Publications by authors named "Yuki Ueda"

80 Publications

Late-onset obstructive hydrocephalus associated with occipital encephalocele with large skull defect successfully treated by endoscopic third ventriculostomy.

Childs Nerv Syst 2022 Jul 29. Epub 2022 Jul 29.

Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan.

Background: Hydrocephalus is one of the most common presentations of occipital encephaloceles and usually develops within the first year of life. This case report presents a rare case of late-onset obstructive hydrocephalus associated with occipital encephalocele with an extraordinarily large occipital skull defect.

Case Report: At birth, a newborn girl presented with an absence of a vast amount of occipital cranium and skin and was diagnosed with occipital hydroencephalomeningocele. Under meticulous sterile management, the affected area was successfully epithelialized, and the patient was discharged without infectious complication. Despite an obstructed cerebral aqueduct, she grew without any signs of hydrocephalus until the age of 7 years. Her gait gradually worsened, and imaging tests at the age of 8 years revealed markedly enlarged lateral and third ventricles but not the fourth ventricle. Endoscopic third ventriculostomy successfully relieved her symptoms with improvement of hydrocephalus.

Conclusion: This is the first case of late-onset obstructive hydrocephalus associated with an occipital encephalocele characterized by large-scale cranial bony defects. Although further investigation is required to elucidate the mechanism of hydrocephalus, this rare phenomenon should be noted during neurological and radiological follow-up.
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http://dx.doi.org/10.1007/s00381-022-05619-zDOI Listing
July 2022

[A Case of Myeloid Sarcoma in the Small Intestine Presenting with Intussusception].

Gan To Kagaku Ryoho 2021 Dec;48(13):1573-1575

Dept. of Surgery, Hyogo Prefectural Awaji Medical Center.

A sixty-something man presented with lower abdominal pain in early Y month 20XX, and was examined at the hospital's internal medicine outpatient clinic. An abdominal CT showed a soft tissue mass around the left hip joint, and multiple enlarged lymph nodes from inside the pelvis to the mesentery of the abdomen. We noted a small-intestinal intussusception in the lower right abdomen, and suspected malignant lymphoma. We did a CT-guided biopsy on the left hip joint soft tissue mass, and performed surgery on the small-intestinal intussusception. During surgery, we noted an approximately 30 cm ileal intussusception located about 60 cm from the terminal ileum, and enlarged lymph nodes in the nearby mesentery. We removed the ileal intussusception. The pathological diagnosis was myeloid sarcoma, and the soft tissue mass in the left hip joint was also diagnosed as myeloid sarcoma. We performed a bone-marrow biopsy at the hematology department, and diagnosed acute myeloid leukemia M2. We then started remission-induction therapy and consolidation therapy, and the patient was diagnosed as in remission in Y+5 month 20XX. We also need to keep in mind myeloid sarcoma in the intestine as a subtype of acute myeloid leukemia, as malignant tumor in the small intestine presenting with intussusception.
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December 2021

Adrenal function during long-term ACTH therapy for patients with developmental and epileptic encephalopathy.

Epilepsia Open 2022 03 14;7(1):194-200. Epub 2021 Dec 14.

Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan.

Some patients with developmental and epileptic encephalopathy (DEE) respond to adrenocorticotropic hormone (ACTH) therapy but relapse soon after. While long-term ACTH therapy (LT-ACTH) has been attempted for these patients, no previous studies have carefully assessed adrenal function during LT-ACTH. We evaluated the effectiveness of LT-ACTH, as well as adverse effects (AE), including their adrenal function in three DEE patients. Patients underwent a corticotropin-releasing hormone (CRH) stimulation test during LT-ACTH, and those with peak serum cortisol below 15 μg/dL were considered to be at high risk of adrenal insufficiency (AI). Two of three responded, and their life-threatening seizures with postgeneralized electroencephalogram (EEG) suppression decreased. Although no individuals had serious AE, CRH stimulation test revealed relatively weak responses, without reaching normal cortisol peak level (18 μg/dL). Hydrocortisone replacement during stress was prepared in a case with lower cortisol peak than our cutoff level. LT-ACTH could be a promising treatment option for cases of DEE that relapse soon after effective ACTH treatment. The longer duration and larger cumulative dosage in LT-ACTH than in conventional ACTH could increase the relative risk of AI. Careful evaluation with pediatric endocrinologists, including hormonal stimulation tests, might be useful for continuing this treatment safely.
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http://dx.doi.org/10.1002/epi4.12566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886065PMC
March 2022

Endoscopic ultrasonography for pre-operative local assessment and endoscopic ultrasonography-guided marking before gastrojejunostomy for duodenal obstruction using magnetic compression anastomosis.

J Clin Transl Res 2021 Oct 20;7(5):621-624. Epub 2021 Sep 20.

Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Japan.

