors predicting poor outcome were best supportive care, with a hazard ratio (HR) of 3.3 (95%CI=1.3-8.5), American Society of Anesthesiologists physical status classification (ASA) with a HR of 13.5 (95%CI=1.3-136.0) and Eastern Cooperative Oncology Group (ECOG) performance status of 4, with a HR of 3.3 (95%CI=1.0-6.2)., Conclusion: Salvage PTBD with chemotherapy has the potential to achieve prolonged survival in patients with unresectable MBO, including those with failure of ERCP and/or surgical bypass., (Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)
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- 2022
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27. Assessing the incidence of complications and malignancies in the long-term management of benign biliary strictures with a percutaneous transhepatic drain.
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Yoshitomi M, Kawahara R, Taniwaki S, Midorikawa R, Kojima S, Muroya D, Arai S, Shirahama T, Kanno H, Fukutomi S, Goto Y, Nomura Y, Akashi M, Sato T, Sakai H, Hisaka T, and Akagi Y
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- Aged, Aged, 80 and over, Constriction, Pathologic etiology, Constriction, Pathologic surgery, Drainage adverse effects, Drainage methods, Female, Humans, Incidence, Male, Middle Aged, Neoplasm Recurrence, Local complications, Retrospective Studies, Treatment Outcome, Cholestasis etiology, Cholestasis surgery, Postoperative Complications etiology
- Abstract
Abstract: Percutaneous drainage catheters (PDCs) are required for the management of benign biliary strictures refractory to first-line endoscopic treatment. While biliary patency after PDC placement exceeds 75%, long-term catheterization is occasionally necessary. In this article, we assess the outcomes of patients at our institution who required long-term PDC placement.A single-institution retrospective analysis was performed on patients who required a PDC for 10 years or longer for the management of a benign biliary stricture. The primary outcome was uncomplicated drain management without infection or complication. Drain replacement was performed every 4 to 12 weeks as an outpatient procedure.Nine patients (three males and six females; age range of 48-96 years) required a long-term PDC; eight patients required the long-term PDC for an anastomotic stricture and one for iatrogenic bile duct stenosis. A long-term PDC was required for residual stenosis or patient refusal. Drain placement ranged from 157 to 408 months. In seven patients, intrahepatic stones developed, while in one patient each, intrahepatic cholangiocarcinoma or hepatocellular carcinoma occurred.Long-term PDC has a high rate of complications; therefore, to avoid the need for using long-term placement, careful observation or early surgical interventions are required., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2022
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28. Efficacy of a Novel Prophylactic Barbiturate Therapy for Severe Traumatic Brain Injuries: Step-down Infusion of a Barbiturate with Normothermia.
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Kajiwara S, Hasegawa Y, Negoto T, Orito K, Kawano T, Yoshitomi M, Sakata K, Takeshige N, Yamakawa Y, Jono H, Saito H, Hirayu N, Takasu O, Hirohata M, and Morioka M
- Subjects
- Barbiturates therapeutic use, Child, Child, Preschool, Glasgow Coma Scale, Humans, Infant, Intracranial Pressure, Treatment Outcome, Brain Injuries, Brain Injuries, Traumatic complications, Brain Injuries, Traumatic drug therapy, Intracranial Hypertension drug therapy, Intracranial Hypertension etiology, Intracranial Hypertension prevention & control
- Abstract
This study aimed to examine the beneficial effects of a novel prophylactic barbiturate therapy, step-down infusion of barbiturates, using thiamylal with normothermia (NOR+sdB), on the poor outcome in the patients with severe traumatic brain injuries (sTBI), in comparison with mild hypothermia (MD-HYPO). From January 2000 to March 2019, 4133 patients with TBI were admitted to our hospital. The inclusion criteria were: a Glasgow coma scale (GCS) score of ≤8 on admission, age between 20 and 80 years, intracranial hematoma requiring surgical evacuation of the hematoma with craniotomy and/or external decompression, and patients who underwent management of body temperature and assessed their outcome at 6-12 months. Finally, 43 patients were included in the MD-HYPO (n = 29) and NOR+sdB (n = 14) groups. sdB was initiated intraoperatively or immediately after the surgical treatment. There were no significant differences in patient characteristics, including age, sex, past medical history, GCS on admission, type of intracranial hematoma, and length of hospitalization between the two groups. Although NOR+sdB could not improve the patient's poor outcome either at discharge from the intensive care unit (ICU) or at 6-12 months after admission, the treatment inhibited composite death at discharge from the ICU. The mean value of the maximum intracranial pressure (ICP) in the NOR+sdB group was <20 mmHg throughout the first 120 h. NOR+sdB prevented composite death in the ICU in patients with sTBI, and we may obtain novel insights into the beneficial role of prophylactic barbiturate therapy from suppression of the elevated ICP during the first 120 h.
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- 2021
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29. Effect of herbal medicine daikenchuto on gastrointestinal symptoms following laparoscopic colectomy in patients with colon cancer: A prospective randomized study.
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Hanada K, Wada T, Kawada K, Hoshino N, Okamoto M, Hirata W, Mizuno R, Itatani Y, Inamoto S, Takahashi R, Yoshitomi M, Watanabe T, Hida K, Obama K, and Sakai Y
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- Aged, Colectomy trends, Colonic Neoplasms physiopathology, Female, Gastrointestinal Diseases physiopathology, Gastrointestinal Microbiome physiology, Herbal Medicine methods, Herbal Medicine trends, Humans, Laparoscopy trends, Male, Middle Aged, Panax, Prospective Studies, Zanthoxylum, Zingiberaceae, Colectomy methods, Colonic Neoplasms drug therapy, Colonic Neoplasms surgery, Gastrointestinal Diseases drug therapy, Gastrointestinal Diseases surgery, Laparoscopy methods, Plant Extracts administration & dosage
- Abstract
We conducted a prospective randomized study to investigate the effect of daikenchuto (DKT) on abdominal symptoms following laparoscopic colectomy in patients with left-sided colon cancer. Patients who suffered from abdominal pain or distention on postoperative day 1 were randomized to either the DKT group or non-DKT group. The primary endpoints were the evaluation of abdominal pain, abdominal distention, and quality of life. The metabolome and gut microbiome analyses were conducted as secondary endpoints. A total of 17 patients were enrolled: 8 patients in the DKT group and 9 patients in the non-DKT group. There were no significant differences in the primary endpoints and postoperative adverse events between the two groups. The metabolome and gut microbiome analyses showed that the levels of plasma lipid mediators associated with the arachidonic acid cascade were lower in the DKT group than in the non-DKT group, and that the relative abundance of genera Serratia and Bilophila were lower in the DKT group than in the non-DKT group. DKT administration did not improve the abdominal symptoms following laparoscopic colectomy. The effects of DKT on metabolites and gut microbiome have to be further investigated., (Copyright © 2021 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)
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- 2021
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30. Droplet digital polymerase chain reaction assay for the detection of the minor clone of KIT D816V in paediatric acute myeloid leukaemia especially showing RUNX1-RUNX1T1 transcripts.
