Publications by authors named "Akira Matsushita"

81 Publications

The Progress of the Gait Impairment and Brain Activation in a Patient with Post-stroke Hemidystonia.

Phys Ther Res 2021 24;24(2):176-186. Epub 2021 Feb 24.

Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Japan.

Objective: We explore the effects of body weight-supported (BWS) treadmill training, including the change of cortical activation, on a patient with post-stroke hemidystonia.

Patient: The patient was a 71-year-old man with left thalamus hemorrhage. His motor symptoms indicated slight impairment. There was no overactive muscle contraction in the supine, sitting, or standing positions. During his gait, the right initial contact was the forefoot, and his right knee showed an extension thrust pattern. These symptoms suggested that he had post-stroke hemidystonia.

Methods: The patient performed BWS treadmill training 14 times over 3 weeks. The effects of the BWS training were assessed by a step-length analysis, electromyography and functional magnetic resonance imaging (fMRI).

Results: The patient's nonparetic step length was extended significantly in the Inter-BWS (p<0.001) and Post-BWS (p=0.025) periods compared to the Pre-BWS session. The excessive muscle activity of the right gastrocnemius medialis in the swing phase was decreased at the Inter-BWS, Post-BWS, and follow-up compared to the Pre-BWS session. The peak timing difference of the bilateral tibialis anterior muscle became significant (p<0.05) on the first day of the intervention. The fMRI revealed that the cortical areas activated by the motor task converged through the intervention (p<0.05, family-wise error corrected).

Conclusion: These results suggest that there was improvement of the patient's symptoms of post-stroke hemidystonia due to changes in the brain activity during voluntary movement after BWS intervention. Body weight-supported treadmill training may thus be an effective treatment for patients with poststroke hemidystonia.
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http://dx.doi.org/10.1298/ptr.E10032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419483PMC
February 2021

Management of simple hepatic cyst.

J Nippon Med Sch 2021 Sep 14. Epub 2021 Sep 14.

Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School.

Simple hepatic cysts are typically saccular, thin-walled masses with fluid-filled epithelial lined cavities that arise from aberrant bile duct cells during embryonic development. With the development of diagnostic modalities such as ultrasonography, computed tomography and magnetic resonance imaging, simple hepatic cysts are seen with relative frequency in daily clinical examination. US is the most useful and noninvasive tool for the diagnosis of simple hepatic cysts, and can generally differentiate simple hepatic cysts from abscesses, hemangiomas and malignancies. Cysts with irregular walls, septations, calcifications or daughter cysts on US should be evaluated with enhanced CT or MRI to differentiate simple hepatic cysts from cystic neoplasms or hydatid cysts.Growth and compression of hepatic cysts cause abdominal discomfort, pain, distension and dietary symptoms such as nausea, vomiting, a feeling of fullness and early satiety. Complications of simple hepatic cysts include infection, spontaneous hemorrhage, rupture, and external compression of biliary tree or major vessels.Asymptomatic simple hepatic cysts should be observed. Treatment for symptomatic simple hepatic cysts includes percutaneous aspiration, aspiration followed by sclerotherapy, and surgery. The American College of Gastroenterology clinical guidelines recommend laparoscopic fenestration based on its high success rate and low invasiveness. Percutaneous procedures for treatment of simple hepatic cysts are particularly effective for the immediate palliation of patient symptoms; however, they are not generally recommended because of the high rate of recurrence.Management of simple hepatic cysts requires correct differentiation from neoplasms and infections, and the selection of a reliable treatment.
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http://dx.doi.org/10.1272/jnms.JNMS.2022_89-115DOI Listing
September 2021

Patient satisfaction and loyalty in Japanese primary care: a cross-sectional study.

BMC Health Serv Res 2021 Mar 25;21(1):274. Epub 2021 Mar 25.

Department of Medical Education and Research, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan.

Background: This study aimed to explore associations between various elements of primary care, patient satisfaction, and loyalty.

Methods: This cross-sectional study used a modified version of the Primary Care Assessment Tool (PCAT), which was adapted for Japan. We distributed the PCAT questionnaire to patients aged 20 years or older at five rural primary care centres in Japan. We confirmed the validity and reliability of the measure for our study. Next, we examined which elements of primary care were related to patient satisfaction and loyalty using Spearman's correlation and structural equation modelling.

Results: Of 220 eligible patients, 206 participated in this study. We developed nine component scales: first contact (regular access), first contact (urgent access), longitudinality, coordination, comprehensiveness (variety of care), comprehensiveness (risk prevention), comprehensiveness (health promotion), family-centeredness, and community orientation. Longitudinality and first contact (urgent access) were related with patient satisfaction. Longitudinality, first contact (regular access), and family-centeredness were related to patient loyalty. In the structural equation modelling analysis, two variables were significantly related to loyalty, namely a combined variable including longitudinality and first contact (regular access), along with family-centeredness.

Conclusions: While a patient satisfaction model could not be distilled from the data, longitudinality, first contact (urgent access), and family-centeredness were identified as important elements for the cultivation of patient loyalty. This implies that primary care providers need to develop a deep understanding of patients' contexts and concerns and pay attention to their level of access to cultivate greater patient loyalty.
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http://dx.doi.org/10.1186/s12913-021-06276-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992825PMC
March 2021

Three cases of follicular pancreatitis: association between radiological findings and pathological features.