Background And Aim: A 93-year-old woman who was bedridden with severe dementia was referred to our department with a 3-day history of repeated vomiting after meals. Computed tomography revealed significant dilatation of the duodenum up to the level of the third portion, which was compressed by a large, low-density mass. Upper gastrointestinal endoscopy showed narrowing of the third portion of the duodenum with edematous mucosa covered with multiple white spots, where the endoscope was able to pass through with mild resistance. B-cell lymphoma was histopathologically suspected from biopsy specimens of the mucosa. We performed gastrojejunostomy through the magnetic compression anastomosis (MCA) technique. We prepared two neodymium magnets: Flat plate shaped (15 × 3 mm) with a small hole 3 mm in diameter; a nylon thread was passed through each hole. We then confirmed the absence of no non-target tissue, including large vessels and intestine adjacent to the anastomosis where the magnets were to be placed using endoscopic ultrasonography (EUS) from the stomach. EUS-guided marking using biopsy forceps by biting the mucosa and placing a hemoclip was performed at the anastomosis site in the stomach. The magnet was pushed and delivered to the duodeno-jejuno junction, and another magnet was delivered to the marking point in the stomach. The magnets were attracted toward each other transmurally. The magnets fell into the colon by 11 days after starting the compression, and the completion of gastrojejunostomy was confirmed.

Relevance For Patients: Endoscopic gastrojejunostomy using MCA is useful as a minimally invasive alternative treatment for duodenal obstruction. EUS for the pre-operative local assessment and EUS-guided marking can ensure the safety of the MCA procedure.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8580526PMC
October 2021

A Rare Case of COVID-19 Pneumonia Concomitant with Bleeding from Acute Gastric Mucosal Lesions.

Intern Med 2021 1;60(21):3421-3426. Epub 2021 Nov 1.

Department of Pathology, Kyoto Okamoto Memorial Hospital, Japan.

A 70-year-old man was diagnosed with coronavirus disease 2019 (COVID-19) pneumonia. Twenty-six days after admission, he experienced hematemesis despite improvement in his respiratory symptoms. Contrast-enhanced computed tomography revealed edematous stomach wall thickening with neither ischemic findings in the gastric wall nor obstruction of the gastric artery. Emergent esophagogastroduodenoscopy showed diffuse dark-red mucosa accompanied by multiple easy-bleeding, irregularly shaped ulcers throughout almost the whole stomach without active bleeding or visible vessels. The clinical course, including the endoscopic findings, progressed favorably with conservative treatment. COVID-19 pneumonia can present with acute gastric mucosal lesion, which may be induced by microvascular thrombosis due to COVID-19-related coagulopathy.
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http://dx.doi.org/10.2169/internalmedicine.7803-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627797PMC
November 2021

Reduction of Recombinant Adeno-Associated Virus Vector Adsorption on Solid Surfaces by Polyionic Hydrophilic Complex Coating.

J Pharm Sci 2022 03 24;111(3):663-671. Epub 2021 Oct 24.

Department of Biotechnology, Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka 565-0871, Japan; Life and Living Systems (ExCELLS), National Institutes of Natural Sciences, 5-1 Higashiyama, Myodaiji-cho, Okazaki, Aichi, 444-8787, Japan. Electronic address:

Recombinant adeno-associated virus (rAAV) vectors have proven efficacy as gene therapy vehicles. However, non-specific adsorption of these vectors on solid surfaces is encountered during production, storage, and administration, as well as in quantification processes. Such adsorption has been reported to result in the loss of up to 90% of vector particles and can also result in high variability in vector genome quantification. In this study, we demonstrate the effective decrease of recombinant adeno-associated virus vector adsorption by application of a polyionic hydrophilic complex polymer coating on the surfaces of the tools used in viral vector quantification analyses [i.e., pipette tips, cryotube vials, and quantitative polymerase chain reaction (qPCR) plates]. qPCR analyses showed efficient recovery of vector particles from tools with this coating, with up to 95% of vector particle loss being prevented, leading to a higher transduction efficiency in vitro. Thus, the tested coating has the potential to be widely used in material processing in the gene therapy field.
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http://dx.doi.org/10.1016/j.xphs.2021.10.022DOI Listing
March 2022

Involvement of a Multidrug Efflux Pump and Alterations in Cell Surface Structure in the Synergistic Antifungal Activity of Nagilactone E and Anethole against Budding Yeast .

Antibiotics (Basel) 2021 May 6;10(5). Epub 2021 May 6.

Graduate School of Science, Osaka City University, Sumiyoshi-ku, Osaka 558-8585, Japan.

Nagilactone E, an antifungal agent derived from the root bark of , inhibits 1,3-β glucan synthesis; however, its inhibitory activity is weak. Anethole, the principal component of anise oil, enhances the antifungal activity of nagilactone E. We aimed to determine the combinatorial effect and underlying mechanisms of action of nagilactone E and anethole against the budding yeast . Analyses using gene-deficient strains showed that the multidrug efflux pump is associated with nagilactone E resistance; its transcription was gradually restricted in cells treated with the drug combination for a prolonged duration but not in nagilactone-E-treated cells. Green-fluorescent-protein-tagged Pdr5p was intensively expressed and localized on the plasma membrane of nagilactone-E-treated cells but not in drug-combination-treated cells. Quick-freeze deep-etch electron microscopy revealed the smoothening of intertwined fiber structures on the cell surface of drug-combination-treated cells and spheroplasts, indicating a decline in cell wall components and loss of cell wall strength. Anethole enhanced the antifungal activity of nagilactone E by enabling its retention within cells, thereby accelerating cell wall damage. The combination of nagilactone E and anethole can be employed in clinical settings as an antifungal, as well as a food preservative to restrict food spoilage.
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http://dx.doi.org/10.3390/antibiotics10050537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148520PMC
May 2021

A case report of Leigh syndrome diagnosed by endomyocardial biopsy.

