研究者詳細 - 北郷　実

論文 - 北郷　実

分割表示 275 件中 221 - 240 件目／全件表示 >>

Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus-related cirrhosis.

Hibi T, Shinoda M, Itano O, Obara H, Kitago M, Abe Y, Yagi H, Tanaka M, Hoshino K, Fujino A, Kuroda T, Kawachi S, Tanabe M, Shimazu M, Kitagawa Y

Hepatology research : the official journal of the Japan Society of Hepatology （Blackwell Publishing Ltd） 45 （ 12 ） 1178 - 84 2015年12月

ISSN 1386-6346

Aim: Recent randomized trials have failed to prove the benefit of steroid-free immunosuppression in liver transplantation for hepatitis C virus (HCV)-related cirrhosis. Furthermore, there is a lack of data on the use of basiliximab in living donor liver transplantation (LDLT). This pilot study evaluated the safety and efficacy of a steroid minimization protocol using basiliximab compared with standard immunosuppression. Methods: A single center, prospective cohort analysis was conducted to compare two immunosuppression regimens in adult recipients who underwent LDLT for HCV since 2004: calcineurin inhibitor/mizoribine/basiliximab (the St- group) and calcineurin inhibitor/mizoribine/steroid (the St+ group). Study end-points were rejection rates, recurrent HCV, patient survival and other adverse events up to 2years after transplantation. Results: A total of 27 consecutive patients were enrolled. Transplantation characteristics were similar between the two groups (14 St- and 13 St+) except ABO incompatible cases being more common in the St+ group. Rejection rates, recurrent HCV, patient survival, fibrosis stage and new-onset diabetes mellitus at 2years were comparable between the t

Access to Document (DOI)

Validation of hepatectomy for elderly patients with hepatocellular carcinoma.

Kishida N, Hibi T, Itano O, Okabayashi K, Shinoda M, Kitago M, Abe Y, Yagi H, Kitagawa Y

Annals of surgical oncology （Springer New York LLC） 22 （ 9 ） 3094 - 101 2015年09月

ISSN 1068-9265

Background: The safety and feasibility of hepatectomy for hepatocellular carcinoma (HCC) in the elderly population have not been defined to date. Methods: A single-center, retrospective cohort study was conducted with 104 patients who underwent hepatectomy for HCC from 2005 to 2010. The patients were divided into two groups, the elderly group (age, ≥75 years
n = 22) and the nonelderly group (age, &lt
75 years
n = 82), for comparison of short- and long-term outcomes. Results: More patients were categorized as preoperative Eastern Cooperative Oncology Group (ECOG) performance status 1 in the elderly group (32 %) than in the nonelderly group (6 %) (P = 0.003). Complications with a Clavien–Dindo classification of grade 3a or higher were more frequently observed in the elderly group (41 %) than in the nonelderly group (17 %) (P = 0.006). Multivariate logistic regression showed ECOG performance status 1 as the only independent predictor of complications classified as Clavien–Dindo grade 3a or higher. The in-hospital mortality rates were similar between the two groups (P = 0.20). During a median follow-up period of 47 months, the unadjusted 5-year recurrence-free survival rates were similar in the elderly (25 %) and nonelderly (33 %) groups (P = 0.80). Multiple tumors and high alpha-fetoprotein levels emerged as independent negative indicators of recurrence-free survival using multivariate Cox analyses. The adjusted risk for recurrence was not elevated in the elderly group (hazard ratio [HR], 0.92
95 % confidence interval [CI] 0.50–1.68
P = 0.78). Conclusions: Despite the more frequent occurrence of complications with a Clavien–Dindo grade of 3a or higher among the elderly patients undergoing hepatectomy for HCC, their mortality and recurrence rates were comparable with those of the nonelderly patients. Therefore, age alone is not a determinant of surgical candidacy for HCC.

Access to Document (DOI)

Harness Traction Technique (HARNESS): Novel Method for Controlling the Transection Plane During Laparoscopic Hepatectomy.

