Publications by authors named "Hiroki Mori"

238 Publications

Muscle-penetration method: Cable nerve grafting with well vascularized surrounding tissue and shortest graft length.

J Plast Reconstr Aesthet Surg 2022 Apr 27. Epub 2022 Apr 27.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.bjps.2022.04.041DOI Listing
April 2022

A case of Gross E esophageal atresia discovered following a unique clinical course.

J Med Invest 2022 ;69(1.2):141-144

Department of Pediatric and Pediatric Endoscopic Surgery, Tokushima University, Tokushima, Japan.

The patient was a 15 months-old boy who had been diagnosed CHARGE syndrome, which is a multiple congenital anomaly syndrome caused by mutations in the CHD7 gene. Mechanical ventilation management was initiated 2 hours after birth for dysphagia and respiratory failure, and tracheotomy was performed 3 months after birth for dysphagia and failed extubation. He was repeatedly hospitalized due to pneuomoniae. Approximately 1 year after birth, the boy had two consecutive episodes of sudden ventilatory insufficiency while replacing the tracheotomy cannula. A bronchoscopic examination under general anesthesia revealed a tracheoesophageal fistula directly below the tracheostomy. The patient was diagnosed with Gross E esophageal atresia, and we speculated that the cannula migrated to the esophagus via the fistula during tracheostomy cannula replacement. Gross E esophageal atresia is a rare disease. Its diagnosis is often delayed, and it is discovered by recurrent pneumonia in many cases. A tracheoesophageal fistula may also be found in children with deformities of the respiratory system. Furthermore, tracheoesophageal fistulae are often found in the neck. Therefore, when sudden ventilatory insufficiency occurs in a child with a tracheostomy after replacing the tracheostomy cannula, caution must be exercised since the cannula may have migrated to the esophagus via a fistula. J. Med. Invest. 69 : 141-144, February, 2022.
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http://dx.doi.org/10.2152/jmi.69.141DOI Listing
April 2022

Synthesis and Strong π-π Interaction of Hexaazatriphenylene Derivatives with Alternating Electron-Withdrawing and -Donating Groups.

Chem Asian J 2022 Apr 17:e202200225. Epub 2022 Apr 17.

Department of Chemistry, School of Science and Technology, Kwansei Gakuin University, 2-1 Gakuen, Sanda, Hyogo 669-1337, Japan.

Hexaazatriphenylene (HAT) derivatives have attracted wide attention because of their electron-deficient nature and unique self-assembly properties. In this work, a facile synthesis method for obtaining HAT derivatives with alternating electron-withdrawing nitrile and electron-donating alkoxy groups (HATCNOCn) is proposed. Crystal structure analysis indicated that HATCNOCn forms a one-dimensional columnar structure via strong π-π interactions. Density functional theory calculations revealed that the edge of HATCNOCn is divided into positively and negatively charged sites owing to the presence of alternating nitrile and alkoxy groups, which would induce strong π-π interactions. Thermal analysis and polarizing optical microscopy revealed that HATCNOCn exhibits columnar liquid-crystal phases. Time-resolved microwave conductivity measurements further demonstrated the photoconductive nature of HATCNOCn. The proposed strategy could provide a new strategy for the design of novel organic semiconductive materials.
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http://dx.doi.org/10.1002/asia.202200225DOI Listing
April 2022

Efficient multitask learning with an embodied predictive model for door opening and entry with whole-body control.

Sci Robot 2022 Apr 6;7(65):eaax8177. Epub 2022 Apr 6.

Faculty of Science and Engineering, Waseda University, Tokyo, Japan.

Robots need robust models to effectively perform tasks that humans do on a daily basis. These models often require substantial developmental costs to maintain because they need to be adjusted and adapted over time. Deep reinforcement learning is a powerful approach for acquiring complex real-world models because there is no need for a human to design the model manually. Furthermore, a robot can establish new motions and optimal trajectories that may not have been considered by a human. However, the cost of learning is an issue because it requires a huge amount of trial and error in the real world. Here, we report a method for realizing complicated tasks in the real world with low design and teaching costs based on the principle of prediction error minimization. We devised a module integration method by introducing a mechanism that switches modules based on the prediction error of multiple modules. The robot generates appropriate motions according to the door's position, color, and pattern with a low teaching cost. We also show that by calculating the prediction error of each module in real time, it is possible to execute a sequence of tasks (opening door outward and passing through) by linking multiple modules and responding to sudden changes in the situation and operating procedures. The experimental results show that the method is effective at enabling a robot to operate autonomously in the real world in response to changes in the environment.
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http://dx.doi.org/10.1126/scirobotics.aax8177DOI Listing
April 2022

Early postoperative complications and their measures after skull base reconstruction: A study from the standpoint of plastic and reconstructive surgeons.

Auris Nasus Larynx 2022 Mar 18. Epub 2022 Mar 18.

Department of Head and Neck Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Objective: In skull base surgery, postoperative complications may be lethal and it is important to know how to deal with these. There are several reports on complications after skull base reconstruction, but it is difficult to understand which are important for plastic surgeons in charge of reconstruction. The objective of this study is to clarify the early postoperative survival-related complications after skull base reconstruction of which plastic surgeons should participate in treatment.

Methods: One hundred and seventy-seven patients who underwent skull base reconstruction at our department over the last 12 years were retrospectively surveyed. The cases of early complications in which plastic surgeons were actively involved in treatment were investigated and the preventive measures actually taken at our facility are examined in addition to treatment methods after development.