Eur Heart J Case Rep 2021 Feb 8;5(2):ytaa582. Epub 2021 Feb 8.

Department of Pediatrics, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan.

Background: Leigh syndrome is a neurodegenerative disorder caused by mitochondrial dysfunction with both phenotypic and genetic heterogeneity. Mitochondrial impairments are usually demonstrated by skeletal muscle biopsy. We report a case of Leigh syndrome diagnosed by endomyocardial biopsy (EMB), not by skeletal muscle biopsy.

Case Summary: At aged 7 months, the patient had delayed motor development. He developed metabolic acidosis triggered by an infection with elevated lactate and pyruvate values in serum and cerebrospinal fluid when he was 1 year old. T2-weighted imaging on magnetic resonance imaging of the brain revealed bilateral hyperintensity in midbrain and dorsal pons. Biopsied skeletal muscle did not show evidence of mitochondrial disease. Left ventricular hypertrophy, bilateral putamen hyperintensity in T2-weighted imaging and a lactate peak in the right basal ganglia in single voxel spectroscopy, and a convulsive seizure appeared at the age of 12, 15, and 16, respectively. When he was 17 years old, biopsied myocardium showed cytoplasmic vacuolization and a marked proliferation of mitochondria within myofibrils pathologically. Respiratory chain enzyme activity of the biopsied myocardium showed decreased activity of complex I. Genetic testing revealed an m.14453 A>G mutation on the MT-ND6 gene. He was finally diagnosed with Leigh syndrome. Administration of oral 5-aminolevulinic acid reduced the frequency of seizures.

Discussion: EMB led to the diagnosis of Leigh syndrome. Efforts to find and conduct the biopsy of affected organs are important to diagnose mitochondrial disease. EMB is a useful diagnostic method when there is a difficulty in diagnosing mitochondrial disease by skeletal muscle biopsy.
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http://dx.doi.org/10.1093/ehjcr/ytaa582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898571PMC
February 2021

Uptake of Metal (Zn, Y, Ti) Oxide Nanoparticles by Poaceae and Cucurbitaceae Plants Based On Metal Properties and Surface Conditions.

J Phys Chem B 2021 02 10;125(7):1755-1759. Epub 2021 Feb 10.

Faculty of Life and Environmental Science, Shimane University, Matsue 690-8504, Japan.

Metal nanoparticles (NPs) may serve as biomarkers, as the surfaces can be chemically modified to enable an analysis of several biosystems, including plant pathogenesis. We supplied metal oxide NPs including those of ZnO, TiO, YO, and YO doped with europium to plants of eight species of the Poaceae and Cucurbitaceae families. The plants were grown using hydroponics, where NPs were incorporated into the cultivation media. Energy-dispersive X-ray spectroscopy was used to detect the uptake of NPs by the plant in regions of the root, stem, and leaf. Results show that ZnO NPs were taken up more readily by the plants compared to other NPs. Unmodified NPs were only delivered up till the stems and not the leaves; however, when the surfaces were modified using photoinduced hydrophilization supplemented with poly(ethylene glycol), NPs were delivered to the leaves of plants. It is suggested that plants readily take up metals such as zinc that function as nutrients. Additionally, hydrophilization of NP surfaces using UV irradiation enhances uptake, where modified ZnO and TiO NPs may be delivered to the leaves. These findings may be used to design biomarker systems for detecting tissue damage and infections in various crops.
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http://dx.doi.org/10.1021/acs.jpcb.0c10101DOI Listing
February 2021

A box-shaped shielding device for reducing the risk of COVID-19 droplet infection during gastrointestinal endoscopic procedures.

J Clin Transl Res 2020 Dec 11;6(6):236-240. Epub 2020 Dec 11.

Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kumiyama-cho, Kyoto, Japan.

Background And Aims: Endoscopists and endoscopic assistants are easily exposed to germs, including COVID-19, during aerosol-generating procedures such as gastrointestinal endoscopy. This retrospective study investigated the utility of a box-shaped shielding device for reducing the risk of COVID-19 droplet infection during endoscopic procedures.

Methods: We created a cuboid box (500 × 650 × 450 mm) with four sides were covered with a transparent, vinyl-chloride sheet having two windows for endoscopic passage and assistance. The shielding box was then placed over a patient's head and shoulders and covered with another transparent vinyl sheet. We assessed its utility and safety using the medical data concerning the procedure time and vital signs and a questionnaire for the endoscopic staff and patients.