Itano O, Oshima G, Kitago M, Suzuki K, Hayatsu S, Shinoda M, Abe Y, Hibi T, Yagi H, Ikoma N, Aiko S, Kitagawa Y

Surgical laparoscopy, endoscopy & percutaneous techniques （Lippincott Williams and Wilkins） 25 （ 4 ） e117 - 21 2015年08月

ISSN 1530-4515

We present our experience using a novel method for controlling the transection plane, which we termed as the Harness Traction Technique (HARNESS) and evaluate its usefulness. From May 2009 to March 2012, laparoscopic hepatectomies using HARNESS were performed on 35 patients. After the superficial hepatic parenchyma on the line was transected at 1 to 2 cm depth, 5 mm tape was placed along the groove of the line and tied to prevent it from slipping off. Tape was tied and pulled using a forceps toward the best direction for minimizing the bleeding, moving the transection point to the appropriate position and creating good tension for parenchymal transection at the transection point. There were no conversions to laparotomy or intraoperative complications. HARNESS is useful for controlling the dissection line during laparoscopic hepatectomy, leading to precise and safe laparoscopic liver parenchymal dissection.

Access to Document (DOI)

Helicobacter cinaedi bacteremia with cellulitis after ABO-incompatible living-donor liver transplantation: Case report.

Mishima K, Obara H, Sugita K, Shinoda M, Kitago M, Abe Y, Hibi T, Yagi H, Matsubara K, Mori T, Takano Y, Fujiwara H, Itano O, Hasegawa N, Iwata S, Kitagawa Y

World journal of gastroenterology （WJG Press） 21 （ 25 ） 7911 - 5 2015年07月

ISSN 1007-9327

Helicobacter cinaedi (H. cinaedi), a Gram-negative spiral-shaped bacterium, is an enterohepatic non-Helicobacter pylori Helicobacter species. We report the first case of H. cinaedi bacteremia with cellulitis after liver transplantation. A 48-year-old male, who had been a dog breeder for 15 years, underwent ABO-incompatible living-donor liver transplantation for hepatitis C virus-induced decompensated cirrhosis using an anti-hepatitis B core antibody-positive graft. The patient was preoperatively administered rituximab and underwent plasma exchange twice to overcome blood type incompatibility. After discharge, he had been doing well with immunosuppression therapy comprising cyclosporine, mycophenolate mofetil, and steroid according to the ABO-incompatible protocol of our institution. However, 7 mo after transplantation, he was admitted to our hospital with a diagnosis of recurrent cellulitis on the left lower extremity, and H. cinaedi was detected by both blood culture and polymerase chain reaction analysis. Antibiotics improved his symptoms, and he was discharged at day 30 after admission. Clinicians should be more aware of H. cinaedi in immunocompromised patients, such as ABO-incompatible transplant recipients.

Access to Document (DOI)

Effects of Addition of Early Enteral Nutritional Support During the Postoperative Phase in Patients after Living-Donor Liver Transplantation.

Ei S, Shinoda M, Itano O, Obara H, Kitago M, Hibi T, Yagi H, Abe Y, Matsubara K, Ono Y, Kawachi S, Hoshino K, Kuroda T, Tanabe M, Kitagawa Y

