| JaLCDOI | 10.18926/AMO/52407 |
|---|---|
| FullText URL | 68_2_111.pdf |
| Author | Shirakawa, Yasuhiro| Noma, Kazuhiro| Maeda, Naoaki| Katsube, Ryoichi| Tanabe, Shunsuke| Ohara, Toshiaki| Sakurama, Kazufumi| Fujiwara, Toshiyoshi| |
| Abstract | Thoracoscopic esophagectomy in the prone position (TEPP) might enable solo-surgery in cases requiring resection of the esophagus and the surrounding lymph nodes due to the associated advantages of good exposure of the surgical field and ergonomic considerations for the surgeon. However, no one approach can be for all patients requiring extensive lymphadenectomy. We recently developed an assistant-based procedure to standardize exposure of the surgical field. Patients were divided into 1 of 2 groups:a pre-standardization group (n＝37) and a post-standardization group (n＝28). The thoracoscopic operative time was significantly shorter (p＝0.0037) in the post-standardization group (n＝28; 267±31min) than in the pre-standardization group (n＝37;301±53min). Further, learning curve analysis using the moving average method showed stabilization of the thoracoscopic operative time after the standardization. No significant differences were found in the number of mediastinal lymph nodes dissected or intraoperative blood loss between the 2 groups. There were also no significant differences in the complication rate. Assistant-based surgery and standardization of the procedure resulted in a well-exposed and safe surgical field. TEPP decreased the operative time, even in patients requiring extensive lymphadenectomy. |
| Keywords | thoracoscopic esophagectomy prone position standardization |
| Amo Type | Original Article |
| Publication Title | Acta Medica Okayama |
| Published Date | 2014-04 |
| Volume | volume68 |
| Issue | issue2 |
| Publisher | Okayama University Medical School |
| Start Page | 111 |
| End Page | 117 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2014 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 24743786 |
| Web of Science KeyUT | 000334652700006 |
| JaLCDOI | 10.18926/AMO/52898 |
|---|---|
| FullText URL | 68_5_291.pdf |
| Author | Tsuzaki, Ryuichiro| Takaki, Akinobu| Yagi, Takahito| Ikeda, Fusao| Koike, Kazuko| Iwasaki, Yoshiaki| Shiraha, Hidenori| Miyake, Yasuhiro| Sadamori, Hiroshi| Shinoura, Susumu| Umeda, Yuzo| Yoshida, Ryuichi| Nobuoka, Daisuke| Utsumi, Masashi| Nakayama, Eiichi| Fujiwara, Toshiyoshi| Yamamoto, Kazuhide| |
| Abstract | It is not known how the immune system targets hepatitis C virus (HCV)-infected HLA-mismatched hepatocytes under immune-suppressed conditions after orthotopic liver transplantation (OLT). In addition, the relationship between the HCV-specific immune response and IL28B variants as predictors of HCV clearance has not been well-characterized. We determined the IL28B polymorphisms for 57 post-OLT HCV carriers, and we assessed the HCV-specific immune responses by measuring the peripheral blood mononuclear cell-derived HCV-specific interferon-gamma (IFN-γ) response using an enzyme-linked immunospot assay. At 1-3 years after OLT, patients with no active hepatitis showed higher total spots on the immunospot assay. At＞3 years after OLT, patients with resolved HCV showed higher levels of core, NS3, NS5A, and total spots compared to the chronic hepatitis patients. The IL28B major genotype in the donors correlated with higher spot counts for NS5A and NS5B proteins at 1-3 years after OLT. In the post-OLT setting, the HCV-specific immune response could be strongly induced in patients with no active hepatitis with an IL28B major donor or sustained virological response. Strong immune responses in the patients with no active hepatitis could only be maintained for 3 years and diminished later. It may be beneficial to administer IFN treatment starting 3 years after OLT, to induce the maximum immunological effect. |
| Keywords | interferon gamma ELISPOT assay single nucleotide polymorphisms dendritic cell CD4 T cell |
| Amo Type | Original Article |
| Publication Title | Acta Medica Okayama |
| Published Date | 2014-10 |
| Volume | volume68 |
| Issue | issue5 |
| Publisher | Okayama University Medical School |
| Start Page | 291 |
| End Page | 302 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2014 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 25338486 |
| Web of Science KeyUT | 000343269300006 |
| Related Url | http://ousar.lib.okayama-u.ac.jp/metadata/53129 |
| JaLCDOI | 10.18926/AMO/53024 |
|---|---|
| FullText URL | 68_6_349.pdf |
| Author | Yamamoto, Tsuyoshi| Kajikawa, Yutaka| Otani, Satoru| Yamada, Yuki| Takemoto, Syunji| Hirota, Minoru| Ikeda, Masae| Iwagaki, Hiromi| Saito, Shinya| Fujiwara, Toshiyoshi| |
