Publications by authors named "Yasuyuki Suzuki"

590 Publications

Prognostic Significance of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology for the Prediction of Major Cardiac Events after Revascularization.

Intern Med 2021 Jun 12. Epub 2021 Jun 12.

Department of Cardiology, Nihon University School of Medicine, Japan.

Objective This retrospective study was aimed at determining whether or not stress phase bandwidth (SPBW), a left ventricular (LV) mechanical dyssynchrony index, predicts major cardiac events (MCEs) and stratifies the risk of those in patients with coronary artery disease (CAD) who undergo revascularization. Methods Patients were followed up to confirm the prognosis for at least one year. The SPBW was calculated by a phase analysis using the Heart Risk View-F software program. The composite endpoint was the onset of MCEs, consisting of cardiac death, non-fatal myocardial infarction, unstable angina pectoris, and severe heart failure requiring hospitalization. Patients The study subjects were 332 patients with CAD who underwent coronary angiography and revascularization after confirming ≥5% ischemia detected by rest Tl and stress Tc-tetrofosmin electrocardiogram-gated single-photon emission computed tomography myocardial perfusion imaging. Results During the follow-up, 35 patients experienced MCEs of cardiac death (n=5), non-fatal myocardial infarction (n=3), unstable angina pectoris (n=11), and severe heart failure requiring hospitalization (n=16). A receiver operating characteristics analysis indicated that the optimal cut-off value of the SPBW was 52° for predicting MCEs, and the MCE rate was significantly higher in the patients with an SPBW >52° than in those with an SPBW ≤52°. Results of the multivariate analysis showed the SPBW and estimated glomerular filtration rate to be independent predictors for MCEs. In addition, the cut-off value of the SPBW significantly stratified the risk of MCEs according to the results of the Kaplan-Meier analysis. Conclusion Evaluating the SPBW before revascularization may help predict future MCEs in patients with CAD who intended to undergo treatment.
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http://dx.doi.org/10.2169/internalmedicine.6995-20DOI Listing
June 2021

Response to the comment on "Current status and management of pancreatic trauma with main pancreatic duct injury: A multicenter nationwide survey in Japan".

J Hepatobiliary Pancreat Sci 2021 Jun 11. Epub 2021 Jun 11.

Departments of Gastroenterological Surgery, Kagawa University, Kita-gun, Japan.

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http://dx.doi.org/10.1002/jhbp.999DOI Listing
June 2021

Long-Lasting Event-Related Beta Synchronizations of Electroencephalographic Activity in Response to Support-Surface Perturbations During Upright Stance: A Pilot Study Associating Beta Rebound and Active Monitoring in the Intermittent Postural Control.

Front Syst Neurosci 2021 21;15:660434. Epub 2021 May 21.

Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka, Japan.

Movement related beta band cortical oscillations, including beta rebound after execution and/or suppression of movement, have drawn attention in upper extremity motor control literature. However, fewer studies focused on beta band oscillations during postural control in upright stance. In this preliminary study, we examined beta rebound and other components of electroencephalogram (EEG) activity during perturbed upright stance to investigate supraspinal contributions to postural stabilization. Particularly, we aimed to clarify the timing and duration of beta rebound within a non-sustained, but long-lasting postural recovery process that occurs more slowly compared to upper extremities. To this end, EEG signals were acquired from nine healthy young adults in response to a brief support-surface perturbation, together with the center of pressure, the center of mass and electromyogram (EMG) activities of ankle muscles. Event-related potentials (ERPs) and event-related spectral perturbations were computed from EEG data using the perturbation-onset as a triggering event. After short-latency (<0.3 s) ERPs, our results showed a decrease in high-beta band oscillations (event-related desynchronization), which was followed by a significant increase (event-related synchronization) in the same band, as well as a decrease in theta band oscillations. Unlike during upper extremity motor tasks, the beta rebound in this case was initiated before the postural recovery was completed, and sustained for as long as 3 s with small EMG responses for the first half period, followed by no excessive EMG activities for the second half period. We speculate that those novel characteristics of beta rebound might be caused by slow postural dynamics along a stable manifold of the unstable saddle-type upright equilibrium of the postural control system without active feedback control, but with active monitoring of the postural state, in the framework of the intermittent control.
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http://dx.doi.org/10.3389/fnsys.2021.660434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175801PMC
May 2021

Pediatric sedation using dexmedetomidine and remimazolam for magnetic resonance imaging.

J Anesth 2021 Jun 5. Epub 2021 Jun 5.

Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.

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http://dx.doi.org/10.1007/s00540-021-02957-1DOI Listing
June 2021

Higher Frequency of Fish Intake May Be Associated with a Lower Neutrophil/Lymphocyte Ratio: Anti-Atherosclerotic Effects of Fish Consumption.

Ann Nutr Metab 2021 May 26:1-8. Epub 2021 May 26.

Department of Medicine, Division of Cardiology, Nihon University School of Medicines, Tokyo, Japan.

Background: Higher fish consumption has been reported to be associated with a lower incidence of coronary artery disease (CAD). An elevated neutrophil/lymphocyte ratio (NLR), a marker of systemic inflammation, is reportedly associated with the development of adverse CAD events. We hypothesized that a higher fish intake was associated with a lower NLR.