Results: We performed endoscopic retrograde cholangiopancreatography-related procedures using this device for two patients suspected of having COVID-19-associated pneumonia. Both patients were smoothly and successfully treated without any complications. No difficulties were noted with either endoscopic operation or in assisting the procedure, and the transparency was good enough to observe the patients' faces and movements.

Conclusions: This box-shaped shielding device can be used to reduce the risk of COVID-19 droplet infection during endoscopic procedures in the clinical setting.

Relevance For Patients: The COVID-19 outbreak has reminded healthcare personnel working in endoscopy units of the importance of infection prevention during endoscopy. The box-shaped shielding device can help endoscopic staff avoid hospital-setting COVID-19 infection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868116PMC
December 2020

Selective Eating in Autism Spectrum Disorder Leading to Kwashiorkor and Brain Edema.

Pediatr Neurol 2021 03 26;116:55-56. Epub 2020 Dec 26.

Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.pediatrneurol.2020.12.007DOI Listing
March 2021

[Endoscopic closure of an esophago-pleural fistula resulting from a perforated esophageal ulcer due to systemic sclerosis:filling and shielding using polyglycolic acid sheets and fibrin glue].

Nihon Shokakibyo Gakkai Zasshi 2021 ;118(1):78-85

Department of Gastroenterological Surgery, Kyoto Okamoto Memorial Hospital.

A woman in her 70s with systemic sclerosis experienced dyspnea, and consequently, she was diagnosed with an esophago-pleural fistula, which was caused by a perforated esophageal ulcer. We administered conservative treatments including continuous pleural drainage and total parenteral nutrition. The fistula was closed but recurred, at which point we attempted to close the fistula by filling and shielding using polyglycolic acid (PGA) sheets and fibrin glue (FG). We were able to safely and smoothly fill and shield the fistula using the PGA sheets with a guidewire. We show that endoscopic closure of an esophago-pleural fistula using this technique is an effective, low-invasive treatment for gastrointestinal perforation and refractory fistulas.
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http://dx.doi.org/10.11405/nisshoshi.118.78DOI Listing
January 2021

Diagnostic dilemma in a case of obstructive sleep apnoea syndrome with reversible pulmonary hypertension and right heart failure: A case report.

Int J Pediatr Otorhinolaryngol 2020 Nov 11;138:110378. Epub 2020 Sep 11.

Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan.

Childhood obstructive sleep apnoea syndrome (OSAS) secondary to adenoid hyperplasia is known to give rise to pulmonary hypertension. However, we present a case of a toddler with pulmonary hypertension (PH) and right heart failure due to OSAS, the cause of which is difficult to identify. After the patient underwent an adenotonsillectomy, OSAS disappeared and the PH eventually resolved. Both paediatricians and otolaryngologists should know that paediatric OSAS can occur even in the setting of mild, clinically insignificant palatine tonsil hypertrophy and adenoid hyperplasia. Surgical intervention should be considered without losing the opportunity if it could be the cause of PH.
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http://dx.doi.org/10.1016/j.ijporl.2020.110378DOI Listing
November 2020

A case of severe autosomal dominant spinal muscular atrophy with lower extremity predominance caused by a de novo BICD2 mutation.

Brain Dev 2021 Jan 2;43(1):135-139. Epub 2020 Sep 2.

Department of Pediatrics, Japanese Kitami Red Cross Hospital, Japan.

Background: Heterozygous variants in BICD2 cause autosomal dominant spinal muscular atrophy with lower extremity predominance. These variants are also identified in individuals with severe forms of congenital muscle atrophy representing arthrogryposis multiplex.

Case Report: A girl was born with severe muscle weakness and respiratory distress. A fetal ultrasound had detected polyhydramnios and multiple joint contractures in utero. She was born with severe muscle weakness and respiratory distress. Bilateral hip joint dislocation and multiple bone fractures were also present at birth. Although she depends on medical care, including assisted ventilation and tube feeding, she has reached eight years of age. Her motor developmental skills were reduced owing to muscle weakness and deformity of her lower extremities, whereas her cognitive development slowly but steadily grew. Whole exome sequencing revealed a novel de novo missense BICD2 variant (c.1625G > A, p.(Cys542Tyr)), which was evaluated as likely pathogenic.

Conclusion: This is the first case report of a severe form of spinal muscular atrophy with lower extremity predominance caused by a de novo BICD2 variant in Japan.
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http://dx.doi.org/10.1016/j.braindev.2020.08.006DOI Listing
January 2021

Filling of Polyglycolic Acid Sheets for Closure of Gastrointestinal Fistulas With an Easily Deliverable Technique Using a Guidewire.

Gastroenterology Res 2020 Jun 18;13(3):96-100. Epub 2020 Jun 18.

Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan.

Background: This retrospective study aimed to investigate the suitable indications, methodology and long-term effect of the closure of gastrointestinal (GI) fistulas using polyglycolic acid (PGA) sheets and fibrin glue (FG) and to evaluate the usefulness of a delivery technique using a guidewire.