| Abstract | Accumulated studies have shown that ω-3 polyunsaturated fatty acids such as eicosapentaenoic acid (EPA) have protective roles against inflammatory responses such as hyperlipidemia, diabetes mellitus (DM) and cardiovascular diseases. Here we examined the effects of administering EPA to hyperlipidemic patients and other patients undergoing cardiac surgery to determine whether this treatment would increase plasma EPA levels and to clarify the association between EPA treatment and adiponectin production in hyperlipidemic patients. We also assessed the effect of preoperative EPA administration on postoperative adverse events such as postoperative atrial fibrillation (POAF) and postoperative infection in the cardiac surgery patients. The EPA administration significantly increased the serum EPA concentrations in both patient populations (p＜0.001). In the hyperlipidemic patients, the EPA administration significantly increased plasma adiponectin levels (p＜0.05), accompanied by a decrease in insulin resistance designated by the HOMA-IR (homeostasis model assessment of insulin resistance) score (p＜0.05) and Hs-CRP (high sensitivity C-reactive protein) value (p＜0.05). In the cardiac surgery patients, no significant effect of EPA on cardiac adverse events such as POAF was observed. However, our results clearly demonstrated that both the neutrophil-to-lymphocyte ratio and the 2nd-line antibiotic requirement in the EPA group were significantly decreased compared to the untreated control group (p＜0.05). We suggest that EPA administration may exert anti-inflammatory effects in patients with hyperlipidemia and in those undergoing cardiac surgery, possibly through an increase in plasma adiponectin levels. |
| Keywords | eicosapentaenoic acid adiponectin hyperlipidemic patients cardiac surgery atrial fibrillation |
| Amo Type | Original Article |
| Publication Title | Acta Medica Okayama |
| Published Date | 2014-12 |
| Volume | volume68 |
| Issue | issue6 |
| Publisher | Okayama University Medical School |
| Start Page | 349 |
| End Page | 361 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2014 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 25519029 |
| Web of Science KeyUT | 000346882200005 |
| Related Url | http://ousar.lib.okayama-u.ac.jp/metadata/53125 |
| JaLCDOI | 10.18926/AMO/53340 |
|---|---|
| FullText URL | 69_2_113.pdf |
| Author | Inada, Ryo| Nagasaka, Takeshi| Toshima, Toshiaki| Mori, Yoshiko| Kondo, Yoshitaka| Kishimoto, Hiroyuki| Hiraki, Takao| Oshiro, Taihei| Kanemitsu, Yukihide| Fujiwara, Toshiyoshi| |
| Abstract | A case of advanced rectal cancer treated by aggressive local and systemic treatment who has survived more than 7 years from initial recurrence is presented. A 55-year-old woman was diagnosed with advanced lower rectal cancer and underwent a low anterior resection with complete removal of all regional lymph nodes and total mesorectal excision. The tumor was diagnosed as a moderately differentiated adenocarcinoma, pStage IIIB (T3, N2a, M0). Twenty-six months after the initial surgery, local recurrence in the pelvis was detected by computed tomography, and total pelvic exenteration with distal sacrectomy (TPES) was performed after systemic chemotherapy with a molecular-targeted drug. Six months after the TPES, multiple lung metastases were detected. Consequently, the patient underwent radiofrequency ablation (RFA) and chemotherapy. The disease has since been controlled for 38 months. As volume control is essential for cancer treatment, it may be important to combine appropriate local therapy with systemic therapy to metastatic or recurrent sites in order to achieve much longer disease control. |
| Keywords | colorectal cancer recurrence total pelvic exenteration radiofrequency ablation systemic chemotherapy |
| Amo Type | Case Report |
| Publication Title | Acta Medica Okayama |
| Published Date | 2015-04 |
| Volume | volume69 |
| Issue | issue2 |
| Publisher | Okayama University Medical School |
| Start Page | 113 |
| End Page | 118 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2015 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 25899633 |
| Web of Science KeyUT | 000353181700006 |
| JaLCDOI | 10.18926/AMO/53524 |
|---|---|
| FullText URL | 69_3_173.pdf |
| Author | Shirakawa, Yasuhiro| Noma, Kazuhiro| Ohara, Toshiaki| Kashima, Hajime| Maeda, Naoaki| Tanabe, Shunsuke| Kagawa, Shunsuke| Fujiwara, Toshiyoshi| |