J Surg Case Rep 2020 Jun 15;2020(6):rjaa134. Epub 2020 Jun 15.

Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan.

Follicular pancreatitis (FP) is characterized by nodular mass composed of lymphoid hyperplasia and fibrosis. We here present radiological and pathological features of three cases of FP. The three patients were middle- or old-aged men, and nodular mass was pointed out at health examination. Computed tomography failed to demonstrate a mass. Magnetic resonance imaging demonstrated a mass in each case. F-fluorodeoxyglucose positron-emission tomography (FDG-PET) demonstrated two nodular masses with high standardized uptake value (SUV) in two cases and single mass in one case. The pathological examination disclosed two lesions with fibrosis and hyperplastic lymphoid follicles in two cases and one lesion in one case. Masses with high SUV appeared to correspond with the lesions of FP. Compared with the features of FDG-PET images of pancreatic ductal carcinoma, multiple lesions with high SUV favor a diagnosis of FP rather than pancreatic cancer. FDG-PET is useful for the diagnosis of FP.
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http://dx.doi.org/10.1093/jscr/rjaa134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297552PMC
June 2020

Robotic rehabilitation of the paralyzed upper limb for a stroke patient using the single-joint hybrid assistive limb: a case study assessed by accelerometer on the wrist.

J Phys Ther Sci 2020 Feb 14;32(2):192-196. Epub 2020 Feb 14.

Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki, Ibaraki 300-0394, Japan.

[Purpose] Recent studies have reported the effectiveness of robotic rehabilitation of paralyzed upper limbs in stroke patients. For example, the Single-Joint Hybrid Assistive Limb has been shown to improve upper limb impairments. However, limited data are available on the effectiveness of robotic rehabilitation of the upper limb with regards to daily living. In this case study, an accelerometer was adopted to examine whether rehabilitation using the Single-Joint Hybrid Assistive Limb improved upper limb activity during daily living in a stroke patient. [Participant and Methods] The participant was a 69-year-old male diagnosed with stroke and left hemiparesis. The Single-Joint Hybrid Assistive Limb was applied to the participant's elbow on the paralyzed side. The participant wore an accelerometer on each wrist to measure the activities of the upper limbs. Clinical tests of the paralyzed upper limb were also performed. [Results] The activity of the paralytic limb was significantly higher after Single-Joint Hybrid Assistive Limb intervention than before the intervention. On the other hand, none of the results of the clinical tests changed beyond a clinically important difference. [Conclusion] The Single-Joint Hybrid Assistive Limb could be useful for promoting active use of a paralyzed upper limb in daily living. In addition, an accelerometer could be especially useful for evaluating the effects of robotic rehabilitation.
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http://dx.doi.org/10.1589/jpts.32.192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7032986PMC
February 2020

Conversion Surgery for Metastatic Pancreatic Mucinous Carcinoma Responsive to Systemic Chemotherapy with Modified FOLFIRINOX: A Case Report.

J Nippon Med Sch 2019 Dec 17;86(5):284-290. Epub 2019 May 17.

Department of Gastroenterological Surgery, Nippon Medical School.

We report a case of metastatic pancreatic-head mucinous carcinoma (with multiple lymph node and bone metastases) and review the relevant literature. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was useful for diagnosis, and a satisfactory outcome was achieved after systemic chemotherapy with FOLFIRINOX followed by resection of the primary lesion as conversion surgery. The patient was a 55-year-old man. Hematological findings included elevated serum tumor marker levels: CEA 12.7 ng/mL, DUPAN-2 400 U/mL. Findings from several imaging modalities and EUS-FNA confirmed a clinicopathological diagnosis of metastatic pancreatic mucinous carcinoma with multiple bone and lymph node metastases. Five courses of modified FOIFIRINOX (m-FFX) were given as systemic chemotherapy, which had an antitumor effect. Subtotal stomach-preserving pancreaticoduodenectomy and extensive lymph-node dissection were thus performed. Histopathological analysis showed invasive ductal carcinoma, muc (pT3, pN1b, cM1). After surgery, the clinical course was notable for the absence of complications. Tegafur/gimeracil/oteracil (S-1) was started as maintenance adjuvant chemotherapy postoperatively, and no disease progression has been observed at 10 months after surgery.
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http://dx.doi.org/10.1272/jnms.JNMS.2019_86-502DOI Listing
December 2019

Development of the Japanese version of the general practice assessment questionnaire: measurement of patient experience and testing of data quality.

BMC Fam Pract 2018 11 28;19(1):181. Epub 2018 Nov 28.

Department of Medical Education and Research, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan.

Background: Physicians' interpersonal performance is critical in medical practice, especially primary care practice. The General Practice Assessment Questionnaire (GPAQ) was developed in the United Kingdom to evaluate the quality of primary care from the viewpoint of patients. This questionnaire highlights the evaluation of interpersonal skills and interactions between physicians and patients. Though several other tools also exist to evaluate primary care quality, the GPAQ has several distinctive evaluation items, covering receptionists, access to primary care, and enablement (patients' understanding of self-care and of their own health after consultation). Our purpose was to develop and validate a Japanese version of the GPAQ.

