AIM: To investigate mucin expression profiles in colorectal carcinoma (CRC) histological subtypes with regard to clinicopathologic variables and prognosis. METHODS: Mucin (MUC)2 and MUC5AC expressions were assessed by...AIM: To investigate mucin expression profiles in colorectal carcinoma (CRC) histological subtypes with regard to clinicopathologic variables and prognosis. METHODS: Mucin (MUC)2 and MUC5AC expressions were assessed by immunohistochemistry for a total of 250 CRC cases that underwent surgical resection. CRCs included 63 well-to-moderately differentiated adenocar-cinomas (WMDAs), 91 poorly differentiated adenocarcinomas (PDAs), 81 mucinous adenocarcinoma (MUAs), and 15 signet-ring cell carcinomas (SRCCs). MUC2 and MUC5AC were scored as positive when ≥ 25% and ≥ 1% of cancer cells were stained positive, respectively. The human mutL homolog 1 and human mutS homolog 2 expressions were assessed by immunohistochemistry in PDAs to investigate mismatch-repair (MMR) status.Tumors that did not express either of these two were considered MMR-deficient. Results were analyzed for associations with clinicopathologic variables and the prognosis in individual histological CRC subtypes. RESULTS: MUC2-positive and MUC5AC-positive WMDA percentages were 49.2% and 30.2%, respectively. In contrast, MUC2-positive and MUC5AC-positive PDA percentages were 9.5% and 51.6%, respectively. MUC2 levels tended to decrease and MUC5AC levels tended to increase from WMDA to PDA. In 21 tumors comprising both adenoma and adenocarcinoma components in a single tumor (4 WMDAs, 7 PDAs, and 10 MUAs), MUC2 was significantly downregulated in PDA and MUC5AC was downregulated in PDA and MUA in the adenoma-carcinoma sequence. These results suggested that MUC2 levels might be associated with malignant potential and that MUC5AC expression was an early event in tumorigenesis. Despite worse prognoses than WMDA, high MUC2 expression levels were maintained in MUA (95.1%) and SRCC (71.5%), which suggested a pathogenesis for these subtypes distinct from that of WMDA. No significant associations were found between MUC2 expression and any clinicopathologic variables in any histological subtype. MUC5AC expression in PDA was closely associated with right-sided location展开更多
AIM: To evaluate the effect of first line esomeprazole(EPZ)-based triple therapy on Helicobacter pylori(H. pylori) eradication.METHODS: A total of 80 Japanese patients with gastritis who were diagnosed as positive for...AIM: To evaluate the effect of first line esomeprazole(EPZ)-based triple therapy on Helicobacter pylori(H. pylori) eradication.METHODS: A total of 80 Japanese patients with gastritis who were diagnosed as positive for H. pylori infection by endoscopic biopsy-based or ^(13)C-urea breath tests were included in this study. The average age of the patients was 57.2 years(male/female, 42/38). These patients were treated by first-line eradication therapy with EPZ 40 mg/d, amoxicillin 1500 mg/d, and clarithromycin 400 mg/d for 7 d. All drugs were given twice per day. Correlations between H. pylori eradication, CYP2C19 genotype, and serum pepsinogen(PG) level were analyzed. This study was registered with the UMIN Clinical Trials Registry(UMIN000009642).RESULTS: The H. pylori eradication rates by EPZbased triple therapy evaluated by intention-to-treat and per protocol were 67.5% and 68.4%, respectively, which were similar to triple therapies with other first-generation proton pump inhibitors(PPIs). The eradication rates in three different CYP2C19 genotypes, described as extensive metabolizer(EM), intermediate metabolizer, and poor metabolizer, were 52.2%, 72.1%, and 84.6%, respectively. The H. pylori eradication rate was significantly lower in EM than non-EM(P < 0.05). The serum PG?Ⅰ?level and PG?Ⅰ/Ⅱ ratio were significantly increased after eradication of H. pylori(P < 0.01), suggesting that gastric atrophy was improved by H. pylori eradication. Thus, first-line eradication by EPZbased triple therapy for patients with H. pylori-positive gastritis was influenced by CYP2C19 genotype, and the eradication rate was on the same level with other firstgeneration PPIs in the Japanese population.CONCLUSION: The results from this study suggest that there is no advantage to EPZ-based triple therapy on H. pylori eradication compared to other firstgeneration PPIs.展开更多
We describe a 77-year-old woman with chronic hepatitis B who became resistant to lamivudine.She was started on adefovir(10 mg daily)while still continuing lamivudine therapy.Four mo later her liver function improved a...We describe a 77-year-old woman with chronic hepatitis B who became resistant to lamivudine.She was started on adefovir(10 mg daily)while still continuing lamivudine therapy.Four mo later her liver function improved and serum Hepatitis B virus(HBV)-DNA level became undetectable.Three years after the start of additional adefovir treatment,hepatocellular carcinoma (HCC)was detected and the patient underwent a successful hepa-tectomy.Our findings suggest tha-t the addition of adefovir to ongoing lamivudine therapy cannot completely suppress hepatocarcinogenesis,but is useful for improving liver function in patients with lamivudine-resistant HBV-related cirrhosis,allowing HCC surgery.展开更多
AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 wer...AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.展开更多
