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| 1 | Review of the diagnosis and management of gastrointestinal bezoars显示文摘The formation of a bezoar is a relatively infrequentdisorder that affects the gastrointestinal system.Bezoars are mainly classified into four types dependingon the material constituting the indigestible mass of thebezoar phytobezoars, trichobezoars, pharmacobezoars,and lactobezoars. Gastric bezoars often cause ulcerativelesions in the stomach and subsequent bleeding,whereas small intestinal bezoars present with smallbowel obstruction and ileus. A number of articles haveemphasized the usefulness of Coca-Cola? administrationfor the dissolution of phytobezoars. However, persimmonphytobezoars may be resistant to such dissolutiontreatment because of their harder consistency comparedto other types of phytobezoars. Better understanding ofthe etiology and epidemiology of each type of bezoarwill facilitate prompt diagnosis and management.Here we provide an overview of the prevalence, classification,predisposing factors, and manifestations ofbezoars. Diagnosis and management strategies arealso discussed, reviewing mainly our own case series.Recent progress in basic research regarding persimmonphytobezoars is also briefly reviewed. | Masaya Iwamuro Hiroyuki Okada Kazuhiro Matsueda Tomoki Inaba Chiaki Kusumoto Atsushi Imagawa Kazuhide Yamamoto | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，4： | 22 |
| 2 | Correlation between hepatic blood flow and liver function in alcoholic liver cirrhosis显示文摘AIM:To elucidate the correlation between hepatic blood flow and liver function in alcoholic liver cirrhosis(AL-LC).METHODS:The subjects included 35 patients with ALLC(34 men,1 woman;mean age,58.9±10.7 years;median age,61 years;range:37-76 years).All patientswere enrolled in this study after obtaining written informed consent.Liver function was measured with tests measuring albumin(Alb),prothrombin time(PT),brain natriuretic peptide(BNP),branched amino acid and tyrosine ratio(BTR),branched chain amino acid(BCAA),tyrosine,ammonia(NH3),cholinesterase(Ch E),immunoreactive insulin(IRI),total bile acid(TBA),and the retention rate of indocyanine green 15 min after administration(ICG R15).Hepatic blood flow,hepatic arterial tissue blood flow(HATBF),portal venous tissue blood flow(PVTBF),and total hepatic tissue blood flow(THTBF)were simultaneously calculated using xenon computed tomography.RESULTS:PVTBF,HATBF and THTBF were 30.2±10.4,20.0±10.7,and 50.3±14.9 m L/100 m L/min,respectively.Alb,PT,BNP,BTR,BCAA,tyrosine,NH3,Ch E,IRI,TBA,and ICG R15 were 3.50±0.50 g/d L,72.0%±11.5%,63.2±56.7 pg/m L,4.06±1.24,437.5±89.4μmol/L,117.7±32.8μmol/L,59.4±22.7μg/d L,161.0±70.8 IU/L,12.8±5.0μg/d L,68.0±51.8μmol/L,and 28.6%±13.5%,respectively.PVTBF showed a significant negative correlation with ICG R15(r=-0.468,P<0.01).No significant correlation was seen between ICG 15R,HATBF and THTBF.There was a significant correlation between PVTBF and Alb(r=0.2499,P<0.05),and NH3 tended to have an inverse correlation with PVTBF(r=-0.2428,P=0.0894).There were also many significant correlations between ICG R15 and liver function parameters,including Alb,NH3,PT,BNP,TBA,BCAA,and tyrosine(r=-0.2156,P<0.05;r=0.4318,P<0.01;r=0.4140,P<0.01;r=0.3610,P<0.05;r=0.5085,P<0.001;r=0.4496,P<0.01;and r=0.4740,P<0.05,respectively).CONCLUSION:Our investigation showed that there is a close correlation between liver function and hepatic blood flow. | Hideaki Takahashi Ryuta Shigefuku Yoshihito Yoshida Hiroki Ikeda Kotaro Matsunaga Nobuyuki Matsumoto Chiaki Okuse Shigeru Sase Fumio Itoh Michihiro Suzuki | 2014 | World Journal of Gastroenterology2014，20，45： | 14 |