Methods: It involved 10 applications in six patients (median age 73 (range 53 - 78) years old, three men) with GI fistulas. A guidewire was introduced endoscopically or percutaneously into the fistula beyond the opposite orifice of the fistula with radiologic control. A tapered catheter was inserted over the guidewire, and the fistula was cleaned with an adequate quantity of saline. Subsequently, a small piece of PGA sheet was skewered onto the guidewire at the center and then pushed using the tapered catheter over the guidewire and delivered into the fistula. In cases of endoscopic procedure, the mucosa around the fistula was ablated, and the orifice of the fistula along with the surrounding mucosa was shielded with a piece of PGA sheet fixed with hemoclips and FG.

Results: Technical success of fistula closure was achieved in all applications, and no complications were observed after the procedure. The long-term occlusion of the fistula was ultimately achieved in four of six patients at 202 - 654 days (median duration, 244 days) after the last procedure with one or two applications.

Conclusions: The closure of GI fistulas using PGA sheets and FG demonstrated long-term efficacy for upper GI fistula of a certain length, and the filling technique using a guidewire ensured a safe smooth procedure.
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http://dx.doi.org/10.14740/gr1284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331856PMC
June 2020

Photocatalytic hydrogen peroxide splitting on metal-free powders assisted by phosphoric acid as a stabilizer.

Nat Commun 2020 07 7;11(1):3386. Epub 2020 Jul 7.

Research Center for Solar Energy Chemistry, and Division of Chemical Engineering, Graduate School of Engineering Science, Osaka University, Toyonaka, 560-8531, Japan.

Hydrogen peroxide (HO) has received increasing attention as an energy carrier. To achieve a sustainable energy society, photocatalytic HO splitting (HO (l) → H (g)O (g); ΔG° = + 131 kJ mol) is a desirable reaction for on-site H generation. However, this reaction has not been reported because conventional photocatalysis decomposes HO by disproportionation (HO (l) → HO (l) + 1/2O (g); ΔG° = -117 kJ mol) and by promoting HO reduction instead of H reduction. Here we report the successful example of HO splitting. Visible light irradiation of a graphitic carbon nitride loaded with graphene quantum dots as co-catalysts (GQDs/g-CN) in a HO solution containing phosphoric acid (HPO) produces H. HPO associates with HO via hydrogen bonding, and this stabilization of HO suppresses its reduction, thus promoting H reduction. The all-organic photosystem with HPO as a stabilizer may provide a basis of photocatalytic HO splitting.
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http://dx.doi.org/10.1038/s41467-020-17216-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341847PMC
July 2020

IgG4-related Autoimmune Hepatitis with a Suspected Drug-induced Etiology.

Intern Med 2020 1;59(11):1401-1405. Epub 2020 Jun 1.

Department of Pathology, Kyoto Okamoto Memorial Hospital, Japan.

A 69-year-old man was referred to our department with acute hepatitis. He had been newly treated with benidipine hydrochloride for two months. His blood test results were as follows: aspartate aminotransferase, 1,614 IU/L; alanine aminotransferase, 1,091 IU/L and anti-smooth muscle antibody, ×80. Needle liver biopsy specimen showed interface hepatitis with mainly lymphocytic infiltration and bridging fibrosis in the periportal area. Immunohistochemistry revealed lymphocytic infiltration positive for IgG4. We diagnosed him with IgG4-related AIH with an etiology that was suspected of being drug-induced. Oral prednisolone was started and then tapered after achieving biochemical remission. Hepatitis recurred after the cessation of steroids; however, remission was achieved with ursodeoxycholic acid.
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http://dx.doi.org/10.2169/internalmedicine.4092-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332635PMC
August 2020

[A Surgically Resected Case of Lung Metastases and Sister Mary Joseph's Nodule 24 Months after Operation for Pancreatic Cancer].

Gan To Kagaku Ryoho 2019 Dec;46(13):2354-2356

Dept. of Digestive Surgery, Hyogo Prefectural Awaji Medical Center.

Metastatic umbilical tumors from internal malignancy, known as Sister Mary Joseph's Nodule(SMJN), are a relatively rare prognostic sign. An 86-year-old woman with pancreatic body carcinoma underwent distal pancreatectomy for D2 lymph node removal in 20XX. No peritoneal dissemination was found at that time. Postoperative chemotherapy was not administered due to her age. Eighteen months postoperatively, tumor marker values increased and chest computed tomography(CT) revealed a single mass in the left lung. We resected the suspected lung metastasis. Positron emission tomography-CT performed 23 months postoperatively for increased tumor marker values after resection showed a 18F-fluorodeoxyglucose accumulation ofapproximately 4 cm in the umbilicus. The diagnosis by biopsy was umbilical metastasis ofthe pancreatic cancer. No recurrence or other metastases were found, so we performed an umbilical tumor resection and abdominoplasty 24 months postoperatively. No peritoneal dissemination was found in her abdomen and the ascites cytology was negative. The tumor was in the subcutaneous tissue; thus, the possibility of infiltration from the primary site or peritoneal dissemination was low. The tumor marker values decreased after the resection. She was followed-up without postoperative anticancer chemotherapy. However, the tumor marker values increased again, so chemotherapy was initiated. We report a case ofresection of pancreatic cancer and operation for lung and umbilical metastases of pancreatic cancer.
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December 2019

Measurement and empirical evaluation of acoustic loss in tube with abrupt area change.