Colorectal cancer(CRC)results from the progressive accumulation of genetic and epigenetic alterations that lead to the transformation of normal colonic mucosa to adenocarcinoma.Approximately 75%of CRCs are sporadic an...Colorectal cancer(CRC)results from the progressive accumulation of genetic and epigenetic alterations that lead to the transformation of normal colonic mucosa to adenocarcinoma.Approximately 75%of CRCs are sporadic and occur in people without genetic predisposition or family history of CRC.During the past two decades,sporadic CRCs were classified into three major groups according to frequently altered/mutated genes.These genes have been identified by linkage analyses of cancer-prone families and by individual mutation analyses of candidate genes selected on the basis of functional data.In the first half of this review,we describe the genetic pathways of sporadic CRCs and their clinicopathologic features.Recently,large-scale genome analyses have detected many infrequently mutated genes as well as a small number of frequently mutated genes.These infrequently mutated genes are likely described in a limited number of pathways.Gene-oriented models of CRC progression are being replaced by pathway-oriented models.In the second half of this review,we summarize the present knowledge of this research field and discuss its prospects.展开更多
Background: Pain in patients with orthopedic problems is an important aspect of surgical evaluation. However, the effect on the quality of life depends not only on the degree of pain but also on its type. Hip arthrosc...Background: Pain in patients with orthopedic problems is an important aspect of surgical evaluation. However, the effect on the quality of life depends not only on the degree of pain but also on its type. Hip arthroscopy has been performed for hip joint symptoms caused by femoroacetabular impingement (FAI) and hip labrum tears. However, the degree and type of pain after hip arthroscopy remains unknown. Objective: This study aimed to clarify the degree and type of pain during 6 months after hip arthroscopy. Methods: Non-athlete patients aged 20 - 65 years who underwent hip arthroscopy between December 2018 and October 2019 participated in a questionnaire survey before hospitalization and at 1, 3, and 6 months after surgery. The questionnaire comprised the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for quality of life, International Physical Activity Questionnaire (IPAQ) for activities, and the Short-Form McGill Pain Questionnaire (SF-MPQ-2) for pain. Results: The analysis included 10 patients (men: 4, women: 6, mean age: 38 ± 8.6 years, FAI: 6 cases, hip labrum tears: 4 cases). The average time from symptom onset to surgery was 26.9 ± 19.0 months. The analysis from before surgery to 6 months after surgery showed improvement over time in all scale scores (JHEQ, IPAQ, and SF-MPQ-2). The degree of pain was significantly improved based on the JHEQ visual analog scale evaluation (P = 0.019) 3 months after surgery. Significant improvement in intermittent pain (P = 0.011) based on SF-MPQ-2 was noted 3 months after surgery;however, no significant improvement in continuous pain was noted. Conclusions: Patients who underwent hip arthroscopy showed significant improvements in the degree of pain and type of intermittent pain from before surgery to 3 months after surgery, however, no change was observed in continuous pain.展开更多
Primary esophageal or gastric melanoma is a very rare disease with early metastasis. Due to its atypical symptom and less efficiency of chemotherapy and radiotherapy, the prognosis of esophageal or gastric melanoma is...Primary esophageal or gastric melanoma is a very rare disease with early metastasis. Due to its atypical symptom and less efficiency of chemotherapy and radiotherapy, the prognosis of esophageal or gastric melanoma is still very poor. Surgical resection remains the preferential treatment for esophageal or gastric melanoma. Here we present an extremely rare case of primary advanced esophago-gastric melanoma. Debulking surgery was performed without chemotherapy or radiotherapy. However, abdominal recurrence and hepatic metastases were found within one month by a postoperative follow-up computed tomography. Three and a half months after surgical resection, the patient died of extensive abdominal metastasis.展开更多
To evaluate the usefulness of total colonoscopy (TCS) for patients undergoing gastric endoscopic submucosal dissection (ESD) and to assess risk factors for colorectal neoplasms.METHODSOf the 263 patients who underwent...To evaluate the usefulness of total colonoscopy (TCS) for patients undergoing gastric endoscopic submucosal dissection (ESD) and to assess risk factors for colorectal neoplasms.METHODSOf the 263 patients who underwent ESD at our department between May 2010 and December 2013, 172 patients undergoing TCS during a one-year period before and after ESD were targeted. After excluding patients with a history of surgery or endoscopic therapy for colorectal neoplasms, 158 patients were analyzed. Of the 868 asymptomatic patients who underwent TCS during the same period because of positive fecal immunochemical test (FIT) results, 158 patients with no history of either surgery or endoscopic therapy for colorectal neoplasms who were matched for age and sex served as the control group for comparison.RESULTSTCS revealed adenoma less than 10 mm in 53 patients (33.6%), advanced adenoma in 17 (10.8%), early colorectal cancer in 5 (3.2%), and advanced colorectal cancer in 4 (2.5%). When the presence or absence of adenoma less than 10 mm, advanced adenoma, and colorectal cancer and the number of adenomas were compared between patients undergoing ESD and FIT-positive patients, there were no statistically significant differences in any of the parameters assessed. The patients undergoing ESD appeared to have the same risk of colorectal neoplasms as the FIT-positive patients. Colorectal neoplasms were clearly more common in men than in women (P = 0.031). Advanced adenoma and cancer were significantly more frequent in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus (P = 0.019).CONCLUSIONIn patients undergoing gastric ESD, TCS appears to be important for detecting synchronous double neoplasms. Advanced adenoma and cancer were more common in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus. Caution is therefore especially warranted in patients with these risk factors.展开更多