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Sasaki K, Tsujimoto S, Miyake M, Uchiyama Y, Ikeda J, Yoshitomi M, Shimosato Y, Tokumasu M, Matsuo H, Yoshida K, Ohki K, Kaburagi T, Yamato G, Hara Y, Takeuchi M, Kinoshita A, Tomizawa D, Taga T, Adachi S, Tawa A, Horibe K, Hayashi Y, Matsumoto N, Ito S, and Shiba N
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- Adolescent, Child, Child, Preschool, Female, Humans, Infant, Leukemia, Myeloid, Acute epidemiology, Male, Point Mutation, Polymerase Chain Reaction, Survival Analysis, Core Binding Factor Alpha 2 Subunit genetics, Leukemia, Myeloid, Acute genetics, Oncogene Proteins, Fusion genetics, Proto-Oncogene Proteins c-kit genetics, RUNX1 Translocation Partner 1 Protein genetics
- Abstract
KIT D816V mutation within exon 17 has been particularly reported as one of the poor prognostic factors in pediatric acute myeloid leukemia (AML) with RUNX1-RUNX1T1. The exact frequency and the prognostic impact of KIT D816V minor clones at diagnosis were not examined. In this study, the minor clones were examined and the prognostic significance of KIT D816V mutation in pediatric patients was investigated. Consequently, 24 KIT D816V mutations (7.2%) in 335 pediatric patients were identified, and 12 of 24 were only detected via the digital droplet polymerase chain reaction method. All 12 patients were confined in core binding factor (CBF)-AML patients. The 5 year event-free survival of the patients with KIT D816V mutation was significantly inferior to those without KIT D816V mutation (44.1% [95% confidence interval (CI), 16.0%-69.4%] vs. 74.7% [95% CI, 63.0%-83.2%] P-value = 0.02, respectively). The 5 year overall survival was not different between the two groups (92.9% [95% CI, 59.0%-NA vs. 89.7% [95% CI, 69.6%-96.8%] P-value = 0.607, respectively). In this study, KIT D816V minor clones in patients with CBF-AML were confirmed and KIT D816V was considered as a risk factor for relapse in patients with RUNX1-RUNX1T1-positive AML., (© 2021 British Society for Haematology and John Wiley & Sons Ltd.)
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- 2021
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31. A novel step-down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control.
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Yamakawa Y, Morioka M, Negoto T, Orito K, Yoshitomi M, Nakamura Y, Takeshige N, Yamamoto M, Takeuchi Y, Oda K, Jono H, and Saito H
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- Adult, Aged, Aged, 80 and over, Brain Injuries, Traumatic blood, Brain Injuries, Traumatic complications, Cerebrovascular Disorders complications, Cerebrovascular Disorders diagnosis, Dose-Response Relationship, Drug, Female, Glasgow Coma Scale, Humans, Hypnotics and Sedatives adverse effects, Hypnotics and Sedatives pharmacokinetics, Infusions, Intravenous methods, Injury Severity Score, Intracranial Hypertension diagnosis, Intracranial Hypertension etiology, Intracranial Pressure drug effects, Male, Middle Aged, Thiamylal adverse effects, Thiamylal pharmacokinetics, Treatment Outcome, Brain Injuries, Traumatic drug therapy, Cerebrovascular Disorders drug therapy, Hypnotics and Sedatives administration & dosage, Intracranial Hypertension drug therapy, Thiamylal administration & dosage
- Abstract
Intracranial pressure (ICP) has to be maintained quite constant, because increased ICP caused by cerebrovascular disease and head trauma is fatal. Although controlling ICP is clinically critical, only few therapeutic methods are currently available. Barbiturates, a group of sedative-hypnotic drugs, are recognized as secondary treatment for controlling ICP. We proposed a novel "step-down infusion" method, administrating barbiturate (thiamylal) after different time point from the start of treatment under normothermia, at doses of 3.0 (0-24 h), 2.0 (24-48 h), 1.5 (48-72 h), and 1.0 mg/kg/h (72-96 h), and evaluated its safety and effectiveness in clinical. In 22 patients with severe traumatic brain injury or severe cerebrovascular disease (Glasgow coma scale ≤8), thiamylal concentrations and ICP were monitored. The step-down infusion method under normothermia maintained stable thiamylal concentrations (<26.1 µg/ml) without any abnormal accumulation/elevation, and could successfully keep ICP <20 mmHg (targeted management value: ICP <20 mmHg) in all patients. Moreover the mean value of cerebral perfusion pressure (CPP) was also maintained over 65 mmHg during all time course (targeted management value: CPP >65 mmHg), and no threatening changes in serum potassium or any hemodynamic instability were observed. Our novel "step-down infusion" method under normothermia enabled to maintain stable, safe thiamylal concentrations to ensure both ICP reduction and CPP maintenance without any serious side effects, may provide a novel and clinically effective treatment option for patients with increased ICP., (© 2021 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics.)
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- 2021
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32. Hepatic Epithelioid Hemangioendothelioma Presenting Synchronously with Hepatocellular Carcinoma.