J Acoust Soc Am 2020 Jan;147(1):364

Graduate School of Bio-Applications and Systems Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Nakacho, Koganei, Tokyo 184-8588, Japan.

This study measures the acoustic power loss that occurs when an acoustic wave passes through a tube with an abrupt change in area. It is determined that the power loss is proportional to the third power of the velocity amplitude, and that the proportionality coefficient depends upon the area change ratio of the tube. On the other hand, the proportionality coefficient is almost independent of the acoustic impedance and frequency in the 80-250 Hz range. Furthermore, the effect of a tapered tube in reducing the coefficient is experimentally investigated. Based on these experimental results, an empirical estimation method for the acoustic power loss is proposed and validated using a high-pressure-helium-filled tube.
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http://dx.doi.org/10.1121/10.0000597DOI Listing
January 2020

Endoscopic Gastrojejunostomy for Superior Mesenteric Artery Syndrome Using Magnetic Compression Anastomosis.

Gastroenterology Res 2019 Dec 21;12(6):320-323. Epub 2019 Nov 21.

Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan.

An 89-year-old woman who was bedridden suffered repeated vomiting due to superior mesenteric artery syndrome (SMAS). We performed gastrojejunostomy via the magnetic compression anastomosis (MCA) technique because her situation was not improved by conservative therapy and because the operative risk was high. We prepared two neodymium magnets: a flat plate-shaped magnet (15 × 3 mm) and a ring-shaped magnet of the same size. The ring-shaped magnet which passed through a guidewire was pushed to the duodenum by an endoscope over the guidewire. The duodenal stricture was balloon-dilated in front of the magnet, and the magnet was pushed all together beyond the stricture and placed at the duodenojejunal junction. Subsequently, the flat plate-shaped magnet was delivered endoscopically to the stomach using a biopsy forceps. The magnets were attracted towards each other transmurally after one more flat plate-shaped magnet was added to the gastric-side magnet. Completion of gastrojejunostomy was confirmed while retrieving the magnets 10 days after starting compression. She has been asymptomatic for 1 month since anastomosis. Endoscopic gastrojejunostomy using MCA was an effective, low-invasive treatment for SMAS.
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http://dx.doi.org/10.14740/gr1229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879032PMC
December 2019

A rare case of Goodpasture syndrome concomitant with bleeding jejunal Dieulafoy's lesion.

Clin J Gastroenterol 2020 Jun 30;13(3):382-385. Epub 2019 Nov 30.

Department of Nephrology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.

An 81-year-old man was diagnosed with Goodpasture syndrome (GS) because he met the criteria of positive anti-GBM antibodies, rapid progressive glomerulonephritis and pulmonary hemorrhage. After starting plasmapheresis and steroid pulse therapy, he experienced tarry stool and contrast-enhanced CT revealed an aneurysmal finding in the jejunum. Paroral enteroscopy showed a jejunal Dieulafoy's lesion (DL) with gush-out hemorrhage. Hemostasis was successfully achieved by hemoclipping, and he then experienced no re-bleeding events. GS can present as a jejunal DL, and contrast-enhanced CT is useful for investigating the etiology and site of small intestinal bleeding, which can lead to smooth, effective endoscopic hemostasis.
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http://dx.doi.org/10.1007/s12328-019-01078-3DOI Listing
June 2020

Experience of Endoscopic Jejunojejunostomy for Anastomotic Obstruction After Subtotal Gastrectomy Using Magnetic Compression Anastomosis.

Gastroenterology Res 2019 Oct 4;12(5):267-270. Epub 2019 Oct 4.

Department of Surgery, Kyoto Okamoto Memorial Hospital, Kyoto 613-0034, Japan.

Magnetic compression anastomosis (MCA) was developed as a low-invasive treatment for gastro-enteric or entero-enteric obstruction. A 72-year-old man underwent subtotal gastrectomy with Billroth II reconstruction for early gastric cancer. After the operation, he suffered from repeated aspiration pneumonia due to anastomotic obstruction caused by jejunal kinking at the efferent loop of anastomosis. We therefore performed jejunojejunostomy via the MCA technique, as his situation was not improved despite conservative therapy and he had a high reoperative risk. We prepared two flat plate-shaped neodymium magnets (15 × 3 mm) each with a small hole, and a nylon thread was passed through each hole. Each magnet was then delivered endoscopically to the anal side of the jejunal kinking, subsequently to the anastomosis, using biopsy forceps. The two magnets immediately became attracted towards each other transmurally. Oozing hemorrhage with clot at the mated magnets was observed 10 days after starting the compression. After retrieving the magnets, we confirmed the completion of jejunojejunostomy and then successfully achieved hemostasis of the anastomotic hemorrhage using argon plasma coagulation. The widely patent anastomosis was confirmed endoscopically 1 month after canalization; and he has been asymptomatic and able to eat a normal diet ever since. Endoscopic MCA is an effective, low-invasive treatment for anastomotic obstruction after subtotal gastrectomy. A standardized, safer procedure should be established for general use in the clinical setting.
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http://dx.doi.org/10.14740/gr1214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785290PMC
October 2019

Prophylactic Biliary Stenting Before Cholecystectomy in Patients With Gallstones and Common Bile Duct Stones.