| Abstract | A chyle leak can occur as a complication after neck or chest surgery. Such a leak prolongs the hospital stay and is sometimes life-threatening. The treatment options are conservative management, interventional radiologic embolization, and surgery. Thoracoscopic ligation of the thoracic duct has emerged as a promising and definitive treatment. The case of a 65-year-old Japanese male patient with a rare congenital right aortic arch (typeⅢB1 of Edwardʼs classification) and a severe chyle leak that occurred after a total pharyngolaryngo-esophagectomy (TPLE) is described. The chyle leak was successfully managed by thoracoscopic ligation of the thoracic duct via a left-side approach with the patient in the prone position. |
| Keywords | chyle leak thoracic duct thoracoscopy prone position |
| Amo Type | Case Report |
| Publication Title | Acta Medica Okayama |
| Published Date | 2015-06 |
| Volume | volume69 |
| Issue | issue3 |
| Publisher | Okayama University Medical School |
| Start Page | 173 |
| End Page | 176 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2015 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 26101193 |
| Web of Science KeyUT | 000356903000006 |
| JaLCDOI | 10.18926/AMO/53672 |
|---|---|
| FullText URL | 69_5_267.pdf |
| Author | Inada, Ryo| Nagasaka, Takeshi| Kondo, Yoshitaka| Watanabe, Ayako| Toshima, Toshiaki| Kubota, Nobuhito| Kikuchi, Satoru| Ishida, Michihiro| Kuroda, Shinji| Mori, Yoshiko| Kishimoto, Hiroyuki| Fujiwara, Toshiyoshi| |
| Abstract | The aim of this single-institution, retrospective, observational case-control study was to evaluate the safety and feasibility of laparoscopic proctocolectomy (PC) for ulcerative colitis (UC), by comparing it with a case-control series of open PC. Twenty UC patients who underwent laparoscopic PC were retrospectively compared with the open PC group of 12 patients matched for age, sex, and urgency of the operation. In the laparoscopic PC group, the operative time was significantly longer, but the amount of blood loss was significantly smaller. The open PC patients underwent an intraoperative blood transfusion significantly more often, and the serum C-reactive protein level on the first postoperative day was significantly higher in the open PC group. In the laparoscopic PC group, the rate of severe postoperative morbidities, grades 3 and 4 on the Clavien-Dindo classification, was significantly lower, and the median length of hospital stay was significantly shorter. Laparoscopic PC for patients with UC showed superior perioperative outcomes to open PC, except for longer operative time. |
| Keywords | laparoscopic surgery total proctocolectomy open proctocolectomy ulcerative colitis case-matched study |
| Amo Type | Original Article |
| Publication Title | Acta Medica Okayama |
| Published Date | 2015-10 |
| Volume | volume69 |
| Issue | issue5 |
| Publisher | Okayama University Medical School |
| Start Page | 267 |
| End Page | 273 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2015 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 26490023 |
| Web of Science KeyUT | 000365519600002 |
| JaLCDOI | 10.18926/AMO/53675 |
|---|---|
| FullText URL | 69_5_291.pdf |
| Author | Sugiu, Kumi| Iwamoto, Takayuki| Kelly, Catherine M.| Watanabe, Naoki| Motoki, Takayuki| Itoh, Mitsuya| Ohtani, Shoichiro| Higaki, Kenji| Imada, Takako| Yuasa, Takeshi| Omori, Masako| Sonobe, Hiroshi| Fujiwara, Toshiyoshi| Matsuoka, Junji| |
| Abstract | Although in the neoadjuvant setting for estrogen receptor (ER)-positive breast cancers, chemotherapy or hormone therapy alone does not result in satisfactory tumor response, it is unknown whether concurrent chemo-endocrine therapy is superior to chemotherapy alone in clinical outcomes. We conducted a randomized phase II trial to test the responses of ER-positive patients to concurrent administration of chemo-endocrine therapy in the neoadjuvant setting. Women with stage II-III, ER-positive, invasive breast cancer (n=28) received paclitaxel followed by fluorouracil, epirubicin, cyclophosphamide (T-FEC) and were randomized to receive concurrent chemo-endocrine therapy consisting of goserelin administered subcutaneously for premenopausal women or an aromatase inhibitor for postmenopausal women. The primary endpoint was the pathological complete response (pCR) rate after neoadjuvant therapy. Twenty-eight patients were randomized. There were no significant differences in pCR rate between the concurrent group (12.5%;2/16) and the chemotherapy alone group (8.3%;1/12). Tumor size after therapy was significantly reduced in the concurrent therapy group (p=0.035), but not in the chemotherapy-alone group (p=0.622). Neoadjuvant chemotherapy with concurrent hormone therapy provided no significant improvement in pCR rate in ER-positive breast cancers. These preliminary results should be followed up by further studies. |
