AIM: To assess the clinical features and prognosis of 151 patients with extrahepatic metastases from primary hepatocellular carcinoma (HCC), and describe the treatment strategy for such patients. METHODS: After the di...AIM: To assess the clinical features and prognosis of 151 patients with extrahepatic metastases from primary hepatocellular carcinoma (HCC), and describe the treatment strategy for such patients. METHODS: After the diagnosis of HCC, all 995 consecutive HCC patients were followed up at regular intervals and 151 (15.2%) patients were found to have extrahepatic metastases at the initial diagnosis of primary HCC or developed such tumors during the follow-up period. We assessed their clinical features, prognosis, and treatment strategies. RESULTS: The most frequent site of extrahepatic metastases was the lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). The cumulative survival rates after the initial diagnosis of extrahepatic metastases at 6, 12, 24, and 36 mo were 44.1%, 21.7%, 14.2%, 7.1%, respectively. The median survival time was 4.9 mo (range, 0-37 mo). Fourteen patients (11%) died of extrahepatic HCC, others died of primary HCC or liver failure. CONCLUSION: The prognosis of HCC patients with extrahepatic metastases is poor. With regard to the cause of death, many patients would die of intrahepatic HCC and few of extrahepatic metastases. Although most of HCC patients with extrahepatic metastases should undergo treatment for the primary HCC mainly, treatment of extrahepatic metastases in selected HCC patients who have good hepatic reserve, intrahepatictumor stage (T0-T2), and are free of portal venous invasion may improve survival.展开更多
AIM To compare vonoprazan 10 and 20 mg vs lansoprazole 15 mg as maintenance therapy in healed erosive esophagitis(EE).METHODS A total of 607 patients aged ≥ 20 years, with endoscopically-confirmed healed EE following...AIM To compare vonoprazan 10 and 20 mg vs lansoprazole 15 mg as maintenance therapy in healed erosive esophagitis(EE).METHODS A total of 607 patients aged ≥ 20 years, with endoscopically-confirmed healed EE following 8 wk of treatment with vonoprazan 20 mg once daily, were randomized 1:1:1 to receive lansoprazole 15 mg(n = 201), vonoprazan 10 mg(n = 202), or vonoprazan 20 mg(n = 204), once daily. The primary endpoint of the study was the rate of endoscopically-confirmed EE recurrence during a 24-wk maintenance period. The secondary endpoint was the EE recurrence rate at Week 12 during maintenance treatment. Additional efficacy endpoints included the incidence of heartburn and acid reflux, and the EE healing rate 4 wk after the initiation of maintenance treatment. Safety endpoints comprised adverse events(AEs), vital signs, electrocardiogram findings, clinical laboratory results, serum gastrin and pepsinogen Ⅰ/Ⅱ levels, and gastric mucosa histopathology results.RESULTS Rates of EE recurrence during the 24-wk maintenance period were 16.8%, 5.1%, and 2.0% with lansoprazole 15 mg, vonoprazan 10 mg, and vonoprazan 20 mg, respectively. Vonoprazan was shown to be non-inferior to lansoprazole 15 mg(P < 0.0001 for both doses). In a post-hoc analysis, EE recurrence at Week 24 was significantly reduced with vonoprazan at both the 10 mg and the 20 mg dose vs lansoprazole 15 mg(5.1% vs 16.8%, P = 0.0002, and 2.0% vs 16.8%, P < 0.0001, respectively); by contrast, the EE recurrence rate did not differ significantly between the two doses of vonoprazan(P = 0.1090). The safety profiles of vonoprazan 10 and 20 mg were similar to that of lansoprazole 15 mg in patients with healed EE. Treatment-related AEs were reported in 11.4%, 10.4%, and 10.3% of patients in the lansoprazole 15 mg, vonoprazan 10 mg, and vonoprazan 20 mg arms, respectively.CONCLUSION Our findings confirm the non-inferiority of vonoprazan 10 and 20 mg to lansoprazole 15 mg as maintenance therapy for patients with healed EE.展开更多
AIM:To investigate the usefulness of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) in the differentiation of autoimmune pancreatitis(AIP).METHODS:We retrospectively reviewed 47 of 56 AIP patients who un...AIM:To investigate the usefulness of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) in the differentiation of autoimmune pancreatitis(AIP).METHODS:We retrospectively reviewed 47 of 56 AIP patients who underwent EUS-FNA and met the Asian diagnostic criteria.On 47 EUS-FNA specimens,we evaluated the presence of adequate material and characteristic features of lymphoplasmacytic sclerosing pancreatitis(LPSP) and idiopathic duct-centric pancreatitis(IDCP) mentioned in the International Consensus Diagnostic Criteria and examined if these findings make a contribution to the differential diagnosis of type 1 and type 2 AIP.A disposable 22-gauge needle was used for EUS-FNA.RESULTS:Adequate specimens including pancreatic tissue for differentiating AIP from cancer were obtained from 43 of 47 patients who underwent EUSFNA.EUS-FNA was performed from the pancreatic head in 21 cases,which is known to be technically difficult when performed by core biopsy;there was no significant difference in the results compared with pancreatic body-tail.Nine of 47 patients met level 1 findings of LPSP and 5 patients met level 2 findings of LPSP.No one met level 1 findings of IDCP,but 3 patients met level 2 findings of IDCP.Of 10 seronegative cases,2 cases were diagnosed with "definitive type 1 AIP",and 3 cases were diagnosed with "probable type 2 AIP" when considering both the level 2 histological findings and response to steroids.CONCLUSION:EUS-FNA is useful in the differentiation of type 1 and type 2 AIP,particularly in seronegative cases.展开更多