Methods: This cross-sectional study tested the validity and reliability of the Japanese version of the questionnaire. We translated the original GPAQ into Japanese and assessed its reliability and validity among patients aged ≥20 years at five rural primary care centres located in Shimane and Okayama prefectures, Japan. We also examined its internal reliability using Cronbach's alpha coefficient and construct validity-including item-scale correlations, item-other scale correlations, and inter-scale correlations. Moreover, we examined correlations between each score and overall satisfaction using Spearman's correlation coefficient for criterion-related validity.

Results: The translated version of the GPAQ was administered, and we received 252 responses (mean age: 68 ± 12.3 years, male: 42.9%); all data were analysed. The translated questionnaire showed good reliability and validity, with Cronbach's alphas ranging from 0.79-0.92 for all scales, and satisfactory item-scale, item-other scale, and inter-scale correlations. Correlations with overall satisfaction were strong (Spearman's correlation coefficients: 0.31-0.38) for all scales except 'continuity of care'.

Conclusions: The Japanese version of the GPAQ was acceptable, reliable, and valid. This could be a useful instrument to evaluate key areas of primary care performance in Japan, particularly physicians' communication skills. Further work is required to evaluate its utility in urban areas.
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http://dx.doi.org/10.1186/s12875-018-0873-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6264598PMC
November 2018

Rapid stimulation of human dentate gyrus function with acute mild exercise.

Proc Natl Acad Sci U S A 2018 10 24;115(41):10487-10492. Epub 2018 Sep 24.

Laboratory of Exercise Biochemistry and Neuroendocrinology, Faculty of Health and Sport Sciences, University of Tsukuba, 305-8574 Ibaraki, Japan;

Physical exercise has beneficial effects on neurocognitive function, including hippocampus-dependent episodic memory. Exercise intensity level can be assessed according to whether it induces a stress response; the most effective exercise for improving hippocampal function remains unclear. Our prior work using a special treadmill running model in animals has shown that stress-free mild exercise increases hippocampal neuronal activity and promotes adult neurogenesis in the dentate gyrus (DG) of the hippocampus, improving spatial memory performance. However, the rapid modification, from mild exercise, on hippocampal memory function and the exact mechanisms for these changes, in particular the impact on pattern separation acting in the DG and CA3 regions, are yet to be elucidated. To this end, we adopted an acute-exercise design in humans, coupled with high-resolution functional MRI techniques, capable of resolving hippocampal subfields. A single 10-min bout of very light-intensity exercise (30%[Formula: see text]) results in rapid enhancement in pattern separation and an increase in functional connectivity between hippocampal DG/CA3 and cortical regions (i.e., parahippocampal, angular, and fusiform gyri). Importantly, the magnitude of the enhanced functional connectivity predicted the extent of memory improvement at an individual subject level. These results suggest that brief, very light exercise rapidly enhances hippocampal memory function, possibly by increasing DG/CA3-neocortical functional connectivity.
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http://dx.doi.org/10.1073/pnas.1805668115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6187140PMC
October 2018

White matter diffusion abnormalities in migraine and medication overuse headache: A 1.5-T tract-based spatial statistics study.

Clin Neurol Neurosurg 2018 11 17;174:167-173. Epub 2018 Sep 17.

Department of Neurology, Ibaraki Prefectural University of Medical Sciences, Ami, Japan.

Objectives: Migraine and medication overuse headache are common, but its pathophysiology remains unclear. Differential diagnosis of chronic headache is still challenging. Conventional brain imaging techniques exclude secondary causes of headache but cannot produce a proper diagnosis. Accordingly, more sensitive diagnostic methods are needed for certain diagnosis. In the present study, we performed voxel-wise tract-based spatial statistics of 1.5-T diffusion tensor imaging in migraine patients and healthy volunteers.

Patients And Methods: One hundred and three migraine patents and 46 healthy volunteers were registered. The fractional anisotropy values in the white matter of each group compared to age-matched healthy volunteers.

Results: Compared to the controls, the migraine without aura with medication overuse headache had remarkable fractional anisotropy decrease in the white matter in several regions. The migraine with aura without medication overuse headache also had significant fractional anisotropy decrease compared to the controls. The disease duration and frequency of migraine attack were not correlated with fractional anisotropy values of the corpus callosum.

Conclusion: Our 1.5-T DTI study demonstrated significantly lower fractional anisotropy in the white matter in the MoA with medication overuse headache and MwA without medication overuse headache groups, suggesting that fractional anisotropy abnormalities may be useful biomarkers in headache patients.
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http://dx.doi.org/10.1016/j.clineuro.2018.09.022DOI Listing
November 2018

Clinical Effect of C2 Peripheral Nerve Field Stimulation Using Electroacupuncture for Primary Headache.

Neuromodulation 2018 Dec 22;21(8):793-796. Epub 2018 Mar 22.

Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.

Objective: We applied C2 peripheral nerve field stimulation using electroacupuncture (EA-C2-PNfS) for primary headache, and investigated its clinical effectiveness.

Materials And Methods: Fifty-four primary headache patients (10 men, 44 women) with a mean age of 48.6 ± 15.0 years underwent EA-C2-PNfS for three months. We used questionnaires to assess outcomes; pain intensity (11-point numerical rating scale [NRS]), quality of daily life (Headache Impact Test [HIT-6]), depression (Self-Rating Depression Scale [SDS]). Monthly headache days and acute headache medication days were obtained from diaries.