Annals of transplantation 20 357 - 65 2015年06月

ISSN 1425-9524

BACKGROUND: Early initiation of enteral nutrition is recommended after some surgical procedures. This study retrospectively analyzed the effects of addition of early enteral nutrition (EEN) support during the postoperative phase in patients after living-donor liver transplantation (LDLT). MATERIAL AND METHODS: The subjects were adult patients who underwent LDLT in our department and received either total parenteral nutrition (TPN) or EEN for postoperative nutritional support. We retrospectively compared clinical parameters between the TPN group (n=50) and the EEN group (n=45). RESULTS: There were no significant differences in preoperative demographic data between the EEN and TPN groups with the exception of the follow-up period after surgery. In the EEN group, EEN was provided uneventfully; the daily amount of enteral nutrition was 996±465 kcal on postoperative day 7. Central venous catheters were removed significantly earlier in the EEN group than in the TPN group (postoperative day 11±7 vs. 28±18). The postoperative C-reactive protein level and the incidence of bacterial infection were significantly lower in the EEN group than in the TPN group. The postoperative length of hospital stay was significantly shorter and 6-month survival was significantly higher in the EEN group than in the TPN group. A multivariate analysis indicated that EEN was a significant factor for both shorter hospital stay and 6-month survival. CONCLUSIONS: Our retrospective analyses suggest that introduction of EEN had a great impact on postoperative short-term outcomes of LDLT.

Access to Document (DOI)

Long-term complete response of advanced hepatocellular carcinoma treated with multidisciplinary therapy including reduced dose of sorafenib: case report and review of the literature.

Shinoda M, Kishida N, Itano O, Ei S, Ueno A, Kitago M, Abe Y, Hibi T, Yagi H, Masugi Y, Tanabe M, Aiura K, Sakamaoto M, Tanimoto A, Kitagawa Y

World journal of surgical oncology 13 144 - 144 2015年04月

ISSN 1477-7819

An 83-year-old man underwent computed tomography during a routine check-up due to a history of surgical treatment for pancreatic cancer. Two tumors were detected in the anterior segment of the liver. A needle biopsy of the larger tumor was performed, and pathological examination showed that the tumor was a poorly differentiated hepatocellular carcinoma. Resection was not performed considering the patient's poor physical condition. Thus, transcatheter arterial chemoembolization and radiofrequency ablation of the tumors were performed. Three months later, residual tumor of the larger lesion and multiple pulmonary metastases were detected. This time, continuous hepatic arterial infusion chemotherapy was performed. Although the pulmonary metastases markedly reduced, tumor thrombi appeared in the right portal vein on computed tomography. Finally, sorafenib was administered, which led to disappearance of the tumor thrombi and no other signs of recurrence 8 months after initiation of sorafenib on computed tomography. Although sorafenib administration has continued at reduced doses of 200 mg per day or less due to hypertension, complete response has persisted for the past 34 months. It is

Access to Document (DOI)

Cryoablation provides superior local control of primary hepatocellular carcinomas of >2 cm compared with radiofrequency ablation and microwave coagulation therapy: an underestimated tool in the toolbox.

Ei S, Hibi T, Tanabe M, Itano O, Shinoda M, Kitago M, Abe Y, Yagi H, Okabayashi K, Sugiyama D, Wakabayashi G, Kitagawa Y

Annals of surgical oncology 22 （ 4 ） 1294 - 300 2015年04月

ISSN 1068-9265

BACKGROUND: Although cryoablation (Cryo) has been advocated as an effective locoregional therapy for hepatocellular carcinoma (HCC), few studies have compared the outcomes with those of radiofrequency ablation (RFA) and microwave coagulation therapy (MCT). METHODS: Consecutive patients with primary HCCs of <5 cm received Cryo or RFA/MCT between 1998 and 2011 and were monitored for local recurrence (defined as a recurrent tumor at or in direct contact with the ablated area) and overall complication rates. RESULTS: The median tumor size was 2.5 cm in the Cryo group (n = 55) and 1.9 cm in the RFA/MCT group (n = 64; P < 0.001), but other patient characteristics were similar. Multivariate Cox regression analysis revealed Cryo as the only independent factor for improved 2-year local recurrence-free survival, with a hazard ratio (HR) of 0.3 (95 % confidence interval, 0.1-0.9; P = 0.02). Tumor diameter was a negative indicator of local recurrence-free survival (HR, 2.0; 95 % confidence interval, 1.1-3.5; P = 0.02). Subgroup analysis of patients with tumors of >2 cm demonstrated significantly better local recurrence rates in the Cryo group compared with the RFA/MCT group (21 vs. 56 % at 2 years; P = 0.006). Overall complication rates and incidences of Clavien-Dindo classification grade ≥ III were identical (both P = 1.00). No in-hospital mortality occurred. CONCLUSIONS: Appropriate use of Cryo, as shown in this series, is safe and provides significantly improved local control for the treatment of primary HCCs of >2 cm compared with RFA/MCT.