The aim of this study is to investigate the condition of the Ariake Sea, Japan, which has been suffering from severe environmental issues for the past few decades. Water quality data have been generated from several p...The aim of this study is to investigate the condition of the Ariake Sea, Japan, which has been suffering from severe environmental issues for the past few decades. Water quality data have been generated from several points in this area for over 30 years by the Fukuoka, Saga, Kumamoto, and Nagasaki prefectures. In order to understand the characteristics of this sea, principal component analysis (PCA) was utilized using 11 water quality parameters;transparency, temperature, salinity, dissolved oxygen (DO), chemical oxygen demand (COD), dissolved inorganic nitrogen (DIN), ammonium-nitrogen (NH4<sup style='margin-left:-7px;'>+-N), nitrate-nitrogen (NO3<sup style='margin-left:-7px;'>--N), nitrite-nitrogen (NO2<sup style='margin-left:-7px;'>--N), phosphate-phosphorus, (PO4<sup style='margin-left:-7px;'>3--P) and silica. PCA conveyed the amount of nutrients originating from the river, the organic pollution level, and seasonal changes. Subsequently, principal component scores were calculated for each point. It was concluded that the Ariake Sea environment has been affected by two main factors, which are the nutrients from the Chikugo River and anticlockwise tidal residual flow. These two factors must be considered for the environmental restoration of the Ariake Sea.展开更多
We report a rare case of a small-bowel lymphangioma causing massive gastrointestinal (GI) bleeding that we successfully diagnosed and treated using double-balloon enteroscopy (DBE). An 81-year-old woman suffering from...We report a rare case of a small-bowel lymphangioma causing massive gastrointestinal (GI) bleeding that we successfully diagnosed and treated using double-balloon enteroscopy (DBE). An 81-year-old woman suffering from repeated GI bleeding of unknown origin underwent a capsule endoscopy at a previous hospital. She was suspected of having bleeding from the jejunum, and was referred to our department for diagnosis and treatment. An oral DBE revealed a 20 mm × 10 mm, regularly surfaced, white to yellowish, elongated, pedunculated jejunal polyp with small erosions at 10 cm distal to the ligament of Treiz. Since no other source of bleeding was identified by endoscopy in the deep jejunum, anendoscopic polypectomy (EP) was performed for this lesion. A subsequent histopathological examination of the resected polyp showed clusters of lymphatic vessels with marked cystic dilatation in the submucosa and the deep layer of the lamina propria mucosae. These characteristics are consistent with the typical features of small-bowel lymphangioma with erosions. Although clip-ping hemostasis was performed during EP, re-bleeding occurred. Finally, a complete hemostasis was achieved by performing an additional argon plasma coagulation.展开更多
An environmental friendly anodizing treatment (Anomag) from a phosphate-based so lution without heavy metals on AZ91D magnesium alloy was studied. The characteri stics of the coatings, such as structure, composition a...An environmental friendly anodizing treatment (Anomag) from a phosphate-based so lution without heavy metals on AZ91D magnesium alloy was studied. The characteri stics of the coatings, such as structure, composition and corrosion resistance w ere investigated. The effects of this anodizing treatment on the mechanical prop erties were examined. X-ray diffraction (XRD) analysis revealed that the structu re of the coatings is amorphous or glassy. In salt spray tests coatings with an average thickness of 10μm had an anticorrosive performance of over 1000 hours. Fatigue tests revealed that anodizing onto AZ91D magnesium alloy does not affect the fatigue strength. These results demonstrate the utility of this anodizing t reatment on magnesium alloy for application as a structural material, such as in the automotive field.展开更多
The fixing of a silane coupling agent to Zn-Ni-silica(SiO_(2))composite coatings was studied for the purpose of developing a coating process as an alternative to chromating.The corrosion resistance of Zn-Ni-silica com...The fixing of a silane coupling agent to Zn-Ni-silica(SiO_(2))composite coatings was studied for the purpose of developing a coating process as an alternative to chromating.The corrosion resistance of Zn-Ni-silica composite coatings was rem arkably improved by the silica nanoparticles in the composite,which were disper sed in the surface of this film.The silane coupling agent formed chemical bonds with the inorganic silica particles during the silane coupling treatment on the se composite coatings.The treatment suppressed the formation of white corrosion products to the same extent as chromating,as measured in salt spray tests.It is concluded that treating Zn-Ni-silica composite coatings with silane coupling agents is a viable alternative technique to chromating.展开更多
BACKGROUND Accurate diagnosis and early resection of colorectal polyps are important to prevent the occurrence of colorectal cancer.However,technical factors and morphological factors of polyps itself can lead to miss...BACKGROUND Accurate diagnosis and early resection of colorectal polyps are important to prevent the occurrence of colorectal cancer.However,technical factors and morphological factors of polyps itself can lead to missed diagnoses.Imageenhanced endoscopy and chromoendoscopy(CE)have been developed to facilitate an accurate diagnosis.There have been no reports on visibility using a combination of texture and color enhancement imaging(TXI)and CE for colorectal tumors.AIM To investigate the visibility of margins and surfaces with the combination of TXI and CE for colorectal lesions.METHODS This retrospective study included patients who underwent lower gastrointestinal endoscopy at the Toyoshima Endoscopy Clinic.We extracted polyps that were resected and diagnosed as adenomas or