Background： Preventing anterior cruciate ligament（ACL） injuries is very important for athletes, and dynamic knee valgus is considered a risk factor for non-contact ACL injury. However, little is known about whether...Background： Preventing anterior cruciate ligament（ACL） injuries is very important for athletes, and dynamic knee valgus is considered a risk factor for non-contact ACL injury. However, little is known about whether the functions of the hip abductor and rear-foot increase dynamic knee valgus. A two-dimensional（2D） video-based screening test focused on hip abductor and rear-foot functions among factors involved in dynamic knee valgus. The present study determined associations between hip and rear-foot dynamic alignment and dynamic knee valgus.Methods： This cross-sectional study recruited 130 female basketball players（258 legs） from nine high-school teams. The players performed single-leg squats and single-leg drop landings to provide knee-in（KID） and hip-out（HOD） distances on 2D video images. Hip and rear-foot dynamic alignment was evaluated using a dynamic Trendelenburg test（DTT） and a dynamic heel-floor test（HFT）.Results： The Chi-square test revealed no significant difference in the prevalence of DTT-positivity between single-leg squats（28.7%） and singleleg drop landings（23.3%）. The prevalence of HFT-positivity was significantly greater during landings（51.4%） than during single-leg squats（31.0%, p 〈 0.01）. The KID values for both single-leg squats and single-leg drop landings were greater in the DTT-positive than in the DTTnegative group（15.1 5.4 cm and 20.2 7.5 cm, p 〈 0.001）. The HOD values were similarly greater in the DTT-positive group（15.2 1.9 cm and 17.6 2.8 cm, p 〈 0.001）. The KID values for both single-leg squats and single-leg drop landings were greater in the HFT-positive than in the HFT-negative group（12.2 5.1 cm, p 〈 0.01; 14.7 7.2 cm, p 〈 0.001）, whereas HOD values for these tasks did not significantly differ between the two groups.Conclusion： Dynamic hip mal-alignment might be associated with both greater KID and HOD, whereas rear-foot eversion is associated only with greater KID. Hip abductor and rear-foot dysfunction are im展开更多
BACKGROUND Adult-onset Ménétrier’s disease is strongly associated with Helicobacter pylori(H.pylori)infection and an elevated risk of carcinogenesis.Cases of early-stage gastric cancer developed in H.pylori...BACKGROUND Adult-onset Ménétrier’s disease is strongly associated with Helicobacter pylori(H.pylori)infection and an elevated risk of carcinogenesis.Cases of early-stage gastric cancer developed in H.pylori-negative Ménétrier’s disease are extremely rare.We report a case of early gastric cancer in H.pylori-negative Ménétrier’s disease that was curatively resected with endoscopic submucosal dissection(ESD).CASE SUMMARY A 60-year-old woman was referred to our hospital after her medical examination detected anemia.Contrast-enhanced upper gastrointestinal(UGI)radiography revealed translucency of the nodule-aggregating surface with giant rugae.Blood tests showed hypoproteinemia and were negative for serum H.pylori immunoglobulin G antibodies.The 99mTc-DTPA-human serum albumin scintigraphy showed protein loss from the stomach.UGI endoscopy showed a 40-mm protruding erythematous lesion on giant rugae of the greater curvature of lower gastric body,suggesting early-stage gastric cancer due to Ménétrier’s disease.En bloc resection with ESD was performed for diagnosis and treatment.Histology of ESD showed well-differentiated tubular adenocarcinoma.The cancer was confined to the mucosa,and complete curative resection was achieved.Foveolar hyperplasia and atrophy of the gastric glands were observed in non-tumor areas,histologically corresponding to Ménétrier’s disease.Three years after ESD,gastric cancer had not recurred,and Ménétrier’s disease remained in remission with spontaneous regression of giant gastric rugae.CONCLUSION Complete curative resection was achieved through ESD in a patient with earlystage gastric cancer and H.pylori-negative Ménétrier’s disease.展开更多
Laparoscopy-assisted distal gastrectomy (LADG) has been widely used to treat early gastric cancer (EGC). The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system predicts the risk of fatal pos...Laparoscopy-assisted distal gastrectomy (LADG) has been widely used to treat early gastric cancer (EGC). The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system predicts the risk of fatal postoperative complications by quantifying the patient’s reserve and degree of surgical stress, but there have been a few reports of use of the E-PASS scoring system to assess the risk of mortality following special types of surgical procedures such as LADG. In this study we assessed the feasibility of LADG versus open distal gastrectomy (ODG) by the E-PASS scoring system. The subjects of this study consisted of 69 stage IA gastric cancer patients who underwent LADG (LADG group) and 69 stage IA gastric cancer patients who underwent ODG (ODG group). The mean age of the patients in the LADG group was 68.6 years, which was significantly higher than the mean age of 63.4 years in the ODG group. There were no statistically significant differences between the groups in operation time or preoperative risk score, but there were statistically significant differences in blood loss, surgical stress score, comprehensive risk score, and duration of postoperative hospital stay. We conclude that using the E-PASS scoring system, LADG appreciates a more beneficial procedure for the treatment of EGC than ODG.展开更多