Access to Document (DOI)

Gene transfer of high-mobility group box 1 box-A domain in a rat acute liver failure model.

Tanaka M, Shinoda M, Takayanagi A, Oshima G, Nishiyama R, Fukuda K, Yagi H, Hayashida T, Masugi Y, Suda K, Yamada S, Miyasho T, Hibi T, Abe Y, Kitago M, Obara H, Itano O, Takeuchi H, Sakamoto M, Tanabe M, Maruyama I, Kitagawa Y

The Journal of surgical research （Academic Press Inc.） 194 （ 2 ） 571 - 580 2015年04月

ISSN 0022-4804

Background High-mobility group box 1 (HMGB1) has recently been identified as an important mediator of various kinds of acute and chronic inflammation. The protein encoded by the box-A domain of the HMGB1 gene is known to act as a competitive inhibitor of HMGB1. In this study, we investigated whether box-A gene transfer results in box-A protein production in rats and assessed therapeutic efficacy in vivo using an acute liver failure (ALF) model. Materials and methods Three types of adenovirus vectors were constructed-a wild type and two mutants-and a mutant vector was then selected based on the secretion from HeLa cells. The secreted protein was subjected to a tumor necrosis factor (TNF) production inhibition test in vitro. The vector was injected via the portal vein in healthy Wistar rats to confirm box-A protein production in the liver. The vector was then injected via the portal vein in rats with ALF. Results Western blot analysis showed enhanced expression of box-A protein in HeLa cells transfected with one of the mutant vectors. The culture supernatant from HeLa cells transfected with the vector inhibited TNF-α production from macrophages. Expression of box-A protein was confirmed in the transfected liver at 72 h after transfection. Transfected rats showed decreased hepatic enzymes, plasma HMGB1, and hepatic TNF-α messenger RNA levels, and histologic findings and survival were significantly improved. Conclusions HMGB1 box-A gene transfer results in box-A protein production in the liver and appears to have a beneficial effect on ALF in rats.

Access to Document (DOI)

Phase I pilot study of Wilms tumor gene 1 peptide-pulsed dendritic cell vaccination combined with gemcitabine in pancreatic cancer.

Mayanagi S, Kitago M, Sakurai T, Matsuda T, Fujita T, Higuchi H, Taguchi J, Takeuchi H, Itano O, Aiura K, Hamamoto Y, Takaishi H, Okamoto M, Sunamura M, Kawakami Y, Kitagawa Y

Cancer science 106 （ 4 ） 397 - 406 2015年04月

ISSN 1347-9032

This study aimed to evaluate the feasibility of and immune response to Wilms tumor gene 1 (WT1) peptide-pulsed dendritic cell vaccination combined with gemcitabine (DCGEM) as a first-line therapy among patients with advanced pancreatic cancer. Ten HLA-A*2402 patients were treated with WT1 peptide-pulsed DC vaccination (1 × 107 cells) on days 8 and 22 and gemcitabine (1000 mg/m2) on days 1, 8 and 15. Induction of a WT1-specific immune response was evaluated using the delayed-type hypersensitivity (DTH) skin test, interferon-γ enzyme-linked immunospot and HLA tetramer assays, along with assays for various immunological factors. DCGEM was well-tolerated, and the relative dose intensity of gemcitabine was 87%. Disease control associated with a low neutrophil/lymphocyte ratio was observed in all three patients with DTH positivity; it was also correlated with a low percentage of granulocytic myeloid derived suppressor cells in the pretreatment peripheral blood (P = 0.017). Patients with liver metastases and high levels of inflammatory markers such as C-reactive protein and interleukin-8 (IL-8) showed poor survival even though a WT1-speci

Access to Document (DOI)

Upregulation of integrin β4 promotes epithelial-mesenchymal transition and is a novel prognostic marker in pancreatic ductal adenocarcinoma.