Results: The headache intensity significantly declined after the EA-C2-PNfS with reduction of NRS pain scale; 7.4 ± 1.9 at baseline, 4.9 ± 2.9 at three month (p < 0.001). Both HIT-6 and SDS showed significant improvement (p < 0.001). Some patients showed moderate depression in SDS before treatment, that was alleviated in patients with tension-type headache after the EA-C2-PNfS. Monthly headache days significantly decreased from 18.0 ± 9.0 at one month to 14.0 ± 10.2 at three months (p < 0.001), accompanied with reduction of the monthly acute headache medication days from 8.0 ± 6.7 to 6.4 ± 6.5 (p = 0.003).

Conclusions: EA-C2-PNfS was successfully used for reducing severity and disability in primary headache patients. We conclude that EA-C2-PNfS is a favorable option for medically intractable primary headache as less-invasive neuromodulation.
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http://dx.doi.org/10.1111/ner.12772DOI Listing
December 2018

Experience-based surgical approach to pancreatic mucinous cystic neoplasms with ovarian-type stroma.

Oncol Lett 2018 Feb 14;15(2):2451-2458. Epub 2017 Dec 14.

Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.

The present study aimed to elucidate the clinicopathological characteristics of resected mucinous cystic neoplasm (MCN) with ovarian-type stroma and identify a surgical approach for MCN treatment, on the basis of Republic of Korean (Yonsei University College of Medicine, Seoul, South Korea) and Japanese (Nippon Medical School, Tokyo, Japan) bi-institutional collaboration. The present study retrospectively reviewed 55 MCNs with ovarian-type stroma using pathological re-examination. Clinicopathological features and preoperative clinical parameters were evaluated to predict malignant alterations in MCNs. The proportion of surgically treated MCNs has recently been increasing. All patients included in the present study were female, with a mean age of 47.9±13.3 years. Mural nodules were noted in 8 patients (14.5%) and the mean cyst size was 6.1±4.2 cm. A total of 9 patients (16.4%) were identified to exhibit non-invasive mucinous cystadenocarcinoma. The number of patients with small tumors (R=-0.079, P=0.038) and asymptomatic pancreatic MCNs (P=0.022) was significantly increased (P<0.05), which resulted in the more frequent application of minimally invasive surgery (P<0.001). During the follow-up period (mean, 51.6 months; range, 1.1-242.8 months), no recurrence or tumor-associated mortality was identified. The presence of mural nodules (P=0.002) and a tumor size ≥4.5 cm (P=0.027) were identified as potential clinical parameters for predicting malignant transformation. The significance of mural nodules in predicting malignant transformation was increased in large MCNs (≥4.5 cm) of the pancreas compared with small MCNs (<4.5 cm) (P=0.002). Overall, non-invasive pancreatic MCNs are not aggressive, and minimally invasive pancreatectomy may be an effective approach for suitable patients.
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http://dx.doi.org/10.3892/ol.2017.7627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777367PMC
February 2018

International Summit on Laparoscopic Pancreatic Resection (ISLPR) "Coimbatore Summit Statements".

Surg Oncol 2018 Mar 27;27(1):A10-A15. Epub 2017 Dec 27.

Division of HPB & Minimal Access Surgery, GEM Hosptial & Research Centre, Coimbatore, India.

The International Summit on Laparoscopic Pancreatic Resection (ISLPR) was held in Coimbatore, India, on 7th and 8th of October 2016 and thirty international experts who regularly perform laparoscopic pancreatic resections participated in ISPLR from four continents, i.e., South and North America, Europe and Asia. Prior to ISLPR, the first conversation among the experts was made online on August 26th, 2016 and the structures of ISPLR were developed. The aims of ISPLR were; i) to identify indications and optimal case selection criteria for minimally invasive pancreatic resection (MIPR) in the setting of both benign and malignant diseases; ii) standardization of techniques to increase the safety of MIPR; iii) identification of common problems faced during MIPR and developing associated management strategies; iv) development of clinical protocols to allow early identification of complications and develop the accompanying management plan to minimize morbidity and mortality. As a process for interactive discussion, the experts were requested to complete an online questionnaire consisting of 65 questions about the various technical aspects of laparoscopic pancreatic resections. Two further web-based meetings were conducted prior to ISPLR. Through further discussion during ISPLR, we have created productive statements regarding the topics of Disease, Implementation, Patients, Techniques, and Instrumentations (DIPTI) and hereby publish them as "Coimbatore Summit Statements".
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http://dx.doi.org/10.1016/j.suronc.2017.12.001DOI Listing
March 2018

Voluntary ambulation using voluntary upper limb muscle activity and Hybrid Assistive Limb® (HAL®) in a patient with complete paraplegia due to chronic spinal cord injury: A case report.

J Spinal Cord Med 2019 07 19;42(4):460-468. Epub 2018 Jan 19.

e Department of Orthopaedic Surgery , Faculty of Medicine, University of Tsukuba , Ibaraki , Japan.

