Publications by authors named "Koji Hayashi"

49 Publications

Long-term survival case of esophageal carcinosarcoma coexisting with alcoholic liver cirrhosis successfully treated by staged operation: A case report.

Int J Surg Case Rep 2021 Jun 30;83:105946. Epub 2021 Apr 30.

Department of Surgery, Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan.

Introduction: Patients with esophageal cancers including carcinosarcoma sometimes have underlying liver cirrhosis because of a history of heavy drinking. It is definitely required to determine the appropriate surgical strategy and to manage the patients promptly when performing esophagectomy for the esophageal carcinosarcoma coexisting with alcoholic liver cirrhosis.

Presentation Of Case: A 56-year-old male patient with a history of chest pain and difficulty swallowing was admitted to our hospital. He had a history of drinking 250 g of alcohol per day. Endoscopy revealed an irregular protruding tumor on the left wall of the lower-third thoracic esophagus. Computed tomography showed a tumor lesion in the lower-third thoracic esophagus; the images also showed irregularities on the surface of the liver, suggestive of coexisting alcoholic liver cirrhosis. The preoperative diagnosis was T3N2M0, Stage III esophageal leiomyosarcoma. In consideration of the underlying alcoholic liver cirrhosis, a staged operation was planned for this patient as a curative treatment. The patient had an uneventful postoperative clinical course and was discharged on the 47th day after the first surgery. Final histopathological diagnosis was T2N0M0, Stage II esophageal carcinosarcoma. The patient is alive without recurrence three years after surgery.

Discussion: This is the first report of long-term survival case of esophageal carcinosarcoma with alcoholic liver cirrhosis that was treated successfully by staged operation.

Conclusions: Despite coexisting with alcoholic liver cirrhosis, staged operation could reduce the surgical invasiveness, so that very good short-term outcome and long-term survival was obtained in the patient with esophageal carcinosarcoma.
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http://dx.doi.org/10.1016/j.ijscr.2021.105946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129925PMC
June 2021

[Factors Associated with Self-reported Medication Adherence in Japanese Community-dwelling Elderly Individuals: The Nakajima Study].

Yakugaku Zasshi 2021 ;141(5):751-759

Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences.

Medication non-adherence in the elderly population is a major problem, preventing them from obtaining optimal therapeutic effects. Identifying the factors affecting medication adherence is crucial for improving and maintaining health among the elderly population and enhance healthcare economy. The purpose of this study was to examine the prevalence of self-reported medication adherence, and identify the associated factors and the influence of health-related quality of life (HRQOL) in the Japanese community-dwelling elderly population. This cross-sectional study was part of the Nakajima study and targeted inhabitants aged ≥60 years who underwent health examinations in 2017. Data regarding medication adherence were acquired through interviews and self-administered questionnaires. Medication adherence were assessed using a visual analog scale, and HRQOL was assessed by EuroQol five-dimensional questionnaire with 3 levels. Among the 455 participants, low and high medication adherence were seen in 9.7% and 66.2% of the participants, respectively (visual analog scores <80% and ≥95%, respectively). Medication adherence was significantly lower in participants taking medications ≥3 times daily than in those taking medications once or twice daily; a regimen involving drug administration ≥3 times daily had significantly lower odds of medication adherence. The use of a drug profile book and HRQOL had significant positive association with medication adherence. Our results suggest that low dosing frequency and using a drug profile book was positively associated with medication adherence among elderly persons, which in turn could enhance their QOL.
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http://dx.doi.org/10.1248/yakushi.20-00254DOI Listing
January 2021

[Laparoscopic Abdominoperineal Resection Following Intensive Chemotherapy for Stage Ⅳ Rectal Cancer with Unresectable Metastases].

Gan To Kagaku Ryoho 2020 Dec;47(13):2260-2262

Dept. of Surgery, Kinan Hospital.

The need to remove palliative primary tumors in the incurable Stage Ⅳ colorectal cancer patients remains debatable. Here, we describe the case of a 62-year-old man diagnosed with rectal cancer(cT3N2bM1b, cStage Ⅳb)with both primary tumor and metastatic lesions that were unresectable. Systemic chemotherapy was administered with 5-fluorouracil, Leucovorin, and oxaliplatin(FOLFOX)or FOLFOX with bevacizumab(BEV). After 12 months of treatment, CT scan revealed that both the primary tumor and metastases had shrunk significantly, leading to the conclusion that the primary tumor was resectable. Subsequently, laparoscopic abdominoperineal resection was performed. The patient was discharged 21 days postoperatively, and chemotherapy(FOLFOX plus BEV)was reintroduced 24 days after discharge. The patient was alive 25 months after the first consultation. Palliative primary tumor resection involves risks of operative complications and tumor progression owing to the absence of chemotherapy; however, some recent evidence has shown that primary tumor resection was associated with better prognosis and could be a good option on an individual patient basis. Further studies are required to establish the optimal strategy for patients with Stage Ⅳ colorectal cancer.
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December 2020

[A Case of Successful Treatment of Simultaneous Multiple Liver Metastasis from Gastric Cancer with Multidisciplinary Therapy].

