Japan-Korea Cooperative Project : Pancreatic Surgery Proposed from Japan The Impact of Pancreatic Duct Stent in Pancreatic Fistula Following Pancreaticoduodenectomy

Hiroki Yamaue,Manabu Kawai,Tomoo Kosuge,Shuji Isaji,Satoshi Hirano,Yoshiaki Murakami,Masaru Miyazaki 한국간담췌외과학회 2014 한국간담췌외과학회 학술대회지 Vol.2014 No.4

The Impact of Neoadjuvant Chemotherapy for Borderline Resectable Pancreatic Cancer

( Manabu Kawai ),( Seiko Hirono ),( Ken-ichi Okada ),( Motoki Miyazawa ),( Yuji Kitahata ),( Ryohei Kobayashi ),( Masaki Ueno ),( Shinya Hayami ),( Hiroki Yamaue ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Backgrounds: According to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines, pancreatic ductal adenocarcinoma (PDAC) can be classified as resectable, borderline resectable, or unresectable. Although borderline resectable PDAC (BRPC) may technically be resectable, it has particularly high risks of margin-positive resection and postoperative recurrence. Therefore, preoperative treatment is recommended for BRPC patients in both the NCCN Guidelines and an expert consensus statement. However, the establishment of the most appropriate neoadjuvant therapy is needed by further studies. The aim of these studies is to evaluate the impact of neoadjuvant chemotherapy for BRPC and confirm the safety and efficacy of two regimens of neoadjuvant therapy for BRPC. Our Clinical Trials: First, we evaluated the impact of neoadjuvant chemotherapy for BRPC. 143 BRPC-A patients undergoing pancreatectomy were reviewed from among 330 pancreatic cancer patients, including 111 potentially resectable pancreatic cancer patients and 76 BRPC with portal vein involvement patients. We compared the clinicopathological factors of 40 BRPC-A patients treated with neoadjuvant treatment followed by surgery and those of 103 BRPC-A patients treated with upfront surgery. The R0 rate and progression-free survival of BRPC-A patients who received neoadjuvant therapy and subsequent surgical resection were significantly better compared to those who received upfront surgery (R0: P = 0.041; progression-free survival: P = 0.033), but overall survival was not significantly different. Neoadjuvant treatment followed by surgery might provide clinical benefits for BRPC-A patients; however, the establishment of the most appropriate neoadjuvant treatment is needed by further studies. To evaluate appropriate neoadjuvant treatment, two prospective pilot trials were conducted as follows; modified FOLFIRINOX (without bolus 5-FU and LV, also decreased the dose of irinotecan; FIRINOX) and nab-paclitaxel plus gemcitabine therapy. Modified FOLFIRINOX was given to the first five patients in the 4-cycle group of the regimen and next five patients in the 8-cycle group. The primary end point was the toxicity of the therapy and one of the secondary end points were the optimal duration. The overall rate of grade 3 and 4 events was 80 %: 3 patients (60%) in the four-cycle group and five patients (100%) in the eight-cycle group had grade 3 or 4 adverse events. There was no incidence of serious adverse effect such as febrile neutropenia, sepsis, liver abscess or uncontrollable diarrhea. There was no clinically relevant morbidity presented in patients who underwent surgery. R0 rates by intention to treat were 60.0% in the four-cycle group and 40 % in the eight-cycle group (P = 0.999). The histopathologic treatment effect based on the Evans grade revealed grade I (n = 1), IIa (n = 3) in the four-cycle group and grade I (n = 2), IIa (n = 1) in the eight-cycle group. Nab-paclitaxel plus gemcitabine therapy: the primary endpoint was the toxicity, and secondary endpoints were the resection rate, the R0 resection rate. The overall rate of any grade and grade 3-4 events were 100% and 90%. The majority of these adverse events represented expected neutropenia. The resection and R0 resection rates were 80% and 70%, respectively. Conclusion: FIRINOX therapy was feasible and safe for strictly selected patients with BRPC. On the other hand, nab-paclitaxel plus gemcitabine therapy was safe and feasible without strict selection of patients with BRPC. A multicenter phase II study is in progress to investigate the efficacy of neoadjuvant nab-paclitaxel plus gemcitabine therapy on overall survival (UMIN000024154).

