Preoperative Prognostic Nutritional Index is a significant predictive factor for posthepatectomy bile leakage

Atsushi Nanashima,Masahide Hiyoshi,Naoya Imamura,Koichi Yano,Takeomi Hamada,Kengo Kai,Takahiro Nishida,Yukako Uchise,Risa Sakamoto,Mayu Inomata 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.4

Backgrounds/Aims: It is known that preoperative nutritional status can influence patient outcomes after hepatectomy. Prognostic Nutritional Index (PNI) is a useful parameter to reflect patient outcomes undergoing gastro-intestinal surgery. The aim of this study was to retrospectively evaluate relationships of nutritional parameters, demographics, and surgical records with postoperative outcomes in a cohort study. Methods: Curative hepatectomy was performed for 182 patients at the University of Miyazaki between 2015 and 2018. Each preoperative level of albumin, prealbumin, lymphocyte, total cholesterol, or the comprehensively calculated Onodera’s PNI was examined as a nutritional parameter. Results: The mean PNI was 39.6 ± 5.1, with PNI below 40 observed in 91 (50.0%) patients. Nutritional parameters were not different among patients with various liver diseases. Serum albumin or prealbumin level was significantly correlated with each hepatic parameter (p < 0.01). Prealbumin and total cholesterol levels were significantly correlated with postoperative prothrombin activity (p < 0.05). Albumin or prealbumin levels and PNI were significantly lower in patients with posthepatectomy complications, particularly bile leakage in comparison those without such complications (p < 0.05). Multiple logistic analysis showed that albumin level was an independent risk factor for complications after hepatectomy (risk ratio [RR]: 1.33) and that lymphocyte count was an independent risk factor for bile leakage (RR: 1.28) (p < 0.05). The cut-off level of albumin was approximately 3.8 mg/dL and that of lymphocyte count was 1,320/㎣. Conclusions: Preoperative PNI reflected perioperative liver functional status. It was a predictive parameter for postoperative complications, particularly biliary leakage.

A cohort study on the risk of hepatectomy and pancreatectomy after history of abdominal surgery on other organs

Atsushi Nanashima,Masahide Hiyoshi,Naoya Imamura,Koichi Yano,Takeomi Hamada,Takashi Wada,Takahiro Nishida,Kazuyo Tsuchiya,Fumiaki Kawano,Shinsuke Takeno,Takuto Ikeda 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.4

Backgrounds/Aims: The present study analyzed the postoperative outcomes in patients who underwent hepatectomy or pancreatectomy, with a history of intra-abdominal surgery involving other organs, to elucidate surgical efficacy. Methods: We examined the perioperative parameters in 28 patients who underwent hepatectomy (n=12) and pancreatectomy (n=16) after receiving prior abdominal organ resection (esophagectomy, n=2; gastrectomy, n=5; resection of small intestine, n=2; appendectomy, n=5; colorectal resection, n=9; hepatectomy, n=1; cholecystectomy, n=3; splenectomy, n=2, pancreatectomy ,right adrenectomy, nephrectomy and myoma uteri, n=1 each). Results: Age, gender, a history of comorbidities, and primary diseases were not significantly different between the groups. The present operation was predominantly indicated for liver metastases in all patients undergoing hepatectomy. Several diseases were detected in pancreaticoduodenectomy (PD) patients. Laboratory data were not significantly different between groups. Although operating time and blood loss during hepatectomy did not differ significantly between the groups, the operating time was significantly longer in patients undergoing PD compared with distal pancreatectomy (p<0.05). Red cell blood transfusion was most frequently used in patients who underwent major hepatectomy and PD (p<0.05). The prevalence of postoperative complications was not significantly different between groups. Hospital death was not observed and the period of hospital stay did not differ between groups. Conclusions: Carefully scheduled hepatectomy or pancreatectomy is safe even in cases with prior abdominal surgery under the present strategy.

Light-Driven Soft Actuators for Micro-Mechanical Applications

김현경,Atsushi Sudo,Haruo Nishida,Taleshi Endo 한국고분자학회 2007 한국고분자학회 학술대회 연구논문 초록집 Vol.2007 No.4

Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia

Koichi Hamada,Koichiro Kawano,Atsushi Yamauchi,Ryota Koyanagi,Yoshinori Horikawa,Shinya Nishida,Yoshiki Shiwa,Noriyuki Nishino,Michitaka Honda 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3

Background/Aims: Evidence that general anesthesia (GA) reduces the operative time of esophageal endoscopic submucosal dissection(ESD) is currently insuffcient. This study aims to evaluate the effcacy and safety of esophageal ESD under GA. Methods: A total of 227 lesions from 198 consecutive patients with superficial esophageal neoplasms treated by ESD at 3 Japaneseinstitutions between April 2011 and September 2017 were included in this retrospective study. For ESD, GA and deep sedation (DS)were used in 102 (51.5%, GA group) and 96 patients (48.5%, DS group), respectively. Results: There were no statistically significant differences in age, sex, or comorbidities between the groups. In the GA group, the tumorsize was larger (21 [3–77] mm vs. 14 [3–63] mm, p<0.001), luminal circumference was larger (≥2/3; 13.9% vs. 5.4%, p=0.042), proceduretime was shorter (28 [5–202] min vs. 40 [8–249] min, p<0.001), and submucosal dissection speed was faster (25.2 [7.8–157.2] mm2 /minvs. 16.2 [2.4–41.3] mm2 /min, p<0.001). The rates of intraoperative perforation and aspiration pneumonia were lower in the GA group,but the difference did not achieve statistical significance (p=0.242 and p=0.242). Conclusions: GA shortens the procedure time of esophageal ESD.