Gan To Kagaku Ryoho 2020 Dec;47(13):1759-1761

Dept. of Surgery, Mimihara General Hospital.

The patient was a 63-year-old male. The upper esophagogastroduodenoscopy for anemia found a type 2 tumor at the greater curvature of the gastric angular region, which was revealed as a low-differentiated adenocarcinoma by biopsy. The abdominal CT showed a total of 10 metastases of 11-27 mm in size at the bilateral hepatic lobes. T3(SS)N0M1H1P0 and cStage Ⅳ of gastric cancer was diagnosed. SP therapy was performed for 1 year: the size of gastric primary focus reduced, and a metastatic lesion of 7 mm in size was found only at S1. We performed a gastrectomy of the pylorus side and hepatic S1 radiofrequency ablation. Postoperatively, S-1 single therapy has continued, and the patient has survived to date for 2 years without any recurrence. Although the prognosis of a simultaneous multiple liver metastasis from gastric cancer tends to be poor, our multidisciplinary approach resulted in a favorable prognosis.
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December 2020

Reduced-port laparoscopic appendectomy for acute appendicitis in pregnancy.

J Surg Case Rep 2020 Jun 15;2020(6):rjaa097. Epub 2020 Jun 15.

Department of Surgery, Kinan Hospital, Tanabe, Wakayama, Japan.

Current guidelines indicate that laparoscopic appendectomies are safe for pregnant patients with acute appendicitis. Recently, single- and reduced-port laparoscopic surgeries have gained popularity for nonpregnant patients, because they minimize abdominal wall trauma. Here, we describe a reduced-port laparoscopic appendectomy (RPLA) in a 31-year-old pregnant female performed at 27 weeks gestational age. Preoperative abdominal ultrasonography and computed tomography imaging showed an inflamed, swollen appendix and blood test results showed elevations in the white blood cell count and the C-reactive protein level. Accordingly, acute appendicitis was diagnosed. A surgical incision was performed at the umbilicus with an EZ-access device; an additional 5-mm trocar was placed at the right lower quadrant. Recovery was uneventful. The patient was discharged 8 days postoperatively. A vaginal delivery was achieved at term. The RPLA was a good surgical option for minimizing surgical invasiveness, without increasing the technical difficulty, in conditions where the uterus and fetus are growing.
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http://dx.doi.org/10.1093/jscr/rjaa097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297555PMC
June 2020

Toric Lentis Mplus intraocular lens opacification: A case report.

Am J Ophthalmol Case Rep 2020 Jun 19;18:100672. Epub 2020 Mar 19.

Yokohama Sky Eye Clinic, Kanagawa, Japan.

Purpose: To present the case of a patient with Toric Lentis Mplus intraocular lens (IOL) (Oculentis, Berlin, Germany) opacification after vitrectomy and his follow-up.

Observations: A 44-year-old man with high myopia and right optic neuritis history complained of visual impairment due to cataract in the right eye. We performed uneventful phacoemulsification and implanted a Toric Lentis Mplus IOL in his right eye. Six months later, he came to us with a retinal detachment in the nasal area of the right eye. We performed a 25-gauge vitrectomy with gas tamponade and endolaser treatment. Ten months after the vitrectomy, he complained of blurred vision in the right eye again. On slit-lamp examination, we observed a wide opacification localized to the anterior surface of the IOL. We explanted the IOL from the right eye and replaced it with a Clareon IOL (Alcon, Fort Worth, TX). The explanted IOL was examined under light microscopy and scanning electron microscopy.

Conclusions And Importance: We described a case of postoperative opacification of Toric Lentis Mplus IOL after vitrectomy. We found calcium aggregate deposits on the anterior surface of the IOL. Given the higher frequency of fundus disease observed in patients with high myopia, hydrophilic acrylic IOLs should be used with caution in patients with high myopia and in young patients. To our knowledge, this is the first report of Toric Lentis Mplus IOL opacification after the 2017 Field Safety Notice by Oculentis in response to the Food and Drug Administration's recall.
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http://dx.doi.org/10.1016/j.ajoc.2020.100672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149404PMC
June 2020

Heterogeneity of Treg/Th17 According to Cancer Progression and Modification in Biliary Tract Cancers via Self-Producing Cytokines.

Dig Dis Sci 2020 10 18;65(10):2937-2948. Epub 2019 Dec 18.

Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 (E2) Yamadaoka, Suita, 537-8511, Japan.