Methods And Results: This cross-sectional study was conducted in a cohort of 8,237 Japanese subjects who had no history of atherosclerotic cardiovascular disease registered at the Health Planning Center of Nihon University Hospital between April 2018 and March 2019. The average weekly frequency of fish intake was 2.32 ± 1.31 days. The NLR decreased significantly as the weekly frequency of fish intake (0 day, 1-2 days, 3-4 days, or 5-7 days) increased (p = 0.001). A multiple stepwise regression analysis identified the weekly frequency of fish intake (β = -0.045, p < 0.0001) and habitual alcohol intake (β = -0.051, p < 0.0001) as significant but weak, negative, and independent determinants of the NLR. Conversely, the presence of metabolic syndrome (β = 0.046, p < 0.0001), the presence of treatment for diabetes mellitus (β = 0.054, p < 0.0001), and the presence of treatment for hypertension (β = 0.043, p < 0.0001) were significant positive and independent determinants of the NLR.

Conclusions: The present results suggest that a higher frequency of fish intake appears to be associated with a lower NLR, suggesting an anti-systemic inflammation effect. This association may partially explain the preventive effects of a higher fish intake on CAD events.
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http://dx.doi.org/10.1159/000515915DOI Listing
May 2021

Influence of national culture on mentoring relationship: a qualitative study of Japanese physician-scientists.

BMC Med Educ 2021 May 25;21(1):300. Epub 2021 May 25.

Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.

Background: Nurturing of physician-scientists is an important mission of academic medical institutes. Although the importance of mentorship in developing future physician-scientists internationally is well established, not much information is available about how they are mentored and how national cultures influence the mentoring relationship. This study explores the cultural characteristics of mentoring relationships between senior mentors and junior mentees of Japanese physician-scientists.

Method: A qualitative approach has been employed to explore mentoring relationships of Japanese physician-scientists from cultural viewpoints, through semi-structured interviews with 17 mentees who had the experience of working overseas as post-doctoral research fellow. The reflection of their experiences and the perception of mentoring relationships before going abroad were thematically analyzed by applying Hofstede's model of six cultural dimensions as a theoretical framework.

Results: Twelve characteristic themes for mentoring were observed, including trustworthy dependency on mentor, embracing paternalistic mentoring, mentee's initiative within expectations of mentor based on power distance, a sense of loyalty to mentor/organization/colleagues, family-like relationship with mentor based on collectivism, sense of security on being led by mentor through uncertainty avoidance, motivation by role modeling for the competitive academic world, and adaption of female mentee/mentor to a male-dominated academic structure based on masculinity, a long-term relationship between mentor and mentee, receiving advice for organizational continuity based on long-term orientation, putting work before leisure, and friendly relationship between mentor and mentee outside of work based on indulgence.

Conclusions: This study identified the characteristic mentoring relationships of postgraduate mentees of Japanese physician-scientists. Considering the importance of mentoring for physician-scientists in a globalized society, understanding the characteristics of national cultures would help in ensuring culture-sensitive mentoring and would contribute to the development of academic medicine.
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http://dx.doi.org/10.1186/s12909-021-02744-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152319PMC
May 2021

Value of parametric indexes to identify tracheal atresia with or without fistula on fetal magnetic resonance imaging.

Pediatr Radiol 2021 May 14. Epub 2021 May 14.

Department of Radiology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.

Background: Tracheal atresia causes some secondary changes (dilated trachea, flattened/inverted diaphragm, hyperintense and hyperinflated lungs). They can be reduced if a high airway fistula is present.

Objective: This study evaluated fetal MR images of tracheal atresia and the secondary changes, focusing on the presence of a fistula.

Materials And Methods: We assessed fetal MR images of tracheal atresia without fistula (n=4, median 26 weeks), tracheal atresia with fistula (n=4, median 33 weeks) and controls (n=30, median 32 weeks). We evaluated airway obstruction using true-positive rate in tracheal atresia and false-positive rate in controls indicating they are likely normal variants. Tracheal diameter, craniocaudal-anteroposterior ratio of the right hemidiaphragm, lung-to-liver signal intensity ratio, and cardiothoracic ratio were compared among the three groups using the Kruskal-Wallis test followed by pairwise comparison using the Mann-Whitney U test.

Results: True-positive rate was 100% in tracheal atresia, while false-positive rate was 20% in controls. The Kruskal-Wallis test showed differences among groups in craniocaudal-anteroposterior ratio and cardiothoracic ratio (P<0.001) but not in tracheal diameter (P=0.256) or lung-to-liver signal intensity ratio (P=0.082). The pairwise comparison in craniocaudal-anteroposterior ratio and cardiothoracic ratio showed differences between controls and tracheal atresia without fistula (P<0.01) and with fistula (P<0.05).

Conclusion: Fetal MRI is useful for the diagnosis of tracheal atresia, and detection of airway obstruction is essential. Lower craniocaudal-anteroposterior ratio and cardiothoracic ratio might be reliable measures even if a fistula is present.
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http://dx.doi.org/10.1007/s00247-021-05092-xDOI Listing
May 2021

Correction: Endoscopic direct visualization of gallbladder polypoid lesion using peroral digital single-operator cholangioscopy.

Endoscopy 2021 Jul 10;53(7):C8. Epub 2021 May 10.

Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.

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http://dx.doi.org/10.1055/a-1491-3849DOI Listing
July 2021

Pocket Creation and Ring-thread Traction Facilitates Colorectal Endoscopic Submucosal Dissection for Non-experts.