| Keywords | breast cancer neoadjuvant chemotherapy concurrent hormone therapy estrogen receptor positive tumor response |
| Amo Type | Original Article |
| Publication Title | Acta Medica Okayama |
| Published Date | 2015-10 |
| Volume | volume69 |
| Issue | issue5 |
| Publisher | Okayama University Medical School |
| Start Page | 291 |
| End Page | 299 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2015 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 26490026 |
| Web of Science KeyUT | 000365519600005 |
| JaLCDOI | 10.18926/AMO/54419 |
|---|---|
| FullText URL | 70_3_197.pdf |
| Author | Takagi, Kosei| Yagi, Takahito| Yoshida, Ryuichi| Shinoura, Susumu| Umeda, Yuzo| Nobuoka, Daisuke| Kuise, Takashi| Watanabe, Nobuyuki| Sui, Kenta| Fuji, Tomokazu| Fujiwara, Toshiyoshi| |
| Abstract | The operative mortality and morbidity of pancreaticoduodenectomy (PD) remain high. We analyzed PD patientsʼ clinical characteristics and surgical outcomes and discuss how PD clinical outcomes could be improved. We retrospectively reviewed the cases of 400 patients who underwent a PD between January 1998 and April 2014 at Okayama University Hospital, a very-high-volume center. We identified and compared the clinical outcomes between two time periods (period 1: 1998-2006 vs. period 2: 2007-2014). The total postoperative mortality and major complication rates were 0.75 and 15.8 , respectively, and the median postoperative length of stay (LOS) was 32 days. Subsequently, patients who underwent a PD during period 2 had a significantly shorter LOS than those who underwent a PD during period 1 (29 days vs. 38.5 days, p＜0.001). The incidence of mortality and major complications did not differ between the two periods. In our multivariate analysis, period 1 was an independent factor associated with a long LOS (p＜0.001). The improvement of the surgical procedure and perioperative care might be related to the shorter LOS in period 2 and ot the consistently maintained low mortality rate after PD. The development of multimodal strategies to accelerate postoperative recovery may further improve PDʼs clinical outcomes. |
| Keywords | pancreaticoduodenectomy surgical outcome mortality major complication length of stay |
| Amo Type | Original Article |
| Publication Title | Acta Medica Okayama |
| Published Date | 2016-06 |
| Volume | volume70 |
| Issue | issue3 |
| Publisher | Okayama University Medical School |
| Start Page | 197 |
| End Page | 203 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2016 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 27339209 |
| Web of Science KeyUT | 000379406100007 |
| JaLCDOI | 10.18926/AMO/54421 |
|---|---|
| FullText URL | 70_3_213.pdf |
| Author | Kikuchi, Satoru| Kagawa, Shunsuke| Ohara, Toshiaki| Kubota, Tetsushi| Kuwada, Kazuya| Kagawa, Tetsuya| Kuroda, Shinji| Shirakawa, Yasuhiro| Nishizaki, Masahiko| Fujiwara, Toshiyoshi| |
| Abstract | A 69-year-old man underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) at the lesser curvature in the angle of stomach. Histological examination revealed tub1, pM, ly0, v0, pLM(-), pVM(-), and the resection was considered curative. The scar after ESD was followed by esophagogastroduodenoscopy (EGD) and biopsy. Twenty months later, EGD showed an ulcerative lesion in the vicinity of the ESD scar, and histological examination of the biopsy specimen showed adenocarcinoma. A distal gastrectomy with lymph node dissection was then performed. Postoperative pathology showed tub1, pM, pN0, ly0, v0, and Stage 1A. Skip lesions were seen in the specimen resected by ESD, and the histological review confirmed so-called “dysplasia-like atypia” (DLA) between the lesions. It has been reported recently that in DLA, the dysplasia-like change involves only the bases of the pits, without upper pit or surface epithelium involvement, and it is said that the rate of DLA is higher in gastric cancer patients. We speculated that a precancerous lesion close to the resected cancer developed into a local recurrence. |
| Keywords | dysplasia-like atypia early gastric cancer endoscopic submucosal dissection local recurrence |
| Amo Type | Case Report |
| Publication Title | Acta Medica Okayama |
| Published Date | 2016-06 |
| Volume | volume70 |
| Issue | issue3 |
| Publisher | Okayama University Medical School |
| Start Page | 213 |
| End Page | 216 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2016 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 27339211 |
| Web of Science KeyUT | 000379406100009 |
| JaLCDOI | 10.18926/AMO/54514 |
|---|---|
| FullText URL | 70_4_327.pdf |