| 3 | Evaluation of the relationship between hepatocellular carcinoma location and transarterial chemoembolization efficacy显示文摘AIM To evaluate the relationship between the location of hepatocellular carcinoma(HCC) and the efficacy of transarterial chemoembolization(TACE).METHODS We evaluated 115 patients(127 nodules), excluding recurrent nodules, treated with TACE between January 2011 and June 2014. TACE efficacy was evaluated according to m RECIST. The HCC location coefficient was calculated as the distance from the central portal portion to the HCC center(mm)/liver diameter(mm) on multiplanar reconstruction images rendered(MPR) to visualize bifurcation of the right and left branches of the portal vein and HCC center. The HCC location coefficient was compared between complete response(CR) and non-CR groups in Child-Pugh grade A and B patients.RESULTS The median location coefficient of HCC among all nodules, the right lobe, and the medial segment was significantly higher in the CR group than in the non-CR group in the Child-Pugh grade A patients(0.82 vs 0.62, P < 0.001; 0.71 vs 0.59, P < 0.01; 0.81 vs 0.49, P < 0.05, respectively). However, there was no significant difference in the median location coefficient of the HCC in the lateral segment between in the CR and in the non-CR groups(0.67 vs 0.65, P > 0.05). On the other hand, in the Child-Pugh grade B patients, the HCC median location coefficient in each lobe and segment was not significantly different between in the CR and in the non-CR groups.CONCLUSION Improved TACE efficacy may be obtained for HCC in the peripheral zone of the right lobe and the medial segment in Child-Pugh grade A patients. | Izumi Miki Satoru Murata Fumio Uchiyama Daisuke Yasui Tatsuo Ueda Fumie Sugihara Hidemasa Saito Hidenori Yamaguchi Ryusuke Murakami Chiaki Kawamoto Eiji Uchida Shin-ichiro Kumita | 2017 | World Journal of Gastroenterology2017，23，35： | 8 |
| 4 | Endoscopic features of early-stage signet-ring-cell carcinoma of the stomach显示文摘AIM: To identify the features of early signet ring cell gastric carcinoma using magnification endoscopy with narrow band imaging(NBI).METHODS: A retrospective review was conducted of 12 cases of early signet ring cell gastric carcinoma who underwent treatment in a single institution between January 2009 and April 2013. All patients had magnification endoscopy with NBI and indigo carmine contrast to closely examine the mucosal architecture, including the microvasculature and arrangement of gastric pits. Histologic examination of the final endoscopic submucosal dissection or gastrectomy specimen was performed and compared with the endoscopic findings to identify patterns specific to signet ring cell carcinoma.RESULTS: Twelve patients with early signet ring cell gastric carcinoma were identified; 75% were male, and average age was 61 years. Most of the lesions were stage T1a(83%), while the remainder were T1b(17%). The mean lesion size was 1.4 cm2. On standard endoscopy, all 12 patients had a pale, flat lesion without any evidence of mucosal abnormality such as ulceration, elevation, or depression. On magnification endoscopywith NBI, all of the patients had irregularities in the glands and microvasculature consistent with early gastric cancer. In addition, all 12 patients exhibited the 'stretch sign', an elongation or expansion of the architectural structure. Histologic examination of the resected specimens demonstrated an expanded and edematous mucosal layer infiltrated with tumor cells.CONCLUSION: The 'stretch sign' appears to be specific for signet ring cell carcinoma and may aid in the early diagnosis and treatment of this aggressive pathology. | Chainarong Phalanusitthepha Kevin L Grimes Haruo Ikeda Hiroki Sato Chiaki Sato Chananya Hokierti Haruhiro Inoue | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，7： | 8 |