In Vivo 2021 May-Jun;35(3):1655-1660

Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan.

Background/aim: Colorectal endoscopic submucosal dissection (ESD) is a difficult technique. Counter-traction may facilitate the procedure but its efficacy in non-experts remains unclear. We determined the safety and efficacy of pocket creation and ring-thread traction (PRM) for non-expert colorectal ESD.

Patients And Methods: We retrospectively compared patients who underwent conventional colorectal ESD (C-group, n=50) or PRM (pocket creation, whole-circumferential cutting, ring-thread traction, submucosal dissection; PRM-group, n=48). All procedures were performed by four non-experts, each with ≤40 experiences of colorectal ESD.

Results: Procedural time was significantly shorter in the PRM-group compared with the C-group (p=0.007), with less additional device usage (p<0.001). There also tended to be fewer perforation incidents and muscle injuries in the PRM-group. There were no significant differences in en bloc or R0 resection rates between the groups.

Conclusion: PRM may be a safe, useful, and cost-effective technique for non-experts learning to perform colorectal ESD.
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http://dx.doi.org/10.21873/invivo.12424DOI Listing
June 2021

Architecture matters: Tissue preservation strategies for tetralogy of Fallot repair.

J Card Surg 2021 Apr 28. Epub 2021 Apr 28.

Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.

Background: Great variability exists in repair strategies for the tetralogy of Fallot. While transannular patching, as introduced by Kirklin, was a breakthrough for primary repair, pulmonary regurgitation and a need for reoperation have led to the development of methods that preserve the natural morphology of the right ventricular outflow tract.

Methods: State-of-the-art details of tetralogy of Fallot repair are explained from the standpoint of architectural preservation, especially with regard to sparing native tissue such as the annulus, valve, or infundibulum. Particular attention is given to the latest technical details of each approach, benefits and disadvantages, and any long-term data available.

Results: The choice of procedure is complex and unique to each case as transannular patching alone may carry long-term pulmonary risks. Modifications that spare the annulus, valves, or infundibulum may thus be essential as preservation of natural morphology has resulted in excellent mid-term results.

Conclusions: The complexity of tetralogy of Fallot repair demands constant attention to clinical presentation and vigilance against long-term sequelae. Techniques will continue to improve over time as long-term data guides the refinement of these innovative surgical methods.
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http://dx.doi.org/10.1111/jocs.15584DOI Listing
April 2021

Successful Management of Parkinson's Disease Dyskinesia During Local Anesthesia With Dexmedetomidine.

Cureus 2021 Mar 6;13(3):e13739. Epub 2021 Mar 6.

Neurology, Saiseikai Matsuyama Hospital, Matsuyama, JPN.

Dyskinesia is among the most problematic issues for local anaesthesia management in Parkinson's disease (PD) patients. We present a case of a patient with PD who underwent spinal anaesthesia while utilizing dexmedetomidine (DEX) to reduce dyskinesia during urological surgery. DEX stimulates α₂-adrenergic receptors, which works to reduce the dyskinesia in PD patients.
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http://dx.doi.org/10.7759/cureus.13739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020600PMC
March 2021

Rewarding journeys: exploring medical students' learning experiences in international electives.

Med Educ Online 2021 Dec;26(1):1913784

Medical Education Development Centre, Gifu University, Gifu City, Japan.

International electives are recognized as a high-impact practice in clinical education. However, medical students' actual learning experiences during electives have not been explored fully. Specifically, drawing on language management theory, this exploratory case study investigates students' perceived learning outcomes and the managing processes by which they gained benefits from cross-cultural learning experiences in international electives. Written reflective reports in a series of e-portfolios were collected from 43 Japanese medical students who participated in a four-week international elective. Moreover, to further explore their emotions and the reasons behind adopting a particular adjustment behaviour, follow-up interviews with 12 students were undertaken soon after they returned home. Using reflexive thematic analysis, the qualitative data were analysed. Their perceived learning outcomes were categorized into seven themes: medical knowledge and skills, communication, career management and development, international healthcare, society and culture, medical education, and personal development. During the programme, they experienced linguistic, sociolinguistic, and sociocultural difficulties, and attempted to overcome them by employing various adjustment strategies, such as meaning-focused coping, social relationship building, management of learning opportunities, communication management, and developing approaches to learning. Managing problems in academic contact situations is not a linear process; it is iterative and cyclical. Since the combination of several strategies was needed depending on the situation, the management process is a context-dependent and complex phenomenon. The findings in this study provide new insights into student participation in short-term international elective programmes in order to develop academic and social support strategies for educators at both home and host institutions.
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http://dx.doi.org/10.1080/10872981.2021.1913784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043609PMC
December 2021

Particle Size Distributions in Surgical Smoke Generated by Advanced Energy Devices: A Meaningful Perspective From an Experimental Study in the Time of COVID-19.

Ann Surg 2021 05;273(5):e168-e170

Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido, Japan.

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http://dx.doi.org/10.1097/SLA.0000000000004807DOI Listing
May 2021

Age-Specific Dose Regimens of Dexmedetomidine for Pediatric Patients in Intensive Care Following Elective Surgery: A Phase 3, Multicenter, Open-Label Clinical Trial in Japan.

Pediatr Crit Care Med 2021 Apr 2. Epub 2021 Apr 2.

Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan. Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Japan. Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan. Department of Clinical Development, Maruishi Pharmaceutical Co., Ltd, Osaka, Japan. Clinical Pharmacology, Pfizer R&D, Tokyo, Japan. Clinical Statistics, Pfizer R&D, Tokyo, Japan. Clinical Research, Pfizer R&D, Tokyo, Japan.

Objectives: To demonstrate the efficacy, safety, and pharmacokinetics of dexmedetomidine as a potential sedative for pediatric surgery patients in the ICU.

Design: Phase 3, multicenter, open-label study.

Setting: This study included 61 patients at 13 tertiary hospitals in Japan.

Patients: Pediatric patients (≥ 45 wk corrected gestational age to < 17 yr) undergoing intensive care treatment with mechanical ventilation requiring greater than 6 hours estimated duration of sedation following elective cardiac surgery.

Interventions: Dexmedetomidine was IV administered without a loading dose at age-specific dose regimens 0.2-1.4 (< 6 yr) and 0.2-1.0 µg/kg/hr (≥ 6 yr). The primary endpoint was the percentage of patients who did not require a rescue sedative (midazolam) infusion during mechanical ventilation or for the first 24 hours of a greater than 24 hours ventilation following the commencement of dexmedetomidine administration.

Measurements And Main Results: Overall, 47 of the 61 patients (77.0%) did not require rescue midazolam. Adverse events were reported in 53 patients (86.9%). Frequently observed adverse events were hypotension (47.5%), bradycardia (31.1%), and respiratory depression (26.2%). Most of these adverse events were mild, a few moderate, and none severe. Although serious adverse events occurred in four patients, including one cardiac tamponade resulting in the withdrawal of dexmedetomidine, none of the adverse events resulted in mortality or were directly related to dexmedetomidine. The plasma dexmedetomidine concentration generally reached the target concentration of 0.3-1.25 ng/mL at 1-2 hours prior to completion of administration or immediately prior to the commencement of tapering.

Conclusions: The age-specific dose regimens of dexmedetomidine without an initial loading dose achieved an adequate sedation level during mechanical ventilation and caused no clinically significant adverse events in the intensive care pediatric patients. These effects were achieved within the therapeutic range of dexmedetomidine plasma concentration and were accompanied by minimal effects on hemodynamics and respiration.
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http://dx.doi.org/10.1097/PCC.0000000000002730DOI Listing
April 2021

Ampullary carcinoma of the duodenum: current clinical issues and genomic overview.

Surg Today 2021 Apr 2. Epub 2021 Apr 2.

Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.

Ampullary carcinomas of the duodenum are uncommon. Moreover, the diversity in the clinical outcomes of these patients makes it difficult to interpret previous studies and clinical trial results. The difficulty in proper staging of ampullary carcinomas, especially with regard to the T category of the tumor in the TNM system, reflects the anatomic complexity and non-uniform histopathologic subtypes. One major reason for this difficulty in interpretation is that the tumors may arise from any of the three epithelia (duodenal, biliary, or pancreatic) that converge at this location. Generally, ampullary carcinomas are classified into intestinal and pancreaticobiliary types based on morphology and immunohistochemical features. While many studies have described their specific characteristics and clinical impact, the prognostic value of these subtypes is controversial. In recent years, whole-exome sequencing analyses have advanced our understanding of the genomic overview of ampullary carcinoma. Gene mutations serve as prognostic and predictive biomarkers for this disease. Therefore, basic knowledge of the genomic profile of ampullary carcinomas is required for surgeons to understand how best to apply precision medicine as well as surgery and adjuvant therapies. This review provides an overview of the current basic and clinical issues of ampullary carcinoma.
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http://dx.doi.org/10.1007/s00595-021-02270-0DOI Listing
April 2021

Adequate tissue sampling for the assessment of pathological tumor regression in pancreatic cancer.

Sci Rep 2021 Mar 22;11(1):6586. Epub 2021 Mar 22.

Oncology Pathology, Department of Pathology and Host-Defense, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.

Standardized pathological evaluation of the regression assessment of neoadjuvant pancreatic cancer is necessary to improve prognostication and compare treatment outcomes in clinical trials. However, appropriate tissue sampling from surgically resected pancreatic cancer after neoadjuvant therapy has not been elucidated. We compared the tumor regression scores in the largest cancer slide determined macroscopically or histologically. We reviewed all slides and macroscopic photos of cut surfaces from resected pancreas of patients treated with neoadjuvant chemotherapy (n = 137; chemoradiotherapy or chemotherapy). The tumor regression scores (the Evans, College of American Pathologists, Japanese Pancreas Society grading systems, and Area of Residual Tumor [ART] score) were evaluated for the largest tumor slide determined by macroscopy or histologically as well as all slides from the resected pancreas. The largest cancer slides determined macroscopically and histologically were discrepant in 26% of the cases. Cancer cells were not detected in the largest macroscopically defined cut slides in 3%. Only ART scores assessed in the largest histological slides displayed significant difference in overall survival. We recommend obtaining the largest histological slides to provide adequate assessment for regression of neoadjuvant-treated pancreatic cancer. Sufficient sampling to detect the largest histological slides would be mandatory.
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http://dx.doi.org/10.1038/s41598-021-86152-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985517PMC
March 2021

Gender differences in the associations among fish intake, lifestyle, and non-HDL-C level in Japanese subjects over the age of 50 years: Anti-atherosclerotic effect of fish consumption.