Results: Plastic surgical complications were wound infection in seven patients, impaired blood flow in transplanted tissue in two patients, cerebrospinal fluid leakage in five patients, and intracranial compression in three patients. Total number of postoperative complications were seventeen and the total complication rate was 9.6%. Complication rates tended to be higher in anterior-middle skull base cases than in anterior or middle alone cases and higher with free tissue transfer than with locoregional flap. Multivariate analysis revealed that operation time was a significantly higher risk factor (p=0.012) and preoperative chemotherapy was a significantly lower risk factor (p=0.033) for the development of complications. It was also found that the hospitalization length was significantly longer when complications occurred (p<0.0001). Wound infection was treated with removal of the cause, sufficient drainage, and irrigation. Regarding preventive measures, it is necessary to pay attention especially to intracranial contamination with epithelial components. Rapid surgical measures were necessary when blood flow of the transplanted tissue was impaired. For pedicle flaps, conservation of the feeding vessel is needed, and for free flaps, reliable vascular anastomosis is needed as preventive measures. Plastic surgeons play a role in reducing the risk of cerebrospinal fluid leakage through covering the repaired dura mater with tissue with favorable blood flow, especially in reoperation after development of leakage. Skull base reconstruction with soft tissue may cause intracranial compression, and sometimes, it is not resolved by conservative treatment and reoperation is selected.

Conclusion: Plastic surgical postoperative complications were clarified, and treatment methods and preventive measures for them were examined. Careful consideration of blood flow, placement, and volume of the transplanted flap is important to prevent complications.
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http://dx.doi.org/10.1016/j.anl.2022.03.006DOI Listing
March 2022

Risk factors for metachronous contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for unilateral inguinal hernia in children.

Surg Today 2022 Feb 24. Epub 2022 Feb 24.

Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.

Purposes: We use the laparoscopic percutaneous extraperitoneal closure (LPEC) method as the standard procedure for pediatric inguinal hernia. Despite judging there to be no contralateral patent processus vaginalis (PPV) at the time of the first LPEC, we experienced five cases in which metachronous contralateral inguinal hernia (MCH) developed, so we report the characteristics, including the predictors.

Methods: For pediatric inguinal hernia, the LPEC method was used in 1277 cases from 2005 to 2019 in our department. Of these, 374 patients underwent unilateral LPEC, and we compared the 5 patients with MCH onset and the 369 without MCH onset. The items to be examined were the gender, age, presence of a low birth weight, initial-onset side, and contralateral internal inguinal ring classification.

Results: There was no significant difference in the gender, age, initial-onset side, or contralateral internal inguinal ring classification between the two groups. Low-birth-weight infants were significantly more common among those with MCH than among those without MCH.

Conclusions: The only predictor of a contralateral onset after LPEC for pediatric inguinal hernia was a low birth weight. Therefore, for the above-mentioned unilateral LPEC cases, the possibility of a contralateral onset after LPEC due to acquired factors rather than congenital factors should be considered.
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http://dx.doi.org/10.1007/s00595-022-02480-0DOI Listing
February 2022

Myxoid type and non-myxoid type of intimal sarcoma in large vessels and heart: review of histological and genetic profiles of 20 cases.

Virchows Arch 2022 Apr 16;480(4):919-925. Epub 2022 Feb 16.

Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Intimal sarcoma is one of the most common and well-known primary malignant neoplasms of the aorta and heart. The authors reviewed cases of intimal sarcoma from histological, immunohistochemical and genetic perspectives. Twenty cases of intimal sarcoma were retrieved. Immunohistochemistry and FISH of MDM2 and PDGFRA genes were performed. All 20 tumours were composed of spindle-shaped, stellate, oval or polygonal tumour cells with irregular hyperchromatic nuclei arranged in a haphazard pattern, accompanied by nuclear pleomorphism and frequent mitotic figures. Other histological findings were as follows: abnormal mitosis in 10 cases (50%), necrosis in 15 cases (75%), myxoid stroma in 12 cases (60%), cartilaginous formation in 1 case (5%), haemorrhage in 12 cases (60%) and fibrinous deposition in 14 cases (70%). The tumours were positive for MDM2 in 16 cases (80%), ERG in 4 cases (20%), alpha-smooth muscle actin in 6 cases (30%), desmin in 5 cases (25%) and AE1/AE3 in 4 cases (20%). Immunohistochemical positivity was focal in each case. Loss of H3K27me3 expression was noted in 2 cases (10%). MDM2 and PDGFRA gene amplifications were detected in 11 cases (55%) and 1 case (5%), respectively. Fisher's exact test revealed a significant correlation between MDM2 gene amplification and myxoid stroma (p = 0.0194). No parameters showed any association with the anatomical location of the tumours. It was suggested that myxoid histology of intimal sarcoma may be associated with MDM2 gene amplification and that intimal sarcoma may be divided into myxoid and non-myxoid types.
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http://dx.doi.org/10.1007/s00428-022-03293-9DOI Listing
April 2022

Investigation of Predictors of Successful Replantation of Distal Digits at the Nail Bed Level: The Contribution of Digital Nerve Repair to Survival Rate.

Plast Reconstr Surg 2022 04;149(4):889-896

From the Department of Hand Surgery, Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopaedic Hospital; Department of Hand Surgery and Microsurgery, Yotsuya Medical Cube; and Department of Plastic and Reconstructive Surgery, Graduate School of Science, Tokyo Medical and Dental University.

Background: Replantation of amputated digits at the nail bed level is surgically challenging and differs from replantation at a more proximal amputation level. This study aimed to determine the predictors influencing the success rate of fingertip replantation.

Methods: Overall, 239 digits of 226 patients who underwent replantation surgery from August of 2009 to March of 2020 were considered. A total of 15 independent variables (i.e., sex; age; injured hand; digit; history of smoking; history of hypertension or diabetes; injury mechanism; amputation level; ischemia duration; surgeon's expertise; numbers of repaired arteries, veins, and nerves; and the need for a vein graft) were investigated for their effects on the survival of the replanted digits.

Results: Of all 239 digits, 190 (79.5 percent) survived. Univariate analysis indicated that non-crush-avulsion injury, expertise and experience of the surgeon, vein repair, and nerve repair contributed to increasing the survival rate. Binary logistic regression analysis demonstrated that injury mechanism, vein repair, and nerve repair were significant predictive factors. In addition, in non-vein-repaired, blunt cut, or Ishikawa subzone II cases, digital nerve repair contributed significantly to promote the success rate relative to vein-repaired, crush-avulsion-type injury, and subzone I cases.