| 5 | Chloroplast DNA variation and phylogeography of Ligularia tongolensis (Asteraceae), a species endemic to the Hengduan Mountains region of China显示文摘In this research, we aimed to study the genetic variation and phylogeographic pattern of Ligularia tongolensis, a perennial herb endemic to the Hengduan Mountains region of China. We sequenced two chloroplast DNA (cpDNA) intergenic spacers (trnQ-5 rps16, trnL-rpl32) in 140 individuals from 14 populations of three groups (Jinshajiang vs. Yalongjiang vs. Wumeng) within this species range. High levels of haplotype diversity (Hd = 0.814) and total genetic diversity (Ht = 0.862) were detected at the species level, based on a total of 12 haplotypes identified. Low levels of intrapopulation diversity (Hs = 0.349), high levels of genetic divergence (Gst = 0.595, Nst = 0.614, Fst = 0.597), and the absence of isolation by distance tests were also found in L. tongolensis. Furthermore, H2 and H5, the dominant haplotypes that located at internal nodes and deviated from extinct ancestral haplotype in the network, were found to be shared between Jinshajiang and Yalongjiang groups. These results indicate that past fragmentation may be the important factor responsible for the present phylogeographical pattern of L. tongolensis. Meanwhile, the locations occupied by each group might have served as independent refugia for L. tongolensis during the Quaternary glaciation. Unimodal mismatch distribution and star-like genealogies indicated this species underwent past demographic expansion events, with expansion ages of 274 ka BP. | Jin-Feng WANG Yue-Zhi PAN Xun GONG Yu-Chung CHIANG Chiaki KURODA | 2011 | Journal of Systematics and Evolution2011，49，2： | 7 |
| 6 | Peritoneal bleeding due to percutaneous transhepatic gallbladder drainage:An autopsy report显示文摘A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.There were three centesis scars for the PTGBD,and only one pathway from the most dorsal centesis scar reached the gallbladder.Microscopically,the PTGBD pathway crossed and injured the intrahepatic arterial wall,and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver.Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder.Consequently,the PTGBD caused lethal bleeding.When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface,it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding. | Yoko Ihama Maki Fukazawa Kenji Ninomiya Takumi Nagai Chiaki Fuke Tetsuji Miyazaki | 2012 | World Journal of Hepatology2012，4，10： | 7 |
| 7 | 东俄洛橐吾遗传变异与分化的ISSR分析显示文摘应用ISSR标记对东俄洛橐吾(Ligularia tongolensis)的遗传多样性进行了研究。从100个引物中筛选出8个用于正式扩增。在所研究的8个居群共150个个体中检测到148个多态位点。在居群水平上,多态位点百分率(PPB)为50.45%,Nei′s基因多样性指数(H)和Shannon信息指数(I)分别为0.1595和0.2440。在物种水平上,多态位点百分率(PPB)为88.10%,Nei′s基因多样性指数(H)和Shannon信息指数(I)分别为0.2811和0.4279。居群间的遗传分化系数(Gst)达0.4355。研究结果表明东俄洛橐吾的遗传多样性水平很高,居群间遗传分化较大。这与其多样化的生态环境是有必然联系的。因适应其多样化的生态环境而形成了遗传多样性;且因其生态环境的不连续性阻碍了居群间的基因交流而产生了遗传分化,即东俄洛橐吾高水平的遗传多样性和遗传分化是适应其分布区多样化生态环境的结果。 | 王金凤 Chiaki kuroda 龚洵 | 2007 | 云南植物研究2007，29，5： | 5 |
| 8 | Natural hybridization and introgression in sympatric Ligularia species(Asteraceae,Senecioneae)显示文摘The difficulty in clarifying species of genus Ligularia Cass.has been attributed to rapid and continuous allopatric speciation in small and isolated populations,combined with interspecific diploid hybridization in the Qinghai-Tibetan Plateau and adjacent areas.However,no concrete example has been reported to prove this hypothesis.We studied a natural mixed population of six species of Ligularia in which some individuals were morphologically intermediate between L.subspicata and L.nelumbifolia.Based on DNA sequences(trnC-F,trnL-rpL32,trnQ5 rps16,trnK-rps16,and internal transcribed spacer) and inter-simple sequence repeat data,we concluded that putative hybrids are primarily products of hybridization between L.nelumbifolia and L.subspicata.The other four species or additional,unknown species may also be involved in hybridization.This hybridization is bidirectional but asymmetrical.Hybrid individuals were mostly the first generation,but F2 and later-generation hybrids were also present.Moreover,the backcrossed individuals detected indicate that natural gene flow occurs among at least three Ligularia species.Hybrids may become stabilized to form new species or may function as intermediates in evolutionary diversification. | Jiao-Jun YU Chiaki KURODA Xun GONG | 2011 | Journal of Systematics and Evolution2011，49，5： | 5 |