Masugi Y, Yamazaki K, Emoto K, Effendi K, Tsujikawa H, Kitago M, Itano O, Kitagawa Y, Sakamoto M

Laboratory investigation; a journal of technical methods and pathology 95 （ 3 ） 308 - 19 2015年03月

ISSN 0023-6837

Access to Document (DOI)

Usefulness of immunohistochemical studies in diagnosing metachronous gallbladder and small intestinal metastases from lung cancer with gastrointestinal hemorrhage: a case report.

Tanaka M, Kitago M, Akiyama N, Iwamaru A, Yamamoto T, Suzuki F, Hibi T, Abe Y, Yagi H, Shinoda M, Itano O, Ogata K, Kitagawa Y

World journal of surgical oncology （BioMed Central Ltd.） 13 （ 1 ） 63 2015年02月

ISSN 1477-7819

Isolated metachronous gastrointestinal metastases from advanced-stage lung cancer are rarely diagnosed on the basis of symptoms and resected. In this report, we present a case of resectable metachronous gallbladder and small intestinal metastases of lung cancer. An 86-year-old woman was treated for lung cancer with resection of the right inferior lobe. Five months after the surgery, she was re-admitted because of melena and anemia. Ultrasonography showed a gallbladder tumor with gastrointestinal hemorrhage, and laparoscopic-assisted cholecystectomy was subsequently performed. However, 2 months after this event, the patient presented again with melena and anemia and was diagnosed with a small intestinal tumor. Therefore, laparoscopic-assisted partial resection of the small intestine was performed. Immunohistochemical staining for thyroid transcription factor-1 and cytokeratin 7 confirmed that the two resected tumors were metachronous metastases of the primary lung cancer. The patient died of liver metastases 5 months after the last surgery. Our experience with this case suggests that surgical resection might not be curative but palliative for patients with isolated gallbladder and small intestinal metastases diagnosed on the basis of melena that is resistant to conservative treatment.

Access to Document (DOI)

Two Cases of Pathological Complete Response to Neoadjuvant Chemoradiation Therapy in Pancreatic Cancer.

Fujii-Nishimura Y, Nishiyama R, Kitago M, Masugi Y, Ueno A, Aiura K, Kawachi S, Kawaida M, Abe Y, Shinoda M, Itano O, Tanimoto A, Sakamoto M, Kitagawa Y

The Keio journal of medicine （Keio Journal of Medicine） 64 （ 2 ） 26 - 31 2015年

ISSN 0022-9717

Neoadjuvant chemoradiation therapy (NACRT) is increasingly used in patients with a potentially or borderline resectable pancreatic ductal adenocarcinoma (PDA) and it has been shown to improve survival and reduce locoregional metastatic disease. It is rare for patients with PDA to have a pathological complete response (pCR) to NACRT, but such patients reportedly have a good prognosis. We report the clinicopathological findings of two cases of pCR to NACRT in PDA. Both patients underwent pancreatectomy after NACRT (5-fluorouracil, mitomycin C, cisplatin, and radiation). Neither had residual invasive carcinoma and both showed extensive fibrotic regions with several ducts regarded as having pancreatic intraepithelial neoplasia 3/carcinoma in situ in their post-therapy specimens. It is noteworthy that both patients had a history of a second primary cancer. They both had comparatively good outcomes: one lived for 9 years after the initial pancreatectomy and the other is still alive without recurrence after 2 years.

Access to Document (DOI)

Cystic tumor of the liver without ovarian-like stroma or bile duct communication: two case reports and a review of the literature.