| Author | Watanabe, Mototsugu| Yamamoto, Hiromasa| Eikawa, Shingo| Shien, Kazuhiko| Shien, Tadahiko| Soh, Junichi| Hotta, Katsuyuki| Wada, Jun| Hinotsu, Shiro| Fujiwara, Toshiyoshi| Kiura, Katsuyuki| Doihara, Hiroyoshi| Miyoshi, Shinichiro| Udono, Heiichiro| Toyooka, Shinichi| |
| Abstract | A study to evaluate the effect of metformin on the immune system was commenced in July 2014. Metformin is one of the most commonly prescribed drugs for type 2 diabetes, and previous studies have reported that metformin has an anti-tumor effect. The aim of this study is to evaluate the efficacy of metformin on the immune system in human cancer patients in vivo. The primary outcome parameter will be the rate change in the population of CD8＋ T cells, which produce multiple cytokines. |
| Keywords | metformin CD8＋ T cells cancer immunology |
| Amo Type | Clinical Study Protocols |
| Publication Title | Acta Medica Okayama |
| Published Date | 2016-08 |
| Volume | volume70 |
| Issue | issue4 |
| Publisher | Okayama University Medical School |
| Start Page | 327 |
| End Page | 330 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2016 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 27549683 |
| Web of Science KeyUT | 000384748600018 |
| JaLCDOI | 10.18926/AMO/54594 |
|---|---|
| FullText URL | 70_5_363.pdf |
| Author | Takagi, Kosei| Yagi, Takahito| Yoshida, Ryuichi| Shinoura, Susumu| Umeda, Yuzo| Nobuoka, Daisuke| Kuise, Takashi| Watanabe, Nobuyuki| Fujiwara, Toshiyoshi| |
| Abstract | Sarcopenia following liver surgery has been reported as a predictor of poor prognosis. Here we investigated predictors of outcomes in patients with hepatocellular carcinoma (HCC) and attempted to establish a new comprehensive preoperative assessment protocol. We retrospectively analyzed the cases of 254 patients who underwent curative hepatectomy for HCC with Child-Pugh classification A at our hospital between January 2007 and December 2013. Sarcopenia was evaluated by computed tomography measurement. The influence of sarcopenia on outcomes was evaluated. We used multivariate analyses to assess the impact of prognostic factors associated with outcomes, including sarcopenia. Of the 254 patients, 118 (46.5%) met the criteria for sarcopenia, and 32 had an American Society of Anesthesiologists (ASA) physical status ≥3. The sarcopenic group had a significantly lower 5-year overall survival rate than the non-sarcopenic group (58.2% vs. 82.4% , p＝0.0002). In multivariate analyses of prognostic factors, sarcopenia was an independent predictor of poor survival (hazard ratio [HR]＝2.28, p＝0.002) and poor ASA status (HR＝3.17, p＝0.001). Sarcopenia and poor ASA status are independent preoperative predictors for poor outcomes after hepatectomy. The preoperative identification of sarcopenia and ASA status might enable the development of comprehensive approaches to assess surgical eligibility. |
| Keywords | sarcopenia American Society of Anesthesiologists physical status hepatectomy hepatocellular carcinoma prognostic factor |
| Amo Type | Original Articles |
| Publication Title | Acta Medica Okayama |
| Published Date | 2016-10 |
| Volume | volume70 |
| Issue | issue5 |
| Publisher | Okayama University Medical School |
| Start Page | 363 |
| End Page | 370 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2016 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 27777428 |
| Web of Science KeyUT | 000388098700005 |
| JaLCDOI | 10.18926/AMO/54601 |
|---|---|
| FullText URL | 70_5_401.pdf |
| Author | Kuroda, Shinji| Kikuchi, Satoru| Nishizaki, Masahiko| Kagawa, Shunsuke| Hinotsu, Shiro| Fujiwara, Toshiyoshi| |
| Abstract | Although intermittent pneumatic compression (IPC) has become common as perioperative prophylaxis for venous thromboembolism (VTE) consisting of pulmonary thromboembolism (PE) and deep vein thrombosis (DVT), the prophylactic effect against VTE, especially lethal PE, is not yet satisfactory. Therefore, pharmacologic prophylaxis, such as with enoxaparin, is desirable. While the efficacy and safety of enoxaparin have been proven in several clinical trials, concern about bleeding with longterm (at least 7 days) use have potentially decreased its widespread adoption. We have launched a phase II study to evaluate the efficacy and safety of short-term (3 days) enoxaparin, in which a total of 70 gastric cancer patients undergoing gastrectomy will be recruited, and the primary endpoint is the incidence of DVT. This study could contribute to making pharmacologic prophylaxis for VTE more common. |
| Keywords | venous thromboembolism enoxaparin short-term use gastric cancer surgery |
| Amo Type | Clinical Study Protocols |
| Publication Title | Acta Medica Okayama |
| Published Date | 2016-10 |