Nutr Metab Cardiovasc Dis 2021 05 13;31(5):1434-1444. Epub 2021 Jan 13.

Department of Medicine, Division of Cardiology, Nihon University School of Medicines, Tokyo, Japan.

Background And Aims: Higher fish consumption may lead to the suppression of atherogenesis. The present study was aimed at investigating the gender differences in association with the frequency of fish intake, lifestyle behaviors and serum non-high-density lipoprotein cholesterol (non-HDL-C) levels.

Methods And Results: This cross-sectional study was conducted in a cohort of 4320 (2479 males, 1570 females) healthy Japanese subjects over 50 years of age registered at the Health Planning Center of Nihon University Hospital between April 2018 and March 2019. The average weekly frequency of fish intake was 2.58 ± 1.39 days in males and 2.42 ± 1.36 days in females. In males, the serum non-HDL-C level decreased significantly as the weekly frequency of fish intake (0-1 days, 2-3 days, 4-5 days, or 6-7 days) increased (p < 0.0001). Multiple stepwise regression analysis identified the weekly frequency of fish intake (β = -0.056, p = 0.004) and habitual aerobic exercise (β = -0.063, p = 0.001) as independent determinants of the serum non-HDL-C level. On the other hand, no such associations were observed in females. However, the proportion of subjects engaging in habitual aerobic exercise increased as the frequency of fish intake increased even among females.

Conclusions: A higher frequency of fish intake may be associated with healthier lifestyle behaviors and lower non-HDL-C levels in males, but not in females. There appear to be gender differences in the relationships between the intake of fish and lifestyle behaviors on lipid metabolism.

Clinical Trial Registration: umin (http://www.umin.ac.jp/) Study ID: UMIN000035899.
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http://dx.doi.org/10.1016/j.numecd.2020.12.031DOI Listing
May 2021

Potential benefit of laparoscopic surgery for rectal cancer on postoperative male sexual function.

Colorectal Dis 2021 Mar 13. Epub 2021 Mar 13.

Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.

Aim: The aim of this retrospective study was to evaluate the incidence of male sexual dysfunction after mid to low rectal cancer surgery and to identify factors associated with postoperative erectile and ejaculatory dysfunction.

Methods: The subjects were 410 consecutive male patients who underwent surgery for mid to low rectal cancer from 2009 to 2015. Two questionnaires on sexual function were administered: the International Index of Erectile Function, and an original questionnaire on ejaculatory status. Erectile and ejaculatory dysfunction were examined before and 3, 6, 12 months after surgery. In patients without preoperative dysfunction, multivariate regression analyses were performed to identify factors associated with the incidence of erectile and ejaculatory dysfunction at 12 months after surgery.

Results: Of 410 patients, 234 (57%) gave complete responses to the questionnaires, of whom 108 (46%) and 155 (66%) had severe erectile dysfunction, while 115 (49%) and 168 (72%) had severe ejaculatory dysfunction before and 12 months after surgery, respectively. Of the patients who maintained sexual function preoperatively, the incidence of erectile and ejaculatory dysfunction at 12 months after surgery was 51% (64/126) and 49% (58/119), respectively. In multivariate analysis, age >60 years (P = 0.02), laparotomy (P = 0.002), and creation of a diverting ileostomy (P = 0.003) were independent factors associated with postoperative erectile dysfunction, while age >60 years (P = 0.005), laparotomy (P = 0.04), and lateral lymph node dissection (P = 0.001) were independent factors associated with postoperative ejaculatory dysfunction.

Conclusion: Sexual dysfunction occurred in almost half of patients after rectal cancer surgery, and was independently associated with several factors, including laparotomy.
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http://dx.doi.org/10.1111/codi.15626DOI Listing
March 2021

Role of Short-Term Neoadjuvant Chemoradiotherapy for Potentially Resectable Pancreatic Cancer.

Am Surg 2021 Feb 25:3134821998671. Epub 2021 Feb 25.

Departments of Gastroenterological Surgery, Kagawa University, Kagawa, Japan.

Although the efficacy of neoadjuvant therapies for pancreatic cancer (PDAC) is reported in recent years, ideal neoadjuvant treatment for patients with potentially resectable (R) PDAC remains uncertain. We conducted the retrospective study about the effect of short-term neoadjuvant chemoradiotherapy (sNACRT) on R PDAC. The 94 patients received curative intent pancreatectomy for R PDAC between 2000 and 2016. Among them, 31 patients received sNACRT (S1 60 mg/m2/day for 2w and RTx 30 Gy/2w). Clinical outcomes of the 31 patients with sNACRT were analyzed in comparison with 63 patients without sNACRT. The 1-, 3-, and 5-year overall survival (OS) rates were 93, 71, and 62% in the patients with sNACRT and 78, 35, and 26% in the patients without sNACRT ( = .0007), respectively. Lymph node metastasis was found in 41.9% of patients with sNACRT and 56.5% of patients without sNACRT ( = .09). Microscopic tumor infiltration at resection margins (R1) was found in no patient with sNACRT and 5 patients (7.9%) without sNACRT (=.042). Retropancreatic infiltration ( = .04), lymphatic invasion ( = .002), plexus invasion ( = .042), and main pancreatic duct extension ( = .004) were significantly fewer in patients with sNACRT than the patients without sNACRT. The recurrences were found in 64% of patients with sNACRT (39% distant, 16% local, and 10% mix pattern) and 68% in patients without sNACRT (28% distant, 21% local, and 19% mix pattern). The recurrence patterns were significantly different ( = .008) between the groups. Short-term neoadjuvant chemoradiotherapy decreased R1 resection rate and improved OS. Short-term neoadjuvant chemoradiotherapy may provide ideal local control during the short term and improve clinical outcome of R PDAC.
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http://dx.doi.org/10.1177/0003134821998671DOI Listing
February 2021

Early gastric cancer with an Adachi type VI (group 26) vascular anomaly diagnosed preoperatively and treated by laparoscopic surgery: a case report.