Conclusions: Vein repair, nerve repair, non-crush-avulsion injury, and surgeon's expertise and experience were the predictors for successful replantation. Intraoperative vein and nerve repair are recommended to improve the survival rate of fingertip replantation at the nail bed level.

Clinical Question/level Of Evidence: Risk, III.
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http://dx.doi.org/10.1097/PRS.0000000000008908DOI Listing
April 2022

Prognosis of Subcutaneous Mastectomy for Special Types of Breast Cancer.

Medicina (Kaunas) 2022 Jan 12;58(1). Epub 2022 Jan 12.

Department of Specialized Surgeries, Graduated School, Tokyo Medical and Dental University, Tokyo 1138519, Japan.

In the treatment of the special type of breast cancer (STBC), the choice of chemotherapeutic agents is often based on the characteristic features of the histological type. On the other hand, the surgical strategy is usually determined by the tumor size and presence of lymph node metastasis, and the indication for immediate reconstruction is rarely discussed based on the histological type. The prognoses of STBC and invasive ductal carcinoma of the breast (IDC) patients who underwent subcutaneous mastectomy (SCM) with immediate reconstruction at our institution were compared. A total of 254 patients with SCM with immediate reconstruction from 1998 to 2018 were included; their tumor diameter or induration was less than 25 mm, and it was not in close proximity to the skin. Preoperative chemotherapy and non-invasive cancer cases were excluded. The number of patients was 166 for skin-sparing mastectomy (SSM) and 88 for nipple-sparing mastectomy (NSM). The reconstructive techniques were deep inferior epigastric artery perforator flap (DIEP) reconstruction in 43 cases, latissimus dorsi flap reconstruction (LDflap) in 63 cases, tissue expander (TE) in 117 cases, and transverse rectus abdominis myocutaneous flap/vertical rectus abdominis myocutaneous flap (TRAM/VRAM) reconstruction in 31 cases. The histological types of breast cancer were 211 IDC and 43 STBC; 17 were mucinous carcinoma (MUC), 17 were invasive lobular carcinoma (ILC), 6 were apocrine carcinoma, 1 was tubular carcinoma, and 2 were invasive micropapillary carcinoma. There was no difference in local recurrence or disease-free survival (LRFS, DFS) between IDC and STBC, and overall survival (OS) was significantly longer in STBC. OS was better in the STBC group because SCM with immediate reconstruction was performed for STBC, which is a histological type with a relatively good prognosis. Highly malignant histological types, such as squamous cell carcinoma or metaplastic carcinoma, were totally absent in this study. The indications for SCM with immediate reconstruction for relatively common STBCs such as MUC and ILC can be the same as for IDC.
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http://dx.doi.org/10.3390/medicina58010112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780999PMC
January 2022

[A Case of Laparoscopic Total Gastrectomy for Gastric Cancer after Rectus Abdominis Flap Reconstruction for Breast Cancer].

Gan To Kagaku Ryoho 2021 Dec;48(13):1652-1654

Dept. of Specialized Surgery, Tokyo Medical and Dental University.

A 60-year-old woman underwent laparoscopic total gastrectomy for gastric cancer with a good postoperative course. At the age of 45, she had underwent skin-sparing total mastectomy, sentinel node biopsy, and right rectus abdominis flap reconstruction for left breast cancer. Since there is a certain risk of abdominal wall hernia after the abdominal flap reconstruction, laparoscopic surgery with less abdominal wall damage might be useful. Although the umbilicus is hollowed out and sutured to a small hole in the cranial skin after abdominal flap reconstruction, there seems to be no problem in using the umbilicus for the port. The abdominal wall is scarred after the abdominal flap reconstruction, but normal insufflation pressure was sufficient to perform the operation in our case. Additionally, we must be careful not to damage the flap pedicle, and it would be useful to check its location by ultrasonography before starting the operation.
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December 2021

Outcomes of Restrictive Cardiomyopathy in Japanese Children - A Retrospective Cohort Study.

Circ J 2021 Dec 21. Epub 2021 Dec 21.

Department of Pediatric Cardiology, Tokyo Women's Medical University.

Background: There has been no nationwide survey on the prognosis of pediatric restrictive cardiomyopathy (RCM) in Japan; therefore, this retrospective multicentered study was designed to investigate the long-term survival rate of pediatric patients with RCM in Japan.Methods and Results:A multicentered, retrospective observational study was performed between 1990 and 2014 and included patients diagnosed with RCM who were aged <18 years from 18 Japanese institutions. A total of 54 patients were diagnosed with RCM. The median age at diagnosis was 4.4 years, and the median duration of observation was 2.2 years at the time of this study. Of these patients, 54% had symptoms, including heart failure. Twelve patients died without heart transplantation, mostly due to heart failure. The median time to death from diagnosis was 2.5 years. Freedom from death at 1, 5, and 10 years was 91%, 68%, and 62%, respectively. Death occurred within 5 years of diagnosis in most patients. Twenty-two patients underwent heart transplantation. Freedom from heart transplantation at 1, 5, and 10 years was 77%, 58%, and 53%, respectively. Freedom from death or heart transplantation at 1, 5, and 10 years was 72%, 40%, and 34%, respectively. The presence of symptoms was a risk factor for death or transplantation.

Conclusions: The prognosis of pediatric RCM is poor, and the heart transplantation rate is low in Japan.
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http://dx.doi.org/10.1253/circj.CJ-21-0706DOI Listing
December 2021

[A case of corrosive gastritis caused by accidental ingestion of calcium chloride that resulted in gastric stenosis and penetration].

Nihon Shokakibyo Gakkai Zasshi 2021 ;118(12):1142-1150

Department of Surgery, Saiseikai Matsusaka General Hospital.

