Publications by authors named "Koji Yasuda"

110 Publications

[A Case of Preoperative Diagnosis of Intraductal Papillary Tumor with Good Course after Surgical Resection].

Gan To Kagaku Ryoho 2022 Apr;49(4):482-485

Dept. of Surgery, Kishiwada Tokushukai Hospital.

Background: Intraductal papillary neoplasm of bile duct(IPNB)is a papillary tumor that develops in the bile duct inside and outside the liver, and is a relatively new disease concept recognized as a precancerous/early cancer lesion of bile duct cancer.

Case: A 74-year-old woman. A nearby doctor pointed out liver dysfunction in a medical examination, and he was introduced for the purpose of detailed examination. No subjective symptoms were observed. The blood sampling test showed no increase in tumor markers. Abdominal CT/MRI examination and abdominal echo examination showed multiple nodules from the origin of the left intrahepatic bile duct and intrahepatic bile duct dilation predominantly on the left side. No other findings indicating metastasis were found, including the PET-CT test. Endoscopic retrograde cholangiography revealed a poorly contrast-enhanced area in the B3 region, and intraluminal ultrasonography confirmed a mass that coincided with the poorly contrast-enhanced area and grew papillary. No tumor growth was observed in the other branches or common bile ducts, but all ducts were filled with suspended matter, which was thought to be mucus. Histopathological examination of the tumor biopsy revealed atypical epithelium with papillary structure and moderate nuclear atypia. A diagnosis of intraductal papillary tumor was made, and left hepatic lobectomy was performed. Postoperative histopathological examination revealed a complex papillary growth of highly dysplastic mucus-producing epithelium similar to the pancreatic duct/bile duct epithelium, and no obvious infiltrative growth. The postoperative course was uneventful, and the patient was discharged 16 days after the operation. Currently, 6 months after the operation, he is outpatient without recurrence. We report a case of intraductal papillary tumor that had a favorable course after surgical resection in the preoperative diagnosis, with some review of the literature.
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April 2022

Adsorption Behavior of TEMPO-Based Organic Friction Modifiers during Sliding between Iron Oxide Surfaces: A Molecular Dynamics Study.

Langmuir 2022 Mar 2;38(10):3170-3179. Epub 2022 Mar 2.

Department of Complex Systems Science, Graduate School of Informatics, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan.

Organic friction modifiers (OFMs) added to lubricating oils to reduce friction and wear are crucial for reducing energy loss and CO emissions. In our previous studies, we have developed -(2,2,6,6-tetramethyl-1-oxyl-4-piperidinyl)dodecaneamide, referred to as CTEMPO, as a new type of OFM and experimentally demonstrated its superior performance to conventional OFMs of stearic acid and glycerol monooleate. However, the behavior of CTEMPO adsorbing onto solid surfaces from base oil during sliding, which largely dictates the lubrication performance, is yet to be elucidated. Here, we performed molecular dynamics simulations for confined shear of a CTEMPO solution in poly-α-olefin between hematite surfaces. Unlike conventional OFMs, which typically have one functional group or multiple functional groups of the same type, CTEMPO features two functional groups of different types: one amide and one terminal free oxygen radical. The results showed that adsorbed boundary films with a double-layer structure form stably during sliding, owing to double- or single-site surface adsorption and interlayer hydrogen bonding via the two functional groups. Additionally, some molecules in each of the first and second layers also form intralayer hydrogen bonding. Such multitype adsorption is unique and favorable for enhancing the strength of boundary films to withstand heavily loaded and prolonged sliding. The velocity distribution indicates that the first and second layers are solid- and liquid-like, respectively. The second layer could act as a buffer for the first layer, which is the last barrier to prevent solid-solid contact, against shear. We also found that the second layer can act as a reservoir to rapidly repair the once depleted region in the first layer because of the interlayer hydrogen bonding. The combination of the high strength and self-repair ability of the CTEMPO boundary films can rationally explain the experimentally observed properties of high load-carrying capacity, excellent antiwear effect, and high stability of friction over time.
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http://dx.doi.org/10.1021/acs.langmuir.1c03203DOI Listing
March 2022

Confirmed complete response to nivolumab for advanced gastric cancer with peritoneal dissemination: a case report.

J Med Case Rep 2021 Dec 21;15(1):604. Epub 2021 Dec 21.

Department of General Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada-shi, Osaka-fu, 596-0042, Japan.

Background: Recent advances in cancer immunotherapy have been remarkable, with many reports on the clinical effects of immune checkpoint inhibitors. Nivolumab has been covered by the national health insurance in Japan as a third-line agent for advanced and recurrent gastric cancer since September 2017. The objective response rate for nivolumab for gastric cancer is 11.2%. However, patients' quality of life during this treatment has not been examined. Here, we report a case in which multidisciplinary treatment, including with nivolumab, resulted in long-term survival and improved quality of life.

Case Presentation: A 70-year-old Asian woman was referred for surgery for gastric cancer. Postoperative pathological examination revealed peritoneal dissemination, and the patient was diagnosed with stage IV gastric cancer. Therefore, she was treated with S-1 and cisplatin based on negative immunohistochemical staining of resected specimens for human epidermal growth factor receptor 2. However, owing to instability and adverse events, treatment was subsequently changed to S-1 monotherapy. Two years after changing to S-1 monotherapy, she developed recurrence of peritoneal dissemination and was treated with docetaxel. Radiation therapy was also used because the recurrent lesions were local. However, 6 months later, new peritoneal dissemination and lymph node metastasis were observed and nivolumab was started. Subsequent abdominal computed tomography revealed a marked reduction in the disseminated nodules and lymphadenopathy. After 54 cycles of nivolumab, the lesions had disappeared completely. The patient has not developed side effects, including immune-responsive adverse events, has improved quality of life, and is returning to work. She is currently taking nivolumab, and there is no evidence of recurrence approximately 3 years after starting nivolumab.