Background/aim: We previously demonstrated that inflammatory cytokine interleukin-6 (IL-6) was produced during cancer progression, worked together with transforming growth factor-beta 1 (TGF-β1), and induced the epithelial-mesenchymal transition (EMT) with chemo-resistance against gemcitabine (GR) at the invasion front of biliary tract cancers (BTCs). However, the significance of cytokine-induced T cell accumulation at the tumor microenvironment in biliary tract cancer (BTC) is not well understood. Because these cytokines (IL-6 and TGF-β1) are able to differentiate naïve T cells into Foxp3-expressing T cells (Tregs) and/or IL-17-producing T helper 17 (Th17) cells, we investigated the relationship between heterogeneous, cancer-producing cytokines and T cell differentiation.

Methods: In total, 127 curative resected specimens from patients with BTCs at Osaka University Hospital between 2000 and 2012 were evaluated for IL-6, TGF-β1, Tregs, and Th17 cells by immunohistochemistry. The ability of BTC-GR cells to undergo T cell differentiation was investigated in vitro.

Results: Tregs accumulated at the tumor center and Th17 cells accumulated at the invasion front during cancer progression and/or metastasis; each signaled poor prognosis. Treg accumulation was related to TGF-β1 expression by cancer cells, and Th17 cell accumulation was related to IL-6 expression by cancer cells, in resected specimens; this was confirmed in vitro. Compared with parent cells, GR cells produced IL-6 but not TGF-β1 in a time-dependent manner, had EMT features, and induced T cell differentiation to Th17 cells but not Tregs.

Conclusion: Cytokines produced by cancer cells (IL-6 and TGF-β1) induced heterogeneity of Tregs and Th17 cells in the tumor microenvironment, supporting progression of BTC.
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http://dx.doi.org/10.1007/s10620-019-06011-9DOI Listing
October 2020

Autoimmune Encephalitis Associated with Anti-gamma-aminobutyric Acid B Receptor Antibodies Mimicking Syncope.

Intern Med 2020 Mar 6;59(6):843-847. Epub 2019 Dec 6.

Second Department of Internal Medicine (Neurology), Faculty of Medical Sciences, University of Fukui, Japan.

Autoimmune encephalitis associated with autoantibodies to the gamma-aminobutyric acid B receptor (GABAR-AE) typically involves limbic symptoms with limbic abnormalities visible in brain magnetic resonance imaging (MRI). We herein report a case of a 48-year-old man with GABAR-AE whose initial presentation was limited to syncope without limbic symptoms or MRI abnormalities. Interestingly, serial MRI also revealed no abnormalities even after the appearance of limbic symptoms. Our findings suggest that GABAR-AE can initially mimic common syncope and that MRI findings may remain normal throughout the clinical course. Even if patients have normal MRI findings, GABAR-AE should be considered if limbic symptoms worsen.
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http://dx.doi.org/10.2169/internalmedicine.3652-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118379PMC
March 2020

Arthroscopic Antegrade Cancellous Bone Autotransplantation for Osteochondral Lesions of the Tibial Plafond.

Arthrosc Tech 2019 Aug 1;8(8):e875-e881. Epub 2019 Aug 1.

Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.

Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. The ideal treatment for osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously. We introduce a technique of arthroscopic antegrade cancellous bone autotransplantation; fibrocartilage regeneration can be expected for the cartilaginous lesion while bony lesion is replaced with the normal bone using this technique.
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http://dx.doi.org/10.1016/j.eats.2019.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823771PMC
August 2019

Esophagectomy for the patients with squamous cell carcinoma of the esophagus after allogeneic hematopoietic stem cell transplantation.

Int J Clin Oncol 2020 Jan 23;25(1):82-88. Epub 2019 Sep 23.

Department of Esophageal Surgery, National Cancer Center Hospital, Chuo-ku, Japan.

Background: The number of long-term survivors after allogeneic hematopoietic stem cell transplantation (HSCT) has increased recently. Esophageal squamous cell carcinoma occurs at a particularly high incidence as a secondary cancer after HSCT. However, standard treatment for these patients has not been established yet. The objectives of this study were to investigate outcomes of esophagectomy for esophageal carcinoma developed in HSCT patients, and to provide the appropriate perioperative management.

Methods: Ten HSCT patients underwent esophagectomy for esophageal squamous cell carcinoma between December 2007 and September 2017 at the National Cancer Center Hospital. The surgical outcomes and long-term prognosis of these patients were reviewed retrospectively.

Results: In the former group, 5 of the 7 patients (71.4%) developed pneumonia after esophagectomy, with two of them requiring intubation because of respiratory failure. None of the three patients of the latter group, who received broad-spectrum antibiotics for more than 7 days after the surgery, developed any postoperative complications. The estimated survival probability of these patients at 5 years after the surgery was 53.3%.

Conclusions: HSCT patients have an extremely high risk of developing pneumonia after esophagectomy, and the condition can easily become serious. Therefore, broad-spectrum antibiotics should be administered prophylactically to prevent severe pneumonia during the perioperative period in these patients.
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http://dx.doi.org/10.1007/s10147-019-01549-0DOI Listing
January 2020

Neuronal intranuclear inclusion disease showing blepharoptosis and positive serum anti-acetylcholine receptor antibody without myasthenia gravis.

