Publications by authors named "Hiroki Sato"

602 Publications

Predictors of Ischemic Complication in Anterior Choroidal Artery Aneurysm Repair.

World Neurosurg 2022 Aug 5. Epub 2022 Aug 5.

Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.wneu.2022.07.111DOI Listing
August 2022

Timing of Colonoscopy in Acute Lower Gastrointestinal Bleeding: A Multicenter Retrospective Cohort Study.

Gastrointest Endosc 2022 Aug 2. Epub 2022 Aug 2.

Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan.

Background And Aims: We aimed to determine the optimal timing of colonoscopy and factors that benefit patients who undergo early colonoscopy for acute lower gastrointestinal bleeding.

Methods: We identified 10,342 patients with acute hematochezia (CODE BLUE-J study) admitted to 49 hospitals in Japan. Of these, 6,270 patients who underwent a colonoscopy within 120 h were included in this study. Inverse probability of treatment weighting method was used to adjust for baseline characteristics among early (≤24 h; n=4,133), elective (24-48 h; n=1,137), and late (48-120 h; n=1,000) colonoscopy. The average treatment effect was evaluated for outcomes. The primary outcome was 30-day rebleeding.

Results: The early group had a significantly higher rate of stigmata of recent hemorrhage (SRH) identification and a shorter length of stay (LOS) than the elective and late groups. However, the 30-day rebleeding rate was significantly higher in the early group than in the elective and late groups. Interventional radiology (IVR)/surgery requirement and 30-day mortality did not significantly differ among the groups. The interaction with heterogeneity of effects was observed between early/late colonoscopy and shock index (shock index <1: OR, 2.097; shock index ≥1: OR, 1.095; P for interaction=0.038) and performance status (PS) (PS 0-2: OR, 2.481; PS ≥3: OR, 0.458; P for interaction=0.022) for 30-day rebleeding. Early colonoscopy had a significantly lower IVR/surgery requirement in the shock index ≥1 cohort (OR, 0.267; 95% CI, 0.099-0.721) compared with late colonoscopy.

Conclusions: Early colonoscopy increased the rate of SRH identification and shortened LOS, but involved an increased risk of rebleeding and did not improve mortality and IVR/surgery requirement. Early colonoscopy benefited particularly patients with shock index ≥1 or performance status ≥3 at presentation.
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http://dx.doi.org/10.1016/j.gie.2022.07.025DOI Listing
August 2022

Timing of Colonoscopy in Acute Lower Gastrointestinal Bleeding: A Multicenter Retrospective Cohort Study.

Gastrointest Endosc 2022 Aug 2. Epub 2022 Aug 2.

Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan.

Background And Aims: We aimed to determine the optimal timing of colonoscopy and factors that benefit patients who undergo early colonoscopy for acute lower gastrointestinal bleeding.

Methods: We identified 10,342 patients with acute hematochezia (CODE BLUE-J study) admitted to 49 hospitals in Japan. Of these, 6,270 patients who underwent a colonoscopy within 120 h were included in this study. Inverse probability of treatment weighting method was used to adjust for baseline characteristics among early (≤24 h; n=4,133), elective (24-48 h; n=1,137), and late (48-120 h; n=1,000) colonoscopy. The average treatment effect was evaluated for outcomes. The primary outcome was 30-day rebleeding.

Results: The early group had a significantly higher rate of stigmata of recent hemorrhage (SRH) identification and a shorter length of stay (LOS) than the elective and late groups. However, the 30-day rebleeding rate was significantly higher in the early group than in the elective and late groups. Interventional radiology (IVR)/surgery requirement and 30-day mortality did not significantly differ among the groups. The interaction with heterogeneity of effects was observed between early/late colonoscopy and shock index (shock index <1: OR, 2.097; shock index ≥1: OR, 1.095; P for interaction=0.038) and performance status (PS) (PS 0-2: OR, 2.481; PS ≥3: OR, 0.458; P for interaction=0.022) for 30-day rebleeding. Early colonoscopy had a significantly lower IVR/surgery requirement in the shock index ≥1 cohort (OR, 0.267; 95% CI, 0.099-0.721) compared with late colonoscopy.

Conclusions: Early colonoscopy increased the rate of SRH identification and shortened LOS, but involved an increased risk of rebleeding and did not improve mortality and IVR/surgery requirement. Early colonoscopy benefited particularly patients with shock index ≥1 or performance status ≥3 at presentation.
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http://dx.doi.org/10.1016/j.gie.2022.07.025DOI Listing
August 2022

Cardiopulmonary arrest caused by nafamostat mesylate during hemodialysis.

Clin Case Rep 2022 Jul 25;10(7):e6140. Epub 2022 Jul 25.

Critical Care and Emergency Center National Hospital Organization Hokkaido Medical Center Sapporo Japan.

Dialysis-related adverse reactions can be serious and difficult to predict. In our case, nafamostat mesylate (NM) was thought to be the cause of cardiopulmonary arrest (CPA) due to NM-induced anaphylaxis but was not reflected in the allergy tests. Rare but life-threatening drawbacks occur immediately after hemodialysis initiation.
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http://dx.doi.org/10.1002/ccr3.6140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9314566PMC
July 2022

Prediction of depth of invasion and lymph node metastasis in superficial pharyngeal cancer by magnifying endoscopy using the Japan Esophageal Society classification.

DEN open 2023 Apr 12;3(1):e151. Epub 2022 Jul 12.

Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan.

Backgrounds: The pharynx has no muscularis mucosae, so it is unclear whether diagnostic techniques used for the esophagus can be applied to the pharynx. This study investigated the usefulness of magnifying endoscopy with narrowband imaging using the Japan Esophageal Society (JES) classification for predicting the depth of invasion and lymph node metastasis (LNM) in pharyngeal cancer.

Methods: A total of 123 superficial pharyngeal carcinoma lesions that had been observed preoperatively with magnifying endoscopy with narrowband imaging between January 2014 and June 2021 were analyzed. Predictors of subepithelial invasion (SEP) and LNM were sought based on endoscopic findings, including microvascular morphology, using the JES classification.