Surveillance of Extended-Spectrum β-Lactamase-producing Enterobacteriaceae Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis

Yasumasa Kawano,Takeshi Nishida,Atsushi Togawa,Yuhei Irie,Kota Hoshino,Norihiko Matsumoto,Hiroyasu Ishikura 대한중환자의학회 2016 Acute and Critical Care Vol.31 No.4

Background: The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU) patients already under active surveillance by means of sputum and urine cultures. We aimed to assess the efficacy of stool cultures for screening for ESBL-E in a non-outbreak situation. Methods: We conducted a retrospective cohort study in an ICU. Sputum and urine samples were cultured for ESBL-E surveillance purposes from January to September 2013 (phase 1). Stool cultures were routinely performed in addition from January to September 2014 (phase 2). Antimicrobial use density values and clinical outcomes were investigated and compared between phase 1 and 2. Results: We identified 512 and 478 patients in phase 1 and phase 2, respectively. ESBL-E were found in the feces of 65 (13.6%) patients in phase 2. The antimicrobial use density values (expressed as defined daily doses per 1,000 bed-days) were not significantly different between the two phases for fluoroquinolones (7 vs. 10, p = 0.376), third-generation cephalosporins (24.2 vs. 29.5, p = 0.724), tazobactam/ piperacillin (44.6 vs. 57.3, p = 0.489), and carbapenems (73 vs. 55.5, p = 0.222). Moreover, there were no significant differences in ICU mortality and length of stay (11.5% vs. 9.8%, p = 0.412, and 9 vs. 10 days, p = 0.28, respectively). Conclusions: Stool culture seemed ineffective in improving the antimicrobial use density of broad-spectrum antimicrobials, clinical outcomes, and ICU length of stay, and is not recommended for surveillance of ESBL-E in a non-outbreak situation.

Relationship between the gut microbiota and bile acid composition in the ileal mucosa of Crohn’s disease

Shigeki Bamba,Osamu Inatomi,Atsushi Nishida,Masashi Ohno,Takayuki Imai,Kenichiro Takahashi,Yuji Naito,Junichi Iwamoto,Akira Honda,Naohiro Inohara,Akira Andoh 대한장연구학회 2022 Intestinal Research Vol.20 No.3

Background/Aims: Crosstalk between the gut microbiota and bile acid plays an important role in the pathogenesis of gastrointestinal disorders. We investigated the relationship between microbial structure and bile acid metabolism in the ileal mucosa of Crohn’s disease (CD).Methods: Twelve non-CD controls and 38 CD patients in clinical remission were enrolled. Samples were collected from the distal ileum under balloon-assisted enteroscopy. Bile acid composition was analyzed by liquid chromatography-mass spectrometry. The gut microbiota was analyzed by 16S rRNA gene sequencing.Results: The Shannon evenness index was significantly lower in endoscopically active lesions than in non-CD controls. β-Diversity, evaluated by the UniFrac metric, revealed a significant difference between the active lesions and non-CD controls (<i>P</i>=0.039). The relative abundance of <i>Escherichia</i> was significantly higher and that of <i>Faecalibacterium</i> and <i>Roseburia</i> was significantly lower in CD samples than in non-CD controls. The increased abundance of <i>Escherichia</i> was more prominent in active lesions than in inactive lesions. The proportion of conjugated bile acids was significantly higher in CD patients than in non-CD controls, but there was no difference in the proportion of primary or secondary bile acids. The genera <i>Escherichia</i> and <i>Lactobacillus</i> were positively correlated with the proportion of conjugated bile acids. On the other hand, <i>Roseburia</i>, <i>Intestinibacter</i>, and <i>Faecalibacterium</i> were negatively correlated with the proportion of conjugated bile acids.Conclusions: Mucosa-associated dysbiosis and the alteration of bile acid composition were identified in the ileum of CD patients. These may play a role in the pathophysiology of ileal lesions in CD patients.