The purpose of this multicenter study was to evaluate the clinical performance of an ultrahigh molecular weight polyethylene (UHMWPE) fiber cable for re-attachment of the osteotomized greater trochanter in hip surgery...The purpose of this multicenter study was to evaluate the clinical performance of an ultrahigh molecular weight polyethylene (UHMWPE) fiber cable for re-attachment of the osteotomized greater trochanter in hip surgery. Included in the study were 85 hips that had undergone surgery with greater trochanter osteotomy, including 50 hip arthroplasty procedures and 35 hip osteotomies. The osteotomized greater trochanter was reattached using one or more UHMWPE fiber cables. The bone union and displacement of the greater trochanter were assessed in radiographs for up to 12 months after surgery. Non-union of the osteotomy site occurred in 4.7% of the cases. In approximately 90% of the cases, displacement was less than 2 mm at up to 12 months after surgery. The UHMWPE fiber cable was a good biomaterial for reattaching the osteotomized greater trochanter and may also be an option for osteosynthesis procedures.展开更多
Solitons are stable solitary waves.In 1834,Scott Russel first observed such a solitary water wave in a narrow channel near Edinburgh.In 1895,D.Korteweg and G.de Vries had derived the Korteweg-de Vries (KdV)equations f...Solitons are stable solitary waves.In 1834,Scott Russel first observed such a solitary water wave in a narrow channel near Edinburgh.In 1895,D.Korteweg and G.de Vries had derived the Korteweg-de Vries (KdV)equations for waves on shallow water surfaces.In 1965,N.Zabusky and M.Kruskal had demonstrated the stability of the solitary waves in the Korteweg-de Vries equation using numerical simulations,and coined the term "soliton".In 1967,Gardner, Greene,Kruskal,and Miura had discovered the mathematical technique of the inverse scattering transform to find analytical solutions to the KdV equation in a systematic manner,and the KdV equation was thus recognized as a paradigmatic integrable partial differential equation.展开更多
AIM:To predict treatment success using only simple clinical data from peg-interferon plus ribavirin therapy for chronic hepatitis C. METHODS:We analyzed the clinical data of 176 patients with chronic hepatitis and hep...AIM:To predict treatment success using only simple clinical data from peg-interferon plus ribavirin therapy for chronic hepatitis C. METHODS:We analyzed the clinical data of 176 patients with chronic hepatitis and hepatitis C virus genotype 1 who received 48 wk standard therapy, derived a predictive formula to assess a sustained virological response of the individual patient using a logistic regression model and confirmed the validity of this formula.The formula was constructed using data from the first 100 patients enrolled and validated using data from the remaining 76 patients. RESULTS:Sustained virological response was obtained in 83(47.2%)of the patients and we derived formulae to predict sustained virological response at pretreatment and weeks 4,12 and 24.The likelihood of sustained virological response could be predicted effectively bythe formulae at weeks 4,12 and 24(the area under the curve of the receiver operating characteristic:0.821, 0.802,and 0.891,respectively),but not at baseline (0.570).The formula at week 48 was also constructed and validation by test data achieved good prediction with 0.871 of the area under the curve of the receiver operating characteristic.Prediction by this formula was always superior to that by viral kinetics. CONCLUSION:These results suggested that our formula combined with viral kinetics provides a clear direction of therapy for each patient and enables the best tailored treatment.展开更多
The carrier dynamics in organic photovoltaic (OPV) cells were investigated by impedance spectroscopy. We introduced a novel impedance spectrum representation called dynamic modulus plot (DMP), which allowed us to obse...The carrier dynamics in organic photovoltaic (OPV) cells were investigated by impedance spectroscopy. We introduced a novel impedance spectrum representation called dynamic modulus plot (DMP), which allowed us to observe the layer-to-layer carrier injection behavior graphically. In this work, the impedance responses were characterized in the N,N’-diphenyl-N,N’-di-m-tolyl- 4,4’-diaminobiphenyl (TPD)/C60 p-n heterostructured OPV cells against applied voltages. The dependence of impedance responses on the layer thickness revealed a constant internal electric field that disturbed the carrier transport within the OPV cells. We applied this technique to new donor materials, in which thiophene units were inserted to the center of TPD. By increasing the number of thiophene units in TPD the fill-factor (FF) improved from 33% to 59%, which increased the power conversion efficiency (PCE). Based on the DMP analysis, we assigned the improvement in device performance to the reduction of the internal electric field.展开更多