Kishida N, Shinoda M, Masugi Y, Itano O, Fujii-Nishimura Y, Ueno A, Kitago M, Hibi T, Abe Y, Yagi H, Tanimoto A, Tanabe M, Sakamaoto M, Kitagawa Y

World journal of surgical oncology （BioMed Central Ltd.） 12 （ 1 ） 229 2014年07月

ISSN 1477-7819

We report two cases of cystic neoplasm of the liver with mucinous epithelium in which both ovarian-like stroma and bile duct communication were absent. The first case was a 41-year-old woman. She underwent right trisegmentectomy due to a multilocular cystic lesion, 15 cm in diameter, with papillary nodular components in the medial segment and right lobe. Histologically, arborizing papillae were seen in the papillary lesion. The constituent neoplastic cells had sufficient cytoarchitectural atypia to be classified as high-grade dysplasia. The second case was a 60-year-old woman. She underwent left lobectomy due to a unilocular cystic lesion, 17 cm in diameter, in the left lobe. Histologically, the cyst wall was lined by low columnar epithelia with slight cellular atypia. In both cases, neither ovarian-like stroma nor bile duct communications were found throughout the resected specimen. According to the most recent World Health Organization (WHO) classification in 2010, cystic tumors of the liver with mucinous epithelium are classified as mucinous cystic neoplasms when ovarian-like stromata are found, and as intraductal papillary neoplasm of bile duct when bile duct communication exists. Therefore, we diagnosed the cystic tumors as 'biliary cystadenoma' according to the past WHO classification scheme from 2000. We believe that the combined absence of both ovarian-like stroma and bile duct communication is possible in mucinous cystic tumors of the liver. Herein, we have described the clinicopathologic features of the two cases and reviewed past cases in the literature. © 2014 Kishida et al.
licensee BioMed Central Ltd.

Access to Document (DOI)

Upregulated SMAD3 promotes epithelial-mesenchymal transition and predicts poor prognosis in pancreatic ductal adenocarcinoma.

Yamazaki K, Masugi Y, Effendi K, Tsujikawa H, Hiraoka N, Kitago M, Shinoda M, Itano O, Tanabe M, Kitagawa Y, Sakamoto M

Laboratory investigation; a journal of technical methods and pathology 94 （ 6 ） 683 - 91 2014年06月

ISSN 0023-6837

In pancreatic ductal adenocarcinoma (PDAC), features of epithelial-mesenchymal transition (EMT) are often seen in tumor tissue, and such features correlate with poor prognosis. Solitary infiltration of tumor cells represents a morphological phenotype of EMT, and we previously reported that a high degree of solitary cell infiltration correlates with EMT-like features, including reduced E-cadherin and elevated vimentin levels. Using solitary cell infiltration to evaluate the degree of EMT, gene-expression profiling of 12 PDAC xenografts was performed, and SMAD3 was identified as an EMT-related gene. Immunohistochemistry using clinical specimens (n=113) showed that SMAD3 accumulated in the nuclei of tumor cells, but was not detected in most epithelial cells in the pancreatic duct. Moreover, SMAD3 upregulation correlated with malignant characteristics, such as higher tumor grade and lymph node metastasis, as well as with EMT-like features. SMAD4, which plays a key role in transforming growth factor-β (TGF-β) signaling, is inactivated in approximately half of PDAC cases. In this study, the nuclear accumulation of SMAD3 was immunohistochemically detected even in SMAD4-negative cases. SMAD3 knockdown resulted in upregulated E-cadherin, downregulated vimentin, and reduced cell motility in pancreatic cancer cells regardless of SMAD4 status. In addition, TGF-β-treatment resulted in EMT induction in cells carrying wild-type SMAD4, and EMT was suppressed by SMAD3 knockdown. Patients with upregulated SMAD3 and a high degree of solitary cell infiltration had shorter times to recurrence and shorter survival times after surgery, and multivariate analysis showed that both factors were independent prognostic factors linked to unfavorable outcomes. These findings suggest that SMAD3 in PDAC is involved in the promotion of malignant potential through EMT induction in tumor cells regardless of SMAD4 status and serves as a potential biomarker of poor prognosis.

Access to Document (DOI)

Left-side hepatectomy in living donors: through a reduced upper-midline incision for liver transplantation.