| Volume | volume70 |
| Issue | issue5 |
| Publisher | Okayama University Medical School |
| Start Page | 401 |
| End Page | 404 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2016 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 27777435 |
| Web of Science KeyUT | 000388098700012 |
| JaLCDOI | 10.18926/AMO/54981 |
|---|---|
| FullText URL | 71_2_127.pdf |
| Author | Shirakawa, Yasuhiro| Noma, Kazuhiro| Maeda, Naoaki| Tanabe, Shunsuke| Kuroda, Shinji| Kagawa, Shunsuke| Katsui, Kuniaki| Katayama, Norihisa| Kanazawa, Susumu| Fujiwara, Toshiyoshi| |
| Abstract | Currently, chemoradiation is the most widely used nonsurgical treatment for esophageal cancer. However, some patients, particularly the very elderly or those with severe vital organ dysfunction, face difficulty with the chemotherapy component. We therefore examined the outcome of radiation therapy (RT) alone for patients with esophageal cancer at our facility. Between January 2005 and December 2014, 84 patients underwent RT at our hospital, and 78 of these patients received concomitant chemotherapy. The remaining 6 patients underwent RT alone; these patients were considered to be high-risk and to have no lymph node metastasis (stage I). Five of them received irradiation up to a curative dose: 4 showed a complete response (CR) and 1 showed a partial response (PR). Of the patients exhibiting CR, 3 are currently living recurrence-free, whereas 1 patient underwent endoscopic submucosal dissection (ESD) as salvage therapy for local recurrence, with no subsequent recurrence. High-risk stage I esophageal cancer patients can be treated radically with RT alone under certain conditions. In the future, to broaden the indications for RT monotherapy to include some degree of advanced cancers, a novel concurrent therapy should be identified. |
| Keywords | esophageal cancer radiation therapy high-risk patient |
| Amo Type | Original Article |
| Publication Title | Acta Medica Okayama |
| Published Date | 2017-04 |
| Volume | volume71 |
| Issue | issue2 |
| Publisher | Okayama University Medical School |
| Start Page | 127 |
| End Page | 133 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2017 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 28420894 |
| Author | Takagi, Kosei| Yagi, Takahito| Shinoura, Susumu| Umeda, Yuzo| Yoshida, Ryuichi| Nobuoka, Daisuke| Watanabe, Nobuyuki| Kuise, Takashi| Fuji, Tomokazu| Araki, Hiroyuki| Fujiwara, Toshiyoshi| |
|---|---|
| Published Date | 2017-02 |
| Publication Title | Acta Medica Okayama |
| Volume | volume71 |
| Issue | issue1 |
| Content Type | Journal Article |
| JaLCDOI | 10.18926/AMO/54830 |
| Title Alternative | Thoracoscopic esophagectomy was effective in a case of lower esophageal stenosis due to recurrence of achalasia after myotomy 40 years previously |
|---|---|
| FullText URL | 129_41.pdf |
| Author | Katsura, Yuki| Shirakawa, Yasuhiro| Tanabe, Shunsuke| Maeda, Naomi| Noma, Kazuhiro| Fujiwara, Toshiyoshi| |
| Abstract | When planning surgery for achalasia, it is important to plan for adequate myotomy and prevention of reflux. However, achalasia may recur if the procedure was inadequate or in patients with a long-term course. The present case is a 68-year-old woman who underwent myotomy of the lower esophageal sphincter 40 years ago, but recently reported difficulty in swallowing. Dilatation of the thoracic esophagus and stenosis of the abdominal esophagus were identified by examination, and the patient was diagnosed with recurrence of achalasia. After percutaneous endoscopic gastrostomy was performed to recover nutritional status, thoracoscopic esophagectomy was carried out. The patient'spost-operative course was uneventful and oral intake was enabled. At the time of writing, there has been no re-recurrence. There is no standard therapy for post-operative recurrence of achalasia. We believe that thoracoscopic esophagectomy for the recurrence of achalasia is a safe and minimally invasive alternative to conventional surgery. |
| Keywords | 食道アカラシア (achalasia) 再手術 (reoperation) 食道亜全摘 (esophagectomy) |
| Publication Title | Journal of Okayama Medical Association |
| Published Date | 2017-04-03 |
| Volume | volume129 |
| Issue | issue1 |
| Start Page | 41 |
| End Page | 44 |
| ISSN | 0030-1558 |
| language | Japanese |
| Copyright Holders | Copyright (c) 2017 岡山医学会 |
| File Version | publisher |
| DOI | 10.4044/joma.129.41 |
| NAID | 130005632071 |
| JaLCDOI | 10.18926/AMO/61906 |
|---|---|
| FullText URL | 75_2_231.pdf |
| Author | Endo, Motochika| Yano, Shuya| Asano, Hiroaki| Takeda, Sho| Hamada, Yuki| Kondo, Yoshitaka| Kuroda, Shinji| Shigeyasu, Kunitoshi| Kikuchi, Satoru| Tanaka, Takehiro| Teraishi, Fuminori| Nishizaki, Masahiko| Kagawa, Shunsuke| Fujiwara, Toshiyoshi| |