Results: The lesions were divided into carcinoma in situ ( = 41) and SEP ( = 82). Multivariate analysis identified B2-B3 vessels (odds ratio [OR] 6.54, 95% confidence interval [CI] 1.74-24.61,  = 0.005) and a middle/large avascular area (OR 4.15, 95% CI 1.18-14.62,  = 0.027) as independent predictors of SEP. Significant predictors of LNM were protruding type, B2-B3 vessels, middle/large avascular area, SEP, venous invasion, lymphatic invasion, and tumor thickness > 1000 μm. Median tumor thickness increased significantly in the order of B1 < B2 < B3 vessels (B1, 305 μm; B2, 1045 μm; B3, 4043 μm;  < 0.001). The LNM rates for B1, B2, and B3 vessels were 1.6% (1/63), 4.8% (2/42), and 55.6% (10/18), respectively ( < 0.001).

Conclusions: Magnifying endoscopy with narrowband imaging using the JES classification could predict the depth of invasion in superficial pharyngeal carcinoma. The JES classification may contribute to the prediction of LNM, suggesting that it could serve as an alternative to tumor thickness.
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http://dx.doi.org/10.1002/deo2.151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307742PMC
April 2023

Cooperative action of gut-microbiota-accessible carbohydrates improves host metabolic function.

Cell Rep 2022 Jul;40(3):111087

Research Center for Drug Discovery and Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo 105-8512, Japan. Electronic address:

Microbiota-accessible carbohydrates (MACs) exert health-promoting effects, but how each MAC impacts gut microbiota and regulates host physiology remains unclear. Here, we show that l-arabinose and sucrose cooperatively act on gut microbiota and exert anti-obesogenic effects. Specifically, l-arabinose, a monosaccharide that is poorly absorbed in the gut and inhibits intestinal sucrase, suppresses diet-induced obesity in mice in the presence of sucrose. Additionally, the suppressive effect of l-arabinose on adiposity is abrogated in mice lacking the short-chain fatty acid (SCFA) receptors GPR43 and GPR41. Mechanistically, l-arabinose increases the relative abundance of acetate and propionate producers (e.g., Bacteroides), while sucrose enhances SCFA production. Furthermore, l-arabinose and sucrose activate the glycolytic and pentose phosphate pathways of Bacteroides, respectively, indicating that they synergistically promote acetate production through distinct pathways. These findings suggest that each MAC has a unique property and thus may serve as a precision gut-microbiota modulator to promote host homeostasis.
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http://dx.doi.org/10.1016/j.celrep.2022.111087DOI Listing
July 2022

Responsiveness and minimal clinically important differences of the Trunk Assessment Scale for Spinal Cord injury (TASS).

J Spinal Cord Med 2022 Jul 1:1-9. Epub 2022 Jul 1.

Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan.

Objective: To confirm the responsiveness and minimal clinically important differences (MCIDs) of the Trunk Assessment Scale for Spinal Cord Injury (TASS).

Participants And Methods: We evaluated 48 Japanese individuals with spinal cord injury (SCI) (age 64.1 ± 10.4 yrs, 28 with tetraplegia) admitted to two institutions at admission, at 1 month of hospitalization, and at discharge with the TASS, the Trunk Control Test in individuals with an SCI (TCT-SCI) motor score, the Functional Independence Measure motor score (mFIM), and the Global Rating of Change Scale (GRCS). We assessed the TASS responsiveness by determining the correlation coefficients for the changes in the TASS' and other assessments' scores. We calculated the MCIDs by five anchor-based methods.

Results: The changes in the TASS and those in the other assessments were weakly correlated at 1 month and moderately correlated at discharge. The TASS MCIDs were observed at 1 month and at discharge.

Conclusion: Our findings confirmed that the change in TASS scores had weak-to-moderate correlations with the changes in the participants' upper- and lower-limb function and activities of daily living. Using the MCID for the TASS determined by anchor-based methods may lead to a better interpretation of changes in the trunk function of individuals with SCIs.
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http://dx.doi.org/10.1080/10790268.2022.2087138DOI Listing
July 2022

Risk scoring system for the pre-procedural prediction of clinical failure of peroral endoscopic myotomy: a multicenter case-control study.

Endoscopy 2022 Jun 15. Epub 2022 Jun 15.

Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan.

Background and study aims Peroral endoscopic myotomy (POEM) is effective for the management of achalasia and its variants. However, this treatment can be ineffective in some patients. We aimed to develop and validate a risk scoring system for predicting the clinical failure of POEM preoperatively. Patients and methods Consecutive patients who underwent POEM in 14 high-volume centres between 2010 and 2020 were enrolled in this study. Clinical failure was defined as an Eckardt score of ≥4 or retreatment. A risk scoring system for predicting short-term clinical failure of POEM was developed using multivariable logistic regression and internally validated using bootstrapping and decision curve analysis. Results Of the 2740 study patients, 112 patients (4.1%) had clinical failure 6 months after POEM. Risk scores were assigned for three preoperative factors as follows: preoperative Eckardt score (1 point), manometric diagnosis (-4 points for type II achalasia), and a history of prior treatments (1 point for pneumatic dilation or 12 points for surgical/endoscopic myotomy). The discriminative capacity (concordance statistics, 0.68; 95% confidence interval [CI], 0.62-0.72) and calibration (slope 1.15; 95% CI, 0.87-1.40) were shown. Decision curve analysis demonstrated its clinical usefulness. Patients were categorized into low- (0-8 points: estimated risk of clinical failure <5%) and high-risk (9-22 points: ≥5%) groups. The proportions of clinical failure for the categories were stratified according to the mid-term outcomes (log-rank test; p<0.0001). Conclusions This risk scoring system can predict clinical failure of POEM preoperatively and provide useful information for making treatment decisions.
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http://dx.doi.org/10.1055/a-1876-7554DOI Listing
June 2022

Favorable control of hepatocellular carcinoma with peritoneal dissemination by surgical resection using indocyanine green fluorescence imaging: a case report and review of the literature.

