Publications by authors named "Takuya Wada"

49 Publications

Ruptured type A aortic dissection with saddle pulmonary embolism-like appearance on computed tomography angiography.

J Card Surg 2021 May 30. Epub 2021 May 30.

Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan.

We present a case of ruptured type A acute aortic dissection with pulmonary trunk compression by mediastinal hematoma. This condition mimicked a pulmonary embolism on the early arterial phase of computed tomography angiography, whereas the correct diagnosis was determined from the late arterial phase and unenhanced computed tomography. We highlight the importance of carefully interpreting triphasic computed tomography angiography to assess the status of aortic dissection.
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http://dx.doi.org/10.1111/jocs.15691DOI Listing
May 2021

Avoiding anticoagulation drugs for postoperative atrial fibrillation enabled successful conservative treatment of left atrial dissection: a case report.

Surg Case Rep 2021 May 12;7(1):120. Epub 2021 May 12.

Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan.

Background: Left atrial dissection is a rare complication of cardiac surgery, most commonly associated with mitral valve surgery. Herein, we report on the successful conservative treatment of left atrial dissection while avoiding anticoagulation therapy.

Case Presentation: A 64-year-old man developed left atrial dissection during operation for acute type A aortic dissection, most likely due to retrograde cardioplegia cannulation. As there was no connection between the left atrial dissection cavity and the left atrium on enhanced computed tomography, we did not administer anticoagulants to prevent expansion of the left atrial dissection cavity. However, the patient developed atrial fibrillation, which was successfully managed by beta-blocker and amiodarone administration. Follow-up imaging showed gradual left atrial dissection reduction, and the patient was started on anticoagulation therapy.

Conclusion: We were able to resolve left atrial dissection by preventing the use of anticoagulation therapy in the acute stage by managing the atrial fibrillation with antiarrhythmic drugs.
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http://dx.doi.org/10.1186/s40792-021-01194-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116416PMC
May 2021

[Traction-assisted Negative Pressure Wound Therapy for Pediatric Poststernotomy Mediastinitis:Report of Two Cases].

Kyobu Geka 2021 Feb;74(2):121-124

Department of Cardiovascular Surgery, Akita University, Akita, Japan.

We herein report two cases of pediatric poststernotomy mediastinitis treated by traction-assisted negative pressure wound therapy (NPWT) with Zip Surgical Skin Closure (Zip), which is a non-invasive skin closure device. We used this device with NPWT in cases of pediatric poststernotomy mediastinitis to stabilize the sternum and reduce the natural retractive forces of the skin. The patients were two boys (two and three months old), with an onset of infection at 13 and eight postoperative days, respectively. The culture examination detected methicillin-susceptible Staphylococcus aureus in both cases. Traction-assisted NPWT with Zip was performed at-75 mmHg for 16 and 33 days, and the wounds healed completely. In conclusion, this modification was successfully applied to treat pediatric poststernotomy mediastinitis and may help reduce the duration of treatment.
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February 2021

Type A acute aortic dissection in a patient with patent ductus arteriosus.

Ann Thorac Surg 2021 May 5. Epub 2021 May 5.

Department of Cardiovascular Surgery, Nakadori General Hospital, Minamidori Misonocho 3-15, Akita 010-8577, Japan.

Cardiac or aortic surgeries requiring cardiopulmonary bypass in combination with patent ductus arteriosus in adults present a special problem that requires a tailored approach. We report a case of ruptured type A acute aortic dissection in a 73-year-old woman with patent ductus arteriosus. In this case, we highlight that transpulmonary direct ductus arteriosus closure and subsequent frozen elephant deployment with total arch replacement are reasonable and reliable treatments for type A acute aortic dissection in a patient with patent ductus arteriosus.
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http://dx.doi.org/10.1016/j.athoracsur.2021.04.066DOI Listing
May 2021

Usefulness of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in elderly patients: a single-center retrospective cohort study.

Jpn J Clin Oncol 2021 May;51(6):895-904

Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.

Background: The effectiveness of endoscopic treatment for superficial esophageal squamous cell carcinoma in the elderly is unclear.

Methods: We retrospectively studied efficacy and safety of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in 358 patients at our hospital from July 2005 to December 2018. Patients were divided into elderly (≥75 years) and young (≤74 years) groups. Efficacy was evaluated based on overall survival and disease-specific survival, whereas safety was investigated based on the frequency of endoscopic submucosal dissection-related adverse events.

Results: The median observation period was 50 months. The elderly group comprised 111 patients, and young group comprised 247 patients. In the elderly and young groups, 76 (68.5%) and 159 (64.4%) underwent curative resection (P = 0.450), 8 (7.2%) and 34 (13.8%) underwent non-curative resection plus additional treatment and 12 (10.8%) and 15 (6.0%) underwent follow-up, respectively. The frequency of additional treatment for non-curative resection was significantly lower in the elderly group (P = 0.023). The 3-year overall survival of the elderly and young groups was 85.6 and 94.1%, respectively (P = 0.003). The 3-year disease-specific survival of the elderly and young groups was 98.4 and 98.5% (P = 0.682), respectively. The frequency of endoscopic submucosal dissection-related adverse events did not differ significantly between the groups (P = 0.581). The Charlson Comorbidity Index ≥2 was an independent prognostic factor for survival in the elderly group (P = 0.010; hazard ratio, 5.570; 95% confidence interval, 1.519-20.421).

