Reasons for Diagnostic Failure in Forty-Five Consecutive Mucosal Cutting Biopsy Examinations of Gastric Subepithelial Tumors

Yoshiko Nakano,Toshitatsu Takao,Yoshinori Morita,Shinwa Tanaka,Takashi Toyonaga,Eiji Umegaki,Yuzo Kodama 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.5

Background/Aims: Mucosal cutting biopsy (MCB) is useful for the histopathological diagnosis of gastric subepithelial tumors (SETs). However, there is little information on cases in which MCB did not establish a diagnosis. In the current study, we aimed to investigatethe characteristics of cases in which MCB was unsuccessful. Methods: Cases in which MCB was used to histopathologically diagnose gastric SETs at Kobe University Hospital between August 2012and October 2018 were retrospectively reviewed. Results: Forty-five cases in which MCB was used to diagnose 43 gastric SETs in 43 patients were analyzed. The median tumor sizewas 20 mm (range, 8–50 mm). Pathological examinations resulted in definitive and suspected diagnoses and no diagnosis in 29(gastrointestinal stromal tumor: n=17, leiomyoma: n=7, aberrant pancreas: n=3, others: n=2), 6, and 10 cases, respectively. Failure toexpose the tumor according to retrospective examinations of endoscopic images was significantly associated with no diagnosis. Otherpossible explanations included a less elevated tumor, biopsy of the surrounding field instead of the tumor due to the mobility, and poorendoscope maneuverability due to the tumor being close to the cardia. Conclusions: Clear exposure of gastric SETs during MCB may improve the diagnostic rate of such examinations.

Endoscopic Self-Expandable Metal Stent Placement for Malignant Afferent Loop Obstruction After Pancreaticoduodenectomy: A Case Series and Review

Arata Sakai,Hideyuki Shiomi,Takao Iemoto,Ryota Nakano,Takuya Ikegawa,Takashi Kobayashi,Atsuhiro Masuda,Yuzo Kodama 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.4

In this study, we assessed a series of our cases in which endoscopic self-expandable metal stents (SEMSs) were used to treat malignantafferent loop obstruction (ALO) that arose after pancreaticoduodenectomy (PD). We retrospectively examined the records of 7 patientswho underwent endoscopic SEMS placement for malignant ALO following PD. Clinical success was achieved in all cases. The medianprocedure time was 30 min (range, 15–50 min). There were no cases of stent occlusion, and no procedure-related adverse events wereencountered. All patients died of their primary disease, and the median overall survival period was 155 days (range, 96–374 days). Are-intervention involving endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting was performed forobstructive jaundice and acute cholangitis in 1 case. In conclusion, endoscopic SEMS placement may be an effective and safe treatmentfor malignant ALO that arises after PD.

Efficacy of the Envelope Method in Applying Polyglycolic Acid Sheets to Post-Endoscopic Submucosal Dissection Ulcers in Living Pigs

Hiroya Sakaguchi,Toshitatsu Takao,Yoshitaka Takegawa,Yuki Koga,Kazunori Yamanaka,Masataka Sagata,Shinwa Tanaka,Yoshinori Morita,Takashi Toyonaga,Yuzo Kodama 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1

Background/Aims: Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD)ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This studyassessed the usefulness of the envelope-based delivery system with and against gravity in living pigs. Methods: PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelopemethods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors werecompared. Results: With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm2 and 0.32 (0.18–0.52) min/cm2 with theconventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm2 and 0.50 (0.39–0.58) min/cm2 (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional grouphad insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similarbetween the groups. Conclusions: The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriatelyboth with and against gravity in living pigs.