J Neurol Sci 2019 May 16;400:119-121. Epub 2019 Mar 16.

Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.jns.2019.03.013DOI Listing
May 2019

Exosomal miR-155 Derived from Hepatocellular Carcinoma Cells Under Hypoxia Promotes Angiogenesis in Endothelial Cells.

Dig Dis Sci 2019 03 22;64(3):792-802. Epub 2018 Nov 22.

Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, E-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.

Purpose: In this study, we aim to clarify whether exosomes secreted from hepatocellular carcinoma (HCC) cells under hypoxia affect angiogenesis in endothelial cells.

Methods: Exosomes derived from human liver cancer cell lines were cultured under hypoxic or normoxic conditions for 24 h, isolated using ExoQuick-TC, and co-cultured with HUVECs to evaluate angiogenic activity. We also evaluated the expression of miR-155 in the exosomes from 40 patients with HCC.

Results: Exosomes under hypoxia remarkably enhanced tube formation of HUVECs. Both cellular and exosomal miR-155 were significantly up-regulated under hypoxic conditions. Knockdown of miR-155 in HCC cells attenuated the promotion of tube formation by exosomes under hypoxia in HUVECs, and high expression of exosomal miR-155 in preoperative plasma was significantly correlated with early recurrence.

Conclusion: These results suggest that exosomes derived from HCC cells under hypoxia induce tube formation of HUVECs and that exosomal miR-155 may affect angiogenic activity in HCC.
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http://dx.doi.org/10.1007/s10620-018-5380-1DOI Listing
March 2019

Higher Blood Vitamin C Levels are Associated with Reduction of Apolipoprotein E E4-related Risks of Cognitive Decline in Women: The Nakajima Study.

J Alzheimers Dis 2018 ;63(4):1289-1297

Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.

Background: Antioxidants like vitamins C and E may minimize the risk for Alzheimer's disease.

Objective: We examined whether vitamins C and E modify the apolipoprotein E (APOE) E4-related risks for developing cognitive decline.

Methods: We conducted a population-based prospective study including Japanese residents aged 65 years from Nakajima, Japan. The participants received an evaluation of cognitive function and underwent blood tests including tests for vitamins C and E levels and APOE phenotypes. The APOE E4-by-gender-by-vitamin C or E interactions on developing cognitive decline were analyzed.

Results: Of 606 participants with normal cognitive function determined using a baseline survey (2007-2008), 349 completed the follow up survey between 2014 and 2016. In women with APOE E4, significantly reduced risk for cognitive decline was observed for the highest blood vitamin C concentration tertile [multivariate OR 0.10 (95% CI 0.01-0.93)] compared with the lowest tertile. In men without APOE E4, significantly reduced risk for cognitive decline was observed for the highest blood vitamin E concentration tertile [multivariate OR 0.19 (0.05-0.74)] as compared with the lowest tertile.

Conclusion: Our results demonstrate significant beneficial effects of vitamins C and E in reducing the risk of cognitive decline in women with APOE E4 and men without APOE E4, respectively.
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http://dx.doi.org/10.3233/JAD-170971DOI Listing
June 2019

Obtaining Adequate Tension for Extensor Hallucis Longus Tendon Rupture Repair Using Wide-Awake Surgery: A Case Report.

J Foot Ankle Surg 2018 Mar - Apr;57(2):414-417. Epub 2017 Dec 7.

Professor and Chairman, Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.

Wide-awake surgery has potential advantages for treating extensor or flexor tendon injury. We present a case of chronic extensor hallucis longus injury treated with turn-down reconstruction using wide-awake surgery with a selective nerve block. To the best of our knowledge, this is the first such case reported. The patient had dropped a knife proximal to the right hallux metatarsophalangeal joint. Because direct suturing was thought to be difficult, turn-down reconstruction was performed under a selective nerve block. At 8 months postoperatively, the hallux had 75° of extension in the metatarsophalangeal joint and -5° of extension in the interphalangeal joint, similar to those of the healthy foot. The Japanese Society for Surgery of the foot objective hallux scale score had improved from 87 to 100, and the subjective scores in the subcategories of pain and pain-related, physical functioning and daily living, and shoe-related in the self-administered foot evaluation questionnaire had improved from 82.8 to 94.4, 97.7 to 100, and 50 to 83.3, respectively. Turn-down reconstruction using wide-awake surgery with a selective nerve block can be used for chronic extensor hallucis longus rupture and can be expected to provide good results.
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http://dx.doi.org/10.1053/j.jfas.2017.08.025DOI Listing
September 2018

Microbial Contamination of Ice Machines Is Mediated by Activated Charcoal Filtration Systems in a City Hospital.