Conclusions: Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in elderly patients is as safe as that for young patients. The evaluation of Charlson Comorbidity Index was considered to help estimate the prognosis of elderly patients.
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http://dx.doi.org/10.1093/jjco/hyab030DOI Listing
May 2021

Calcified Aortic Wall Removal for Dysphagia Aortica Caused by Chronic Traumatic Aortic Pseudoaneurysm.

Ann Vasc Surg 2021 Feb 5. Epub 2021 Feb 5.

Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan.

In this study, we report a case of a 45-year-old man with dysphagia aortica secondary to chronic traumatic aortic pseudoaneurysm of the aortic isthmus. He had been involved in a motor vehicle accident 27 years earlier. Computed tomography demonstrated a severely calcified aortic pseudoaneurysm of the aortic isthmus that compressed the esophagus extrinsically. An invasive surgical procedure involving a graft replacement and removal of the calcified aortic wall released the esophageal compression and completely improved the patient's symptoms. To the best of our knowledge, a case of dysphagia aortica caused by calcified pseudoaneurysm has never been reported.
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http://dx.doi.org/10.1016/j.avsg.2021.01.088DOI Listing
February 2021

A case of juvenile eosinophilic cholangitis: Rapid peripheral blood hypereosinophilia after admission leading to diagnosis.

JGH Open 2021 Feb 10;5(2):314-316. Epub 2020 Nov 10.

Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan.

A 15-year-old boy was referred to our hospital with elevated hepatobiliary enzyme levels and jaundice. Magnetic resonance cholangiopancreatography performed at the previous medical facility revealed a stricture of the intrahepatic and extrahepatic bile duct. Computed tomography showed dilatation and wall thickness of the intrahepatic bile ducts. Primary sclerosing cholangitis or cholangiocarcinoma was suspected. Endoscopic retrograde cholangiopancreatography (ERCP) showed stricture in the intrahepatic and extrahepatic bile duct. On admission, the eosinophil count in the peripheral blood was normal; however, rapid hypereosinophilia in the peripheral blood was observed after admission, leading us to suspect eosinophilic cholangitis (EC). A bile duct biopsy showed inflammatory cells and eosinophil infiltration during a second ERCP. The patient was diagnosed with EC based on histopathology.
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http://dx.doi.org/10.1002/jgh3.12454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857273PMC
February 2021

Direct Abdominal Aortic Access for Thoracic Endovascular Aortic Repair in a Patient with Severe Aortic and Arterial Calcification.

Ann Vasc Surg 2021 May 15;73:509.e21-509.e24. Epub 2021 Jan 15.

Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan.

Aortic and arterial calcification is a complication of advanced atherosclerosis and is a critical intraoperative issue that can reduce the ability to achieve safe and adequate access for stent graft introduction. Different vascular access sites are used to deliver stent grafts when a standard transfemoral or iliac access is not feasible. We report a challenging case of a direct transabdominal aortic thoracic endovascular aortic repair for a thoracic aortic aneurysm complicated with severe aortic and arterial calcification, in which the noncalcified area of the infrarenal abdominal aorta was extremely limited. This may be a reasonable access site, especially for patients with severe aortic and arterial calcification.
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http://dx.doi.org/10.1016/j.avsg.2020.11.001DOI Listing
May 2021

[Tricuspid Valve Replacement Preserving the Leaflets in a Congenitally Corrected Transposition of the Great Arteries;Report of a Case].

Kyobu Geka 2020 Dec;73(13):1109-1112

Department of Cardiovascular Surgery, Akita University, Akita, Japan.

In patients with a congenitally corrected transposition of the great arteries (ccTGA), the regurgitation of the systemic atrioventricular valve (SAVV) increases and anatomical right ventricular (ARV) dysfunction often progressively develops. A low systemic ventricular ejection fraction( SVEF) is a risk factor for mortality. However, in patients with a low ejection fraction of ARV, it is unclear how to best perform valve replacement for patients with regurgitation of SAVV. A 70-year-old female with respirator discomfort was admitted to our hospital and diagnosed to have situs solitus ccTGA, severe SAVV regurgitation, and ARV dysfunction. Her ARV ejection fraction was 25% and she was therefore dependent on inotropic agents. We successfully performed a tricuspid valve replacement while preserving the leaflets, the chorda tendineae's, and papillary muscles, and placing the lead for cardiac resynchronization therapy on the ARV. Her postoperative course was uneventful. Thereafter, she was discharged 6 weeks after surgery.
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December 2020

[Thoracic Endovascular Repair for Chronic Aortic Dissection with Aberrant Origin of the Left Vertebral Artery;Report of a Case].

Kyobu Geka 2020 Nov;73(12):1032-1036

Department of Cardiovascular Surgery, Akita University, Akita, Japan.

We herein report a case of thoracic endovascular aortic repair( TEVAR) for chronic aortic dissection with an aberrant left vertebral artery( LVA) originating from the aortic arch. A 51-year-old man with a medical history of Stanford type B acute aortic dissection 2 years ago was transferred to our institution for the treatment of an aortic expansion. Computed tomography showed a large entry just distal to the takeoff of the left subclavian artery and a dilated dissected thoracic aorta. A left cervical incision over the anterior border of the sternocleidomastoid was made, and the LVA was identified. The proximal LVA was ligated and anastomosed to the left common carotid artery in an end-to-side fashion. After completion of the carotid-subclavian bypass, TEVAR was performed in the usual fashion. The postoperative course was uneventful without stroke or spinal cord injury. At the 1-year follow-up, the false lumen had shrunk and the LVA remained patent.
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November 2020

Barrett's Esophageal Adenocarcinoma Involving a White Globe Appearance within the Long-Segment Barrett's Esophagus.