Gastroenterology Res 2019 Aug 25;12(4):191-197. Epub 2019 Aug 25.

Department of Surgery, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.

Background: The usefulness of prophylactic biliary stenting for patients with common bile duct stones (CBDS) and gallstones (GS) to prevent recurrent biliary events after endoscopic sphincterotomy (EST) and CBDS extraction before elective cholecystectomy remains controversial. The aim of this study was to evaluate the risk of recurrent CBDS around the perioperative period and clarify its risk factors.

Methods: The clinical data of all patients who received prophylactic biliary stenting after EST for CBDS and later underwent cholecystectomy for GS followed by stent extraction in our institution were retrospectively reviewed. The numbers of residual CBDS at the end first and second endoscopic retrograde cholangiography (ERC) studies were compared. Univariate and multivariate analyses were performed using a logistic regression model to determine risk factors for recurrent CBDS in the perioperative period.

Results: Forty-two consecutive patients received prophylactic biliary stenting and subsequent cholecystectomy for GS. Three of these patients were excluded from this study because the number of residual stones was not confirmed. The median maximum CBDS diameter at second ERC was 0 mm (range, 0 - 10 mm); six patients had multiple CBDS (≥ 5). The number of CBDS at second ERC was increased in comparison to that at the first ERC in 15 patients (38.4%), and was unchanged or decreased in 24 patients. The median minimum cystic duct diameter was 4 mm (range, 1 - 8 mm). The median interval between first ERC and operation was 26 days (range, 2 - 131 days). The median interval between operation and second ERC was 41 days (range, 26 - 96 days). Laparoscopic cholecystectomy (LC) was performed in 38 patients, one of whom was converted from LC to open cholecystectomy. Postoperative complications (transient bacteremia) occurred in one patient. The cystic duct diameter was an independent risk factor for an increased number of CBDS at second ERC in the multivariate analysis (odds ratio 0.611 (95% confidence interval (0.398 - 0.939)), P = 0.03).

Conclusion: Recurrent CBDS around the perioperative period of cholecystectomy is not a rare complication after EST and the removal of CBDS with concomitant GS. Prophylactic biliary stenting is considered useful for preventing CBDS-associated complications, especially for patients in whom the cystic duct diameter is larger (≥ 5 mm).
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http://dx.doi.org/10.14740/gr1207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731041PMC
August 2019

Experience of Manual Compression Hemostasis Under Endoscopic Observation for Acute Hemorrhagic Rectal Ulcer.

Gastroenterology Res 2019 Apr 7;12(2):107-110. Epub 2019 Apr 7.

Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.

We experienced two cases in which manual compression hemostasis under endoscopic observation was used in patients with acute hemorrhagic rectal ulcer (AHRU). The patients experienced an episode of massive fresh hematochezia, requiring the blood transfusion. Emergent sigmoidoscopy revealed multiple ulcers with a large protuberant visible vessel or with gush-out hemorrhage on the lower rectum. Endoscopic hemostasis by hemoclips and hypertonic saline-epinephrine injection was attempted; however, mechanical mucosal injury induced by hemoclips and needles caused another gush-out hemorrhage. Thus, the site of bleeding was manually compressed by a forefinger under endoscopic observation. After 5 min, compression hemostasis was achieved, and the postoperative course was uneventful. Manual compression hemostasis under endoscopic observation is useful and worth attempting for AHRU.
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http://dx.doi.org/10.14740/gr1162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469901PMC
April 2019

A Rare Case of Local Recurrence Following Curative Endoscopic Submucosal Dissection of Intramucosal Differentiated-Type Gastric Cancer.

Gastroenterology Res 2019 Apr 7;12(2):103-106. Epub 2019 Apr 7.

Department of Pathology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.

A 78-year-old man underwent endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) (type 0-IIa) in the anterior wall of the antrum. resection was achieved. The histopathological examination revealed very well-differentiated tubular adenocarcinoma (tub1) of 30 × 22 mm in size, confined to the mucosa. No lymphovascular invasion or ulceration was observed, and there was no undifferentiated-type component and the margins were tumor-free. Therefore, this lesion fulfilled the eCuraA criteria. Two years after ESD, esophagogastroduodenoscopy revealed an irregular, slightly-depressed lesion within the post-ESD scar. Tubular adenocarcinoma was suspected based on histopathological examination of a biopsy specimen. The tumor was resected by ESD. A histopathological examination revealed well-differentiated tubular adenocarcinoma (tub1) of 6 × 4 mm in size, confined to the mucosa. No lymphovascular invasion was detected and the margins were tumor-free. These findings indicated a curative resection. Recurrence following a curative ESD of an intramucosal differentiated-type EGC which fulfilled the eCuraA criteria is rare. Careful endoscopic observation using magnifying narrow band imaging (NBI) is needed after ESD, even when curative resection is achieved.
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http://dx.doi.org/10.14740/gr1159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469905PMC
April 2019

Measurement of acoustic dissipation occurring in narrow channels with wet wall.