BMC Surg 2021 Feb 23;21(1):99. Epub 2021 Feb 23.

Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.

Background: It is important to understand the branching pattern of the celiac artery for a safe surgery. Various branching anomalies of the celiac artery were classified by Adachi in 1928. In Adachi's classification, type VI (group 26) is a rare anatomical anomaly (0.4%) that requires care when carrying out a surgery in gastric cancer patients with this anomaly. Herein, we reported a case treated successfully with laparoscopic distal gastrectomy with D1+ lymph node dissection for early gastric cancer.

Case Presentation: An 84-year-old female was referred to our division for an additional surgical treatment for early gastric cancer that was resected by endoscopic submucosal dissection. A three-dimensional computed tomography angiography revealed an angioplany of the common hepatic artery branching from the left gastric artery. According to Adachi's classification, the anomaly of this patient corresponded to type VI (group 26). Preoperative anatomical information of this rare anomaly helped us to safely perform a laparoscopic distal gastrectomy and lymph node dissection with common hepatic artery preservation. The patient had an uneventful postoperative course and was discharged on postoperative day 11.

Conclusions: We consider that Group 26 anomalies require the most precise anatomical understanding among Adachi classification type VIs, since it affects hepatic blood flow and can cause serious complications. In this time, we reported a successful case to perform laparoscopic distal gastrectomy with safety and accuracy by preoperative understanding of the precise vascular anatomy.
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http://dx.doi.org/10.1186/s12893-021-01100-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903757PMC
February 2021

Association between microRNA-527 and glypican-3 in hepatocellular carcinoma.

Oncol Lett 2021 Mar 26;21(3):229. Epub 2021 Jan 26.

Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki-cho, Kagawa 761-0793, Japan.

The present study aimed to identify the specific microRNAs (miRNAs/miRs) and their corresponding target genes involved in hepatocellular carcinomas (HCCs). Microarray analysis was performed to examine the miRNA expression profiles of four paired HCC and corresponding non-cancerous (N) liver tissues using 985 miRNA probes. The Human miRNA Target database was used to identify the target genes of differentially expressed miRNAs between the HCC and N tissues. The protein expression levels of target genes in the HCC tissues and cell lines were evaluated using western blotting. miRNA-mediated suppression of target gene expression was evaluated by transiently transfecting the miRNA into the HCC cell lines. Of the 985 miRNAs evaluated, four miRNAs were differentially expressed (three upregulated and one downregulated miRNAs). Of these four miRNAs, miRNA-527 was highly downregulated in the HCC tissues. Glypican-3 (GPC-3) was predicted as a target gene of miRNA-527. Western blotting revealed that GPC-3 protein is highly expressed in the HCC tissues and HCC cell lines compared with N and normal cell lines. Transfection with miR-527 resulted in suppression of GPC-3 protein expression in the Cos7 cells. Furthermore, transfection with miR-527 also inhibited the intrinsic expression of GPC-3 in the Huh-7 cell line. This indicated that miR-527 in the HCC tissues may be an important novel miRNA that targets the GPC-3 gene expression. GPC-3, whose expression is regulated by miR-527, may be involved in the development and progression of HCC.
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http://dx.doi.org/10.3892/ol.2021.12490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856685PMC
March 2021

Coronary artery bypass for Takayasu's arteritis involving the aortic root in a child.

J Card Surg 2021 Jun 15;36(6):2127-2129. Epub 2021 Feb 15.

Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.

The patient was a 12-year-old female who presented with angina pectoris, aortic root dilatation, and aortic regurgitation (AR) caused by Takayasu's arteritis (TA). After the management of systemic inflammation, she underwent off-pump coronary artery bypass with the radial artery (RA), which extended from the left axillary artery to the left descending coronary artery, via left mini-thoracotomy. Postoperative angiography revealed the growth of the RA graft. The patient is well 4 years after surgery without progression of AR. Off-pump coronary artery bypass is a palliative therapy. Moreover, it could be a feasible option in a child with TA involving the aortic root.
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http://dx.doi.org/10.1111/jocs.15425DOI Listing
June 2021

Laparoscopic hand-sewn esophagojejunal anastomosis in laparoscopic proximal gastrectomy for early gastric cancer.

Langenbecks Arch Surg 2021 Mar 6;406(2):491-496. Epub 2021 Feb 6.

Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.

Purpose: In Asian countries, proximal gastrectomy is a standard treatment option for early primary gastric cancer located in the upper third of the stomach. However, laparoscopic proximal gastrectomy (LPG) is not widely employed due to the technical difficulty of laparoscopic esophagojejunal anastomosis. Therefore, we began performing laparoscopic hand-sewn esophagojejunal anastomosis. In this report, we describe the technique of this method and the short-term surgical outcomes.