We sought to describe our experience with the Hybrid Assistive Limb® (HAL®) for active knee extension and voluntary ambulation with remaining muscle activity in a patient with complete paraplegia after spinal cord injury. A 30-year-old man with complete paraplegia used the HAL® for 1 month (10 sessions) using his remaining muscle activity, including hip flexor and upper limb activity. Electromyography was used to evaluate muscle activity of the gluteus maximus, tensor fascia lata, quadriceps femoris, and hamstring muscles in synchronization with the Vicon motion capture system. A HAL® session included a knee extension session with the hip flexor and voluntary gait with upper limb activity. After using the HAL® for one month, the patient's manual muscle hip flexor scores improved from 1/5 to 2/5 for the right and from 2/5 to 3/5 for the left knee, and from 0/5 to 1/5 for the extension of both knees. Knee extension sessions with HAL®, and hip flexor and upper-limb-triggered HAL® ambulation seem a safe and feasible option in a patient with complete paraplegia due to spinal cord injury.
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http://dx.doi.org/10.1080/10790268.2017.1423267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718935PMC
July 2019

Active elbow flexion is possible in C4 quadriplegia using hybrid assistive limb (HAL®) technology: A case study.

J Spinal Cord Med 2017 07 29;40(4):456-462. Epub 2017 Mar 29.

d Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba, Ibaraki 305-8575 , Japan.

Context: Patients with complete quadriplegia after high cervical spinal cord injury are fully dependent with activities of daily living. Assistive technology can improve their quality of life. We examined the use of a hybrid assistive limb for single joints (HAL-SJ) in a 19-year-old man with complete C4 quadriplegia due to chronic spinal cord injury to restore function of active elbow flexion. This is the first report on the use of the HAL-SJ in a patient with spinal cord injury.

Findings: The HAL-SJ intervention for each elbow was administered in 10 sessions. Clinical assessment using surface EMG was conducted to evaluate muscle activity of the trapezius, biceps brachii, infraspinatus, and triceps brachii muscle before, and during the 2nd, 3rd, 6th, and 9th interventions. Surface electromyography (EMG) before intervention showed no contraction in the upper arms, but in the bilateral trapezius. The HAL-SJ used motion intention from the right trapezius for activation. After the 6th and 7th session, respectively, biceps EMG showed that voluntary contraction and right elbow flexion could be performed by motion intention from the right biceps. After the 10th session, voluntary bicep contraction was possible. HAL-SJ treatment on the left elbow was performed using the same protocol with a similar outcome. After completing treatment on both upper extremities, both biceps contracted voluntarily, and he could operate a standard wheelchair for a short distance independently.

Conclusion: HAL-SJ intervention is feasible and effective in restoring elbow flexor function in a patient with C4 chronic spinal cord injury and complete quadriplegia.
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http://dx.doi.org/10.1080/10790268.2017.1305036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537963PMC
July 2017

Study on laparoscopic spleen preserving distal pancreatectomy procedures comparing splenic vessel preservation and non-preservation.

Transl Gastroenterol Hepatol 2016 6;1:27. Epub 2016 Apr 6.

Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo 113-8603, Japan.

Background: The purpose of this study is to investigate whether two types of laparoscopic spleen-preserving distal pancreatectomy (Lap-SPDP) techniques are being implemented safely. The study compares the clinical outcomes from laparoscopic Warshaw operation (Lap-W) with those from laparoscopic splenic vessels preserving SPDP (Lap-SPDP-VP) and considers the role of those operations.

Methods: On August 2013, the Warshaw technique was introduced to our institution and 17 patients with a lesion in the distal pancreas who underwent Lap-SPDP by December 2015 were enrolled. Six patients who underwent a Lap-W and 11 patients who underwent a Lap-SPDP-VP were investigated retrospectively.

Results: In the Lap-W and Lap-SPDP-VP patients, the sizes of the tumors were 46.5±31.2 and 25.7±14.9 mm [Probability (P) value =0.0913)]; the operative times were 287 min (range, 225-369 min) and 280 min (range, 200-496 min); the blood loss was 95 mL (range, 50-200 mL) and 60 mL (range, 0-650 mL); the length of the postoperative hospital stay was 12 days (range, 8-43 days) and 11 days (range, 7-28 days); median follow-up was 19 months (range, 13-28 months) and 23 months (range, 6-28 months), respectively. There was no case of symptomatic spleen infarction in either group. However, partial infarctions of the spleen without symptoms were observed by computed tomography in three out of six cases (50%) in the Lap-W. No patient required reoperation and the postoperative mortality was zero in both groups. All patients were alive and recurrence-free at the end of the follow-up period. Collateral veins around the spleen developed in 83.3% (five out of six patients) in the Lap-W and developed in 12.5% (one out of eight patients) in the Lap-SPDP-VP. A significant difference was observed between groups (P=0.0256). Gastric varices developed in 33.3% (two out of six patients) in the Lap-W. However, no case of rupture of varices, or other late phase complications was observed in either group.

Conclusions: Both the Lap-W and Lap-SPDP-VP were found to be safe and effective, and in cases in which the detachment work of the splenic vessels from the tumor or the pancreatic parenchyma is difficult, performing Lap-W, rather than Lap-SPDP-VP, is considered appropriate. While Lap-SPDP is recommended for patients with benign or low grade malignant diseases, long-term follow-up to monitor hemodynamic changes in splenogastric circulation is considered needed.
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http://dx.doi.org/10.21037/tgh.2016.03.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244713PMC
April 2016

A brain phantom for motion-corrected PROPELLER showing image contrast and construction similar to those of in vivo MRI.

Magn Reson Imaging 2017 Feb 11;36:32-39. Epub 2016 Oct 11.

Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan.