J Environ Health 2016 Jun;78(10):32-5

Although microbial contamination of ice machines has been reported, no previous study has addressed microbial contamination of ice produced by machines equipped with activated charcoal (AC) filters in hospitals. The aim of this study was to provide clinical data for evaluating AC filters to prevent microbial contamination of ice. We compared microbial contamination in ice samples produced by machines with (n = 20) and without an AC filter (n = 40) in Shunan City Shinnanyo Municipal Hospital. All samples from the ice machine equipped with an AC filter contained 10-116 CFUs/g of glucose nonfermenting gram-negative bacteria such as Pseudomonas aeruginosa and Chryseobacterium meningosepticum. No microorganisms were detected in samples from ice machines without AC filters. After the AC filter was removed from the ice machine that tested positive for Gram-negative bacteria, the ice was resampled (n = 20). Analysis found no contaminants. Ice machines equipped with AC filters pose a serious risk factor for ice contamination. New filter-use guidelines and regulations on bacterial detection limits to prevent contamination of ice in healthcare facilities are necessary.
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June 2016

Nontraumatic tibial polyethylene insert cone fracture in mobile-bearing posterior-stabilized total knee arthroplasty.

Arthroplast Today 2016 Dec 15;2(4):157-163. Epub 2016 Sep 15.

Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan.

A 72-year-old male patient underwent mobile-bearing posterior-stabilized total knee arthroplasty for osteoarthritis. He experienced a nontraumatic polyethylene tibial insert cone fracture 27 months after surgery. Scanning electron microscopy of the fracture surface of the tibial insert cone suggested progress of ductile breaking from the posterior toward the anterior of the cone due to repeated longitudinal bending stress, leading to fatigue breaking at the anterior side of the cone, followed by the tibial insert cone fracture at the anterior side of the cone, resulting in fracture at the base of the cone. This analysis shows the risk of tibial insert cone fracture due to longitudinal stress in mobile-bearing posterior-stabilized total knee arthroplasty in which an insert is designed to highly conform to the femoral component.
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http://dx.doi.org/10.1016/j.artd.2016.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247562PMC
December 2016

Novel approach to pleurodesis with 50 % glucose for air leakage after lung resection or pneumothorax.

Surg Today 2016 May 24;46(5):599-602. Epub 2015 Jul 24.

Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan.

Purpose: Pleurodesis is performed in patients demonstrating air leakage after lung resection and in those with pneumothorax who must avoid surgery. However, there have so far been very few reports of pleurodesis with 50 % glucose. We herein examined the feasibility and effectiveness of this novel pleurodesis technique.

Methods: Thirty-five patients after lung resection and 11 pneumothorax patients without surgery were treated with pleurodesis using 50 % glucose. Approximately, 200 mL of 50 % glucose solution was injected into the pleural space and repeated until the air leakage stopped. Cases in which the air leakage did not stop after three injections were considered to be unsuccessful and subsequently treated with conventional pleurodesis using OK-432.

Results: Thirty-nine patients were successfully treated with 50 % glucose, although 7 patients required further treatment with OK-432. The unsuccessful group had some pulmonary comorbidities (P < 0.001), and the pleural effusion volume after pleurodesis was less than that in the successful group (P < 0.001). Although the air leakage did not stop in unsuccessful patients, the amount of air leakage markedly decreased. A temporary elevation of the blood sugar level was observed in 20 patients, but no other side effects had appeared.

Conclusions: Pleurodesis with 50 % glucose is an easy, safe, and effective treatment modality. It is therefore considered to be a useful alternative method for pleurodesis.
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http://dx.doi.org/10.1007/s00595-015-1223-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819551PMC
May 2016

Exacerbation of myasthenia gravis by intravenous peramivir.

Muscle Nerve 2015 Jun 5;51(6):935-6. Epub 2015 Mar 5.

Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.

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http://dx.doi.org/10.1002/mus.24594DOI Listing
June 2015

Reversible acute bilateral blindness resulting from a frontal brain tumor: a case report.

Br J Neurosurg 2014 Dec 5;28(6):793-5. Epub 2014 May 5.

Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan.

We experienced an unusual case of a 15-year-old girl who suffered acute bilateral blindness caused by a frontal lobe tumour. She underwent emergent operation, after which her vision recovered. This case emphasizes that a brain mass can cause sudden onset blindness and an emergency intervention might save the patient's sight.
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http://dx.doi.org/10.3109/02688697.2014.913774DOI Listing
December 2014

Endoscopic resection of a talocalcaneal coalition using a posteromedial approach.

Arthrosc Tech 2014 Feb 14;3(1):e39-43. Epub 2013 Dec 14.

Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.