J Acoust Soc Am 2019 Jan;145(1):71

Department of Bio-Functions and Systems Science, Tokyo University of Agriculture and Technology, Nakacho 2-24-16, Koganei, Tokyo 184-8588, Japan.

The acoustic dissipation that occurs in a porous medium is experimentally investigated. Two conditions are tested. One is that the wall of the porous medium is wet by water, and the other is that it is dry. Experimental results show that water does not affect viscous dissipation; however, it affects the dissipation caused by pressure oscillation. Furthermore, it is found that the effect of water on the dissipation due to pressure oscillation increases with the temperature of the working gas. A theory that can consider the effect of condensation and evaporation on sound propagation is used to investigate the result. The theoretically and experimentally obtained values of dissipation are in good agreement. The reason for the effect of water is analyzed using the theory.
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http://dx.doi.org/10.1121/1.5085775DOI Listing
January 2019

Three-legged radiographic view for evaluating cranioventral lung region in standing calves with bovine respiratory disease.

J Vet Med Sci 2019 Jan 7;81(1):120-126. Epub 2018 Dec 7.

Veterinary Medical Center, Obihiro University of Agriculture and Veterinary Medicine, Inada, Obihiro, Hokkaido 080-8555, Japan.

This study proposed a novel radiographic positioning in order to image the cranioventral lung region using a portable X-ray unit and digital radiography system. In the novel position, calves were restrained in a chute and a unilateral forelimb was pulled cranially with the contralateral forelimb tied to the chute; the forelimbs were then spread cranio-caudally as in a scissor position (Three-legged view: TL view). In a preliminary study, we applied the TL view for imaging of 14 clinically healthy calves. In a clinical study, accuracy in detecting cranioventral lung lesions was compared between the standard standing view and the TL view for 19 calves, which were culled from herd; the results of postmortem examination were used as gold standard. Seven evaluators independently interpreted the images. The median (range) number of trials and the time for obtaining optimal position were 2 (1-7) and 263 sec (105-488), respectively in 14 healthy calves. Calves thicker than approximately 40 cm were not considered candidates for TL view in this setting because of difficulty in restraint and the low output of the portable X-ray unit. The TL view improved the detection of consolidation in the cranioventral lung region, compared with the standard view. The TL view was considered an optional view when the cranioventral lung region was an area of interest, because this view was relatively easy to perform and required a small number of personnel, even for large calves.
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http://dx.doi.org/10.1292/jvms.18-0333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361651PMC
January 2019

Feasibility of Underwater Endoscopic Mucosal Resection for Colorectal Lesions: A Single Center Study in Japan.

Gastroenterology Res 2018 Aug 8;11(4):274-279. Epub 2018 Feb 8.

Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan.

Background: Underwater endoscopic mucosal resection (U-EMR) has emerged as an alternative technique for the resection of colorectal lesions. This study aimed to evaluate our initial experience using U-EMR.

Methods: This is a single-center, retrospective case series study. We analyzed the clinical outcomes of consecutive patients who underwent U-EMR in our endoscopy center, from December 2015 to February 2017.

Results: Our analysis included 64 lesions, contributed by 38 patients, with a mean age of 68.6 years (range, 25 to 90 years). The study sample included 33 right-sided and 25 left-sided colon lesions, and seven rectal lesions, with an average size of 16.2 mm (6 - 40 mm). Of these, 46 lesions were polypoid and 18 ones non-polypoid. Histologically, 31 lesions were low-grade adenomas, eight ones were high-grade adenomas, 11 were mucosal cancers, four were submucosal cancers, and 10 were classified as "others". resection was achieved in 52 (81%) lesions, with an resection rate of 95% for lesions < 20 mm and 55% for lesions ≥ 20 mm. Complete resection of neoplastic epithelial lesions, defined by a negative pathological margin, was achieved in 32 of 59 neoplastic epithelial lesions (54%). We identified three cases (5%) of post-procedural bleeding and one case of perforation (2%).

Conclusions: U-EMR can be feasibly used for resection of colonic lesions, including lesions ≥ 20 mm, although the resection rate for these lesions was lower than for lesions < 20 mm.
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http://dx.doi.org/10.14740/gr1021wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089589PMC
August 2018

Independent occurrence of de novo and variants in brothers with different neurological disorders - leukodystrophy and autism.

Hum Genome Var 2018 19;5:18. Epub 2018 Jul 19.

4Department of Genetics, Yokohama City University, Yokohama, Japan.

Consecutive occurrence of de novo variants in the same family is an extremely rare phenomenon. Two siblings, a younger brother with hypomyelinating leukodystrophy and an elder brother with severe intellectual disability and autistic features, had independent de novo variants of c.139T > G (p.Leu47Val) and c.1393G > A (p.Glu465Lys), respectively. These novel variants were predicted to be pathogenic. Both patients also had a known variant, c.499C > T (p.Arg167Trp).
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http://dx.doi.org/10.1038/s41439-018-0020-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053359PMC
July 2018
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