Shinoda M, Tanabe M, Itano O, Obara H, Kitago M, Abe Y, Hibi T, Yagi H, Fujino A, Kawachi S, Hoshino K, Kuroda T, Kitagawa Y

Transplantation proceedings 46 （ 5 ） 1400 - 6 2014年06月

ISSN 0041-1345

Access to Document (DOI)

Computer assisted surgery, preoperative planning and navigation for pancreatic cancer.

Abe Y, Itano O, Kitago M, Shinoda M, Yagi H, Hibi T, Takano K, Chiba N, Kawachi S, Shimazu M, Kitagawa Y

Journal of hepato-biliary-pancreatic sciences （Blackwell Publishing Asia） 21 （ 4 ） 251 - 5 2014年04月

ISSN 1868-6974

Currently, the best treatment for locally advanced pancreatic cancer is considered to be safe and effective surgery, followed by appropriate additional therapies implemented as quickly as possible. The use of diagnostic imaging to assist surgery is being researched in a range of institutions. This report introduces the results of a study into the optimized contrast conditions for computed tomography (CT)-volume rendering image generation, effective in providing image support for pancreatic surgery, and introduces actual cases in which imaging support was used in surgery. The authors demonstrated that the conventional contrast protocols used in making a diagnosis are not necessarily the optimum protocols for image creation. It is thought that the use of image-supported surgery will improve the safety and effectiveness of pancreatic surgery. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Access to Document (DOI)

Mesenchymal stem cells support hepatocyte function in engineered liver grafts.

Kadota Y, Yagi H, Inomata K, Matsubara K, Hibi T, Abe Y, Kitago M, Shinoda M, Obara H, Itano O, Kitagawa Y

Organogenesis （Landes Bioscience） 10 （ 2 ） 268 - 77 2014年04月

ISSN 1547-6278

Recent studies suggest that organ decellularization is a promising approach to facilitate the clinical application of regenerative therapy by providing a platform for organ engineering. This unique strategy uses native matrices to act as a reservoir for the functional cells which may show therapeutic potential when implanted into the body. Appropriate cell sources for artificial livers have been debated for some time. The desired cell type in artificial livers is primary hepatocytes, but in addition, other supportive cells may facilitate this stem cell technology. In this context, the use of mesenchymal stem cells (MSC ) is an option meeting the criteria for therapeutic organ engineering. Ideally, supportive cells are required to (1) reduce the hepatic cell mass needed in an engineered liver by enhancing hepatocyte function, (2) modulate hepatic regeneration in a paracrine fashion or by direct contact, and (3) enhance the preservability of parenchymal cells during storage. Here, we describe enhanced hepatic function achieved using a strategy of sequential infusion of cells and illustrate the advantages of co-cultivating bone marrow-derived MSC s with primary hepatocytes in the engineered whole-liver scaffold. These co-recellularized liver scaffolds colonized by MSC s and hepatocytes were transplanted into live animals. After blood flow was established, we show that expression of adhesion molecules and proangiogenic factors was upregulated in the graft.

Access to Document (DOI)

Influence of preoperative anti-cancer therapy on resectability and perioperative outcomes in patients with pancreatic cancer: project study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Motoi F, Unno M, Takahashi H, Okada T, Wada K, Sho M, Nagano H, Matsumoto I, Satoi S, Murakami Y, Kishiwada M, Honda G, Kinoshita H, Baba H, Hishinuma S, Kitago M, Tajima H, Shinchi H, Takamori H, Kosuge T, Yamaue H, Takada T