Resection is a standard surgical procedure for a talocalcaneal coalition (TCC). A posterior approach is the representative technique for hindfoot endoscopy, and there is only 1 report of endoscopic resection of TCC using this approach. Disadvantages of the posterior approach for TCC are as follows: (1) the indication is limited to posterior-facet coalition, (2) the flexor hallucis longus can be an obstacle in approaching the coalition, (3) the acute insertion angle between the endoscope and instrument reduces operability, and (4) a position change and additional skin incision are essential for conversion to an open procedure. In contrast, a posteromedial approach for TCC with established portals at the entrance and exit of the flexor retinaculum is a useful technique because (1) the indication is allow to middle- and posterior-facet coalitions, (2) increased perfusion pressure allows the creation of sufficient working space, (3) operating the instrument only at the coalition site decreases the risk of tendon injury and neurovascular damage, (4) the obtuse insertion angle between the endoscope and instrument improves operability, and (5) a position change and additional skin incision are unnecessary for conversion to an open procedure.
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http://dx.doi.org/10.1016/j.eats.2013.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986476PMC
February 2014

Metformin prevents and reverses inflammation in a non-diabetic mouse model of nonalcoholic steatohepatitis.

PLoS One 2012 18;7(9):e43056. Epub 2012 Sep 18.

Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan.

Background: Optimal treatment for nonalcoholic steatohepatitis (NASH) has not yet been established, particularly for individuals without diabetes. We examined the effects of metformin, commonly used to treat patients with type 2 diabetes, on liver pathology in a non-diabetic NASH mouse model.

Methodology/principal Findings: Eight-week-old C57BL/6 mice were fed a methionine- and choline-deficient plus high fat (MCD+HF) diet with or without 0.1% metformin for 8 weeks. Co-administration of metformin significantly decreased fasting plasma glucose levels, but did not affect glucose tolerance or peripheral insulin sensitivity. Metformin ameliorated MCD+HF diet-induced hepatic steatosis, inflammation, and fibrosis. Furthermore, metformin significantly reversed hepatic steatosis and inflammation when administered after the development of experimental NASH.

Conclusions/significance: These histological changes were accompanied by reduced hepatic triglyceride content, suppressed hepatic stellate cell activation, and the downregulation of genes involved in fatty acid metabolism, inflammation, and fibrogenesis. Metformin prevented and reversed steatosis and inflammation of NASH in an experimental non-diabetic model without affecting peripheral insulin resistance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0043056PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445596PMC
March 2013

Adolescent growth spurt and growth pattern factors related to the short stature of Pygmy hunter-gatherers of Southeast Cameroon.

Ann Hum Biol 2013 Jan 12;40(1):9-14. Epub 2012 Sep 12.

Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan.

Introduction: Many studies have been carried out to reveal the mechanism of the short stature of Pygmy hunter-gatherers in the African rainforest. However, due to limitations concerning age-estimation, sample collecting and data analysis, their complete growth pattern has not yet been clarified.

Aims: This study has three aims as below; (1) to develop a smoothed growth curve, (2) to elucidate the presence of adolescent growth spurt and (3) to assess the correlation of growth pattern factors to their final short stature.

Subjects And Methods: Anthropometric measurements including height and weight were carried out for 626 Baka children in southeast Cameroon. LMS method and Preece-Baines function were adopted to develop a smoothed growth curve and to assess their growth pattern.

Results: The height velocity curve and acceleration curve derived from the LMS method showed the presence of an adolescent growth spurt. Biological parameters indicated their spurt was extremely weak and started at nearly the same time as published populations. Height gains between take-off and final height were almost equal between Baka children and children in published populations.

Conclusion: The presence of a weak adolescent growth spurt is suggested in the growth pattern of Pygmy hunter-gatherers. Moreover, their short adult stature is possibly related to growth rate before onset of puberty.
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http://dx.doi.org/10.3109/03014460.2012.720711DOI Listing
January 2013

Hemifacial flushing after bathing and crying.

J Pediatr 2012 Jun 23;160(6):1058-9. Epub 2012 Feb 23.

Department of Pediatrics, Fukuiken Saiseikai Hospital, Fukui, Japan.

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http://dx.doi.org/10.1016/j.jpeds.2012.01.032DOI Listing
June 2012

Increased expression of DNA methyltransferase 3a in obese adipose tissue: studies with transgenic mice.

Obesity (Silver Spring) 2010 Feb 13;18(2):314-21. Epub 2009 Aug 13.

Department of Molecular Medicine and Metabolism, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.