Effect of Seeding Layers on Preparation of PLZT Thin Films by Sol-Gel Method

Hirano, Tomio,Kawai, Hiroki,Suzuki, Hisao,Kaneko, Shoji,Wada, Tatsuya The Korean Ceramic Society 1999 The Korean journal of ceramics Vol.5 No.1

$(Pb_xLa_{1-x}) (Zr_yTi_{1-y})O_3$ (PLZT) thin films with electrooptic effect are promising for the optical application such as display or light shutter. However, it is difficult to use inexpensive and transparent glass substrates because the conventional process for preparation of PLZT requires temperatures above $600^{\circ}C$. In order to deposit a perovskite PLZT thin films at low processing temperatures through alkoxide route, we have offered several seeding processes which reduce the activation energy for crystallization. In this study, we optimized the stacking structure of multilayered PLZT for obtaining single phase perovskite at lower temperatures. As a result, ferroelectric PLZT thin films with different compositions were successfully prepared at a temperature as low at $500^{\circ}C$.

Design of Flux-Axis Angular Speed Estimation using Induced Voltage in Speed Sensor-less Field Oriented Control for Induction Motor

Jun-ichi Itoh,Kazuya Kawai,Koroku Nishizawa,Hiroki Watanabe 전력전자학회 2019 ICPE(ISPE)논문집 Vol.2019 No.5

This paper proposes a design method of the flux-axis angular speed estimation using induced voltage in a speed sensor-less field oriented control for induction motor (IM) drive systems. In this method, the d-axis induced voltage is regulated to zero by a feedback control to estimate the fluxaxis angular speed. A low pass filter (LPF) is necessary in this estimation to avoid the recursive calculation. In this paper, the design method of compensation gain kpem and the cut-off angular frequency of LPF ωlpf are considered. As a result, the relation between kpem, ωlpf, convergence time of the d-axis induced voltage have a match to the equation and designed model in this paper. Furthermore, the maximum error between the simulation and estimated results of the time constant of the flux-axis angular speed introduced due to LPF is 3.7% when ωlpf is 200 rad/s. As the experimental results, when a torque step of 100% is applied to the induction motor, the convergence time of the motor speed is 1.6 s as the worst case with kpem set as 2.0 p.u. and the cut-off angular frequency set as 1000 rad/s. However, if kpem is set as 2.0 p.u. and ωlpf is set as 400 rad/s, the convergence time of the motor speed is 0.43 s as the best case, which is reduced by 73.1% compared to the worst case. As the result, kpem should decide by the target steady-state error, lpf should bigger than the cut-off angular frequency of the PI controller ωASR. Where, if the ωlpf is high, the convergence time of the motor speed is high.

N-Butyl Cyanoacrylate Embolization with Blood Flow Control of an Arterioportal Shunt That Developed after Radiofrequency Ablation of Hepatocellular Carcinoma

Tetsuo Sonomura,Nobuyuki Kawai,Kazushi Kishi,Akira Ikoma,Hiroki Sanda,Kouhei Nakata,Hiroki Minamiguchi,Motoki Nakai,Seiki Hosokawa,Hideyuki Tamai,Morio Sato 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.2

We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.

P 36 : Situation of detection of ESBL- producing Enterobacteriaceae in the east area of Aichi prefecture in Japan

( Hitoshi Kuramae ),( Norio Tatsumi ),( Keiko Sugaki ),( Atsushi Naito ),( Hiroki Kawai ),( Ikuo Yamaguchi ),( Mitsuhiro Hori ),( Kazuhisa Inuzuka ) 대한임상병리사협회 2015 임상미생물검사학회 발표자료집 Vol.2015 No.-

Introduction Recently, several bacteria isolated in a clinical setting have drug-resistance, which has become a serious problem. Particularly, extended-spectrum β- lactamase (ESBL) producing Enterobacteriaceae(ESBLPE) have spread not only in-hospital infection but also community-acquired infection. In 2006, we established a meeting which is called "Mikawan-kai" for the purpose of establishment and the standardization of the method for detection criteria of ESBLPE with 17 institutions in east area of Aichi prefecture. We report about the situation and trend of ESBLPE detection in this area. Materials and Methods This study was carried out by 7 institutions (190-836 bed) in east area of Aichi prefecture from January to December in 2013. The judgment of ESBLPE was conducted by the routine method in each institution. Results The range of detection rates identified or suspected ESBLPE were E. coli : 8-13%, K. pneumoniae : 3-6%, K. oxytoca : 0-17%, and P. mirabilis : 6-22%, respectively. And the results of antimicrobial susceptibility tests of E. coli showed that the rates of resistance to CPDX, CTX, and CAZ, which were recommended as a screening of identification for ESBLPE, were 12-18%, 8-13%, and 2-6%. Discussion and conclusion The highest frequency of detection of ESBLPE was E. coli, which was about 10% in each institution and has been increasing as compared with that of previous research in 2009 (4-9%). The results of ESBLPE detection in K. oxytoca and P. mirabilis showed some differences among institutions. Resistance rate for antimicrobial drug seems to be higher in CPDX, which is lower in CAZ. The detection rate of ESBLPE has not steeply increased for recent 5 years, whereas it still accounts for a high rate. For the prevention to further expansion of ESBLPE in this area, we intend to develop our activity through standardization of detection methods and criterion of identification for ESBLPE and share information.