| 9 | Endovascular treatment of post-laparoscopic pancreatectomy splenic arteriovenous fistula with splenic vein aneurysm显示文摘Splenic arteriovenous fistulas(SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A 40-year-old man underwent a laparoscopic, spleen-preserving, distal pancreatectomy for an endocrine neoplasm of the pancreatic tail. Three months after surgery, a computed tomography(CT) scan demonstrated an SAVF with a dilated splenic vein. The SAVF, together with the splenic vein aneurysm, was successfully treated using percutaneous transarterial coil embolization of the splenic artery, including the SAVF and drainage vein. After the endovascular treatment, the patient's recovery was uneventful. He was discharged on postoperative day 6 and continues to be well 3 mo after discharge. An abdominal CT scan performed at his 3-mo follow-up demonstrated complete thrombosis of the splenic vein aneurysm, which had decreased to a 40 mm diameter. This is the first reported case of SAVF following a laparoscopic pancreatectomy and demonstrates the usefulness of endovascular treatment for this type of complication. | Tatsuo Ueda Satoru Murata Akira Yamamoto Jin Tamai Yuko Kobayashi Chiaki Hiranuma Hiroshi Yoshida Shin-ichiro Kumita | 2015 | World Journal of Gastroenterology2015，21，25： | 5 |
| 10 | Pancreatic involvement in chronic viral hepatitis显示文摘AIM: To elucidate the frequency and characteristics of pancreatic disorders in the course of chronic viral hepatitis. METHODS: We prospectively assessed the serum pancreatic enzyme levels and imaging findings in patients with chronic viral hepatitis and healthy control subjects. RESULTS: Serum amylase (t-Amy), salivary amylase (s-Amy), pancreatic amylase (p-Amy) and serum lipase levels were higher in hepatitis patients in comparison to control subjects. However, in asymptomatic viral carriers, only the serum t-Amy levels were higher than those of the controls. The levels of each enzyme rose with the progression of liver disease in patients with hepatitis B or C; whereas the levels of each enzyme within the same clinical stage of the disease did not differ between patients diagnosed with either hepatitis B or hepatitis C virus. Imaging findings demonstrated chronic pancreatitis in only 1 out of 202 patients (0.5%).CONCLUSION: Our data suggest that serum levels of pancreatic enzymes increase with the progression of liver disease in patients diagnosed with viral hepatitis. Pancreatic disease, asymptomatic in most cases, may represent an extrahepatic manifestation of chronic viral hepatitis. | Yoshiki Katakura Hiroshi Yotsuyanagi Kiyoe Hashizume Chiaki Okuse Noriaki Okuse Kohji Nishikawa Michihiro Suzuki Shiro Iino Fumio Itoh | 2005 | World Journal of Gastroenterology2005，11，23： | 5 |
| 11 | Ribavirin contributes to eradicate hepatitis C virus through polarization of T helper 1/2 cell balance into T helper 1 dominance显示文摘The mechanism of action of ribavirin(RBV) as an immunomodulatory and antiviral agent and its clinical significance in the future treatment of patients with hepatitis C virus(HCV) infection are reviewed.RBV up-regulates type 1 and/or 2 cytokines to modulate the T helper(Th) 1/2 cell balance to Th1 dominance.Examination of co-stimulatory signaling indicated that RBV down-modulates inducible co-stimulator on Th cells,which contributes to differentiating na?ve Th cells into Th2 cells while reducing their interleukin-10 production.The effects on T-regulatory(Treg) cells were also investigated,and RBV inhibited the differentiation of na?ve Th cells into adaptive Treg cells by downmodulating forkhead box-P3.These findings indicate that RBV mainly down-regulates the activity of Th2 cells,resulting in the maintenance of Th1 activity that contributes to abrogating HCV-infected hepatocytes.Although an interferon-free treatment regimen exhibits almost the same efficacy without serious complications,regimens with RBV will be still be used because of their ability to facilitate the cellular immune response,which may contribute to reducing the development of hepatocellular carcinogenesis in patients infected with HCV. | Katsuhisa Nakatsuka Masanori Atsukawa Masumi Shimizu Hidemi Takahashi Chiaki Kawamoto | 2015 | World Journal of Hepatology2015，7，25： | 4 |