Magnified single-balloon enteroscopy in the diagnosis of intestinal follicular lymphoma: a case series

( Kenichiro Takahashi ),( Shigeki Bamba ),( Masahiro Kawahara ),( Atsushi Nishida ),( Osamu Inatomi ),( Masaya Sasaki ),( Tomoyuki Tsujikawa ),( Ryoji Kushima ),( Mitsushige Sugimoto ),( Katsuyuki Kit 대한장연구학회 2018 Intestinal Research Vol.16 No.4

The objective of this study was to evaluate the magnified endoscopic findings in the diagnosis of follicular lymphoma in the small intestine in comparison with those of intestinal follicular lymphoma and lymphangiectasia. Four patients with follicular lymphoma and 3 with lymphangiectasia in the small intestine were retrospectively analyzed. A prototype magnifying single-balloon enteroscope was used. The findings of the intestinal follicular lymphoma and lymphangiectasia were retrospectively analyzed to determine the magnified endoscopic findings of follicular lymphoma in the small intestine. Opaque white granules were observed in 3 of the 4 patients with follicular lymphoma. Magnified narrow-band imaging (NBI) of the opaque white granules showed stretched microvessels, which had a diminutive tree-like appearance. The remaining patient had no opaque white granules and only displayed whitish villi. Magnified NBI observation of the whitish villi revealed the absence of marginal villus epithelium, which was confirmed by histology. The magnified NBI enteroscopy revealed the diminutive tree-like appearance on the opaque white granules and the absence of marginal villus epithelium of the whitish villi in intestinal follicular lymphoma. These findings may be useful in diagnosing follicular lymphoma. (Intest Res 2018;16:628-634)

Induction of allergic contact dermatitis by astigmatid mite-derived monoterpene, α-acaridial

Toshio Sasai,Yunosuke Hirano,Sayaka Maeda,Isamu Matsunaga,Atsushi Otsuka,Daisuke Morita,Ritsuo Nishida,Hideo Nakayama,Yasumasa Kuwahara,Masahiko Sugita,Naoki Mori 한국응용곤충학회 2008 한국응용곤충학회 학술대회논문집 Vol.2008 No.10

α-Acaridial [2(E)-(4-methyl-3-pentenyl)butenedial] is a novel monoterpene secreted from the house dust mites. Because of its molecular nature of a highly reactive, small lipidic compound, we addressed whether α-acaridial might function as a haptenic allergen that induced allergic contact dermatitis. Mice sensitized with α-acaridial were challenged by the same antigen on the ear skin. After 2 days, significant ear swelling with a prominent infiltration of CD4+ T lymphocytes was observed. In vitro, α-acaridial exhibited an outstanding ability to quickly interact with and chemically modify a reference protein. Virtually all cysteine residues and a sizable fraction of lysine residues were found to be selectively modified, suggesting that α-acaridial could potentially interact with any proteins. Previously, numerous mite-derived proteinaceous allergens have been associated with contact dermatitis. Our study now emphasizes that small lipidic compounds released from mites comprise a new class of mite allergens, and therefore, is of significant medical implications.

Efficacy and safety of cold forceps polypectomy utilizing the jumbo cup: a prospective study

( Hiroshi Hasegawa ),( Shigeki Bamba ),( Kenichiro Takahashi ),( Masaki Murata ),( Taketo Otsuka ),( Hiroshi Matsumoto ),( Takehide Fujimoto ),( Rie Osaki ),( Hirotsugu Imaeda ),( Atsushi Nishida ),( 대한장연구학회 2019 Intestinal Research Vol.17 No.2

Background/Aims: There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an ade-noma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colo-noscopy 1 year later. Methods: We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed. Results: The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience. Conclusions: CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon. (Intest Res 2019;17:265-272.)

Mangiferin Induces Apoptosis by Suppressing Bcl-xL and XIAP Expressions and Nuclear Entry of NF-κB in HL-60 Cells

Kaori Shoji,Kaori Shoji,Masanobu Tsubaki,Yuzuru Yamazoe,Takao Satou,Tatsuki Itoh,Yasuhiro Kidera,Yoshihiro Tanimori,Masashi Yanae,Hideaki Matsuda,Atsushi Taga,Haruyuki Nakamura,Shozo Nishida 대한약학회 2011 Archives of Pharmacal Research Vol.34 No.3

Mangiferin, 1,3,6,7-tetrahydroxyxanthone-C2-β-D-glucoside (C-glucosylxanthone), is a xanthone derivative that is widely distributed in higher plants. Recently, mangiferin was found to exhibit potential antitumor effects. However, the molecular mechanisms of this effect have not been elucidated. In the present study, we attempt to clarify the mechanism of mangiferininduced apoptosis in the human acute myeloid leukemia cell line HL-60; mangiferin was found to induce apoptosis. We also observed a concurrent increase in caspase-3 activity and DNA fragmentation. Furthermore, on examining the survival signals expressed during apoptotic induction, we observed that mangiferin caused a remarkable decrease in the nuclear entry of NF-κB p65. However, there were no changes in the expression of other survival signals,such as extracellular signal-regulated kinase 1/2, protein kinase B, and p38 mitogenactivated protein kinase. In addition, mangiferin suppressed the expressions of Bcl-xL and XIAP; however, we did not note any changes in the levels of Bcl-2, Bax, and Bim. These results indicate that mangiferin induces apoptosis by suppressing NF-κB activation and expressions of Bcl-xL and XAIP. These findings suggest that mangiferin may be useful as an anticancer agent and can be used in combination therapy with other anticancer drugs for the treatment of acute myeloid leukemia.