BACKGROUND Esophageal adenocarcinoma(EAC)derived from long-segment Barrett’s esophagus(LSBE)is extremely rare in Asia.LSBE-related EAC is often difficult to diagnose in the horizontal extent.If the tumor has spread t...BACKGROUND Esophageal adenocarcinoma(EAC)derived from long-segment Barrett’s esophagus(LSBE)is extremely rare in Asia.LSBE-related EAC is often difficult to diagnose in the horizontal extent.If the tumor has spread throughout the LSBE,whole circumferential endoscopic submucosal dissection(ESD)should be performed,which is difficult to complete safely.Additionally,whole circumferential ESD can bring refractory postoperative stenosis.We hereby report a case of EAC involving the whole circumference of the LSBE,achieving complete endoscopic removal without complications.CASE SUMMARY An 85-year-old man with the chief complaint of dysphagia underwent esophagogastroduodenoscopy.We suspected a flat-type cancerous lesion that extended the whole circumference of the LSBE(C 3.5,M 4.0)using narrow-band imaging magnification endoscopy(NBI-M).We achieved circumferential en bloc resection of the lesion safely with special ESD techniques.Histology of the ESD specimens demonstrated that the superficial EAC extended the whole circumference of the LSBE,and papillary or well-differentiated tubular adenocarcinoma was confined in the lamina propria mucosa showing a vertical negative margin.To prevent post-ESD stenosis,we performed endoscopic local injection of steroids,followed by oral administration of steroids.There was no evidence of esophageal refractory stenosis or tumor recurrence 30 mo after ESD.In summary,we experienced a rare case of LSBE-related EAC.The horizontal tumor extent was accurately diagnosed by NBI-M.Additionally,we achieve whole circumferential ESD safely without postoperative refractory stenosis.CONCLUSION NBI-M,ESD,and steroid therapy enabled the curative resection of superficial full circumferential LSBE-related EAC without refractory postoperative stenosis.展开更多
文摘AIM: To investigate mucin expression profiles in colorectal carcinoma (CRC) histological subtypes with regard to clinicopathologic variables and prognosis. METHODS: Mucin (MUC)2 and MUC5AC expressions were assessed by immunohistochemistry for a total of 250 CRC cases that underwent surgical resection. CRCs included 63 well-to-moderately differentiated adenocar-cinomas (WMDAs), 91 poorly differentiated adenocarcinomas (PDAs), 81 mucinous adenocarcinoma (MUAs), and 15 signet-ring cell carcinomas (SRCCs). MUC2 and MUC5AC were scored as positive when ≥ 25% and ≥ 1% of cancer cells were stained positive, respectively. The human mutL homolog 1 and human mutS homolog 2 expressions were assessed by immunohistochemistry in PDAs to investigate mismatch-repair (MMR) status.Tumors that did not express either of these two were considered MMR-deficient. Results were analyzed for associations with clinicopathologic variables and the prognosis in individual histological CRC subtypes. RESULTS: MUC2-positive and MUC5AC-positive WMDA percentages were 49.2% and 30.2%, respectively. In contrast, MUC2-positive and MUC5AC-positive PDA percentages were 9.5% and 51.6%, respectively. MUC2 levels tended to decrease and MUC5AC levels tended to increase from WMDA to PDA. In 21 tumors comprising both adenoma and adenocarcinoma components in a single tumor (4 WMDAs, 7 PDAs, and 10 MUAs), MUC2 was significantly downregulated in PDA and MUC5AC was downregulated in PDA and MUA in the adenoma-carcinoma sequence. These results suggested that MUC2 levels might be associated with malignant potential and that MUC5AC expression was an early event in tumorigenesis. Despite worse prognoses than WMDA, high MUC2 expression levels were maintained in MUA (95.1%) and SRCC (71.5%), which suggested a pathogenesis for these subtypes distinct from that of WMDA. No significant associations were found between MUC2 expression and any clinicopathologic variables in any histological subtype. MUC5AC expression in PDA was closely associated with right-sided location
基金Supported by Research Grant of Kitasato Institute Hospital
文摘AIM: To evaluate the effect of first line esomeprazole(EPZ)-based triple therapy on Helicobacter pylori(H. pylori) eradication.METHODS: A total of 80 Japanese patients with gastritis who were diagnosed as positive for H. pylori infection by endoscopic biopsy-based or ^(13)C-urea breath tests were included in this study. The average age of the patients was 57.2 years(male/female, 42/38). These patients were treated by first-line eradication therapy with EPZ 40 mg/d, amoxicillin 1500 mg/d, and clarithromycin 400 mg/d for 7 d. All drugs were given twice per day. Correlations between H. pylori eradication, CYP2C19 genotype, and serum pepsinogen(PG) level were analyzed. This study was registered with the UMIN Clinical Trials Registry(UMIN000009642).RESULTS: The H. pylori eradication rates by EPZbased triple therapy evaluated by intention-to-treat and per protocol were 67.5% and 68.4%, respectively, which were similar to triple therapies with other first-generation proton pump inhibitors(PPIs). The eradication rates in three different CYP2C19 genotypes, described as extensive metabolizer(EM), intermediate metabolizer, and poor metabolizer, were 52.2%, 72.1%, and 84.6%, respectively. The H. pylori eradication rate was significantly lower in EM than non-EM(P < 0.05). The serum PG?Ⅰ?level and PG?Ⅰ/Ⅱ ratio were significantly increased after eradication of H. pylori(P < 0.01), suggesting that gastric atrophy was improved by H. pylori eradication. Thus, first-line eradication by EPZbased triple therapy for patients with H. pylori-positive gastritis was influenced by CYP2C19 genotype, and the eradication rate was on the same level with other firstgeneration PPIs in the Japanese population.CONCLUSION: The results from this study suggest that there is no advantage to EPZ-based triple therapy on H. pylori eradication compared to other firstgeneration PPIs.