J Med Case Rep 2022 Jun 6;16(1):222. Epub 2022 Jun 6.

Department of Gastroenterological Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.

Background: The optimal management for peritoneal dissemination in patients with hepatocellular carcinoma remains unclear. Although several reports have described the usefulness of surgical resection, the indications should be carefully considered. Herein, we report the case of a patient with hepatocellular carcinoma with peritoneal recurrence who underwent surgical resection using an indocyanine green fluorescence navigation system and achieved favorable disease control.

Case Presentation: A 45-year-old Asian woman underwent left hemihepatectomy for a ruptured hepatocellular carcinoma. Seventeen months after the initial surgery, a single nodule near the cut surface of the liver was detected on computed tomography, along with elevation of tumor markers. The patient was diagnosed with peritoneal metastasis and underwent a surgical resection. Twelve months later, a single nodule on the dorsal side of the right hepatic lobe was detected on computed tomography, and we performed surgical resection. Indocyanine green (0.5 mg/kg) was intravenously administered 3 days before surgery, and the indocyanine green fluorescence imaging system revealed clear green fluorescence in the tumor, which helped us perform complete resection. Indocyanine green fluorescence enabled the detection of additional lesions that could not be identified by preoperative imaging, especially in the second metastasectomy. There was no further recurrence at 3 months postoperatively.

Conclusion: When considering surgical intervention for peritoneal recurrence in patients with hepatocellular carcinoma, complete resection is mandatory. Given that disseminated nodules are sometimes too small to be detected by preoperative imaging studies, intraoperative indocyanine green fluorescence may be an essential tool for determining the indications for surgical resection.
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http://dx.doi.org/10.1186/s13256-022-03440-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169282PMC
June 2022

Efficacy of peroral endoscopic myotomy for esophageal motility disorders after gastric surgery: Japan Achalasia Multicenter Study.

Dig Endosc 2022 Jun 2. Epub 2022 Jun 2.

Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.

Objectives: Patients with esophageal motility disorders (EMDs) including achalasia after gastric surgery have not been thoroughly characterized. Furthermore, the efficacy of peroral endoscopic myotomy (POEM) in this population should be clarified.

Methods: In this retrospective multicenter study of 3707 patients with EMDs, 31 patients (0.8%) had a history of gastric surgery. Patient characteristics and POEM efficacy were compared between patients with and without previous gastric surgery.

Results: In patients with EMD after gastric surgery, age at EMD diagnosis was higher (72.0 years), male sex was predominant (90.3%), and the American Society of Anesthesiologists physical status score was higher (≥II, 48.4%). High-resolution manometry (HRM) findings did not reveal significant differences. In patients who underwent gastric surgery, atrophic gastritis was common (80.6%), and gastric cancer was the primary surgical indication (32.3%). Distal gastrectomy was performed in 28 patients (90.3%). POEM was effective (3.3% adverse events; 100% treatment success). The incidence rates of reflux esophagitis (RE) and symptomatic gastroesophageal reflux disease (GERD) were 60.0% and 16.7%, respectively, without significant intergroup differences, and severe RE was not observed in the long-term follow-up. Extended gastric myotomy was a risk factor for RE.

Conclusion: Patients with gastric surgery often present severe disease manifestations; the surgical indication is mainly gastric cancer. HRM findings can be similarly used for diagnosis in patients with and without gastric surgery. POEM maintains safety and efficacy with acceptable RE and symptomatic GERD rates. To prevent RE, extended myotomy should be avoided.
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http://dx.doi.org/10.1111/den.14369DOI Listing
June 2022

Feasibility of local therapy for recurrent pancreatic cancer.

Pancreatology 2022 May 24. Epub 2022 May 24.

Department of Gastroenterological Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.

Background: Despite advances in perioperative management, recurrence after curative pancreatectomy is a critical issue in the treatment of pancreatic ductal adenocarcinoma (PDAC). The significance of local therapy for recurrent PDAC remains unclear.

Methods: We reviewed the medical records of patients with PDAC who underwent curative resection at our institution between January 2009 and December 2019. We examined the patterns of relapse and assessed the clinical outcomes of patients with recurrence who underwent local therapy, including surgical resection, radiotherapy, and radiofrequency ablation.

Results: A total of 246 patients with PDAC who underwent R0 or R1 resection were included in this study. The 3-year overall survival (OS) rate was 39.8%, and the 1-year recurrence-free survival rate was 51.2% for the entire population. Recurrence was observed in 172/246 (69.9%) patients, including multiple site recurrences in 50, liver metastasis in 41, locoregional recurrence in 34, and peritoneal dissemination in 27. Of the 172 patients, treatment was administered in 137 (79.7%), and 16 received local therapy, including surgical resection (n = 13), radiotherapy (n = 5), and RFA (n = 1). PS-matched analysis revealed that patients with recurrence who were treated with chemotherapy combined with local therapy showed better post-recurrence survival rates than those treated with chemotherapy alone (P = 0.016). Detailed clinical courses of these patients are presented in the main manuscript.

Conclusions: Our results suggest that a multimodal approach may improve the clinical outcomes of patients with recurrent PDAC.
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http://dx.doi.org/10.1016/j.pan.2022.05.004DOI Listing
May 2022

Adenomatoid mesothelioma arising from the diaphragm: a case report and review of the literature.

J Med Case Rep 2022 May 30;16(1):228. Epub 2022 May 30.

Department of Gastroenterological Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.

Background: Adenomatoid mesothelioma is a rare subtype of malignant mesothelioma that can be confused with adenomatoid tumors, which are classified as benign. The clinical features and optimal management of adenomatoid mesothelioma have not been elucidated in the literature. In this report, we present an extremely rare case of adenomatoid mesothelioma that developed on the peritoneal surface of the diaphragm as well as a literature review of adenomatoid mesothelioma in the abdominal cavity.