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Kanno H, Sato T, Midorikawa R, Kojima S, Fukutomi S, Goto Y, Nomura Y, Yoshitomi M, Kawahara R, Sakai H, Hisaka T, Akagi Y, and Okuda K
- Abstract
Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant tumor with unknown pathogenesis. Herein, we report a case of a hepatic EHE presenting synchronously with a hepatocellular carcinoma (HCC). To the best of our knowledge, this is the second case report of synchronous hepatic EHE and HCC. An 84-year-old man presented with back pain. During examination, a tumor in liver segment 3 was coincidentally detected. Tumor marker (carbohydrate antigen 19-9, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II) levels were elevated. Contrast-enhanced computed tomography revealed perinodular enhancement in the arterial and portal phases. Another tumor was detected in liver segment 2, which was homogeneously enhanced in the arterial phase, followed by washout in the portal and late phases. Based on these imaging findings, we diagnosed the tumor in segment 3 as a solitary cholangiocellular carcinoma and the tumor in segment 2 as a solitary HCC. Lateral sectionectomy of the liver was performed. Microscopically, spindle-shaped and epithelioid cells were present in the tumor in segment 3. On immunohistochemistry, the tumor cells were positive for CD31 and CD34, focally positive for D2-40, and negative for AE1/AE3. Therefore, the tumor in segment 3 was ultimately diagnosed as an EHE and the tumor in segment 2 as a well-differentiated HCC. Preoperative diagnosis of EHE is difficult owing to the lack of specific findings. Intratumoral calcification, halo sign, and lollipop sign are occasionally found in EHE and are useful imaging findings for diagnosis. Clinical behavior is unpredictable, ranging from indolent growth to rapid progression. Clinical or pathological predictors of the course of EHE are urgently required., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021 by S. Karger AG, Basel.)
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- 2021
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33. Investigation of factors associated with reduced clinical benefits of personalized peptide vaccination for pancreatic cancer.
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Uchino Y, Muroya D, Yoshitomi M, Shichijo S, Yamada A, Sasada T, Yamada T, Okuda K, Itoh K, and Yutani S
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The aim of the present study was to determine the factors associated with reduced clinical benefits of personalized peptide vaccination (PPV) for pancreatic cancer. Phase II PPV clinical trials comprising 309 (8 non-advanced and 301 advanced-stage) patients with pancreatic cancer were conducted. Two to four peptides were selected among a set of 31 different peptides as vaccine candidates for personalized peptide vaccination based on human leukocyte antigen types and preexisting peptide-specific IgG levels, and subcutaneously injected. The selected peptides were subcutaneously injected. Of the 309 patients, 81 failed to complete the 1st PPV cycle due to rapid disease progression, and their median overall survival [2.1 months; 95% confidence interval (CI), 1.8-2.7] was significantly shorter than that of the remaining 228 patients (8.4 months; 95% CI, 8.4-9.9; P<0.01). 'Immune boosting' was defined when IgG levels before vaccination increased more than 2-fold after vaccination. Immune boosting was observed in the majority of patients with PPV irrespective of whether or not they received concomitant chemotherapy. Additionally, patients demonstrating immune boosting exhibited longer survival rates. Although the positive-response rates and peptide-specific IgG levels in pre- and post-vaccination samples differed among the 31 peptides, patients exhibiting immune boosting in response to each of the vaccinated peptides demonstrated longer survival times. Pre-vaccination factors associated with reduced clinical benefits were high c-reactive protein (CRP) levels, high neutrophil counts, lower lymphocyte and red blood cell counts, advanced disease stage and the greater number of chemotherapy courses prior to the PPV treatment. The post-vaccination factors associated with lower clinical benefits were PPV monotherapy and lower levels of immune boosting. In conclusion, pre-vaccination inflammatory signatures, rather than pre- or post-vaccination immunological signatures, were associated with reduced clinical benefits of personalized peptide vaccination (PPV) for pancreatic cancer., (Copyright: © Uchino et al.)
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- 2021
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34. Endoscopic third ventriculostomy for myelomeningocele-related hydrocephalus after shunt failure: Long-term outcome in a series of 8 patients.
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Takeshige N, Uchikado H, Nakashima D, Negoto T, Nagase S, Yoshitomi M, Sakata K, and Morioka M
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- Adolescent, Adult, Child, Choroid Plexus surgery, Female, Humans, Intracranial Hypertension complications, Male, Meningomyelocele complications, Neuroendoscopy methods, Third Ventricle surgery, Young Adult, Hydrocephalus surgery, Intracranial Hypertension surgery, Meningomyelocele surgery, Ventriculostomy adverse effects, Ventriculostomy methods
- Abstract
Objective: Endoscopic third ventriculostomy (ETV) has now become an accepted mode of hydrocephalus treatment. However, the long-term effects of ETV for myelomeningocele-related hydrocephalus (MMC-rH) after shunt malfunction remains unclear. We aimed to assess the long-term outcome and the factors associated with the success of ETV for MMC-rH after shunt malfunction., Methods: We performed a retrospective analysis of data collected between 2001 and 2018 from 8 patients with MMC-rH after shunt malfunction, who underwent ETV at the Kurume University Hospital and were followed up for at least 5 years. We extracted data regarding age, sex, clinical symptoms, radiological imaging, intraoperative findings, and outcomes., Results: The overall success rate was 62.5% and their ETV success score is 67.5. The most frequent clinical symptom was intracranial hypertension symptoms (100 %), followed by Chiari type II symptoms (87.5 %). In preoperative MRI scans, we observed aqueduct stenosis in 6 cases, Chiari type II malformations in 7 cases, four patients had a narrow prepontine cistern, five patients had an absent septum pellucidum, and three presented with stenosis of the foramen of Monro. All cases in the failure group had the above 5 symptoms. Based on intraoperative findings, a thick third ventricle floor was found in 5 patients. Two patients had a thin hypothalamic adhesion in the third ventricle floor. They had no major complications., Conclusion: ETV for MMC-rH after shunt malfunction is an effective treatment option. However, we recommend that a neurosurgeon with extensive experience in neuroendoscopy perform ETV because MMC patients more often had intraventricular malformations than those with other hydrocephalus diseases., (Copyright © 2020. Published by Elsevier B.V.)