| 12 | Fatal liver failure caused by reactivation of lamivudine-resistant hepatitis B virus:A case report显示文摘We present a case of fetal liver failure caused by the activation of lamivudine-resistant hepatitis B virus (HBV) nine months after lamivudine treatment. A 57-year old man visited our hospital for the treatment of decompensated chronic hepatitis B. Lamivudine was started in December 2001. Subsequently, serum HBV was negative for HBV DNA with seroconversion from HBeAg to anti-HBe and improvement of liver function. However, HBV DNA and HBeAg were again detected in September 2002. He was complicated by breakthrough hepatitis and admitted to our hospital in November for severely impaired liver function. Vidarabine treatment was started and serum HBV DNA and alanine aminotransferase (ALT) decreased transiently. However, after the start of α-interferon treatment, HBV DNA level increased and liver function deteriorated. He died 1 mo after admission. An analysis of amino acid sequences in the polymerase region revealed that rtM204I/V with rtL80I/V occurred at the time of viral breakthrough. After the start of antiviral treatment, rtL180M was detected in addition to rtM204I/V and rtL80I/V, and became predominant in the terminal stage of the disease. HBV clone with a high replication capacity may be produced by antiviral treatment leading to the worsening of liver function. Antiviral therapy for patients with breakthrough hepatitis in advanced liver disease should be carefully performed. | Yuka Suzuki Hiroshi Yotsuyanagi Chiaki Okuse Yoshihiko Nagase Hideaki Takahashi Kyoji Moriya Michihiro Suzuki Kazuhiko Koike Shiro Iino Fumio Itoh | 2007 | World Journal of Gastroenterology2007，13，6： | 4 |
| 13 | Hierarchical structures hydrogel evaporator and superhydrophilic water collect device for efficient solar steam evaporation显示文摘Efficient light absorption and trapping are of vital importance for the solar water evaporation by hydrogel-based photothermal conversion materials.Conventional strategies are focused on the development of the composition and structure of the hydrogers internal network.In our point of view,the importance of the surface structure of hydrogel has usually been underestimated or ignored.Here inspired by the excellent absorbance and water transportation ability of biological surface structure,the hierarchical structured hydrogel evaporators(HSEs)increased the light absorption,trapping,water transportation and water-air interface,which is the beneficial photothermal conversion and water evaporation.The HSEs showed a rapid evaporation rate of 1.77 kg·m^(-2)·h^(-1)at about 92%energy efficiency under one sun(1 kW·m^(-2)).Furthermore,the superhydrophilic window device was used in this work to collect the condensed water,which avoids the light-blocking caused by the water mist formed by the small droplets and the problem of the droplets stick on the device dropping back to the bulk water.Integrated with the excellent photothermal conversion hydrogel and superhydrophilic window equipment,this work provides efficient evaporation and desalination of hydrogel-based solar evaporators in practical large-scale applications. | Wenwei Lei Sovann Khan Lie Chen Norihiro Suzuki Chiaki Terashima Kesong Liu Akira Fujishima Mingjie Liu | 2021 | Nano Research2021，14，4： | 4 |