文摘We describe a 77-year-old woman with chronic hepatitis B who became resistant to lamivudine.She was started on adefovir(10 mg daily)while still continuing lamivudine therapy.Four mo later her liver function improved and serum Hepatitis B virus(HBV)-DNA level became undetectable.Three years after the start of additional adefovir treatment,hepatocellular carcinoma (HCC)was detected and the patient underwent a successful hepa-tectomy.Our findings suggest tha-t the addition of adefovir to ongoing lamivudine therapy cannot completely suppress hepatocarcinogenesis,but is useful for improving liver function in patients with lamivudine-resistant HBV-related cirrhosis,allowing HCC surgery.
文摘AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.
文摘Colorectal cancer(CRC)results from the progressive accumulation of genetic and epigenetic alterations that lead to the transformation of normal colonic mucosa to adenocarcinoma.Approximately 75%of CRCs are sporadic and occur in people without genetic predisposition or family history of CRC.During the past two decades,sporadic CRCs were classified into three major groups according to frequently altered/mutated genes.These genes have been identified by linkage analyses of cancer-prone families and by individual mutation analyses of candidate genes selected on the basis of functional data.In the first half of this review,we describe the genetic pathways of sporadic CRCs and their clinicopathologic features.Recently,large-scale genome analyses have detected many infrequently mutated genes as well as a small number of frequently mutated genes.These infrequently mutated genes are likely described in a limited number of pathways.Gene-oriented models of CRC progression are being replaced by pathway-oriented models.In the second half of this review,we summarize the present knowledge of this research field and discuss its prospects.
文摘Background: Pain in patients with orthopedic problems is an important aspect of surgical evaluation. However, the effect on the quality of life depends not only on the degree of pain but also on its type. Hip arthroscopy has been performed for hip joint symptoms caused by femoroacetabular impingement (FAI) and hip labrum tears. However, the degree and type of pain after hip arthroscopy remains unknown. Objective: This study aimed to clarify the degree and type of pain during 6 months after hip arthroscopy. Methods: Non-athlete patients aged 20 - 65 years who underwent hip arthroscopy between December 2018 and October 2019 participated in a questionnaire survey before hospitalization and at 1, 3, and 6 months after surgery. The questionnaire comprised the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for quality of life, International Physical Activity Questionnaire (IPAQ) for activities, and the Short-Form McGill Pain Questionnaire (SF-MPQ-2) for pain. Results: The analysis included 10 patients (men: 4, women: 6, mean age: 38 ± 8.6 years, FAI: 6 cases, hip labrum tears: 4 cases). The average time from symptom onset to surgery was 26.9 ± 19.0 months. The analysis from before surgery to 6 months after surgery showed improvement over time in all scale scores (JHEQ, IPAQ, and SF-MPQ-2). The degree of pain was significantly improved based on the JHEQ visual analog scale evaluation (P = 0.019) 3 months after surgery. Significant improvement in intermittent pain (P = 0.011) based on SF-MPQ-2 was noted 3 months after surgery;however, no significant improvement in continuous pain was noted. Conclusions: Patients who underwent hip arthroscopy showed significant improvements in the degree of pain and type of intermittent pain from before surgery to 3 months after surgery, however, no change was observed in continuous pain.
文摘Primary esophageal or gastric melanoma is a very rare disease with early metastasis. Due to its atypical symptom and less efficiency of chemotherapy and radiotherapy, the prognosis of esophageal or gastric melanoma is still very poor. Surgical resection remains the preferential treatment for esophageal or gastric melanoma. Here we present an extremely rare case of primary advanced esophago-gastric melanoma. Debulking surgery was performed without chemotherapy or radiotherapy. However, abdominal recurrence and hepatic metastases were found within one month by a postoperative follow-up computed tomography. Three and a half months after surgical resection, the patient died of extensive abdominal metastasis.
文摘To evaluate the usefulness of total colonoscopy (TCS) for patients undergoing gastric endoscopic submucosal dissection (ESD) and to assess risk factors for colorectal neoplasms.METHODSOf the 263 patients who underwent ESD at our department between May 2010 and December 2013, 172 patients undergoing TCS during a one-year period before and after ESD were targeted. After excluding patients with a history of surgery or endoscopic therapy for colorectal neoplasms, 158 patients were analyzed. Of the 868 asymptomatic patients who underwent TCS during the same period because of positive fecal immunochemical test (FIT) results, 158 patients with no history of either surgery or endoscopic therapy for colorectal neoplasms who were matched for age and sex served as the control group for comparison.RESULTSTCS revealed adenoma less than 10 mm in 53 patients (33.6%), advanced adenoma in 17 (10.8%), early colorectal cancer in 5 (3.2%), and advanced colorectal cancer in 4 (2.5%). When the presence or absence of adenoma less than 10 mm, advanced adenoma, and colorectal cancer and the number of adenomas were compared between patients undergoing ESD and FIT-positive patients, there were no statistically significant differences in any of the parameters assessed. The patients undergoing ESD appeared to have the same risk of colorectal neoplasms as the FIT-positive patients. Colorectal neoplasms were clearly more common in men than in women (P = 0.031). Advanced adenoma and cancer were significantly more frequent in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus (P = 0.019).CONCLUSIONIn patients undergoing gastric ESD, TCS appears to be important for detecting synchronous double neoplasms. Advanced adenoma and cancer were more common in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus. Caution is therefore especially warranted in patients with these risk factors.