Conclusions: Nivolumab may have beneficial effects in some patients with advanced or recurrent gastric cancer. Although the prognosis for gastric cancer and peritoneal dissemination is poor, multidisciplinary treatment that includes nivolumab may lead to long-term survival.
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http://dx.doi.org/10.1186/s13256-021-03200-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8690463PMC
December 2021

Subdiaphragmatic abscess due to penetration of a duodenal ulcer successfully treated with endoscopic transgastric drainage: a case report.

J Med Case Rep 2021 Jul 26;15(1):396. Epub 2021 Jul 26.

Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan.

Background: Subdiaphragmatic abscesses are sometimes caused by intraabdominal infections. We report a case of endoscopic ultrasound-guided transgastric drainage.

Case Presentation: A 75-year-old Asian man was referred to our hospital for treatment for upper gastrointestinal bleeding. On admission, blood tests showed a marked inflammatory response, and abdominal computed tomography showed free air in the abdominal cavity and a left subdiaphragmatic abscess. Therefore, the patient was diagnosed with an intraabdominal abscess associated with a perforated duodenal ulcer. Because he did not have generalized peritonitis, fasting and antibiotic treatment were the first therapies. However, because of the strong pressure on the stomach associated with the abscess and difficulty eating, we performed endoscopic ultrasound-guided transgastric drainage. After treatment, the inflammatory response resolved, and food intake was possible. The patient's condition remains stable.

Conclusions: Drainage is the basic treatment for subdiaphragmatic abscesses; however, percutaneous drainage is often anatomically difficult, and surgical drainage is common. We suggest that our success with endoscopic ultrasound-guided transgastric drainage in this patient indicates that this approach can be considered in similar cases and that it can be selected as a minimally invasive treatment method.
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http://dx.doi.org/10.1186/s13256-021-02970-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311959PMC
July 2021

Abrupt Aggravation of Encapsulated Seroma after Breast Reconstruction with Extended Latissimus Dorsi Muscle Flap.

Case Rep Oncol 2021 Jan-Apr;14(1):290-295. Epub 2021 Mar 2.

Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan.

A 57-year-old woman underwent salvage nipple-preserving mastectomy with immediate breast reconstruction using extended latissimus dorsi muscle flap for her in-breast recurrence. The patient had been well with a presumed encapsulated seroma in her back for 8 years and 3 months but suddenly developed a protrusion of the persistent seroma. The patient requested us to improve the cosmetic deterioration of the visible large protrusion. In the operation, the operative target was converted from the newly protruded portion to the whole persistent seroma due to the leakage of presumed contaminated fluid. The posterior wall of the long-lasting seroma sticked rigidly to the ribs, forcing us not to resect the whole capsule but to resect the anterior and lateral walls with scraping the posterior wall with a curet. Pathological study showed a dense fibrous capsule, amorphous eosinophilic material, cholesterin crystals, and massive histiocyte infiltration. Postoperative course was uneventful, but wound healing was not observed over 3 weeks after operation. Minocycline 100 mg diluted in 20 mL saline was injected into the seroma cavity after full aspiration of the seroma fluid, causing immediate irritable sensation around the seroma cavity and complete disappearance of the seroma cavity in 3 weeks after the minocycline injection. Pathogenesis of this extremely rare complication remains uncertain, but long-lasting seroma formation should be avoided not to cause this type of late-phase complication. Minocycline injection into the seroma cavity is a feasible method to accelerate the wound healing.
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http://dx.doi.org/10.1159/000513491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983582PMC
March 2021

[A Case of Lung Adenocarcinoma with Pulmonary Hypertrophic Osteoarthropathy].

Gan To Kagaku Ryoho 2021 Feb;48(2):297-299

Dept. of Surgery, Kishiwada Tokushukai Hospital.

Background: Hypertrophic osteoarthropathy(HOA)is a syndrome that has three signs, the digital finger, periosteal neoplasia of the iliac bone, and arthritis. Among them, the secondary 1 associated with lung disease is called pulmonary hypertrophic osteoarthropathy(PHO). It is reported that many of the underlying diseases are associated with primary lung cancer, but in Japan, this is a rare condition with about 0.2 to 5.0%.

Case: A 68-year-old man. The patient was complaining of an arthralgia, and treated by the department of rheumatology. The thoracic CT scan for a screening pointed out a tumor in the right lower lobe, and referred to the department of surgery. Blood test showed CEA 21.8 ng/mL and LH 10.2 mIU/mL, FSH 23.1 mIU/mL. Chest CT showed a lung mass measuring 6.5×3.5 cm in the right lower lobe, and tracheobronchial lymph- node swelling. Bone scintigraphy showed abnormal accumulations in the long bones. We performed right lower lobectomy by thoracoscope. The pathological results were adenocarcinoma, G2, pT3, pN1, pm0, pl1, Ly1, V1, stage ⅢA. The arthralgia was relieved early after surgery. The patient recovered uneventfully and was discharged after the operation. Adjuvant chemotherapy was started, he was been well without recurrence.
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February 2021

Sigmoid Volvulus with Widespread Bowel Ischemia after Endoscopic Reduction Successfully Treated with Elective Laparoscopic Surgery.

Case Rep Gastroenterol 2020 May-Aug;14(2):286-290. Epub 2020 May 13.

Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan.