Angiopoietin-1 Induces Krüppel-like Factor 2 Expression through a Phosphoinositide 3-Kinase/AKT-dependent Activation of Myocyte Enhancer Factor 2

Sako, Keisuke,Fukuhara, Shigetomo,Minami, Takashi,Hamakubo, Takao,Song, Haihua,Kodama, Tatsuhiko,Fukamizu, Akiyoshi,Gutkind, J. Silvio,Koh, Gou Young,Mochizuki, Naoki American Society for Biochemistry and Molecular Bi 2009 The Journal of biological chemistry Vol.284 No.9

<P>Angiopoietin-1 (Ang1) regulates both vascular quiescence and angiogenesis through the receptor tyrosine kinase Tie2. We and another group have recently shown that Ang1 and Tie2 form distinct signaling complexes at cell-cell and cell-matrix contacts and further demonstrated that the former selectively induces expression of Krüppel-like factor 2 (KLF2), a transcription factor involved in vascular quiescence. Here, we investigated the mechanism of how Ang1/Tie2 signal induces KLF2 expression to clarify the role of KLF2 in Ang1/Tie2 signal-mediated vascular quiescence. Ang1 stimulated KLF2 promoter-driven reporter gene expression in endothelial cells, whereas it failed when a myocyte enhancer factor 2 (MEF2)-binding site of KLF2 promoter was mutated. Depletion of MEF2 by siRNAs abolished Ang1-induced KLF2 expression, indicating the requirement of MEF2 in KLF2 induction by Ang1. Constitutive active phosphoinositide 3-kinase (PI3K) and AKT increased the MEF2-dependent reporter gene expression by enhancing its transcriptional activity and stimulated the KLF2 promoter activity cooperatively with MEF2. Consistently, inhibition of either PI3K or AKT and depletion of AKT abrogated Ang1-induced KLF2 expression. In addition, we confirmed the dispensability of extracellular signal-regulated kinase 5 (ERK5) for Ang1-induced KLF2 expression. Furthermore, depletion of KLF2 resulted in the loss of the inhibitory effect of Ang1 on vascular endothelial growth factor (VEGF)-mediated expression of vascular cell adhesion molecule-1 in endothelial cells and VEGF-mediated monocyte adhesion to endothelial cells. Collectively, these findings indicate that Ang1/Tie2 signal stimulates transcriptional activity of MEF2 through a PI3K/AKT pathway to induce KLF2 expression, which may counteract VEGF-mediated inflammatory responses.</P>

Agreement and accuracy of radiographic assessment using a decision aid for medial Oxford partial knee replacement: multicentre study

( Takafumi Hiranaka ),( Ryosuke Furuhashi ),( Kenichiro Takashiba ),( Takao Kodama ),( Kazuhiko Michishita ),( Hiroshi Inui ),( Eita Togashi ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Background: Indication for mobile-bearing partial knee replacement (PKR) is made on the basis of a radiological decision aid. This study aimed to reveal the inter-rater reproducibility and accuracy of the decision aid when used by experienced surgeons. Patients and methods: Anonymised radiographic image sets (anteroposterior, lateral, varus/valgus stress in 20° knee flexion, and skyline views) from 20 consecutive patients who underwent knee replacement were assessed by 12 experienced surgeons. Agreements of each section and accuracy were compared by intra-operative inspection of the status of the anterior cruciate ligament (ACL) and medial and lateral cartilage according to the protocol of Radiographic Assessment for Medial Oxford PKR. Fleiss’ kappa (κ) values were used as a statistical measure. Results: Full-thickness medial cartilage had the best agreement between the surgeons (κ = 94.7%) and best accuracy (94.2%). Although functioning ACL (90.8%), intact cartilage (91.7%) and full-thickness lateral cartilage defects (86.1%) were accurately diagnosed, diagnoses of deficient ACL (up to 42.5%) and partial-thickness lateral cartilage defects (11.7%) were poor; they were sometimes misdiagnosed as being intact. Moreover, agreement of lateral and valgus stress radiographs regarding intact MCL function, as well as the overall decision, was considered to be inadequate (κ = 0.47, 0.58 and 0.51, respectively). Conclusions: Although the radiological aid is useful for selection of patients who are likely to be suitable for PKR, surgeons should still carefully assess the lateral weight-bearing area for partial-thickness loss and deficiency of the ACL because they were sometimes overlooked by surgeons using radiographs. MRI will be helpful to improve the accuracy of determination of Oxford PKR indication.