Case Presentation: The patient was a 61-year-old Japanese woman who had undergone resection of a malignant peripheral nerve sheath tumor of the hand 18 years prior. She was diagnosed with clinical stage I lung adenocarcinoma on follow-up chest radiography. Simultaneously, a 20-mm enhancing nodule with slow growth on the right diaphragm was detected on contrast-enhanced computed tomography. She presented no specific clinical symptoms. At this point, the lesion was suspected to be a hypervascular tumor of borderline malignancy, such as a solitary fibrous tumor. After a left upper lobectomy for lung adenocarcinoma, she was referred to our department, and laparoscopic tumor resection was performed. Adenomatoid tumors were also considered based on the histopathological and immunohistochemical analyses, but we made the final diagnosis of adenomatoid mesothelioma using the results of the genetic profile. The patient remains alive, with no recurrence noted 6 months after surgery.

Conclusion: We encountered a valuable case of adenomatoid mesothelioma of peritoneal origin. There are some previously reported cases of adenomatoid mesothelioma and adenomatoid tumors that may need to be recategorized according to the current classification. It is important to accumulate and share new findings to clarify the clinicopathological characteristics and genetic status of adenomatoid mesothelioma.
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http://dx.doi.org/10.1186/s13256-022-03420-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9150286PMC
May 2022

Novel large deletion involving EVC and EVC2 in Ellis-van Creveld syndrome.

Hum Genome Var 2022 May 17;9(1):15. Epub 2022 May 17.

Department of Pediatrics, Tokushima University Hospital, Kuramotocho, Tokushima, Japan.

Ellis-van Creveld syndrome is an autosomal recessive skeletal dysplasia that is characterized by thoracic hypoplasia, polydactyly, oral abnormalities, and congenital heart disease. It is caused by pathogenic variants in the EVC or EVC2 genes. We report a case of a newborn with a compound heterozygous variant comprising NM_147127.5: c.1991dup:[p.Lys665Glufs*10] in the EVC2 gene and a novel large deletion involving exon 1 in EVC and exons 1-7 in EVC2.
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http://dx.doi.org/10.1038/s41439-022-00190-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9114401PMC
May 2022

Risks of refractory chest pain after peroral endoscopic myotomy in achalasia-related esophageal motility disorders: short-term results from a multicenter study in Japan.

Gastrointest Endosc 2022 May 11. Epub 2022 May 11.

Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo.

Background And Aims: The etiology of chest pain in achalasia-related esophageal motility disorders (AEMDs) and the frequency and risk factors of persistent chest pain after peroral endoscopic myotomy (POEM) remain unclear.

Methods: A multicenter cohort study including 14 hospitals was conducted to elucidate the characteristics of patients with chest pain and the efficacy of POEM.

Results: Consecutive cases of AEMDs included 2,294 (64.2%) and 1,280 (35.8%) patients with and without chest pain, respectively. Among the 2,107 patients with chest pain who underwent POEM, we observed complete remission in 1,464 patients (69.5%) and non-remission in 643 patients (30.5%) including partial response in 619 patients (29.4%) and resistance in 24 patients (1.1%). Multivariate analysis revealed that advanced age (odds ratio [OR]:0.28), male sex (OR:0.70), prior treatment (OR:1.39), and sigmoid type (OR:0.65) were related to the prevalence of chest pain. Long disease duration (OR:0.69) and esophageal dilation (OR:0.79) were related with decreased severity. POEM improved patients' quality of life that was hindered by chest pain. Early onset (OR:1.45), advanced age (OR:0.58), male sex (OR:0.79), prior treatment (OR:1.37), and posterior myotomy (OR:1.42) were associated with non-remission after POEM; high-resolution manometry (HRM) findings and myotomy length showed no statistical significance on pain etiology and persistence after POEM.

Conclusions: The prevalence and severity of chest pain were dependent on age, sex, disease duration, prior treatment, and esophageal morphology, rather than HRM findings. The efficacy of POEM is satisfactory; however, residual pain was often observed. Excessively long myotomy can be avoided, and anterior myotomy may be recommended.
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http://dx.doi.org/10.1016/j.gie.2022.04.1347DOI Listing
May 2022

Randomized single-blind comparative study of the midazolam/pethidine combination and midazolam alone during bronchoscopy.

BMC Cancer 2022 May 12;22(1):539. Epub 2022 May 12.

Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.

Background: Bronchoscopy can be a distress for the patient. There have been few studies on the combination of sedatives and opioids. The aim of this study was to demonstrate the usefulness and safety of administration of the combination of midazolam and pethidine during bronchoscopy.

Methods: In this prospective randomized single (patient)-blind study, we randomly assigned 100 patients who were scheduled to undergo bronchoscopy biopsy to receive treatment with either the midazolam/pethidine combination (combination group) or midazolam alone (midazolam group) during examinations. After the end of bronchoscopy, patients completed a questionnaire and the visual analogue scale was measured. The primary outcome was the patients' acceptance of re-examination assessed by visual analogue scale. We also assessed pain levels, vital signs, midazolam use, xylocaine use, and adverse events. Univariate analyses were performed using Fisher's exact test for categorical data, and the t-test or Mann-Whitney test was carried out for analysis of numeric data. All P-values were two-sided, and values < 0.05 were considered statistically significant.

Results: We analyzed 47 patients in the combination group and 49 patients in the midazolam group. The primary outcome was a good trend in the combination group, but not significantly different (3.82 ± 2.3 in combination group versus 4.17 ± 2.75 in midazolam alone, P = 0.400). In the combination group, the visual analog scale score for pain during bronchoscopy was significantly lower (1.10 ± 1.88 versus 2.13 ± 2.42, P = 0.022), and the sedation level score per the modified observer's assessment of alertness/sedation scale was significantly deeper (3.49 ± 0.98 versus 3.94 ± 1.03, P = 0.031). Maximal systolic blood pressure during testing was significantly lower (162.39 ± 23.45 mmHg versus 178.24 ± 30.24 mmHg, P = 0.005), and the number of additional administrations of midazolam was significantly lower (2.06 ± 1.45 versus 2.63 ± 1.35, P = 0.049). There were also significantly fewer adverse events (30 versus 41, P = 0.036).