An 87-year-old man complaining of abdominal distention was referred to our hospital. Plain radiograph and enhanced computed tomography (CT) showed a dilated sigmoid colon with a coffee bean sign, leading to the diagnosis of sigmoid volvulus. Based on symptoms and the CT and laboratory test findings, we initially treated the patient with endoscopic reduction, resulting in successful reduction of the sigmoid volvulus with widespread presumed mucosal ischemia. Due both to the lack of emerging symptoms suggesting colon perforation and to the laboratory test findings after endoscopic reduction, we treated the patient without further urgent surgical intervention. Two months later, the patient underwent successful elective laparoscopic surgery with a redundant sigmoid colon resection and a functional end-to-end anastomosis. He has been well without any events for 20 months. Conservative treatment with careful observation should be taken into consideration in the treatment of sigmoid volvulus with mild to moderate ischemia after endoscopic reduction.
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http://dx.doi.org/10.1159/000507611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265717PMC
May 2020

Rhesus Monkey Rhadinovirus Isolated from Hemangioma Tissue.

Microbiol Resour Announc 2020 Mar 19;9(12). Epub 2020 Mar 19.

New England Primate Research Center, Southborough, Massachusetts, USA

We isolated a rhesus monkey rhadinovirus, isolate RRVmmu 209-07, from hemangioma tissue. The virion DNA was sequenced by Illumina-based sequencing. Isolate RRVmmu 209-07 is highly similar overall to RRV 26-95, but considerable differences exist in the 3' region of the genome.
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http://dx.doi.org/10.1128/MRA.01347-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082460PMC
March 2020

[A Case of Advanced Gastric Cancer with Liver Metastases Treated with Curative Conversion Therapy after S-1 plus Oxaliplatin].

Gan To Kagaku Ryoho 2019 Dec;46(13):1925-1927

Dept. of Surgery, Kishiwada Tokushukai Hospital.

An 81-year-old man was referred to our hospital. Upper gastrointestinal endoscopy revealed a type 2 tumor in the antrum of the stomach. The histopathological findings showed a moderately differentiated HER2-negative adenocarcinoma. Two low-density areas of 17mm and 26mm in diameter were observed in the liver S6 and S8respectively at the CT scan. Nine courses of S-1 plus oxaliplatin(SOX)therapy were administered to this patient with gastric cancer and liver metastases. Since both the primary tumor and the liver metastases were significantly reduced by the chemotherapy, distal gastrectomy(D2 dissection)and partial liver resection(liver S6, S8)were performed. The histopathological findings revealed no tumor cells in the primary tumor, lymph nodes, and liver metastases, with a histologic effect of Grade 3. The patient underwent adjuvant therapy with S-1. He has been alive without recurrence for 11 months post-surgery.
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December 2019

[A Case of Gastrointestinal Stromal Tumor in the Rectum with Preservation of Anal Function after Neoadjuvant Chemotherapy UsingImatinib].

Gan To Kagaku Ryoho 2019 Dec;46(13):2383-2385

Dept. of Surgery, Kishiwada Tokushukai Hospital.

A n 81-year-old woman was admitted to our institution. Computed tomography performed before transcatheter aortic valve implantation(TAVI)for aortic stenosis revealed a tumor in the rectum. Lower endoscopy revealed that the tumor was a 60mm submucosal tumor and located 2 cm from the anal verge. Abiopsy revealed the diagnosis to be gastrointestinal stromal tumor(GIST). Although the tumor was located near the anal verge and might have invaded the surrounding organs, neoadjuvant chemotherapy(NAC) with 400mg/day of imatinib was initiated to preserve anal function as requested by the patient and her family. After 3 months, the tumor size decreased by 36.6% and there was a decrease in rate of tumor shrinkage. We performed transanal tumor resection and temporary colostomy. After 6 months, we performed colostomy closure, and the patient has remained recurrence-free and is continuing chemotherapy.
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December 2019

[Two Cases of Advanced Gastric Cancer with Simultaneous Liver Metastasis with Long-Term Recurrence-Free Survival].

Gan To Kagaku Ryoho 2019 Dec;46(13):2333-2335

Dept. of Surgery, Kishiwada Tokushukai Hospital.

We report 2 cases of postoperative long-term survival of gastric cancer with synchronous liver metastasis. Case 1 was a 65- year-old man. Examination for anemia revealed advanced type 5 cancer in the antrum and suspected invasion of the transverse colon. A nodule 15mm in diameter suspected to be metastasis was also found in the liver S2. As no unresectable factors were present, partial hepatectomy, partial transverse colon resection, and distal gastrectomy were performed. Postoperatively, S-1 chemotherapy was administered for 14 months. Seven years after surgery, the patient is alive without recurrence. Case 2 was a 67-year-old woman. Examination for anemia revealed advanced type 2 cancer in the lower gastric body and a nodule 12mm in diameter suspected to be liver metastasis in the liver S8. Partial resection of the liver, total gastrectomy, cholecystectomy, and splenectomy were performed because no unresectable factors were observed. Postoperatively, chemotherapy with S-1 was administered for 38 months. Six years after surgery, she is alive without recurrence. Although there is no clear evidence for radical surgery for gastric cancer with simultaneous liver metastases, these results indicate that resection may be considered in cases with small numbers of metastases.
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December 2019

Calcification and abscess formation around the catheter tip of a central venous access port: a case report.

J Med Case Rep 2020 Jan 16;14(1):10. Epub 2020 Jan 16.

Department of General Surgery, Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada-shi, Osaka-fu, 596-0042, Japan.