serrated polyps(hyperplastic polyps and sessile serrated lesions)from our endoscopic database.An expert endoscopist performed the lower gastrointestinal endoscopies and observed the lesion using white light imaging(WLI),TXI,CE,and TXI+CE modalities.Indigo carmine dye was used for CE.Three expert endoscopists rated the visibility of the margin and surface patterns in four ranks,from 1 to 4.The primary outcomes were the average visibility scores for the margin and surface patterns based on the WLI,TXI,CE,and TXI+CE observations.Visibility scores between the four modalities were compared by the Kruskal-Wallis and Dunn tests.RESULTS A total of 48 patients with 81 polyps were assessed.The histological subtypes included 50 tubular adenomas,16 hyperplastic polyps,and 15 sessile serrated lesions.The visibility scores for the margins based on WLI,TXI,CE,and TXI+CE were 2.44±0.93,2.90±0.93,3.37±0.74,and 3.75±0.49,respectively.The visibility scores for the surface based on WLI,TXI,CE,and TXI+CE were 2.25±0.80,2.84±0.84,3.12±0.72,and 3.51±0.60,respectively.The visibility scores for the detection and surface on TXI were significantly lower than that on CE but higher than that on WLI(P<0.001).The visibility scores for the margin and surface on TXI+CE展开更多
Rice grows well under certain condition and environment including soil, water and nutrients. Some researches have shown that traditional method with continues flooding need tremendeous amount of water for rice cultiva...Rice grows well under certain condition and environment including soil, water and nutrients. Some researches have shown that traditional method with continues flooding need tremendeous amount of water for rice cultivation and gives low water productivity. To increase the water productivity, number of water saving irigation techniques have been studied and applied. Study on effect of number of water irrigation treatments on water productivity of rice was carried out. Eight irrigation treatments were conducted for growing rice in pot experiment i.e. shallow intermittent irrigation (SII), alternate wetting and drying (AWD1, AWD2, AWD3 and AWD4), shallow water depth with wetting and drying (SWD1 and SWD2), and semi-dry cultivation (SDC). The performance of those treatments in terms of agronomic and water parameters was compared to the shallow intermittent irrigation as a control method. The study reveals that the shallow intermittent irrigation needs the highest amount of water compare with other treatments. The lowest amount of water was achieved under the semi-dry cultivation. It could save water up to 18.4% compare to the control treatment. By using the alternate wetting and drying and the shallow water depth with wetting and drying treatments, irrigated water can be reduced up to 13.1% and 5.4%, respectively. The highest grain was obtained by alternate wetting and drying (AWD4) and the semi-dry cultivation yielded the smalest grain. On average the alternate wetting and drying and shallow water depth with wetting and drying increased the grain yield by 22.9% and 17.9%, whereas the semi-dry cultivation reduced the yield up to 14% compare to the shallow water depth treatment. The alternate wetting and drying treatments have significantly improved the water productivity by 41.6%, shallow water depth with wetting and drying increased by 24.2% relative to the shallow intermittent irrigation treatment, whereas the most saving water treatment i.e. the semi-dry cultivation performed quite similar with the shallow water de展开更多
A polarization control device was developed using a plasmonic metasurface with the aim of achieving the desired polarization state. In this study, the Ag metal grating structure was fabricated as a plasmonic metasurfa...A polarization control device was developed using a plasmonic metasurface with the aim of achieving the desired polarization state. In this study, the Ag metal grating structure was fabricated as a plasmonic metasurface by electron beam lithography and a lift-off process. The phase difference of the fabricated sample was 21.0°. This value is almost consistent with the simulation (24.0°). Then, the transmission and phase difference is dependent on the structural parameter. Because of the propagation of surface plasmon polariton at the interface between Ag and SiO<sub>2</sub> or Ag and air, it is believed that the transmittance and the phase difference for TM polarized light can be controlled by the structural parameters. By plotting on the Poincaré sphere after calculating the S-parameter by simulation, it is clear that the arbitrary polarization status can be controlled by the structural parameter.展开更多
Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sa...Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sagittal alignment in standing posture in younger generation. Methods: Subjects included 57 females and 32 males (average age, 29.9 ± 5.7 years). All subjects were 20s or 30s. Spinal curvature was assessed using SpinalMouse. The subjects were also divided into a normal group (VAS zero group) and a pain group by VAS results. Statistical analysis was performed by Student’s t-test. Significance was defined as p < 0.05. Results: The normal group and pain group included 29 and 60 subjects, respectively. In terms of location of pain, thirty-one subjects felt neck pain, 50 felt pain above the scapula, and 17 felt pain between the thoracic spine and scapula. Thoracic kyphosis and lumbar lordosis in the pain group were significantly higher than those in the normal group (p = 0.013 and p = 0.020, respectively). Thoracic kyphosis in subjects with neck pain or pain above scapula was significantly higher than that in subjects without pain (p = 0.0075 and p = 0.025, respectively). Lumbar lordosis in subjects with pain above the scapula or interscapula was significantly higher than that in subjects without pain (p = 0.016).展开更多