Case Rep Gastroenterol 2020 Sep-Dec;14(3):510-515. Epub 2020 Oct 22.

Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.

The diagnosis of Barrett's esophageal adenocarcinoma (BEA) in patients with Barrett's esophagus (BE) using endoscopy can be difficult and there are few specific endoscopic findings for BEA. However, white globe appearance (WGA) has been reported to be a specific endoscopic finding for early gastric cancer. We encountered a 51-year-old male patient with BEA exhibiting WGA. Esophagogastroduodenoscopy identified a red, depressed lesion of 10 mm within the long-segment BE (LSBE), while magnifying endoscopy with narrow-band imaging identified WGA. Endoscopic submucosal dissection (ESD) was performed based on our suspicion of BEA. Based on the ESD findings, we diagnosed adenocarcinoma accompanying LSBE histopathologically. WGA was identified, and intraglandular necrotic debris was discovered histologically at the same site. Therefore, WGA may be helpful in the diagnosis of BEA.
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http://dx.doi.org/10.1159/000508861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670350PMC
October 2020

Genome sequence of Hydrangea macrophylla and its application in analysis of the double flower phenotype.

DNA Res 2021 Jan;28(1)

Tochigi Prefectural Agricultural Experimental Station, Utsunomiya, Tochigi 320-0002, Japan.

Owing to its high ornamental value, the double flower phenotype of hydrangea (Hydrangea macrophylla) is one of its most important traits. In this study, genome sequence information was obtained to explore effective DNA markers and the causative genes for double flower production in hydrangea. Single-molecule real-time sequencing data followed by a Hi-C analysis were employed. Two haplotype-phased sequences were obtained from the heterozygous genome of hydrangea. One assembly consisted of 3,779 scaffolds (2.256 Gb in length and N50 of 1.5 Mb), the other also contained 3,779 scaffolds (2.227 Gb in length, and N50 of 1.4 Mb). A total of 36,930 genes were predicted in the sequences, of which 32,205 and 32,222 were found in each haplotype. A pair of 18 pseudomolecules was constructed along with a high-density single-nucleotide polymorphism (SNP) genetic linkage map. Using the genome sequence data, and two F2 populations, the SNPs linked to double flower loci (djo and dsu) were discovered. DNA markers linked to djo and dsu were developed, and these could distinguish the recessive double flower allele for each locus, respectively. The LEAFY gene is a very likely candidate as the causative gene for dsu, since frameshift was specifically observed in the double flower accession with dsu.
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http://dx.doi.org/10.1093/dnares/dsaa026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934569PMC
January 2021

Additional posterior wall isolation is associated with gastric hypomotility in catheter ablation of atrial fibrillation.

Int J Cardiol 2021 03 31;326:103-108. Epub 2020 Oct 31.

Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.

Background: Gastric hypomotility (GH) is a possible complication of catheter ablation (CA) for atrial fibrillation (AF). However, it is unclear which factors are associated with GH. We sought to elucidate the relationship between the CA procedure and GH.

Methods: The study population consisted of 254 patients who underwent CA for AF from November 2017 to October 2018. Finally, 119 patients were enrolled and divided into two groups: with or without GH (GH or non-GH groups). To evaluate the association with GH, the clinical backgrounds and procedure characteristics of the radiofrequency CA (RFCA) were compared between the two groups.

Results: The median age was 69 years old with 34% of female. GH were observed in 27.7% of patients who underwent RFCA, which was significantly higher than that in the cohort of patients who underwent esophago-gastro-duodenoscopy during the same time period (1.9%: 151 in 8063 patients, p < 0.0001). According to the detailed RFCA procedure, additional posterior wall isolation with pulmonary vein isolation (PVI) had a higher prevalence of GH than that with only PVI (54.8% vs. 18.2%; odds ratio 5.46, 95%CI 2.24-13.32, p = 0.0002). After an adjustment using a multivariate logistic analysis, a posterior wall isolation with the PVI was identified as the only independent predictor for GH (odds ratio 5.01, 95%CI 1.94-13.43, p = 0.0009).

Conclusions: Additional posterior wall isolation with PVI was associated with gastric hypomotility.
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http://dx.doi.org/10.1016/j.ijcard.2020.10.069DOI Listing
March 2021

Randomized study of prevention of gastrointestinal toxicities by nutritional support using an amino acid-rich elemental diet during chemotherapy in patients with esophageal cancer (KDOG 1101).

Esophagus 2021 Apr 3;18(2):296-305. Epub 2020 Oct 3.

Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan.

Background: This randomized study was designed to evaluate the clinical effect of an elemental diet during chemotherapy in patients with esophageal cancer.

Methods: The inclusion criteria were as follows: (1) esophageal squamous cell carcinoma, (2) stage IB-IV, (3) schedule to receive docetaxel, cisplatin, and 5-fluorouracil (DCF chemotherapy), (4) 20-80 years old, (5) performance status of 0-2, (6) oral intake ability, and (7) written informed consent. Patients were divided into two groups: the elemental supplementary group and the non-supplementary group. Patients received ELENTAL (160 g/day) orally 9 weeks after the start of chemotherapy. Primary endpoint was the incidence of grade 2 or higher gastrointestinal toxicity according to the Common Terminology Criteria for Adverse Events, version 4.0. Secondary endpoints were the incidence of all adverse events and the evaluation of nutritional status.