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- 2021
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35. Long-term outcomes of endoscopic third ventriculostomy for Blake's pouch cyst in adults.
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Takeshige N, Uchikado H, Yoshitake H, Negoto T, Yoshitomi M, Sakata K, and Morioka M
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- Adult, Cerebral Ventricles surgery, Colonic Pouches, Female, Humans, Male, Middle Aged, Neuroendoscopy methods, Retrospective Studies, Time, Treatment Outcome, Cysts surgery, Hydrocephalus surgery, Third Ventricle surgery, Ventriculostomy methods
- Abstract
Objective: The optimal treatment method for persistent Blake's pouch cyst (BPC) remains unclear owing to its low prevalence. We aimed to characterize a patient population with adult BPC and to identify the risk factors associated with endoscopic third ventriculostomy (ETV) for BPC. This study reports the largest number of BPC cases in adults and is the first report to reveal the long-term outcomes of ETV in such patients., Methods: We performed a retrospective analysis of data collected from seven adult patients with BPC between 2005 and 2019. They underwent ETV at the Kurume University Hospital and were followed up for five years or more. We extracted data regarding patient age, sex, clinical symptoms, radiological imaging, intraoperative findings and outcomes., Results: The ages of the patients ranged between 30 and 60 years (45 ± 12 years). The mean postoperative follow-up time was 92.1 ± 13.5 months. The overall success rate was 71.4%. The most frequent symptom was headache (86%), followed by mild cognitive impairment (71%). The average cerebrospinal fluid pressure was slightly elevated (18.4 ± 1.4 cmH2O). A decrease in ventricular size (Evans' index) detected early after ETV was associated with satisfactory clinical outcomes (p = 0.02). The incidence of prepontine scarring was observed in all cases of the ETV failure group. A significant risk factor for ETV was the to-and-fro movements of the third ventricle floor after ETV (p = 0.048)., Conclusions: ETV could be a safe and effective treatment option for adult patients with BPC. It is important that prepontine scarring and the to-and-fro movements of the third ventricle after ETV should be confirmed carefully when performing ETV on adult patients with BPC., (Copyright © 2020. Published by Elsevier B.V.)
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- 2021
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36. A 2-year-old patient with a diffuse intrinsic pontine glioma and radiation-induced moyamoya syndrome.
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Iizuka A, Shiba N, Shimosato Y, Yoshitomi M, Nakamura T, Miyatake S, Takano Y, Sasaki K, Takeuchi M, Murata H, Yamamoto T, Matsumoto N, and Ito S
- Subjects
- Brain Stem Neoplasms pathology, Child, Preschool, Diffuse Intrinsic Pontine Glioma pathology, Female, Humans, Moyamoya Disease pathology, Radiotherapy adverse effects, Brain Stem Neoplasms radiotherapy, Diffuse Intrinsic Pontine Glioma radiotherapy, Moyamoya Disease etiology
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- 2020
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37. A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis.
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Kanno H, Sakai H, Hisaka T, Kojima S, Midorikawa R, Fukutomi S, Nomura Y, Goto Y, Sato T, Yoshitomi M, Kawahara R, and Okuda K
- Abstract
Background: Reactive lymphoid hyperplasia (RLH) of the liver is a benign disorder. It is usually observed in the skin, orbit, thyroid, lung, breast, or gastrointestinal tract, but rarely in the liver. Since the first report of RLH of the liver in 1981, only 75 cases have been described in the past literature. Herein, we report a case of RLH of the liver in a patient with autoimmune hepatitis (AIH), which was misdiagnosed as hepatocellular carcinoma (HCC) preoperatively and resected laparoscopically., Case Presentation: A 43-year-old Japanese woman with autoimmune hepatitis was followed up for 5 years. During her medical checkup, a hypoechoic nodule in segment 6 of the liver was detected. The nodule had been gradually increasing in size for 4 years. Abdominal ultrasound (US) revealed a round, hypoechoic nodule, 12 mm in diameter. Contrast-enhanced computed tomography (CT) demonstrated that the nodule was slightly enhanced in the arterial dominant phase, followed by perinodular enhancement in the portal and late phases. A magnetic resonance imaging (MRI) scan showed low signal intensity on the T1-weighted image (T1WI) and slightly high signal intensity on the T2-weighted image (T2WI). The findings of the Gd-EOB-DTPA-enhanced MRI were similar to those of contrast-enhanced CT. Tumor markers were all within the normal range. The preoperative diagnosis was HCC and a laparoscopic right posterior sectionectomy was performed. Pathological examination revealed that the nodular lesion was infiltrated by small lymphocytes and plasma cells, and germinal centers were present. Immunohistochemistry was positive for B cell and T cell markers, indicating polyclonality. The final diagnosis was RLH of the liver., Conclusions: The pathogenesis of RLH of the liver remains unknown, and a definitive diagnosis based on imaging findings is extremely difficult. If a small, solitary nodule is found in female patients with AIH, the possibility of RLH of the liver should be considered.
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- 2020
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38. The Usefulness of Straight Chemotherapy for Dermal Exposed Anaplastic Lymphoma Kinase Fusion-Positive Anaplastic Large-Cell Lymphoma with Intracranial Invasion.
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Abe H, Nakamura T, Yoshitomi M, Enaka M, Tateishi K, Shiba N, Yamanaka S, and Yamamoto T
- Abstract
Anaplastic large-cell lymphoma (ALCL) is characterized as extranodal lymphoma and usually chemosensitive disease with overall survival rate of 70%-90%. Prognosis is roughly distinguished by the existence of anaplastic lymphoma kinase (ALK) fusion in tumor cells with higher frequencies observed in the pediatric population, and the outcome of ALK fusion-positive ALCL is relatively good when appropriate treatment is completed. Here, we report a case of dermal-exposed ALK fusion-positive ALCL with intracranial invasion. The patient received straight chemotherapy (ALCL99 protocol) without any plastic or resection surgery. The dermal dehiscence was rapidly healed with controllable local infection, and the tumor was regressed without relapse. Therefore, straight chemotherapy has clinical relevance and is a useful treatment strategy for ALK fusion-positive ALCL with dermal dehiscence., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Asian Journal of Neurosurgery.)