Conclusions: The combination uses of midazolam and pethidine for sedation resulted in significant improvements in the pain, blood pressure, additional use of midazolam, and safety during bronchoscopy among patients.

Trial Registration: This study was registered in the University Medical Hospital Information Network in Japan (UMINCTR Registration number: UMIN000032230 , Registered: 13/April/2018).
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http://dx.doi.org/10.1186/s12885-022-09640-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9102220PMC
May 2022

Potential efficacy of multipoint pacing in the reduction of mitral regurgitation volume: a case report.

ESC Heart Fail 2022 Aug 28;9(4):2724-2727. Epub 2022 Apr 28.

Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan.

A 70-year-old woman who had cardiac sarcoidosis and severe tethering mitral regurgitation (MR) and had been implanted with a biventricular pacemaker experienced recurrent hospitalisation due to decompensated heart failure (HF). Application of MultiPoint™ pacing reduced the MR volume and maintained the symptoms under control; however, the predicted longevity of the device significantly decreased because of the very high threshold of the added pacing site. Transcatheter mitral valve repair (TMVR) using MitraClip® was performed to further diminish the severe MR, thereby enabling the switch from highly consumptive multipoint pacing (MPP) to energy-saving single-point pacing. MPP could further reduce MR compared to the conventional single-point pacing, and this could be a bridging therapy to TMVR in some patients implanted with a biventricular pacemaker. This is the first case to report that switching from conventional single-point pacing to MPP decreased the MR, to some extent, resulting in the improvement of HF symptoms.
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http://dx.doi.org/10.1002/ehf2.13944DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288779PMC
August 2022

Correlation Among Body Composition Parameters and Long-Term Outcomes in Crohn's Disease After Anti-TNF Therapy.

Front Nutr 2022 1;9:765209. Epub 2022 Apr 1.

Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan.

Background: The impact of the body composition on the pathophysiology and clinical course of Crohn's disease (CD) has not been fully elucidated.

Aims: To reveal the correlations among body composition and long-term outcomes in CD after anti-TNF therapy.

Methods: patients who received anti-TNF therapy as their first biologic treatment were enrolled. The skeletal muscle index (SMI), visceral and subcutaneous fat area (VFA, SFA), and the ratio of the VFA to SFA (mesenteric fat index; MFI) at the 3 lumbar level were measured using computed tomography (CT) imaging before the induction. The correlation among the body composition and outcomes were retrospectively analyzed.

Results: The 5-year cumulative secondary failure- and resection-free rates in patients with a low SMI (39.1% and 64.8%) were significantly lower than those with a high SMI (67.5% and 92.7%; = 0.0071 and 0.0022, respectively). The 5-year cumulative secondary failure-free rate in the patients with low VF (45.0%) was significantly lower than that in those with high VF (77.6%; = 0.016), and the 5-year cumulative resection-free rate in patients with a high MFI (68.9%) was significantly lower than that in those with a low MFI (83.0%; = 0.031). Additionally, patients with low age and BMI had significantly lower cumulative secondary failure- and resection-free rates than those with high age and BMI (low age: 37.4% and 71.2%; high age: 70.7% and 88.9%; = 0.0083 and 0.027, respectively) (low BMI: 27.2% and 64.8%; high BMI: 68.3% and 87.9%; = 0.014 and 0.030, respectively), respectively. In the multivariate analyses, a low SMI was the only independent risk factor for secondary failure (hazard ratio [HR] 2.15, 95% confidence interval [CI] 1.04-4.44), while low age (HR 4.06, 95% CI 1.07-15.4), a low SMI (HR 4.19, 95% CI 1.01-17.3) and high MFI were risk factors for bowel resection (HR 4.31, 95% CI 1.36-13.7).

Conclusion: The skeletal muscle mass and ratio of visceral to subcutaneous fat were suggested to reflect the long-term clinical outcome and may be helpful as prognostic markers after anti-TNF therapy in CD.
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http://dx.doi.org/10.3389/fnut.2022.765209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010511PMC
April 2022

High capacity all-solid-state lithium battery enabled by formation of an ionic conduction path by lithiation of MgH.

RSC Adv 2022 Mar 6;12(17):10749-10754. Epub 2022 Apr 6.

Institute for Materials Chemistry and Engineering, Kyushu University Kasuga-koen 6-1 Kasuga 816-8580 Japan

All-solid-state Li batteries have attracted significant attention because of their high energy density and high level of safety. In a solid-state Li-ion battery, the electrodes contain a solid electrolyte that does not contribute directly to the capacity. Therefore, a battery that does not require a solid electrolyte in its electrode mixture should exhibit a higher energy density. In this study, a MgH electrode was used as the negative electrode material without a solid electrolyte in its mixture. The resultant battery demonstrated excellent performance because of the formation of an ionic conduction path based on LiH in the electrode mixture. LiH and Mg clearly formed upon lithiation and returned to MgH upon delithiation as revealed by TEM-EELS analysis. This mechanism of electrolyte formation enables the development of a solid-state battery with a high energy density.
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http://dx.doi.org/10.1039/d2ra01199aDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984686PMC
March 2022

Factors affecting the recruitment of new obstetrician-gynecologists in Japan: A report of the MIRAI Committee of the Japanese Society of Obstetrics and Gynecology.

J Obstet Gynaecol Res 2022 Jul 12;48(7):1961-1967. Epub 2022 Apr 12.

Department of Reproductive Medicine, Chiba University, Chiba, Japan.

Aim: There is a chronic shortage of obstetrician-gynecologists in Japan. To increase the number of obstetrician-gynecologists, it is crucial to increase the number of residents being recruited. The purpose of this study was to identify the factors that led students and interns to specialize in obstetrics and gynecology through a questionnaire survey.

Methods: We sent a questionnaire to the obstetrics and gynecology departments of all the medical schools in Japan (N = 81) and collected data about the institutional background, including the location, total number of obstetrician-gynecologists employed, and number of newly joined obstetrics-gynecology residents and resigned obstetrician-gynecologists and the educational and recruitment activities for medical students and interns. The net balance (increased or decreased) over the fiscal years 2013-2015 was considered a surrogate marker for the number of newly joined obstetrics-gynecology residents. We used binomial logistic regression analysis to determine the factors related to a positive net balance of obstetrician-gynecologists.