Journal of hepato-biliary-pancreatic sciences （WILEY） 21 （ 2 ） 148 - 58 2014年02月

ISSN 1868-6974

Background Little is known about the effects of neoadjuvant therapy on outcomes in patients with pancreatic cancer. This study evaluated the effects of neoadjuvant therapy on resectability and perioperative outcomes. Methods A total of 992 patients were enrolled, with 971 deemed eligible. Of these, 582 had resectable tumors and 389 had borderline resectable tumors, and 388 patients received neoadjuvant therapy. Demographic characteristics and peri- and postoperative parameters were assessed by a questionnaire survey. Results The R0 rate was significantly higher in patients with resectable tumors who received neoadjuvant therapy than in those who underwent surgery first, but no significant difference was noted in patients with borderline resectable tumors. Operation time was significantly longer and blood loss was significantly greater in patients who received neoadjuvant therapy than in those who underwent surgery first, but there were no significant differences in specific complications and mortality rates. The node positivity rate was significantly lower in the neoadjuvant than in the surgery-first group, indicating that the former had significantly lower stage tumors. Conclusions Neoadjuvant therapy may not increase the mortality and morbidity rate and may be able to increase the chance for curative resection against resectable tumor.

Access to Document (DOI)

[Past roles and future prospects of the National Clinical Database for board-certifying systems of the Japan Surgical Society].

Kitago M, Kitagawa Y

Nihon Geka Gakkai zasshi 115 （ 1 ） 5 - 7 2014年01月

ISSN 0301-4894

Board-certifying systems play an important role as guideposts in postgraduate training courses to develop superior surgeons with both general and subspecialty surgery competence. The board-certified surgeon designation of the Japan Surgical Society (JSS) as the first guidepost has provided the foundations for board-certified surgeon systems of subspecialty surgical societies as the second guidepost. In April 2010, the National Clinical Database (NCD) was founded by the JSS and other societies. Data on surgery and treatment have been entered into the NCD from January 1, 2011, and more than 1 million cases were submitted to the NCD in that year. The NCD is an unprecedented, advanced activity. The data will be used for the authorization of board-certified surgeons of subspecialty surgical societies as well as that of the JSS. The data will be also used for benchmarking, and clinical research teams will cooperate with the NCD.

Lymphoepithelioma-like hepatocellular carcinoma: a case report and a review of the literature.

Shinoda M, Kadota Y, Tsujikawa H, Masugi Y, Itano O, Ueno A, Mihara K, Hibi T, Abe Y, Yagi H, Kitago M, Kawachi S, Tanimoto A, Sakamoto M, Tanabe M, Kitagawa Y

World journal of surgical oncology 11 97 2013年05月

ISSN 1477-7819

We report a rare case of lymphoepithelioma-like hepatocellular carcinoma. A 79-year-old Japanese man had undergone curative resection of extrahepatic bile ducts because of bile duct cancer 9 years prior. The bile duct cancer was diagnosed as mucosal adenocarcinoma, and the patient had been followed up every 6 months for the last 9 years. A recent computed tomography examination revealed a tumor, 4.2 cm in size, in the lateral segment of the liver. Based on the imaging findings, the tumor was diagnosed as hepatocellular carcinoma. Serology tests were negative for hepatitis B and C viruses. Chest and abdominal image analyses showed no evidence of metastasis, but a swollen lymph node was noted around the abdominal aorta. The patient subsequently underwent extended lateral segmentectomy and resection of the swollen lymph node. Microscopically, the tumor had the characteristic appearance of poorly differentiated hepatocellular carcinoma. Moreover, an abundant infiltration of inflammatory cells was observed in the tumor. Therefore, we diagnosed the tumor as lymphoepithelioma-like hepatocellular carcinoma. The resected para-aortic lymph node also had a carcinoma with features similar to those of the main tumor. The patient has been alive for 20 months since performance of the surgery. Since the first report of lymphoepithelioma-like hepatocellular carcinoma in 2000, only nine cases have been reported in the medical literature, and the clinicopathological features of the disease have not been well documented. Herein, we describe the clinicopathological features of this case for further understanding of the disease and review past cases in the literature. © 2013 Shinoda et al.
licensee BioMed Central Ltd.

Access to Document (DOI)

　前のページ - 次のページ　

北郷 実

論文 - 北郷 実

北郷　実

論文 - 北郷　実