Epigenetic mechanisms are likely to be involved in the development of obesity. This study was designed to examine the role of a DNA methyltransferase (Dnmt3a), in obese adipose tissue. The gene expression of Dnmts was examined by quantitative real-time PCR analysis. Transgenic mice overexpressing Dnmt3a in the adipose tissue driven by the aP2 promoter were created (Dnmt3a mice). DNA methylation of downregulated genes was examined using bisulfite DNA methylation analysis. Dnmt3a mice were fed a methyl-supplemented or high-fat diet, and subjected to body weight measurement and gene expression analysis of the adipose tissue. Expression of Dnmt3a was markedly upregulated in the adipose tissue of obese mice. The complementary DNA (cDNA) microarray analysis of Dnmt3a mice revealed a slight decrease in the gene expression of secreted frizzled-related protein 1 (SFRP1) and marked increase in that of interferon responsive factor 9 (IRF9). In the SFRP1 promoter, DNA methylation was not markedly increased in Dnmt3a mice relative to wild-type mice. In experiments with a high-fat diet or methyl-supplemented diet, body weight did not differ significantly with the genotypes. Gene expression levels of inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) and monocyte chemoattractant protein-1 (MCP-1) were higher in Dnmt3a mice than in wild-type mice on a high-fat diet. This study suggests that increased expression of Dnmt3a in the adipose tissue may contribute to obesity-related inflammation. The data highlight the potential role of Dnmt3a in the adult tissue as well as in the developing embryo and cancer.
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http://dx.doi.org/10.1038/oby.2009.246DOI Listing
February 2010

Metformin suppresses glucose-6-phosphatase expression by a complex I inhibition and AMPK activation-independent mechanism.

Biochem Biophys Res Commun 2009 Oct 5;388(2):311-6. Epub 2009 Aug 5.

Dainippon Sumitomo Pharma Co., Ltd., 3-1-98 Kasugade-naka, Konohana, Osaka 554-0022, Japan.

Metformin is widely used as a hypoglycemic agent for the treatment of type 2 diabetes. Both metformin and rotenone, an inhibitor of respiratory chain complex I, suppressed glucose-6-phosphatase (G6pc), a rate limiting enzyme of liver glucose production, mRNA expression in a rat hepatoma cell line accompanied by a reduction of intracellular ATP concentration and an activation of AMP-activated protein kinase (AMPK). When yeast NADH-quinone oxidoreductase 1 (NDI1) gene was introduced into the cells, neither inhibition of ATP synthesis nor activation of AMPK was induced by these agents. Interestingly, in contrast to rotenone treatment, G6pc mRNA down-regulation was observed in the NDI1 expressing cells after metformin treatment. Since NDI1 can functionally complement the complex I under the presence of metformin or rotenone, our results indicate that metformin induces down-regulation of G6pc expression through an inhibition of complex I and an activation of AMPK-independent mechanism.
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http://dx.doi.org/10.1016/j.bbrc.2009.07.164DOI Listing
October 2009

Repair process after fibrocartilaginous enthesis drilling: histological study in a rabbit model.

J Orthop Sci 2009 Jan 13;14(1):76-84. Epub 2009 Feb 13.

Department of Orthopaedic Surgery, Nara Medical University, Kashihara-shi, Nara, 634-8522, Japan.

Background: Disorders of the enthesis are often a consequence of sports injuries. However, there is uncertainty regarding the process of mechanical stress-related injuries at the enthesis and the subsequent repair process of the injured tissues. To elucidate the repair process of the fibrocartilaginous enthesis, we studied the repair of injured fibrocartilaginous enthesis and the morphological characteristics of the repaired tissue.

Methods: We drilled 0.5-mm holes in the right tibial insertion of the patellar tendon of Japanese white rabbits, with their own left sides serving as controls. Specimens harvested at 1, 2, 4, 6, 8, and 12 weeks were examined histologically. Morphologically, the ratios of calcified fibrocartilage-bone interface lengths to enthesial lengths were compared between the control and surgical groups.

Results: Repair initiation was observed in the deep bone layer at 1 week, with remarkable progress at 2 weeks. Repair at the enthesis and neoosteogenesis in deep bone layers were detected at 4 weeks, and the drill hole disappeared at 6 weeks. The tendon was partially invaded by fibrocartilage-covered chondroid bone at 8 weeks, and regenerated fibrocartilaginous enthesis and increased calcified fibrocartilage-bone interface irregularity was identified at 12 weeks. The ratios of calcified fibrocartilage-bone interface lengths to enthesial lengths were significantly greater in the surgical group than in the control group.

Conclusions: Repair progressed from bone to fibrocartilage and ended at fibrous tissue. Cancellous bone disruption triggered repair in all layers. Removal of the subchondral plate enabled infiltration of nutrients via blood vessels, with the underlying bone acting as a scaffold for the regenerating fibrocartilage.
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http://dx.doi.org/10.1007/s00776-008-1284-9DOI Listing
January 2009

Distinct topography of erosion and new bone formation in achilles tendon enthesitis: implications for understanding the link between inflammation and bone formation in spondylarthritis.

Arthritis Rheum 2008 Sep;58(9):2694-9

University of Leeds and Chapel Allerton Hospital, Leeds, UK.

Objective: This study combined ultrasonography of the Achilles tendon enthesis at different stages of spondylarthritis (SpA) with microanatomic studies of normal cadaveric entheses, with the aim of exploring the relationship between bone erosion and new bone formation in enthesitis.