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- 2019
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39. Indocyanine Green Fluorescence-Guided Laparoscopic Lateral Lymph Node Dissection for Rectal Cancer.
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Kawada K, Yoshitomi M, Inamoto S, and Sakai Y
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- Coloring Agents pharmacology, Humans, Laparoscopy adverse effects, Laparoscopy methods, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Staging, Spectroscopy, Near-Infrared methods, Treatment Outcome, Indocyanine Green pharmacology, Lymph Node Excision adverse effects, Lymph Node Excision methods, Lymph Nodes pathology, Lymph Nodes surgery, Lymphatic System diagnostic imaging, Neoplasm, Residual prevention & control, Rectal Neoplasms pathology, Rectal Neoplasms surgery, Surgery, Computer-Assisted methods
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- 2019
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40. Conversion surgery for initially unresectable carcinoma of the ampulla of Vater following pathological complete response to chemotherapy: a case report.
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Sato Y, Hara T, Takami Y, Wada Y, Ryu T, Sasaki S, Yoshitomi M, Momosaki S, Murakami M, Hijioka M, Kaku T, Kawabe K, and Saitsu H
- Abstract
Background: Carcinoma of the ampulla of Vater with distant metastases is regarded as unresectable. Systemic chemotherapy is basically the treatment of choice for such tumors., Case Presentation: A 68-year-old woman was referred to our hospital and diagnosed with carcinoma of the ampulla of Vater with lymph node and multiple liver metastases. She underwent systemic chemotherapy with a combination of gemcitabine and cisplatin. After 19 months of treatment, the primary tumor and liver metastases were difficult to detect on follow-up images. Shrinkage of the enlarged lymph nodes was also confirmed. Surgical resection was performed with curative intent after a multidisciplinary meeting. Pathological examination of the resected specimen showed no residual tumors. Systemic chemotherapy achieved a pathological complete response. The postoperative course was uneventful, and the patient remained free of recurrent disease at 10 months of follow-up., Conclusion: This case shows the possibility of conversion surgery after systemic chemotherapy for carcinoma of the ampulla of Vater.
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- 2019
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41. Gamma knife surgery-induced aneurysm rupture associated with tissue plasminogen activator injection: A case report and literature review.
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Kikuchi J, Takeuchi Y, Sugi K, Negoto T, Yoshitomi M, Hirohata M, and Morioka M
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Background: Cases involving delayed development of intracranial aneurysms related to gamma knife surgery (GKS) have been recently reported. Here, we present a rare case of GKS-induced aneurysm rupture after intravenous injection of tissue plasminogen activator (t-PA) for occlusion of the middle cerebral artery (MCA). To the best of our knowledge, this is the first case in which t-PA-induced rupture of a GKS-related unruptured aneurysm., Case Description: A 56-year-old woman underwent GKS for left trigeminal neuralgia. Eighteen years later, she suddenly experienced MCA occlusion with consciousness disturbance and right hemiparesis. She received an intravenous injection of t-PA and then was transferred to our hospital. We confirmed residual thrombus, and she underwent mechanical thrombectomy successfully. A postthrombectomy brain computed tomography scan revealed subarachnoid hemorrhage with a hematoma in the left cerebellar hemisphere. Cerebral angiography revealed a small irregular-shaped aneurysm at the branching site of the left circumflex branch at the distal position of the anterior inferior cerebellar artery, which was not detected on initial imaging. Coil embolization was performed. One month after the ischemic attack, she was transferred to a rehabilitation hospital, with a modified Rankin Scale score of 5., Conclusions: The tendency to rupture is greater for GKS-induced aneurysms than for intrinsic unruptured aneurysms, according to previous reports. When performing acute treatment for cerebral infarction in patients with a history of GKS, the presence of aneurysms should be evaluated and we should keep in mind that GKS aneurysms are very small and tend to rupture., Competing Interests: There are no conflicts of interest.
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- 2019
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42. Optimal treatment strategy for rectal cancer based on the risk factors for recurrence patterns.
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Yamamoto T, Kawada K, Hida K, Ganeko R, Inamoto S, Yoshitomi M, Watanabe T, and Sakai Y
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- Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Female, Humans, Lymph Nodes surgery, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Pelvic Neoplasms pathology, Prognosis, Rectal Neoplasms pathology, Risk Factors, Survival Rate, Young Adult, Chemoradiotherapy mortality, Lymph Node Excision mortality, Lymph Nodes pathology, Neoadjuvant Therapy mortality, Neoplasm Recurrence, Local therapy, Pelvic Neoplasms therapy, Rectal Neoplasms therapy
- Abstract
Background: For rectal cancer, multimodality therapeutic approach is necessary to prevent local recurrence and distant metastasis. However, the efficacy of additional treatments, such as neoadjuvant chemoradiotherapy (nCRT), neoadjuvant chemotherapy (NAC), and lateral pelvic lymph node dissection (LPLND), has not been scrutinized., Methods: Recurrence patterns were categorized into local recurrence and distant metastasis. Local recurrence was classified into two types: (1) pelvic cavity recurrence and (2) LPLN recurrence. First, we analyzed the risk factors for each recurrence pattern. Second, based on the status of clinically suspected involvement of circumferential resection margin (cCRM), the efficacy of additional treatments was investigated., Results: A total of 240 patients was enrolled. nCRT was performed for 25 (10%), NAC was for 46 (19%), and LPLND was for 35 patients (15%). As the recurrence patterns, pelvic cavity recurrence occurred in 15 (6%), LPLN recurrence in 8 (3%), and distant metastasis in 42 patients (18%). Five-year overall survival and relapse-free survival were 87% and 70%, respectively. Multivariate analysis indicated that pelvic cavity recurrence was associated with cCRM status and tumor histology, that LPLN recurrence was with serum carcinoembryonic antigen level and LPLN swelling, and that distant metastasis was with clinical N category. In the cCRM-positive subgroup (n = 66), cumulative rate of pelvic cavity recurrence was lower in the nCRT group than in the NAC or non-NAC/nCRT group (P = 0.02 and 0.09, respectively)., Conclusion: cCRM status was associated with pelvic cavity recurrence, and LPLN swelling was with LPLN recurrence. nCRT could reduce pelvic cavity recurrence in cCRM-positive subgroup.