Background: Thrombosis of the internal jugular vein occasionally occurs in association with long-term placement of a central venous catheter; however, such complications rarely involve calcification within the blood vessels. We report a case of calcification and abscess formation around a central venous catheter tip.

Case Presentation: Our patient was an 84-year-old Asian woman who developed a fever that had started approximately 5 months after the placement of a central venous catheter. At the time of presentation, blood tests showed a marked inflammatory response, and chest computed tomography showed a high absorption area and air density around the catheter tip. Therefore, the patient was diagnosed with abnormal intravascular calcification and a deep neck abscess associated with long-term central venous catheter placement. The initial plan was to administer antibiotics and remove the central venous catheter. However, central venous catheter removal was deemed difficult due to the calcification and therefore required an incision. Because of the patient's advanced age and dementia, her family requested antibiotic treatment only. Following antibiotic treatment, the patient's inflammatory response normalized, and her fever resolved. The treatment was discontinued, and the patient's condition gradually stabilized.

Conclusions: Catheter-related complications of central venous catheter placement include vascular occlusion, extravasation of the infusion, and infection. However, abnormal calcification in the blood vessels is extremely rare, and there has been only one case report of a neonate with central venous catheter-related vascular calcification in Japan. The etiology of intravascular calcification is considered to be related to the infusion content and the infusion rate of high caloric infusions and blood products. The incidence of complications associated with long-term central venous catheter placement is expected to increase with the increasing aging of the population and advances in chemotherapy. The report of the clinical course of this rare case adds to the body of knowledge in this area.
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http://dx.doi.org/10.1186/s13256-019-2333-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964066PMC
January 2020

Filiform polyposis with sigmoid colon adenocarcinoma: a case report.

Surg Case Rep 2019 Nov 28;5(1):184. Epub 2019 Nov 28.

Department of Surgical Oncology, The University of Tokyo, 7-3-1, Tokyo, Japan.

Background: Filiform polyposis is a rare form of inflammatory polyposis, which is occasionally formed in the colon of patients with history of inflammatory bowel disease (IBD). It is characterized by presence of several to hundreds of slender, worm-like polyps in the colon lined by histologically normal colonic mucosa and often coalesce, resulting in a tumor-like mass. Filiform polyposis is most frequently associated with a post-inflammatory reparative process in patients with IBD history, and only cases of filiform polyposis occurring in patients without IBD history have been reported. Filiform polyposis has been considered as a benign inflammatory polyposis without any risk of dysplasia, while the possibility of carcinogenesis of inflammatory polyps is not fully excluded. To date, only three cases of filiform polyposis coexisting with dysplasia have been reported.

Case Presentation: A 59-year-old male patient with no past medical history of IBD underwent laparoscopic sigmoidectomy for obstructive filiform polyposis, which was associated with sigmoid colon adenocarcinoma. Based on the histological findings of the resected specimen, invasive sigmoid colon adenocarcinoma was surrounded by filiform polyposis, and adenocarcinoma also scattered uniformly on the surface of filiform polyposis. In immunohistochemistry, abnormal p53 expression was observed in adenocarcinoma, while it was not shown in mucosa on filiform polyposis.

Conclusions: This is the fourth case of filiform polyposis that is closely associated with colon dysplasia or adenocarcinoma based on histological findings. However, immunohistochemical findings did not support the theory that inflammation initiates adenocarcinoma in filiform polyposis like IBD. Hence, further immunohistochemical and genetic analyses are needed to clarify the association between filiform polyposis and carcinogenesis.
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http://dx.doi.org/10.1186/s40792-019-0747-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883011PMC
November 2019

Alcohol-induced changes in the gut microbiome and metabolome of rhesus macaques.

Psychopharmacology (Berl) 2019 May 22;236(5):1531-1544. Epub 2019 Mar 22.

Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, USA.

Rationale: Increasing evidence has demonstrated that changes in the gut microbiome, including those associated with dietary influences, are associated with alterations in many physiological processes. Alcohol consumption is common across human cultures and is likely to have a major effect on the gut microbiome, but there remains a paucity of information on its effects in primates.

Objectives: The effects of chronic alcohol consumption on the primate gut microbiome and metabolome were studied in rhesus macaques that were freely drinking alcohol. The objectives of the study were to determine what changes occurred in the gut microbiome following long-term exposure to alcohol and if these changes were reversible following a period of abstinence.

Methods: Animals consuming alcohol were compared to age-matched controls without access to alcohol and were studied before and after a period of abstinence. Fecal samples from rhesus macaques were used for 16S rRNA sequencing to profile the gut microbiome and for metabolomic profiling using mass spectrometry.

Results: Alcohol consumption resulted in a loss of alpha-diversity in rhesus macaques, though this was partially ameliorated by a period of abstinence. Higher levels of Firmicutes were observed in alcohol-drinking animals at the expense of a number of other microbial taxa, again normalizing in part with a period of abstinence. Metabolomic changes were primarily associated with differences in glycolysis when animals were consuming alcohol and differences in fatty acids when alcohol-drinking animals became abstinent.

Conclusions: The consumption of alcohol has specific effects on the microbiome and metabolome of rhesus macaques independent of secondary influences. Many of these changes are reversed by a relatively short period of abstinence.
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http://dx.doi.org/10.1007/s00213-019-05217-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613802PMC
May 2019

Resonance State Method for Electron Injection in Dye Sensitized Solar Cells.

J Chem Theory Comput 2018 Oct 14;14(10):5090-5104. Epub 2018 Sep 14.

Graduate School of Informatics , Nagoya University , Furo-cho, Chikusa-ku, Nagoya , Aichi 464-8601 , Japan.