文摘Background： Preventing anterior cruciate ligament（ACL） injuries is very important for athletes, and dynamic knee valgus is considered a risk factor for non-contact ACL injury. However, little is known about whether the functions of the hip abductor and rear-foot increase dynamic knee valgus. A two-dimensional（2D） video-based screening test focused on hip abductor and rear-foot functions among factors involved in dynamic knee valgus. The present study determined associations between hip and rear-foot dynamic alignment and dynamic knee valgus.Methods： This cross-sectional study recruited 130 female basketball players（258 legs） from nine high-school teams. The players performed single-leg squats and single-leg drop landings to provide knee-in（KID） and hip-out（HOD） distances on 2D video images. Hip and rear-foot dynamic alignment was evaluated using a dynamic Trendelenburg test（DTT） and a dynamic heel-floor test（HFT）.Results： The Chi-square test revealed no significant difference in the prevalence of DTT-positivity between single-leg squats（28.7%） and singleleg drop landings（23.3%）. The prevalence of HFT-positivity was significantly greater during landings（51.4%） than during single-leg squats（31.0%, p 〈 0.01）. The KID values for both single-leg squats and single-leg drop landings were greater in the DTT-positive than in the DTTnegative group（15.1 5.4 cm and 20.2 7.5 cm, p 〈 0.001）. The HOD values were similarly greater in the DTT-positive group（15.2 1.9 cm and 17.6 2.8 cm, p 〈 0.001）. The KID values for both single-leg squats and single-leg drop landings were greater in the HFT-positive than in the HFT-negative group（12.2 5.1 cm, p 〈 0.01; 14.7 7.2 cm, p 〈 0.001）, whereas HOD values for these tasks did not significantly differ between the two groups.Conclusion： Dynamic hip mal-alignment might be associated with both greater KID and HOD, whereas rear-foot eversion is associated only with greater KID. Hip abductor and rear-foot dysfunction are im
文摘BACKGROUND Adult-onset Ménétrier’s disease is strongly associated with Helicobacter pylori(H.pylori)infection and an elevated risk of carcinogenesis.Cases of early-stage gastric cancer developed in H.pylori-negative Ménétrier’s disease are extremely rare.We report a case of early gastric cancer in H.pylori-negative Ménétrier’s disease that was curatively resected with endoscopic submucosal dissection(ESD).CASE SUMMARY A 60-year-old woman was referred to our hospital after her medical examination detected anemia.Contrast-enhanced upper gastrointestinal(UGI)radiography revealed translucency of the nodule-aggregating surface with giant rugae.Blood tests showed hypoproteinemia and were negative for serum H.pylori immunoglobulin G antibodies.The 99mTc-DTPA-human serum albumin scintigraphy showed protein loss from the stomach.UGI endoscopy showed a 40-mm protruding erythematous lesion on giant rugae of the greater curvature of lower gastric body,suggesting early-stage gastric cancer due to Ménétrier’s disease.En bloc resection with ESD was performed for diagnosis and treatment.Histology of ESD showed well-differentiated tubular adenocarcinoma.The cancer was confined to the mucosa,and complete curative resection was achieved.Foveolar hyperplasia and atrophy of the gastric glands were observed in non-tumor areas,histologically corresponding to Ménétrier’s disease.Three years after ESD,gastric cancer had not recurred,and Ménétrier’s disease remained in remission with spontaneous regression of giant gastric rugae.CONCLUSION Complete curative resection was achieved through ESD in a patient with earlystage gastric cancer and H.pylori-negative Ménétrier’s disease.
文摘Laparoscopy-assisted distal gastrectomy (LADG) has been widely used to treat early gastric cancer (EGC). The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system predicts the risk of fatal postoperative complications by quantifying the patient’s reserve and degree of surgical stress, but there have been a few reports of use of the E-PASS scoring system to assess the risk of mortality following special types of surgical procedures such as LADG. In this study we assessed the feasibility of LADG versus open distal gastrectomy (ODG) by the E-PASS scoring system. The subjects of this study consisted of 69 stage IA gastric cancer patients who underwent LADG (LADG group) and 69 stage IA gastric cancer patients who underwent ODG (ODG group). The mean age of the patients in the LADG group was 68.6 years, which was significantly higher than the mean age of 63.4 years in the ODG group. There were no statistically significant differences between the groups in operation time or preoperative risk score, but there were statistically significant differences in blood loss, surgical stress score, comprehensive risk score, and duration of postoperative hospital stay. We conclude that using the E-PASS scoring system, LADG appreciates a more beneficial procedure for the treatment of EGC than ODG.