The removal of phosphorus from water using marble dust as sorbent material was studied by conducting batch tests, kinetic sorption model and isotherm model. The kinetic sorption model based on a pseudo equation was ap...The removal of phosphorus from water using marble dust as sorbent material was studied by conducting batch tests, kinetic sorption model and isotherm model. The kinetic sorption model based on a pseudo equation was applied to predict the rate constant of sorption. Thorough investigations to understand the mechanism of phosphorus sorption onto the marble dust using kinetic sorption models, pseudo first order and pseudo second order kinetic sorption models showed that the kinetic sorption is consistent with the second order model, from which it can be inferred that the mechanism of sorption is chemisorption. The Langmuir and Freundlich isotherm models were applied to describe the equilibrium isotherms. The results of isotherm models showed that the Langmuir isotherm agrees very well with the experimental data compare with Freundlich isotherm. Batch tests and kinetic sorption models results showed that using the marble dust as sorbent material could be remove more than 94.3% of phosphorus from water.展开更多
We report a case of a 32-year-old woman with episodic right lower quadrant abdominal pain. With the diagnosis of either acute appendicitis or tubo-ovarian abscess, she was treated with antibiotics, which successfully ...We report a case of a 32-year-old woman with episodic right lower quadrant abdominal pain. With the diagnosis of either acute appendicitis or tubo-ovarian abscess, she was treated with antibiotics, which successfully relieved the pain and the inflammatory findings. She repeated the clinical condition a few times and antibiotics worked each time. In a year, her subjective symptoms became milder, however, a giant pelvic cyst appeared. She had an exploratory laparotomy to confirm this diagnosis. Histopathological studies revealed herniated appendiceal mucosa through the muscular layer associated with chronic inflammation and marked fibrosis. Gynecological disorders such as endometriosis or lutein cyst rupture was denied. These findings represent appendiceal diverticulitis. We discuss the clinical features of the disease and its relation with the pelvic pseudocyst.展开更多
In the early 2000s,the main stream of endoscopic ultrasonography(EUS)changed from a mechanical scanning method to electronic radial or linear scanning methods.Subsequently,useful applications in trans-abdominal ultras...In the early 2000s,the main stream of endoscopic ultrasonography(EUS)changed from a mechanical scanning method to electronic radial or linear scanning methods.Subsequently,useful applications in trans-abdominal ultrasonography came within reach of EUS.In particular,contrast-enhanced EUS(CE-EUS)and EUS-elastography became cutting-edge diagnostic modalities for pancreatic disorders.Each type of pancreatic disorder has characteristic hemodynamics.CE-EUS uses color Doppler flow imaging and harmonic imaging to classify pancreatic lesions.EUS-elastography can assess tissue hardness by measuring its elasticity.This parameter appears to correlate with the malignant potential of the lesions.Tissue elasticity studies can provide information on both its pattern and distribution.The former is the conventional method of morphological diagnosis,but it is restricted to observations made in a region of interest(ROI).The latter is an unbiased analysis that can be performed by image analysis software and is theoretically constant,regardless of the ROI.Though EUSfine needle aspiration(FNA)is also a very useful diagnostic tool,there are several limitations.Diagnostic EUS-FNA of pancreatic cystic lesions has marginal utility mainly due to low sensitivity.Therefore,in particular,endoscopists should keep this limitation in mind.展开更多
We report a rare case of paraganglioma that developed in the mesentery of terminal ileum. A 78-year-old woman complained of right-sided abdominal pain. Abdominal computed tomography revealed a solid heterogeneously en...We report a rare case of paraganglioma that developed in the mesentery of terminal ileum. A 78-year-old woman complained of right-sided abdominal pain. Abdominal computed tomography revealed a solid heterogeneously enhanced mass in the right lower abdomen. The tumor was laparoscopically excised. The mesenteric tumor was well circumscribed, ovoid, and encapsulated and measured 3 cm × 1.5 cm × 1.5 cm. Histological examination showed a cellular neoplasm comprised of nests and groups of tumor cells separated by fibrovascular connective tissue, giving a characteristic nested Zellballen pattern. Immunohistochemically, the tumor cells were positive for chromogranin, synaptophysin, CD56, and vimentin and negative for cytokeratins, SMA, CD34, CD117/c-kit and S100. On the basis of histologic and immunohistochemical features, a diagnosis of mesenteric paraganglioma was made. The operative and postoperative courses were unremarkable, and the patient was discharged on postoperative day 7. She was doing well 1 year after the surgery with no signs of recurrence. Extra-adrenal paragangliomas most commonly develop adjacent to the aorta, particularly the area corresponding to the organ of Zuckerkandl. Mesenteric paraganglioma, as in our case, is extremely rare; only 11 cases have been reported in the literature. We herein discuss the clinical findings of these cases.展开更多
The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined cli...The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.展开更多
Senescence accelerated mice (SAMP8) have a shorter lifespan with deficits in learning and memory, compared with control SAMR1 mice (Takeda, Elsevier Science BV, 1994).