Results: Thirty-six patients in the elemental supplementary group and 35 patients in the non-supplementary group were included in the analysis. The incidence of grade 2 or higher gastrointestinal toxicity and all grade 3 or 4 adverse events did not differ significantly between the groups. In the elemental supplementary group, the body weight (p = 0.057), muscle mass (p = 0.056), and blood levels of transferrin (p = 0.009), total amino acids (p = 0.019), and essential amino acids (p = 0.006) tended to be maintained after chemotherapy.

Conclusion: Nutritional support provided by an amino acid-rich elemental diet was ineffective for reducing the incidence of adverse events caused by DCF chemotherapy in patients with esophageal cancer.
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http://dx.doi.org/10.1007/s10388-020-00787-wDOI Listing
April 2021

Favipiravir-induced fever in coronavirus disease 2019: A report of two cases.

Int J Infect Dis 2020 Dec 28;101:188-190. Epub 2020 Sep 28.

Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Tokyo, Japan. Electronic address:

Favipiravir, an antiviral agent, is undergoing clinical trials for treating novel coronavirus disease 2019 (COVID-19). Here, we report two cases of COVID-19 with favipiravir-induced fever. In both cases, pyrexia was observed following the administration of favipiravir despite improvements in symptoms of COVID-19. No other cause for fever was evident after careful physical examination and laboratory investigation. The fever subsided in both patients after the discontinuation of favipiravir. To the best of our knowledge, this is the first report of favipiravir-induced fever in COVID-19 patients.
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http://dx.doi.org/10.1016/j.ijid.2020.09.1450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521433PMC
December 2020

Usefulness of argon plasma coagulation for superficial esophageal squamous cell neoplasia in patients at high risk or with limited endoscopic resectability.

Turk J Gastroenterol 2020 07;31(7):529-537

Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.

Background/aims: Endoscopic resection is the standard treatment for superficial esophageal squamous-cell neoplasia (SESCN). However, we encounter patients in whom endoscopic resection is difficult to perform. We retrospectively studied the usefulness of argon plasma coagulation (APC) in patients with SESCN.

Materials And Methods: The study comprised 45 patients with SESCN (81 lesions) who underwent APC in our hospital from March 1999 through August 2016. Clinicopathological characteristics, treatment time, the presence or absence of metastasis and recurrence, adverse events, and outcomes were studied.

Results: The median follow-up was 40 months. The median age was 70 years. The tumor diameter was 10 mm or longer in 48 lesions and less than 10 mm in 33 lesions. The median treatment time was 22 minutes. The reasons for selecting APC were as follows: technical difficulty caused by the presence of metachronous multiple lesions in the radiation field after chemoradiotherapy or close proximity to the ulcer scar remaining after endoscopic treatment in 49 lesions (60.4%), and the presence of underlying diseases in 26 lesions (32.0%). Adverse events occurred in 2 patients (4.4%) who had hypoxemia due to over-sedation. Two lesions (2.5%) recurred locally but could be locally controlled by additional APC. No patient had metastasis or recurrence or died of esophageal neoplasia. The 3-year overall survival rate was 87.0%, and the 3-year recurrence-free survival rate was 97.2%.

Conclusion: APC can be a useful treatment option for SESCN in patients with a limited life expectancy, poor performance status, or technical difficulty in resection of superficial neoplasms.
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http://dx.doi.org/10.5152/tjg.2020.19329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480201PMC
July 2020

Severe hypoperistalsis caused by a 3-min single shot cryoballoon ablation for paroxysmal atrial fibrillation: A case report.

J Cardiol Cases 2020 Jul 24;22(1):26-28. Epub 2020 Apr 24.

Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.

A 61-year-old male was referred to our hospital to receive catheter ablation of paroxysmal atrial fibrillation. Since no anatomical abnormalities were detected by preoperative computed tomography of left atrium and pulmonary veins (PVs), he underwent a cryoballoon ablation for a PV isolation. We performed single, 3-min freeze applications to all four PVs while monitoring the esophageal temperature. Immediately after the procedure, he complained of nausea, followed by a body weight loss of 9 kg over 2 months. Since no structural abnormalities were detected even through careful evaluation, he was diagnosed with hypoperistalsis caused by the cryoballoon ablation. Although his symptoms partially improved, they persisted over a year. The cryoballoon procedure is believed to be relatively safe, but even just a simple 3-min freeze application caused severe hypoperistalsis in the present case. Operators should recognize the risk of such complications. < Cryoballoon ablation is thought to be a safe procedure, however, there are important complications. Asymptomatic or mild-symptomatic hypoperistalsis after cryoballoon ablation is not uncommon. In this case, even just a single 3-min freeze for each pulmonary vein caused severe hypoperistalsis. Repetitive or longer freezes are reported as a risk for this complication, therefore, the operator should recognize the risk of this complication, and a shorter freeze time may be considered instead of a fixed 3-min freeze.>.
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http://dx.doi.org/10.1016/j.jccase.2020.03.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326658PMC
July 2020

Neoadjuvant chemotherapy plus surgery for high-risk advanced gastric cancer: long-term results of KDOG1001 trial.