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- 2019
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43. Leptomeningeal Carcinomatosis After Neoplastic Cerebral Aneurysm Rupture.
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Koga M, Aoki T, Negoto T, Makizono T, Sugi K, Fujimori K, Kajiwara S, Komaki S, Yoshitomi M, Sugita Y, and Morioka M
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- Aneurysm, Ruptured diagnostic imaging, Aneurysm, Ruptured surgery, Breast Neoplasms diagnostic imaging, Breast Neoplasms surgery, Cerebral Angiography, Fatal Outcome, Female, Humans, Intracranial Aneurysm diagnostic imaging, Intracranial Aneurysm surgery, Meningeal Carcinomatosis diagnostic imaging, Meningeal Carcinomatosis surgery, Middle Aged, Tomography, X-Ray Computed, Aneurysm, Ruptured complications, Breast Neoplasms complications, Intracranial Aneurysm complications, Meningeal Carcinomatosis etiology
- Abstract
Background: Several possible mechanisms exist for the spread of a primary tumor to the leptomeninges in leptomeningeal carcinomatosis. This report describes a case caused by direct bleeding in the subarachnoid space from a neoplastic cerebral aneurysm rupture., Case Description: A 48-year-old Japanese woman, who was diagnosed with breast carcinoma (pT3 pN2 M0) at the age of 45 years and underwent mastectomy and chemotherapy, was admitted in a coma following a sudden-onset severe headache. Computed tomography revealed diffuse hemorrhage in the subarachnoid space, and angiography revealed an aneurysm at the distal middle cerebral artery. Superficial temporal artery-middle cerebral artery bypass, aneurysmal trapping, and aneurysm resection were performed within 24 hours of admission. Staining for AE1/AE3 revealed accumulation of atypical cells with a high nuclear-cytoplasmic ratio in the aneurysmal wall. After showing initial improvement, she developed disturbed consciousness due to complicated ventricular enlargement on day 45. Although the cerebrospinal fluid in the acute phase had no atypical cells, subsequent testing revealed atypical cells, which supported a diagnosis of leptomeningeal carcinomatosis due to breast cancer dissemination. The patient died on day 78 after receiving standard endocrine therapy and radiation therapy., Conclusions: Tumor cells reach the leptomeninges via hematogenous spread or direct extension from preexisting lesions and can undergo neuraxis dissemination via the cerebrospinal fluid. Subarachnoid hemorrhage and leptomeningeal carcinomatosis are both devastating conditions with extremely poor prognoses. This patient experienced delayed disturbed consciousness leptomeningeal carcinomatosis with decreased performance status, which made it difficult to justify aggressive treatment on the basis of her poor prognosis., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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44. A Clinical Scoring System for Predicting Microvascular Invasion in Patients with Hepatocellular Carcinoma Within the Milan Criteria.
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Ryu T, Takami Y, Wada Y, Tateishi M, Hara T, Yoshitomi M, Momosaki S, Yasumori K, Saitsu H, and Okuda K
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- Adult, Aged, Aged, 80 and over, Biomarkers metabolism, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular metabolism, Carcinoma, Hepatocellular surgery, Contrast Media, Female, Gadolinium DTPA, Humans, Liver Neoplasms diagnostic imaging, Liver Neoplasms metabolism, Liver Neoplasms surgery, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasm Invasiveness, Protein Precursors metabolism, Prothrombin metabolism, ROC Curve, Retrospective Studies, Tumor Burden, alpha-Fetoproteins metabolism, Carcinoma, Hepatocellular pathology, Liver Neoplasms pathology, Microvessels pathology
- Abstract
Background: Microvascular invasion (MVI) is recognized as a risk factor for early recurrence of hepatocellular carcinoma (HCC) within the Milan criteria after curative treatment., Methods: One hundred eleven consecutive patients with HCC within the Milan criteria who underwent hepatic resection were retrospectively reviewed. Independent preoperative predictors of MVI were identified, and a scoring system was developed using significant predictors., Results: MVI was identified in 51 of 111 patients (46%). Multivariate analysis identified the following independent predictors of MVI: alpha-fetoprotein (AFP) of > 95 ng/mL (odds ratio [OR], 9.87; 95% confidence interval [95% CI], 2.24-56.8; P = 0.002), des-γ-carboxy prothrombin (DCP) of > 55 mAU/mL (OR, 5.50; 95% CI, 2.09-15.4; P < 0.001), tumor size of > 2.8 cm (OR, 6.10; 95% CI, 2.07-20.0; P < 0.001), and non-smooth tumor margin in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) (OR, 5.34; 95% CI, 1.84-16.9; P = 0.002). A clinical scoring system was developed using these four variables. Within a total possible score of 0 to 4, the prevalence of MVI with a score of 0, 1, 2, 3, and 4 was 4.5%, 24.0%, 45.5%, 91.7%, and 100%, respectively (P < 0.001). The area under the curve of the scoring system was 0.865 based on the receiver operating characteristic curve analysis of the prediction score., Conclusions: Our clinical scoring system, consisting of AFP, DCP, tumor size, and tumor margin in Gd-EOB-DTPA-enhanced MRI, can be valuable for predicting MVI in HCC within the Milan criteria before curative treatment.
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- 2019
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45. The effects of intraoperative ICG fluorescence angiography in laparoscopic low anterior resection: a propensity score-matched study.