| Abstract | Targeted therapies for malignant melanoma have improved patients’ prognoses. A primary gastrointestinal malignant melanoma is very rare, with no standard treatment strategy. We treated a 78-year-old Japanese female with advanced primary gastrointestinal melanoma of the descending colon and gallbladder. We administered a multidisciplinary treatment: surgical resection of the descending colon and gallbladder tumors, resection of the metastatic lymph nodes behind the pancreas head, and immune checkpoint antibody-blockade therapy (nivolumab) for ~4 years. PET/CT demonstrated no recurrent lesion for > 3 years. Multidisciplinary therapies (e.g., surgery, chemotherapy, radiotherapy, target therapy, and immune checkpoint antibody-blockade therapy) can successfully treat primary gastrointestinal malignant melanoma. |
| Keywords | primary gastrointestinal melanoma laparoscopic surgery immune checkpoint antibody-blockade inhibitor |
| Amo Type | Case Report |
| Publication Title | Acta Medica Okayama |
| Published Date | 2021-04 |
| Volume | volume75 |
| Issue | issue2 |
| Publisher | Okayama University Medical School |
| Start Page | 231 |
| End Page | 238 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2021 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 33953431 |
| NAID | 120007029881 |
| JaLCDOI | 10.18926/AMO/62394 |
|---|---|
| FullText URL | 75_4_431.pdf |
| Author | Kunitomi, Toshiki| Nasu, Junichirou| Minami, Daisuke| Iwamoto, Takayuki| Nishie, Hiroyuki| Saito, Shinya| Fujiwara, Toshiyoshi| Matsuoka, Junji| |
| Abstract | This study aimed to evaluate whether there are differences in the attitudes and practices of cancer pain manage-ment between medical oncologists and palliative care physicians. An online nationwide survey was used to collect responses from board-certified medical oncologists and palliative care physicians in Japan. The survey questionnaire comprised 30 questions. The differences in responses between medical oncologists and palliative care physicians were examined. Out of the 1,227 questionnaires sent, 522 (42.5%) were returned. After apply-ing the exclusion criteria, 445 questionnaires (medical oncologists: n = 283; palliative care physicians: n = 162) were retained for analysis. Among the questions about potential barriers to optimal cancer pain man-agement, both medical oncologists and palliative care physicians considered the reluctance of patients to take opioids due to fear of adverse effects as the greatest barrier. Significantly different ratings between medical oncologists and palliative care physicians were observed on 5 of the 8 questions in this area. Significantly differ-ent ratings were observed for all questions concerning pain specialists and their knowledge. For effective cancer pain management, it is important to account for differences in attitudes and practice between medical oncolo-gists and palliative care physicians. |
| Keywords | cancer pain management opioid medical oncologist palliative care physician barriers |
| Amo Type | Original Article |
| Publication Title | Acta Medica Okayama |
| Published Date | 2021-08 |
| Volume | volume75 |
| Issue | issue4 |
| Publisher | Okayama University Medical School |
| Start Page | 431 |
| End Page | 437 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2021 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 34511609 |
| Web of Science KeyUT | 000697944600004 |
| NAID | 120007146037 |
| JaLCDOI | 10.18926/AMO/62818 |
|---|---|
| FullText URL | 75_6_755.pdf |
| Author | Takagi, Kosei| Kuise, Takashi| Umeda, Yuzo| Yoshida, Ryuichi| Yoshida, Kazuhiro| Nagai, Yasuo| Noma, Kazuhiro| Tanabe, Shunsuke| Maeda, Naoaki| Yagi, Takahito| Fujiwara, Toshiyoshi| |
| Abstract | Approximately 4% of patients with esophageal cancer develop a second primary malignancy in the upper gastrointestinal trunk. However, hepatectomy following esophagectomy for esophageal cancer has rarely been reported. We report the case of a 70-year-old man who underwent an esophagectomy for esophageal cancer with retrosternal gastric tube reconstruction. Nine years later, he developed hepatocellular carcinoma with tumor thrombus involving the left portal vein, and was successfully treated with left hemihepatectomy. Special attention should be paid to avoiding incidental injury of the gastric tube as well as the right gastroepiploic artery during the hepatectomy. |
| Keywords | liver resection, esophagectomy, retrosternal gastric tube reconstruction |
| Amo Type | Case Report |
| Publication Title | Acta Medica Okayama |