Langenbecks Arch Surg 2020 Sep 2;405(6):777-785. Epub 2020 Jul 2.

Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, 252-0374, Japan.

Purpose: The purpose of this study is to evaluate the long-term survival outcomes of KDOG1001 trial after a minimum follow-up of 3 years.

Methods: Patients with bulky N2 lymph nodes, linitis plastica (type 4), or large ulcero-invasive-type tumors (type 3) received up to four 28-day cycles of DCS neoadjuvant chemotherapy (docetaxel at 40 mg/m, cisplatin at 60 mg/m on day 1, and S-1 at 40 mg/m twice daily for 2 weeks) followed by gastrectomy with D2 lymphadenectomy plus adjuvant S-1 therapy for 1 year. The final preplanned analysis of long-term outcomes including overall survival and relapse-free survival was conducted after minimum follow-up of 3 years. This trial is registered with the University Hospital Medical Information Network Clinical Trials Registry, number UMIN 000003642, and has been completed.

Results: From May 2010 through January 2017, 40 patients were enrolled. All included patients underwent neoadjuvant chemotherapy with DCS followed by gastrectomy with D2 lymphadenectomy, and 32 (80%) completed adjuvant S-1 therapy for 1 year. After a median follow-up for surviving patients of 68 months at the last follow-up in January 2020, 3-year overall survival rate was 77.5% (95% confidence interval 62.1-87.9%), while 3-year relapse-free survival rate was 62.5% (95% confidence interval 46.8-76.0%).

Conclusion: Neoadjuvant chemotherapy with 4 cycles of DCS followed by D2 gastrectomy plus adjuvant S-1 was associated with relatively good long-term oncologic outcomes for patients with the high-risk gastric cancer.
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http://dx.doi.org/10.1007/s00423-020-01924-wDOI Listing
September 2020

DNA markers based on retrotransposon insertion polymorphisms can detect short DNA fragments for strawberry cultivar identification.

Breed Sci 2020 Apr 26;70(2):231-240. Epub 2020 Feb 26.

Graduate School of Environmental and Life Science, Okayama University, 1-1-1 Tsushima-Naka, Kita-ku, Okayama 700-8530, Japan.

In this study, DNA markers were developed for discrimination of strawberry ( × L.) cultivars based on retrotransposon insertion polymorphisms. We performed a comprehensive genomic search to identify retrotransposon insertion sites and subsequently selected one retrotransposon family, designated CL3, which provided reliable discrimination among strawberry cultivars. Through analyses of 75 strawberry cultivars, we developed eight cultivar-specific markers based on CL3 retrotransposon insertion sites. Used in combination with 10 additional polymorphic markers, we differentiated 35 strawberry cultivars commonly cultivated in Japan. In addition, we demonstrated that the retrotransposon-based markers were effective for PCR detection of DNA extracted from processed food materials, whereas a SSR marker was ineffective. These results indicated that the retrotransposon-based markers are useful for cultivar discrimination for processed food products, such as jams, in which DNA may be fragmented or degraded.
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http://dx.doi.org/10.1270/jsbbs.19116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272250PMC
April 2020

Multiple gastrointestinal metastasis after endoscopic submucosal dissection for poorly differentiated gastric adenocarcinoma.

Clin J Gastroenterol 2020 Oct 8;13(5):717-721. Epub 2020 Jun 8.

Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.

A 76-year-old man had a diagnosis of double primary cancers consisting of poorly differentiated esophageal squamous cell carcinoma (ESCC) invading the submucosa and poorly differentiated gastric adenocarcinoma (GAC) invading the submucosa. The clinical stage of both ESCC and GAC was T1N0M0 stage I. The tumor diameter of ESCC and GAC was 20 mm and 25 mm, respectively. We performed chemoradiotherapy for ESCC. Chemotherapy consisted of nedaplatin in an intravenous dose of 90 mg/m on day 1 and 5-fluorouracil in an intravenous dose of 800 mg/m on days 1-5, repeated every 4 weeks for two cycles. Radiotherapy consisted of 50.4 Gy in 28 fractions for ESCC. GAC was down-staged after chemoradiotherapy for ESCC and was treated by endoscopic submucosal dissection (ESD). The tumor was histopathologically confirmed to be down-staged to intramucosal cancer with a diameter of 18 mm and no evidence of lymphovascular invasion and ulceration. Multiple metastasis occurred in the stomach, the small intestine and the colorectum after ESD. ESD is not a curative treatment even if chemotherapy is effective for poorly differentiated GAC invading the submucosa. Multiple gastrointestinal metastasis may be a unique recurrence pattern after ESD for such a lesion.
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http://dx.doi.org/10.1007/s12328-020-01155-yDOI Listing
October 2020

A phase I study of docetaxel/oxaliplatin/S-1 (DOS) combination neoadjuvant chemotherapy for patients with locally advanced adenocarcinoma of the esophagogastric junction.

Int J Clin Oncol 2020 Jun 2;25(6):1090-1097. Epub 2020 Mar 2.

Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.

Background: The optimal dose of each drug used in the docetaxel, oxaliplatin, and S-1 (DOS) chemotherapy remains to be clarified for the Japanese population. The purpose of this study was to determine a recommended dose for a combination neoadjuvant DOS chemotherapy for Japanese patients with locally advanced adenocarcinoma of the esophagogastric junction (AEG).