文摘The purpose of this multicenter study was to evaluate the clinical performance of an ultrahigh molecular weight polyethylene (UHMWPE) fiber cable for re-attachment of the osteotomized greater trochanter in hip surgery. Included in the study were 85 hips that had undergone surgery with greater trochanter osteotomy, including 50 hip arthroplasty procedures and 35 hip osteotomies. The osteotomized greater trochanter was reattached using one or more UHMWPE fiber cables. The bone union and displacement of the greater trochanter were assessed in radiographs for up to 12 months after surgery. Non-union of the osteotomy site occurred in 4.7% of the cases. In approximately 90% of the cases, displacement was less than 2 mm at up to 12 months after surgery. The UHMWPE fiber cable was a good biomaterial for reattaching the osteotomized greater trochanter and may also be an option for osteosynthesis procedures.
文摘Solitons are stable solitary waves.In 1834,Scott Russel first observed such a solitary water wave in a narrow channel near Edinburgh.In 1895,D.Korteweg and G.de Vries had derived the Korteweg-de Vries (KdV)equations for waves on shallow water surfaces.In 1965,N.Zabusky and M.Kruskal had demonstrated the stability of the solitary waves in the Korteweg-de Vries equation using numerical simulations,and coined the term "soliton".In 1967,Gardner, Greene,Kruskal,and Miura had discovered the mathematical technique of the inverse scattering transform to find analytical solutions to the KdV equation in a systematic manner,and the KdV equation was thus recognized as a paradigmatic integrable partial differential equation.
文摘AIM:To predict treatment success using only simple clinical data from peg-interferon plus ribavirin therapy for chronic hepatitis C. METHODS:We analyzed the clinical data of 176 patients with chronic hepatitis and hepatitis C virus genotype 1 who received 48 wk standard therapy, derived a predictive formula to assess a sustained virological response of the individual patient using a logistic regression model and confirmed the validity of this formula.The formula was constructed using data from the first 100 patients enrolled and validated using data from the remaining 76 patients. RESULTS:Sustained virological response was obtained in 83(47.2%)of the patients and we derived formulae to predict sustained virological response at pretreatment and weeks 4,12 and 24.The likelihood of sustained virological response could be predicted effectively bythe formulae at weeks 4,12 and 24(the area under the curve of the receiver operating characteristic:0.821, 0.802,and 0.891,respectively),but not at baseline (0.570).The formula at week 48 was also constructed and validation by test data achieved good prediction with 0.871 of the area under the curve of the receiver operating characteristic.Prediction by this formula was always superior to that by viral kinetics. CONCLUSION:These results suggested that our formula combined with viral kinetics provides a clear direction of therapy for each patient and enables the best tailored treatment.
文摘The carrier dynamics in organic photovoltaic (OPV) cells were investigated by impedance spectroscopy. We introduced a novel impedance spectrum representation called dynamic modulus plot (DMP), which allowed us to observe the layer-to-layer carrier injection behavior graphically. In this work, the impedance responses were characterized in the N,N’-diphenyl-N,N’-di-m-tolyl- 4,4’-diaminobiphenyl (TPD)/C60 p-n heterostructured OPV cells against applied voltages. The dependence of impedance responses on the layer thickness revealed a constant internal electric field that disturbed the carrier transport within the OPV cells. We applied this technique to new donor materials, in which thiophene units were inserted to the center of TPD. By increasing the number of thiophene units in TPD the fill-factor (FF) improved from 33% to 59%, which increased the power conversion efficiency (PCE). Based on the DMP analysis, we assigned the improvement in device performance to the reduction of the internal electric field.
文摘BACKGROUND Esophageal adenocarcinoma(EAC)derived from long-segment Barrett’s esophagus(LSBE)is extremely rare in Asia.LSBE-related EAC is often difficult to diagnose in the horizontal extent.If the tumor has spread throughout the LSBE,whole circumferential endoscopic submucosal dissection(ESD)should be performed,which is difficult to complete safely.Additionally,whole circumferential ESD can bring refractory postoperative stenosis.We hereby report a case of EAC involving the whole circumference of the LSBE,achieving complete endoscopic removal without complications.CASE SUMMARY An 85-year-old man with the chief complaint of dysphagia underwent esophagogastroduodenoscopy.We suspected a flat-type cancerous lesion that extended the whole circumference of the LSBE(C 3.5,M 4.0)using narrow-band imaging magnification endoscopy(NBI-M).We achieved circumferential en bloc resection of the lesion safely with special ESD techniques.Histology of the ESD specimens demonstrated that the superficial EAC extended the whole circumference of the LSBE,and papillary or well-differentiated tubular adenocarcinoma was confined in the lamina propria mucosa showing a vertical negative margin.To prevent post-ESD stenosis,we performed endoscopic local injection of steroids,followed by oral administration of steroids.There was no evidence of esophageal refractory stenosis or tumor recurrence 30 mo after ESD.In summary,we experienced a rare case of LSBE-related EAC.The horizontal tumor extent was accurately diagnosed by NBI-M.Additionally,we achieve whole circumferential ESD safely without postoperative refractory stenosis.CONCLUSION NBI-M,ESD,and steroid therapy enabled the curative resection of superficial full circumferential LSBE-related EAC without refractory postoperative stenosis.