Purpose: A fast spin-echo sequence based on the Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction (PROPELLER) technique is a magnetic resonance (MR) imaging data acquisition and reconstruction method for correcting motion during scans. Previous studies attempted to verify the in vivo capabilities of motion-corrected PROPELLER in real clinical situations. However, such experiments are limited by repeated, stray head motion by research participants during the prescribed and precise head motion protocol of a PROPELLER acquisition. Therefore, our purpose was to develop a brain phantom set for motion-corrected PROPELLER.

Materials And Methods: The profile curves of the signal intensities on the in vivo T-weighted image (TWI) and 3-D rapid prototyping technology were used to produce the phantom. In addition, we used a homemade driver system to achieve in-plane motion at the intended timing. We calculated the Pearson's correlation coefficient (R) between the signal intensities of the in vivo TWI and the phantom TWI and clarified the rotation precision of the driver system. In addition, we used the phantom set to perform initial experiments to show the rotational angle and frequency dependences of PROPELLER.

Results: The in vivo and phantom TWIs were visually congruent, with a significant correlation (R) of 0.955 (p<.001). The rotational precision of the driver system was within 1 degree of tolerance. The experiment on the rotational angle dependency showed image discrepancies between the rotational angles. The experiment on the rotational frequency dependency showed that the reconstructed images became increasingly blurred by the corruption of the blades as the number of motions increased.

Conclusions: In this study, we developed a phantom that showed image contrasts and construction similar to the in vivo TWI. In addition, our homemade driver system achieved precise in-plane motion at the intended timing. Our proposed phantom set could perform systematic experiments with a real clinical MR image, which to date has not been possible in in vivo studies. Further investigation should focus on the improvement of the motion-correction algorithm in PROPELLER using our phantom set for what would traditionally be considered problematic patients (children, emergency patients, elderly, those with dementia, and so on).
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http://dx.doi.org/10.1016/j.mri.2016.10.003DOI Listing
February 2017

Cecal Volvulus Following Elective Laparoscopic Cholecystectomy: A Case Report.

J Nippon Med Sch 2016 ;83(4):172-6

Department of Surgery, Nippon Medical School.

Cecal volvulus is characterized by torsion of the cecum around its own mesentery. However, cecal volvulus rarely develops soon after elective laparoscopic cholecystectomy. We report on a case of cecal volvulus that developed in a 54-year-old women 1 day after elective laparoscopic cholecystectomy and was successfully treated via colonoscopic decompression. The symptoms gradually improved in conjunction with recovery from postoperative ileus. Whether the incidence of volvulus has increased with the use of laparoscopic procedures, including laparoscopic cholecystectomy, has yet to be determined. Considering the current trend toward minimally invasive surgery, cecal volvulus should be considered in patients who have postoperative abdominal pain and distention.
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http://dx.doi.org/10.1272/jnms.83.172DOI Listing
April 2017

Successful treatment of limy bile syndrome extending to the common bile duct by laparoscopic cholecystectomy and common bile duct exploration: A case report and literature review.

Asian J Endosc Surg 2017 Feb 24;10(1):59-62. Epub 2016 Aug 24.

Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, Japan.

Limy bile syndrome extending to the common bile duct (CBD) is a rare condition that lacks a standardized treatment. Laparoscopic cholecystectomy with laparoscopic choledocholithotomy by CBD exploration is preferred because it preserves the function of the sphincter of the Vater's papilla and allows treatment of both lesions. A 37-year-old man who was receiving entecavir for chronic hepatitis B developed right upper quadrant pain. Abdominal ultrasonography revealed a calcified shadow in the gallbladder and CBD. Abdominal imaging revealed a liquid-like material identified by a calcified shadow in two phases separated by a fluid-fluid level. Abdominal and 3-D drip infusion cholangiography CT showed stones in the gallbladder and CBD with limy bile. The patient underwent laparoscopic cholecystectomy and choledocholithotomy. Intraoperatively, white-yellow-colored bile and stones were drained from the CBD. A C-tube was placed. Postoperatively, remnant stones and radiopaque materials were absent. The stones comprised of >95% calcium carbonate.
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http://dx.doi.org/10.1111/ases.12317DOI Listing
February 2017

Invention of Two Instruments Fitted with SECUREA™ Useful for Laparoscopic Liver Resection.

J Nippon Med Sch 2016 ;83(3):107-12

Department of Surgery, Nippon Medical School.

Laparoscopic liver resection (LLR) became common in Japan when advanced techniques and instruments for the procedure became available and the national medical insurance began covering partial resection and lateral segmentectomy. A successful LLR requires a gentle and powerful hold on the specimens, a steady operating field, and fast and rapid compression of the bleeding point to achieve hemostasis. In this paper we describe two instruments developed in our department by attaching the SECUREA™ endoscopic surgical spacer to the forceps and suction tube used for LLR. The instruments are useful and practical for any type of LLR, even in the hands of less experienced surgeons.
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http://dx.doi.org/10.1272/jnms.83.107DOI Listing
April 2017

Suppression of STAT5b in pancreatic cancer cells leads to attenuated gemcitabine chemoresistance, adhesion and invasion.

Oncol Rep 2016 Jun 1;35(6):3216-26. Epub 2016 Apr 1.

Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal solid malignancies, and there is an urgent need for new therapeutic strategies based on the molecular biology of PDAC. Signal transducers and activators of transcription 5 (STAT5) are known to be activated in a variety of malignancies and involved in tumor proliferation, apoptosis, and invasion, whereas the expression and biological role of STAT5b in PDAC are less clearly defined. In the present study, we examined the expression and role of STAT5b in human pancreatic cancer cell lines. Expressions of STAT5b mRNA and protein were detected in eight kinds of pancreatic cancer cells. Confocal microscopy and western blot analysis indicated that STAT5b is localized in both cytoplasm and nuclei. Immunoprecipitation analysis revealed tyrosine phosphorylation of STAT5b in pancreatic cancer cells. These results indicate that STAT5b in pancreatic cancer cells is constitutively activated. STAT5b shRNA clones in PANC-1 cells, which express relatively high levels of STAT5b, exhibited reduced chemoresistance against gemcitabine, adhesion and invasion compared to sham. On the other hand, AsPC-1 and BxPC3 cells, which express relatively low levels of STAT5b, exhibited reduced chemoresistance compared to PANC-1 cells. Moreover, STAT5b overexpression clones in AsPC-1 cells exhibited increased chemoresistance compared to sham. STAT5b shRNA clones in PANC-1 cells were more sensitive to the proapoptotic actions of gemcitabine, as evidenced by PARP and cleaved caspase-3 activation. Gemcitabine also significantly reduced Bcl-xL levels in the STAT5b shRNA-expressing cells. We also investigated the clinicopathological characteristics of STAT5b expression of PDAC. Although a significant correlation between STAT5b expression and overall survival rates was not observed, a significant correlation with main pancreatic duct invasion was observed. These findings suggest that STAT5b confers gemcitabine chemoresistance and promotes cell adherence and invasiveness in pancreatic cancer cells. Targeting STAT5b may lead to novel therapeutic strategies for PDAC.
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http://dx.doi.org/10.3892/or.2016.4727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869940PMC
June 2016

The voluntary driven exoskeleton Hybrid Assistive Limb (HAL) for postoperative training of thoracic ossification of the posterior longitudinal ligament: a case report.

J Spinal Cord Med 2017 05 9;40(3):361-367. Epub 2016 Feb 9.

a Department of Orthopaedic Surgery, Faculty of Medicine , University of Tsukuba , Tsukuba City , Japan.

Context: The hybrid assistive limb (HAL) is a wearable robot suit that assists in voluntary control of knee and hip joint motion by detecting bioelectric signals on the surface of the skin with high sensitivity. HAL has been reported to be effective for functional recovery in motor impairments. However, few reports have revealed the utility of HAL for patients who have undergone surgery for thoracic ossification of the posterior longitudinal ligament (thoracic OPLL). Herein, we present a postoperative thoracic OPLL patient who showed remarkable functional recovery after training with HAL.

Findings: A 63-year-old woman, who could not walk due to muscle weakness before surgery, underwent posterior decompression and fusion. Paralysis was re-aggravated after the initial postoperative rising. We diagnosed that paralysis was due to residual compression from the anterior lesion and microinstability after posterior fixation, and prescribed bed rest for a further 3 weeks. The incomplete paralysis gradually recovered, and walking training with HAL was started on postoperative day 44 in addition to standard physical therapy. The patient underwent 10 sessions of HAL training until discharge on postoperative day 73. Results of a 10-m walk test were assessed after every session, and the patient's speed and cadence markedly improved. At discharge, the patient could walk with 2 crutches and no assistance. Furthermore, no adverse events associated with HAL training occurred.

Conclusion: HAL training for postoperative thoracic OPLL patients may enhance improvement in walking ability, even if severe impairment of ambulation and muscle weakness exist preoperatively.
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http://dx.doi.org/10.1080/10790268.2016.1142056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472024PMC
May 2017

Development of an MRI-powered robotic system for cryoablation.

Annu Int Conf IEEE Eng Med Biol Soc 2015 Aug;2015:1186-9

This study proposes a novel MRI-powered robotic system controlled with the magnetic field generated by a magnetic resonance imaging (MRI) scanner. In the proposed system, we use an MRI-powered actuator unit proposed in the previous study and a spherical positioning mechanism. The actuator unit contains a ferromagnetic sphere, which acts as a power source and is used to control the positioning unit inside the MRI environment. These elements enable the development of a remote needle tip positioning system for use within the MRI scanner. Potential applications of the developed system include the automation of procedures during under MRI inspections, especially the cryoablation of breast cancer. In this paper, we report on the performance evaluation and the MR-safety of the proposed system and describe the newly developed spherical positioning mechanism, which can be activated by the actuator units.
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http://dx.doi.org/10.1109/EMBC.2015.7318578DOI Listing
August 2015

An Encouragement of Functional MRI.

Authors:
Akira Matsushita

Igaku Butsuri 2016 ;36(2):92-96

Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital.

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http://dx.doi.org/10.11323/jjmp.36.2_92DOI Listing
June 2017

Mitotic index and multipolar mitosis in routine histologic sections as prognostic markers of pancreatic cancers: A clinicopathological study.

Pancreatology 2016 Jan-Feb;16(1):127-32. Epub 2015 Nov 10.

Department of Pathology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan; Research Team for Geriatric Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan.

Objectives: Pancreatic cancer is characterized by genomic complexity and chromosomal instability, and atypical mitotic figures are morphological features of this phenotype. In the present study, we determined the frequency and the clinicopathological and prognostic significance of mitotic figures in pancreatic cancers.