| 14 | Risk factors for retinopathy associated with interferonα-2b and ribavirin combination therapy in patients with chronic hepatitis C显示文摘AIM: To elucidate the frequency and risk factors for retinopathy in patients with chronic hepatitis C who are treated by interferon-ribavirin combination therapy. METHODS: We prospectively analyzed 73 patients with histologically confirmed chronic hepatitis C, who underwent combination therapy for 24 wk. Optic fundi were examined before, and 2, 4, 12 and 24 wk after the start of combination therapy. RESULTS: Fourteen patients (19%) developed retinopathy, which was initially diagnosed by the appearance of a cotton wool spot in 12 patients. Retinal hemorrhage was observed in 5 patients. No patient complained of visual disturbance. Retinopathy disappeared in 9 patients (64%) despite the continuation of combination therapy. However, retinopathy persisted in 5 patients with retinal hemorrhage. A comparison of the clinical background between the groups with and without retinopathy showed no significant differences in age, gender, viral genotype, RNA level, white blood cell count, platelet count, prothrombin time, complications by diabetes mellitus or hypertension, or pretreatment arteriosclerotic changes in the optic fundi. However, multiple logistic regression analysis revealed that complication by hypertension was observed with a high frequency in the group with retinopathy (P = 0.004, OR=245.918, 95% CI=5.6-10786.2). CONCLUSION: Retinopathy associated with combination therapy of interferon a-2b and ribavirin tends to develop in patients with hypertension. | Chiaki Okuse Hiroshi Yotsuyanagi Yoshihiko Nagase Yuhtaro Kobayashi Kiyomi Yasuda Kazuhiko Koike Shiro Iino Michihiro Suzuki Fumio Itoh | 2006 | World Journal of Gastroenterology2006，12，23： | 4 |
| 15 | An autopsy case of a primary aortoenteric fistula: A pitfall of the endoscopic diagnosis显示文摘A primary aortoenteric fistula (PAEF), defined as a communication between the native aorta and the gastrointestinal tract, is a rare cause of gastrointes-tinal bleeding. The preoperative diagnosis of PAEF is extremely difficult. Consequently, PAEF may cause sudden and unexpected death. We present an autopsy case of a 68-year-old man who died of massive gastro-intestinal bleeding due to a PAEF. Autopsy revealed a pinhole rupture located on the third part of the duode-nal mucosa and fistulized into the adjacent abdominal aortic aneurysm (AAA). Our case indicates that the aortoenteric fistula can result in fatal gastrointestinal bleeding. Consequently, a PAEF should be included in the differential diagnosis of gastrointestinal bleeding. | Yoko Ihama Tetsuji Miyazaki Chiaki Fuke Yasushi Ihama Ryoji Matayoshi Hiroshi Kohatsu Fukunori Kinjo | 2008 | World Journal of Gastroenterology2008，14，29： | 4 |
| 16 | The POM-DOM piezophilic microorganism continuum(PDPMC)—The role of piezophilic microorganisms in the global ocean carbon cycle显示文摘The deep ocean piezosphere accounts for a significant part of the global ocean,hosts active and diverse microbial communities which probably play a more important role than hitherto recognized in the global ocean carbon cycle.The conventional biological pump concept and the recently proposed microbial carbon pump mechanism provide a foundation for our understanding of the role of microorganisms in cycling of carbon in the ocean.However,there are significant gaps in our knowledge and a lack of mechanistic understanding of the processes of microbially-mediated production,transformation,degradation,and export of marine dissolved and particulate organic matter(DOM and POM)in the deep ocean and the ecological consequence.Here we propose the POM-DOM piezophilic microorganism continuum(PDPMC)conceptual model,to address these important biogeochemical processes in the deep ocean.We propose that piezophilic microorganisms(bacteria and archaea)play a pivotal role in deep ocean carbon cycle where microbial production of exoenzymes,enzymatic breakdown of DOM and transformation of POM fuels the rapid cycling of marine organic matter,and serve as the primary driver for carbon cycle in the deep ocean. | FANG JiaSong ZHANG Li LI Jiang Tao Chiaki KATO Christian TAMBURINI ZHANG YuZhong DANG HongYue WANG GuangYi WANG FengPing | 2015 | Science China Earth Sciences2015，58，1： | 4 |