Results: We obtained responses from 59 (72.8%) medical schools. Medical students who observed deliveries were more likely to become obstetrician-gynecologists than those who did not (95% confidence interval: 1.000-1.045, p = 0.052). Medical school location (rural or urban), providing medical students with preparatory lectures for national board examinations, and providing interns with experience as the first assistant during surgery were not associated with an increase in the number of newly joined obstetrician-gynecologists.

Conclusions: The experience of observing deliveries may encourage medical students to become obstetrician-gynecologists.
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http://dx.doi.org/10.1111/jog.15263DOI Listing
July 2022

Transoral Endoscopic Examination of the Oropharynx With Tongue Protrusion, Phonation, and Open Mouth.

Cancer Diagn Progn 2021 Nov-Dec;1(5):427-434. Epub 2021 Nov 3.

Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan.

Background/aim: We examined the diagnostic performance of the tongue protrusion with phonation and open mouth (TOPPOM) method for visualizing structures of the oropharynx.

Patients And Methods: Transoral endoscopy was performed on 20 healthy participants to evaluate 12 oropharynx subsites under three conditions: open mouth (OM), phonation with open mouth (POM), and TOPPOM. Each subsite was scored from 0 to 2 depending on subsite visualization, and the scores were summed. Images of subsite-adjacent mucosa were similarly scored.

Results: The total scores were significantly higher for TOPPOM than for POM and for POM than for OM. Such scores were observed for both the palatine arches, both palatine tonsils, the left lingual tonsillar sulcus, and the vallecula.

Conclusion: TOPPOM enables visualization of the oropharynx through transoral endoscopic examination, and TOPPOM with conventional transnasal endoscopy may enable early detection of oropharyngeal carcinomas and lesions and improve the performance of pre- and post-treatment evaluations.
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http://dx.doi.org/10.21873/cdp.10057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8962863PMC
November 2021

Esophageal Diverticulum - Indications and Efficacy of Therapeutic Endoscopy.

Intern Med 2022 1;61(7):943-949. Epub 2022 Apr 1.

Division of Gastroenterology, Niigata University Faculty of Medical Graduate School of Medical and Dental Science, Japan.

Objective Esophageal diverticulum is rare, and the concomitance of esophageal motility disorders (EMDs) and the efficacy of novel endoscopic treatment have not been investigated in Japan. Methods An examination including high-resolution manometry (HRM) was performed for patients with both EMDs and epiphrenic diverticulum. EMD-related epiphrenic diverticulum and Zenker's diverticulum were treated using salvage peroral endoscopic myotomy (s-POEM) and endoscopic diverticulotomy, respectively. Results Six cases of epiphrenic diverticulum were diagnosed in this study. Among 125 patients with achalasia and spastic disorders, concomitant epiphrenic diverticulum was observed in 4 (3.2%). Of these, three showed a normal lower esophageal sphincter pressure on HRM, although gastroscopy and esophagography revealed typical findings of an impaired lower esophageal sphincter relaxation. These four patients were successfully treated with s-POEM, and the Eckardt score improved from 6.3 to 0.25 at 32.5 (range: 13-56) months of follow-up, with equivalent treatment efficacy to that observed for achalasia and spastic disorders without epiphrenic diverticulum. In contrast, the two remaining cases of epiphrenic diverticulum had normal esophageal motility. Six cases of Zenker's diverticulum were diagnosed, and endoscopic diverticulotomy was successfully performed in all. The dysphagia score decreased from 2.8 to 0.17 at 14.8 (range: 2-36) months of follow-up. Overall, 12 endoscopic treatments were performed for esophageal diverticulum; no adverse events were observed. Conclusion In epiphrenic diverticulum patients, concomitant EMDs are not rare and should be carefully diagnosed. A normal lower esophageal sphincter pressure on HRM does not always mean a normal lower esophageal sphincter relaxation. S-POEM and endoscopic diverticulotomy are effective minimally invasive treatment options for EMD-related epiphrenic diverticulum and Zenker's diverticulum.
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http://dx.doi.org/10.2169/internalmedicine.8196-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9038461PMC
April 2022

Development of Dilated Esophagus, Sigmoid Esophagus, and Esophageal Diverticulum in Patients With Achalasia: Japan Achalasia Multicenter Study.

J Neurogastroenterol Motil 2022 Apr;28(2):222-230

Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.

Background/aims: Patients with achalasia-related esophageal motility disorders (AEMDs) frequently present with dilated and sigmoid esophagus, and develop esophageal diverticulum (ED), although the prevalence and patients characteristics require further elucidation.

Methods: We conducted a multicenter cohort study of 3707 patients with AEMDs from 14 facilities in Japan. Esophagography on 3682 patients were analyzed.

Results: Straight (n = 2798), sigmoid (n = 684), and advanced sigmoid esophagus (n = 200) were diagnosed. Multivariate analysis revealed that long disease duration, advanced age, obesity, and type I achalasia correlate positively, whereas severe symptoms and integrated relaxation pressure correlate negatively with development of sigmoid esophagus. In contrast, Grade II dilation (3.5-6.0 cm) was the most common (52.9%), while grade III dilation (≥ 6 cm) was rare (5.0%). We found early onset, male, obesity, and type I achalasia correlated positively, while advanced age correlated negatively with esophageal dilation. Dilated and sigmoid esophagus were found mostly in types I and II achalasia, but typically not found in spastic disorders. The prevalence of ED was low (n = 63, 1.7%), and non-dilated esophagus and advanced age correlated with ED development. Patients with right-sided ED (n = 35) had a long disease duration ( = 0.005) with low integrated relaxation pressure values ( = 0.008) compared with patients with left-sided ED (n = 22). Patients with multiple EDs (n = 6) had lower symptom severity than patients with a single ED ( = 0.022).