Herein, the ab initio method is applied to examine metastable molecular excited states on a solid surface using resonance state theory and Green's function. A formula for the complex energy correction that determines the decay rate is presented; the configuration interaction effect together with major molecule-surface interactions are considered in more detail as compared to previous studies. Furthermore, the lifetimes of the excited states of Ru-terpyridine dyes adsorbed on an anatase surface are calculated, and the effects of the molecular structure and adsorption mode on the electron injection rate are studied. Also, the adsorption structures and relative stabilities of a series of Ru-terpyridine dyes-including the black dye-are reported. An implicit solvation model is necessary to reliably calculate the alignment between the photoabsorption spectrum and the conduction band density of states, governing the injection rate. Finally, some of the factors that limit the injection ability of dyes are discussed.
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http://dx.doi.org/10.1021/acs.jctc.8b00364DOI Listing
October 2018

Recent advances in neoadjuvant chemoradiotherapy in locally advanced rectal cancer.

J Anus Rectum Colon 2017 25;1(2):39-44. Epub 2018 May 25.

Department of Surgical Oncology, The University of Tokyo.

Preoperative chemoradiotherapy (CRT) has been actively used in Europe and the United States to treat advanced low rectal cancer, and provides excellent local control. In Japan, however, the standard treatment is lateral lymph node dissection, and to date CRT has not been actively used. In recent years, an increasing number of Japanese institutions have been using preoperative CRT to treat locally advanced rectal cancer. In this review, we describe the latest trends in CRT under five headings: short-course or long-course radiation, efforts to improve combined chemotherapy, the addition of preoperative adjuvant chemotherapy, the watch and wait strategy, and the significance of lateral lymph node dissection in patients receiving CRT.
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http://dx.doi.org/10.23922/jarc.2017-005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768670PMC
May 2018

Smoking and tumor obstruction are risk factors for anastomotic leakage after laparoscopic anterior resection during rectal cancer treatment.

J Anus Rectum Colon 2017 25;1(1):7-14. Epub 2018 May 25.

Department of Surgical Oncology, The University of Tokyo, Japan.

Objectives: To clarify the surgical outcomes and risk factors for anastomotic leakage (AL) following laparoscopic anterior resection (Lap-AR) for the treatment of rectal cancer.

Methods: We retrospectively reviewed the records of 175 consecutive primary rectal cancer patients who had undergone Lap-AR at our institution between April 2012 and November 2015. Patient, tumor, and surgical variables were analyzed using univariate analyses.

Results: Of 175 patients, 116 were men (66.3%). All four patients who had AL (2.3%) were men and current smokers with heavy smoking histories. In three of the AL cases, preoperative total colonoscopy was impossible owing to tumor obstruction, and the other case had concomitant obstructive colitis after oral bowel preparation. Univariate analysis identified tumor size, tumor obstruction, and smoking history as factors significantly associated with AL development.

Conclusions: Tumor size, tumor obstruction, and smoking history were risk factors for AL following Lap-AR for the treatment of primary rectal cancer.
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http://dx.doi.org/10.23922/jarc.2016-012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768678PMC
May 2018

Marked edema of colonic stoma after colectomy and severe pulmonary hypertension: Report of two cases.

Clin Res Hepatol Gastroenterol 2018 02 29;42(1):e1-e4. Epub 2017 Dec 29.

Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.

Introduction: Pulmonary hypertension (PH) is a disease with a poor prognosis and is a risk for perioperative heart and respiratory failure. Few reports exist regarding a colectomy performed in patients with PH. Herein, we report two cases of colectomy performed in patients with severe PH, accompanied with marked edema of the colonic stoma after surgery.

Case Presentation: In case 1, a 54-year-old patient with sigmoid cancer and severe primary PH underwent Hartmann's operation. After the operation, his stoma became markedly edematous and ulcerated. Swelling of the stoma became gradually reduced, and the patient was discharged from hospital 36 days after the operation. In case 2, a 62-year-old patient with upper rectal cancer and severe PH also underwent Hartmann's operation; his stoma became markedly edematous without ulceration.

Conclusion: Marked edema of the colonic stoma was observed in two cases with severe PH, with ulceration of the mucosa observed in one case. It was considered reasonable to avoid anastomosis in cases with severe PH.
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http://dx.doi.org/10.1016/j.clinre.2017.04.003DOI Listing
February 2018

Leucine-rich repeat-containing G protein-coupled receptor 5 and CD133 expression is associated with tumor progression and resistance to preoperative chemoradiotherapy in low rectal cancer.

Oncol Lett 2017 Dec 18;14(6):7791-7798. Epub 2017 Oct 18.

Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-8656, Japan.

Preoperative chemoradiotherapy has been performed as a standard therapy for advanced low rectal cancer. Cancer stem cells (CSCs) have been reported to contribute to resistance to treatment and patient prognosis. Leucine-rich repeat-containing G protein-coupled receptor 5 (LGR5) and cluster of differentiation (CD133) are putative markers for CSCs. However, their prognostic ability remains unknown, and evaluation of a single marker can be insufficient due to the heterogeneity of cancer. LGR5 and CD133 expression was immunohistochemically evaluated in surgical specimens of 56 patients who received curative resection following chemoradiotherapy for advanced low rectal cancer. In addition, the correlations between their expression levels, and clinicopathological features and patient prognosis were asessed. LGR5 expression was significantly correlated with lymphatic invasion, lymph node metastasis, and tumor node metastasic (TNM) stage. CD133 expression was significantly correlated with vascular invasion and the tumor regression grade. Combined expression was significantly correlated with lymphatic invasion, tumor regression grade and TNM stage, but not with overall, and disease-free survival. LGR5 and CD133 expressions may represent useful markers associated with tumor progression and resistance to chemoradiotherapy in patients with low rectal cancer. Furthermore, combined expression of these markers may be a more useful marker compared with the expression of each single marker.
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http://dx.doi.org/10.3892/ol.2017.7207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5727605PMC
December 2017

Conversion to Resection in Patients Receiving Systemic Chemotherapy for Unresectable and/or Metastatic Colorectal Cancer-Predictive Factors and Prognosis.