| 17 | Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation显示文摘AIM:To investigate the need for pancreatic stenting after endoscopic sphincterotomy(EST)in patients with difficult biliary cannulation.METHODS:Between April 2008 and August 2013,2136 patients underwent endoscopic retrograde cholangiopancreatography(ERCP)-related procedures.Among them,55 patients with difficult biliary cannulation who underwent EST after bile duct cannulation using the pancreatic duct guidewire placement method(P-GW)were divided into two groups:a stent group(n=24;pancreatic stent placed)and a no-stent group(n=31;no pancreatic stenting).We retrospectively compared the two groups to examine the need for pancreatic stenting to prevent post-ERCP pancreatitis(PEP)in patients undergoing EST after biliary cannulation by P-GW.RESULTS:No differences in patient characteristics or endoscopic procedures were observed between the two groups.The incidence of PEP was 4.2%(1/24)and29.0%(9/31)in the Stent and no-stent groups,respectively,with the no-stent group having a significantly higher incidence(P=0.031).The PEP severity was mild for all the patients in the stent group.In contrast,8 had mild PEP and 1 had moderate PEP in the no-stent group.The mean serum amylase levels(means±SD)3 h after ERCP(183.1±136.7 vs 463.6±510.4 IU/L,P=0.006)and on the day after ERCP(209.5±208.7vs 684.4±759.3 IU/L,P=0.002)were significantly higher in the no-stent group.A multivariate analysis identified the absence of pancreatic stenting(P=0.045;odds ratio,9.7;95%CI:1.1-90)as a significant risk factor for PEP.CONCLUSION:In patients with difficult cannulation in whom the bile duct is cannulated using P-GW,a pancreatic stent should be placed even if EST has been performed. | Kazunari Nakahara Chiaki Okuse Keigo Suetani Yosuke Michikawa Shinjiro Kobayashi Takehito Otsubo Fumio Itoh | 2014 | World Journal of Gastroenterology2014，20，26： | 4 |
| 18 | Thrombomodulin in the management of acute cholangitisinduced disseminated intravascular coagulation显示文摘AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P < 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P < 0.01, OR = 12, 95%CI: 2.3-60). Although the difference did not reach statistical significance, primary diseases(malignancies)(P = 0.055, OR = 3.9, 95%CI: 0.97-16) and the non-use of r TM had a tendency to be associated with persistent DIC(P = 0.08, OR = 4.3, 95%CI: 0.84-22).CONCLUSION: The add-on effects of r TM are anticipated in the treatment of AC-induced DIC, although biliary drainage for AC remains crucial. | Keigo Suetani Chiaki Okuse Kazunari Nakahara Yosuke Michikawa Yohei Noguchi Midori Suzuki Ryo Morita Nozomi Sato Masaki Kato Fumio Itoh | 2015 | World Journal of Gastroenterology2015，21，2： | 4 |
| 19 | Surgical resection of a solitary para-aortic lymph node metastasis from hepatocellular carcinoma显示文摘Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced com- puted tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically. | Junji Ueda Hiroshi Yoshida Yasuhiro Mamada Nobuhiko Taniai Sho Mineta Masato Yoshioka Youichi Kawano Tetsuya Shimizu Etsuko Hara Chiaki Kawamoto Keiko Kaneko Eiji Uchida | 2012 | World Journal of Gastroenterology2012，18，23： | 3 |
| 20 | Early neurological deterioration represents recurrent attack in acute small non-lacunar stroke显示文摘 | Noriko Matsumoto Kazumi Kimura Chiaki Yokota Kiminobu Yonemura Kuniyasu Wada Makoto Uchino Kazuo Minematsu | 2003 | Journal of the Neurological Sciences2003，，2： | 3 |
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