| Published Date | 2021-12 |
| Volume | volume75 |
| Issue | issue6 |
| Publisher | Okayama University Medical School |
| Start Page | 755 |
| End Page | 758 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | Copyright Ⓒ 2021 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 34955546 |
| Web of Science KeyUT | 000735319800004 |
| NAID | 120007180274 |
| JaLCDOI | 10.18926/AMO/63425 |
|---|---|
| FullText URL | 76_2_203.pdf |
| Author | Masuda, Tomoya| Tazawa, Hiroshi| Hashimoto, Yuuri| Ieda, Takeshi| Kikuchi, Satoru| Kuroda, Shinji| Noma, Kazuhiro| Urata, Yasuo| Kagawa, Shunsuke| Fujiwara, Toshiyoshi| |
| Abstract | The epithelial-mesenchymal transition (EMT), a normal biological process by which epithelial cells acquire a mesenchymal phenotype, is associated with migration, metastasis, and chemoresistance in cancer cells, and with poor prognosis in patients with esophageal cancer. However, therapeutic strategies to inhibit EMT in tumor environments remain elusive. Here, we show the therapeutic potential of telomerase-specific replication- competent oncolytic adenovirus OBP-301 in human esophageal cancer TE4 and TE6 cells with an EMT phenotype. Transforming growth factor-β (TGF-β) administration induced the EMT phenotype with spindleshaped morphology, upregulation of mesenchymal markers and EMT transcription factors, migration, and chemoresistance in TE4 and TE6 cells. OBP-301 significantly inhibited the EMT phenotype via E1 accumulation. EMT cancer cells were susceptible to OBP-301 via massive autophagy induction. OBP-301 suppressed tumor growth and lymph node metastasis of TE4 cells co-inoculated with TGF-β-secreting fibroblasts. Our results suggest that OBP-301 inhibits the TGF-β-induced EMT phenotype in human esophageal cancer cells. OBP-301-mediated E1A overexpression is a promising antitumor strategy to inhibit EMT-mediated esophageal cancer progression. |
| Keywords | esophageal cancer EMT TGF-β oncolytic adenovirus E1A |
| Amo Type | Original Article |
| Publication Title | Acta Medica Okayama |
| Published Date | 2022-04 |
| Volume | volume76 |
| Issue | issue2 |
| Publisher | Okayama University Medical School |
| Start Page | 203 |
| End Page | 215 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | Copyright Ⓒ 2022 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 35503449 |
| Web of Science KeyUT | 000792291900003 |
| JaLCDOI | 10.18926/AMO/52006 |
|---|---|
| FullText URL | 67_6_333.pdf |
| Author | Tazawa, Hiroshi| Kagawa, Shunsuke| Fujiwara, Toshiyoshi| |
| Abstract | Autophagy is a catabolic process that produces energy through lysosomal degradation of intracellular organelles. Autophagy functions as a cytoprotective factor under physiological conditions such as nutrient deprivation, hypoxia, and interruption of growth factors. On the other hand, infection with pathogenic viruses and bacteria also induces autophagy in infected cells. Oncolytic virotherapy with replication-competent viruses is thus a promising strategy to induce tumor-specific cell death. Oncolytic adenoviruses induce autophagy and subsequently contribute to cell death rather than cell survival in tumor cells. We previously developed a telomerase-specific replication-competent oncolytic adenovirus, OBP-301, which induces cell lysis in tumor cells with telomerase activities. OBP-301-mediated cytopathic activity is significantly associated with induction of autophagy biomarkers. In this review, we focus on the tumor-suppressive role and molecular basis of autophagic machinery induced by oncolytic adenoviruses. Addition of tumor-specific promoters and modification of the fiber knob of adenoviruses supports the oncolytic adenovirus-mediated autophagic cell death. Autophagy is cooperatively regulated by the E1-dependent activation pathway, E4-dependent inhibitory pathway, and microRNA-dependent fine-tuning. Thus, future exploration of the functional role and molecular mechanisms underlying oncolytic adenovirus-induced autophagy would provide novel insights and improve the therapeutic potential of oncolytic adenoviruses. |
| Keywords | oncolytic adenovirus autophagy E2F1 microRNA |
| Amo Type | Review |
| Publication Title | Acta Medica Okayama |
| Published Date | 2013-12 |
| Volume | volume67 |
| Issue | issue6 |
| Publisher | Okayama University Medical School |
| Start Page | 333 |
| End Page | 342 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| Content Type | Journal Article |
| language | English |
| Copyright Holders | CopyrightⒸ 2013 by Okayama University Medical School |
| File Version | publisher |
| Refereed | True |
| PubMed ID | 24356717 |
| Web of Science KeyUT | 000328915700001 |