Clin Colorectal Cancer 2018 03 19;17(1):e91-e97. Epub 2017 Oct 19.

Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.

Background: Systemic chemotherapy increases the possibility of resection in patients with initially unresectable colorectal cancer (CRC), especially patients with hepatic metastasis. However, the predictive factors and prognosis of conversion to resection after chemotherapy in patients with various organ metastases remain largely unknown.

Patients And Methods: We reviewed the data from metastatic CRC (mCRC) patients who had received oxaliplatin- or irinotecan-based systemic chemotherapy from 2005 to 2016. The predictors for conversion to surgery were assessed by multivariate analyses. Cancer-free survival and overall survival after the initiation of treatment were compared between patients who had undergone successful conversion therapy and those who had undergone surgery first for resectable stage IV CRC.

Results: Of 99 mCRC patients receiving first-line chemotherapy, 23 underwent secondary surgical resection. Single organ metastasis, the presence of liver metastases, and the use of biologic agents were independent predictors of successful conversion therapy. The long-term survival of patients who underwent successful secondary surgery did not differ significantly from that of the 112 patients with resectable stage IV CRC who had undergone surgery first.

Conclusion: Liver metastases and single organ metastasis were more likely to be resected after chemotherapy than were other metastatic lesions in mCRC. The use of biologic agents contributed to the increased conversion rate. Successful conversion resulted in outcomes similar to those of resectable stage IV CRC.
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http://dx.doi.org/10.1016/j.clcc.2017.10.002DOI Listing
March 2018

Successful Management of a Positive Air Leak Test during Laparoscopic Colorectal Surgery.

Dig Surg 2018 22;35(3):266-270. Epub 2017 Sep 22.

Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.

Background/aims: Anastomotic leakage remains the most serious complications of colorectal surgery. To prevent colorectal anastomotic leakage (CAL), an air leak test (ALT) with intraoperative colonoscopy (IOCS) is performed to detect mechanically insufficient colorectal anastomoses. The approaches to an intraoperative anastomotic air leak (IOAL) have not been fully investigated. This study aimed to clarify the safe management of an IOAL in laparoscopic colorectal surgery.

Methods: One hundred forty-eight consecutive patients who underwent laparoscopic resection with double-stapling technique (DST) anastomosis for left-sided colorectal cancer between April 2015 and June 2016 were included and retrospectively reviewed.

Results: Intraoperative anastomotic ALT yielded positive results in 7 patients. In all 7 patients, reanastomoses were performed, and diverting stomas were constructed to protect the anastomosis in 2 patients whose reanastomosis sites were close to the anus. Three of the revised DST anastomoses showed air leakage on the repeat ALT; these sites underwent suturing repair and were confirmed to be airtight. None of the patients with a positive intraoperative ALT had postoperative CAL. The overall CAL rate was 1.4%.

Conclusions: Combination management using DST revision, direct suturing repair, and a diverting stoma is recommended for intraoperative repair of anastomotic defects detected by IOCS.
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http://dx.doi.org/10.1159/000480157DOI Listing
October 2018

Giant gastrointestinal stromal tumor of the vermiform appendix: A case report.

Mol Clin Oncol 2017 Sep 19;7(3):399-403. Epub 2017 Jul 19.

Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.

Gastrointestinal stromal tumors (GISTs) of the vermiform appendix are rare, measuring <3 cm in 82.4% of the reported cases. Neoadjuvant therapy with the receptor tyrosine kinase inhibitor imatinib mesylate has the potential to improve resectability and organ preservation rates in locally advanced or metastatic/recurrent GISTs. We herein report the case of a 67-year-old male patient with an unusually large GIST (22 cm in diameter) of uncertain origin in the right lower abdominal quadrant, with a solitary peritoneal metastasis. Due to the size of this GIST and presence of metastatic disease, neoadjuvant therapy with imatinib (400 mg/day orally) was administered. Follow-up imaging studies revealed marked shrinkage of the primary and metastatic tumors. Subsequently, laparoscopic exploration revealed that the main tumor originated from the tip of the vermiform appendix, and that the peritoneal metastasis was located in the ascending mesocolon. The patient underwent laparoscopic appendectomy and excision of the peritoneal metastasis, without tumor rupture. Therefore, in appropriately selected patients, neoadjuvant imatinib for borderline resectable or oligometastatic GISTs may be a reasonable choice.
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http://dx.doi.org/10.3892/mco.2017.1334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582452PMC
September 2017

Intestinal perforation after nivolumab immunotherapy for a malignant melanoma: a case report.

Surg Case Rep 2017 Aug 25;3(1):94. Epub 2017 Aug 25.

Department of Surgical Oncology, Faculty of Medicine, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.

Background: Nivolumab is a monoclonal antibody against programmed death 1 and has become a standard treatment of advanced melanoma because of its durable response and survival benefits. In this report, we present a case of severe intestinal perforation after nivolumab immunotherapy for malignant melanoma.

Case Presentation: A 73-year-old man with stage IV malignant melanoma underwent nivolumab therapy. The patient presented to our hospital because of a progressing abdominal pain. Radiological evaluation revealed evidence of free intraperitoneal air. Therefore, we diagnosed the patient as having an intestinal perforation, which was successfully resolved after surgical treatment.