Methods: We surveyed the mitotic figures of the normal ductal epithelium, acinar cells, pancreatic intraepithelial neoplasias, and pancreatic cancers on hematoxylin-and-eosin-stained tissue specimens (n = 121).

Results: Pancreatic cancer cells showed significantly higher mitotic indices as compared with the ductal cells, acinar cells, and pancreatic intraepithelial neoplasias. Both normal and atypical mitosis were significantly elevated only in pancreatic cancers. In pancreatic cancers, approximately 30% of total mitosis was atypical including multipolar, lag-type, ring and asymmetrical mitosis, and anaphase bridges. The Kaplan-Meier curves in pancreatic cancers showed significant correlations between total mitosis and disease free survival. Furthermore, the cases with multipolar mitosis showed poorer prognosis than those without. Lymph node metastasis and multipolar mitosis were independent prognostic factors for overall survival of patients with pancreatic cancer. In addition, lymph node metastasis and total mitosis were independent factors for disease free survival.

Conclusion: These findings suggest that routinely obtained pathological specimens, even small biopsy or cytological specimens, can provide valuable information concerning the prognosis of pancreatic cancers.
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http://dx.doi.org/10.1016/j.pan.2015.10.005DOI Listing
December 2016

Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy.

Asian J Endosc Surg 2016 Feb 15;9(1):32-6. Epub 2015 Nov 15.

Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.

Introduction: The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated.

Methods: Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group).

Results: The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications.

Conclusion: Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy.
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http://dx.doi.org/10.1111/ases.12256DOI Listing
February 2016

Quantitative Assessment of Head Motion toward Functional Magnetic Resonance Imaging during Stepping.

Magn Reson Med Sci 2016 Jul 6;15(3):273-80. Epub 2015 Nov 6.

Center for Cybernics Research, University of Tsukuba.

Purpose: Stepping motions have been often used as gait-like patterns in functional magnetic resonance imaging (fMRI) to understand gait control. However, it is still very difficult to stabilize the task-related head motion. Our main purpose is to provide characteristics of the task-related head motion during stepping to develop robust restraints toward fMRI.

Methods: Multidirectional head and knee position during stepping were acquired using a motion capture system outside MRI room in 13 healthy participants. Six phases in a stepping motion were defined by reference to the left knee angles and the mean of superior-inferior head velocity (Vmean) in each phase was investigated. Furthermore, the correlation between the standard deviation of the knee angle (θsd) and the maximum of the head velocity (Vmax) was evaluated.

Results: The standard deviation of each superior-inferior head position and pitch were significantly larger than the other measurements. Vmean showed a characteristic repeating pattern associated with the knee angle. Additionally, there were significant correlations between θsd and Vmax.

Conclusions: This is the first report to reveal the characteristics of the task-related head motion during stepping. Our findings are an essential step in the development of robust restraint toward fMRI during stepping task.
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http://dx.doi.org/10.2463/mrms.mp.2015-0015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608123PMC
July 2016

Multispectral Imaging of Pancreatic Mixed Acinar-neuroendocrine-ductal Carcinoma with Triple-immunoenzyme Staining.

J Nippon Med Sch 2015 ;82(3):122-3

Division of Physiological Pathology, Department of Applied Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University.

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http://dx.doi.org/10.1272/jnms.82.122DOI Listing
February 2016

Clinical outcomes of 15 consecutive patients who underwent laparoscopic insulinoma resection: The usefulness of monitoring intraoperative blood insulin during laparoscopic pancreatectomy.

Asian J Endosc Surg 2015 Aug 14;8(3):303-9. Epub 2015 Apr 14.

Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.

Background: Insulinoma is a very serious functional tumor. Surgeons should confirm complete resection of insulinomas before completing the operation, even in laparoscopic surgery.

Methods: Between August 2007 and September 2014, 15 consecutive patients with biochemical evidence of an insulinoma underwent laparoscopic pancreatectomy. Intraoperatively, a peripheral arterial blood sample was taken, and insulin was measured by quick insulin assay. Insulin levels were determined before anesthesia induction, every 30 min thereafter, and every 30 min for at least 1 h after tumor resection to confirm insulin levels did not increase before surgery was completed.

Results: All 15 patients (3 men and 12 women, average age 57.2 years) successfully underwent laparoscopic resection. One patient had two tumors, and the remaining 14 patients had one tumor each (three in the head, five in the body, and eight in the tail of the pancreas). Preoperative localization and regionalization studies identified the tumor correctly through CT (12/15 [80.0%]), MRI (9/12 [75.0%]), angiography (11/13 [84.6%]), endoscopic ultrasonography (7/10 [70.0%]), and selective arterial calcium injection (14/14 [100%]). Intraoperative ultrasonography detected 13 of 15 tumors (86.7%), and intraoperative blood insulin monitoring confirmed the complete resection of 16 of 16 tumors (100%). All patients were discharged with normal insulin levels and have been followed up for 3-88 months. There has been no recurrence of symptoms in any patients and none has died.

Conclusion: Complete removal of an insulinoma can be reliably predicted by intraoperative blood insulin monitoring even in laparoscopic pancreatectomies.
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http://dx.doi.org/10.1111/ases.12187DOI Listing
August 2015
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