Methods: Patients with cT3 or more advanced AEG without distant metastasis were eligible for this study. The planned dosages of docetaxel (mg/m, day 1), oxaliplatin (mg/m, day 1), and S-1 (mg/day, days 1-14) were: 50/100/80-120 at level 1, and 60/100/80-120 at level 2, respectively. The treatment cycle was repeated every 3 weeks, and patients were assessed for response to the treatment after 2 and 3 cycles. This study was registered in the UMIN Clinical Trial Registry (UMIN 000022210).

Results: We enrolled 12 patients with locally advanced AEG in this study. At dose level 1, one of the six patients experienced dose-limiting toxicity (DLT) of grade 3 diarrhea and grade 3 febrile neutropenia. Two of the next six patients also experienced DLT of need for more than 2-week delay of the start of the second cycle due to adverse events at dose level 2. Based on these results, level 2 was considered the recommended dose for this regimen.

Conclusion: Recommended doses of docetaxel (mg/m), oxaliplatin (mg/m), and S-1 (mg/day) were 60/100/80-120. This chemotherapy scheme showed good preliminary efficacy with acceptable toxicity warranting a further phase II trial to investigate the efficacy of this regimen.
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http://dx.doi.org/10.1007/s10147-020-01638-5DOI Listing
June 2020

Magnetic resonance relaxometry improves the accuracy of conventional MRI in the diagnosis of endometriosis-associated ovarian cancer: A case report.

Mol Clin Oncol 2019 Sep 1;11(3):296-300. Epub 2019 Jul 1.

Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan.

Endometriosis is a precancerous condition for endometriosis-associated ovarian cancer (EAOC). In the present study, conventional magnetic resonance imaging (MRI) and MR relaxometry were used to examine a case of clear cell carcinoma that arose in a pre-existing right-sided benign ovarian endometrioma (OE). The 42-year-old nulliparous woman suspected of EOAC, as assessed by conventional MRI, requested fertility-sparing surgery such as laparoscopic endometrioma cystectomy. Furthermore, the MR transverse relaxation rate (R2) was determined using a single-voxel, multi-echo MR sequence using a 3 Tesla-MR system. An R2 value <12.1 s was indicative of malignancy, as described in previous studies. In the present study, MR relaxometry identified an R2 value of 7.98 s in the right cyst, which suggested the malignant transformation of benign OE. Based on these findings, fertility-sparing surgery was contraindicated. In conclusion, MR relaxometry may represent a new clinical approach as an adjunctive modality for the diagnosis of EAOC. When patients exhibiting a pelvic mass suspected of EAOC desire fertility-sparing treatment options, MR relaxometry can facilitate the selection of conservative management.
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http://dx.doi.org/10.3892/mco.2019.1889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667887PMC
September 2019

A retrospective study of definitive chemoradiotherapy in patients with resectable small cell neuroendocrine carcinoma of the esophagus.

Esophagus 2020 04 18;17(2):135-140. Epub 2019 Jul 18.

Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan.

Background: Standard treatment for resectable small cell neuroendocrine carcinoma of the esophagus (SCNEC-E) remains to be established.

Methods: We retrospectively studied 7 consecutive patients with resectable SCNEC-E who received definitive chemoradiotherapy (dCRT) to evaluate the safety and efficacy. Treatment consisted of two courses of chemotherapy with cisplatin (80 mg/m on day 1) and etoposide (100 mg/m on days 1-3) or carboplatin (AUC 5 on day 1) and etoposide (80 mg/m on days 1-3) given every 4 weeks during dCRT. The total radiation dose was 50.4 Gy (28 fractions).

Results: The clinical stage was IA in 1 patient, IB in 2 patients, IIA in 3 patients, and IIB in 1 patient. Definitive CRT was completed in all patients. The median overall treatment time of radiotherapy was 44 days. The chemotherapy regimen included in dCRT was cisplatin and etoposide in 3 patients and carboplatin and etoposide in 4 patients. Acute adverse events of grade 3 or 4 were neutropenia 100%, thrombocytopenia 43%, febrile neutropenia 43%, and nausea 14%. There were no late grade 3 or 4 adverse events. The median survival time was 32 months. The complete response rate was 100%. The recurrence rate was 43%. The median survival of the 4 patients without recurrence was 56 months.

Conclusions: Definitive CRT with cisplatin and etoposide or carboplatin and etoposide is a feasible treatment for the resectable SCNEC-E, and long-term survival can be achieved in some patients.
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http://dx.doi.org/10.1007/s10388-019-00686-9DOI Listing
April 2020

Modified Isolation Selective Cerebral Perfusion Technique for Intracardiac Disease with Mobile Atheroma.

Ann Vasc Dis 2019 Jun;12(2):222-224

Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.

Isolation selective cerebral perfusion (ISCP) technique is reportedly an effective method for preventing brain complications during the treatment of arch aneurysms. Here we present the case of a patient with intracardiac disease complicated by mobile atheroma in the proximal aorta. In this patient, not only the arterial cannulation of the ascending aorta might have posed a high risk of brain stroke but also the original ISCP technique could not be applied. We applied the ISCP technique for non-aortic disease without using circulatory arrest to prevent aortogenic brain embolism. The patients who underwent treatment using this technique were discharged without neurologic complications.
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http://dx.doi.org/10.3400/avd.cr.18-00146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600107PMC
June 2019

A diagnostic challenge of seromucinous borderline tumor: A case report.

Medicine (Baltimore) 2019 May;98(22):e15707

Department of Obstetrics and Gynecology.