Conclusion: Although intestinal perforation after nivolumab immunotherapy is rare, it can be severe and requires early diagnosis and emergency surgery to ensure a favorable prognosis.
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http://dx.doi.org/10.1186/s40792-017-0370-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572476PMC
August 2017

Results of a 36-year surveillance program for ulcerative colitis-associated neoplasia in the Japanese population.

Dig Endosc 2018 Mar 2;30(2):236-244. Epub 2017 Nov 2.

Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.

Background And Aim: Surveillance colonoscopy has been carried out for patients with long-standing ulcerative colitis who have an increased risk for colorectal cancer. The aim of the present study was to determine the incidence of and the risk factors for neoplasia.

Methods: We evaluated 289 ulcerative colitis patients who underwent surveillance colonoscopy between January1979 and December 2014. Cumulative incidence of neoplasia and its risk factors were investigated. Clinical stage and overall survival were compared between the surveillance and non-surveillance groups.

Results: Cumulative risk of dysplasia was 3.3%, 12.1%, 21.8%, and 29.1% at 10, 20, 30 and 40 years after the onset of ulcerative colitis, respectively. Cumulative risk of colorectal cancer was 0.7%, 3.2%, 5.2%, and 5.2% at 10, 20, 30 and 40 years from the onset of ulcerative colitis, respectively. Total colitis was a risk factor for neoplasia (P = 0.015; hazard ratio, 2.96).

Conclusions: Our surveillance colonoscopy program revealed the incidence and risk factors of ulcerative colitis-associated neoplasias in the Japanese population. Total colitis is a risk factor for neoplasia.
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http://dx.doi.org/10.1111/den.12955DOI Listing
March 2018

Fluoride Depletes Acidogenic Taxa in Oral but Not Gut Microbial Communities in Mice.

mSystems 2017 Jul-Aug;2(4). Epub 2017 Aug 8.

Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Fluoridation of drinking water and dental products prevents dental caries primarily by inhibiting energy harvest in oral cariogenic bacteria (such as and ), thus leading to their depletion. However, the extent to which oral and gut microbial communities are affected by host fluoride exposure has been underexplored. In this study, we modeled human fluoride exposures to municipal water and dental products by treating mice with low or high levels of fluoride over a 12-week period. We then used 16S rRNA gene amplicon and shotgun metagenomic sequencing to assess fluoride's effects on oral and gut microbiome composition and function. In both the low- and high-fluoride groups, several operational taxonomic units (OTUs) belonging to acidogenic bacterial genera (such as , , and ) were depleted in the oral community. In addition, fluoride-associated changes in oral community composition resulted in depletion of gene families involved in central carbon metabolism and energy harvest (2-oxoglutarate ferredoxin oxidoreductase, succinate dehydrogenase, and the glyoxylate cycle). In contrast, fluoride treatment did not induce a significant shift in gut microbial community composition or function in our mouse model, possibly due to absorption in the upper gastrointestinal tract. Fluoride-associated perturbations thus appeared to have a selective effect on the composition of the oral but not gut microbial community in mice. Future studies will be necessary to understand possible implications of fluoride exposure for the human microbiome. Fluoride has been added to drinking water and dental products since the 1950s. The beneficial effects of fluoride on oral health are due to its ability to inhibit the growth of bacteria that cause dental caries. Despite widespread human consumption of fluoride, there have been only two studies of humans that considered the effect of fluoride on human-associated microbial communities, which are increasingly understood to play important roles in health and disease. Notably, neither of these studies included a true cross-sectional control lacking fluoride exposure, as study subjects continued baseline fluoride treatment in their daily dental hygiene routines. To our knowledge, this work (in mice) is the first controlled study to assess the independent effects of fluoride exposure on the oral and gut microbial communities. Investigating how fluoride interacts with host-associated microbial communities in this controlled setting represents an effort toward understanding how common environmental exposures may potentially influence health.
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http://dx.doi.org/10.1128/mSystems.00047-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547758PMC
August 2017

Laparoscopic surgery for colorectal cancers complicated by Leriche syndrome: A report of three cases.

Oncol Lett 2017 Aug 15;14(2):1920-1924. Epub 2017 Jun 15.

Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.

Leriche syndrome is a disease of aortoiliac occlusion, which causes diminished femoral pulses, impotence and claudication. As blood flow to the rectum is also decreased in Leriche syndrome, reconstruction with anastomosis may be complicated by ischemia when performing rectal cancer surgery. The inferior epigastric arteries often provide collateral circulation to the lower limbs in patients with Leriche syndrome, therefore, attention should be paid not to injure them during trocar insertion when performing laparoscopic surgeries. The present study is a report on three cases of patients with colorectal cancer who were successfully treated with laparoscopic surgeries. The first case was of a 71-year-old man with rectal cancer. A preoperative computed tomography (CT) scan revealed occlusion of the aorta below the origin of the inferior mesenteric artery. The blood flow to the lower limbs was supplied through collateral arteries, including the inferior epigastric arteries and the deep circumflex iliac arteries. A laparoscopic Hartmann's operation was performed successfully following marking of the inferior epigastric arteries using ultrasonography to avoid damaging them during trocar insertion. The second case involved a 70-year-old man with three colorectal cancers of the transverse and sigmoid colon and rectum. A CT scan revealed occlusion of the aorta below the origin of the renal arteries. Laparoscopic assisted low anterior resection and left hemicolectomy with colostomy were performed. The final patient was a 61-year-old man with rectal cancer. As the right internal iliac artery was patent, the patient underwent laparoscopic assisted low anterior resection. All the patients were discharged from the hospital without complications. It is important to visualize the image the blood flow via CT angiography and to mark collateral arteries using ultrasonography preoperatively in patients with Leriche syndrome for whom laparoscopic surgery was planned for to treat colorectal cancer.
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http://dx.doi.org/10.3892/ol.2017.6391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530085PMC
August 2017

Increased Copy Number Variation of mtDNA in an Array-based Digital PCR Assay Predicts Ulcerative Colitis-associated Colorectal Cancer.