Preeclampsia is a heterogeneous disease, and there are major differences in severity, fetal growth and poor placentation between early- and late-onset preeclampsia. Here, we examined the effect of onset period on feta...Preeclampsia is a heterogeneous disease, and there are major differences in severity, fetal growth and poor placentation between early- and late-onset preeclampsia. Here, we examined the effect of onset period on fetal and neonatal growth in preeclampsia with a cross-sectional study including 102 pregnant women with preeclampsia visited Okayama University Hospital from 2009 to 2013. The subjects were retrospectively compared in terms of body mass index (BMI), weight gain during pregnancy, complications, weeks of delivery, neonatal body weight and BMI at birth, fetal growth restriction (FGR), small for gestational age (SGA), pathological findings in the placenta, and infant’s weight at 1 month after birth. Neonatal body weight and BMI at birth were significantly lower and the extent of FGR and the frequency of SGA were higher in early-onset group compared with late-onset group. Mean daily weight gain during the neonatal period was significantly lower in the early-onset group compared with the late-onset group, however the weight gain rate during the neonatal period in the early-onset group was higher than that in late-onset group. In conclusions, there are significant differences in fetal and neonatal growth between early- and late-onset preeclampsia and the catch up for growth might start during neonatal period.展开更多
Aim: We aimed to investigate whether the agonists for liver X receptor (LXR) ameliorate lupus-like phenotypes in mice mediated by the clearance of apoptotic cells, and compare with peroxisome proliferator-activated re...Aim: We aimed to investigate whether the agonists for liver X receptor (LXR) ameliorate lupus-like phenotypes in mice mediated by the clearance of apoptotic cells, and compare with peroxisome proliferator-activated receptor (PPAR) γ plus PPARδ agonists, which also facilitate the clearance of apoptotic cells and exert anti-inflammatory effects in systemic lupus erythematosus (SLE). Methods: We investigated the efficacy of LXR agonist (GW3965) or dual treatment of PPARγ (pioglitazone) and PPARδ (GW0742) agonists in SLE animal models, female MRL/MpJ-Fas/J mice and BALB/cAJcl mice treated with pristane. The data were analyzed with one-way analysis of variance and Tukey’s honestly significant difference tests. Results: The treatment with LXR or PPARγ/δ agonists did not significantly alter the swelling of lymph nodes, ds-DNA production, albuminuria, histological score of glomerular lesions, and mRNA expression of target genes including Abca1, C1qa, Icam1, Mertk and Tnf. Conclusion: LXR or PPARγ/δ agonists targeting the impaired clearance for apoptosis cells may not be efficient in the remission induction therapy in SLE.展开更多
文摘AIM: To assess the clinical features and prognosis of 151 patients with extrahepatic metastases from primary hepatocellular carcinoma (HCC), and describe the treatment strategy for such patients. METHODS: After the diagnosis of HCC, all 995 consecutive HCC patients were followed up at regular intervals and 151 (15.2%) patients were found to have extrahepatic metastases at the initial diagnosis of primary HCC or developed such tumors during the follow-up period. We assessed their clinical features, prognosis, and treatment strategies. RESULTS: The most frequent site of extrahepatic metastases was the lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). The cumulative survival rates after the initial diagnosis of extrahepatic metastases at 6, 12, 24, and 36 mo were 44.1%, 21.7%, 14.2%, 7.1%, respectively. The median survival time was 4.9 mo (range, 0-37 mo). Fourteen patients (11%) died of extrahepatic HCC, others died of primary HCC or liver failure. CONCLUSION: The prognosis of HCC patients with extrahepatic metastases is poor. With regard to the cause of death, many patients would die of intrahepatic HCC and few of extrahepatic metastases. Although most of HCC patients with extrahepatic metastases should undergo treatment for the primary HCC mainly, treatment of extrahepatic metastases in selected HCC patients who have good hepatic reserve, intrahepatictumor stage (T0-T2), and are free of portal venous invasion may improve survival.
文摘AIM To compare vonoprazan 10 and 20 mg vs lansoprazole 15 mg as maintenance therapy in healed erosive esophagitis(EE).METHODS A total of 607 patients aged ≥ 20 years, with endoscopically-confirmed healed EE following 8 wk of treatment with vonoprazan 20 mg once daily, were randomized 1:1:1 to receive lansoprazole 15 mg(n = 201), vonoprazan 10 mg(n = 202), or vonoprazan 20 mg(n = 204), once daily. The primary endpoint of the study was the rate of endoscopically-confirmed EE recurrence during a 24-wk maintenance period. The secondary endpoint was the EE recurrence rate at Week 12 during maintenance treatment. Additional efficacy endpoints included the incidence of heartburn and acid reflux, and the EE healing rate 4 wk after the initiation of maintenance treatment. Safety endpoints comprised adverse events(AEs), vital signs, electrocardiogram findings, clinical laboratory results, serum gastrin and pepsinogen Ⅰ/Ⅱ levels, and gastric mucosa histopathology results.RESULTS Rates of EE recurrence during the 24-wk maintenance period were 16.8%, 5.1%, and 2.0% with lansoprazole 15 mg, vonoprazan 10 mg, and vonoprazan 20 mg, respectively. Vonoprazan was shown to be non-inferior to lansoprazole 15 mg(P < 0.0001 for both doses). In a post-hoc analysis, EE recurrence at Week 24 was significantly reduced with vonoprazan at both the 10 mg and the 20 mg dose vs lansoprazole 15 mg(5.1% vs 16.8%, P = 0.0002, and 2.0% vs 16.8%, P < 0.0001, respectively); by contrast, the EE recurrence rate did not differ significantly between the two doses of vonoprazan(P = 0.1090). The safety profiles of vonoprazan 10 and 20 mg were similar to that of lansoprazole 15 mg in patients with healed EE. Treatment-related AEs were reported in 11.4%, 10.4%, and 10.3% of patients in the lansoprazole 15 mg, vonoprazan 10 mg, and vonoprazan 20 mg arms, respectively.CONCLUSION Our findings confirm the non-inferiority of vonoprazan 10 and 20 mg to lansoprazole 15 mg as maintenance therapy for patients with healed EE.