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Wada T, Kawada K, Hoshino N, Inamoto S, Yoshitomi M, Hida K, and Sakai Y
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- Aged, Anastomosis, Surgical adverse effects, Anastomotic Leak prevention & control, Digestive System Surgical Procedures, Female, Humans, Indocyanine Green, Intraoperative Care methods, Lymph Node Excision, Male, Middle Aged, Odds Ratio, Propensity Score, Rectal Neoplasms diagnostic imaging, Retrospective Studies, Anastomotic Leak etiology, Fluorescein Angiography methods, Laparoscopy methods, Rectal Neoplasms surgery
- Abstract
Background: It remains unclear whether indocyanine green (ICG) angiography could reduce the rate of postoperative anastomotic leakage (AL) following rectal surgery. The aim was to determine whether intraoperative ICG angiography could decrease symptomatic AL following laparoscopic low anterior resection (LAR)., Methods: This is a retrospective study of 149 patients with rectal cancer who underwent laparoscopic LAR at a single institution. Propensity score matching (PSM) was employed to compare groups with and without ICG angiography., Results: Before PSM, the symptomatic AL rate was 10.4% (5/48) in patients with ICG angiography, compared with 6.9% (7/101) in cases without ICG angiography (P = 0.52). In patients with ICG angiography, poor perfusion of the proximal colon judged by ICG angiography led to additional colon resection in 27.1% (13/48). Symptomatic AL occurred in 30.8% (4/13) of the patients who had revision of the transection site, whereas it occurred in only 2.9% (1/35) of the patients who did not need revision of the transection site (P = 0.015). After PSM, the symptomatic AL rate was 8.8% (3/34) in patients with ICG angiography, compared with 14.7% (5/34) in cases without ICG angiography (P = 0.71). In univariate analysis, high BMI, preoperative chemotherapy, and lateral lymph node dissection were significantly associated with symptomatic AL. Multivariate analysis indicated that only lateral lymph node dissection remained significantly associated with AL (odds ratio, 10.05; 95% confidence interval, 1.75-58.61; P = 0.011)., Conclusions: Intraoperative ICG angiography is useful for prediction of AL following laparoscopic LAR.
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- 2019
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46. Leakage sign for acute subdural hematoma in clinical treatment.
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Yamamoto M, Orito K, Nakamura Y, Takeshige N, Yoshitomi M, Takeuchi Y, Uzu H, Takasu O, Abe T, Tanoue S, Uchiyama Y, and Morioka M
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- Adult, Aged, Aged, 80 and over, Cerebral Hemorrhage pathology, Female, Hematoma, Subdural, Acute pathology, Humans, Male, Middle Aged, Tomography, X-Ray Computed methods, Cerebral Angiography methods, Cerebral Hemorrhage diagnostic imaging, Computed Tomography Angiography methods, Hematoma, Subdural, Acute diagnostic imaging
- Abstract
Background: Acute subdural hematoma (ASDH) is a serious traumatic disease, and predictive methods for hematoma growth are necessary to decide whether emergent operation is necessary. This study aimed to evaluate the incidence of "leakage" using computed tomography angiography (CTA) in patients with ASDH and to identify its prognostic value., Methods: Sixty-seven patients with ASDH were examined using CTA (mean age 64.1 ± 20.6 years; 24 men) by analyzing two serial scans (CTA phase and delayed phase). We defined a positive leakage sign as a > 10% increase in Hounsfield units (HU) in the region of interest. Hematoma expansion was determined using plain CT after 24 h in patients who did not undergo emergent surgery., Results: Of the 67 patients, conservative therapy was administered to 35 patients; of these patients, 9 showed hematoma expansion, and 8 of these 9 patients (88.9%) showed positive leakage signs. The sensitivity and specificity of leakage signs to hematoma expansion in the no-surgery group were 88.8% and 76.1%, respectively. All positive leakage signs were found within 4.5 h of injury; patients showing negative leakage signs showed a decreased tendency towards hematoma 24 h after injury. Patients presenting with positive leakage signs had poor outcomes., Conclusions: The results indicated that the leakage sign is a sensitive predictor of hematoma expansion and poor outcomes in ASDH. If the hematoma is small but leakage sign-positive, strict observation is necessary and aggressive surgery may improve outcomes.
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- 2019
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47. Oncological outcomes after hepatic resection and/or surgical microwave ablation for liver metastasis from gastric cancer.
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Ryu T, Takami Y, Wada Y, Tateishi M, Matsushima H, Yoshitomi M, and Saitsu H
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- Adult, Aged, Aged, 80 and over, Disease-Free Survival, Female, Humans, Liver Neoplasms mortality, Male, Middle Aged, Prognosis, Retrospective Studies, Survival Rate, Treatment Outcome, Ablation Techniques methods, Hepatectomy, Liver Neoplasms secondary, Liver Neoplasms surgery, Microwaves therapeutic use, Stomach Neoplasms pathology
- Abstract
Background: Indications and efficacy of surgical treatment for liver metastases from gastric cancer (LMGCs) remain controversial. This retrospective study was designed to clarify the benefits of surgical treatment and identify prognostic factors., Methods: Between December 1997 and December 2015, 34 consecutive patients underwent hepatic resection and surgical microwave ablation for synchronous or metachronous LMGCs at our institution. We analyzed their cumulative overall survival (OS) and recurrence-free survival (RFS) rates and clinical parameters to identify predictors of prognosis., Results: Of the 34 patients, 14 underwent hepatic resection, 13 underwent surgical microwave ablation, and 7 underwent hepatic resection combined with surgical microwave ablation. Their OS rates were 1-year: 84.4%, 3-year: 38.6%, and 5-year: 34.7%; and their RFS rates were 1-year: 38.5%, 3-year: 28.0%, and 5-year: 28.0%. OS did not significantly vary among the surgical procedures. In multivariable analysis, positive of both CEA and CA19-9 were independent predictors of poor survival (hazard ratio [HR] 4.51; P = 0.049) and early recurrence (HR 5.70; P = 0.047)., Conclusions: Both hepatic resection and surgical microwave ablation for LMGCs are effective and can improve survival in selected patients., (Copyright © 2017. Published by Elsevier Taiwan LLC.)
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- 2019
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48. [Head Injuries due to Ladder-related Falls].