Methods: Between February 2016 and June 2020, 18 patients underwent LPG with double-tract reconstruction at our institution. Laparoscopic hand-sewn esophagojejunal anastomosis was attempted for all patients.

Results: The median operative time for the 18 patients was 431 min (range: 301-549 min), and the estimated blood loss was 100 mL (range: 0-1524 mL). The median time for the hand-sewn esophagojejunostomy was 42 min (range: 26-81 min). Only one case was converted to open surgery after the reconstruction due to bleeding from an artery of the lesser curvature. No anastomotic leakage was observed in any patients (0/18, 0 %); however, two patients developed anastomotic stenosis (2/18, 11%). The mean length of postoperative hospital stay was 10 days (range: 8-28 days).

Conclusion: The laparoscopic hand-sewn esophagojejunal anastomosis in LPG is a simple, cost-effective, and safe procedure. We believe that our method is a feasible choice. However, careful and longer follow-up of more patients is necessary to determine the advantages of our method.
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http://dx.doi.org/10.1007/s00423-021-02104-0DOI Listing
March 2021

Incremental Predictive Value of Coronary Calcium Score in Risk Stratification of Coronary Revascularization in Patients With Normal or Mild Ischemia Using Nuclear Myocardial Perfusion Single Photon Emission Computed Tomography.

Circ J 2021 May 28;85(6):877-882. Epub 2021 Jan 28.

Division of Cardiology, Department of Medicine, Nihon University.

Background: The incremental predictive value of the coronary artery calcium score (CACS) for risk stratification of coronary revascularization in patients with normal or mildly abnormal nuclear myocardial perfusion single photon emission computed tomography (MPS) scores is unknown.Methods and Results:We analyzed 528 patients in whom CACS was calculated and who underwent stress MPS within 3 months. Patients with known coronary artery disease, prior coronary revascularization, and those undergoing hemodialysis were excluded. Patients were followed-up with coronary revascularization based on the evidence of physiological ischemia defined by fractional flow reserve or severe coronary stenosis (≥90%). CACS was significantly associated with the summed stress score (SSS) from MPS assessment. Multivariate logistic regression analysis showed that high CACS (≥300; odds ratio [OR] 5.44, 95% confidence interval [CI] 2.28-13.0) and SSS (OR 1.29, 95% CI 1.18-1.40) were significant (P<0.001) predictors of future coronary revascularization. The log-rank test showed that high CACS stratified coronary revascularization in normal SSS (0-3; P<0.001) or mildly abnormal SSS (4-8; P=0.028) groups, whereas high CACS did not significantly stratify coronary revascularization in moderate to severe SSS (≥9; P=0.757).

Conclusions: Risk stratification using CACS with a cut-off value 300 may have incremental predictive value for revascularization in patients with normal or mildly abnormal MPS.
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http://dx.doi.org/10.1253/circj.CJ-20-0805DOI Listing
May 2021

Trends in PACU utilization in Japanese children's hospitals.

J Anesth 2021 04 26;35(2):321. Epub 2021 Jan 26.

Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.

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http://dx.doi.org/10.1007/s00540-020-02891-8DOI Listing
April 2021

Aspirin inhibits cholangiocarcinoma cell proliferation via cell cycle arrest in vitro and in vivo.

Int J Oncol 2021 02 30;58(2):199-210. Epub 2020 Dec 30.

Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kida, Kagawa 761‑0793, Japan.

Cholangiocarcinoma is the most common biliary duct malignancy and the second most common primary liver cancer, accounting for 10‑20% of hepatic malignancies. With high mortality and poor prognosis, the 5‑year survival rate of cholangiocarcinoma is only 10%. A previous study demonstrated a significant association between aspirin use and a decreased risk of cholangiocarcinoma. However, the effect of aspirin on cholangiocarcinoma remains unknown. Therefore, the aim of the present study was to investigate the effects of aspirin on cholangiocarcinoma in vitro and in vivo. Three cholangiocarcinoma cell lines were used to analyze the effect of aspirin on cell proliferation, cell cycle progression, apoptosis, and the regulation of microRNAs. MicroRNAs are known to regulate the development and progression of various types of cancer. An HuCCT‑1 xenograft model was used for the in vivo study. It was determined that aspirin inhibited the proliferation of human cholangiocarcinoma cells (except TKKK cells). Aspirin induced cell cycle arrest in the G0/G1 phase and regulated cell‑cycle related proteins in cholangiocarcinoma cells (HuCCT‑1 cells) but did not induce apoptosis. The expression of miR‑340‑5p was significantly upregulated after treatment, and overexpression of miR‑340‑5p inhibited the proliferation of HuCCT‑1 cells and decreased the levels of cyclin D1. TKKK cells had low miR‑340‑5p expression, which may explain why aspirin had no effect on their proliferation. In vivo, aspirin reduced the growth of xenografted tumors. In conclusion, the present study indicated that aspirin partially inhibited cholangiocarcinoma cell proliferation and tumor growth by inducing G0/G1 phase cell cycle arrest, potentially through the miR‑340‑5p/cyclin D1 axis.
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http://dx.doi.org/10.3892/ijo.2020.5165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864011PMC
February 2021

Effects of Transanal Irrigation on Gut Microbiota in Pediatric Patients with Spina Bifida.

J Clin Med 2021 Jan 10;10(2). Epub 2021 Jan 10.

Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.