基金Supported by The Research Committee of Intractable Pancreatic Diseases provided by the Ministry of Health,Labour,and Welfare of Japan
文摘AIM:To investigate the usefulness of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) in the differentiation of autoimmune pancreatitis(AIP).METHODS:We retrospectively reviewed 47 of 56 AIP patients who underwent EUS-FNA and met the Asian diagnostic criteria.On 47 EUS-FNA specimens,we evaluated the presence of adequate material and characteristic features of lymphoplasmacytic sclerosing pancreatitis(LPSP) and idiopathic duct-centric pancreatitis(IDCP) mentioned in the International Consensus Diagnostic Criteria and examined if these findings make a contribution to the differential diagnosis of type 1 and type 2 AIP.A disposable 22-gauge needle was used for EUS-FNA.RESULTS:Adequate specimens including pancreatic tissue for differentiating AIP from cancer were obtained from 43 of 47 patients who underwent EUSFNA.EUS-FNA was performed from the pancreatic head in 21 cases,which is known to be technically difficult when performed by core biopsy;there was no significant difference in the results compared with pancreatic body-tail.Nine of 47 patients met level 1 findings of LPSP and 5 patients met level 2 findings of LPSP.No one met level 1 findings of IDCP,but 3 patients met level 2 findings of IDCP.Of 10 seronegative cases,2 cases were diagnosed with "definitive type 1 AIP",and 3 cases were diagnosed with "probable type 2 AIP" when considering both the level 2 histological findings and response to steroids.CONCLUSION:EUS-FNA is useful in the differentiation of type 1 and type 2 AIP,particularly in seronegative cases.
文摘The aim of this study is to investigate the condition of the Ariake Sea, Japan, which has been suffering from severe environmental issues for the past few decades. Water quality data have been generated from several points in this area for over 30 years by the Fukuoka, Saga, Kumamoto, and Nagasaki prefectures. In order to understand the characteristics of this sea, principal component analysis (PCA) was utilized using 11 water quality parameters;transparency, temperature, salinity, dissolved oxygen (DO), chemical oxygen demand (COD), dissolved inorganic nitrogen (DIN), ammonium-nitrogen (NH4<sup style='margin-left:-7px;'>+-N), nitrate-nitrogen (NO3<sup style='margin-left:-7px;'>--N), nitrite-nitrogen (NO2<sup style='margin-left:-7px;'>--N), phosphate-phosphorus, (PO4<sup style='margin-left:-7px;'>3--P) and silica. PCA conveyed the amount of nutrients originating from the river, the organic pollution level, and seasonal changes. Subsequently, principal component scores were calculated for each point. It was concluded that the Ariake Sea environment has been affected by two main factors, which are the nutrients from the Chikugo River and anticlockwise tidal residual flow. These two factors must be considered for the environmental restoration of the Ariake Sea.
文摘We report a rare case of a small-bowel lymphangioma causing massive gastrointestinal (GI) bleeding that we successfully diagnosed and treated using double-balloon enteroscopy (DBE). An 81-year-old woman suffering from repeated GI bleeding of unknown origin underwent a capsule endoscopy at a previous hospital. She was suspected of having bleeding from the jejunum, and was referred to our department for diagnosis and treatment. An oral DBE revealed a 20 mm × 10 mm, regularly surfaced, white to yellowish, elongated, pedunculated jejunal polyp with small erosions at 10 cm distal to the ligament of Treiz. Since no other source of bleeding was identified by endoscopy in the deep jejunum, anendoscopic polypectomy (EP) was performed for this lesion. A subsequent histopathological examination of the resected polyp showed clusters of lymphatic vessels with marked cystic dilatation in the submucosa and the deep layer of the lamina propria mucosae. These characteristics are consistent with the typical features of small-bowel lymphangioma with erosions. Although clip-ping hemostasis was performed during EP, re-bleeding occurred. Finally, a complete hemostasis was achieved by performing an additional argon plasma coagulation.
文摘An environmental friendly anodizing treatment (Anomag) from a phosphate-based so lution without heavy metals on AZ91D magnesium alloy was studied. The characteri stics of the coatings, such as structure, composition and corrosion resistance w ere investigated. The effects of this anodizing treatment on the mechanical prop erties were examined. X-ray diffraction (XRD) analysis revealed that the structu re of the coatings is amorphous or glassy. In salt spray tests coatings with an average thickness of 10μm had an anticorrosive performance of over 1000 hours. Fatigue tests revealed that anodizing onto AZ91D magnesium alloy does not affect the fatigue strength. These results demonstrate the utility of this anodizing t reatment on magnesium alloy for application as a structural material, such as in the automotive field.
文摘The fixing of a silane coupling agent to Zn-Ni-silica(SiO_(2))composite coatings was studied for the purpose of developing a coating process as an alternative to chromating.The corrosion resistance of Zn-Ni-silica composite coatings was rem arkably improved by the silica nanoparticles in the composite,which were disper sed in the surface of this film.The silane coupling agent formed chemical bonds with the inorganic silica particles during the silane coupling treatment on the se composite coatings.The treatment suppressed the formation of white corrosion products to the same extent as chromating,as measured in salt spray tests.It is concluded that treating Zn-Ni-silica composite coatings with silane coupling agents is a viable alternative technique to chromating.
基金Our study was approved by the ethics committee of the Certified Institutional Review Board of the Yoyogi Mental Clinic(certificate number.RKK227).