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Yoshitake H, Miyagi N, Yoshitomi M, Komaki S, Nakamura Y, Yamamoto M, Kajiwara S, Takasu O, and Morioka M
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- Aged, Female, Humans, Injury Severity Score, Male, Retrospective Studies, Risk Factors, Accidental Falls, Craniocerebral Trauma etiology
- Abstract
We examined the clinical characteristics and outcomes of patients who had fallen from ladders and statistically analyzed the prognostic factors, highlighting the impact of the coexistence of head injuries on their prognoses. The clinical records of patients who had experienced ladder-related falls who were admitted to the Advanced Emergency Medical Service Center at Kurume University Hospital between April 2013 and August 2015 were retrospectively reviewed. A total of 86 patients were enrolled. The mean patient age was 69.2 years, and 82 patients were male. The median fall height was 2.55 m. Sixty patients fell during non-professional use of the ladder. Forty-four patients experienced some type of head injury. Although the older patients had more frequent complications with head injuries, the height of the fall was not related statistically. The group of patients with head injuries exhibited trends of older age, lower Glasgow Coma Scale scores, higher Injury Severity Score, and poorer outcomes than those of the group of patients without head injuries. Multivariate analysis showed that head injury and non-professional use were independent risk factors for poor outcomes. Our results revealed that ladder-related falls with head injury can occur when older people are working at home, even if they have fallen from a low height. Especially when older men work with the ladder at home, local community-based education and guidance for the prevention of ladder-related fall injuries are needed.
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- 2018
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49. Prognosis of Hepatocellular Carcinoma Patients Who Achieved Long-Term Recurrence-Free Survival After Curative Therapy: Impact of the ALBI Grade.
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Matsushima H, Takami Y, Ryu T, Yoshitomi M, Tateishi M, Wada Y, and Saitsu H
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- Aged, Carcinoma, Hepatocellular diagnosis, Disease-Free Survival, Female, Follow-Up Studies, Humans, Liver Neoplasms diagnosis, Magnetic Resonance Imaging, Male, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Risk Factors, Time Factors, Tomography, X-Ray Computed, Carcinoma, Hepatocellular surgery, Hepatectomy methods, Liver Neoplasms surgery, Neoplasm Staging methods
- Abstract
Background/aims: Some patients experience very late recurrence of HCC more than 5 years after initial therapy. We aimed to clarify the predictive factors for very late recurrence of HCC in such cases., Methods: Among 807 HCC patients undergoing surgical resection or ablative therapy with curative intent, the patients who survived for 5 years without any recurrence were reviewed. The prognosis and possible predictive factors for late recurrence were analyzed retrospectively., Results: A total of 184 patients survived for more than 5 years without recurrence. Among them, 61 patients experienced recurrence, at a median of 6 years after initial therapy. In univariate analysis, the pre-treatment aspartate aminotransferase, alanine aminotransferase, Child-Pugh class, and ALBI grade were not related to recurrence, but those at 5 years after treatment were significantly related to recurrence. By multivariate analysis, an ALBI grade of 2-3 at 5 years was an independent risk factor for recurrence (P < 0.0001). Moreover, variation of the ALBI grade over the 5 years after the initial treatment was significantly related to recurrence-free survival., Conclusions: The ALBI grade is an effective index of the variation in liver function after curative therapy and may be a useful prognostic factor for the long-term recurrence-free survival of HCC patients.
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- 2018
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50. The Safety and Efficacy of Combination Therapy of Sorafenib and Radiotherapy for Advanced Hepatocellular Carcinoma: A Retrospective Study.
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Wada Y, Takami Y, Matsushima H, Tateishi M, Ryu T, Yoshitomi M, Matsumura T, and Saitsu H
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- Aged, Antineoplastic Agents adverse effects, Carcinoma, Hepatocellular mortality, Combined Modality Therapy, Disease-Free Survival, Female, Humans, Liver Neoplasms mortality, Male, Middle Aged, Niacinamide adverse effects, Niacinamide therapeutic use, Phenylurea Compounds adverse effects, Radiation Dosage, Retrospective Studies, Sorafenib, Survival Analysis, Antineoplastic Agents therapeutic use, Carcinoma, Hepatocellular drug therapy, Carcinoma, Hepatocellular radiotherapy, Liver Neoplasms drug therapy, Liver Neoplasms radiotherapy, Niacinamide analogs & derivatives, Phenylurea Compounds therapeutic use, Radiotherapy, Conformal adverse effects
- Abstract
Objective Sorafenib is a standard therapy for advanced hepatocellular carcinoma (HCC), whereas radiotherapy is effective for local control of extrahepatic spread (EHS) or macrovascular invasion (MVI). This study investigated the safety and efficacy of this combined therapy to treat advanced HCC. Methods This retrospective study reviewed 62 patients with advanced-stage HCC with EHS or MVI who received sorafenib therapy, excluding the patients with only lung metastases. Results Of the 62 patients, 15 were treated using the combined therapy of sorafenib and radiotherapy (group RS), and 47 were treated with sorafenib monotherapy (group S). In group RS, patients were treated using three-dimensional conformal radiotherapy with a total irradiation dose of 30-60 Gy (median, 50 Gy). Irradiation was targeted at the bone, lymph nodes, adrenal gland, and MVI in 6, 5, 1, and 4 patients, respectively. The overall incidence of adverse events was 93.3% in group RS and 91.5% in group S (p=N.S.). Incidences of thrombocytopenia, leukopenia, and skin reaction were significantly higher in group RS (73.3%, 40.0%, and 66.7%, respectively) than in group S (36.2%, 10.6%, and 27.7%, respectively, p=0.02, 0.02, and <0.01, respectively). The incidence of severe adverse events, however, was comparable in the 2 groups: 20% in group RS and 19.2% in group S. The median progression-free survival (PFS) of EHS or MVI, PFS of whole lesions, and overall survival were longer in group RS (13.5, 10.6, and 31.2 months, respectively) than in group S (3.3, 3.5, and 12.1 months, respectively) (p<0.01 for all). Conclusion Sorafenib in combination with radiotherapy is a feasible and tolerable treatment option for advanced HCC.
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- 2018
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