Introduction: Magnetic resonance (MR) relaxometry provides a noninvasive predictive tool to discriminate between benign ovarian endometrioma (OE) and endometriosis-associated ovarian cancer (EAOC). Transverse relaxation rate R2 value was determined using a single-voxel, multi-echo MR sequence (HISTO) by a 3T-MR system. R2 with cutoff value of 12.1 s was established to discriminate between benign and malignant tumors.

Patient Concerns: We present a case of a 39-year-old woman who was initially thought to be malignant transformation of endometriosis by diagnostic MR imaging of the vascularized solid components.

Diagnosis: A R2 value of 42.62 s on MR relaxometry demonstrated that this case is non-malignant.

Interventions: To confirm the diagnose, left salpingo-oophorectomy by laparoscopic surgery was performed.

Outcomes: Histopathological results revealed seromucinous borderline tumor (SMBT). Our experience suggests that preoperative MR relaxometry may be useful for discriminating "borderline (SMBT)" from "malignancy (EAOC)." Furthermore, immunohistochemical studies of this case demonstrated ovarian SMBT cells were positive for estrogen receptor, progesterone receptor, and hepatocyte nuclear factor-1beta. A similar expression pattern was also observed in patients with benign OE.

Lessons: In many respects, SMBT characteristics differ from those of EAOC but resemble those of benign OE. MR relaxometry unveils a new clinical approach as an adjunctive modality for discriminating SMBT from EAOC.
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http://dx.doi.org/10.1097/MD.0000000000015707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709009PMC
May 2019

Thoracic Endovascular Aortic Repair on Zone 2 Landing for Type B Aortic Dissection.

Ann Vasc Surg 2019 Oct 8;60:120-127. Epub 2019 May 8.

Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.

Background: Although thoracic endovascular aortic repair (TEVAR) is an effective treatment for both complicated and uncomplicated type B aortic dissection (TBAD), the occurrence of retrograde type A aortic dissection (RTAD) after TEVAR could be a disastrous complication. The aim of this study was to examine the safety of zone 2 TEVAR in the treatment of acute and subacute TBAD.

Methods: A Relay stent graft (SG) was placed proximally beyond the left subclavian artery (LSA) as zone 2 TEVAR for complicated or uncomplicated TBAD. LSA was preserved by physician-modified fenestrated TEVAR (F-TEVAR) if anatomically possible or by surgical reconstruction of debranching TEVAR (D-TEVAR) if necessary. Otherwise, LSA was simply covered. Changes in the aortic diameters after TEVAR were evaluated using CT scanning.

Results: Between 2013 and 2017, 22 patients (mean age: 63 ± 14 years; 16 males) with TBAD were treated with zone 2 TEVAR. Emergency TEVAR was performed in 9 patients (41%) for complicated TBAD, and elective TEVAR was performed in 13 patients (59%) for uncomplicated TBAD in subacute phases. LSA was preserved in 16 patients via 15 F-TEVAR and 1 D-TEVAR and intentionally covered in 6 patients on emergency TEVAR. Elective TEVAR succeeded in the preservation of LSA flow in all patients (emergency 33% vs. elective 100%; P < 0.01). There were no TEVAR-related complications such as stroke, spinal cord ischemia, and RTAD. Thirty-day mortality was 0%. Aortic remodeling as the expansion of true lumen and shrinkage and complete thrombosed occlusion of false lumen were prominent at the level of SG placement 12 months after TEVAR. During the follow-up period, stent-induced new entry at the distal edge of the SG occurred in 1 patient (4%); however, there was no case of aorta-related mortality.

Conclusions: Zone 2 TEVAR for acute and subacute TBAD might be promising for the prevention of RTAD.
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http://dx.doi.org/10.1016/j.avsg.2019.02.017DOI Listing
October 2019

A giant trichobezoar extracted by laparoscopic and endoscopic cooperative surgery (LECS).

Endosc Int Open 2018 Dec 29;6(12):E1413-E1416. Epub 2018 Nov 29.

Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.

A gastric bezoar is a mass that forms in the stomach. A giant gastric bezoar is particularly difficult to treat medically, and surgical therapy is selected. We describe our experience with a patient who had a giant gastric trichobezoar that was extracted by laparoscopic and endoscopic cooperative surgery (LECS) in accordance with the principles of LECS. The patient was a 32-year-old woman who presented at our hospital because of abdominal pain. Upper gastrointestinal endoscopy confirmed the presence of a giant gastric trichobezoar extending from the gastric cardia to the gastric angle. Because endoscopic removal was considered difficult, we extracted the giant gastric trichobezoar by LECS. The concurrent use of endoscopy was considered to allow a gastric bezoar to be extracted more safely and reliably than was previously possible.
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http://dx.doi.org/10.1055/a-0732-4697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6264922PMC
December 2018

A phase II study of neoadjuvant chemotherapy with docetaxel, cisplatin, and S-1, followed by gastrectomy with D2 lymph node dissection for high-risk advanced gastric cancer: results of the KDOG1001 trial.

Gastric Cancer 2019 05 3;22(3):598-606. Epub 2018 Oct 3.

Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, 252-0374, Japan.

Background: The prognosis of patients with gastric cancer with bulky node metastasis, linitis plastica (type 4), or large ulcero-invasive-type tumors (type 3) remains poor. We conducted a phase II study to evaluate the safety and efficacy of neoadjuvant chemotherapy with docetaxel, cisplatin, and S-1 (DCS) for establishing a new treatment modality that improves prognosis.