文摘BACKGROUND Accurate diagnosis and early resection of colorectal polyps are important to prevent the occurrence of colorectal cancer.However,technical factors and morphological factors of polyps itself can lead to missed diagnoses.Imageenhanced endoscopy and chromoendoscopy(CE)have been developed to facilitate an accurate diagnosis.There have been no reports on visibility using a combination of texture and color enhancement imaging(TXI)and CE for colorectal tumors.AIM To investigate the visibility of margins and surfaces with the combination of TXI and CE for colorectal lesions.METHODS This retrospective study included patients who underwent lower gastrointestinal endoscopy at the Toyoshima Endoscopy Clinic.We extracted polyps that were resected and diagnosed as adenomas or serrated polyps(hyperplastic polyps and sessile serrated lesions)from our endoscopic database.An expert endoscopist performed the lower gastrointestinal endoscopies and observed the lesion using white light imaging(WLI),TXI,CE,and TXI+CE modalities.Indigo carmine dye was used for CE.Three expert endoscopists rated the visibility of the margin and surface patterns in four ranks,from 1 to 4.The primary outcomes were the average visibility scores for the margin and surface patterns based on the WLI,TXI,CE,and TXI+CE observations.Visibility scores between the four modalities were compared by the Kruskal-Wallis and Dunn tests.RESULTS A total of 48 patients with 81 polyps were assessed.The histological subtypes included 50 tubular adenomas,16 hyperplastic polyps,and 15 sessile serrated lesions.The visibility scores for the margins based on WLI,TXI,CE,and TXI+CE were 2.44±0.93,2.90±0.93,3.37±0.74,and 3.75±0.49,respectively.The visibility scores for the surface based on WLI,TXI,CE,and TXI+CE were 2.25±0.80,2.84±0.84,3.12±0.72,and 3.51±0.60,respectively.The visibility scores for the detection and surface on TXI were significantly lower than that on CE but higher than that on WLI(P<0.001).The visibility scores for the margin and surface on TXI+CE
文摘Rice grows well under certain condition and environment including soil, water and nutrients. Some researches have shown that traditional method with continues flooding need tremendeous amount of water for rice cultivation and gives low water productivity. To increase the water productivity, number of water saving irigation techniques have been studied and applied. Study on effect of number of water irrigation treatments on water productivity of rice was carried out. Eight irrigation treatments were conducted for growing rice in pot experiment i.e. shallow intermittent irrigation (SII), alternate wetting and drying (AWD1, AWD2, AWD3 and AWD4), shallow water depth with wetting and drying (SWD1 and SWD2), and semi-dry cultivation (SDC). The performance of those treatments in terms of agronomic and water parameters was compared to the shallow intermittent irrigation as a control method. The study reveals that the shallow intermittent irrigation needs the highest amount of water compare with other treatments. The lowest amount of water was achieved under the semi-dry cultivation. It could save water up to 18.4% compare to the control treatment. By using the alternate wetting and drying and the shallow water depth with wetting and drying treatments, irrigated water can be reduced up to 13.1% and 5.4%, respectively. The highest grain was obtained by alternate wetting and drying (AWD4) and the semi-dry cultivation yielded the smalest grain. On average the alternate wetting and drying and shallow water depth with wetting and drying increased the grain yield by 22.9% and 17.9%, whereas the semi-dry cultivation reduced the yield up to 14% compare to the shallow water depth treatment. The alternate wetting and drying treatments have significantly improved the water productivity by 41.6%, shallow water depth with wetting and drying increased by 24.2% relative to the shallow intermittent irrigation treatment, whereas the most saving water treatment i.e. the semi-dry cultivation performed quite similar with the shallow water de
文摘A polarization control device was developed using a plasmonic metasurface with the aim of achieving the desired polarization state. In this study, the Ag metal grating structure was fabricated as a plasmonic metasurface by electron beam lithography and a lift-off process. The phase difference of the fabricated sample was 21.0°. This value is almost consistent with the simulation (24.0°). Then, the transmission and phase difference is dependent on the structural parameter. Because of the propagation of surface plasmon polariton at the interface between Ag and SiO<sub>2</sub> or Ag and air, it is believed that the transmittance and the phase difference for TM polarized light can be controlled by the structural parameters. By plotting on the Poincaré sphere after calculating the S-parameter by simulation, it is clear that the arbitrary polarization status can be controlled by the structural parameter.
文摘Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sagittal alignment in standing posture in younger generation. Methods: Subjects included 57 females and 32 males (average age, 29.9 ± 5.7 years). All subjects were 20s or 30s. Spinal curvature was assessed using SpinalMouse. The subjects were also divided into a normal group (VAS zero group) and a pain group by VAS results. Statistical analysis was performed by Student’s t-test. Significance was defined as p < 0.05. Results: The normal group and pain group included 29 and 60 subjects, respectively. In terms of location of pain, thirty-one subjects felt neck pain, 50 felt pain above the scapula, and 17 felt pain between the thoracic spine and scapula. Thoracic kyphosis and lumbar lordosis in the pain group were significantly higher than those in the normal group (p = 0.013 and p = 0.020, respectively). Thoracic kyphosis in subjects with neck pain or pain above scapula was significantly higher than that in subjects without pain (p = 0.0075 and p = 0.025, respectively). Lumbar lordosis in subjects with pain above the scapula or interscapula was significantly higher than that in subjects without pain (p = 0.016).
文摘The removal of phosphorus from water using marble dust as sorbent material was studied by conducting batch tests, kinetic sorption model and isotherm model. The kinetic sorption model based on a pseudo equation was applied to predict the rate constant of sorption. Thorough investigations to understand the mechanism of phosphorus sorption onto the marble dust using kinetic sorption models, pseudo first order and pseudo second order kinetic sorption models showed that the kinetic sorption is consistent with the second order model, from which it can be inferred that the mechanism of sorption is chemisorption. The Langmuir and Freundlich isotherm models were applied to describe the equilibrium isotherms. The results of isotherm models showed that the Langmuir isotherm agrees very well with the experimental data compare with Freundlich isotherm. Batch tests and kinetic sorption models results showed that using the marble dust as sorbent material could be remove more than 94.3% of phosphorus from water.