Recent studies using 16S rRNA-based microbiota profiling have demonstrated dysbiosis of gut microbiota in constipated patients. The aim of this study was to investigate the changes in gut microbiota after transanal irrigation (TAI) in patients with spina bifida (SB). A questionnaire on neurogenic bowel disfunction (NBD), Bristol scale, and gut microbiota using 16S rRNA sequencing were completed in 16 SB patients and 10 healthy controls aged 6-17 years. Then, 11 of 16 SB patients with moderate to severe NBD scores received TAI for 3 months. Changes in urine cultures were also examined before and after the TAI treatments. In addition, correlation of gut microbiota and Bristol scale was analyzed. Significantly decreased abundance in , and , and significantly increased abundance in and were observed in the SB patients compared with controls and after TAI, respectively. The abundance of was significantly correlated positively with Bristol scale. Urinary tract infection tended to decrease from 82% to 55% after TAI ( = 0.082) despite persistent fecal incontinence. Butyrate-producing bacteria such as play a regulatory role in the intestinal motility and host immune system, suggesting the effects of TAI on gut microbiota.
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http://dx.doi.org/10.3390/jcm10020224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827399PMC
January 2021

Causal relationships between immediate pre-impact kinematics and post-impact kinetics during drop landing using a simple three dimensional multibody model.

J Biomech 2021 02 1;116:110211. Epub 2021 Jan 1.

Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan.

This study aimed to validate a simple dynamic model of single-leg drop-landing to develop a methodological foundation for investigating mechanistic causes of anterior cruciate ligament (ACL) injury and to explore mechanical associations between knee valgus torque and landing kinematics that are considered clinically as a high-risk landing posture for the injury. A triple-inverted-pendulum model in three-dimensional space, composed of rigid-links of head-arms-trunk (HAT), thigh and shank, was employed. We derived causal relationships that can predict post-impact kinetics, including impact ground reaction forces (GRFs) and corresponding knee joint torques from a given body-kinematics immediately before impact, based on an assumption of a completely inelastic collision between a landing foot (the distal end-point of the shank in the model) and the ground. The concordance correlation coefficient (CCC) analysis revealed that our model can achieve an acceptable agreement between experimentally measured and model-predicted impact GRFs and corresponding knee joint torques. The 95% one-tailed lower confidence limit of CCC of vertical, mediolateral GRFs and the varus/valgus torque were 0.665>ρ=0.643,0.786>ρ=0.758 and 0.531>ρ=0.508, respectively, for the least acceptable values ρ. Using this model, effects of three types of hypothetical pre-impact kinematics with modulated (i) medial/lateral leaning HAT angle, (ii) forward/backward HAT tilt-angle, and (iii) knee flexion/extension angle on the impact GRF and corresponding knee joint torque were evaluated. We showed that the smaller knee flexion and the greater HAT leaning toward the landing-limb-side, the larger the knee valgus torque is generated, as a mechanical consequence between the specific pre-impact kinematics and the knee loading associated with the risk of ACL injury. Further exploration of hypothetical kinematics using the model in the future work might contribute to identifying the risky landing kinematics beyond experimental limitations.
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http://dx.doi.org/10.1016/j.jbiomech.2020.110211DOI Listing
February 2021

Association among daily fish intake, white blood cell count, and healthy lifestyle behaviors in an apparently healthy Japanese population: implication for the anti-atherosclerotic effect of fish consumption.

Heart Vessels 2021 Jul 7;36(7):924-933. Epub 2021 Jan 7.

Department of Medicine, Division of Cardiology, Nihon University School of Medicines, Tokyo, Japan.

Higher fish consumption has been reported to be associated with a lower incidence of coronary artery disease. We hypothesized that a higher frequency of fish intake may be associated with lower peripheral white blood cell (WBC) counts, a marker of chronic inflammation, which is known to be involved in the development of atherosclerotic cardiovascular disease (ASCVD), and a healthy lifestyle. This cross-sectional study was conducted between April 2018 and August 2018 at the Health Planning Center of Nihon University Hospital in a cohort of 4105 apparently healthy subjects. The average frequency of fish intake was 2.3 ± 1.3 days per week. The WBC count decreased significantly as the frequency of fish intake (0-2 days, 3-4 days, or 5-7 days per week) increased (s < 0.0001). Multivariate linear regression analysis identified higher weekly frequency of fish intake as a significant independent determinant of a lower WBC count (β =  - 0.051, p = 0.001). Furthermore, as the weekly frequency of fish intake increased, the proportion of habitual cigarette smokers decreased (p = 0.021), that of subjects engaging in habitual aerobic exercises increased (p < 0.0001), and the weekly alcohol intake frequency increased (p < 0.0001). Moreover, the above-mentioned lifestyle behaviors were also independent determinants of the WBC count. These results suggest that a high frequency of fish intake might be associated with healthier lifestyle behaviors as well as lower WBC counts, and thus may both exert beneficial anti-inflammatory effects and represent a component of healthier lifestyle behaviors associated with a lower risk of ASCVD in Japanese. This association may be partially related to the preventive effects of a higher fish intake on ASCVD events. CLINICAL TRIAL REGISTRATION: UMIN ( http://www.umin.ac.jp/ ) Study ID: UMIN000039197 retrospectively registered 1 February 2020.
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http://dx.doi.org/10.1007/s00380-020-01769-9DOI Listing
July 2021