A Japanese woman in her 40s came to our emergency room with vomiting and upper abdominal pain after drinking a bottle of milk tea at home. She had a history of bipolar disorder. Blood tests revealed hypercalcemia (calcium level of 18.6mg/dl). Abdominal computed tomography depicted thickening of the gastric wall and hyperabsorbed material in the stomach. Upper gastroduodenal endoscopy showed extreme mucosal redness from the gastric body to the pylorus. The hypercalcemia improved with intravenous infusion of zoledronic acid. The patient had not been taking any medication that could have caused hypercalcemia. Later, her father drank the same bottle of milk tea at home and developed upper abdominal pain. He was admitted to the hospital because of vomiting, and computed tomography showed hyperabsorbed material in the stomach, as in his daughter's case. Computed tomography of the bottle of milk tea revealed a highly absorbent substance. The bottle was sent to the forensics laboratory for testing, and it was found to contain calcium chloride. Thus both patients had consumed a beverage containing calcium chloride, and corrosive gastritis was diagnosed. Despite fasting and intravenous drip therapy, the first patient underwent a total gastrectomy because of severe stenosis and perforation of the gastric lumen.
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http://dx.doi.org/10.11405/nisshoshi.118.1142DOI Listing
December 2021

Older assistant workers in intermediate care facilities, and their influence on the physical and mental burden of elderly care staff.

BMC Health Serv Res 2021 Nov 30;21(1):1285. Epub 2021 Nov 30.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.

Background: As there is a shortage of care staff in elderly care homes, seniors are expected to work as assistants to help the care staff. This study examined the influence of older assistant workers in intermediate elderly care facilities on care staff, specifically focusing on emotional exhaustion which is a sign of burnout. These facilities provide long-term nursing and supportive care to older residents.

Methods: Data from a mail survey of intermediate elderly care facilities with older assistant workers were analyzed. Care staff were asked about the advantages and disadvantages of introducing older assistant workers in elderly care work, and their degree of emotional exhaustion. We also assessed work self-evaluations of older assistant workers, including the benefits of the work, and physical and mental burdens.

Results: A significantly large number of care staff reported improvements in workload with the employment of older assistant workers. Intermediate elderly care facilities enrolling more older assistant workers showed lower mean emotional exhaustion among care staff, independent of possible covariates. While older assistant workers felt that their work contributed to helping both care users and staff, they also reported a mental burden.

Conclusions: Our results suggest that older assistant workers can play a significant role in reducing the physical and mental burden of intermediate elderly care facility staff. Thus, employing older assistant workers can be an effective approach to addressing shortages of care staff in elderly care homes.
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http://dx.doi.org/10.1186/s12913-021-07302-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8630895PMC
November 2021

Outcomes of hypertrophic cardiomyopathy in Japanese children: a retrospective cohort study.

Heart Vessels 2022 Jun 19;37(6):1075-1084. Epub 2021 Nov 19.

Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan.

There has been no multicenter study on the prognosis of pediatric hypertrophic cardiomyopathy (HCM) in Japan. Therefore, we conducted a retrospective multicenter observational study on the long-term survival rate in patients diagnosed with HCM under the age of 18 between 1990 and 2014. Twenty institutions participated. A total of 180 patients were identified. The median age at diagnosis was 5.8 years old and median duration of observation was 8.3 years. Although six patients (3%) deteriorated into the dilated phase of HCM, no patient received heart transplantation. Freedom from death at 1, 5, 10, and 20 years were 97%, 92%, 84%, and 80%, respectively. There were 26 deaths. Among them, 11 patients died suddenly, presumably due to arrhythmia, and 15 patients died of heart failure. The presence of heart failure symptoms and a greater cardiothoracic ratio were significant risk factors for heart failure-related death. There were no significant risk factors identified for arrhythmia-related death. In conclusion, the prognosis of pediatric HCM in Japan is good and similar to those reported in population-based studies in the United States and Australia. Significant risk factors for heart failure-related death were identified in pediatric patients with HCM in Japan.
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http://dx.doi.org/10.1007/s00380-021-01989-7DOI Listing
June 2022

Comparative Blink Analysis in Patients With Established Facial Paralysis Using High-Speed Video Analysis.

J Craniofac Surg 2021 Nov 5. Epub 2021 Nov 5.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo Department of Plastic and Reconstructive Surgery, Graduate School of Science Research Administration Divisions, Research University Promotion Organization, Tokyo Medical and Dental University, Tokyo, Japan.

Abstract: This study analyzed the blink characteristics of patients with incomplete and complete facial paralysis. The authors measured and compared the palpebral distance, eyelid movement distance, and the eye-closing ratio of blinks in 55 patients with Bell's palsy or Ramsay Hunt syndrome (Bell & Hunt group) and 14 with complete paralysis (Complete Paralysis group). In the Bell & Hunt group, the palpebral distance (7.94 mm) was smaller on the paralyzed side than on the non-paralyzed side (9.61 mm). The eye-closing ratio and the upper eyelid movement were reduced on the paralyzed side (65.3% versus 93.7%, 4.61 versus 7.97 mm) and in the Complete Paralysis group (25.3% versus 94.7%, 2.10 versus 8.49 mm). In the Bell & Hunt group, movement of the upper eyelid on the paralyzed side was weakened despite palpebral contracture. The Complete Paralysis group exhibited highly reduced movement in both the upper and lower eyelids.
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http://dx.doi.org/10.1097/SCS.0000000000008326DOI Listing
November 2021

Influence of Marker Number and Position on Accuracy of Breast Measurement With Three-Dimensional Camera.

Aesthetic Plast Surg 2021 Oct 26. Epub 2021 Oct 26.

Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.

Background: The VECTRA H1 three-dimensional (3D) imaging system (Canfield Scientific, Parsippany, NJ) enables easy 3D image construction and measurement. Although the number and positions of markers on the skin for image synthesis might affect accuracy of measurements, few studies have mentioned the possibility. This study investigated the accuracy and reproducibility of distance measurements using VECTRA H1, focusing on the number and positions of markers.

Methods: A total of 3, 5, or 7 markers were attached to a female breast model including lateral markers 6 cm from the midline and photographed with VECTRA. Five markers were configured in more two ways, with the lateral markers either positioned 3 cm outside the midline (narrow interval) or 9 cm outside the midline (wide interval). 3D models were created three times under each condition, for a total of 15 models. Differences (measurement error) between measured values on 3D models and actual measured values were verified for six distances, such as distance between the nipples.