In Vivo 2017 Jul-Aug;31(4):713-718

Department of Surgical Oncology, the University of Tokyo, Tokyo, Japan.

Aim: Mitochondrial dysfunction plays a central role in carcinogenesis in numerous cancer-related diseases. We examined the copy number variation of mitochondrial DNA (mtDNA) and the expression of energy-producing genes in relation to ulcerative colitis (UC)-associated carcinogenesis.

Materials And Methods: We studied 17 patients with UC-associated adenocarcinoma (UC-Ca) and 16 without UC-associated adenocarcinoma (UC-nonCa). The copy number of mtDNA in non-dysplastic mucosa in both groups was quantified by an array-based digital polymerase chain reaction (PCR) assay. Simultaneously, gene expression related to mitochondrial energy metabolism was determined by a PCR array.

Results: We observed a higher copy number of mtDNA in non-dysplastic mucosa in the UC-Ca group compared to the UC-nonCa group (484.2 vs. 747.7 copies/cell, p=0.022). The sensitivity, specificity, positive predictive value, and negative predictive value for the detection of UC-associated adenocarcinoma by mtDNA copy number were 43.8%, 100%, 100%, and 60.9%, respectively. We observed an increased expression of mitochondrial genes related to energy metabolism together with an increased copy number of mtDNA.

Conclusion: Mitochondrial function and its metabolic process play essential roles in UC carcinogenesis and are possible risk markers for the development of colitic cancer.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566928PMC
http://dx.doi.org/10.21873/invivo.11119DOI Listing
March 2018

Different Impacts of Preoperative Radiotherapy and Chemoradiotherapy on Oncological Outcomes in Patients with Stages II and III Lower Rectal Cancer: A Propensity Score Analysis.

Dig Surg 2018 21;35(3):212-219. Epub 2017 Jun 21.

Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan.

Background/aims: The neoadjuvant therapy for locally advanced rectal cancer has been changed from radiotherapy (RT) to chemoradiotherapy (CRT). This study is aimed at evaluating the benefit of CRT in patients with stage II or III lower rectal cancer, with regard to the impact on recurrence.

Methods: A total of 474 patients with clinical stage II or III lower rectal cancer who received either preoperative RT (n = 221) or CRT (n = 253) followed by total mesorectal excision were identified from our institutional database. Propensity score analysis was performed to mitigate selection biases.

Results: Among stage II patients, the CRT group showed a significantly lower 5-year local recurrence rate than the RT group (3.0 vs. 14.8%, p = 0.002). In contrast, among stage III patients, the CRT group showed a significantly lower 5-year distant recurrence rate than the RT group (27.8 vs. 42.6%, p = 0.04) and also a better 5-year recurrence-free survival (64.2 vs. 48.3%, p = 0.03).

Conclusions: Addition of concurrent chemotherapy to preoperative RT significantly enhanced the local control in stage II patients and decreased distant recurrence in stage III patients. The oncological benefit of CRT may differ between patients with stage II or III rectal cancer.
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http://dx.doi.org/10.1159/000477778DOI Listing
October 2018

Radiation-associated colon cancer: A case report.

Mol Clin Oncol 2017 Jun 8;6(6):817-820. Epub 2017 May 8.

Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.

Radiation-associated colon cancer is a rare clinical entity. We herein describe the case of a patient with radiation-associated colon cancer who had undergone low anterior resection for rectal cancer following preoperative radiotherapy. Certain characteristics of radiation-associated colon cancer are highlighted. The patient was a 48-year-old man who had undergone low anterior resection for rectal cancer following preoperative radiotherapy at a total dose of 50 Gy, at the age of 29 years. When the patient presented at the University of Tokyo Hospital, 19 years after the surgery, he complained of severe anal pain and frequent defecation. Colonoscopy revealed two flat tumors in the sigmoid colon, located 10 cm to the oral side of the anastomosis site, which were diagnosed as well-differentiated adenocarcinomas. In addition, colonoscopy identified five flat polyps near the tumors, which were resected endoscopically. Computed tomography and magnetic resonance imaging revealed a mass in the sigmoid colon and no evidence of distant metastasis. Laparoscopic-assisted intersphincteric resection of the rectum and sigmoid colon with diverting ileostomy was performed. There were no specific postoperative complications and the patient was discharged from the hospital on the 20th postoperative day. On pathological examination, the resected rectum and sigmoid colon contained two separate tumors and six flat polyps. The two tumors were diagnosed as well-differentiated adenocarcinomas with invasion of the subserosa and submucosa, respectively. A total of 17 regional lymph nodes without metastasis were resected. The six flat polyps were diagnosed as tubular adenomas. We herein present a case of a radiation-associated colon cancer in a patient who had undergone low anterior resection for rectal cancer following preoperative radiotherapy 19 years prior. Colonoscopic surveillance of radiation-associated colon cancer may be indicated for rectal cancer patients treated with preoperative radiotherapy, particularly for those with long-standing radiation-induced colitis.
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http://dx.doi.org/10.3892/mco.2017.1252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451881PMC
June 2017
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