Methods: Thirty-seven patients with SpA and Achilles tendon enthesitis (20 with early SpA and 17 with chronic SpA) and 10 normal control subjects underwent ultrasound scanning. The presence of bone erosion and spur formation was recorded at 3 sites: the proximal and distal halves of the enthesis and the adjacent calcaneal superior tuberosity. Parallel histologic analysis was performed on cadaveric Achilles tendon entheses to determine whether regional variations in bone density and trabecular architecture in relation to fibrocartilage distribution are related to disease patterns.

Results: Bone erosion in patients with early SpA occurred at either the proximal insertion or the superior tuberosity (11 of 20 patients; P < 0.001 versus distal enthesis). Very small spurs, which were present almost exclusively at the distal enthesis, were evident in patients with early SpA and in normal control subjects. However, large spurs were evident distally only in patients with chronic SpA (9 of 17 patients, compared with none of 20 patients with early SpA; P < 0.0001). Histologic studies showed that aged normal individuals had small spurs at the corresponding location. The bone-to-marrow ratio was also significantly lower in the regions prone to erosions (P < 0.05).

Conclusion: Bone erosion in association with Achilles tendon enthesitis in SpA is anatomically uncoupled from bone formation-the 2 processes are topographically and temporally distinct. We thus conclude that disease patterns in SpA are related to normal enthesis structure and biomechanics.
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http://dx.doi.org/10.1002/art.23755DOI Listing
September 2008

Comparison of gene expression changes induced by biguanides in db/db mice liver.

J Toxicol Sci 2008 Aug;33(3):339-47

Drug Research Division, Dainippon Sumitomo Pharma Co., Ltd., Osaka.

Large-scale clinical studies have shown that the biguanide drug metformin, widely used for type 2 diabetes, to be very safe. By contrast, another biguanide, phenformin, has been withdrawn from major markets because of a high incidence of serious adverse effects. The difference in mode of action between the two biguanides remains unclear. To gain insight into the different modes of action of the two drugs, we performed global gene expression profiling using the livers of obese diabetic db/db mice after a single administration of phenformin or metformin at levels sufficient to cause a significant reduction in blood glucose level. Metformin induced modest expression changes, including G6pc in the liver as previously reported. By contrast, phenformin caused changes in expression level of many additional genes. We used a knowledge-based bioinformatic analysis to study the effects of phenformin. Differentially expressed genes identified in this study constitute a large gene network, which may be related to cell death, inflammation or wound response. Our results suggest that the two biguanides show a similar hypoglycemic effect in db/db mice, but phenformin induces a greater stress on the liver even a short time after a single administration. These findings provide a novel insight into the cause of the relatively high occurrence of serious adverse effect after phenformin treatment.
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http://dx.doi.org/10.2131/jts.33.339DOI Listing
August 2008

Correlation of compensatory alignment of the subtalar joint to the progression of primary osteoarthritis of the ankle.

Foot Ankle Int 2008 Apr;29(4):400-6

840 Shijo-cho, Kashihara-shi, Nara 634-8522, Japan.

Background: The etiology of primary osteoarthritis of the ankle is not well understood. The varus deformity of the ankle and the compensatory function of the subtalar joint are expected to be important factors in the progression of osteoarthritis. The purpose of this study was to document joint inclination at the various stages and to try to deduce the mechanism of primary, varus osteoarthritis of the ankle.

Materials And Methods: Weightbearing ankle anteroposterior (AP) views, lateral views and subtalar views were taken for 133 ankles in 80 patients (OA group) and 62 ankles in 50 subjects (control group). The OA group was divided into 5 radiographic stages. The inclination of the articular surface of the tibial plafond, the talar dome and the posterior facet of the calcaneus were measured from the radiographs. The inclination of the subtalar joint against the ankle was also calculated. At each stage, each value of the OA group was compared with the control group.

Results: The varus inclination of the articular surface of the tibial plafond progressed by stages; however, anterior opening was not significant at all stages. The valgus inclination of the subtalar joint progressed until the intermediate stage and converted to varus position at the later stage. CONCLUSION The compensatory function of the subtalar joint was most pronounced at the intermediate ankle arthritis stage.
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http://dx.doi.org/10.3113/FAI.2008.0400DOI Listing
April 2008

Paradoxical brain embolism as a cause of central retinal artery occlusion: a case report.

J Neuroimaging 2007 Jul;17(3):255-7

Department of Stroke Medicine, Stroke Center, Kawasaki Medical School, Kurashiki-city, Okayama, Japan.

A 79-year-old right-handed woman was admitted to hospital following sudden onset of severe visual loss in the left eye. Left central retinal artery occlusion (CRAO) was diagnosed. Diffusion-weighted imaging showed an asymptomatic hyperintensity in left middle cerebral artery territory. Transcranial Doppler and transesophageal echocardiography revealed patent foramen ovale. No other embolic sources were identified in the carotid artery, aortic arch, or heart. We report herein a case of CRAO caused by paradoxical brain embolism.
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http://dx.doi.org/10.1111/j.1552-6569.2007.00116.xDOI Listing
July 2007
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