Results: The average difference was 11.1 mm with 3 markers (95% confidence interval (CI), 4.38-17.7 mm, p = 0.0028). In comparison, average difference was -0.395 mm (-0.866 to 0.0763 mm, p = 0.095) with 5 markers, and 0.139 mm (-0186 to 0.465 mm, p = 0.379) with 7 markers, all less than 1 mm. Average difference with narrow interval 5 markers was larger than one with wide interval.

Conclusions: In 3D imaging of the breast using VECTRA H1, distance measurements offering clinically satisfactory accuracy can be made by setting appropriate marker conditions.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-021-02629-1DOI Listing
October 2021

Tool-Use Model to Reproduce the Goal Situations Considering Relationship Among Tools, Objects, Actions and Effects Using Multimodal Deep Neural Networks.

Front Robot AI 2021 28;8:748716. Epub 2021 Sep 28.

Department of Modern Mechanical Engineering, Waseda University, Tokyo, Japan.

We propose a tool-use model that enables a robot to act toward a provided goal. It is important to consider features of the four factors; tools, objects actions, and effects at the same time because they are related to each other and one factor can influence the others. The tool-use model is constructed with deep neural networks (DNNs) using multimodal sensorimotor data; image, force, and joint angle information. To allow the robot to learn tool-use, we collect training data by controlling the robot to perform various object operations using several tools with multiple actions that leads different effects. Then the tool-use model is thereby trained and learns sensorimotor coordination and acquires relationships among tools, objects, actions and effects in its latent space. We can give the robot a task goal by providing an image showing the target placement and orientation of the object. Using the goal image with the tool-use model, the robot detects the features of tools and objects, and determines how to act to reproduce the target effects automatically. Then the robot generates actions adjusting to the real time situations even though the tools and objects are unknown and more complicated than trained ones.
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http://dx.doi.org/10.3389/frobt.2021.748716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8510504PMC
September 2021

Outcomes of Dilated Cardiomyopathy in Japanese Children - A Retrospective Cohort Study.

Circ J 2021 12 28;86(1):109-115. Epub 2021 Sep 28.

Department of Pediatric Cardiology, Tokyo Women's Medical University.

Background: There has been no nationwide survey on the prognosis of pediatric dilated cardiomyopathy (DCM) in Japan. Therefore, we designed this retrospective multicenter study to investigate the long-term survival rate in pediatric patients with DCM in Japan.Methods and Results:In this multicenter retrospective observational study, data were reviewed for 106 patients aged <18 years who had been diagnosed with DCM at any 1 of 18 Japanese institutions between 1990 and 2014. The median age at diagnosis was 2.0 years and the median duration of observation was 3.3 years. Most DCM patients were diagnosed because of symptoms of heart failure. On echocardiography, the median left ventricular end-diastolic dimension z score was 5.4 and fractional shortening was 0.10. Freedom from death or transplantation rates at 1, 3, 5, 10, and 20 years after diagnosis were 76%, 66%, 64%, 58%, and 43%, respectively. Freedom from death rates at 1, 5, 10, and 20 years after diagnosis were 81%, 75%, 72%, and 53%, respectively. The incidence of heart transplantation at 1, 5, 10, and 20 years after diagnosis was 6%, 15%, 20%, and 20%, respectively, suggesting that only 15% of patients in Japan underwent heart transplantation within 5 years of diagnosis.

Conclusions: In Japan, the prognosis of pediatric DCM is poor and the rate of heart transplantation is low.
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http://dx.doi.org/10.1253/circj.CJ-20-1239DOI Listing
December 2021

Laparoscopic Abdominal Surgery after Primary Breast Reconstruction Using an Abdominal Flap.

Medicina (Kaunas) 2021 Sep 10;57(9). Epub 2021 Sep 10.

Department of Specialized Surgeries, Graduated School, Tokyo Medical and Dental University, Tokyo 1138519, Japan.

: Our department has been performing primary breast reconstruction for breast cancer surgery, incorporating a transverse rectus abdominis myocutaneous flap (TRAM)/vertical rectus abdominis myocutaneous flap (VRAM) since 1998 and a deep inferior epigastric artery perforator flap (DIEP) since 2008. Currently, most gastrointestinal operations in abdominal surgery are performed laparoscopically or are robot-assisted. Cases in which abdominal surgery was performed after breast reconstruction using an abdominal flap were reviewed. A total of 119 cases of primary breast reconstruction using an abdominal flap performed in our department were reviewed. The reconstructive techniques were DIEP in 69 cases and TRAM/VRAM in 50 cases. After breast surgery, seven abdominal operations were performed in six cases. In DIEP cases, one robotic surgery was performed for uterine cancer, and one laparoscopic surgery was performed for ovarian tumor. In TRAM/VRAM cases, two laparoscopic cholecystectomies, one laparoscopic total gastrectomy, one laparoscopic ileus reduction, and one open total hysterectomy oophorectomy were performed. Six surgeries were completed by laparoscopy or robotic assistance. The survival rate after breast cancer surgery is improving, and the choice of breast reconstruction procedure should take into account the possibility of performing a prophylactic resection of the ovaries due to the genetic background and possibly postoperative abdominal surgery due to other diseases. However, in cases in which laparoscopic surgery was attempted after breast reconstruction using an abdominal flap, the laparoscopic surgery could be completed in all cases.
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http://dx.doi.org/10.3390/medicina57090952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467968PMC
September 2021

Immediate breast reconstruction is oncologically safe for node-positive patients: Comparison using propensity score matching.

Medicine (Baltimore) 2021 Sep;100(36):e27184

Department of Specialized Surgery, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.