Conclusions: The etiologies of dilated esophagus, sigmoid esophagus, and ED are considered multifactorial and different. Early diagnosis and optimal treatment of AEMDs are necessary to prevent these conditions.
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http://dx.doi.org/10.5056/jnm21188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8978127PMC
April 2022

Serum IL-28A/IFN-λ2 is linked to disease severity of COVID-19.

Sci Rep 2022 03 31;12(1):5458. Epub 2022 Mar 31.

Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, 142-8666, Japan.

Type III interferons (IFNs) play an important role in respiratory viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to determine whether the expression of serum type III IFNs predicted disease severity among patients with the coronavirus disease (COVID-19). A retrospective cohort study was conducted of patients admitted to a single hospital between March 21, 2020, and March 31, 2021. Patients were divided into mild to moderate I (MM) and moderate II to severe (MS) groups based on the COVID-19 severity classification developed by the Japanese Ministry of Health, Labor and Welfare. A total of 257 patients were included in the analysis. Human interleukin-28A (IL-28A/IFN-λ2) expression was significantly lower, and interleukin (IL)-6 expression was significantly higher in the MS group than in the MM group (both p < 0.001). In addition, IL-28A/IFN-λ2 was statistically significantly inversely correlated with the time from disease onset to negative SARS-CoV-2 PCR results (p = 0.049). Multivariable logistic regression analysis showed that IL-28A/IFN-λ2 was an independent predictor of disease severity (p = 0.021). The low expression of IL-28A/IFN-λ2 may serve as a serum biomarker that predicts the severity of COVID-19, possibly through the mechanism of delayed viral elimination.
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http://dx.doi.org/10.1038/s41598-022-09544-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8969403PMC
March 2022

Utility of autologous fecal microbiota transplantation and elucidation of microbiota in diversion colitis.

DEN open 2022 Apr 31;2(1):e63. Epub 2021 Oct 31.

Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University Niigata Japan.

Objectives: Diversion colitis (DC) is an inflammatory disorder caused by interruption of the fecal stream and subsequent nutrient deficiency from luminal bacteria. The utility of fecal microbiota transplantation (FMT) for DC was recently investigated; however, the precise pathogenesis of this condition remains unclear. This study aimed to evaluate the utility of autologous FMT in DC and to determine the related changes in the intestinal microbiota.

Methods: Autologous FMT was performed to reestablish the intestinal microbiota in five patients (average age, 64.6 ± 8.3 years) with DC. They underwent double-ended colostomy. We assessed the diverted colon by endoscopy and evaluated the microbiota before and after FMT using the 16S rRNA gene sequencing method.

Results: All five patients had mild inflammation (ulcerative colitis endoscopic index of severity [UCEIS] 2-3) in the diverted colon based on the colonoscopic findings. Three patients presented with symptoms, such as tenesmus, mucoid stool, and bloody stool. With FMT treatment, all patients achieved endoscopic remission (UCEIS score of 0 or 1) and symptomatic improvement. We observed a significantly decreased α-diversity in DC patients compared to healthy controls. The frequency of aerobic bacteria, such as , in the diverted colon decreased after autologous FMT.

Conclusions: This study was the first to show that the microbiota in the diverted colon was significantly affected by autologous FMT. Since interruption of the fecal stream is central to the development of DC, FMT can be considered a promising treatment.
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http://dx.doi.org/10.1002/deo2.63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8828251PMC
April 2022

Reliability and minimal detectable change of the Trunk Assessment Scale for Spinal Cord Injury (TASS) and the trunk control test for individuals with spinal cord injury.

Spinal Cord Ser Cases 2022 03 12;8(1):30. Epub 2022 Mar 12.

Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-gun, Ibaraki, 300-0331, Japan.

Study Design: Cross-sectional study.

Objectives: To evaluate the reliability and calculate the measurement error of the Trunk Assessment Scale for Spinal Cord Injury (TASS) and trunk control test (TCT-SCI) in individuals with spinal cord injury (SCI).

Setting: Rehabilitation Hospital in Japan.

Methods: The evaluations of TASS and TCT-SCI for individuals with SCI were video-recorded. The inter-rater reliability (two physiotherapists) was confirmed using the videos. ICC (2,1), kappa coefficient (κ) were used to determine the reliability of the total score and each item. Each minimal detectable change (MDC) was calculated.

Results: The TASS and TCT-SCI total scores showed excellent inter-rater reliability (ICC = 0.99, and 1.00). The kappa coefficients of TASS were acceptable to excellent for 8 items (κ = 0.76-1.00), below acceptable for 1 item (κ = 0.62). The kappa coefficients of TCT-SCI were excellent for 12 items (κ = 0.83-1.00), below acceptable for 1 item (κ = 0.68). The inter-rater MDC of the TASS total score was 4.07 points, and the MDC of the TCT-SCI total score was 1.13 points. The intra-rater MDC of the TASS total score was 3.86 points.

Conclusion: Both TASS and TCT-SCI showed high reliability. Differences of less than four points in TASS and one point in TCT-SCI were interpreted as measurement errors between the two raters.
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http://dx.doi.org/10.1038/s41394-022-00502-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8918346PMC
March 2022

Postoperative Complications and Swallowing Function after Jejunal and Skin Flap Reconstruction for Hypopharyngeal Carcinoma-A Multicenter Retrospective Study.

J Clin Med 2022 Mar 7;11(5). Epub 2022 Mar 7.

Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo 160-0023, Japan.