文摘We report a case of a 32-year-old woman with episodic right lower quadrant abdominal pain. With the diagnosis of either acute appendicitis or tubo-ovarian abscess, she was treated with antibiotics, which successfully relieved the pain and the inflammatory findings. She repeated the clinical condition a few times and antibiotics worked each time. In a year, her subjective symptoms became milder, however, a giant pelvic cyst appeared. She had an exploratory laparotomy to confirm this diagnosis. Histopathological studies revealed herniated appendiceal mucosa through the muscular layer associated with chronic inflammation and marked fibrosis. Gynecological disorders such as endometriosis or lutein cyst rupture was denied. These findings represent appendiceal diverticulitis. We discuss the clinical features of the disease and its relation with the pelvic pseudocyst.
文摘In the early 2000s,the main stream of endoscopic ultrasonography(EUS)changed from a mechanical scanning method to electronic radial or linear scanning methods.Subsequently,useful applications in trans-abdominal ultrasonography came within reach of EUS.In particular,contrast-enhanced EUS(CE-EUS)and EUS-elastography became cutting-edge diagnostic modalities for pancreatic disorders.Each type of pancreatic disorder has characteristic hemodynamics.CE-EUS uses color Doppler flow imaging and harmonic imaging to classify pancreatic lesions.EUS-elastography can assess tissue hardness by measuring its elasticity.This parameter appears to correlate with the malignant potential of the lesions.Tissue elasticity studies can provide information on both its pattern and distribution.The former is the conventional method of morphological diagnosis,but it is restricted to observations made in a region of interest(ROI).The latter is an unbiased analysis that can be performed by image analysis software and is theoretically constant,regardless of the ROI.Though EUSfine needle aspiration(FNA)is also a very useful diagnostic tool,there are several limitations.Diagnostic EUS-FNA of pancreatic cystic lesions has marginal utility mainly due to low sensitivity.Therefore,in particular,endoscopists should keep this limitation in mind.
文摘We report a rare case of paraganglioma that developed in the mesentery of terminal ileum. A 78-year-old woman complained of right-sided abdominal pain. Abdominal computed tomography revealed a solid heterogeneously enhanced mass in the right lower abdomen. The tumor was laparoscopically excised. The mesenteric tumor was well circumscribed, ovoid, and encapsulated and measured 3 cm × 1.5 cm × 1.5 cm. Histological examination showed a cellular neoplasm comprised of nests and groups of tumor cells separated by fibrovascular connective tissue, giving a characteristic nested Zellballen pattern. Immunohistochemically, the tumor cells were positive for chromogranin, synaptophysin, CD56, and vimentin and negative for cytokeratins, SMA, CD34, CD117/c-kit and S100. On the basis of histologic and immunohistochemical features, a diagnosis of mesenteric paraganglioma was made. The operative and postoperative courses were unremarkable, and the patient was discharged on postoperative day 7. She was doing well 1 year after the surgery with no signs of recurrence. Extra-adrenal paragangliomas most commonly develop adjacent to the aorta, particularly the area corresponding to the organ of Zuckerkandl. Mesenteric paraganglioma, as in our case, is extremely rare; only 11 cases have been reported in the literature. We herein discuss the clinical findings of these cases.
文摘The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.
文摘Senescence accelerated mice (SAMP8) have a shorter lifespan with deficits in learning and memory, compared with control SAMR1 mice (Takeda, Elsevier Science BV, 1994).
文摘Preeclampsia is a heterogeneous disease, and there are major differences in severity, fetal growth and poor placentation between early- and late-onset preeclampsia. Here, we examined the effect of onset period on fetal and neonatal growth in preeclampsia with a cross-sectional study including 102 pregnant women with preeclampsia visited Okayama University Hospital from 2009 to 2013. The subjects were retrospectively compared in terms of body mass index (BMI), weight gain during pregnancy, complications, weeks of delivery, neonatal body weight and BMI at birth, fetal growth restriction (FGR), small for gestational age (SGA), pathological findings in the placenta, and infant’s weight at 1 month after birth. Neonatal body weight and BMI at birth were significantly lower and the extent of FGR and the frequency of SGA were higher in early-onset group compared with late-onset group. Mean daily weight gain during the neonatal period was significantly lower in the early-onset group compared with the late-onset group, however the weight gain rate during the neonatal period in the early-onset group was higher than that in late-onset group. In conclusions, there are significant differences in fetal and neonatal growth between early- and late-onset preeclampsia and the catch up for growth might start during neonatal period.
文摘Aim: We aimed to investigate whether the agonists for liver X receptor (LXR) ameliorate lupus-like phenotypes in mice mediated by the clearance of apoptotic cells, and compare with peroxisome proliferator-activated receptor (PPAR) γ plus PPARδ agonists, which also facilitate the clearance of apoptotic cells and exert anti-inflammatory effects in systemic lupus erythematosus (SLE). Methods: We investigated the efficacy of LXR agonist (GW3965) or dual treatment of PPARγ (pioglitazone) and PPARδ (GW0742) agonists in SLE animal models, female MRL/MpJ-Fas/J mice and BALB/cAJcl mice treated with pristane. The data were analyzed with one-way analysis of variance and Tukey’s honestly significant difference tests. Results: The treatment with LXR or PPARγ/δ agonists did not significantly alter the swelling of lymph nodes, ds-DNA production, albuminuria, histological score of glomerular lesions, and mRNA expression of target genes including Abca1, C1qa, Icam1, Mertk and Tnf. Conclusion: LXR or PPARγ/δ agonists targeting the impaired clearance for apoptosis cells may not be efficient in the remission induction therapy in SLE.