Abstract: The oncological safety of immediate breast reconstruction (IBR) in lymph node-positive patients is unclear. In the present study, the impact of IBR on recurrence based on data of patients with axillary lymph node metastases only was examined.The subjects were 232 patients who underwent breast surgery. The patients were grouped into 2 cohorts: non-IBR patients who underwent mastectomy with axillary lymph node dissection; and IBR patients with tissue expander or flap transfer and axillary lymph node dissection. The Non-IBR group included 165 patients, and the IBR group included 67 patients. For the comparison of oncological outcomes between the 2 groups, propensity score matching was performed. The propensity scores were calculated by logistic regression analysis, including age, tumor staging, human epidermal growth factor receptor 2 status, and estrogen receptor status. There was no difference in locoregional recurrence-free survival (LRRFS) between the non-IBR and IBR groups. The 5-year LRRFS rate was 78.9% in the non-IBR group and 85.1% in the IBR group. There was no difference in recurrence-free survival (RFS) between the non-IBR and IBR groups. The 5-year RFS rate was 75.6% in the non-IBR group and 78.8% in the IBR group. In all patients, the 5-year LRRFS rate was 77.3%, and the RFS rate was 70.5%. Multivariate Cox regression analysis to identify factors affecting RFS in all patients showed that estrogen receptor status and high nuclear grade were significant prognostic factors; IBR was irrelevant.This is the first report of an analysis using propensity score matching limited to node-positive breast cancer patients, and it showed that IBR is relatively safe in such patients.
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http://dx.doi.org/10.1097/MD.0000000000027184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428751PMC
September 2021

The different concepts of surgical managements between anterior and lateral skull base reconstructions based on surgical purposes.

Auris Nasus Larynx 2022 Apr 27;49(2):271-278. Epub 2021 Aug 27.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Objective: Anterior and middle cranial fossa defects require different strategies, depending on their anatomical location. The aim of this study was to elucidate the surgical managements for the defects based on surgical purposes and to clarify the conceptional differences relating to anterior and lateral skull base reconstructions.

Methods: This study included patients who had undergone reconstructive surgery for anterior or middle cranial fossa defects in our institution between July 2008 and June 2019. It consisted of 66 patients who had been subject to anterior skull base reconstructions, and 84 patients who had experienced lateral skull base reconstructions. The medical records were examined retrospectively, and the surgical purposes and procedures performed were reviewed. The surgical purposes were divided into four groups: Separation, Restoration, Augmentation, and Coverage.

Results: Regarding anterior skull base reconstructions, the Separation group included 65 patients, who represented 98% of this category. There were 26 cases in the Separation-only group, 20 of which were reconstructed with locoregional flaps, and 6 of which with free tissue transfers. A Combination group, which consisted of Separation and Other purposes, consisted of 40 cases. Within this group, 5 cases were reconstructed with locoregional flaps, and 35 with free tissue transfers. Regarding lateral skull base reconstructions, the Separation group included 34 patients, who represented 40% of this category. The rate of the Other purposes represented the majority. In the Separation-only group of 24 patients, 16 cases were reconstructed with locoregional flaps and 8 cases with free tissue transfers. In the Combination group of 10 patients, 2 cases were reconstructed with locoregional flaps and 8 cases with free tissue transfers. In groups other than the Separation group, 27 cases were reconstructed with locoregional flaps and 23 cases with free tissue transfers.

Conclusion: In most anterior cranial fossa defect cases, the surgical purpose is separation. In middle cranial fossa defect cases, there are many cases in which the surgical purpose is not separation. In the Separation groups, relating to both anterior and lateral skull base reconstructions, the use of locoregional flaps was an effective measure. Free tissue transfers were required in many cases of the Combination group. Outside of the Separation group associated with lateral skull base reconstructions, the use of locoregional flaps and free tissue transfers were almost equal in proportion, and the selection of reconstructive procedures tended to change from locoregional flaps to large free flaps with increase in the numbers of surgical purposes.
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http://dx.doi.org/10.1016/j.anl.2021.08.005DOI Listing
April 2022

Geospatial Assessments of DNA Adducts in the Human Stomach: A Model of Field Cancerization.

Cancers (Basel) 2021 Jul 24;13(15). Epub 2021 Jul 24.

Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan.

Background: Field cancerization is a popular concept regarding where cancer cells arise in a plane, such as the opened-up gastrointestinal mucosa. The geospatial distribution of DNA adducts, some of which are believed to initiate mutation, may be a clue to understanding the landscape of the preferred occurrence of gastric cancer in the human stomach, such that the occurrence is much more frequent in the lesser curvature than in the greater curvature.

Methods: Seven DNA adducts, C5-methyl-2'-deoxycytidine, 2'-deoxyinosine, C5-hydroxymethyl-2'-deoxycytidine, N6-methyl-2'-deoxyadenosine, 1,N6-etheno-2'-deoxyadenosine, N6-hydroxymethyl-2'-deoxyadenosine, and C8-oxo-2'-deoxyguanosine, from different points and zones of the human stomach were semi quantitatively measured by liquid chromatography/tandem mass spectrometry. The differences in the quantity of these DNA adducts from the lesser and greater curvature, the upper, middle and lower third zones, the anterior and posterior wall of the stomach, and the mucosae distant from and near the tumor were compared to determine whether the location preference of cancer in the stomach could be explained by the distribution of these DNA adducts. Comparisons were conducted considering the tumor locations and operation methods.

Conclusions: Regarding the DNA adducts investigated, significant differences in quantities and locations in the whole stomach were not noted; thus, these DNA adducts do not explain the preferential occurrence of cancer in particular locations of the human stomach.
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http://dx.doi.org/10.3390/cancers13153728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345122PMC
July 2021

Higher body mass index is a more important risk factor than sarcopenia for complications in reconstruction of the deep inferior epigastric perforator.

Asian J Surg 2022 Jan 31;45(1):360-366. Epub 2021 Jul 31.

Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.

Background: In recent years, breast reconstruction using autologous tissue after breast cancer surgery has become a common procedure. This study investigated the association between the occurrence of complications in breast reconstruction using deep inferior epigastric perforator (DIEP) flaps and patient risk factors among Asian women.