This study compared the incidence of perioperative complications and swallowing function between free jejunal flap reconstruction and cutaneous free tissue flap construction. We included 223 patients who underwent hypopharyngeal reconstruction using free flap. At discharge, +the free jejunal flap was associated with a Functional Oral Intake Scale (FOIS) score of 1-6 in 132 cases (70%) and a score of 7 in 56 cases (30%). Regarding the cutaneous free tissue flaps, FOIS scores of 1-6 were observed in 18 cases (51%), and a score of 7 was noted in 17 cases (49%). Donor site complications occurred in 12% of the patients who underwent free jejunal flap procedures and in none of the patients who underwent cutaneous free tissue flap procedures. We found that the free jejunal flap had a regular dietary intake rate in 56 patients (30%), whereas cutaneous free tissue flaps had a regular dietary intake rate in 17 patients (49%). Cutaneous free tissue flaps had a significantly higher regular dietary intake rate at discharge and a significantly lower incidence of donor site complications than free jejunal flaps. In conclusion, free-flap reconstruction may be a better method than free jejunal flap reconstruction for the treatment of hypopharyngeal cancer.
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http://dx.doi.org/10.3390/jcm11051464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8910937PMC
March 2022

Clinical presentation and therapeutic outcome of patients with jackhammer esophagus-a multicenter cohort study in Japan.

Esophagus 2022 07 6;19(3):393-400. Epub 2022 Mar 6.

Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Bunkyo-Ku Tokyo, Japan.

Background: Jackhammer esophagus (JE) is a hypercontractile esophageal motility disorder diagnosed using high-resolution manometry (HRM). We sought to determine the clinical presentation and therapeutic data of patients with JE in Japan.

Methods: The study included patients with JE, diagnosed through HRM performed for suspicious esophageal motility disorders. Demographics, esophagogastroduodenoscopy, radiology, and therapy data were collected from patient charts.

Results: Among the 4,412 HRM tests performed, 89 patients (61.6 ± 13.4 years; 64 males, 25 females) were diagnosed with JE (2.0%). Dysphagia was the most frequent symptom (80%), followed by chest pain (40%) and heartburn (25%). Esophagogastroduodenoscopy showed abnormal findings in 32% of patients: corkscrew/rosary beads appearance in 26%, narrowing in 11%. Eosinophilic infiltration (> 15 eosinophils/high power field) was diagnosed in 21%. Esophagography showed abnormal findings in 9% of the patients. For the initial therapy, 47 patients received medical treatment followed by peroral endoscopic myotomy (21 patients) and laparoscopic myotomy (two patients). Thirteen patients did not receive any treatment and 10 of those (77%) reported spontaneous resolution of symptoms. Patients who required invasive treatment experienced severe disability in their quality of life and greater maximal distal contractile integral than those who did not.

Conclusions: HRM showed that the prevalence of JE was very low (2%). Esophagogastroduodenoscopy revealed some characteristic features of JE in patients. Some patients showed improvement of symptoms without invasive treatments. Follow-up with/without medical treatment should be considered before performing invasive treatment in patients whose distal contractile integral is relatively low and the quality of life is not impaired.
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http://dx.doi.org/10.1007/s10388-022-00916-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9166863PMC
July 2022

A Case of Recurrent Metastatic Parotid Acinic Cell Carcinoma Responsive to Pembrolizumab.

In Vivo 2022 Mar-Apr;36(2):1047-1051

Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan.

Background: No clear chemotherapy regimen for recurrent or metastatic parotid cancer exists. We describe our experience with pembrolizumab to treat recurrent or metastatic parotid cancer.

Case Report: A 73-year-old woman with swelling in the lower part of the right ear for 10 years before surgery was diagnosed with right parotid cancer, underwent total right parotidectomy, and reported recurrence. She requested treatment due to diminished quality of life caused by neurological symptoms. Tissue was collected from the recurrent lesion and its combined positive score was >20; pembrolizumab was started 9 years postoperatively.

Results: To date, the patient has received 14 cycles of pembrolizumab. Evaluation by computed tomography showed a partial response to treatment. The only immune-related adverse event was grade 1 pneumonia in both lungs.

Conclusion: Significant response to pembrolizumab in recurrent or metastatic parotid cancer is rarely reported, making this a remarkable case. We plan to continue pembrolizumab administration.
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http://dx.doi.org/10.21873/invivo.12801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8931906PMC
March 2022

Surgical resection of mixed neuroendocrine-non-neuroendocrine neoplasm in the biliary system: a report of two cases.

Surg Case Rep 2022 Mar 2;8(1):38. Epub 2022 Mar 2.

Department of Gastroenterological Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.

Background: Mixed neuroendocrine-non-neuroendocrine neoplasm (MINEN) is a rare disease and there is scarce literature on its diagnosis, treatment, and prognosis. We encountered two unusual cases of MINEN in the biliary tract, one in the ampulla of Vater and the other in the distal bile duct. In this report, we describe the clinical course of these two cases in detail.

Case Presentation: Case 1: A 69-year-old woman presented with a chief complaint of epigastric pain. When endoscopic sphincterotomy and retrograde biliary drainage were performed for gallstone pancreatitis, an ulcerated lesion was found in the ampulla of the Vater. Based on the biopsy results, the lesion was diagnosed as the ampulla of Vater carcinoma and subtotal stomach-preserving pancreatoduodenectomy (SSPPD) was performed. Postoperative histopathological examination revealed the coexistence of adenocarcinoma and neuroendocrine carcinoma components, consistent with the diagnosis of MINEN. In addition, lymph node metastasis was found on the dorsal side of the pancreas and the metastatic component was adenocarcinoma. Adjuvant chemotherapy with etoposide and cisplatin was administered for 6 months, and presently the patient is alive without recurrence 64 months after surgery. Case 2: A 79-year-old man presented with a chief complaint of anorexia. Cholangiography showed severe stenosis of the distal bile duct. A biopsy was conducted from the stenotic lesion and it revealed the lesion to be adenocarcinoma. A diagnosis of distal bile duct carcinoma was made, and SSPPD was performed. Histopathological examination revealed the coexistence of adenocarcinoma and neuroendocrine carcinoma components, and the tumor was confirmed as MINEN of the distal bile duct. No adjuvant chemotherapy was administered due to the poor performance status. 7 months later, the patient was found to have a liver metastasis.

Conclusion: We experienced two valuable cases of biliary MINEN. To identify better treatments, it is important to consider the diversity of individual cases and to continue sharing a variety of cases with different presentations.
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http://dx.doi.org/10.1186/s40792-022-01386-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8891401PMC
March 2022
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