Clinical features of very early-onset inflammatory bowel disease in Japan: a retrospective single-center study

Masaaki Usami,Ichiro Takeuchi,Reiko Kyodo,Yuri Hirano,Kosuke Kashiwagi,Hiroki Fujikawa,Hirotaka Shimizu,Toshinao Kawai,Katsuhiro Arai 대한장연구학회 2022 Intestinal Research Vol.20 No.4

Background/Aims: Very early-onset inflammatory bowel disease (VEO-IBD), defined as IBD diagnosed in patients younger than 6 years, is a challenge for pediatric gastroenterologists. Although there have been reports regarding VEO-IBD in Western countries, those in Asia are still lacking. This study aimed to investigate the clinical features of Japanese VEO-IBD patients.Methods: Patients with VEO-IBD diagnosed between 2006 and 2019 were evaluated retrospectively. The disease phenotypes were classified into ulcerative colitis type (UC-type) and Crohn’s disease type (CD-type), and the clinical features and courses were compared between the phenotypes.Results: Overall, 54 VEO-IBD patients (19 patients with UC-type and 35 patients with CD-type) were evaluated. The median age at onset was 18 months. One patient had severe combined immunodeficiency (SCID), and 9 patients had monogenic IBD. Monogenic IBD was more prevalent in the CD-type patients with perianal disease (CD-type (PD)). The age at onset was significantly lower in the CD-type group (P<0.05). The most common initial symptom was bloody stools (70%), followed by diarrhea (63%), weight loss (24%), fever (20%), and perianal disease (20%). Excluding patients with SCID and monogenic IBD, 23 out of 44 patients (52%) required biologics. The biologics were switched in 11 out of 44 patients (25%), and the majority of these patients (82%) were in the CD-type group. Overall, 9 patients (20%) required intestinal resection or ostomy placement.Conclusions: CD-type tends to occur at an earlier age, and monogenic IBD occurs significantly more frequently in CD-type (PD). Disease severity and treatment should be individualized, owing to the disease heterogeneity.

Review : EUS-Guided Biliary Drainage

( Kenji Yamao ),( Kazuo Hara ),( Nobumasa Mizuno ),( Akira Sawaki ),( Susumu Hijioka ),( Yasumasa Niwa ),( Masahiro Tajika ),( Hiroki Kawai ),( Shinya Kondo ),( Yasuhiro Shimizu ),( Vikram Bhatia ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.s1

Endoscopic ultrasonography (EUS) combines endoscopy and intraluminal ultrasonography, and allows imaging with a high-frequency transducer over a short distance to generate high-resolution ultrasonographic images. EUS is now a widely accepted modality for diagnosing pancreatobiliary diseases. EUS-guided fineneedle aspiration (EUS-FNA) using a curved linear- array echoendoscope was initially described more than 20 years ago, and since then many researchers have expanded its indications to sample diverse lesions and have also used it for various therapeutic purposes. EUS-guided biliary drainage (EUS-BD) is one of the therapeutic procedures that has been developed using a curved linear-array echoendoscope. Technically, EUS-BD includes rendezvous techniques via transesophageal, transgastric, and transduodenal routes, EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS). Published data have demonstrated a high success rate, albeit with a comparatively high rate of nonfatal complications for EUS-CDS and EUS-HGS, and a comparatively low success rate with a low complication rate for the rendezvous technique. At present, these procedures represent an alternative to surgery or percutaneous transhepatic biliary drainage (PTBD) for patients with obstructive jaundice when endoscopic biliary drainage (EBD) has failed. However, these procedures should be performed in centers with extensive experience in linear EUS and therapeutic biliary ERCP. Large prospective studies are needed in the near future to establish standardized EUS-BD procedures as well as to perform controlled comparative trials between EUS-BD and PTBD, between rendezvous techniques and direct-access techniques (EUS-CDS and EUS-HGS), and between EBD and EUS-BD. (Gut Liver 2010;4(Suppl. 1):S67-75)