Methods: This study included cases of breast reconstruction using DIEP flaps performed at our institution. We retrospectively investigated the relationship between preoperative and operative patient factors and postoperative complications by collecting data from medical records. Sarcopenia was also evaluated by calculating psoas muscle index from the area of the iliopsoas muscle at the level of the third lumbar vertebra using images from preoperative computed tomography. Postoperative complications were compared between a low-body mass index (BMI) group and a high-BMI group, defined using BMI values of <25 kg/m and ≥25 kg/m, respectively.

Results: A total of 129 cases of breast reconstruction using DIEP flaps were included in this analysis. The frequency of postoperative complications was significantly higher in the high-BMI group, including for skin flap necrosis of the breast (p = 0.03), recipient-site infection (p = 0.03), and donor-site seroma (p = 0.003). Moreover, abdominal circumference correlated significantly with recipient-site infection (p = 0.01) and donor-site seroma (p = 0.002). Sarcopenia did not show significant correlations with any complications.

Conclusion: BMI was identified as a risk factor for the occurrence of postoperative complications in breast reconstruction using the DIEP flap, but sarcopenia was not.
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http://dx.doi.org/10.1016/j.asjsur.2021.06.059DOI Listing
January 2022

A Case of Breast Cancer in a Patient with a Congenital Pectoralis Muscle Defect.

Case Rep Oncol 2021 May-Aug;14(2):1092-1096. Epub 2021 Jul 12.

Department of Specialized Surgeries, Graduated School, Tokyo Medical and Dental University, Tokyo, Japan.

Congenital pectoral muscle defects are very rare, and when accompanied by limb defects, they are called Poland syndrome. A woman in her 70s, 4 years after partial mastectomy for breast cancer, underwent mastectomy for a local recurrence. During the operation, the pectoralis major and minor muscles were found to be defective. However, the patient did not have any limb defects. Although congenital pectoral muscle defects are very rare, it would be better to confirm defects of the pectoral muscle by preoperative diagnostic imaging such as CT because the postoperative treatment may be affected.
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http://dx.doi.org/10.1159/000516189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299385PMC
July 2021

Reliability of Temporal Vascular Anastomosis and Techniques for Better Outcomes.

J Reconstr Microsurg 2022 Jan 29;38(1):41-46. Epub 2021 Jun 29.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Background:  Although there are several potential recipient vessels in the neck, those in the temporal region are limited. In skull base reconstruction, there are difficulties associated with the anastomosing recipient vessels in the neck region since long nutrient vessels are needed in the flap. We evaluated the reliability of temporal vascular anastomosis by comparing surgical outcomes between reconstructive methods and examined which surgical procedures may achieve better results.

Methods:  We examined the medical records of free tissue transfer cases between April 2007 and March 2018. Seventy-three surgeries were performed in the temporal region, including skull base reconstruction in 48, head and neck reconstruction (without skull base) in 16, and secondary surgery for head deformities in nine cases. In total, 445 neck surgeries were performed. Postoperative complications were retrospectively analyzed.

Results:  The postoperative complication rates were 8.2 and 2.7% for all temporal and neck surgeries, respectively. There were no arterial complications in the temporal region and all of the six postoperative anastomotic complications were due to venous thrombosis. In contrast, there were 12 cases of vascular anastomotic complications, with six cases each of arterial and venous thrombosis in the neck. In the temporal region, the complication rate was 2.1% for skull base reconstruction, 11% for secondary revision, and 25% in head and neck reconstruction. The corresponding values for middle temporal vein (MTV) usage rates were 54, 22, and 25%. In skull base reconstruction, a coronal incision was made in all cases. A more frequent use of the MTV was associated with a reduced complication rate.

Conclusion:  The low complication rate in the temporal region was attributed to the wide surgical field and low tension of anastomotic vessels. Multiple venous anastomoses, including those of the MTV, are recommended to prevent complications.
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http://dx.doi.org/10.1055/s-0041-1729883DOI Listing
January 2022

Risk of carcinogenesis in the biliary epithelium of children with congenital biliary dilatation through epigenetic and genetic regulation.

Surg Today 2022 Feb 16;52(2):215-223. Epub 2021 Jun 16.

Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.

Purposes: Congenital biliary dilatation (CBD), defined as pancreaticobiliary maljunction (PBM) with biliary dilatation, is a high risk factor for biliary tract cancer (BTC). KRAS and p53 mutations reportedly affect this process, but the mechanisms are unclear, as is the likelihood of BTC later in life in children with CBD. We investigated potential carcinogenetic pathways in children with CBD compared with adults.

Methods: The subjects of this study were nine children with CBD and 13 adults with PBM (10 dilated, 3 non-dilated) without BTC who underwent extrahepatic bile duct resections, as well as four control patients who underwent pancreaticoduodenectomy for non-biliary cancer. We evaluated expressions of Ki-67, KRAS, p53, histone deacetylase (HDAC) and activation-induced cytidine deaminase (AID) in the biliary tract epithelium immunohistochemically.

Results: The Ki-67 labeling index (LI) and expressions of KRAS, p53, HDAC, and AID in the gallbladder epithelium were significantly higher or tended to be higher in both the children with CBD and the adults with PBM than in the controls.

Conclusions: BTC may develop later in children with CBD and in adults with PBM, via HDAC and AID expression and through epigenetic and genetic regulation.
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http://dx.doi.org/10.1007/s00595-021-02325-2DOI Listing
February 2022

Study of the protocol used to evaluate skin-flap perfusion in mastectomy based on the characteristics of indocyanine green.

Photodiagnosis Photodyn Ther 2021 Sep 11;35:102401. Epub 2021 Jun 11.

Department of Specialized Surgeries, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.

Background: Indocyanine green angiography enables real-time visualization of blood vessels at depths of up to 10 mm beneath the body surface, thereby aiding the evaluation of the viability of skin flaps and predicting necrosis in surgical fields requiring good tissue perfusion. Although skin-flap necrosis also occurs in mastectomy without reconstruction, most studies have focused on reconstructive plastic surgery. Several patients undergoing mastectomy are eligible for postoperative adjuvant therapy, but complications can lead to delays in treatment and thus require prevention. However, a lack of a standard protocol for evaluating skin-flap perfusion using indocyanine green necessitates the study of its characteristics to facilitate comparison of the perfusion rate among individuals.