Methods: Patients received up to four 28-day cycles of DCS therapy (docetaxel at 40 mg/m, cisplatin at 60 mg/m on day 1, and S-1 at 40 mg/m twice daily for 2 weeks) followed by gastrectomy with D2 nodal dissection. S-1 chemotherapy was administered for 1 year after surgical resection. The primary endpoint was the percentage of complete resections of the primary tumor with clear margins (R0 resection). The planned sample size was 40; this was calculated based on an expected R0 rate of 85% and a threshold R0 rate of 65%, with a one-sided alpha of 5% and a power of 90%.

Results: Between 2010 and 2017, 40 patients were enrolled. The R0 resection rate was 90%. The most common grade 3 or 4 adverse events during DCS therapy were leukocytopenia (27.5%), neutropenia (55.0%), and hyponatremia (22.5%). The most common grade 3 or 4 surgical morbidity was pancreatic fistula (12.5%); mortality was 0%. The pathological response rate was 57.5% with a grade 3 histological response rate of 8%.

Conclusions: Neoadjuvant chemotherapy with DCS was feasible and showed a sufficient R0 resection rate. A future study with a sufficient follow-up period should confirm survival outcomes.
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http://dx.doi.org/10.1007/s10120-018-0884-0DOI Listing
May 2019

Feasibility of definitive chemoradiation therapy with nedaplatin and 5-fluorouracil in elderly patients with esophageal squamous cell carcinoma: A retrospective study.

Adv Radiat Oncol 2018 Jul-Sep;3(3):305-313. Epub 2018 Mar 1.

Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.

Purpose: This study was designed to retrospectively analyze the safety and efficacy of chemoradiation therapy with nedaplatin and 5-fluorouracil in elderly patients with esophageal squamous cell carcinoma.

Methods And Materials: Eligible patients were aged 76 years or older, had a histopathologic diagnosis of esophageal squamous cell carcinoma, and were treated at the Kitasato University Hospital between January 2010 and March 2016. Chemotherapy consisted of nedaplatin in an intravenous dose of 90 mg/m on day 1 and 5-fluorouracil in an intravenous dose of 800 mg/m on days 1 to 5, repeated every 4 weeks for 2 cycles. Radiation therapy consisted of 50.4 Gy in 28 fractions for thoracic tumors and 61.2 Gy for cervical tumors.

Results: Twenty-five patients were studied. Patient characteristics were as follows: median age 79 years (range, 76-85 years), clinical stage I/II/III/IV (7/8/8/2, respectively), and surgically resectable/unresectable (17/8, respectively). The completion rates of radiation therapy and chemoradiation therapy were 100% and 84%, respectively. Grade ≥3 acute toxicities included neutropenia (76%), leukopenia (72%), thrombocytopenia (32%), anemia (28%), anorexia (32%), oral mucositis (20%), febrile neutropenia (12%), and esophagitis (8%). Grade ≥3 late toxicities included esophageal stenosis (12%) and pleural effusion (4%). The complete response rate was 64%. In the median follow-up period of 18.9 months, the 1-year overall survival rate was 68%.

Conclusions: Definitive chemoradiation therapy with nedaplatin and 5-fluorouracil may be a feasible treatment option for elderly patients with esophageal squamous cell carcinoma.
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http://dx.doi.org/10.1016/j.adro.2018.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127966PMC
March 2018

Effectiveness and safety of endoscopic aspiration mucosectomy and endoscopic submucosal dissection in patients with superficial esophageal squamous-cell carcinoma.

Surg Endosc 2019 05 5;33(5):1433-1440. Epub 2018 Sep 5.

Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.

Background: Endoscopic submucosal dissection (ESD) has been performed in a high proportion of patients with superficial esophageal squamous-cell carcinoma. Endoscopic aspiration mucosectomy (EAM) is a more straightforward technique that is easier to perform. We retrospectively evaluated the safety and efficacy of EAM and ESD to clarify the advantages and disadvantages of each procedure.

Methods: A total of 374 patients (423 lesions) who underwent endoscopic resection were retrospectively studied. The following variables were evaluated (1) procedure time and adverse events as safety, and (2) en bloc complete resection rate, local recurrence rate, lymph node recurrence rate, overall survival rate, and cause-specific survival rate as efficacy.

Results: EAM was performed in 134 patients (149 lesions), and ESD was performed in 240 patients (274 lesions). The procedure times of EAM and ESD were 31.0 ± 22.4 and 85.7 ± 46.5 min (p < 0.001), respectively. The perforation rates were 0 and 6.2% (p = 0.002), respectively. The en bloc complete resection rates were 48.3 and 91.6% (p < 0.001), respectively. The local recurrence rates were 5.5 and 0% (p < 0.001), respectively. For lesions measuring less than 15 mm in diameter, EAM had a relatively good en bloc complete resection rate (EAM, 76.1% vs. ESD, 100%) and a significantly short procedure time (EAM, 25.2 ± 15.2 min vs. ESD, 62.7 ± 35.2 min; p < 0.001).

Conclusions: ESD has a higher en bloc complete resection rate and a better local control rate than EAM. For lesions measuring less than 15 mm in diameter, EAM may be a treatment option.
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http://dx.doi.org/10.1007/s00464-018-6418-3DOI Listing
May 2019