Methods: This retrospective study focused on the characteristics of indocyanine green and established a protocol for indocyanine green angiography using laser-assisted imaging (SPY system) to predict postoperative skin-flap necrosis from intraoperative images of 30 patients who underwent mastectomy without reconstruction.

Results: Our protocol predicted postoperative skin-flap necrosis as follows. First, the intravenous dose and concentration were set at 2.5 mg/mL and 0.05 mg/kg, respectively. Second, the timing of measurement was set to 100 s after the entry of indocyanine green into the skin (plateau phase); the analysis pattern was set to single frame. Third, comparisons among individuals were made using relative values.

Conclusions: We analyzed the area of postoperative flap necrosis using this protocol. We found that the intraoperative images showed decreased perfusion in that area, which was useful in predicting skin-flap necrosis, as reported by previous breast reconstruction studies.
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http://dx.doi.org/10.1016/j.pdpdt.2021.102401DOI Listing
September 2021

Diagnosing Atrial Septal Defect from Electrocardiogram with Deep Learning.

Pediatr Cardiol 2021 Aug 27;42(6):1379-1387. Epub 2021 Apr 27.

Institute of Advanced BioMedical Engineering and Science, Tokyo Women's Medical University, Tokyo, 162-0054, Japan.

The heart murmur associated with atrial septal defects is often faint and can thus only be detected by chance. Although electrocardiogram examination can prompt diagnoses, identification of specific findings remains a major challenge. We demonstrate improved diagnostic accuracy realized by incorporating a proposed deep learning model, comprising a convolutional neural network (CNN) and long short-term memory (LSTM), with electrocardiograms. This retrospective observational study included 1192 electrocardiograms of 728 participants from January 1, 2000, to December 31, 2017, at Tokyo Women's Medical University Hospital. Using echocardiography, we confirmed the status of healthy subjects-no structural heart disease-and the diagnosis of atrial septal defects in patients. We used a deep learning model comprising a CNN and LTSMs. All pediatric cardiologists (n = 12) were blinded to patient groupings when analyzing them by electrocardiogram. Using electrocardiograms, the model's diagnostic ability was compared with that of pediatric cardiologists. We assessed 1192 electrocardiograms (828 normally structured hearts and 364 atrial septal defects) pertaining to 792 participants. The deep learning model results revealed that the accuracy, sensitivity, specificity, positive predictive value, and F1 score were 0.89, 0.76, 0.96, 0.88, and 0.81, respectively. The pediatric cardiologists (n = 12) achieved means of accuracy, sensitivity, specificity, positive predictive value, and F1 score of 0.58 ± 0.06, 0.53 ± 0.04, 0.67 ± 0.10, 0.69 ± 0.18, and 0.58 ± 0.06, respectively. The proposed method is a superior alternative to accurately diagnose atrial septal defects.
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http://dx.doi.org/10.1007/s00246-021-02622-0DOI Listing
August 2021

Mass spectrometric profiling of DNA adducts in the human stomach associated with damage from environmental factors.

Genes Environ 2021 Apr 9;43(1):12. Epub 2021 Apr 9.

Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.

Background: A comprehensive understanding of DNA adducts, one of the most plausible origins of cancer mutations, is still elusive, especially in human tissues in clinical settings. Recent technological developments have facilitated the identification of multiple DNA adducts in a single experiment. Only a few attempts toward this "DNA adductome approach" in human tissues have been reported. Geospatial information on DNA adducts in human organs has been scarce.

Aim: Mass spectrometry of human gastric mucosal DNA was performed to identify DNA adducts associated with environmental factors.

Materials And Methods: From 59 subjects who had received gastrectomy for gastric cancer, 306 samples of nontumor tissues and 15 samples of tumors (14 cases) were taken for DNA adductome analysis. Gastric nontumor tissue from autopsies of 7 subjects without gastric cancer (urothelial cancer, hepatocellular carcinoma, lung cancer each; the other four cases were without any cancers) was also investigated. Briefly, DNA was extracted from each sample with antioxidants, digested into nucleosides, separated by liquid chromatography, and then electrospray-ionized. Specific DNA adducts were identified by mass/charge number and column retention time compared to standards. Information on lifestyle factors such as tobacco smoking and alcohol drinking was taken from the clinical records of each subject.

Results: Seven DNA adducts, including modified bases, C5-methyl-2'-deoxycytidine, 2'-deoxyinosine, C5-hydroxymethyl-2'-deoxycytidine, N6-methyl-2'-deoxyadenosine, 1,N6-etheno-2'-deoxyadenosine, N6-hydroxymethyl-2'-deoxyadenosine, and C8-oxo-2'-deoxyguanosine, were identified in the human stomach and characterized. Intraindividual differences according to the multiple sites of these adducts were noted but were less substantial than interindividual differences. N6-hydroxymethyl-2'-deoxyadenosine was identified in the human stomach for the first time. The amount of C5-hydroxymethyl-2'-deoxycytidine was higher in the stomachs of subjects without gastric cancer than in the nontumor and tumor portions of the stomach in gastric cancer patients. Higher levels of 1,N6-etheno-2'-deoxyadenosine were detected in the subjects who reported both smoking and drinking than in those without these habits. These DNA adducts showed considerable correlations with each other.

Conclusions: We characterized 7 DNA adducts in the nontumor portion of the human stomach in both gastric cancer subjects and nongastric cancer subjects. A reduction in C5-hydroxymethyl-dC even in the nontumor mucosa of patients with gastric cancer was observed. Smoking and drinking habits significantly influenced the quantity of one of the lipid peroxidation-derived adducts, etheno-dA. A more expansive DNA adductome profile would provide a comprehensive understanding of the origin of human cancer in the future.
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http://dx.doi.org/10.1186/s41021-021-00186-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034090PMC
April 2021
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